Queen of Hearts NaPro Technology- Natural Treatments for Women

Queen of Hearts NaPro Technology- Natural Treatments for WomenQueen of Hearts NaPro Technology- Natural Treatments for WomenQueen of Hearts NaPro Technology- Natural Treatments for Women
Home
Infertility
PCOS
endo
PMS
menopause
Patient Handouts
Progesterone & Pregnancy
FHA
Mental Health
Thyroid Problems
Vitamin D
Chronic Pelvic Pain
Abnormal Uterine Bleeding
Osteoporosis
Education
Semen Analysis
Laparoscopy
NaPro Symposiums
CrMS
FCP webpage
Nutritionists
My favorite Prayers

Queen of Hearts NaPro Technology- Natural Treatments for Women

Queen of Hearts NaPro Technology- Natural Treatments for WomenQueen of Hearts NaPro Technology- Natural Treatments for WomenQueen of Hearts NaPro Technology- Natural Treatments for Women
Home
Infertility
PCOS
endo
PMS
menopause
Patient Handouts
Progesterone & Pregnancy
FHA
Mental Health
Thyroid Problems
Vitamin D
Chronic Pelvic Pain
Abnormal Uterine Bleeding
Osteoporosis
Education
Semen Analysis
Laparoscopy
NaPro Symposiums
CrMS
FCP webpage
Nutritionists
My favorite Prayers
More
  • Home
  • Infertility
  • PCOS
  • endo
  • PMS
  • menopause
  • Patient Handouts
  • Progesterone & Pregnancy
  • FHA
  • Mental Health
  • Thyroid Problems
  • Vitamin D
  • Chronic Pelvic Pain
  • Abnormal Uterine Bleeding
  • Osteoporosis
  • Education
  • Semen Analysis
  • Laparoscopy
  • NaPro Symposiums
  • CrMS
  • FCP webpage
  • Nutritionists
  • My favorite Prayers
  • Sign In
  • Create Account

  • My Account
  • Signed in as:

  • filler@godaddy.com


  • My Account
  • Sign out


Signed in as:

filler@godaddy.com

  • Home
  • Infertility
  • PCOS
  • endo
  • PMS
  • menopause
  • Patient Handouts
  • Progesterone & Pregnancy
  • FHA
  • Mental Health
  • Thyroid Problems
  • Vitamin D
  • Chronic Pelvic Pain
  • Abnormal Uterine Bleeding
  • Osteoporosis
  • Education
  • Semen Analysis
  • Laparoscopy
  • NaPro Symposiums
  • CrMS
  • FCP webpage
  • Nutritionists
  • My favorite Prayers

Account


  • My Account
  • Sign out


  • Sign In
  • My Account

Thyroid Problems

HYPOthyroidism, HYPERthyroidism & Autoimmune Thyroiditis

Important Definitions:

Thyroid Gland:  an endocrine gland located in the anterior neck which consists of two lobes connected by an isthmus. The thyroid tissue within the gland is comprised of spherical structures called " thyroid follicles". "Follicular cells will form the borders of the follicles and a substance called "colloid" is located within the follicles. The follicular cells contain TSH-receptors, which when stimulated will synthesize thyroid hormones (T3 and T4). The thyroid will produce 80% T4 and 20% of T3. Most of the T3 originates from the conversion of T4 to T3 in peripheral tissues in a process called deiodination. 


Thyroid Stimulating Hormone (TSH): a hormone released from the anterior pituitary lobe in response to TRH (Thyrotropin Releasing Hormone, which is synthesized and released by the hypothalamus. TSH will stimulate the thyroid cells to synthesize T3 (triiodothyronine) and T4 (thyroxin). TSH is the one of the routine labs I will draw on your first visit, and this hormone is by far the most important one, as it is the most sensitive and specific marker of thyroid function. One important caveat is that TSH will spike in the AM, we call this the "TSH-circadian spike", so if your labs are drawn in the AM, and the TSH is high, I will likely redraw them after 12:00 noon, before initiating any treatment. Oftentimes, the TSH level will be significantly lower in the afternoon and I don't want to start any medicines that are not absolutely necessary. 


