Hypothyroid Disease and Hashimoto’s Disease

a group of women

Thyroid hormones are key to the normal operation of the body’s metabolism. The thyroid gland regulates metabolism in every cell in the body; if even the slightest deficiency occurs, the patient will generally experience a wide range of complaints. Thyroid hormones regulate metabolism and energy (over 90 percent of the body’s energy is generated in the thyroid and adrenals) balance, as well as growth, development, body temperature, and activity of the nervous system. They stimulate carbohydrate and fat breakdown; increase protein synthesis, vitamin utilization, and mitochondrial function; and increase the basal metabolic rate. Thyroid deficiency often gets undiagnosed and has been called the “great imitator” for the vast number of medical conditions that thyroid conditions can mimic. Perhaps 13 million Americans suffer from some degree of hypothyroidism. The disease affects eight times as many women as men, possibly because women need higher levels of thyroid hormone than men.

A view of the thyroid gland reveals that it has a profound impact on overall health.  The thyroid is directly involved in the modulation of carbohydrates and proteins, fat metabolism, vitamin utilization, mitochondrial function (cellular energy), digestion, muscle and nerve activity, sex hormones, blood flow, oxygen utilization, and metabolism.

An enlarged thyroid gland, known as a goiter, usually results from an iodine deficiency associated with either hypothyroid or hyperthyroid disease. It can easily be detected by a physician.

Primary hypothyroidism, which manifests as elevated thyroid stimulating hormone (TSH) and low T4, and secondary hypothyroidism, manifesting as a combination of low T4 levels and low TSH secondary to pituitary dysfunction, are both well defined. Hypothyroidism affects 8 times more men than women.  Why? Most likely it is because women need higher levels of thyroid hormone than men.

The liver and adrenal glands, and to a lesser degree the kidneys, play a dominant, although often under-discussed, role in the metabolism of thyroid hormones.

Hypothyroidism, in reality, often has causes that are amenable to treatment. These causes include stress (elevated cortisol), poor nutrition (micronutrient deficiency), low-calorie diet, high refined carbohydrates, chemical toxicity from both man-made and naturally occurring compounds, and most frequently, estrogen-dominance. Estrogen dominance can be derived from excess estrogen from hormone-fed animals, chickens, and dairy cattle, as well as environmental xenoestrogens like dioxin, birth-control pills, lawn chemicals, pesticides, bug sprays, and golf course chemicals.

Hashimoto’s Thyroiditis is a hypothyroid condition of autoimmune origin.  In this case, the thyroid is invaded by the host’s own white blood cells, and the body makes antibodies to attack the thyroid gland.  Many people with Hashimoto’s have other endocrine diseases, such as diabetes, adrenal insufficiency, underactive parathyroid glands, or other autoimmune diseases such as rheumatoid arthritis, Sjogren’s syndrome, lupus, or pernicious anemia.  It affects more women than men (4:1 ratio) and incidence increases with age (45-60 years). These antibodies also bind to the gastrointestinal tract (causing low vitamin B12 levels), and bind to the adrenal glands and pancreas. 

There is reason to believe that Hashimoto’s is caused by a bacteria called Yersinia enterocolitica.  The bacteria lives in the fecal matter of livestock, domesticated and wild animals.  One can be exposed by consuming contaminated meats, especially raw or undercooked products such as dairy products and cow’s milk, oysters and other raw seafood, poultry, and sewage-contaminated waters and produce fertilized with raw manure.  Researchers found that the prevalence of antibodies to Yersinia, evidence of exposure was 14 times higher in patients with Hashimoto’s thyroiditis than in the control group.

SYMPTOMS

The symptoms of hypothyroidism are gradual and sometimes mistaken for depression or hormonal imbalance. Facial expressions become dull, eyelids droop, and the face and eyes become puffy and swollen.

The patient will experience tiredness, fatigue, mental dullness, depression, constipation, cold hands and feet, weight gain, loss of hair, dry skin, brittle nails, joint aches and pains, ringing in the ears, frequent infection, low blood pressure, high cholesterol, and low sex drive (libido).

Sometimes the patient is suffering from all the symptoms of thyroid deficiency but has normal test results. The thyroid slowdown could be slight or age-related and not easily detectable with a blood test.

