The Case:  Emily is dealing with hair loss, sluggishness and constipation. Emily tried changing her diet and taking adrenal supplements but not much changed. Lab results confirm her suspicion that her thyroid is slow (even though the numbers are technically in range).  Emily’s numbers come up right on the edge of optimal so I knew that we needed to dig a bit deeper to find out what else was playing a role in her health mystery.    The Investigation Emily went to see her primary care doctor and asked her to run all the thyroid markers. The doctor was actually very open and ran everything she requested including TSH, total and free t4, total and free t3, reverse t3 and thyroid antibodies.  Her doctor reported that everything was within range, but as a fan of the show, Emily knew that ‘in range’ doesn’t mean optimal. My first instinct here was to run a hair test, and get to the bottom of the hair loss, sluggishness and constipation.   Top Thyroid Expert I asked my friend and colleague Dr. Michael Biamante to come back on the show to talk about thyroid, since he is the New York City Thyroid Doctor.    We have often spoken about the connection between people taking synthetic thyroid supplements and still reporting that they don’t feel quite right.   Factors that Affect the Thyroid There are many things that can affect the performance of your thyroid, and it’s important to consider them all when trying to solve a health mystery involving the thyroid or symptoms likely related to thyroid issues. Here’s a quick reference:   Kidneys: Regulate potassium levels in the body. Adrenal Cortex: Produces corticosteroids and glucose, aids in retention of potassium in your cells. Sodium: Low thyroid hormone can cause a low tissue sodium level. Potassium: Facilitates proper nerve and muscle function. Zinc & Magnesium: Both encourage potassium storage in the cells which is important for conversion of T3. Copper: Blocks potassium which can impact T3 conversion.   Hair Test for Calcium & Potassium A hair analysis test allows us to analyze the tissue levels for each of the minerals.  By looking at a hair analysis test, we can accurately determine the levels of calcium, potassium and other minerals, as well as how they relate or connect to each other.    Why do these mineral levels matter?   Guyton’s book on physiology explains that calcium acts as a governor or antagonist to the thyroid hormone, and that potassium is a synergist. This means that if the body is too high in calcium, or too low in potassium, the thyroid will likely be affected. Calcium and potassium serve as thyroid regulators so their levels in the tissues can impact thyroid performance.    What is the Ideal Ratio of Calcium to Potassium? 4 parts calcium to 1 part potassium is the ideal ratio for the body to have. It’s important to note when looking at any of the minerals, that the relativity and connection between them is key. There’s a lot more to potassium than simply eating a banana, so please make sure you consult your practitioner on this one.   Mystery Solved If you listen to this show, then you know that thyroid issues can be complex. In Emily’s case, her levels were not out of range enough to warrant medication but were certainly not optimal. In addition to her blood work, I ran a hair test and saw very high calcium levels, low sodium and potassium along with slightly elevated copper paired (unsurprisingly) with low zinc. The high calcium levels with low sodium and potassium are indicative of overall weakened adrenals and thyroid.  In Emily’s case, the high amount of copper was antagonizing her zinc which also made sense. Zinc is a needed mineral for converting thyroid hormone T4 into T3.  Next Steps In addition to lifestyle and mindfulness practices as well as a balanced whole food diet, I put Emily on Thyroxal from Apex to help support the thyroid overall.  We also added in Betaine HCL as low sodium levels in the hair are often indicative of low stomach acid. We used B