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Hypothyroidism Variants - Elizabeth Livengood, NMD (2021 Conference) (LDN, low dose naltrexone)
Dr. Elizabeth Livengood shares what she has learned about hypothyroidism variants through her practice. She defines variants of hypothyroidism, describes patients’ experiences with it, gives several ways for how to identify hypothyroidism that isn’t part of the normal evaluation process, shows how to interpret thyroid tests, and lastly, explains appropriate, integrative treatments that she uses.
In the first stage, subclinical hypothyroidism, often patients will have normal lab levels but report symptoms of weight gain, fatigue, depression, brain fog, and not feeling like themselves. Many physicians chalk this up to “getting old”, but Dr. Livengood suggests doing a complete thyroid panel to rule out issues. Listening to the patient here is important.
She explains the next 3 variants of hypothyroidism: primary, secondary, and tertiary. Each of these refers to the location of the problem.
Primary indicates that the problem revolves around the thyroid hormone levels. About 99% of doctors only look for the central primary form of hypothyroidism (where the thyroid doesn’t produce enough T4 and/or convert enough T4 into T3). A subcategory of primary is peripheral hypothyroidism. She explains that this is the function of peripheral tissue (such as the liver) not converting enough T4 into T3, resulting in anxiety, adrenal insufficiency, overstress, and possibly high cholesterol. This could be overlooked because the TSH is probably normal, and so more thorough testing should be considered.
The secondary form of hypothyroidism involves an inadequate pituitary response to low THR, whereas the tertiary form is due to an inadequate hypothalamic response to low TH. These tend to be less common. Outside forces that can impact the thyroid via brain function can be a concussion, tumor, poor posture leading to the poor blood supply to the brain, and even overexposure to electromagnetic frequencies that can interrupt cellular function, leading to cellular hypoxia.
She suggests that after checking for thyroid levels, one should look at thyroid releasing hormones, nutritional status, inflammatory markers, and lifestyle issues: posture, sedentary lifestyle, TBIs, among others.
Hashimoto’s (autoimmune) thyroiditis is another variant of hypothyroidism. This presents with elevated TPO and/or TG antibodies. The patient can be found as euthyroid, subclinical, primary, or even hyperthyroidism. Antibody testing is the way to confirm this diagnosis. A different form of autoimmune thyroiditis will find antibodies to T4 and T3, so conversion levels aren’t around 3:1 or they are wildly disparate between the two. One marker to check via ultrasound for a tumor is thyroglobulin, which is a marker for cancer. If it isn’t present, then it’s likely a form of thyroiditis. The wilder the symptoms (which can swing between hypo and hyper), the more frequent monitoring to get at the root cause is very important.
Another variant, reactive hypothyroidism, is where the patient may or may not be having symptoms. When monitored/tested, you will find a normal response to acute stress, illness, pregnancy, iodine exposure, etc. This could be a normal thyroid response, but should probably be tested 4-8 weeks later to double-check that treatment is necessary.
Dr. Livengood refers to The LDN Book 1 for complete details for exam, history taking, and labs for euthyroid, subclinical, and Hashimoto’s protocol. She reviews specifics in all three areas, when looking into primary, secondary, and tertiary, including looking for weight gain, low temperature, edema, headache, brain fog, and changes in menstruation, a good exam and history taking. Testing looks into ruling out things like IBS, anemia, low T and checking TSH, RT3, ACTH, GH, estrogen, and testosterone.
Her main emphasis is to look beyond central hypothyroidism. She cautions that if antibody levels are present, not to wait to treat the patient. Even when thyroid labs are “picture perfect” if your patient is having symptoms, the peripheral tissues could be lacking in T3 (not the pituitary gland). She reviews specific treatment and testing options based on various situations. One situation she explains is when there are antibodies present, she treats with a combination of low dose naltrexone, selenium, and Ashwagandha.
Some of the integrative treatments she proposes are in the form of dietary changes (using food as medicine to correct irregularities or deficiencies). Incorporating iodine in the form of seaweed. She checks for food sensitivities and allergies that can trigger the autoimmunity of Hashimoto’s. She emphasizes avoiding inflammatory foods: sugar, alcohol, hydrogenated fats, and those the patient is sensitive to. In addition to diet changes, Dr. Livengood suggests getting micro-nutrient testing done, and then, using supplements to address issues found.
When using LDN for antibodies, go “low and slow” starting at 0.5mg and titrating up every couple of weeks. She reviews the use of amino acid therapy, both with supplements and fermented foods. Some medications she mentions for treatment are custom compounded T3/T4 which is bio-identical, and usually less expensive than other glandular forms, and can be very safe for sensitive patients.
One patient, a 45-year-old woman, had been dealing with Hashimoto’s for 15-years. She had Epstein-Barr syndrome, low vitamin D, and HPV. This patient had experienced a couple of pregnancies, an accident that required hospitalization; and has a family history of ulcerative colitis, RA, and celiac. Her wish was to reduce brain fog, anxiety, and increase energy levels. Symptoms she had besides brain fog (memory issues), anxiety, and deep fatigue were weight gain of 15 pounds in the last two years, joint pain, tinnitus, insomnia, constipation which was worse with gluten, severe mood swings and PMS, and feeling overwhelmed by things when she used to be “a good problem solver”.
Treatments that the patient had tried were ibuprofen for menstrual pain; and adding in high vitamin D and dietary changes: having a low gluten diet (80-90% free), low alcohol, and low sugar/processed foods, and drinking Bulletproof coffee for mitochondrial support.
Low dose naltrexone, starting at 1.0mg, and titrating to 2.0mg after two months, and 3mg at 3 months was added. She also had complete food sensitivity testing done, finding sensitivity to dairy as well. After a year of treatment, testing showed that her antibodies had dropped from over 3,000 to 900 in one year’s time and her vitamin D increased drastically. After going gluten-free, alcohol-free, preservative-free, and using the LDN, the patient now wakes up refreshed, having no mood swings, and having very few flare-ups.
For more information, visit Dr. Livengood’s website at https://drelizabethlivengood.com/
KEYWORDS: hypothyroidism, Hashimoto’s, autoimmune, low dose naltrexone, brain fog, fatigue, weight gain, anxiety, thyroiditis, integrative treatments