As I have always stated before, us ladies are a symphony of hormones. If one hormone is out of tune, it is quite apparent. However, sometimes it is hard to hear what instrument (hormone) is out of tune because when one hormone is out of balance, others seem to follow suit. So remember, it is not a good idea to fixate on one hormone being out of balance. It's about balancing them as a whole.
Patients tell me all the time, they have estrogen dominance.' They read on the internet, and their symptoms fit estrogen dominance.' Yes, their symptoms do fit estrogen-dominance, but It does not mean their estrogen is the only hormone that is off.
I am going to go through some common estrogen dominance symptoms' that you might find on the internet. And I will explain what other hormones might be at work here besides estrogen. Later in another episode, I will delve into more detail, causation, and treatment to balance our hormones.
PMS:
“My PMS is off the chain 7-10 days before my period! . This is actually because the progesterone is too low compared to the estrogen level. It is not that estrogen is too-high, but because the progesterone failed to peak after ovulation or it dived too quickly before your period.
Fibrocystic breast tissue:
If your estrogen is high, it can cause dense breast tissue and fibrocystic breasts. Estrogen likes to grow things. So if estrogen is not balanced or is high, the breast tissue will thicken and can become fibrocystic. Also, caffeine can exacerbate or lead to fibrocystic breast tissue.
This is because the progesterone level is to low for the amount of estrogen. Your estrogen levels might be “normal,” but because the progesterone is lacking it cannot hold back the estrogen. So estrogen will continue to grow that uterine lining.
Headaches:
This again is because the progesterone is too low for the amount of estrogen. A drop in progesterone can cause hormonal headaches starting at 14 days before your period. If you have headaches the last half of your cycle, your progesterone might be too low.
Breast swelling and tenderness:
Estrogen can cause water weight. Our breast tissue is very sensitive to estrogen. So if your estrogen is high, it can cause water retention in the breast tissue, making them feel full, heavy and, tender.
Weight gain in the belly:
Female hormones can contribute to weight gain, but not by themselves. It happens via the connection that estrogen/progesterone has with insulin and cortisol. High levels of cortisol and insulin will cause fat to accumulate around the mid-section. When the progesterone is low, or estrogen is high, that can cause insulin and cortisol to elevate. This will make you gain weight and also make it hard to lose.
Mood swings:
Feeling grumpy, snarky, irritable, weep, or sad. When the progesterone to estrogen balance is off, it can definitely affect our moods. If progesterone is low, that causes irritability. When you feel like everything it aggravating and you are quick to anger. That is low progesterone. If you feel weepy and nostalgic, that is high estrogen.
Decreased sex drive:
I think this is because the progesterone is too low and it makes us irritable. And us ladies do not want to have sex if we are angry or aggravated. High levels of estrogen do not drop the sex drive. Low levels of estrogen drop the sex drive. That is why sex flies out the window when we enter perimenopause or menopause.
Fibroids/polyps/exacerbated endometriosis:
Again, estrogen likes to grow stuff. If estrogen is high, it can also grow fibroids and polyps. It does seem to aggravate endometriosis.
Cold hands/feet, hair loss, foggy thinking, memory loss:
If you have any of these symptoms, then we want to look at your thyroid. Thyroid comes into play with estr

You know you have heavy periods when .

When you have tampons everywhere. In every single purse, the glove box of your car. In the glove box of your friend's and spouse's car. In the kitchen drawers, all bathrooms, in your jacket pockets, even your grocery bags.
You never wear white.
You don't own white underwear because at some point they will no longer be white.
You know exactly when and how much ibuprofen you can take.
You have a whole bunch of the light tampons because you never use them from the box.
You laugh at the purple Tampax lites.  Because seriously, what magical woman actually uses them? And we hate her.
You time everything around your period. How long can I stay in the meeting? How long is that exercise class? How long is that road trip and what are the stops on the way?
You always get your period right before or during vacation.
You devote an entire bathroom cabinet to super-heavy-plus tampons and those huge, bulky overnight pads.
If you have heavy periods, aka menorrhagia, then you know quite literally what a pain it can be.  From the pain of cramping to always knowing where is the closest bathroom.  

