2 Things To Do Daily to Correct High TSH Levels

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. That’s DRRUSCIO.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

Dr Ruscio:

Hi, everyone. This is Dr. Michael Ruscio. I just want to make a quick preface that the audio that you’re about to listen to is actually the audio compendium to a video, which has appeared both on our YouTube channel and on our Instagram page for your convenience. We want to always release the audio version of a video here on the podcast. However, it’ll be evident in some videos, more so than others, that the visual aids may be heavily referenced and leaned on. In some cases, having a depiction of a concept can be very helpful in portraying and making comprehendible that concept. So in any case, if you are listening to this and you want the visual aids, please see our YouTube and/or Instagram page so you can have access to those. Okay. And here we go to the audio for today’s video.

Dr Ruscio:

Correctly interpreting high TSH is crucial. We’re trying to balance ensuring that your TSH normalizes—thus prevents hypothyroidism on the one hand—while also avoiding unnecessary medication, which I’ll share with you in a moment, one recent meta-analysis found that 34% of individuals were on lifelong thyroid hormone that did not require it. Thankfully, there are clear lab ranges that guide us in the interpretation and simple nutritional solutions to help lower TSH. This is Dr. Michael Ruscio, and let’s expand on this very important topic.

Dr Ruscio:

Firstly, we need to identify what TSH level is considered high. Now the lab cutoff is anything above 4.5. However, not everything above 4.5 carries the same weight. 4.5 up to 7 to 10; this range, very important, is known as subclinical hypothyroidism and is usually not problematic. Whereas over 10 is more likely problematic and more likely when someone will require lifelong thyroid hormone replacement medication. There’s a touch of nuance here depending on age and symptom severity, but let’s outline this a little bit further because it’s really this mild elevation of TSH that trips a lot of people up. And again, this mild elevation of TSH is known as “subclinical hypothyroidism”, and it’s […] between 7 and 10. And again, this is what gets people into trouble.

Dr Ruscio:

Now, if you’re in this range of mildly elevated TSH, anywhere between […] 4.5 to 10, most of these will normalize with time. Let’s look at a 2007 study examining 13,000 individuals with elevated TSH between 5 and 10. No treatment was given. In a five-year follow up 62% had normal TSH levels. And in a more recent study from 2021, 225 people with this subclinical hypothyroidism, this mild elevation of TSH, were given no treatment. And 74% had normal TSH at a six-month follow up. All right. So those with a TSH of above seven in this study were found to have a higher likelihood of requiring thyroid medication. So the various studies are finding this upper cutoff between 7 and 10. This is why I’m trying to share with you and point out that anything above 4.5 should not be interpreted with the same weight. 4.5 up to between 7 and 10—this is the range at which we’re starting to look at this as something that might be problematic.

Dr Ruscio:

Okay. And this is why the European Thyroid Association recommends a repeat TSH after two to three months. So if you do notice that your TSH is 5 or 6 or 7.5 or 8, have a repeat test after two to three months, there’s a good likelihood that your TSH will normalize. We want to be careful not to jump too quickly to treating this, especially when considering that the treatment is usually lifelong thyroid hormone replacement medication.

Dr Ruscio:

And again, remember that most cases where the TSH is […] between 7 and 10, do not require medication. Very important to understand this. And why does this matter? Well, when you connect that with a recent meta-analysis (and remember a meta-analysis is a summary of studies, so it gives you a really good aggregate trend of what the data are showing) found that 34% of individuals were incorrectly diagnosed as hypothyroid and were on […] lifelong medication that they did not need.

Dr Ruscio:

And also important to clarify, if you’re struggling with symptoms, that they did not demonstrate a benefit from medication. And they were able to come off the medication and still feel the same. And this is likely why a narrative review in the Journal of Internal Medicine concluded, “few patients will experience longterm benefit in their symptoms and in the elderly aggressive treatment may possibly cause harm.” So very important to clarify that if you’re not feeling well and you have this mildly elevated TSH, you should be cautious not to think that thyroid hormone replacement therapy is the solution.

Dr Ruscio:

Now, all that being said, there are proactive steps that can be taken to lower TSH. And because these are nutritional it makes it much more justifiable to try these, even if your TSH is a 5 or 6, but especially if it’s somewhere in that 7, 8, 9, 10 range. And namely they are selenium and inositol. You can aim to consume these or supplement with these every day or every morning.

Dr Ruscio:

And let’s start with the evidence that demonstrates that selenium can actually help to normalize elevated TSH. This comes from a 2020 clinical trial where selenium lowered TSH in those with subclinical hypothyroidism. This study looked at 50 patients, they were given 83 micrograms of selenium daily and normal TSH was restored in about 49% of individuals with no significant changes in their thyroid autoimmunity. So important to distinguish that you can see improvements in TSH while the inflammation of the thyroid gland or the autoimmunity may not improve in tandem per se. And thankfully at a six-month follow up, the majority—over 80%—of individuals maintained a normal TSH with this simple intervention of 83 micrograms per day of selenium.

