n of 1
Sample Size of Me
In a world that focuses on evidence based medicine and research, I am interjecting my own voice and standing in my n of 1-- Sample Size of Me. I have been a chiropractor for over ten years and in tune with my body for over forty years. I have been listening, tracking, and formulating and am ready now to share what I have been paying attention. I claim no authority other than my own personal experience and the education and research I continue to pursue. I ask for no power over others' truths or conclusions. What I do ask for is a place of respect and open-mindedness to share my findings in hopes that what I have learned may help another and help further our ideals and understandings of health and wellness so that we may all achieve our optimal vitality and wholeness.
Is Your Thyroid Your Problem?
(even when everyone has told you that it is not?)
Last winter was a doozy in California-- long and wet and cold. It was a real gift though, in more ways than one by getting us Californians out of the drought. It also helped launch me into my next level of personal wellness and professional work. Let me explain. By the end of the winter I felt a deep cellular exhaustion that was now undeniable. Everyday I felt like I was pushing the river and just getting through my days felt like an epic accomplishment. I felt a depression and hopelessness that was new; my tendency has never been gloom. My husband questioned if it was Seasonal Affective Disorder, but I have never had this and we lived in Portland for years! The weather was no sunnier there. Then as I have to do sometimes, I remembered I have been trained in this and had to take my own health history. I asked myself my favorite health question: “When was the last time you felt normal?”
I realized the last time I felt normal was when I was pregnant with my third son in 2014. I have not felt myself since then. I have a high standard for what my normal is, which includes lots of vitalisy, positivity and my body feeling like my own. Tracing back I put together the pieces after that birth. I remembered not being able to drink caffeine in the morning because I would get too jittery and how when my youngest started sleeping through the night I could not-- I was predictably awake at 3 am with my mind stressed going in circles. Then I had my first panic attack in January 2015 and three resulting years of anxiety and panic. From 2015 through 2018 I tried everything natural to feel better. I did a bunch of blood work and found some things like moderate iron deficiency, lab high cortisol (stress hormone), low B12 and low DHEA. My thyroid had the same pattern it always did, which I will explain later. I treated myself with everything natural: herbs, supplements, therapy, homeopathy, spiritual pursuits, bodywork, and more. It made it so I could get through, but it did not make me feel like myself. It is so challenging with motherhood because exhaustion, anxiety, and overwhelm are so common it is hard to discern what is a normal part of motherhood and what is something that is physiologically out of balance that can be corrected with proper identification and support.
So in March of 2019 when I finally took my own health history I outlined more carefully what my fuel sources are as a human... mainly blood sugar balance, B vitamins status, adrenal health (stress response system), oxygen (iron levels) and thyroid. Through process of elimination (I had treated everything else!!) I realized I must be dealing with thyroid. I went back to my blood panels that tested my thyroid since my first son was born over ten years ago. My thyroid had always tested normal according to all doctors, but I knew it must not be “My Normal.” What is normal anyway?
What is “Normal” Anyway?
The question of “What is Normal” in regard to our invaluable health is of utmost importance. A common way we measure health is through blood work, physical exam and a detailed history. For blood work however, it is important to know that there are no standardized lab reference ranges nationally. The government does not say “this is a healthy level for thyroid.” Reference ranges vary from lab to lab, hospital to hospital and can also be based on the health of the people who tested their thyroid the year before. Arguably, people who are going to get their blood drawn are not vitally healthy, and therefore if reference ranges to determine ‘normal’ is based on this sample population it is already skewed in the ‘unhealthy’ direction. I for one do not want my ‘normal’ or health to be based on this skewed reference range and this population’s’ state of health. In my practice when analyzing patient’s blood results I have noticed huge disparities between reference ranges. The wider the reference range the more people will be included in “normal.” For instance, I have even noticed that places like Kaiser have broader reference ranges then the lab I use, Labcorp.
I locate myself more in the holistic medical field with Functional Medicine being the latest umbrella title under which I work to basically say that I want to look outside the box, look at all the connected pieces, the whole picture. We test things like adrenal health, vitamin D, B vitamins, more than two thyroid markers, etc. that many mainstream doctors do not test because either they do not believe it to be an issue worth testing (adrenal health) or insurance won’t cover it (insurance is really kicking back now against Vitamin D testing, they may well not not cover it now unless doctors use a code for suspected osteoporosis). We also narrow reference ranges about 20% and look for patterns of what may be wrong in the body. Despite my training in Functional Medicine, this has still been a rather shocking experience for me because even though I have trained to be more “outside the box” in my thinking, I was still not thinking out of the blood lab results box or the resistance to any medications box.
