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Hormone Balancing – Thyroid, Adrenal, Ovaries, Pituitary

Hormones require a fine balance in your body so everything works just right. We live in a society that likes to “spot check” one hormonal gland and treat that gland and only that gland, (and nothing but the gland). However, not only does a hormone need to be balanced within itself, such as progesterone and estrogen from the ovaries, but each hormonal gland will affect another hormonal gland. This is why as in a case of hypothyroidism when the T4 level from the thyroid is low, the TSH (thyroid stimulating hormone) from the pituitary will increase, as the body is trying to “push” out more T4 production. But these days due to lackluster patient care and insurance regulations, most doctors only perform a TSH reading to diagnose the thyroid condition. If the TSH is high as in this example, then they assume that T4 is low and therefore the total thyroid is low so you need a medication such as Synthroid or Armour Thyroid. If the TSH is low, then it must be so because the T4 is high and steps must be taken to slow down the thyroid. All this is done without taking into consideration what the actual T4 level is, or as importantly (perhaps more), the T3 level, which is the ultimate goal in thyroid production. It is very possible to have a high TSH and a high T4, as well as it is common to have both low. Since 90% of T4 is converted into T3 in the liver, the function of that organ is of utmost importance. The two primary reasons why T4 is not converted successfully into T3 is due to high insulin levels and high cortisone levels. The T3 is converted into a hormone called Free T3. This can be measured to verify, but rarely is. This gets us into carbohydrate intolerance and adrenal gland function, which must be addressed to treat the thyroid.

So, if I may take this further – here’s a common occurrence. An individual has blood work done for a TSH level. It reads lower than normal. Most likely a T4 level will then be taken, we hope. The T4 level comes back high and steps are discussed to suppress thyroid activity since the individual is making too much thyroid hormone. But, if the T3 level was taken, many times it is low. The T4 is just waiting to be converted into T3, but can’t because the ever-so-common occurrences of carbohydrate intolerances and adrenal stress disorders. The pituitary was smart enough to lower its output of TSH as to not make any more T4 since there’s already enough.

The adrenal glands most of the time are the center of attention when it comes to hormonal balancing. Too much stress increases cortisone levels in the initial stages of the adrenal stress disorder and this will suppress thyroid, pituitary, pineal, and ovary/testes production. In my opinion, and those who practice functional medicine, an adrenal issue is present before a thyroid issue.

Balancing the hormones involves fine-tuning each area with its relationship to the other involved glands. I like to think of one of those street performers who balances ten spinning plates on sticks. After he gets the third or fourth one going, he’s got to go back and get the first one moving again before it falls; then he can go and start the fifth one. He is constantly paying attention to all the plates, keeping them all going, until the tenth one is up and spinning. One spill and it’s all over.

Hormonal balancing before and after menopause is also extremely important. Read the menopause information in this Health section, it’ll make you shake your head.

39 Comments

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  1. Jessica permalink

    Hi Dr. Gangemi – thank you for your informative blog! I happened upon you, as I am currently researching how to properly support my thyroid. I was diagnosed with PCOS about five years ago, though I told I was not a ‘typical’ case (at the time, 5’5″, 115lbs, and my fasting insulin numbers looked good!). I soon started following a paleo diet, following it rigidly for two years. I dropped my carbs to less than 50 g/day for a few months and started packing on weight (I was up to 140 at one point). I think I totally freaked out my adrenals by keeping up high intensity workouts more than five times a week and having my carbs too low. I have since taken off 8 lbs. of that by adding carbs back in, cutting back on the number of workouts/week, and adding in yoga for stress reduction, but I would like to take another 10 off AND restore my reproductive system (at 32 my clock is ticking!).

    Anyway, I have an appointment this Friday with an endocrinologist and would like to go in somewhat knowledgeable. Do you recommend asking for a test to see if I’m converting T4 to T3? How do you recommend we go about balancing these systems? I assume something is off with my insulin if I have PCOS, but I’m afraid to cut carbs too much to reset this due to the reasons I’ve mentioned. Do you recommend starting with nutrition?

    Thank you for all of the information you provide – it truly is invaluable to people like myself.

