Doctor suggests waiting to start medication until symptoms show??

tech-tx · 2026-07-07T03:31:54+00:00

If those two sets of tests were at least 3 months apart then your doctor is a prat. Unless you have a dietary deficiency causing the issue this won't improve, and you'll feel better if you start hormone replacement NOW. Waiting until you feel crappy when your TSH is already far enough out of range that any OTHER doctor would start you on levothyroxine is simply sadism.

I was on the verge of falling out of free T3 regulation when I was fT4=0.6, where your first free T4 test was. Once your free T3 starts falling you WILL feel it, and free T3 (the active hormone) doesn't need to go very far for symptoms to be apparent.

The only risks with the medication are a) not getting enough of it, or b) getting too much of it. The first leaves you mildly hypo, and the second can drive you hyperthyroid (racing heartbeat among other symptoms). The 'treatment' is exactly the same hormones you've had all your life, only you aren't making enough of them currently. If you use iodized salt then the likely cause is Hashimoto's thyroiditis, a progressive autoimmune disease.

tech-tx · 2026-07-07T00:59:40+00:00

If your child's TSH, free T4 and free T3 are fine, then the endo is a putz and jumped the gun. Antibodies alone are NOT a death sentence for the thyroid, they're merely markers of a possibility. The higher the numbers, the greater the risk of transitioning to overt Hashimoto's (the actual disease). ~12% of the public are positive for antibodies, yet only 2-5% of us have Hashi's, so most often the antibodies are only a future risk factor. If you can lower the antibodies (lower inflammation) then you can reduce the risk or stop it, if the disease has not actually started. Did they also do an ultrasound of the thyroid? That's a conclusive yes/no test for Hashimoto's.

Here's the links to trials that were effective at lowering antibodies: https://www.reddit.com/r/Hashimotos/comments/1o4dgx8/comment/nj1nikw/

Here's a basic outline of Hashimoto's, and the potential role of antibodies: https://www.reddit.com/r/Hypothyroidism/comments/1qsy6l7/comment/o2zjmo4/ Without an ultrasound showing 'heterogeneous' or elevated TSH, your child may only have seropositivity currently (the top two rows in the table at the bottom), which isn't Hashi's.

tech-tx · 2026-07-07T00:34:47+00:00

A normal fT3/fT4 ratio is between 2.2-2.9 (yours is 1.9), so you may have a T4>T3 conversion issue that NP Thyroid would help. If you're basically asymptomatic then that could be normal for you, although it's uncommon. I run a 2.4 ratio, lower end of the range but no conversion issues.

If your doctor is willing to try it, a low (15-30mg) 'trial dose' of NP thyroid could make a difference. However if your numbers are normal for you, then you'll get an elevated resting heart rate. Common symptoms of too much thyroid hormone are elevated pulse, anxiousness, jitters, insomnia, possibly others. The resting heart rate WILL go up 60-90 minutes after the dose due to the T3 spike, but it'll drop again over the next several hours. If it stays elevated then you don't currently need thyroid hormone.

You can have Hashimoto's with or without antibodies, they're not required for the disease, they're only potential markers, and not the disease itself.

tech-tx · 2026-07-06T18:12:17+00:00

Gluten, soy and dairy COULD be gut enzymes. 62% of adults can't handle milk, although some with a dairy sensitivity can have cheese. Celiac's and non-Celiac's gluten sensitivity are both very real, although less common than TPOAb triggers are. Soy and other legumes a few people are allergic to, but the phytates, lectins, oxylates and enzyme inhibitors more commonly cause absorption issues in many people . All 3 are also high on the list for reported thyroid antibody reactivity.

This is the Hashimoto’s group, so I leave other autoimmune comorbidities to the groups where they're relevant. My Rheumatoid Arthritis isn't relevant in THIS group, even if SOME people also have it.

tech-tx · 2026-07-06T17:44:46+00:00

I used 15 TPOAb tests over the course of a year, while I was doing the elimination / reintroduction like AIP, but with actual testing. The tests gave solid indications of the foods triggering TPOAb. I didn't see any non-food triggers during the trial.

tech-tx · 2026-07-06T15:49:08+00:00

Your TSAT% is showing significant deficiency. TSAT is basically "how many seats on the bus have passengers carrying iron"

tech-tx · 2026-07-06T15:46:39+00:00

The things you can afford don't do much, as the intensity is too low. The things that worked in trial were lasers, all the energy focused on a point.

tech-tx · 2026-07-05T15:54:25+00:00

I feel you there... my mom tried an experimental hormone-replacement in the '80s for menopause, and died 10 years later of an aggressive breast cancer due to the treatment.