How Your Thyroid is Tested
Thyroid health is generally tested by one or two blood tests. TSH (Thyroid Stimulating Hormone made by the pituitary gland that informs the thyroid how much hormone to make) and Free T4 (thyroxine, the dominant hormone your thyroid makes). The thyroid gland primarily makes T4 which then goes out into peripheral tissues and is converted into T3 (Triiodothyronine). T4 is not active, meaning it does not fuel the cells. T3 is the active/accessible hormone that fuels the cells. The body needs to convert T4 to T3 to increase our cellular metabolism and make us feel like we have the energy we need to be our vital selves. Interestingly, for the past ten years I have tested all of these markers and I have always tested normal TSH and low-normal free T4, but low total T3. What I had been taught about normal TSH and free T4 but low T3 is that I have a “conversion issue”, my body is not properly converting T4 to T3. This was likely due to gut health, liver health, high cortisol (stress hormone), pituitary malfunction, chronic infection, high estrogen, etc. In that five year period I focused on that list and tried everything to remedy without success in regards to my T3 levels. I realized I had to listen to my T3 reading and really place importance on my subjective history (how I feel!). How I feel is reality and determines my day to day experience. Symptoms are telling my story, and symptomatically, I was not myself and I was tired of accepting this state of less than optimal function as normal. This also meant I would likely need to break out of my box of not taking prescription medication or hormones, always believing that my body should be able to balance on its own because my self care over the past many years had explored all other avenues.
Why is Thyroid So Important?
I have been taking Thyroid seminars since 2013 and have plenty of 3 inch thick binders loaded with pertinent information. However, a key to why I began more actively pursuing thyroid help in my life was because of a perspective raised in a video a patient sent me talking about how our cells are batteries that have a certain voltage that indicates health. Only when cells go low voltage does dis-ease occur. This conversation of voltage pinged me. That is what I do in my chiropractic and cranial work, raise people’s vitality, their voltage. Even the old-timer chiropractors knew that they were taking the restriction off the nerve so vitality could flow again, thus allowing voltage to raise and flow unrestricted through our systems. And what regulates the voltage of our cells? Thyroid. I know that! Dang. From my many thyroid seminars I always quote, “thyroid regulates the rate of metabolism of every single cell in your body, you have thyroid receptors on every cell in your body.” This means that when your thyroid runs sluggish (hypothyroid), you literally have low voltage. Meaning, all systems and functions are sluggish and you could suffer from weight gain, inability to lose weight, brain fog, low energy, muscle aches & fatigue, depression, constipation, slow mental functioning, hair thinning, dry skin, feeling cold, scarce sweating, thermoregulation problems, cold hands and feet, infertility or miscarriage, and more. It is like someone took the foot off the gas and you are coasting with no real fuel source. Your cells do not have the fuel they need to operate and to complete their normal functions - therefore a vital “normal” is not possible if your thyroid is not functioning well.
Finding the Right Doctor Who Thinks Outside the Box & Truly Listens
By this point I knew I needed to address my thyroid, even if my TSH was 2.8 and my free T4 was 1 (both lab normal). I decided to reach out to a longtime friend who is a medical doctor in his seventies and who has always thought outside the box. I called him for an appointment and told him what was going on with me. He advised me to take my temperature first thing in the morning before I got out of bed and make a log book. With low thyroid, your motor is low so you run low temperature. Duh, why didn’t I think of that? (Objective markers!) I started taking my temperature under the tongue and never got a reading of above 97. Normal body temperature is 98.6. Then when I went in for an appointment he did a physical exam and noticed my cold hands and feet (which had normalized to me-- they’d been cold so long) and he also noticed some swelling in my ankles, slower pulse rate, and more. He took a detailed history and really listened to my story and asked me about my symptoms, including the fact that I have not lost any weight since my third birth. He agreed that my thyroid was not optimal.