PATHOPHYSIOLOGY

The two main functions of the thyroid gland are to secrete hormones, which exist in two forms: 

Levothyroxine (T4) and triiodothyronine (T3). T4 has four iodine atoms per molecule. Its circulation half-life is seven days, and nutritionally the thyroid gland requires tyrosine and iodine to produce adequate levels of T4. T3 has three iodine atoms per molecule and is converted from T4 in the thyroid, brain, liver, bloodstream, and in various tissues of the body. Circulation half-life is one day. T3 directly boosts energy metabolism in mitochondria, the powerhouse of cells. T3 triggers rapid protein synthesis and influences the reading of the genetic code of genes (where birth defects can occur).

Textbook hypothyroidism symptoms include:

  1. Elevated TSH (thyroid stimulating hormone from the pituitary telling the thyroid to work harder). 
  2. Low Free T4 (thyroxine produced by the thyroid and sent to the tissues). 
  3. Low Free T3 (triiodothyronine converted from T4 to affect cellular metabolic processes). If T3 is low, use zinc and selenium. 

In order for the thyroid to produce these vital hormones, the thyroid needs the element iodine, which is ingested from food and water. Eighty percent of T4 to T3 conversion occurs in the liver.

UNDERSTANDING THE ROLE OF THYROID HORMONE IN THE BODY 

The thyroid hormone (TH) causes a breakdown of proteins and an increase in free fatty acids, as well as oxygen use. TH elevates the heart rate to meet the increased oxygen need. TH regulates body temperature. TSH stimulates the thyroid to produce TH. TH fluctuates in response to caloric intake and external temperature. When you skip a meal it signals the thyroid to go into starvation mode. TH increases protein synthesis in virtually every cell in the body. T3 influences the formation of messenger-RNA. 

When dietary IODINE intake is inadequate for thyroid synthesis, the serum T4 initiates a number of processes to ensure restoration adequate thyroid hormone production. When iodine deficiency is more severe, thyroid hormone production falls and the patient experiences hypothyroidism.

Estrogen partially blocks the efficiency of TH, so women compensate by producing more TH than men. This may be why women have larger thyroids than men and are prone to more thyroid diseases. Growth hormone partially blocks TH, but it also complements TH in its effect on growth, development, and metabolism. 

RISKS

The three most common causes of acquired thyroid disorders are due to iodine deficiency, autoimmune thyroid disease, and iatrogenic factors (radiation, surgery, and drugs). If left untreated, hypothyroidism can cause anemia, low body temperature, and heart failure. A life-threatening condition known as myxedema coma may ensue in which respiration slows, seizures occur, and blood flow to the brain decreases. Exposure to cold, infections, tranquilizing drugs, and trauma can trigger myxedema. Other potential effects from hypothyroidism include infertility, elevated LDL and triglycerides, atherosclerosis, and heart abnormalities. Hypothyroidism is the second leading cause of high cholesterol, after diet. When TH levels drop, the liver no longer functions properly and produces excess cholesterol, fatty acids, and triglycerides.

Since Synthroid contains only T4, the body must convent T4 to T3 and other metabolites. This could be a problem for patients whose body does not convert T4 to T3. This may be why people on Synthroid still complain of “not feeling right.” They may do better on natural glandular preparations.

Some prescription drugs have the potential to interfere with the thyroid hormone and create a slight elevation of TSH. These include lithium, iodine, furosemide, phenylbutazone, sulfonylureas, and several anti-depressant drugs.

Thyroid hormones have been reported to increase urinary loss of calcium, thus reducing bone density and increasing the risk of osteoporosis. Bone density measurements are advised.

Caffeine and other stimulants interfere with T3 and adrenal hormone metabolism while in the body. Smoking depresses TH levels and produces a chronic underlying hypothyroidism as well as low adrenal hormone levels. Alcohol and opiates block the breakdown of T3 in the brain.

Severe hypothyroidism can cause symptoms similar to Alzheimer’s disease: memory loss, confusion, slowness, paranoid depression, and hallucinations. Thyroid disease is one of the most treatable diseases that must be ruled out before arriving at the diagnosis for Alzheimer’s.

CAUSES

Low levels of T3 and T4 are signs that you do not have enough thyroid hormone. Though T4 is the main product, T3 is 3 to 4 times more active. T4 is converted to T3 via peripheral tissues, especially in the liver and lung. Also, an elevated TSH is a sign of thyroid deficiency. When the TSH is high, it means the pituitary gland is trying to make the thyroid gland produce more hormones.