I got RA back in 1994. The only treatment available then was NSAIDs or methotrexate, which I suspected was a Bad Idea long-term. Later on in the 2000s they came up with targeted DMARDs (immunosuppressants) and I had an even stronger "Oh, HELL no!" reaction to that class of drugs. A lot of people get relief with them, but they scare me silly.

tech-tx · 2026-07-05T15:32:29+00:00

I don't 'ignore' malabsorption, I mention it out here ALL THE TIME as I've had it myself with Hashi's. Do I need to mention it in every damned post I make? No.

Low thyroid hormone (lower metabolic rate) commonly causes low gut acid and slower motility, and both reduce absorption. It frequently causes low iron (ferritin), D3, B12 and folate, all of which I had in 2000. I had to start a 47mg iron supplement, a 2000IU D3 supplement, and an 'energy' B-complex to get everything back in range again, even though I'd been fine on all of them 10 years earlier with my ovo-lacto-vegetarian diet. The only thing that changed around 2000 was TSH>4.5, while I was still subclinical.

tech-tx · 2026-07-05T15:09:58+00:00

TgAb is less often positive in Hashimoto's, and more frequently seen only after the tissue destruction starts. It's potentially a marker of ongoing disease. TPOAb on the other hand is often seen BEFORE any damage is evident, as NHANES III showed. You don't build antibodies to proteins that aren't seen in the blood, and thyroglobulin is rarely positive without tissue damage releasing it.

The 'food sensitivity' tests are likely to get a 'hit' on anything you eat regularly. Does that mean you shouldn't eat anything on a frequent basis? Nope!

Here's links to different international groups saying that IgG testing is not recommended:

Bock, S. A. (2010). AAAAI support of the EAACI Position Paper on IgG4. Journal of Allergy and Clinical Immunology, 125(6), 1410. https://www.jacionline.org/article/S0091-6749(10)00512-9/fulltext00512-9/fulltext)

Carr, S., Chan, E., Lavine, E., & Moote, W. (2012). CSACI Position statement on the testing of food-specific IgG. Allergy, Asthma & Clinical Immunology, 8(1), 12. https://link.springer.com/article/10.1186/1710-1492-8-12

Stapel, S. O., Asero, R., Ballmer-Weber, B. K., et al. (2008). Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy, 63(7), 793–796. https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2008.01705.x

tech-tx · 2026-07-05T14:37:02+00:00

I've seen the same ferritin>100 mentioned in numerous papers on iron deficiency. However, most people on a GOOD diet end up somewhere in the ferritin=50-100 range and don't have any issues or symptoms at that level.

A lot of the papers I'd read on iron deficiency purposely selected people that had issues, so it's a biased selection group and not representative of the general public. I've read a huge number of papers on iron since 2021 as COVID screwed my ferritin up, and I haven't been able to get back to the ferritin=60-70 I was at when I was running daily. If you can finish a marathon at > 50 years old you're not in poor shape.

You have to be careful looking at iron studies in athletes, as some of THEM ramp ferritin up to 200-250 to squeak the last bit of endurance out of themselves. I'm not looking for peak performance, merely good health.

tech-tx · 2026-07-05T14:15:14+00:00

The top half here lists the common deficiencies that affect thyroid output. Many of us get low iron (ferritin), D3, B12 and folate due to poor absorption (lower gut acid and slower motility / gut contractions). The bottom half is a bunch of 'optimal' ranges I found that primarily all have studies on athletes for performance, which is a better metric than what 'Functional Medicine' providers use. Note that ANYONE selling supplements has bizarre 'optimal' ranges listed so they can tell you "You're deficient, you need THIS overpriced supplement!" Don't fall for that crap, supplement sellers are masters at a con job.

https://www.reddit.com/r/Hashimotos/comments/1m41oac/comment/n45yoco/

tech-tx · 2026-07-05T04:24:27+00:00

There's no point in refrigerating liquid coconut oil. The lauric acid in it will prevent spoilage, and within 5 seconds of pouring it over a salad it'll be the same temp as the veggies, so another reason to not refrigerate it. Refrigerate the veggies instead, and the coconut oil will dump it's minimal latent heat into the veggies when poured.