    Best,
    Jessica

    • Hi Jessica, this is tough because I have to tell you that I think most endocrine docs are not properly educated on how hormones influence the entire body, other hormonal organs, and how they are affected by diet. Take type II diabetes – they still tell their patients to use Nutrasweet and Splenda. They advise if your sugar is low, drink juice or eat carbs. If it is high, take more of a medication. How about thyroid problems? – Well, they’re still behind the ball there and don’t realize that the number one reason for low thyroid function is Hashimoto’s and the number one reason for that is a food intolerance (most often gluten). Those who do look for an autoimmune disease still treat the gland (using T4 or T3) and not the immune system. So you are probably already more knowledgeable knowing what you already know, and to most endocrine docs, you’re also that patient who is a bit dangerous to them and they may not want to listen to you. This is just my experience, of course, dealing with a lot of patients who I see who have been to Duke, UNC, and other centers.

      For PCOS you’re typically looking at some carb intolerance, but that could be coming from some gut dysbiosis or adrenal problem. Endocrine docs will not acknowledge an adrenal problem unless there is a pathological disease such as Cushing’s or Addison’s.

      So my response may just confuse you more; if it does, let me know. I don’t want to discourage you from seeing an endocrine doc; I’m sure there are some good ones out there – somewhere.

  2. Jessica permalink

    Thank you for your response! I just ordered the Thyroid Revolution book (Mary Shomon), and I plan on devouring it ASAP. Do you recommend something more along the lines of Dr. Mark Hyman’s Blood Sugar Solution for someone with PCOS? I understand it is triggered by insulin resistance. Do you believe that following such a diet would work to improve both insulin and thyroid?

    It is all rather confusing to someone without a medical degree, so thank you again for all of the information.

    Best regards,
    Jessica

    • I am not familiar with that book. The one I recommend to patients which has become the standard for many is this one here at Amazon.

      Paleo Type diets are typically very effective ways to manage blood sugar/insulin levels, unless there is significant gut dysbiosis. In which case, specific gut treatment may be needed and a FODMAPs diet often helps.

  3. Julie permalink

    Dr. Gangemi,
    I stumbled across your website and I have an interesting question for you. I am on an adrenal recovery plan, taking herbs (womentowomen.com) formula, changed my entire diet, low salt, low carbs, low sugar. Eating very simple foods. I also am on estrogen, progesterone (this one is the highest), testosterone, D3, Iodote (supplement to help my thyroid), selenium, zinc, probiotic, fish oil and multi vitamins..so finally feeling engergetic during the day. However I struggle with sleep at night I wake up between 1-3 am. I do all the right things, bed at 9pm, eat 3 hrs. prior, take my herbal pill to sleep better…and nothing works. Any suggestions? Oh I walk every day and sometimes feel like I need to urinate at this time (not always).

    • Not to hit you in the face with this but I don’t see how you can be on an adrenal recovery plan if you’re taking estrogen, progesterone, and testosterone. That is a hormonal storm in my opinion. I’ve never seen a woman not have a problem with testosterone supplementation, regardless if their lab says “low.” And your progesterone will often just continue to provoke increased cortisol production.

      As the sleep article discusses you’ll wake up between 1-3am due to liver toxicity, and taking those hormones is a major stress on your liver.
      http://www.drgangemi.com/healthtopics/sleep/

  4. Julie permalink

    So how do I fix liver toxicity so I don’t wak up between 1-3am? And if I don’t take the hormones I feel even worse, they are the only thing that has actually helped. I appreciate your advice.

    • Cases like yours are impossible to figure out on-line. You need to find a doc to help you sort it all out. Feeling worse when you’re not taking your hormones means you’re not actually correcting anything – you’re covering up the symptoms when you take them.

  5. Jessica permalink

    Hi Dr. I have been diagnosed with PCOS, insulin resistance, severe Hirsutism,you name it. One question I have never been able to get an answer to from multiple PCP’s and OB/GYN’s is how to reduce my Testosterone level. It is chronically at least double the “normal” range.

    There are many more questions and issues, but this has always been the pressing one.
    Thank you.