A most overlooked problem with thyroid function is the peripheral conversion of T4 to T3 by the enzyme T4-5’-deiodinases, and this activity has nothing to do with the thyroid. Using the drug Synthroid will not work here. There are many environmental factors and illnesses that interfere with this enzyme, and the causes of this problem need to be addressed. Examples include starvation, diabetes mellitus, and uremia (toxic blood in urine). Deficiencies of selenium, glutathione, zinc, and other nutrients affect T4 to T3 conversion. A more plausible, yet still controversial, cause may be estrogen-dominance.

Mineral imbalances may also be a causative factor in hypothyroidism. Some of the most common mineral imbalances (as identified via a Hair Analysis) that signify thyroid imbalance include:

  • High calcium levels in connection with low potassium ratio is associated with altered thyroid activity and hence a lower rate of metabolism associated with sluggish thyroid activity. 
  • High copper hair levels cause diminished thyroid activity by increasing calcium levels. 
  • High calcium and high magnesium levels in connection with low sodium and potassium will cause sluggish thyroid. Diminished thyroid activity results in a decreased ability to utilize glucose, thus leading to low energy. 
  • Copper toxicity (associated with high calcium/potassium ratio) is often associated with lowered thyroid and adrenal gland activity which controls oil glands of skin. This may lead to symptoms such as dry and flaky skin, use flaxseed oil. 

When treating the thyroid gland it is critical to always look at the adrenal glands, since the two are directly connected.

OTHER FACTORS

Medications. Some drugs used to treat hyperthyroidism (overactive thyroid gland) may actually cause hypothyroidism. These drugs include propylthiouracil (PTU) and methimazole. The psychiatric drug lithium is known to alter thyroid function. The heart-arrhythmia drug amiodarone contains large amounts of iodine and can cause a decrease in thyroid function. Antidepressant tricyclic drugs and antipsychotic phenothiazines can affect thyroid function at many levels. Low levels of T3 can cause depression. Some of the anti-depressant drugs make the hypothyroid patient feel worse because the drug depresses T3 further. SSRI drugs also suppress pituitary function. The hypothyroid patient should also be cautious in taking Lugol’s solution or any super-saturated potassium iodide solution.

Stress Affects Thyroid Activity. Glucocorticoids, such as elevated cortisol (secreted from the adrenal glands) due to stress, suppress the secretion of TSH and decrease the conversion of relatively inactive T4 to potent T3. Stressors include infection, radiation, anger, fear, depression, anxiety, obesity, surgery, and old age. Adrenal stress may be the leading causes of symptoms of hypothyroidism, especially when thyroid hormones levels (via a blood test) are normal.

Environmental Pollutants. Although a healthy diet and a good liver detoxification can counter environmental insults, factors such as cigarette smoking, halogens (such as chlorine and fluorine used in water supplies), phthalates (PVC’s used in plastics), and Red Dye No. 3 (a popular coloring agent used in food, pharmaceuticals, and cosmetics) all contribute to hypothyroidism. Environmental hazards from heavy metal toxicity and electromagnetic radiation will alter RBC and WBC counts, cause hair loss, and lead to immune and endocrine suppression. Environmental pollutants also include toxic chemical (arsenic, cadmium, lead, aluminum, mercury) and xenobiotics, as well as PCBs in food. 

Pituitary or Hypothalamic Malfunction.  If the pituitary gland or the hypothalamus is unable to signal the thyroid and instruct it to produce thyroid hormones, a decreasing level of circulating T3 and T4 may result. In such cases, deficient TSH is produced by the pituitary gland, and blood levels of TSH are low. Because the thyroid gland is no longer stimulated by pituitary TSH, hypothyroidism results.

Nutrient Deficiencies. Reports from nutritional experts claim that high levels of calcium in the tissues, coupled with low levels of potassium, are associated with altered thyroid activity and hence, a lower rate of metabolism associated with sluggish thyroid activity. In addition, high levels of magnesium and calcium, coupled with low levels of potassium and sodium, will cause a sluggish thyroid gland. Diminished thyroid activity results in a decreased ability to utilize glucose in the body, thus leading to low energy. This information is best derived from doing a Hair Analysis. 

Post-therapeutic Hypothyroidism. This condition results after the destruction of the thyroid gland from radioactive iodine or surgery. The treatment can leave the patient’s thyroid unable to produce sufficient amounts thyroid hormones.

High Levels of LDL (the bad cholesterol). T4 therapy may reduce the risk for atherosclerosis and heart disease in people with low thyroid.

