One Key Reason Why Your Thyroid Medication Isn’t Working

Does your gut need a reset?

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Do you want to start feeling better?

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Do you want to start feeling better?

Yes, Where Do I Start?

One Key Reason Why Your Thyroid Medication Isn’t Working

How Paige, a firefighter, got her energy back.

Paige had always been full of energy, and it was perfect for her firefighter career. Then she noticed more fatigue and lack of sharpness. Luckily, her department happened to be doing a health program that revealed Paige’s hypothyroidism and Hashimoto’s. But thyroid medication didn’t seem to be helping, and she was already on the paleo diet. What more could she do? With further luck, Paige came across the Healthy Gut, Healthy You protocol. Hear the simple steps she took to heal her gut and get her energy back.

Dr. Michael Ruscio, DC: Hi, everyone. I’m here today with Paige. We’re discussing some of the good results she’s had with her health in going through the program laid out in Healthy Gut, Healthy You. Paige, thanks for being here and welcome.

[Continue reading below]

Dr. R’s Fast Facts Summary

Case study with Paige

  • If you have Hypothyroidism occurring at the same time as issues in the gut you may not respond symptomatically to that thyroid hormone medication.

Chief complaints

  • Intestinal symptoms
  • Tired
  • Brain Fog
  • Not feeling herself


  • Hypothyroid
  • Hashimoto’s


  • Thyroid medication was not improving symptoms
  • Paige followed the Health Gut Healthy You protocol and felt much better with
  • After addressing gut issues the Thyroid medication helped her hormone levels

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Paige:  It’s my pleasure. Thank you.

DrMR:   So I said, just a moment ago before we started the recording, I’m bridling myself. I don’t want to ask any of the background. I want to get it all fresh. Tell us about what you were suffering with and what the road up to Healthy Gut, Healthy You looked like.

Paige:  Sure. Well, I have a very fortunate story in that, first of all, I’m a firefighter. Been a firefighter for 16 years.

DrMR:   Thank you.

Paige:  Oh, thank you. It’s been a wonderful career. I have been blessed with great health, and I’ve always been a very high-energy person. And the fire service has always been such a great fit for me in that respect.

High Energy to Fatigue & Cold

I think something changed about three years ago, where I just started to require naps after my shifts. Just felt like I was getting more tired for some reason. I was also getting cold. I’ve always been cold… Everyone would always tease me, I’d be all wrapped up with every single layer that I could at work. But I was colder than normal.

And then also moodier and a little bit less able to retain information than I used to be. Felt a little less sharp. A lot of it I was able to rationalize and explain away with, “Well, I’m getting older,” or “It’s sleep deprivation.” I’m very interested in sleep and always have been interested in health. I’ve always taken that as a high priority in my life.

But again, for all those things, I would have never gone to a doctor and said, “Hey, I’m feeling this, this, or that.” I just thought, “Oh, these are things that I just need to make some adjustments on.” And I did, and it definitely made a difference.

I’d say, in addition, another time marker where, looking back, I’d say there was a shift in my health, was when we responded to the Sonoma fires two years ago.

We got there early in the morning on the first day and were heavily involved in the structures. In wildland firefighting, we don’t use respiratory protection, so there was a lot of exposure. Two weeks of lots of sleep deprivation, exposure, etc. I definitely felt a difference coming back. Again, I was in denial about it, but, “Man, just don’t feel as sharp. Just don’t feel as sharp, I don’t know why,” and I just kept thinking, “I just need to sleep more, I just need to recover.”

Hypothyroidism & Ineffective Treatment

All of that’s the background. The super fortunate thing that happened is that this year, my department sponsored what we’re calling a health pilot program, a six-month program where we partnered with California Center for Functional Medicine. They’re heading it up. They did all the initial blood work for us. We started with a diet reset. I already eat paleo, more or less, pretty nutrient rich diet. I exercise consistently, weight has always been the same, all those things.

So I thought I was going to be very validated, being part of this study. In fact, everyone was like, “Why are you doing this? We have plenty of people that need to get their health on,” whatever. So the blood work came back and I’m thinking I’m going to get all good news.