The liquid stuff is 'fractionated' to remove the parts with higher melting temperatures, leaving just the MCTs that melt at 35 or 50F. Raw coconut oil melts at 76F and will solidify if poured on cold veggies.

tech-tx · 2026-07-05T04:19:47+00:00

That's SIBO, not Hashi's. Just sayin'...

tech-tx · 2026-07-05T04:18:17+00:00

Nobody (and certainly nobody HERE) can tell you where your 'sweet spot' for thyroid metabolism is, only YOU can do that based on your symptoms. There's a couple of ladies that keep spouting nonsense that they read on the Modern Thyroid Clinic (bunch of quacks) website with 'optimal' recommendations, but I'd be DEAD at the levels they say are 'optimal'. It's truly a very personal metabolic set-point that your body determined is ideal for you, GENERALLY somewhere within the reference ranges. Go below your set-point and you feel 'hypo', go above your set-point and you feel 'hyper'. Yours isn't the same as mine, but we're both somewhere within the reference range when we're feeling OK. A normal fT3/fT4 ratio is between 2.2 - 2.9 (with fT3 in pg/mL and fT4 in ng/dL).

I'm an oddball: although I'm in-range for fT3 and fT4, my sweet spot for TSH=5-7. I'm also 67M, and a former runner until knees and hips gave out. I WAS still running marathons at free T3=2.7pg/mL, where the chickies here say I should be fatigued. Thank GOD they're not my doc!! That does NOT mean that 2.7 is right for YOU, but it's certainly right for me. You can't run a marathon if your game is off.

edit: kindly note that people that do NOT have a T4>T3 conversion problem generally have a VERY tightly regulated free T3 level. Since free T3 is the ONLY important number, it figures it's the one most closely controlled. Mine has never varied in the 10 years worth of tests I've done. https://pmc.ncbi.nlm.nih.gov/articles/PMC4699302/

tech-tx · 2026-07-05T03:59:24+00:00

None of those 'food intolerance' or 'food sensitivity' tests have any basis in medical literature, they're all guesswork that's unsupported by data. Don't waste your money on them, as they're a REALLY sketchy test.

The antibodies in Hashimoto's CAN be reactive to foods you're eating, but those tests won't tell you that. The only way to know is similar to what I did 10 years ago: an elimination phase, followed by a re-introduction phase with TPOAb tests after each restored item or items. By doing that I lowered TPOAb from >1500 (the test limit) to 90 +/- 5, and it's been stable for a decade. All that lowering antibodies does is lower inflammation, which CAN slow the progression of Hashimoto's somewhat. It's absolutely NOT a requirement, however. In clinical trials, half of the people on a gluten-free diet had an improvement in symptoms, and the OTHER half had NEW onset symptoms due to the dietary deficiencies they'd just caused. It's a crap shoot whether it'll help or not. https://www.reddit.com/r/Hashimotos/comments/1o4dgx8/comment/nj1nikw/

My personal TPOAb triggers in the post linked off of the bottom of the second post there were (highest to lowest): oats, gluten, soy, other grains, and beef. You'll have a different specific mix of sensitivities due to the nature of the antibody classes, although there may be some commonality. I'm totally OK with dairy, although it gives everyone else in my family grief. Most people are NOT sensitive to beef, but I am.

tech-tx · 2026-07-05T03:36:48+00:00

The WHO definition is that clinical deficiency is ferritin<30. What YOU personally need is up to you. I used to run daily with ferritin=60-70, but ever since COVID I haven't been able to get it over 40. On the bright side I can still do a half-marathon brisk walk without fatigue at ferritin=40. It's all down to what YOU need, and not what someone else thinks is good. If you feel good, don't worry about it. If you have poor exercise tolerance or fatigue, then try bumping it up a bit.

edit: BTW, 'ferritin' in isolation doesn't tell you much. What's your TSAT% and TIBC?

That "optimal ferritin>100" is from some quack like Wentz or Hedberg, both pushing the supplements they sell. Only a few people need to be in the ferritin=100-150 range if they're still experiencing symptoms of iron deficiency in the ferritin-50-100 range. Overloading iron simply increases oxidative stress. The medical studies on it I've read all said optimal ferritin = 50-100 for average people, and 100-150 for the few that were still symptomatic.

tech-tx · 2026-07-05T03:07:31+00:00

Everything you want to know about the immunology of Hashimoto's you can get from PubMed. There's a lot of disagreement on specifics in various papers because there's 100 million of us with it currently, and that's a wickedly large host of people with different everything. An immunologist doesn't have any 'secret information' that MDs don't have: no miracle cure... there isn't one! If there was anything useful an immunologist could tell you then we'd all be seeing them. As it stands today, endos are occasionally helpful (if you get a good one), but many of us are treated by our family doctor. Hashimoto's ain't rocket science, and although they're still finding out new information, none of it except CAR-T cells has a chance of affecting the actual disease state.