Iodine Deficiency. When dietary IODINE intake is inadequate for thyroid synthesis, the serum T4 initiates a number of processes to ensure restoration adequate thyroid hormone production. When iodine deficiency is more severe, thyroid hormone production falls and the patient experiences hypothyroidism. This is caused by an absence of iodine in the diet (iodized salt) or a high consumption of soy, corn, and brassica plants (cabbage, broccoli, Brussels sprouts).

Substance abuse with alcohol and opiates. This can increase T3 levels by impairing the breakdown of T3 in the brain, thus lifting mood. This may play a role in people with substance addiction issues.

Other lifestyle, pathological, and environmental events are associated with altered peripheral conversion of thyroid hormones (decreased T3 and increased rT3). These include aging, burns and trauma, fasting, chemical exposure, chronic alcohol intake, free-radical load, liver disease, surgery, kidney disease, insulin-dependent diabetes, and toxic metal exposure.

THE IODINE CONNECTION

Iodine is a chemical element.  It is found in trace amounts in the human body and its prime function is the synthesis of thyroid hormones.  Severe iodine deficiency results in impaired thyroid synthesis and/or thyroid enlargement (goiter). Iodine deficiency disorders (IDDs), include endemic goiter, hypothyroidism, cretinism (sever mental illness and mutism), decreased fertility, infant mortality, and mental retardation.

Iodine is primarily obtained through the diet but is also a component in some medications.  In addition to iodized salt, some sources of dietary iodine are egg yolks, milk, and milk products because they supplement chicken feed in the United States and the treatment of milk cows and cattle with iodine to increase fertility. Other factor that affects thyroid hormone production is the availability of serum iodine levels includes:

  • Patients with IDD most commonly present goiter.
  • Individuals with severe iodine deficiency may have hypothyroidism and may complain of weight gain, cold intolerance, dry skin, constipation, depression and low energy.
  • In an adult, 100-150 mcg daily is sufficient for normal thyroid function.  But if the Iodine Patch Test fails, using higher doses (over 1,000 mcg daily) may be important.
  • Cretinism is the most extreme manifestation of IDD. 

THE IODINE PATCH TEST

One simple test to prove that your body needs or does not need iodine is to try the Iodine Test Patch.  Buy a bottle of tincture of iodine or Lugol’s solution and paint a 2-inch square spot on the inner arm. If the spot totally disappears in less than eight hours, your thyroid is sucking the iodine from your arm and apparently your body needs iodine.  If it disappears with 16 hours, you need a moderate amount of iodine. If the yellow-orange patch is still seen after 24 hours, you have a sufficient amount of iodine.

You can retest yourself every few weeks or months while on therapy.  You can judge your individual dosage need for iodine. Some thyroid experts agree that most patients who need iodine therapy require from over 1,000 mcg daily.

Whole body iodine sufficiency is also a critical means to counter the effects of thyroid hormone medications (i.e. Synthroid, Levothroid).  Long-term use of these drugs may be associated with depletion of thyroid and tissue iodine levels. Some endocrinologists insist that Synthroid should not be taken without iodine therapy (but see a qualified practitioner before initiating).

DIET

Foods that are goitrogenic (meaning they prevent the utilization of iodine, which is necessary for the production of thyroid hormones) include turnips, cabbage, mustard, soybeans, Brussels sprouts, kale, mustard, peaches, rutabaga, spinach, peanuts, and pine nuts. These foods should be avoided by those with hypothyroidism. Foods such as kelp and dulse have been shown to promote thyroid function.

a california roll wrapped in seaweed

Also avoid excess consumption of dairy products, refined carbohydrates, and hydrogenated fats and oils (coconut oil, palm oil, and margarine). Soy foods and products may reduce the absorption of thyroid hormones. For safety, soy products should be used three hours after taking your thyroid medication.