For the most part, heavy periods are benign, just bothersome. (But if you have heavy periods make sure to discuss with your doctor so that you do not become anemic and test for underlying diseases/disorders.)
But what causes heavy periods?  Below are some of the more common reasons women may develop heavy periods.

Estrogen-Progesterone Imbalance:

Having an elevated level of estrogen or lower progesterone can cause heavy periods.  Estrogen is the best hormone in the world. Estrogens keeps your skin youthful and hydrated.
Your own estrogen is good for your heart, bones, brain, hair, sleep, and libido to name a few.  But she can be a runaway train if not balanced.  Estrogen likes to grow-things.  Estrogen grows our breast tissues and uterine lining. If there is an imbalance of lower progesterone to estrogen, she will grow the uterine lining so thick that you practically hemorrhage once a month.  It is important to have your hormones checked and balanced if you have heavy periods.

Low thyroid function:

Hypothyroid can also contribute to heavy periods.  The thyroid also helps to rein in estrogen's negative effects. If your thyroid is low, the estrogen will grow that uterine lining very thick.  So that you will have heavy periods and also commonly spot through the cycle.  It will also cause the period to last for what seems like FOREVER. If you have heavy periods, mid-cycle spotting, long periods, talk to your doctor about testing your thyroid.

With all of the recent changes in health insurance, blood testing is more expensive than ever.  Below are few questions and situations we get from our patients and thought it would be good to discuss.  Do any of the following sound familiar? My Doctor Won’t Order Thyroid Function Test, What Should I Do? We see this often. Patients complain that they have been to many doctors, internists, endocrinologists and all that gets tested is a TSH for thyroid function. With the internet and dissatisfaction in healthcare, people are becoming their own health advocates. People are researching and keeping a keen eye on their health. People know that they want more than a TSH test for thyroid function. But they run into a wall’ with their conventional doctor. Their primary care, internist, or endocrinologist will not run a free T4 or a free T3. I Want to Find Out if my Friends and Family have a Thyroid Problem: Often thyroid conditions like Hashimoto’s Disease can run in the family. I have a patient that swear their sister, mother or brother have a thyroid problem too. But either the family member is reluctant to approach their doctor about it. Or their doctor will not order the thyroid functional testing or Hashimoto’s antibodies. Read on so I can show you how to find out if your family member has a thyroid issue. I Don’t Have Insurance and Want to Order Blood Work: Unfortunately, health insurance can be costly. My monthly health insurance premiums cost more than my first car. Granted, my first car was not very nice, but I had a whole lot more fun with it than my health insurance. People know they need to get regular screenings, annual and routine blood work done; however, some are terrified that without insurance it will cost a fortune. Honestly, blood work out of pocket can be pretty much the equivalent of a mortgage payment. But read on, I have some tips to help you get blood work without having to promise your first born. My Deductible is Enormous! Blood Work Will Cost Me a Fortune! My deductible is $5000+. I hope that I never meet that 5000$ deductible because if I do, that means something unfortunate happened to me. I might get negotiated rates for blood work, but I will still have to pay out of pocket for my blood work.  This could be quite costly. I Don’t Want to Wait Two Months for an Appointment just to have Blood Work Ordered! Time is money. Time is not a renewable resource, meaning it is going to run out someday. And I don’t want to waste my precious time waiting in a waiting room full of sick people so I can see the doctor. The doctor will then spend 3 minutes with me and give me an order for blood work. Then I have to come back to go over those results. Let’s save some time and avoid all that nonsense. Read on to find out how. I got a Huge Bill for Blood Work, but I have Insurance! I have heard this a lot recently, which is what prompted me to write this. I have patients that have insurance and still have to pay over a $1000 to pay for their blood work. Whether it is a high deductible or limited coverage, they end up with a bill several weeks later that can be well over a 1000$. I know it seems silly that you are paying for healthcare coverage and you get a large ‘out of pocket’ bill for blood work. This a pretty common theme in the last few years. What can you do? Order the test yourself! We all know you cannot walk into a lab like Quest or LabCorp without a requisition from a doctor. And everyone is under the assumption that if insurance is not paying for the test, then it is too expensive. Yes, paying Quest and LabCorp out of pocket directly for lab testing is very expensive, sometimes over 1000$. We have physician-only accounts with Quest and LabCorp to get you reasonable out of pocket pricing. Recently, I have had three patients tell me that they were billed over a 1000$ for their blood work because of deductibles and limited insurance coverage. That is ridiculous because out of pocket those tests would have only cost them about $150 to $300 at the most! So if you want a specific lab test just let me know what tests you want, and I will put them together for you with pricing. I have been getting a lot of patients that want to test their family member’s thyroid function lately. Recently I had a patient with Hashimoto’s hypothyroid tell me that she knows’ her sister has a thyroid problem, but her sister will not go to the doctor to get tested for Hashimoto’s or even for hypothyroid. I felt terrible because I can’t legally order a test through their insurance without establishing them as a patient. We talked about how we can get her sister a test so she can see the data on paper and realize that she too has a thyroid issue. However, we can order the tests cash-pay without establishing them as a patient. They just buy the test, get it done and get the results emailed to them. It turned out, my patient purchased the test for her sister. Just go to our online store to check out our lab panels and pricing. Like I said if there are tests you do not see that you like. Just email us, and we will get the test ordered for you. As an end of the year special, we have put together a thyroid-function panel discounted. Click here and buy it for someone and they have six months to get the test done. Thyroid Lab Testing Specials – get 25% off thyroid testing through the end of January 2018.  Use the code THYROID to get the discount. Thyroid