And the nurse said, “Um, your thyroid is way out of whack.” My initial reaction was, “There’s no way. That test is wrong.” She said it was maxed out. The TSH was at 140 and that’s the max of the test.

DrMR:   Wow.

Paige:  Yeah. So she was asking, “Do you feel this way, this way, that way?”

At first I was like, “No, no, no,” because it didn’t really fit with my narrative. And when I got off the phone, I thought about it. I talked to my husband, and he said, “I’ve noticed those changes in you and skin and some other things,” that again, like I said, I was able to rationalize away. So I had that tested again and sure enough, I was very hypothyroid.

Then they tested the antibodies. So Hashimoto’s seemed to be the diagnosis at that point. We were already well into the diet reset which was a Whole30, paleo, Chris Kresser diet. I’ve done a Whole30 before which for me is always just reducing sugar. I felt more or less the same. I started the autoimmune protocol and I felt better. For about two weeks I felt better, and then it was, again, kind of the same.

Meanwhile, I’m also taking thyroid medication. Didn’t really feel much different.

Then I happened to be listening to Chris Kresser’s podcast, interviewing you. I really loved your approach during that interview. I was starting to think SIBO, really hoping it wasn’t SIBO.

I had asked one of the doctors at the California Center for Functional Medicine. I’m like, “Hey, what if it is SIBO? Should I get tested?” You’re starting to think that way. I was being perfect with my diet.

And they were like, “Well…” They gave me some general direction, “You could try this, you could try that,” but it wasn’t definitive enough.

What Finally Helped: Healing the Gut

One Key Reason Why Your Thyroid Medication Isn’t Working - Probios 3 M

When I heard the interview with you, it was the perfect timing. I loved your approach of A, don’t try to be perfect, B, you don’t stay on any of these diets forever. And make sure you’re still enjoying your life, your family, social life, and all that. I basically bought your book, I read it ravenously. I got to step two, I started the low FODMAP diet, and that was huge.

I bought your supplements for the probiotics and the adrenal support, and within days, I was like, “Whoa, okay.” I felt like old me.

Again, I probably wouldn’t have even felt like it was such a big difference, until I felt better. Then I was like, “Oh, okay, I was not feeling myself.” That’s my story.

DrMR:   Wow. That is a fantastic story. There’s so much there that exemplifies things that I found in the clinic to be important, that I’ve written about in the book, and that I really want to help to reach a broader audience. One of those—again, such a perfect example of this—is if you have hypothyroidism occurring at the same time as issues in your gut, you may not respond symptomatically to that thyroid hormone medication.

Unfortunately what happens to some patients is they get taken down this rabbit hole of trying to fine-tune everything hormonally with their dose while they’re missing what’s going on in their gut, and that is oftentimes the cause of the symptoms.

And what a beautiful example, where you were hypothyroid, you went on medication, you weren’t feeling any better, and then thankfully, as you said, you found Healthy Gut, Healthy You, tuned up your gut. And that was the missing piece in allowing you to respond to the thyroid hormone, and see that resolution of all of your symptoms, which were probably in part caused by thyroid. But oftentimes, again, we forget how much of the symptoms that we’re suffering with are actually caused by someone’s gut.

It’s beautiful. And it wasn’t hard. Low FODMAP diet, probiotics, adrenal support. Again, you made a great point, which is sometimes we Google these things and read about them, and we get this narrative that is so despairing that we think, “Oh, my God, this is going to be years to recover. I’m not going to be able to eat out. I’m going to have to turn into the food police.” There may be a select case that has to go to that extreme, but for most people it’s not that hard if you have the right process. Beautiful, beautiful.

Sponsored Resources

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Back to Health Despite Hashimoto’s

Now, symptoms are pretty much gone, right? You’re sleeping better, your energy’s better, you’re feeling more sharp. Have all those things fully responded?

Paige:  True. The thing I didn’t mention is I did have some intestinal symptoms that I, again, just thought were the new normal. Bloating, especially at the end of the day. I used to eat tons of apples and certain things that now I’ve reduced or eliminated for now. What I found about your book that I loved… it’s super empowering. It’s self-empowering. I’ve loved what I’ve learned about functional medicine. I think it’s amazing.

