On Saturday, May 9, 2020, we hosted our first-ever Thyroid Care Virtual Retreat with some of the most influential women's health experts and advocates sharing insights and practical wisdoms to help you take back control of your thyroid health!

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Schedule of events:

• Grounding Meditation with Fern Olivia, Thyroid Yoga

• ‍Midlife Health with Dr. Leslie Meserve, CurieMD

• ‍Thyroid Nutrition with Pheobe Lapine, Feed Me Phoebe

• ‍Healthy Food Mindset with Lauren Chambers, So Fresh N So Green

• ‍Thyroid Care with Dr. Annemieke Austin, Paloma Health

• ‍Thyroid Treatment 101 with McCall Mcpherson, Thyroid Nation

• ‍Mini-Workout with Dr. Emily Kiberd, Urban Wellness Clinic

• ‍Patient Advocacy with Mary Shomon

• ‍Self-Care with Taylor Morrison, Inner Workout

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During the event, there was not enough time to live answer all the questions posed in the chat. Our experts weighed in to answer all additional questions here.

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Additional questions from virtual retreat

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Additional questions for Dr. Leslie Meserve

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Can you talk about endometrial hyperplasia even if taking progesterone along with estrogen?

Endometrial hyperplasia is a known risk of estrogen use after menopause.  We have a pretty good understanding of the minimum progestin requirement which dramatically reduces that risk - eg. Prometrium 100mg nightly or 200mg for 10 days of each month, Provera 2.gmg daily.

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Can you talk about Sottopelle?  

Pellet therapy is discouraged by the North American Menopause Society.

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What about IUDs? How does that affect menopause as you don’t get your period very often?

IUDs do not affect when or how your body goes through menopause.  

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I’m 54 years old with Hashimoto’s and experiencing hot flashes and chills. I still get my period. Why is this?

Some women continue to have menstrual cycles into their late 50s. You may be perimenopausal, and hot flashes are a known symptom of perimenopause due to fluctuating hormone levels.  It's good to have thyroid function checked every six months to be sure the thyroid is not a component of your symptoms.

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At Home Thyroid Blood test

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If I am menopausal and using estradiol, is additional progesterone necessary?

Yes. It is absolutely necessary to help prevent endometrial hyperplasia.  

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I have Hashimoto’s-hypothyroidism and I'm at the beginning of menopause.  For a few years, I have been noticing puffiness under my eyes that is recently getting much worse.  Could it be thyroid related?  Should I be concerned about kidney or liver-related reasons?

I suggest asking your health care provider to check your thyroid function to be sure this symptoms is not related to abnormal thyroid levels.  I don't suspect a kidney or liver source, but it would be easy to check their function with simple blood tests, as well.  

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Additional questions for Lauren Chambers

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What is the recommended maca intake daily?

I'd recommend one teaspoon daily. It's also important that you are purchasing gelatinized maca versus raw maca, as it's much more bioavailable and easy to absorb. I like Gaia's maca powder.

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Are gluten-free foods ok to eat or do we just avoid those types of food?

Well, that's a tough question to answer as it's dependent on so many things. I'm hesitant to give advice without knowing your gut, hormone, lifestyle, genetics, preferences, etc. but I will say that many people have difficulty digesting gluten due to it's ability to penetrate the gut barrier, leading to leaky gut, digestive symptoms, inflammation and autoimmune disorders. If you are experiencing symptoms or a thyroid condition, I definitely think it'd be worth eliminating gluten for a minimum of two weeks and paying attention to how you feel. Ultimately, you'll get a better sense of how your body responds or reacts to gluten and whether or not you should leave it out of your diet.

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Are there main cravings to look for when hormones are off?

Absolutely! Cravings are an amazing way to get a sense of what's going on on a deeper level in our body. For example, carb cravings can be a sign of a deficiency in b-vitamins or a blood sugar imbalance, while sweet cravings could mean you're deficient in magnesium, which can impact your sleep, anxiety, cortisol levels, etc. I wrote a post on this to help decode cravings.

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I always wonder when people say, “I felt great once I started doing X, Y, Z,” how quickly did you start feeling this effect?

Great question! I think it's different for everyone and truly unique to each person's journey. For me, it was a matter of weeks, but I drastically changed my diet from processed foods to real foods, plants, and green smoothies. On average, the bacteria in our gut divides every 20 minutes, so if we feed it food that either empowers the bacteria to flourish or causes inflammation, we can feel results pretty quickly. On a hormonal level, the changes in our diet can help stabilize insulin and cortisol levels within 72 hours. I think it's an ongoing process, and you truly have to do the work to tune in and pay attention to what is feeling right for you. It's ever-changing, so it requires a lot of checking in and deepening your self-awareness.

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Additional questions for Paloma Health

What's involved with the at-home thyroid test and is it accurate?

