I have a female client, 30 years old, recently diagnosed with subclinical hypothyroidism. Has been taking 25 mcg of thyroxine a day. This brought back her period after a year’s absence, and she has bled twice already in one month. She has had problems with her sex hormones for as long as she can remember, i.e., very severe PMDD, depression, high-low libido, bad lower back cramps, headaches, insomnia, etc., and hormone-induced migraines with aura that leave her paralyzed with pain, trembling, sickness, and give her numbness moving from her lower arm up to each individual finger. Due to her hormonal situation, she didn’t suffer any attacks over the course of the past two years but has now had one again. She is already on a very healthy, balanced, Paleo-type diet. Gets daily gentle movement, long walks, but still struggles with depression and anxiety. It’s sad to see such a young woman not really living her life at all for fear of getting an attack. I’m already trying to work on her stress levels, though this is proving to be a hard task. Any suggestions on how to finally get her hormones balanced?

Chris Kresser:  Well, I’m not sure if you’ve done all of the full case review workup with the gut panels and the HPA axis testing and then—maybe not the blood chemistry. We haven’t covered that yet. Certainly, in a patient like this who has a wide range of symptoms and has had symptoms for a long time like this, you really have to do the full workup. It sounds like diet and even some lifestyle change are not going to be enough to address this particular situation, although like Dr. Brogan’s Vital Mind Reset program, which is a course we talked about on the webinar I did with her the other day, might be really helpful if her depression is situational and related to her perspective or frame, which it often is. Even if it’s related to diet and lifestyle, I think that program may be helpful.

Having said that, in many cases, we find it to be necessary to go on and do the full range of case review tests and even more tests beyond that in some cases for things such as mold and heavy metals or chronic infection, but certainly start with the tests that we’re going over in this course and see what happens.

As for subclinical hypothyroidism, we’re going to be talking about hypothyroidism in the blood chemistry section. I’m going to give you actually even kind of a formula that helps to determine when treatment of subclinical hypothyroidism is necessary or a good idea and when it might be better not to treat it, at least directly. In our approach, and I believe in a functional approach, subclinical hypothyroidism can often be a symptom of other underlying causes, so you would want to address those underlying causes before addressing the hypothyroidism directly to give the body a chance to resolve it without replacement hormone.