  6. TONI permalink

    Dear Dr. Gangemi:
    I am a 41 year old female. i was diagnosed with Graves Disease over 15 years ago. My thyroid was reduced six years ago with radioactive iodine. I have been taking synthroid ever since. Aside from synthroid, I am also taking Natazia. when I started teh Natazia a year ago, I began to not feel well, so I had my thyroid levels checked. things changed, so I had to have my synthroid increased from 100 mcg to 125 mcg and I felt great ever since. Recently, I went to a new doctor, I moved, and he checked my TSH and T3 and T4 along with some other things. He told my TSH levels were high, my T4 levels were high and my T3 were fine. But he lowered my synthroid to 100mcg. I am so tired, weak, I want to cry all the time. I know this is due to the change in my synthroid, What is recommended for a high TSH and high T4 with normal T3? Would synthroid be lowered?
    thank you for your input.
    -Toni

  7. Lucie permalink

    Hi Doctor,
    I am a 37 year old female with type 1(23yrs) diabetes, and addisons for 8 years… it has been a struggle since I was diagnosed with Addisons but this last spring my doctor thought my TSH was high and put me on .025 of synthroid. I believe she tested my T3 and T4 also but dont have those available to me. Presently my TSH measured 0.69 and she prescribed 0.025 only 5 days a week instead of 7. I have heard its dangerous to treat hypothyroid in people with adrenal problems, could this be true in my case?
    I have been on cortisol stress dosing on about 5 occasions in the past year for bronchitis and was on higher doses of prednisone when the last TSH was taken…is this thyroid dumping? This is more like trying to spin 20 plates

    • Yeah you’re absolutely right on the 20 plates. I’d get a second opinion and maybe consult with someone more naturally-minded who looks at the relationship between the hormones rather than compartmentalize.

      A TSH of 0.69 is either HYPOpituitary or HYPERthyroid, not hypothyroid. Since you have the auto-immune issues then you should have the TPO and TG antibodies done ASAP.

  8. Tim permalink

    Good evening, you might be able to help me, I’ve been sick for 10 years now because I tried steroids when I was younger, I guess I’ll wait to see if I get a response before I try to tell the whole situation, but I’ve been to endos and other doctors, I can get all my hormones, vitamins, minerals, vitals, blood sugar, TSH, LH, T4 , testosterone, estrogen, you name it and with nutrition from food and excersise I can have everything within normal range but I’m still sick, when I say sick I mean anxiety, my body won’t accept 95% of any medication or vitamins, I’m guessing that my body is not metabolizing these properly, I’ve tried almost everything and have reached a point of giving up after so many years, I just stumbled onto this website

    • Hi Tim, as I often say to people – “Sometimes you just gotta be treated by a doc or therapist who looks at the entire body from a structural, nutritional, and emotional perspective and understands how everything is interrelated and attributing to a health issue or injury.” Although there’s not a lot of “us” out there, that’s your best bet. A good doc will be able to get you back in a very short period of time and if not, at least explain what is going on and why.

  9. Tim permalink

    Thanks for the reply, where are you located? Are you near Michigan or maybe you know someone that wouldnt give up on me so easily in or near Michigan? I’m from Michigan but I’m in South America right now doing everything I can to try to find the solution, down here I can get most drugs and hormones without a script, and I’m not blind about these kinds of drugs, I’ve done plenty of reading and research so I can be safe about it and not make it worse,

  10. Tim permalink

    If I tell you that my body just doesn’t metabolize ANY type of drug or vitamin, does that give you any idea? If I run for 30 minutes after taking something that seems to metabolize it a little but not completely, also if I take adderall with the drug that also seems to help metabolize it a little but not completely, not even close to completely, just a little

    • That could be an issue with your liver – either something genetic, a lack of a nutrient necessary for liver detoxification, or something hindering your liver – medication(s), caffeine, alcohol, hormones, etc.

  11. Jason permalink

    Hi Dr. Gangemi,

    I am a 39 year old male looking for the root cause of my symptoms. 5 years ago, I went to the doctor to get checked out because I was always tired, couldn’t lose weight, and so on. I was told I was fine, but I knew something wasn’t right. My normal body temp ranged from 94.8 to 95.4.

    Two years ago I began taking 6mg of an iodine supplement daily. Within two weeks, I began feeling better, didn’t have dry skin, lost my “brain fog”, and began losing a little weight. My body temp rose to a steady 97 range. I then added VitD, Krill oil and 1-300mg pill of ThyroGold (a dessicated thyroid pill . With good exercise and diet (that failed in the past) I went from 203 lbs down to 173 lbs in 3-4 months. I was able to maintain this weight withing 5 lbs for a year and a half. Then I slowly started gaining weight while continuing my same routine.