Our at-home thyroid test kit measures TSH, free T3, free T4, and TPO antibodies to you a comprehensive understanding of your thyroid function. The test is done at home with a small lancet, instead of venipuncture. You prick your finger with the lancet and drop a few spots of blood onto a collection card. Once dry, these cards are extremely stable for shipment and storage. Then, you ship your sample off to our CLIA-certified lab, and results are uploaded to your private online dashboard within five business days. Learn more about the accuracy of dried blood spot testing.

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Is the Paloma Health thyroid kit reusable or do patients have to pay for a new kit every time they need their blood tested?

Our at-home thyroid test kit is not reusable. The kit includes everything you need for a one-time collection (including a special collection card, lancets, alcohol swab, bandaid, and prepaid return label). You join our Ambassador program to earn credits toward future purchases, making it more cost-effective.

What is the best way to decrease thyroid antibodies for Hashimoto’s?

A few considerations to reduce your TPO antibodies might include diet, sleep, or lifestyle modifications. The more dietary stress you put on yourself, the more likely you are to experience inflammation. This inflammation can worsen your autoimmune reactions and interfere with your thyroid function. Sleep can also lower inflammation, heal, and restore damaged tissue. Work with your care team to determine if supplements might also support your efforts. Learn more about TPO antibodies.

Is Levothyroxine an immunosuppressant?

Levothyroxine is not an immunosuppressant. earn more about immunosuppressants and Hashimoto’s.

Is NatureThroid a T4 Med?

NatureThroid is a T4/T3 combination medication made from desiccated pig thyroid. It contains lactose as a filler. Learn more about thyroid medications.

I was diagnosed with Hashimoto’s five years ago, but my labs have always been “normal,” so I’ve never been medicated even though I have low thyroid symptoms. How is this possible, and even if our labs are “normal” should I be on medication to help?

Yes, you can definitely still have low thyroid symptoms but have normal labs. This could be caused by a number of issues - sleep deprivation, poor diet, too much caffeine, chronic stress, a pituitary issue, a thyroid hormone conversion issue, etc. It’s important to work with a doctor who takes a comprehensive approach and will help you get to the root cause of your issue.

What do you think about cosmetic injectables for Hashimoto's patients? Could injectables could increase antibodies?

While the overall risk for an adverse reaction is minimal, Botox is a toxin. It can lead to severe or life-threatening complications if misused. If you have Hashimoto’s, or any other autoimmune disorder, it is worth a consult with your doctor before receiving injectable beauty treatments.

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I have subclinical hypothyroidism. My doctor tells me that he believes that I will eventually get full-blown hypothyroidism and he just writes me a prescription for Levo instead of talking about preventative measures. What should I do? 

While there is no definitive way to prevent hypothyroidism, you can make informed choices and modifications to reduce your risk or slow progression.

Additional questions for Dr. Annemieke Austin

I’m 51 and have had hypothyroidism for over 20 years.  I keep it in check with Synthroid.  My periods became very heavy over the last couple years so I recently had endometrial ablation.  I still get periods but very light.  I feel good so far, but I am curious how this interplays with my thyroid?

This may or may not have to do with your thyroid and rather hormonal shifts as you age (ie estrogen/progesterone). Hypothyroidism can cause periods to be heavier so making sure your lab work is up to date and normal is important. 

What should I do if I have Hashimoto’s and nodules on my thyroid?

See your doctor and get a thyroid ultrasound to make sure they appear benign (a.k.a. not concerning). Addressing Hashimoto's takes a comprehensive approach  - please work with your doctor on this either at Paloma, your endocrinologist, or primary care physician. 

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Can you explain the relationship between thyroid disorder and vitamin D deficiency? And what other vitamins tend to be low when you have an autoimmune disorder?

There is no quick answer to this question. Vitamin D is important for immune regulation and probably plays an important role in autoimmune thyroiditis ie Hashimoto's for example. I would try to optimize the blood level to around 40-60.  If you have a chronic gut problem due to an autoimmune disorder or SIBO for example we sometimes see low iron or low zinc levels amongst other issues.  It is very individualized so please work with a physician to help you figure this out.

For someone who had thyroid cancer, is post TT and RAI, but no clear antibodies, is it appropriate to test Free T3?

Yes! I don't see any reason not to. Your body still has to convert T4 to T3 even though you do not have a thyroid gland. 

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Additional questions for Dr. Emily Kiberd

I have a fibromyalgia diagnosis on top of my Hashimoto's and all my doctors are recommending yoga every day. I also think that CrossFit contributed to adrenal burnout a couple of years ago. What might you recommend? 

There is a happy medium between these two. Yoga can create hyper-mobility and doesn’t help support the muscle, especially when we struggle with low muscle mass with Hashimoto’s. Crossfit can definitely create adrenal insufficiency due to high volume with very little rest breaks, as well as a typical six days a week training WOD. I like kettlebells because you can negotiate form while learning the form, you can take long rest breaks, and I would do functional strength moves. I call them the Essential 7 - hinge (like a deadlift), squat, lunge, push, pull, carry, and anti-rotate.