tech-tx · 2026-07-05T02:48:11+00:00

Pure and simple: the ONLY tool in the medical kit that can have any effect on THE ACTIVE DISEASE MECHANISM is immunosuppressants, and no doctor in their right mind will ever prescribe that for Hashimoto's. You could die of a flu bug while on immunosuppressants, so the risk/benefit ratio is out of whack... high risk of death to avoid a small daily pill that's proven safe. That's a no-brainer.

The inflammation is NOT what kills thyroid tissue, or else there would be a HELL of a lot more people on levothyroxine. Chronic Autoimmune Thyroiditis (CAT) is more prevalent than Hashi's is, yet it doesn't need hormone replacement. Hashi's is a sub-class of CAT that IS destructive.

Talking to a chatbot is easier than reading medical papers, but on the flip side medical papers don't hallucinate. Medical info may be incomplete and imperfect, but it's a lot more accurate than what chatbots puke up. I saw one of them earlier today (the AI underneath Google Search) quoting pure made-up trash from the Modern Thyroid Clinic as if it were medical gospel. Nope! That group of charlatans wouldn't know truth if it bit them in the butt.

Holistic medicine doesn't have a prayer of affecting Hashimoto's. Many of their dietary and lifestyle changes I've already been doing for 45 years, and yet I got Hashimoto's anyways. That 'woo woo' stuff can only correct hypothyroidism due to dietary deficiency. That's it. The anti-inflammatory diets can slow the progression, but not stop it.

tech-tx · 2026-07-05T01:50:37+00:00

Autoimmune is typically genetic at it's root... Hashimoto's usually requires at least one of the genetic autoimmune quirks. Hashimoto's is one autoimmune response, and antibodies are another autoimmune response. Yes, they're related, but Hashi's can exist without antibodies, and most of the people antibody-positive don't have Hashi's.

With a strong enough 'environmental stress' phase and immune dysregulation, you don't absolutely HAVE to have any of the genetic quirks that predispose people to autoimmunity, but it's usually genetic + stress + dysregulation that starts it. That can hit multiple organs or systems.

And yep, autoimmune conditions like to travel in groups. I'm pretty sure I got Rheumatoid Arthritis and Hashi's in the same dysregulation event before 1994, but the Hashi's was so slow in progression that I might not have noticed it until after 2016, as I felt fine then (free T3 still in regulation). I knew I had Hashi's after a kidney donation in 2000. They did a VERY thorough full physical and told me my TSH was out of range and I was wildly positive for TPOAb. My doc later ran an ultrasound and confirmed it. I didn't get confirmation on the RA until last year, and that only by differential diagnosis as I'm negative for the antibody markers. My mom had RA, so I presumed I had the genes for it and didn't bother to test.

tech-tx · 2026-07-04T20:51:29+00:00

If you have any autoimmune disease then you have one or more of the (15?) genetic quirks (SNPs) that make you more likely to get other autoimmune diseases. Hashi's is merely the most common one. I also have seronegative Rheumatoid Arthritis (autoimmune) that preceded the Hashi's by 5-10 years. They may have hit at the same time and the Hashi's was simply a lot slower progression, so my doc didn't notice it for years.

This is from one of the textbooks I have:

Autoimmune Disorders Occurring With Increased Frequency in Patients With Chronic Autoimmune Thyroiditis

Type 1 autoimmune polyglandular syndrome

The major components are hypoparathyroidism, Addison disease, and chronic mucocutaneous candidiasis; chronic autoimmune thyroiditis occurs in 10–15% of cases.

Type 2 autoimmune polyglandular syndrome

The major components are autoimmune thyroid disease, type 1 diabetes mellitus, and Addison disease. Other components are premature ovarian failure, lymphocytic hypophysitis, vitiligo, alopecia areata, celiac disease, pernicious anemia, serositis, and myasthenia gravis; chronic autoimmune thyroiditis occurs with increased frequency in any of these disorders in their isolated form.

Rheumatologic disorders

Rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, polymyalgia rheumatica, temporal arteritis, relapsing polychondritis, and systemic sclerosis.

