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Review: Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal

Understanding Hashimoto's Disease & Hypothyroidism


Updated June 13, 2014

Doctor using tablet computer with patient
Thomas Tolstrup/Iconica/Getty Images
Early on in his book, Dr. Datis Kharrazian asks, "If the check-engine light on your car lights up, which would be smarter: to investigate the engine or remove the light?" The book goes on to say that failing to look for the underlying reasons behind the symptoms -- and instead, simply prescribing thyroid medication -- is like "removing the engine light."

Looking for those underlying reasons for Hashimoto's and hypothyroidism is the idea behind Dr. Kharrazian's book, Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal: A Revolutionary Breakthrough In Understanding Hashimoto's Disease and Hypothyroidism. Dr. Kharrazian is a chiropractic practitioner with expertise in nutrition and neurology, and his book has proven popular with some holistic practitioners -- including chiropractors and nutritionists -- as well as some thyroid patients who are looking for other ways -- in addition to or instead of thyroid drugs -- to address Hashimoto's disease and hypothyroidism. (You can read Mary Shomon's in-depth Q&A with Dr. Kharrazian regarding the role of chiropractors in thyroid management here.)

At its core, Why Do I Still Have Thyroid Symptoms makes it clear that hypothyroidism is not a one-size-fits-all diagnosis, and while thyroid replacement treatment helps some people, it doesn't necessarily resolve symptoms in everyone.

Why thyroid treatment doesn't resolve symptoms for everyone is the overriding question Dr. Kharrazian seeks to answer. To tackle this question, Dr. Kharrazian has outlined his theories regarding the causes of Hashimoto's disease, as well as his explanation of the various causes of what he refers to as "functional hypothyroidism" -- which he defines as hypothyroidism despite normal -- or "euthyroid" levels on thyroid blood tests. He provides nutritional and supplement protocols, as well as dietary changes, that he feels will address and resolve Hashimoto's and functional hypothyroidism. He also addresses the need to evaluate and manage blood sugar, digestive and adrenal imbalances, and outlines the tests and supplements needed to evaluate and treat each type of dysfunction. There is a great deal of thoughtful research in Dr. Kharrazian's approach, and his recommendations are explained in depth, and with many citations and journal references.

Dr. Kharrazian points to the two key directions to look for in the causes of hypothyroidism -- Hashimoto's disease, and six types of metabolic pathway dysfunctions.

Looking at Hashimoto's, the book delves into the immune system issues that may cause the disease, Dr. Kharrazian focuses on two different types of Hashimoto's, what he refers to as TH-1 (TH stands for T-helper cell) dominant., where natural killer and T-cells that kill other cells are overproduced, and TH-2 dominant, where too many B-cells -- the cells that identify immune-unfriendly intruders -- are overproduced. He provides detailed recommendations regarding tests to assess these issues, and nutritional protocols he says will help modulate these immune responses.

One of the areas where Dr. Kharrazian has been breaking new ground is in his information about the role of diet as a trigger for Hashimoto's disease. In particular, he says, "anecdotal evidence strongly suggests a diet that is not only gluten-free, but also dairy-free promises the best results in managing Hashimoto's."

We know that gluten sensitivity and celiac disease are more common in Hashimoto's and other autoimmune disease patients, but in his book, Dr. Kharrazian argues that the linkage is much stronger than typically recognized, and proposes that most people with Hashimoto's or hypothyroidism should consider a gluten-free diet. According to Dr. Kharrazian, "Because the molecular structure of gluten so closely resembles that of the thyroid gland, the problem may be one of mistaken identity. Every time undigested gluten mistakenly slips into the bloodstream, the immune system responds by destroying it for removal."

Dr. Kharrazian also takes a strong stand on the controversial issue of iodine supplementation. Not a fan of iodine supplementation for Hashimoto's patients, Dr. Kharrazian recommends that patients "rule out an autoimmune thyroid condition," before starting iodine, if taking it at all.

Beyond Hashimoto's, Dr. Kharrazian considers functional hypothyroidism to be the result of one of six metabolic dsyfunctions he has identified, including:

  • Primary hypothyroidism, in which the pituitary gland is not functioning at all
  • Hypothyroidism resulting from pituitary hypofunction
  • Inability to convert T4 into T3 due to excess cortisol
  • Excessive production of T3 which causes resistance to thyroid hormone, usually as a result of excessive testosterone from insulin resistance and/or polycystic ovary syndrome
  • Hypothyroidism due to elevated thyroid binding globulin, which is the result of oral contraceptive or estrogen treatment
  • Inability of hormones to get into cells, due to excessive cortisol
Here, Dr. Kharrazian is presenting information that is similar to and complements the work of Kent Holtorf, MD and Dr. John Lowe, who have, for a number of years, been researching and writing about thyroid transport, impaired T4-T3 conversion, Reverse T3 dominance, T3 resistance, and other factors that prevent cells, tissues, and organs from effectively receiving enough thyroid hormone.

The book provides detailed recommendations regarding tests and nutritional supplements for each metabolic dysfunction leading to hypothyroidism.

The one place where I question Dr. Kharrazian's conclusion is in his assertion that primary hypothyroidism is the only pattern of hypothyroidism that can be "effectively managed with thyroid replacement hormone." The book even states: "the majority of people with hypothyroidism do not need thyroid hormone medication. In fact, medication can make functional hypothyroidism irreversible."

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