Three reasons why your thyroid medication isn’t working

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  1. Jamie’s avatar

    Great series Chris.  Just a quick question regarding iodine (and I appreciate you are busy atm so no hurry).  While I can appreciate that simply throwing large doses of iodine at the thyroid problem may be an issue (people need to realise that often having too much of something can cause exactly the same sorts of issues as not having enough – iron is the classical example), what are your throughts for those who live in known iodine-deficient areas.  I am based in New Zealand and most of our soils are very low in iodine and iodine supplementation has recently been strongly recommended for all women planning a pregnancy in New Zealand and along the eastern seaboard of Australia for this very reason.  Thanks of ryour preciosu time in advance.

  2. Jesse’s avatar

    I’m confused. In the last post you said that depressing the immune system was worse than the disease it would be treating:
    “But in the case of Hashimoto’s, the consequences – i.e. side effects and complications – of using immunosuppressive drugs are believed to outweigh the potential benefits. (Thanks to conventional medicine for a relative moment of sanity here.)”
    But in this article, you say it is unfortunate that this treatment is rarely done.
    Which is it? Am I misunderstanding something?

  3. Chris Kresser’s avatar


    There’s a difference between suppressing the immune system across the board with steroids and dampening the parts of it that need dampening.  And there are many ways to reduce inflammation that don’t involve immunosuppressive drugs.

  4. Chris Kresser’s avatar


    I’m going to cover iodine in detail in the next article.

  5. Jesse’s avatar

    Oh, ok. I guess you haven’t gotten to that part yet.

  6. claire’s avatar

    I’ve been reading your blog with interest, being uninsured and only able to access my naturopath when I can pay out of pocket. What you report makes me think I’m generally on the right path towards keeping healthy and healing myself as I get older. Here’s my question.
    Will you be talking about the tests to determine the need for iodine? My naturopath suggested I take one and I was put on iodine after that.
    I wonder about all the immune system problems I’ve developed as I’ve moved through my 40′s: Allergies, mild asthma, tinea versicolor, mild eczema, thyroid problems, the list keeps growing.
    I still feel energetic and mostly fine but I can’t help but get stressed out trying to figure out how to keep healthy. What should one do if it seems that their immune system is out of balance? Thyroid is just part of it. A very important part according to this article. Thanks

  7. Sarah’s avatar

    This series is amazing thank you!!!  I was diagnosed with Hashimoto’s a year ago from an antibody blood test even though my TSH was normal I was put on Synthroid.  I also suffer from Chronic Idiopathic Urticaria and take Reactine daily to control the hives.
    I am very curious about your next segment as I would love some tips on addessing the autoimmune part of this as I clearly am suffering from two autoimmune diseases, all which came on after the birth of my second daughter.
    I would love to know what you think about high cortisol levels and its effect on thyroid hormones, more specifically the conversion of T4 to T3 and/or antibodies that could be faciliated by high cortisol?  I can remember being 18 years old and put on the birth control pill and having all the symptoms of hypothyroidism after about a year on the pill, but all my labs came back normal (aka my TSH was normal) except my cortisol was very very high.  Dr said this was normal on the birth control pill.  About 6 months after that at a clinic a different dr said my thyroid felt firm and to get it checked out.  I was 19 and stupid and did not.  Since then I have steadily had increasing problems with weight gain, acne, fatigue, allergies, and now hashimoto’s and hives.  Seems connected in my mind but I would love your thoughts…when you have time of course :-)

  8. Chris Kresser’s avatar


    I wish there was an easy answer to your question. Unfortunately, autoimmune disease is complex and each case must be considered individually. That said, I’ll be providing some general steps to regulate the immune system and reduce inflammation that are applicable to everyone. Stay tuned.

  9. Chris Kresser’s avatar


    Birth control pills increase thyroid binding proteins, which in turn decreases the levels of free thyroid hormone (the active forms) available to the body. This won’t turn up on a test unless free hormones are measured, which they rarely are. That explains why you had hypothyroid symptoms on the pill, but had normal test results. Cortisol is a hormone that is elevated during an active stress response. Stress is inflammatory. Inflammation reduces T4 to T3 conversion, dysregulates the HPT axis, and decreases receptor function.

    So yeah, it’s all related.

    In a later post I’ll be talking more explicitly about problems that cause hypothyroid symptoms that won’t show up on normal lab tests. I’ve just mentioned one (increase in thyroid binding proteins), but I’ll go into more detail on that and talk about a few more.