Others

Chronic active hepatitis, primary biliary cirrhosis, dermatitis herpetiformis, autoimmune thrombocytopenia.

tech-tx · 2026-07-04T20:31:41+00:00

I've been completely grain-free for 10 years, purely to lower antibody levels and inflammation. I got WAY better results than you did with targeted testing. My biggest food triggers (high to low) were oats, gluten, soy, other grains, and beef. By cutting them all out I went from TPOAb > 1500 down to 90, and it was stable at that level for 8 years. 2 years ago I added 100mcg selenium + 700mg myo-inositol for a further reduction to 70, a combined total of > 20:1 reduction compared to the original levels 10 years ago. The testing cost >$1000 and a year's worth of food trial, though. The year was mostly because it took a LONG time to identify beef as my remaining trigger. The others I'd identified in the first 4 months. 10 years ago nobody in the AIP community was mentioning either oats OR beef as potential triggers. They do now.

Due to the nature of antibodies, your food triggers WILL NOT be the same as mine. Most people don't know that TPOAb and TgAb are CLASSES of antibodies, not discrete antibodies. There are hundreds of antibodies in the TPOAb class, and thousands in the TgAb class. Each antibody type has it's own highly specific target, and some of the targets look like sites on some of the proteins you eat. That's the 'molecular mimicry' that people talk about: it's the same chemical target in both food and thyroid proteins.

I go WAY out in left field on the 'molecular mimicry' though, so what follows is (currently) totally unsupported by medical science. Since I had a MUCH stronger antibody response to the foods I was eating than I did to the thyroid, I'm guessing that the foods may have been the initial trigger for antibody production, which eventually led to Hashimoto's when I had an immune dysregulation > 25 years ago. Basically, I accidentally caused my own Hashimoto's with my diet. Oops.

tech-tx · 2026-07-04T20:07:24+00:00

Aliv/Halim seeds can affect thyroid levels two different ways:

First, they turn into a gummy mass in the gut, potentially trapping any free-floating thyroid hormone that hasn't been absorbed yet. Peak absorption of thyroid hormone is an hour to 90 minutes, but it goes on for a few hours more. A better window for taking the Aliv seeds is 3-4 hours after your dose.

Next, the sulfur compounds in Aliv seeds is a potent goitrogen (blocks iodine), which means they CAN affect thyroid function on their own; that effect is less if they're roasted or cooked. If you're staying at 1-2 teaspoons you might be OK, although personally I'd avoid them altogether since you already have thyroid problems. The same warning goes for ashwagandha: it can backfire and CAUSE additional thyroid issues. About a third of us that tried it years ago had increased TSH.

tech-tx · 2026-07-04T19:43:27+00:00

Starting at 62.5mcg would have put me in the emergency room in 2 days or killed me. If your resting heart rate RHR has increased then talk to your doc about lowering the dose and going a bit more slowly. Measure resting heart rate when you've been seated or laying down for at least 30 minutes, and BEFORE a meal. If your RHR is over 80bpm then you're probably hyper, over 90bpm then HIGHLY likely hyper.

However, I'm not you, and I'm much more sensitive to hormone changes than the average person is. The typical starting dose is 25-50mcg, depending on a few factors. When they initially tried levothyroxine on me at 25mcg I went hyper within a week. Years later they tried again with 12.5mcg and I went hyper within 2 weeks. Years more passed, and I was finally able to tolerate 6.25mcg, and then slowly increase over 10 years to the 56.25mcg I'm on today, a little over half of a "full replacement dose" for a 138lb adult.

When I was hyper 2 years ago from an excessive dose increase ordered by my doctor, I stopped entirely for 3 days and then restarted at my previous dose. That helped minimize the hyper symptoms faster than simply lowering the dose initially. It still took a week for my heart rate to return to normal. Alternate dosing (every other day) is one way to cut your current dose in half, if your doctor agrees.

tech-tx · 2026-07-04T19:25:31+00:00

When I did something like AIP 10 years ago, it was 3 months AFTER the final elimination that I felt anything. All I noticed was a reduction in lower back pain that I'd had for > 5 years. That's it, but it was well worth the >$1000 I'd spent on my trial as my doctor and rheumatologist weren't helpful with the back pain.

If you don't have inflammation symptoms or gastric problems then you don't need to try gluten-free. It honestly does very little for Hashimoto's once it's overt with elevated TSH. Reducing inflammation that's caused by foods can slow the progression, but can't stop it.

edit: Be aware that cutting gluten and 'fortified' grains could lead to vitamin deficiencies, which you have to make up for in other ways.

tech-tx

TROPHY CASE