Which thyroid medication is best?  This is a question we get from patients quite often.  Conventionally for hypothyroidism, there is one medication prescribed. Regardless of your gender, family/personal history, symptoms, goals. If you need thyroid replacement, you will get Synthroid. If you have had your thyroid gland radiated, now it is hypothyroid. If you have had thyroid cancer and your thyroid has been removed. If you have Hashimoto’s disease, or you have a sluggish underactive thyroid. In this day and age, there is only one medication you will be given. Yes, that is Synthroid. Synthroid is T4 monotherapy. Meaning–it is a form of levothyroxine. As mentioned in other blogs, T4/levothyroxine is a stable molecule, which is supposed to convert to the active thyroid molecule, T3. There are so many other ways and medications to treat an under-functioning thyroid, so here is a synopsis of thyroid medications. T4 Monotherapy As I said, there is T4 Monotherapy, also known as levothyroxine. Levothyroxine is also known as Synthroid. Also included in T4 monotherapy is Levoxyl and Tirosint. Synthroid Levoxyl Levothyroxine Tirosint Remember T4 is supposed to convert to T3 which is the active form of thyroid. Often T4 will not efficiently convert to T3. It is common to hear patients say that even on Synthroid or raising their dose, they still feel hypothyroid. Also, higher doses of T4 monotherapy can convert to Reverse-T3 instead of T3. Reverse-T3 (RT3) is an inert molecule that has no activity. Conventional T3 therapy Conventional T3 therapy is not commonly prescribed. The only option for T3 treatment conventionally is to use the commercially available prescription is Cytomel, which is a very unstable medication because it is instant release upon ingesting. Taking too high a dose of Cytomel can put pressure on the heart and cause heart palpitations and even a risk to the cardiovascular system. You must be careful with Cytomel dosing because of the risk to the heart. Most docs only prescribe 5 mcg or at the most 10mcg. Desiccated Thyroid Medications Desiccated thyroid medication is made from a porcine source. It is pig thyroid gland desiccated (dried) to make thyroid replacement medication. This type of medicine is considered a natural form of thyroid medication. The good thing about porcine thyroid is that it has T4 and T3 in the same medication. So a patient can get the T4 and the active form of thyroid, T3 at the same time. There are a few name brands to the porcine thyroid: Armour Nature Throid West Throid WP Thyroid Nature Throid and West Throid are identical medications and are made by the same company, RLC Labs. WP Thyroid is also made by RLC Labs but is made with different fillers such as coconut oil and inulin. Patients that are sensitive to fillers can do better on WP Thyroid, and it can also be chewed up as well as swallowed. There is also compounded porcine thyroid available from a compounding pharmacy. This is useful if a patient is sensitive to fillers in the commercially available brands of desiccated thyroid. Recently with the backorder of Nature Throid and the rising cost of Armour, compounded thyroid is another option. One drawback of desiccated thyroid medication is the doses all come in a 4:1 ratio of T4 to T3. So 65mg of Nature Throid is equal to 38mcg of T4 and 9mcg of T3. Some patients cannot tolerate the T3 and need lower T3 levels, and some patients need more. So with desiccated thyroid, the T4/T3 ratio cannot be individually tailored to the patients. Also, Desiccated thyroid medication is made from pigs, so it is obviously not a vegetarian option of thyroid medication. Compounded Thyroid (T4/T3 levothyroxine/liothyronine) The great thing about compounded T4/T3 it is available in any microgram dosing of levothyroxine/liothyronine.  The dosage of each hormone can be adjusted independently of the other. T4 = Levothyroxine T3 = Liothyronine Instant release Sustained release In most situations, we prefer to prescribe compounded thyroid because of the dosing flexibility for us and the patient.  Compounded porcine and Desiccated thyroid are also great options.  We typically do not prescribe any of the T4 Monotherapy medications or Cytomel very often if at all. If you have any questions, please leave a comment below, or feel free to send an email to [email protected] The post Which Thyroid Medication is Best? | PYHP 021 appeared first on .