Dr Ruscio:

And as a side note, if you’re looking for guidance on your lab work as you’re monitoring your TSH over time, we’ve put together a thyroid 101 guide and the link for that is in the description as a free resource to help you along your path.

Dr Ruscio:

Now, what about selenium supplementation or obtaining selenium from food? Remember the goal here would be 83 micrograms because this is what was used in the previous trial. Now, if you look at this food table we put together, you can see that it’s not too difficult to obtain the 83 micrograms from these foods. Brazil nuts [have] 70 micrograms per serving, three ounces of tuna [has] 92 micrograms per serving, turkey, sardines, eggs [are] all a good source of selenium. And if you do have this mildly elevated TSH, then you should consider integrating these more centrally into your diet or routinely into your diet.

Dr Ruscio:

It’s also interesting to see that one can enhance the effects of selenium by adding another nutrient, inositol. And a review paper from the journal, Frontiers in Endocrinology, outlined numerous trials finding that the combination of selenium plus inositol was better than selenium alone.

Dr Ruscio:

And one of these trials was from 2013, looking at 48 patients with TSH between 4 to 10—so again, this subclinical hypothyroidism—[who were] also experiencing a elevation of thyroid antibodies. They were randomized to receive either inositol at 600 milligrams per day plus selenium or selenium alone. And at a six-month follow up the combination group (the selenium plus the inositol) experienced a 31% decrease in their TSH and a 44% drop in their TPO antibodies. Whereas the selenium alone group had no change in their TSH.

Dr Ruscio:

Important to clarify. This is why it’s so crucial to look at the aggregate findings in a body of evidence and not cherry pick one study alone. We’ve discussed two studies earlier that found that selenium can lower TSH. This study did not find that selenium alone was able to lower TSH. Why it’s so important to look at the aggregation. Let’s say, arbitrarily, there are 10 studies on selenium and TSH. Seven may find benefit, three may not. This is why, again, it’s so important not to look at one cherry-picked study that may only represent three of 10. Whereas the seven of 10, the majority, is really what we’re after. Because that’s what’s most likely to be your experience as someone who uses selenium or whatever the intervention may be.

Sponsor:

Hi, everyone. If you are in need of help, we have a number of resources for you. “Healthy Gut, Healthy You”, my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer there is the clinic—the Ruscio Institute for Functional Medicine—and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path, health coaching support calls every other week, and also we offer health coaching independent of the clinic for those perhaps reading the book and/or looking for guidance with diet, supplementation, etc. There’s also the store that has our Elemental Diet line, our probiotics, and other gut health and health-supportive supplements. And for clinicians, there is our FFMR—the Future of Functional Medicine Review—database which contains case studies from our clinic, research reviews, and practice guidelines. Visit DrRuscio.com/resources to learn more.

Dr Ruscio:

And one more trial here from the Endocrine Journal in 2020, looking at a combination of a inositol with selenium again, and how this influences TSH. You see here in the table that TSH at baseline was 4.7, then six months later 3.5 (coming down), and then at 12 months 2.9. So even more data here showcasing that these natural nutritional supports can help lower this mildly elevated TSH. And what’s going on here?

Dr Ruscio:

How is inositol and selenium improving the TSH? Well, inositol may work by improving the thyroid gland sensitivity to TSH itself while also lowering antibodies. And selenium can lower antibodies and reduce inflammation. Food sources of inositol—remember the goal here or at least what was used in the studies was 600 milligrams per day—and you see things like cantaloupe, oranges, kiwi, wheat bread, [and] peas are all good sources of [inositol].

Dr Ruscio:

And as one quick aside, there is an overlap between hypothyroidism and gluten sensitivity, but the best study examining this to date found only about a 9% overlap. So it is important to clarify that not everyone who has any thyroid condition must avoid gluten. Yes, there is data showing this. It is legitimate. It is true. But we want to be careful to clarify the risk here seems to be, at least according to this one study, about a 9% risk. So we don’t want to broadcast that out as 90% of people or nearly all people who have a thyroid problem should avoid gluten.

Dr Ruscio:

Okay. So in close, elevated TSH is not always a problem. Most cases of subclinical hypothyroidism will become normal with time and no treatment. Be wary of over-treatment. And if you’re unsure, obtain a second opinion, because remember that meta-analysis had found that 34% of individuals were incorrectly diagnosed and were on lifelong medication they did not require. And thankfully selenium and inositol as myo-inositol can help lower TSH. And these can be received via food or supplements and easily integrated into your morning routine.

Dr Ruscio:

This is Dr. Michael Ruscio and I hope this helps.

 

• Dr. Ruscio’s Additional Resources