Thyroxin (T4): a thyroid hormone released from they thyroid gland in response to TSH. Free T4 is the active form of T4 that enters into cells all over the body to regulate your metabolism. Metabolism is measured in calories. Free T4 is one of the routine labs I will draw on your first visit. The half-life of T4 is long, about 4-6 days and for this reason, it is a relatively good marker of your thyroid function. 


Triiodothyronine (T3): a thyroid hormone released from they thyroid gland in response to TSH. Free T3 is the active form of T3 that enters into cells all over the body to regulate your metabolism. I will also draw a total T3 as well as a free T3 during your first visit. However, it is important to remember the T3s are not as important markers of thyroid function, as compared to TSH and Free T4, namely because the half-lives are so much shorter (between 6 hrs to one day), so levels of this hormone will be wax and wane much more rapidly as compared to levels of TSH and T4. 


Primary HYPOthyroidism: this diagnosis is made when the patient has HIGH blood levels of Thyroid Stimulating Hormone (TSH) and LOW or LOW-normal levels Free T4.


Subclinical HYPOthyroidism:  this diagnosis is made when the patient has HIGH or HIGH-normal levels of TSH with normal levels of Free T4. 


Central (Secondary) HYPOthyroidism:  this diagnosis is made when the patient has LOW or LOW-normal levels of T3 and T4 and the TSH level is not appropriately elevated..


Autoimmune Thyroiditis: a condition in which a person's body makes antibodies against proteins that are part of the person's own thyroid tissue; these are called "auto-antibodies". 


Hashimoto's Thyroiditis: a condition were there is inflammation within the thyroid tissue due to auto-antibodies, most often anti-thyroid peroxidase antibodies (anti-TPO Abs) or anti-thyroglobulin antibodies (anti-TG Abs). The inflammation is caused by lymphocytes infiltrating the thyroid tissue, which will eventually cause the thyroid cells to die causing HYPOthyroidism. We don't know why this happens, but most likely there is a combination of environmental factors and a genetic predisposition. 


HYPERthyroidism: this diagnosis is made when the patient has LOW blood levels of Thyroid Stimulating Hormone (TSH) and HIGH or HIGH-normal levels Free T4. 


Graves' Disease: an autoimmune thyroiditis and the most common cause of  HYPERthyroidism. The pt will make Thyroid Stimulating Immunoglobulins (TSIs) also called TSH-receptors antibodies. These autoantibodies will bind to the TSH-receptor sites located on the follicular cells within the thyroid gland and over stimulate the production of T3 and T4.  


Thyroid Function Tests (TFTs): laboratory tests that are done to diagnose thyroid conditions. The most common tests I will ask for are: TSH, FT4, T3 (total and Free), anti-TPO antibodies, anti-TG antibodies, and/or Thyroid Stimulating Immunoglobulins (TSIs).


Thyroid-Binding Globulins: proteins that bind T4 and T3 to transport the hormones through the blood. More than 99.95 % of T4 and 99.5 % of T3 are tightly bound to proteins in the blood, a very small percentage of these hormones are "Free"; only free hormones are metabolically active. 


Thyroglobulin: is a protein found inside the lumen of the thyroid follicles (circular structures within the thyroid tissue). Follicular cells form the borders of the follicles and contain receptors for TSH. When the TSH-receptors are stimulated by TSH (or at times by TSIs), thyroid hormones (T3 and T4 )will be synthesized within the follicles and then released into the blood stream. The thyroglobulin protein serves a a substrate for the synthesis of T3 and T4. 


Thyroid Stimulating Immunoglobulins (TSIs): antibodies made to the TSH-receptors located on the follicular cells within thyroid tissue. TSI's are  also called "TSH-receptor antibodies". They are the most common auto-antibodies found in Graves' Disease. The overstimulation of the TSH-receptors and subsequent over-production of thyroid hormones is the underlying cause of Graves' Disease. 


Anti-thyroid peroxidase antibodies (anti-TPO Ab): antibodies made against thyroid peroxidase, which is an enzyme that catalyzes the synthesis of the thyroid hormones which takes place within the thyroid tissue. 