I’m like, “Oh, God, I didn’t even realize that that sect of medicine existed.” But it does seem prohibitively expensive for most people. I thought about that, like, my insurance wouldn’t cover that. I love how empowering your approach was. And I’m on step two at this point, and I fully intend to go to step five. I’ve already reintroduced some of the AIP things and some of the paleo as well that I had originally eliminated, and have found great success with that.

So yes to all those things. Sleeping better, feel sharper, don’t need naps again, much to the chagrin of crew. They were really liking napping Paige, because I was always very high energy. And I told them, “Hey, I just got diagnosed with Hashimoto’s. It might explain why I’ve been a little more tired,” and they were like, “This is tired Paige? Oh, great.” Anyway, there’s the normal Paige back again! But I let them nap, because it’s important.

DrMR:   Awesome. On the note of empowerment, what an empowering situation you’re now in, which is, you have a diagnosis but you are as powerful and as energetic as you’ve ever been.

I think it’s really important that patients understand that, that if you have the right approach, then you can feel phenomenal. And a diagnosis of SIBO or of Hashimoto’s doesn’t have to change who you are as a person. But there is an important caveat there, which is, you need to have the right therapies to get you back to balance.

In your case, again, I’m so appreciative that you were able to find my book and not get pulled into this Hashimoto’s black hole. And you were able to get to the root cause of your symptoms. Unfortunately some patients will internalize that Hashimoto’s diagnosis, and think that means they’re going to have symptoms for the rest of their life.

If you get the system healed—in your case, you required some medication for your thyroid, yes, but at the same time, needed to heal your gut—then, just like you said, you’re as energetic as you were before. And people at the firehouse are having a hard time keeping up with you, which is great.

Keeping Your Diet as Broad as Possible

There was one other thing that you said, which I just want to touch on for people: sometimes there’s this belief that you have to follow more restrictive diets as you’re trying to get healthier. So you start with the elimination diet of paleo, and you cut out processed foods and grains and dairy. If that doesn’t work you go to autoimmune paleo, where now you also cut out nuts and seeds and eggs and nightshade vegetables.

If that doesn’t work, perhaps you also add in a little FODMAP. It’s not the case that we usually need to aggregate all of these dietary restrictions together and make your plate smaller and smaller and smaller. But rather, feel into one approach, as I outline in Healthy Gut, Healthy You, the elimination/paleo direction, and if that doesn’t work, we can revert over to a low FODMAP direction. And we can identify where you need to restrict and where you can be liberal, which helps keep your food intake broad and not pigeonhole you into this narrow way of eating.

Paige:  Yep, absolutely agree.

DrMR:   Awesome. Well, what a fantastic case this is. Again, it’s a really powerful example of why it’s important to make sure we have a broad view on our health and we don’t get tunnel-visioned into just thinking about, in this case, thyroid. Do you have any closing thoughts that you want to leave people with?

Paige:  I’ve just been telling all my friends (because now I think everything that anybody’s suffering from is their gut, so I’m telling everybody), “You’ve got to buy this book, I’m telling you.”

That’s why I wanted to actually have this conversation with you, really just to say thank you. I think, again, the empowering piece is so important. To give people that opportunity, to put that back into their hands and not feel like, again, you have to go have all these expensive tests…

It’s so easy to get overwhelmed, I think. And I very much enjoy this process of research and I feel very fortunate that I was given the diagnosis without… I’ve read enough stories now to see people feel unhealthy for a very long time and can’t figure out what’s going on with them.

I was very lucky in that respect. So that’s really the main thing, I want to say thank you for the work you’re doing. It’s very important.

DrMR:   Well, a pleasure, Paige. It’s cases like these that really make all the long days and late nights of research and writing worth it, to see the impact it has on people. I was there at one point, and I remember how terrible my life was.

In fact, your story sounds a lot like mine actually, where I was very healthy and all of a sudden there was this acute drop off. I couldn’t figure out why. I feel that kinship with you in that regard. It is unfortunate when you can’t bring your full self to your life. Then to be able to get that back is just such a gift, and seeing other people being able to receive that is just a tremendous honor to be a part of.

So thank you for sharing again, and congratulations on your newfound health.

Paige:  Thank you so much.


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