As I wrote yesterday, I have reached another chapter with my hashimoto battle. I’d been doing everything right, but I was still having “thyroidy days” 3-4 days a week. My blood tests were also doing weird things (in the most recent case, coming back with low TSH AND low T3 and T4) and so the doctors were just shrugging at me and ushering me out the door. I thought I was at a dead end.

By Anna Hatzakis

Which was driving me MENTAL But then. I delved deeper. And I made some VERY EXCITING discoveries that I think will help many of you out there who write to me about your similar frustrations. Many of the principles will speak to anyone with an autoimmune disease, too.

I’ll be writing a few posts on some of the things I’ve found. To kick off, I chatted with Chris Kresser during the week. He’s had his own battles and understands frustration. He runs The Healthy Skeptic and is a practitioner in integrative medicine and acupuncturist (and has a wife with thyroid disease). Anyway, he’s come to specialise in hashimotos. And his info is sound and generous.

Listen in:


In the podcast we cover (and I’m outlining the details below cos it’s all very DENSE info):

The three reasons why your thyroid medication might not be working.

Primarily it’s because hashimotos is an inflammation disease, not a thyroid disease as such. But only the thyroid gets treated (with a band-aid fix – the medication)…causing the other factors involved to continue on. So

  1. Medication doesn’t address the damage done by inflammation to the hypothalamus-pituitary-thyroid (HPT) axis, which is key to hashi.
  2. Medication doesn’t address the damage done by inflammation to thyroid hormone receptors. If there aren’t enough receptors, or they aren’t sensitive enough, it doesn’t matter how much thyroid medication we take. The cells won’t be able to use it.
  3. Medication comes in the form of T4 (this is what thyroxin is), which our bodies are meant to convert into T3 (which is the active form required by our cells).  BUT if your system is stuffed (by inflammation), it can’t make this conversion. Which is just so dumb (and the reason why I supplement my thyroxin with a compounded T3, since the drug companies don’t make it in this format…yes, DUMB!).

The six situations that might explain why your thyroid might be playing up

and what to do.

As you listen to the six scenarios, we’ll be referring to a bunch of blood tests that will help you work out which scenario might be yours.

Below I’ve outlined the blood tests you’ll need to have on hand to do this.  If you’re feeling like crap, I suggest you go to your doctor/therapist and ask for all these to be done at once.

  1. Hypothyroidism caused by pituitary dysfunction: caused by elevated cortisol from infection, blood sugar imbalances, chronic stress, pregnancy, hypoglycemia or insulin resistance. In your blood tests: TSH will be low but within the standard range but T4 will be low, too.
  1. Under-conversion of T4 to T3: caused by inflammation and elevated cortisol levels. In your blood tests: TSH and T4 will be normal. But T3 will be low.
  1. Hypothyroidism caused by elevated Thyroid binding globulin (TBG): caused by high estrogen levels, which are often often associated with birth control pills or estrogen replacement. In your blood tests: TSH and T4 will be normal. T3 will be low and T3 uptake and TBG will be high.
  1. Hypothyroidism caused by decreased TBG: caused by high testosterone levels. In women, it is commonly associated with PCOS and insulin resistance. In your blood tests: TSH and T4 will be normal. T3 will be high and T3 uptake and TBG will be low.
  2. Thyroid resistance: caused by chronic stress and high cortisol levels. You can’t test for this
  3. Low T3 Syndrome: to better understand how this works, it’s probably best to check out Chris’ posts on the matter.

The blood tests to request from your doctor:

T3 uptake
t3, t4, free t3, free t4
vitamin D
fasting glucose
hemoglobin A1c
thyroid antibodies

Finally, I’ll be writing about T-regulating and glutathione recycling in upcoming posts…if it’s all too much, hang out until then. I’ll try to make it clear.

If you’d like more from Chris, check out his ebooks and – yes! – he’s available for consultation all the way from Berkeley in California. He told me he’ll do a free 15 minutes consult to kick off with!

Has this been helpful…do let me know. I’ll endeavour to do more of these kind of chats if you think it is!


Have your say, leave a comment.

  • Annie

    I’m thinking you’re the one who spelt desiccated wrong… Should’ve checked before you thought you were correcting someone else!

  • Fashion Icon

    The drug companies DO make a T3/T4 compound – albeit from nature, it is processed for prescription use: NatureThroid, Armour, Erfa… There must be something similar in your area. Erfa is produced in Canada and can be shipped out of the country with a prescription.