Anti-Thyroglobulin antibodies (anti-TG Ab): antibodies are made against the person's own thyroglobulin protein. Anti-TG Abs are found in about 70% of the time in Hashimoto's thyroiditis, 60% of idiopathic thyroiditis, 30% of Graves' disease, and about 3% of thyroid cancers. 


Iodine: Iodine is obtained only by diet. It can be found in iodized salt (not sea salt), seafood, seaweed, kelp, dairy products and some vegetables. The easiest way to ensure you have adequate iodine intake is by just using iodized salt. 


I do not recommend any iodine drops or supplements. Supplements, in general, are not regulated, and it has been demonstrated numerous times that ingredients do not accurately reflect what the bottles claim the do. I have personally seen iodine 8x the upper limit in a pt who was taking iodine drops recommended by a holistic practitioner. Too much iodine puts the pt at risk of "Iodine-Induced Thyroiditis", which can be life-threatening in some individuals. 

Normal Thyroid Histology

- This is an image of what thyroid gland tissue looks like under a microscope. 

- Notice the thyroid follicles, which are circular structures. 

- Follicular cells form the borders form the follicles. The follicular cells have TSH receptors on them. 

- When the TSH receptors are filled, the synthesis of T4 and T3 ensues. 

- Thyroglobulin forms the colloid (the pink substance within the follicles), which is the site of thyroid hormone synthesis.

Hashimoto's Lymphocytic Infiltration and Destruction of Tissue

Pathology: 

The image to the Left is a surgical specimen from a patient with Hashimoto's thyroiditis. Some areas show normal-appearing follicles with minimal lymphocytic infiltrates, while other areas have complete destruction of follicles with dense lymphocytic infiltrates, in which the lymphocytes form germinal centers. 

Ref: image is from From Up-To-Date. 

Normal Thyroid Anatomy & Physiology

  • The hypothalamus is an area very deep in the center of your brain that is responsible for making an important hormone called Thyrotropin Releasing hormone (TRH). 
  • TRH will go to the pituitary gland, which another structure located deep in your brain (about the size of a pea). 
  • TRH will stimulate the pituitary gland to secrete Thyroid Stimulating Hormone (TSH), which will then go through the blood stream and target the thyroid gland (located in your neck). 
  • The thyroid gland uses iodine to synthesize thyroid hormones (T3 & T4). 
  • T4 is made in much greater quantity than T3, but only T3 is "active". 
  • T4 is converted to T3 in the liver, kidney, brain and muscle cells. 
  • Almost every cell in the body will take up T3, which will regulate metabolism. "Metabolism" is when each cell uses oxygen and glucose, delivered to it via the bloodstream, to make energy to sustain life. 
  • So, we could say that our thyroid hormones help to regulate our metabolism. In reality, they do much, much more.....
  • High T4/T3 results in HYPERthyroidism. 
  • Low T4/T3 results in HYPOthyroidism. 

Reverse T3 (rT3)-To Test or not to Test

You may be hearing about a rT3 test. Many providers feel this is helpful to demonstrated that you are "not converting an adequate amount of T3 to T4. 


My personal opinion is that testing for rT3 and treating for abnormal rT3 levels can cause more harm than benefit for my pts. Here is my thinking: 


  • To the best of my knowledge, research has been done for many years and results have remained somewhat contradictory, which overall makes the studies less convincing. 
  • rT3 has a half-life that is very short (~ 3 hrs) and this hormone is released in response to a rise in cortisol. 
  • Cortisol rising and falling is a normal healthy response to day-to-day stressors. Thus, rT3 levels will rise and fall throughout the day in a normal healthy individual. Albeit, one would be expected to have higher levels of rT3 when stressors are high and/or one's response to environmental stressors is sub-optimal. 
  • As mentioned above (Anatomy & Physiology section). The thyroid gland will make much more T4 than T3, and the T4 is converted to T3 in the liver, kidney, brain and skeletal muscle. 
  • Assessment of this "conversion of T4 to T3" is  most done by calculating a "total T3:rT3 ratio", with an optimal ratio being 10:1. 
  • Thus, when rT3 rises, this indicates a decrease in the conversion of T4 to T3. Remember it is only "free T3" that is active in our cells. 


How is High rT3 is Treated? 