    This past October I had a vasectomy and went from 183 lbs to 206 lbs now. I was sick for 6 weeks with different infections and had daily temperatures rising from 97.7 in the morning and reaching 100 by mid afternoon. I felt horrible. I stopped taking the iodine and ThyroGold. Recent blood test showed the following results:

    2/20/2013
    TSH – .05
    Total Testosterone – 274 (blood test in afternoon)
    Negative Lyme disease test

    3/02/2013
    TSH less than -.03
    T3 Free + T3 Total – 2.7
    Free T4 – 0.7
    Prolactin – 5.1
    Total Testosterone – 450 (test taken early morning)
    Free Testosterone – 83.8

    My endocrinologist says I have Grave’s or nodules and wants a radioactive iodine uptake test performed. My thoughts are it could be a pituitary problem because of my lab results and my hypothyroid symptoms. My endo denies any other cause other than the Grave’s or nodules.

    Can you help me make sense of this please? Something isn’t right with her diagnosis and I feel more tests may need done to find the root cause to treat it properly.

    Thanks in advance for any help or guidance!

  12. Lori permalink

    I was diagnosed with over active thyroid 12 years ago. They gave me nuclear iodine. Then my thyroid went under active Was on synthroid for a while but was you and stopped taking it. The docs monitor my levels and say they returned normal. Last year they found nodules again but said thyroid levels were normal. For the past month I have had insomnia. Missed my cycle and the lack of sleep is made me depressed. Should I be on thyroid medicine for the rest of my life could this be causing sleep issues and depression. I drink water stopped caffeine. Only green tea in the am.

    • I can’t advise you on a medication or specific treatments since you’re not a patient of mine. Sorry.

  13. Mindy permalink

    Hello Dr., is there any way to balance the thyroid levels and female hormone levels? I am 46 yrs. old with Hoshimotos and between that and the hot flashes I am ready to scream. Can you help? Thank you so much

  14. Noelle permalink

    Dr Gangemi,
    my name is Noelle and I have been hypothyroid since age 16. I realized I was when I began to strict diet, i had an eating disorder. So, my doctor gave me a blood test and turned out i was hypothyroid. Many of my family members have this disease but got it when they turned 50. My Dr. strictly put me on synthroid.. and life was crap from there… I was still extremley cold, gained weight FAST, exausted 24/ 7 . By the way i was eating normally at that point.
    However, my doctor said my free t4, and tsh was fine but i still felt like crap!!! So i did my reshearch… heard about the free t3 test. MY DOCTOR REFUSES TO DO IT . I went to an endo he REFUSES TO DO IT . I have a noudle (howver u spell it) on my neck and he said continue taking synthroid and it will go away.
    My life has been hell, i just wanna feel better !! Not have these hypothyroid symptoms .
    I now take thyrosense, my symptoms have improved but not completley… i am very athletic and some days i just can’t get out of bed.
    Any suggestions , i am desperate !
    Thank you.

    • If you’re going to a doc who refuses to work with you then your first step is to find one who will. They’re out there – ask friends or coworkers.

  15. Noelle permalink

    Okay, thank you. Another question, why does synthroid cause me anxiety? Could my thyroid condition be linked to Adrenal Fatigue? If so, would I need to be on thyroid medication ?

  16. daneejela permalink

    Dear Dr. Gangemi,

    I know that you can’t give diagnose over internet, but I would be so grateful if you can just point me in some direction where I should focus to find answers about my condition.

    I’m 28 and diagnosed with mild hypothyreosis six years ago (high TSH, normal T3,T4).
    I’m diagnosed with PCOS too (with elevated testosteron, and hirsutism) , at the age of 17, but gets worsen with time. I was treated with Dianne35 for few years.

    I had strong pollen allergies from my childhood till about 22 (then just disappeared) and even diagnose of allergic asthma. But in few last years have no more problems with that. I’m mentioning

    I know that nutrition is very important, but information out there are very contradicted to each other. Some say carbs are very important for hypothyreosis, others say it’s source of problem.

    Can you point me out on what to focus and what informations are reliable?

    P.S. I’m sorry for any grammatical mistakes, I’m not an native English speaker.

    Any your comment will mean a lot to me, since in my country health care is far away from new science discoveries.