  • Senthilkumaran SV

    Hi Sarah, Thanks a lot for sharing very useful information. By the way I am also from Australia, I had recently total thyroidectomy. I am taking Eutrosig 125 micro Tsh is .11 and my free T4 is 27.3..some one suggested to take t3 cytomel.. Do you know this or equivalent is available in Australia. Please suggest an end who can prescribe this medication. Tks. Senthil.

  • natcrox

    I have had hashimotos 14 years. Past year hish tsh, constantly increasing medication. Now eurothyroid but major fatigue. Neck lymph node enlargements. Ultrasound last june showed no goiter yet have neck swelling. ???

  • ciny

    I think you have to consider a holistic approach. Other glands and organs work together with the thyroid.

  • Sarah T

    Hi Everyone, Having been inspired by Chris Kressers work last year I set out to find a functional medicine practitioner in Australia, I know Chris does consults from the states but with an already disrupted sleeping pattern due to two little ones I wanted to find someone local. This was no easy feat! But finally I found Karl Hughan in Sydney. I’m in Brisbane but he is able to do online consults in the same time zone as me. I started with him in April and he ran a few lab tests following which he thoroughly explained my results in a way I understand and then he recommended some lifestyle and supplement changes that were easy for me to do with my schedule. I have never felt better (even with being run ragged by two boys!). Anyone looking for a functional medicine practitioner in Australia I highly recommended Karl. Look him up on facebook at Karl Hughan Holistic Health.

  • Dianna

    Doctors don’t test for other things besides tag. And they won’t listen to symptoms!

    • DIANNA K

      I meant test for TSH

  • Sharon

    Hi – thank you for your post. Which Dr in Melbourne do you use for your thyroid issues? Many thanks.

  • Cou

    suger/fuctose and high sugar foods / facts feed inflammation so apart from taking your thyroid medicines/supplements cut out all high fructose foods like carrots , beetroots , fruit, ALL grains (can eat quinoa, buckwheat and amaranth) , eutectic. Avcados & olives have only a trace of fructose. try for 3 months min. I go to a functional doctor and boy what a difference!!!!

  • Cou

    everyone should have their total mineral and vitamin content tested then many of these illnesses/conditions would not arise!

  • Renee

    Note: The following history may or may not be relevant to my current condition…but I have been very thorough in documenting major milestones incase they may be contributing factors.

    Apparently I was an extremely morose child prone to fits and tantrums…I don’t have access to other history as I am estranged from my family. At age 13 puberty I failed to develop normal breasts and was teased relentlessly by my school peers and older sister. At this time I also began menstruating, however my periods were extremely painful and distressing, coupled with nausea, vomiting and debilitating cramping. I received no treatment or medication, these symptoms continued into my late 20’s. At age 17 I endured and survived an horrific abduction resulting in prolonged violent sexual assaults and physical/psychological torture…consequently I developed PTSD yet was not treated by a psychologist for this. At 19 I then witnessed first hand the death of my 2 close friends in a devastating highway collision…I again received no counseling. I coped as best I could over the following years moving from job to job whilst dealing with anxiety and poor self image. I immersed myself in language study and moved to Japan where I thrived for 4 years..the happiest time of my life. Whilst working hard and saving money for my life when returned to Australia, my partner broke off our engagement as he had met someone else. I believe I suffered what could only be called a ‘breakdown’ and consequently returned to Australia to rebuild my life anew.

    I fell into depression and began seeing a Psychiatrist in Macquarie Street Sydney…regular sessions over 1 year resulted in my gaining some insight/confidence, which propelled me to pursue a career in the architecture field. I worked for 2 prominent architectural presentation firms in Brisbane and built a reputation as a gifted technician. My depressive moods/anxiety were still a concern coupled with a sudden lack of sex drive…I was treated by a GP and psychologist and diagnosed with Bipolar disorder. I was prescribed several different medications but with minimal success, including: Prozac, Zoloft, Epilim, and Lithium. I then moved to Sydney stopping all medications as they weren’t helping me in any way and threw myself into studying Architecture full time. After 3 years, I graduated top of my class with 42 distinctions receiving the prestigious BDA award for academic excellence. In 2004 I was accepted into an advanced degree at University of Technology Sydney.