Hashimoto Thyroiditis is an autoimmune process where your immune system will attack your thyroid gland. This attack will eventually cause the thyroid function to drop. Inevitably, Hashimoto’s disease causes hypothyroid. There are two primary blood antibodies to test for Hashimoto’s disease. Thyroid Peroxidase Antibody (TPO) Thyroglobulin Antibody (TgAb). If you have one or both of these antibodies, then you would be positive for Hashimoto’s disease. Some people have these antibodies and do not have any hypothyroid issues or changes to their TSH, Free T4, and Free T3. If you catch the presence of the antibodies early enough, you can prevent the onset of Hashimoto’s or the severity of it through supplementation, diet, and lifestyle. As stated above, Hashimoto’s is an autoimmune condition, leading to hypothyroid. Several factors can cause, exacerbate or reduce the onset of Hashimoto’s thyroiditis. Females are more likely to have Hashimoto’s disease Hashimoto’s and it runs in families. High levels of chronic stress can cause a rise in cortisol. Chronic elevations of cortisol can alter immune function. Ingesting a highly processed, refined carbohydrate diet can cause higher levels of insulin and cortisol which again, can alter immune function. Many people have gluten intolerance, and that can exacerbate the onset and severity of Hashimoto’s. A thyroid ultrasound is a non-invasive way of imaging the thyroid. People with Hashimoto’s can have enlarged thyroids, multiple nodules or cysts on the thyroid. But many people without thyroid disease or Hashimoto’s can have nodules and thyroid anomalies. So an ultrasound is not a definitive way of finding out if you have Hashimoto’s. If you are wondering if you have Hashimoto’s thyroiditis, have your blood tested for the presence of Thyroid Peroxidase Antibody (TPO) and Thyroglobulin Antibody (TgAb). The presence of Thyroid Peroxidase Antibodies is the most common in Hashimoto’s Disease. About 70-80% of people with Hashimoto’s with have the TPO antibodies present. Most doctors only test the Anti-TPO in patients, but it is important to also check for the Thyroglobulin Antibodies so that they are not missing patients with Hashimoto’s Disease. In about 15-20% of patients with Hashimoto’s disease, the Thyroglobulin antibodies only are present. The presence of TPO and TG antibodies together is much less common at about 5%. Reference Ranges: TPO <9 iu/mL TGab <1 iu/mL Monitoring the presence and the levels of Hashimoto’s Antibodies is essential in treatment. While Hashimoto’s does lead to hypothyroidism, It is important not to just focus on the hypothyroid aspect of Hashimoto’s disease. While keeping the thyroid function levels in optimal range is a good start in Hashimoto’s. It is also key to work on the adrenals, hormones and immune system. Monitoring the levels of TPO and TgAb can help in evaluating treatment with a patient that has Hashimoto’s. If you are unsure if you have Hashimoto’s disease, the best way to find out is to do a blood test. Testing for Thyroid Peroxidase (TPO) and Thyroglobulin Antibody (TgAb) will show you if you have or have the potential for Hashimoto’s thyroiditis. Hashimoto’s Disease not only can cause hypothyroid, but it can also cause other conditions in the body. Hashimoto’s can cause or exacerbate: Inflammation Joint pain High cholesterol Anemia/low iron Weight gain Brain fog/forgetful/unfocused More susceptible to viruses Dry skin Hair loss Mood issues Headaches Heart Palpitations Sleep disturbances Disruptions in menstrual cycle After you have had the Thyroid Peroxidase Antibody (TPO) and Thyroglobulin Antibody (TgAb) tested, and you have shown positive in one or both. It would be a good idea to get a more thorough blood test for the effects that Hashimoto’s can have. These blood tests are: Basic thyroid function and Hashimoto’s testing: TSH, FreeT4, FreeT3, Thyroid Peroxidase Antibody and Thyroglobulin Antibody. Additional Lab Tests CBC CMP Lipid panel Insulin, fasting Ferritin CRP-hs Sed Rate TSI: thyroid stimulating immunoglobulin to rule out Grave’s Disease DHEA-Sulfate There are other tests that can also be done such as Epstein Barr Virus, other autoimmune and genetic testing. I like to start here so that we can set up a treatment plan to get the patient feeling better. The patient needs to feel better before they can explore exercise, eat better, or work on lifestyle measures. Once a patient is feeling better then we can move on from there in treatment and other causes for Hashimoto’s Disease. If you have any questions, please leave it in the comment section below.  You can also send us an email at [email protected]. The post How Do I Know If I Have Hashimoto Thyroiditis? | PYHP 020 appeared first on .

