Last week I shared some of the questions you wanted answered about Hashimoto’s. I covered topics like the relationship between heavy metals and Hashimoto’s, the role the adrenals play in Hashimoto’s, the relationship between Epstein-Barr Virus (EBV) and Hashimoto’s and how to reduce the risk for kids of people with Hashimoto’s. All of them were very important questions that have a lot to do with the triggers of Hashimoto’s. If you missed it, here is a link to episode 068.    In this episode, I answer more of your questions about Hashimoto’s.    Question #1: With Hashimoto’s, is TSH a reliable indicator of the body’s thyroid hormone needs? If not, what else can we use to know what the body needs? This can be very confusing for anyone with Hashimoto’s. The short answer is, no. TSH is not a reliable indicator. The ranges  for TSH are very broad (typically between about 4.5 - 5 depending on where you live. This range is not really optimal. The optimal range for TSH is between 1.8-3 (if you’re on thyroid medication this shifts a bit).  But, TSH is only one indicator and you need to look at the big picture including your total T4, free T4, total T3, free T3, and reverse T3. This is because TSH is not actually created in the thyroid - it's the thyroid stimulating hormone created in the pituitary gland. So, only looking at TSH doesn’t tell us which hormones the thyroid is producing and at which ratio. And, it doesn’t tell us how well the body (primarily the liver and the gut) are converting these hormones or how the hormones are actually utilized. Essentially, TSH shows a very very small part of a much bigger picture and that is why its not nearly complete. With Hashimoto’s you also want to track your antibody levels so that you can determine which triggers (listen to episode 068 for more on the four triggers) are affecting you and your levels.  I’ve listed the various tests I recommend to get the whole picture of your thyroid functionality and optimal levels for each in the show notes for episode 027. If you are looking for a lab to do these tests, here is a link to a helpful resource and lab.  I’m in the process of creating my thyroid course which is going to get way more in depth about this and how you can figure out your pattern and exactly what to do about it. The course will launch this fall. Add your name to the wait list if you’d like to be personally invited to join.    Question #2: Why does someone with Hashimoto's feel tired all day long? How can we help this and what can we do to wake up feeling refreshed and have more energy throughout the day? While Hashimoto’s is an issue, we need to look at the root cause of the fatigue. It’s true that Hashimoto’s causes the immune system to attack the thyroid and often causes hypothyroidism which has a common symptom of fatigue. So, the first step is to make sure that you are supporting thyroid function optimally with what your body needs (foods, supplements or if necessary thyroid medication that is dosed appropriately) and you are also by avoiding Hashimoto triggers (noted in last week’s episode). If you are doing these things and continue to feel tired, then you may want to consider the role your adrenal glands may be playing in your fatigue. The adrenals and the thyroid are very interrelated. Stress is a key trigger for Hashimoto’s and it can also impact adrenal function.  Clean eating is also recommended but if you continue to feel tired, you may be having some issues with absorption which could be caused by a gut issue. This could be the real cause of the fatigue as well  And finally, check that you are not deficient in nutrients that help us feel more energized like iron, B12 and other B vitamins.  As you can see, feeling tired is quite multi faceted so we have to look at it from all angles.   Question #3: My diagnosis of Hashimoto's only came after being on thyroid medication for years. Can this medication be contributing to Hashimoto's?  In my opinion, I don’t think it