    • Situations like this are best figured out by a holistic doc – search out one in your area.

  17. This is really something that would need to be individually assessed to figure out a sensible treatment option. It’s not something I can give advice on-line for.

  18. Missy permalink

    Hi Dr.Gangemi

    hi I’m 41, 5’5 105 lbs, fit, do lots of raw green juices, just got a test that says FSH 66 estrogen 23

    my real question is: should I just take the estrogen since it is so low, and is there a connection between longstanding very low ferritin /anemia and estrogen/FSH ?? and can iron and other supplements affect hormones?

    I really want to know is there a way to balance the endocrine wholeistically, I just did a 7 day raw cleanse, re-commit to my meditation practice and emotional well being, including endogenous induction meditation for balancing hormones…called secret of loving touch. lol.

    I have been anemic for years and recently committed trying to get my ferritin levels up and the ferritin level was only 9 one year ago, it bumped up to 17 after six months ago, but stalled at 18 after taking 300 mg carbonyl iron daily for the last 3 months(i’m taking it with l-lysine,vitamin c, taurine, empty stomach) avoiding coffee/dairy/gluten for 2 hours.. but was drinking ALOt of coffee(2-4 shots esspresso daily, which i quit all coffee/caffeine a few weeks ago since it affects the adrenals. also possibly significant: trauma history and get triggered with stress /anger very easily, anxiety… I’ve never taken meds though!
    I’ve been taking lots of supplements (! actually trying to cure excessive hair shedding, I know it sounds vain, but it’s been going on since I’m 18, something to do with ferritin below 70 (NEJM just put out a paper confirming this and it inspired me to try and get my ferritin up)and now that i know my estrogen is very low, that is probably a big co-factor.

    the dr. wants to put me on estrogen right away, I want to wait 1 month and see if I can balance my hormones naturally. and check me for adrenals, more extensive thyroid tests (everything including t3-4 came back normal),lupus, rheumatoid, hyper-parathyroid, I have been through a bad breakup with lots of depression, rage and feel very ADD. I know our emotions can deeply effect our health/stress/adrenals/cortisol , but can being on the computer 12 hrs a day/research addiction effect the pituitary??

    this may be significant :
    I also take :
    not consistently but maybe 1-2x per week before bed :
    gaba 500mb
    melatonin 10 mg
    magnesium
    I was taking l-5htp and l-dopa before bed trying to help with depression
    Q:(if it can affect the hgh levels, can it mess with pituitary?)?

    and lots of supplements:
    just started:
    D3 8000 iu (just dropped down to 4000)
    was taking high doses of 3,000 -4,000 kelp iodine after reading Dr. brownstein about low iodine “epidemic” (but that made my period stop for 3 months with hot flashes, which quickly subsided after stopping the iodine, read anecdotes of another woman with same reaction)

    was reading l-lsine can be an antagonist to argnine, which can “put the breaks on pituitary” Q:so could that effect FSH and make it high???

    a bunch of other supplemnts, but , more like, zinc, taurine, fish oil, leutin for eyes, some for joints/skin: msm, orthosilic acid(silica), hyaluronic acid,coq10,multi, green tea extract, grapeseed, macca (balance hormones?)
    should I quit all supplements?
    thanks for your site.

  19. Mike permalink

    Do you treat men with low testosterone, erectile dysfunction, and high cholesterol?

  20. Minnie permalink

    Hi Dr. G

    I am a 32 year old female personal trainer. I eat mostly a paleo diet (lots of pro, veg and lots of health fat from coconut, ghee, olive oil).
    I would really appreciate advice on getting a normal menstrual cycle. Here’s a little background:
    -Menses began age 12.5 – heavy and a lot of cramping. Otherwise regular until age 23.
    -Lost period for 2 years and have struggled to get and maintain it. Comes back intermittently.
    -I’ve worked hard to help my adrenal fatigue and feel like I’ve done pretty well, but am still struggling to get a normal period.
    -Blood work by my naturopath shows that ALL of my hormones and thyroid are low and she feels that my pineal gland is not functioning properly.
    -Only thing that helped me get my period back initially was Chinese medicine (lots of acupuncture and herbs).
    -Difficulty in losing weight (frustrating as a PT!)

    Any thoughts where to go next? Is the pineal dysfunction just about my adrenal glands still being taxed?

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