  10. Sarah’s avatar

    Thanks!  I look forward to your next post :-)
    In reading some more on cortisol and the birth control pill, it seems common place that cortisol is high on oral contraceptives.  Even my lab requisition says it will only test cortisol if patient is confirmed to not be on oral contraceptives.  Could this be a partial link to why so many women suffer from hashi’s?
    Also, to whomever was saying iodine is not an issue…I work as a Nuclear Medicine Technologist and we test the thyroid gland function by giving the patient a very very small dose of radioactive iodine.  We can then measure, with a radiation detector, how much is in the patient’s thyroid and how much is still circulating in their body.  If the patient consumes even seafood (which relatively speaking is low in iodine content) in the 3 weeks prior to their test, it skews the results a lot!  They actually look like their thyroid is hypofunctioning because their thyroid is so full of iodine (for lack of a more medical description) that it won’t take up the radioactive iodine we give them.  So essentially by having them on a no iodine diet 3 weeks prior to the test we can then get a snapshot in time of their thyroid function.
    Just FYI

  11. kara’s avatar

    Hi Chris-
    My husband had hyperthyroidism, which has treated by irradiation. Now he has hypothyroidism and takes Synthroid. Since he thyroid was deliberately damaged, and it isn’t an autoimmune problem, is synthroid his only choice?

  12. Chris Kresser’s avatar

    Since your husband can’t produce thyroid hormone on his own, replacement is his only choice. That said, are you certain he didn’t have Graves’ disease? Graves’ is the autoimmune form of hyperthyroidism. If he had that before, he likely still has it now and it would be important for him to address the autoimmunity.

  13. kara’s avatar

    Thanks, Chris.  Not sure or not if he had Graves disease. Would the doctor have tested and mentioned that? Is there anyway to test that now?

  14. Chris Kresser’s avatar

    It’s entirely possible the doctor didn’t tell you, because it wouldn’t have altered the course of treatment.

    Your husband can have his TSH receptor antibodies tested.  This is sometimes called a TSI test, or a TRAb test.  If these antibodies are elevated, it’s likely he has Graves’.  TPO & TG antibodies are also often elevated, as they are in Hashimoto’s.

  15. Alisa’s avatar

    I’m personally interested in this series, and hope that you will also be addressing your take on how to ” dampen the immune system and decrease inflammation.”

  16. Kathy’s avatar

    What do you think of treatment with Cytomel? It’s T3 only. My concern is that I might need some other thyroid fractions (T4, perhaps T2/T1) as might be found in Armour. Thoughts? 

  17. Chris Kresser’s avatar


    I’m sorry, there’s really no way I can answer that question without doing a full exam and lab work.

  18. hans keer’s avatar

    Eric, I did not study this subject, but my first reacting would be that “dampening” (reducing) the immune system is not a good idea. How would you like to do this and what would be the other effects of this. I would suggest that people try to find and avoid the things that are causing the auto-immune reactions. Illiminating foods like grains (, soy (, dairy and (perhaps) eggs would be a good start. Are you going to continue on this subject?

  19. Chris Kresser’s avatar


    Removing potential immune triggers is important. I will discuss this further. But often that’s not enough. Most autoimmune patients have a Th1/Th2 imbalance that must be addressed. This is what I mean by dampening the immune system. “selectively dampening” or “regulating” would have been more accurate terms.

  20. hans keer’s avatar

    Btw, sorry for calling you Eric. Don’t know where that came from. A mental derangement perhaps :-) . OK, I’m curious about what you are going to say about the triggers. VBR

  21. Mario’s avatar

    First, I know no better medicine to regulate Th1/Th2 imbalance than LDN (low dose naltrexone).

    Second, I think that avoiding some of the immune triggers/endocrine disruptors is almost impossible in our modern society. How one can avoid bromine, bisphenol and other hazardous compounds present in dust, devices, cloths, foams, carpet, furniture, cars, etc, etc, of almost any ambient of any city around the world?

  22. Lethal Lee’s avatar

    “Patients who don’t convert T4 to T3 well do better on bio-identical hormones like Armour, because it contains both T4 and T3 (in a 4.22:1 ratio).”
    Correction Armour is NOT bio-identical. It is natural, that is, it contains Thyroid Hormones (all of them), made naturally by the pig’s thyroid.
    The synthetics ARE bio-identical but are not natural.
    Note I am NOT saying synthetics are better certainly T4 alone is good for no-one IMHO. I tried NTH unfortunately my conversion is lousy. I do very well now on T3 only.
    Note Armour since reformulation doesn’t appear to be effective for many folks anymore.

  23. Chris Kresser’s avatar


    Regarding Armour’s reformulation, one reason some patients do worse on it now (and others do better) is that they changed the fillers. It now has calcium stearate, dextrose, microcrystalline cellulose, sodium starch glycolate, and opadry white as inactive ingredients. Many patients with Hashimoto’s have polyendocrine autoimmune disorders and react differently to the fillers in different hormone products.

  24. Lethal Lee’s avatar

    Hi Chris,
    Actually all of the ingredients you listed were already in Armour, to be precise they were since the FIRST REFORMULATION in 1996.
    However in 2008/9 they again reformulated by greatly REDUCING the dextrose & greatly INCREASING the methylcellulose.
    I wrote about it here
    So I’m acutely aware that for MANY it is not as effective anymore. Interestingly back in 1996 there was a similar reaction to the FIRST reformulation.
    I’m in Australia & the only Dessicated Thyroid available here is Compounded using PCCA Thyroid Extract USP. Unfortunately the Compounders ALL use methylcellulose or worse Hydromellose as fillers. I’ve had to resort to T3 only because of that & now doing very well.

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