    Throughout 2003 of my first qualification studies, my anxiety became extremely high…the result of an aggressive & hostile male stalker. This fearful intrusion in my life became unbearable, resulting in my becoming socially isolated and even more depressed. I began counseling again and my doctor reconfirmed a diagnosis of bipolar disorder, prescribing an antipsychotic and anti depressive. I argued that I was in no way psychotic or delusional, but anxious and depressed due to my progressing social isolation. I refused to fill the prescription for the anti psychotics, however I started taking the anti depressants with trepidation.These meds caused me to feel as though I wasn’t ‘IN’ my life…but I strived to complete my qualification and achieve high results. After the first course of meds I returned to the GP but he was no longer employed there so I saw yet another doctor who prescribed a further 2 repeats and referred me to a counselor. As I don’t experience mania or suffer from any ‘marked’ symptoms of bipolar disorder apart from depression, I don’t believe I have ever had bipolar disorder at all. I have tried in the past to verbalize my symptoms to treating doctors…however; I feel my pleas for help have been minimized due to the diagnosis of bipolar. After more than 13 years, my aggressive stalker has only recently discontinued his invasive behavior due to intervention after I spoke to his superiors at his place of work. I still have a genuine fear that he will start up again though. Due to my social anxiety depression and fear of stalker I had deferred my commencement date for UTS…and never took up study or worked again.

    Problems I’ve been experiencing in last 4-5 years

    For approximately 4-5 years I have been feeling increasingly unwell. My main issues being lack of coordination, vertigo, overtiredness, confusion, lack of motivation and full body aches… In particular arm heaviness and pain/ difficulty walking.

    Over these last few years my eyesight has also deteriorated very quickly…coupled with eye pain & it feels like I always have fine sand in my eyes. This is very debilitating and frustrating. My Optometrist has directed me to use eye sprays for relief…but it has a minimal effect. My eyesight gets worse daily it now seems.

    Mornings on waking are the worst….I awaken with dry mouth & eyes, sore teeth and tongue.. Once I get up I have a great deal of difficulty walking as my ankles feel weak and painful, and the soles of my feet feel as though I am walking on glass. Sleep doesn’t come easy most nights, and I awaken often with a dry mouth and have difficulty returning to sleep. I have periods of chronic insomnia where I haunt the house night after night. When I do sleep I wake myself up frequently gasping for air with a grunt, waking with dried saliva down my chin and/or cheek. With regard to my tongue, it feels like it is too big for my mouth. My dentist commented that I had tears on each side of my tongue, so consequently ground down my teeth to stop this from happening…he also needed to use a tongue depressor as it kept getting in the way. This never happened before.

    Before all these symptoms began, I was a vital motivated and energetic woman. I was ambitious and excelled in my chosen field, receiving praise and accolades/awards for my work. Over the last 11 or so years there has been a major devastating shift, resulting in my being housebound feeling worthless and irrelevant.

    I have not had any sexual urges at all in the last 15 years, resulting in loneliness and isolation from the opposite sex. Masturbation is also something that never even enters my mind…ever. However I have had relationships in my younger years that were physical….this change in sex drive occurred very suddenly and was one of the first marked symptoms.

    My weight and body shape/appearance has also changed dramatically. I eat well and treat food as fuel, yet I have been piling on kilos very quickly. My stomach now protrudes as though I am 6 months pregnant, my face is puffy with no structure, my hands are swollen so much I can no longer wear rings, plus although I have never needed much breast support because my breasts have always been unusually small…my breasts have now become larger fatty and shapeless. I don’t drink alcohol apart from the occasional glass of red wine, and I don’t consume illicit drugs of any kind. Until recently I exercised by walking my dogs twice a day…however my symptoms prevent me from doing this regularly now.

    My dental health has deteriorated a great deal over the last few years…even though I am vigilant with oral care, brushing and flossing twice per day…using mouth wash regularly as well. I have lost 5 teeth in the last 24 months and the enamel on all my teeth has been degrading very quickly.

    The next symptoms are of grave concern to me…my pubic hair has all but all fallen out and not grown back, plus hair on my arms is non existent now, my eyebrows as well refuse to grow back. Hair on my head has become brittle and like straw, and falls out in clumps whilst washing or brushing. Have started to become incontinent…8 times out of 10 I don’t make it to bathroom in time. Last 6 months I have experienced regular diarrhea and fecal incontinence.

    Experiencing feeling of nerve like pain in my back, upper arms & spine…has progressed to weak wrists, lack of dexterity, burning ‘bee sting’ like pain in elbows. Legs also have no strength, shooting pains through calf muscles and heels and clumsy shuffle walking…trip often. I feel like I am walking on glass. No muscle strength in buttock muscles. Upper shoulders & back of neck extending across back of head feels like the flu…tight, aches and tense. Icy burning pain in back of arms and upper back. When I sit for a period of time my legs become restless, in particular my feet. My arms are very weak, I have difficulty carrying things, lifting things above my head, I often drop or knock things over. I used to be an award winning model maker…I can no longer complete fine detail work. Work that requires patience and an eye for detail is impossible as my attention span is very short. My memory these days is also very bad…even trying to retrieve simple words is difficult at times, plus my ability to articulate has decreased a great deal. I have been asked several times if I am intoxicated or on drugs.