Doing 45 min walking daily with 35 min strength training. Hoping for some weight loss. Started elevation diet 3 weeks ago, only lost 7 pounds the first week. Any recommendations?

Eat optimal protein (at least 30 grams per meal) to stimulate muscle protein synthesis, strength training, and full-body movements. If you are doing squats and deadlifts, pick a weight that is heavy enough that by the fifth rep it feels challenging. Take long rest breaks in between lifts, and walk around for 1-1.5 minutes if you are lifting this kind of weight. Seven pounds in the first week is a lot. Just make sure whatever you do is sustainable over time. Usually, you’ll see a drop in weight and water weight with an elimination diet. If you need some guidance on form in your strength program you can check out Thyroid Strong, how to workout without burning out with Hashimoto’s at dremilykiberd.com/yes.

Additional questions for Mary Shomon

For someone who’s been diagnosed in my 20’s with Hashimoto’s and have been on medication for over 20 years and still have thyroid symptoms, and was recently diagnosed with Psoriatic Arthritis and cannot lose any weight. What would you say the next steps are?

Difficulty losing weight, and the addition of other autoimmune diseases over time, are both common complaints from many women with Hashimoto's hypothyroidism. There are a few key steps to consider:

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• Is your thyroid treatment optimal? It's not enough to have thyroid levels that are in the reference range; you want levels that are optimal for you and reflect healthy thyroid function. A consult or second opinion with a Paloma Health provider could be a help!

• Look for potential autoimmunity triggers. In some cases, autoimmunity can be tracked to particular triggers such as food allergies or sensitivities, chronic infections, or toxins in your diet or environment. I would want my health care provider to look deeper for potential triggers because addressing them could reduce inflammation and symptoms, and help support healthy weight loss. 

• Once your thyroid is optimally treated, consider what other hormonal factors may be involved? That involves working with your health care provider to rule out other hormonal factors that can sabotage weight loss, including insulin resistance or chronically high blood sugar, sex hormone imbalances (common after pregnancy, and during perimenopause and menopause), or adrenal issues. 

• Some basic lifestyle factors pack a punch when it comes to weight loss - starting with sleep. Anything less than seven hours a night can wreak havoc on hormones and make weight loss difficult. Also, managing stress is essential. Chronic life stress raises cortisol, and contributes to increased hunger and fat storage - a double whammy! 

• And, of course, it's essential to look at what you eat, when you eat, and how you eat. There's a lot more to weight loss than calories in, calories out, especially when your hormones are involved. It would be helpful to look at different eating methods, and to learn mindful eating approaches that help shift you out of fight-or-flight mode into a rest-and-digest mode. 

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I have a doctor who told me that you should just have your thyroid taken out because you are on medicine anyway.  Time for a new doctor?

My first reaction is, "Absolutely! It's time for a new doctor!" But my next reaction is to want to know more about the situation. For example, I've coached some thyroid patients who had long-term Hashimoto's, with constantly fluctuating thyroid function, levels that changed dramatically with every test, and no relief of their symptoms -- even with optimal treatment. I helped them evaluate the pros and cons of having the thyroid surgery recommended by their doctors. They all have said it was the best decision they ever made! At the same time, I've also coached patients whose doctors very cavalierly recommended thyroid surgery -- when there were less drastic and invasive treatment options. Those doctors seemed to think that the thyroid is a non-essential gland that's easily replaced by taking medication. And that's NOT true for many thyroid patients! The bottom line: trust your instinct. If a doctor makes you feel uncomfortable in any way, that's a good reason to move on and find a true partner for your thyroid care. 

What are other related medical issues strongly correlated with hypothyroidism or Hashimoto’s?

There are many related issues. For example, with Hashimoto's, the underlying autoimmunity means that you're at a slightly higher risk of developing other autoimmune conditions, including Sjogren's Syndrome, Psoriatic Arthritis, and Alopecia, for example. People with hypothyroidism also have a higher risk of developing Type 2 diabetes. For women, hypothyroidism is associated with an increased risk of fertility challenges, pregnancy complications, and menstrual disorders. And those are just a few examples. The key message? Optimal treatment of your hypothyroidism helps reduce your risks of related conditions, so that's always the crucial foundation for better overall health.

Can mold and heavy metals prevent the thyroid or thyroid medication from working optimally?

Any toxins - including mold and heavy metals - can negatively affect your overall health, immune system, and hormonal balance, including your thyroid. Pay attention to specific thyroid-sabotaging toxins, like endocrine-disrupting chemicals, excessive fluoride, and pesticides and hormones in food, and make it a point to minimize your exposure to toxins -- including in your water, food, personal care products, and home -- for optimal health and hormonal balance. 

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