My doctor and I discussed treatment options. I had already done the natural supplements and herbs for thyroid with limited success so I was ready to try the bigger guns, prescription thyroid hormone replacement. Most doctors prescribe synthetic hormones (synthroid, levothyroxine, etc). These are T4 only and I already knew I had a conversion issue. I asked about cytomel (a synthetic form of T3). He said he usually uses Armour thyroid, it is a natural glandular product (made of pig thyroid usually) and it therefore has a mix of T4 and T3 naturally occurring. Great. I did not have any thyroid antibodies (it is extremely important to test for thyroid antibodies- TPO and thyroglobulin-- as they are indications of Hashimoto’s autoimmune process and are also contraindications to glandular thyroid replacement medications and supplements). He started me low dose, 30mg a day (CHEW THEM!) and asked me to step it up to 60mg a day in two weeks if I did not feel any effect from the 30mg. He asked me to watch out for signs of hyperthyroid (heart palpitations, rapid pulse (90 or over), insomnia, sweating, agitation, anxiety). I was so grateful to have someone validate my feelings and assure me I would feel better soon. We agreed I would just try it for a few months, and then re-evaluate based on my subjective experience (how I feel) and my blood work results.
I had already looked into the safety of thyroid medication for all my patients who were feeling guilty on it or not wanting to take it. I felt confident that it was safe to try and as WebMD says, “The main risk of thyroid medicine is if you take too much of it, you can get symptoms of an overactive thyroid: sensitivity to heat, fast heart beat, heart palpitations, hunger, nervousness and anxiety, shakiness, sweating, tiredness, trouble sleeping/insomnia, weight loss.”
“I Feel Like I Have My Wife Back”
Day two on the medication I jumped my dose up to 60mg. Intuitively I knew that 30mg was not enough. I had read in another book to chew the tablets for greater effectiveness. I chewed them when I first woke up, craving energy and wellness. Within a few days I began noticing myself feeling better (it is supposed to take 2-3 weeks). One of the immediate things that changed was my mood. The depression lifted. Then I noticed that when I looked into my supplement drawer I didn’t feel the desire to take anything. I had probably been taking ten different energy support products to get me through the day. My cells felt supported by the thyroid hormone alone. Then I started to notice my energy increase. No afternoon fatigue and more sustained energy in general throughout the day. I actually noticed a decrease in appetite as I usually eat when I am tired to give me energy, and I was not as tired. The weight that I had been stuck with since Ian was born began to budge too. Just a few pounds down, but that was convincing to me. I went up to 90mg for 10 days to see how I felt. I didn’t sleep well so I dropped it back to 60mg. After about three weeks on the medication my parents took my kids so my husband and I could have a much needed and rather rare date. Before the medication I would have to muster up the energy just to go out to dinner and dinner often consisted of me crying, us arguing/discussing and finally remembering that we love each other and are a good team. Luckily when we actually have time to talk and connect we always come back to how much we love each other and have deep respect for each other. After the medication for our date I suggested a mountain bike ride. Luke was surprised I wanted to go biking but rallied and we left at 7pm for what became a fantastic two-hour ride. When we got home Luke said, “wow, that was the best time ever, I feel like I have my wife back.”
As I started feeling better I was shocked by how far off I had been. The last eleven years have been tough. Hormonal roller coasters of pregnancy, years of nursing, the demands of three children, low thyroid function, high cortisol (stress hormone), my professional work, growing my business, growing our house and home, balancing the needs of extended family, dealing with the currents of our country and world, negotiating these newly intense empathic responses to life, it has not been easy. What a relief to have my husband notice the best version of me was coming back online! My cells were getting the fuel they needed to balance me and give me the energy and vitality I was used to, that he fell in love with fifteen years ago.
There is so much more to share and write and I will keep at it. I am three months into the medication and feeling great. In my “n of 1” I have noticed some non-spoken of thyroid symptoms resolve. I feel like I can be in large crowds again, I feel like I have a better sense of myself and my will is stronger, I feel like my personal boundaries are stronger around my own truths, what used to creep in and take importance and override my truth no longer does. I have lost six pounds now and have lessened/changed my eating. My lab high cortisol of five years has normalized to an ideal level. I am more social again (I basically avoided social functions for 5 years but in June hosted my eldest son’s third grade class and their families to our house for an end of year party). It really is unbelievable to feel like me again. I am not sure if this adventure with medication is a reset or a lifelong endeavor. I am committed to figuring this out for myself and my patients because life is too short to not fully and vitally live it.
All my best,