    My memory, concentration and overall brainpower has diminished a great deal over the last few years. I have difficulty completing crossword and sodoku puzzles which used to be a daily joy. I used to even create crosswords….but now that is an impossible task. I am a trained architectural technician and draftsman…however my spatial acuity, 3D skills, fine motor skills and calculating brain is now too weak to do this job.

    My vast music & video collection has remained untouched for a long long time. I grew up with music, and it was a big part of my life…but I never get the urge to listen to it at all these days. I don’t read novels anymore but I used to be an avid reader of at least I book per week. My engagement with the world is now almost nil…as everything just seems too hard and out of my reach. I no longer have any social interaction as my friendships with others just became tedious and difficult.

    My life is now a series of menial tasks and perpetual tiredness, just getting through the day is a major chore. If I hang the washing out and then sit for a period of time I fall asleep..then wake an hour or so later feeling exhausted. I fall asleep often throughout the day and never seem to do anything very productive. Even writing out these symptoms has been a battle, it has taken me 3 weeks to complete. I have spent years isolating myself as I feel unable to contribute or engage with others in the world. Every time I wake up I’m disappointed that I’m still here…another day of feeling nothing and going nowhere. Where did I disappear to? I am just a lump of flesh waiting for oblivion.

    Recently I was invited to attend an art exhibition in Sydney giving me a rare day out. I happened to bump into my old boss from Brisbane…I recognized her immediately and said hello. She had no idea who I was until I said my name. Her reaction was one of shock and puzzlement. After introductions and well wishes we parted ways…Until she noticed me in the hallway near the bathrooms and pulled me aside. She apologized saying she didn’t want to embarrass me in front of my friend and that she was shocked that my appearance had changed so dramatically…she then asked if I had taken the time to have my hormone levels checked by a doctor…I said I had not. She urged me to make an appointment with an endocrinologist to check my thyroid and adrenals as soon as possible.

    3 weeks later I was having a lot of anxiety and feeling generally very unwell. I visited my medical center doctor and asked for several blood tests to check my overall health. Reluctantly the doctor drew blood for non specified tests and the next week they all came back normal…except for high cholesterol levels. I have no idea which tests were performed, as he was very evasive. I asked whether thyroid and adrenals had been checked and suggested that he also include tests for heavy metals toxicity. He then became very annoyed with me saying that he believed I was malingering and that I was delusional because of my bipolar, and that I simply needed to wake up to myself and get on with my life…..OMG. Someone please help me…PLEASE!!!…No one wants to listen.

    Other symptoms include:

    High Cholesterol Numerous sinus
    infections & Ear aches
    Vertigo Heart pain & irregular flutters
    Constant Ringing in ears and hearing loss
    Regular headaches
    Irritability & major depression
    Sporadic bone pain in arms & legs
    Sweating a lot
    Vaginal dryness for years
    Stray facial hairs
    Itchiness under arms and on scalp
    Pain and stiffness in my heels & ankles
    Fainting spells & dizziness

  • Sue

    My 13 year old has hashimotos and her thyroid medication isn’t working please help

  • Sue

    Does anyone know of any specialists that can help my 13 year old she has hashimotos and feels very faint

  • Alana Henderson

    Hi, nearly two months ago I under went a semi thryroidectomy, to remove my right thyroid glad as there was a 4cm nodule on there, that thankfully was benign. Im not on any thyroid medication , and apparently have to wait another month before my thyroid levels can be check. I have had felt tired on and off and also gained another 3kg since the op 😢, prior to the op I gained 12kgs in 4 months. And was told my levels were fine! I’m 33 and always been around the 65kg prior to the weight gain. Has anyone else experienced any of these symptoms before and after surgery? Thankyou 😃

  • Melanie Woodcock

    Just reading this short post has explained suffering from my thyroid since I was 22 years old. Also I think it may have just been a light bulb moment for my mother’s hashimotos issue. She is now suffering with inflamation, which has been diagnosed as Scloris.
    I live in the UK and have had my t3 medicine stopped. No tests nothing just thrown straight back onto t4 which I was taken off because after years of being on it It didn’t help. I had a total Thyroidectomy at 23. Only at the are of 40 did I start to feel well after being put on vitamin d and a couple of years of t3. Now I am suffering all over with usual thyroid crap. Any further advice greatly recieved. My doctors just don’t want to know anymore.
    Thanks for your article. M.