CLINICAL DIAGNOSTICS EVALUATIONS 

  • Basal temperature test (check T3) 
  • Iodine patch test (check T4) See below for instructions. 
  • Symptom survey 
  • Salivary thyroid panel 
  • Blood thyroid function test 
  • Palpitation 

SUPPLEMENT PROTOCOL

  1. SYNTHETIC THYROID HORMONES
    These are prescribed by a physician. Synthroid and Levothroid are synthetic T4, and Cytomel is synthetic T3. Always take on an empty stomach, ½ hour before breakfast.
  2. NATURAL GLANDULAR THYROID EXTRACT (Armour Desiccated Thyroid Hormone)
    Derived from the thyroid gland of a pig, this contains T3 and T4 and most closely resembles human thyroid hormone. Thyroid hormones (T3 and T4) are the only major biochemical molecule known to incorporate iodine. Thyroid hormone is responsible for producing thyroid stimulating hormones (TSH), which are released from the pituitary gland. Always take on an empty stomach.
  3. RAW THYROID and ADRENAL GLANDULARS
    These multiple glandular products are designed to support the thyroid and the adrenals. Thyroid glandular products should be hormone-free. Adrenal and thymus products usually contain bovine nucleoproteins that have vital synergistic nutrients to aid in restoring normal adrenal response which in turn balances the thyroid gland. See a qualified health practitioner before using glandulars. Dosage: As directed by a qualified practitioner.
  4. IODINE/IODIDE
    Iodine deficiency is the leading cause of hypothyroidism and goiter. It is estimated that the thyroid gland must capture approximately 60 mcg iodide (the ionic form of iodine) daily to ensure an adequate supply for thyroid hormone synthesis. Iodine helps enhance clear thinking, decreases infections, increases body temperature, increases thyroid function and protects the gland from radiation. Dosages may vary. The product
    Iodoral contains 5 mg of iodine and 7.5 mg of iodide. Lower doses are suggested for initial treatment, but it is best to see a qualified practitioner before supplementing. KELP is a natural source of iodine. Vitamin E is essential to properly assimilate iodine. Excessive amounts of iodine can cause acne, sinus symptoms, brassy taste and headache. Excessive thyroid symptoms include increased heart rate, tremors (shaking), diarrhea, or insomnia.  See a qualified practitioner before starting high-dose iodine therapy.
  5. L-TYROSINE
    Tyrosine is a non-essential amino acid required for the synthesis of thyroid hormones in the body. Tyrosine is the precursor to thyroid hormones and adrenal hormones. Tyrosine is used by the body to make the neurotransmitters (dopamine, norepinephrine and epinephrine), which play a role in elevating mood and improved adrenal function. Dosage: 500-1,500 mg per day.
  6. MULTI-VITAMIN W/MINERALS & ANTIOXIDANTS
    It is important to supplement with a potent multi-vitamin/mineral formula when either taking thyroid medicines or dealing with hypothyroidism.  Extra antioxidants (especially vitamins C, E, and B-complex) are essential for normal thyroid function. Vitamin C and E may be capable of preventing heavy metal-induced perturbation in thyroid hormones. It has been shown that people with hypothyroidism have an impaired ability to convert beta carotene to vitamin A, so care should be taken to ensure that supplementation for these individuals includes actual vitamin A in addition to some beta carotene.  Dosage: As directed on package.
  7. SELENIUM
    This trace mineral is involved in increasing T4 to T3 conversion. Low levels of selenium may lead to low T3 levels. The role of selenium implies that some deficiency may be directly attributed to disturbances in thyroid hormone metabolism. Mercury may diminish thyroid function because it displaces selenium. Dosage: 200 mcg daily (when supplemented for 3 months) has been shown to decrease thyroid specific antibodies, and thus decrease thyroid inflammation.
  8. BLADDERWRACK
    Bladderwrack is a type of seaweed (not to be confused with deep-sea kelp) that contains free and organically-bound iodine. It also contains polysaccharides, which bind to heavy metals and thus reduce toxic load. Bladderwrack has long been regarded as an herb to help weight loss. Dosage: See a qualified practitioner.
  9. ZINC
    Zinc deficiency contributes to many mineral imbalances. Zinc is essential for over 40 vital enzymes that play an important role in immune system function. A deficiency in zinc, although having no affect on T4, may decrease levels of T3 and rT3 by 30 percent. Zinc is needed for thyroid regulating hormone synthesis. Dosage: 20-60 mg a day.
  10. NIACIN
    Evidence suggests that niacin supplementation can influence thyroid hormone levels in at least some individuals. Dosage: 100-500 mg daily.
  11. COLEUS FORSKOHLII