Generally, two treatments are recommended: 


  1. Decrease stress, which I recommend to ALL of my pts, regardless of their rT3 levels. Read about CBT on my "Therapist" webpage. 
  2. Replace T3 hormone via pharmacotherapy, eg: liothyronine/cytomel. 


Additional Important Information: 

  • Research is robust in demonstrating that it is much easier to optimize thyroid function (measured by TSH levels) using T4 replacement (eg: levothyroxine/synthroid) as compared to replacing T3 (eg: liothyronine/cytomel). 
  • T3 has a much shorter half-life (=5-6 hrs) as compared to T4 (=5-6 days). Therefore it is much more difficult to keep the TSH at optimal levels, which is between 1.0 and 2.5 to optimize fertility. 
  • Thus, I typically prefer to manage thyroid dysfunction using only T4 replacement. 
  • Additionally, patients are at a much higher risk of lowering their TSH (below 1.0) when using cytomel. 
  • A TSH lower than 1.0 can predispose the patient to HYPERthyroidism, which can in turn increase her risk of developing early osteopenia and osteoporosis (read more about this below). 
  • However, If my patients demonstrate an adequate knowledge of what I teach them, and they would still like me to check their rT3 and try replacing their T3 using cytomel, I will be happy to work with you. 
  • I would monitor your thyroid function tests every 12 weeks and adjust your medications accordingly. 

What are the Symptoms of HYPOthyroidism?

  • Fatigue or Lack of energy 
  • Cold Intolerance (feeling cold often) 
  • Lack of cognitive focus 
  • Weight gain or inability to lose weight 
  • Depression 
  • Constipation
  • Brittle nails
  • Excessively dry skin or hair 
  • amenorrhea (no periods)
  • oligomenorrhea (few periods or very long cycles 45 days or more) 
  • infertility
  • recurrent miscarriage
  • For pregnant women, low thyroid hormones put the growing baby at risk for low cognitive function. 

How is HYPOthyroidism Diagnosed?

Thyroid function testing is always done during your fist visit. 

  • Abnormal Thyroid Function Tests (TFTs) 
  • Thyroid Stimulating Hormone (TSH) will be HIGH or HIGH-normal.
  • TSH is the most sensitive and specific test for thyroid hypo-function. 
  • T3/T4 may be LOW or low normal or normal. 
  • The presence of anti-TPO antibodies and/or anti-TG antibodies would indicate an autoimmune process, such as Hashimoto's Thyroiditis or  Idiopathic Thyroiditis. 
  • These auto-antibodies are transient, which means they will come and go. Due to the fact that this antibodies promote the infiltration of lymphocytes into the thyroid tissue, they often cause destruction of normal healthy thyroid tissue over time. (**see the Image of Hashimoto's pathology above) 


*Tidbit: anti-TPO antibodies are almost always seen in pts who have anti-TG Abs. Whereas, anti-TG Abs are found  only about 35% of the time in pts who have anti-TPO Abs. In other words, Anti-TPO Abs are more common and are often the only thyroid function test abnormality.  

What are the Available Treatments for HYPOthyroidism?

  • Levothyroxine -T4 (Synthroid)
  • L-triiodothyronine -T3 (Cytomel)
  • Armour- combined T4 (Levothyroxine) and T3 (Liothyronine) therapy

What are the Symptoms of HYPERthyroidism?

  • Fatigue
  • Anxiety
  • Weight loss
  • Heat Intolerance (feeling hot often)
  • Excessively oily hair and or skin
  • Excessive hair loss
  • Insomnia
  • Diarrhea
  • Heart palpitations
  • Feeling "jittery" 
  • Heavy periods (menorrhagia)
  • Amenorrhea (missed periods)
  • Oligomenorrhea (few periods or very long cycles 45 days or more) 
  • Infertility and or recurrent miscarriage

How is HYPERthyroidism Diagnosed?

Please have your thyroid tests drawn sometime sometime in the afternoon preferably after 3:00 PM, and please do do this lab work NON-Fasting. 