The most common test for thyroid is the TSH, which stands for Thyroid Stimulating Hormone. Unfortunately, this is also the only test most conventional doctors use to screen for thyroid disease.  
If the TSH is elevated (above 4.5 mIU/L), you are hypothyroid, and if the number is low (below 0.45 ng/dL), you are hyperthyroid.  Yes, this is a bit hard to understand because it is the opposite of what we could expect.  High means low and low means high.  It is slightly confusing.  
Thyroid issues, in general, are not always black and white.  It is not as simple as you are hypothyroid or your not.  It is a bit more complicated, especially if someone has positive thyroid auto-antibodies, which we will cover in the next episode.  
The lab numbers are certainly important, but so is the patient.  One rule we always follow is to treat the patient, not the lab test. The TSH is not the only part of the thyroid function and should be tested along with a Free T4 and the Free T3.  
The TSH comes from the brain to signal the thyroid gland to produce or not produce thyroid hormone.  If the thyroid gland is underproducing thyroid hormone, then the TSH increases.  If the thyroid gland is overproducing, then the TSH decreases.  In physiology, this is referred to as a feedback loop.  
For example, imagine asking your daughter to pick up her shoes and put them away. If she puts her shoes away, great, you only had to ask once in a normal-tone of voice.  But what if she ignores you or doesn’t hear you? You would raise your voice until she puts her shoes away.  The TSH does the same thing with an underactive thyroid.  The TSH level increases if the thyroid gland is underproducing hormone.  
TSH Reference Range:

0.45 – 4.5 mIU/L

This reference range is huge, and a lot of people fall into a ‘normal’ TSH level.  We have been trained that if the TSH level is 2.0 mIu.mL or higher, that person may have low thyroid function.  Even the American Association Of Clinical Endocrinologists claim that the TSH levels should be .34 to 2.5 mIu.mL.  
The TSH is not the only part of thyroid function.  The Free T4 and Free T3 should also be done in order thoroughly evaluate the thyroid function. Keep reading, so I can explain what the Free T4 and Free T3 are.
Free T4 (FT4)
Thyroxine, which is abbreviated (T4) is the primary hormone that is produced by the thyroid gland.  The number 4 is related to the number iodine molecules that are needed to make the hormone.  
Thyroxine is very stable and has a long half-life of close to 7 days, but is an inactive hormone and does not have much impact directly on overall body function.  Your body converts T4 into T3, which is the most active form of thyroid hormone.  
For testing purposes, there is a Total T4 and Total T3 test, which is the respective hormone bound to a carrier protein.  Most hormones in the body are transported in the blood via carrier proteins.  With our patients, we prefer just to run the ‘Free,” unbound T4 and T3.  
Free T4 Reference Range:

Free T4 0.8 – 1.8ng/dL

Free T3 (FT3)
Triiodothyronine (T3) is the active form of thyroid hormone.  You can have all the T4 in the world, but without T3 you would still have hypothyroid symptoms.