    Coleus, sometimes called the “power” herb, has an active ingredient in it called forskolin. It has been used in Ayruvedic medicine for many years. Forskolin’s basic mechanism of action is that it increases the amount of cyclic AMP (adenosine monophosphate) in cells by activating an enzyme called adenylate cyclase. Cyclic AMP (cAMP) is one of the most important secondary messengers in the cell. It is considered to be one of the most important cell regulating compounds an effect similar to TSH on the thyroid gland. Coleus is useful in weight loss and improves energy. Dosage: see a qualified practitioner.
  12. ASHWAGANDHA
    This is an adaptogenic herb that boosts T4, and to a lesser extent, T3. The tonic effect can help boost depleted energy levels. Ashwaganda also has a positive benefit in boosting cortisol from the adrenal glands, which in turn will improve thyroid function by relieving excess stress. Dosage: See a qualified practitioner.
  13. FLAX SEED OIL
    Flaxseed is an omega-3 fatty acid that is low in the American diet. It is recommended that omega-3 fatty acids help relieve some of the symptoms caused by hypothyroidism (i.e. dry skin, low energy, and inflammation). Dosage: 1 or 2 capsules 3 times a day with meals.
  14. BACOPA
    This Indian herb has been reported to boost T4 by 41%, but has no affect on T3. Dosage: as directed.
  15. B-COMPLEX
    These essential water-soluble vitamins help increase energy and can help nourish the thyroid gland. Extra VITAMIN B12 might provoke a positive influence on peripheral activation of T3 and T4 (Dosage: 1,000 mcg daily). Extra VITAMIN B6 is advisable also (Dosage: 50-150 mg daily).
  16. COPPER
    Copper is an essential co-factor in iodine production. Copper is needed for the absorption of calcium. Calcium has a direct effect on thyroid function. Dosage: 2-4 mg daily, or as prescribed. CAUTION: Copper toxicity is associated with lower thyroid and adrenal gland activity. 
  17. ESSENTIAL FATTY ACIDS
    These “healthy” fats (fish oil, borage and flaxseed) are useful in hypothyroid support. Utilize black current seed oil, cold water fish oil, and wheat germ oil. Dosage: 1-3 grams daily.
  18. CALCIUM CITRATE
    Calcium citrate may help alleviate bone loss due to thyroid hormone replacement. But calcium has been reported to decrease the effectiveness of Levothyroxine. Take calcium supplements at least 2 hours after taking a thyroid hormone drug. Dosage: 1,000-1,500 mg daily.
  19. ESSIAC TEA
    Essiac has been reported to normalize the thyroid gland. Dosage: See instructions.
  20. ALPHA LIPOIC ACID
    Alpha Lipoic acid appears to influence the metabolic rate of T4 when co-administered with T4 therapy. Dosage: 100-400 mg daily.
  21. CHROMIUM
    It has been reported that depleted chromium levels may adversely affect adrenals which add stress to the thyroid gland. Supplementation may be helpful in alleviating sugar cravings which can adversely affect energy levels. Dosage: 200-400 mcg daily. 
  22. DHEA
    If concentrations of this sex hormone are low (via blood or saliva testing), supplementation may help adrenal function associated with thyroid dysfunction. Dosage: 25 mg 1-3 times a day.
  23. IRON
    There may be a deficiency seen with reduced thyroid function. Supplementing with iron may help maintain a healthy thyroid and normal thyroid hormone levels. Dosage: 20-30 mg daily.
  24. COENZYME Q10
    Coenzyme Q
    10 is a potent antioxidant that may decrease free-radical damage to the thyroid gland. Dosage: 60-120 mg daily.

THE IODINE PATCH TEST

  1. Apply freely on the arm or stomach area a patch of potassium iodide (Lugol’s solution) 
  2. Observe the yellowish stain the iodine makes on the arm and see how long it takes to disappear. 
  3. If the patch is gone in less than 8 hours, the body’s thyroid gland is sucking the iodine from the patch and iodine supplementation may be necessary for up to 3 months. 
  4. If it is gone in 16 hours, supplementation may be needed for 2 months. 
  5. If it is gone in less than 24 hours, supplementation may be needed for 1 month. 
  6. If it is still present after 24 hours then the patient does not need replacement. 

THE BASAL THERMOMETER TEST

  1. Shake down an oral glass thermometer and leave it overnight on a table next to your bed. 
  2. Upon awakening, with little movement, place the thermometer firmly under your armpit or under your tongue. (Menstruating women should do this test only on the second, third, or fourth day of their menstrual flow). 
  3. Keep the thermometer there for 10 minutes. Do not get up!
  4. Record the readings on 3 consecutive days. 

A normal functioning thyroid should have a reading of 97.8 to 98.2. A reading of 97.4 or less may indicate low thyroid function.

 

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