  • Abnormal Thyroid Function Tests (TFTs) 
  • Thyroid Stimulating Hormone (TSH) will be LOW or LOW-normal. 
  • TSH is the most sensitive and specific test for thyroid hyper-function. 
  • T3/T4 may be HIGH or HIGH-normal, or normal. 
  • The presence of TSIs, Thyroid Stimulating Immunoglobulins (also called anti-TSH receptor antibodies are a hallmark of Graves' Disease. 
  • Anti-TPO and/or Anti-TG antibodies may be present to, but they are not the primary drivers of hyperthyroidism. 
  • TSIs will typically stick around in your blood and slowly decrease over time. 
  • The general course of Grave's Disease is that a pt will be started on methimazole, and as the thyroid cells are burning out, due to the over-stimulation, the person will need less and less methimazole. 
  • In time, the pt will move from a HYPERthyroid state to a HYPOthyroid state. 

What are the Available Treatments for HYPERthyroidism?

  • Methimazole (Tapazole) 
  • Propylthiouracil PTU) 
  • Radioactive Iodine Ablation
  • Thyroidectomy (removal of the thyroid gland)  

Hyperthyroidism and Decreased Bone Density

  •  High levels of T3 and T4 (with low levels of TSH) will stimulate the osteoclasts to breakdown the bone, ie: increase bone resorption.
  • This will result in an a decreased density of cortical bone and reduced volume of trabecular bone. 
  • Thus, the patient with HYPERthyroidism is at an increased risk of developing osteopenia and/or osteoporosis earlier in life.

Medical Professionals- A Few Papers on Thyroid Disease

Thyroxine replacement for subfertile women with euthyroid autoimmune thyroid disease or subclinical hypothyroidism (pdf)

Download

Does Time of Sampling or Food Intake Alter Thyroid Function Test? (pdf)

Download

Polycystic Ovary Syndrome, Subclinical Hypothyroidism, the Cut-Off Value of Thyroid Stimulating Hormone; Is There a Link- Findings of a Population-Based Study (pdf)

Download

Low Dose Naltrexone for treating anti-thyroid antibodies

***** Do not take unless under medical supervision *****


There have been many  studies published indicating there may be a benefit in treating anti-thyroid antibodies such as those seen in Hashimoto's Thyroiditis (anti-TPO and anti-TG), see "Important Definitions" above. 


However, from what I have seen the studies have remained contradictory. We know it is true that the presence of anti-thyroid antibodies (when greater than 50) indicates the pt's immune system is recognizing something in the normal healthy thyroid tissue as "abnormal" and is mounting an immune response to attack the normal protein. Therefore, it is likely that over time, the pt will eventually develop HYPOthyroidism. 


The theory presented is that LDN (low dose naltrexone at 4-4.5 mg daily) will decrease the anti-thyroid antibodies and prolong the time the patient has before she becomes hypothyroid. 


However, I am not sure sure there a way to design a quality, evidenced based study to evaluate the effect of LDN on thyroid antibodies, because we also know for sure that these antibodies will naturally wax and wane over time without any treatment. In other words, we cannot prove the LDN is lowering the antibodies, because they will often lower completely on their own. 


That being said, I do believe LDN may have a positive effect in mitigating  inflammation which is found in many disease conditions, including but not limited to Endometriosis and Infertility Below I have posted some studies were LDN has been used to treat inflammatory conditions, such as Rheumatoid Arthritis and Crohn's Disease, as well as a study looking at LDN use in cancer patients. 

LDN Research For Medical Professionals - OPEN ACCES

Low dose naltrexone- Effects on medication in rheumatoid and seropositive arthritis. A nationwide register-based controlled quasi-experimental before-after study (pdf)

Download

Cochrane Review- Low dose naltrexone for induction of remission in Crohn's disease (pdf)

Download

Safety and efficacy of low dose naltrexone in a long covid cohort; an interventional pre-post study (pdf)

Download

Low-dose naltrexone - A promising treatment in immune-related diseases and cancer therapy (pdf)

Download

LDN for the induction of remission in patients with mild to moderate Crohn’s disease- multicenter RC (pdf)

Download

Low dose Naltrexone for induction of remission in inflammatory bowel disease patients (pdf)

Download

Copyright © 2025 Queen of Hearts Fertility Care  & Napro Technology - All Rights Reserved---Ocean Video image courtesy of Sitthijate Poonboon. 

  • Home

Powered by

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.

Accept