What does subclinical Hypothyroidism mean? Should I get tested for Celiac Disease? Episode 29.

So I believe I am in the beginning stages of hashimotos diagnosis, upon my research I came across your podcast. I have not seen my primary care physician yet for a follow up visit after blood work, but my TSH came back at 4.14, she did do a blood test for celiac which was negative, but my food allergy came back as borderline level for wheat and low level allergy for sesame. 

My mother has hypothyroidism (never told hashimotos) and my aunt has been diagnosed with hashimotos. I started discovering my symptoms after I got my BSN  and had my labs tested which were normal. Now I’m discovering that I can get the antibodies and it affect my thyroid before it even shows up on my labs. 

At this point I know that I need to clean up my diet. I am getting a little anxious about it, although I eat fairly healthy I just am so afraid that this diet modification is going to run my life. But all of these symptoms (including reoccurring yeast infections) are what I’ve been feeling for the past 6 months severely, and 6 years not as severely. So I am wondering if the celiac test did not come back positive because I am possibly in the early phases still? 

I am on the second podcast and I love it so thank you for all the advice!


Hi Katie, 

Thanks for your question!  I will start with the question about Celiac disease. I am not sure what blood test you had that tested for Celiac Disease. Here is what I know at the moment. Some labs test for alpha-gliadin in the blood and about half of people who have this test done that actually have celiac disease will have high antibodies against alpha-gliadin. Alpha-gliadin is a protein that the immune system would be on the lookout for and attacking. Half of those with celiac disease also do not test positive for these antibodies.  The tests that are looking for just alpha-gliadin are only getting that one portion of the proteins in gluten that your body is having trouble breaking down. Apparently there are around 60 plus different protein components to gluten that your immune system can launch an attack against. 

You should ask your doctor if their lab tests for more than just alpha-gliadin. Look for a test that will test for transglutaminase antibodies, intestinal transglutaminase as well as skin and brain tissue glutaminase antibodies. It will be a much more thorough test and give you a better picture of whether or not you may have celiac disease. 

What some research is showing is that most, if not all of us have some issue with digesting the proteins in wheat and other gluten containing grains (they actually all have gluten in them just in varying amounts). Just because we don’t feel bad when we eat a food containing gluten doesn’t mean we are not sensitive to it or have an intolerance.  If you regularly have headaches, brain fog, blood pressure, anxiety- things you don’t necessarily associate with your meal from the day before- these are things that could be caused by an intolerance to gluten or any food really. 

Symptoms to a food sensitivity or intolerance are not always digestive. This is something to really think about in your life. What symptoms are you having that have started to just seem “normal” or part of your daily life? Food sensitivity symptoms can show up anywhere in the body, not just in your digestive tract with bloating, diarrhea or constipation, gas, stomach upset etc. They can show up in your skin, joints, in your brain in the form of brain fog, inability to think well. 

Not so long ago the only way to find out if you had celiac disease was to do an endoscopy which is a procedure where a device is inserted into the GI tract to look for damage or inflammation. The damage to your gut would be classified as Marsh I, II or III with each one being progressively worse from inflammation in your intestines but the microvilli are still there in I to some damage in II and in III your microvilli are severely damaged.  You can have symptoms of gluten sensitivity and not have any damage to your microvilli. That doesn’t mean you shouldn’t remove it from your diet. 

If you have positive blood work but no damage to your microvilli, you should probably still avoid gluten. If you have or had things like anemia, chronic anxiety or depression, joint pain, gut issues, chronic fatigue, liver or gallbladder issues, loss of feeling in your hands and feet, skin rashes especially on the back of your upper arms you might want to ask your doctor to test you for celiac disease. 

It sounds like you have the genetic predisposition to thyroid issues with your family members also having it. This means that you have the genetic susceptibility to the problem and it will be your diet and lifestyle that determine whether or not you develop disease. 

I got this from Katie this morning: 

Good Morning! I just had labs drawn on 11/29- 

tsh 3rd gen was 4.14;

triglycerides slightly elevated 155; 

low level wheat allergy, 

low level sesame allergy detected on a food allergy panel. 

labs drawn again on 12/17 

tsh 3rd gen was 5.98, 

tpo 38.8, 

t4 free 0.95,

t3 total 0.99, 

tg <15.

Energy is poor, muscle aches, joint pain/stiffness, unable to lose weight despite healthy eating and exercise, poor recovery for exercise, hair is thin and brittle and I lose a lot but everyone tells me ‘it’s a normal amount’, haven’t really noticed a change in amount, but the outer third of my eyebrows are thin, my bowel movements used to be regular until about a year ago, now I might have one once every 2-3 days, sleep isn’t great and I feel like I need 10hours almost. I am cold regularly, but I also get very hot easily too.

The doctors office called and said it was "subclinical hyptothyroidism and that I don't need to be treated with medicine". I have been symptomatic severely for the last year, and intermittently for the last 7 years. In your opinion should I be on medicine? 

I plan to go gluten free in the new year, I hope that will help with my antibody levels, but will that help my tsh level go down? 

Here is the deal with labs. Often times the lab values that are established for a testing lab come from the population of people that are tested. This means you have healthy people, people who are like you, sub-clinically hypothyroid and people taking medication so you were at a TSH of 4.14 on November 29th and now at 5.98 and they are saying that is not “sick enough” to treat with medication. 

This is complete BS- clearly your TSH is getting higher which means you are feeling worse probably. When I quit taking my meds so I could get a good “baseline” number after being on the GTA Forte from Biotics Research, my digestion stopped completely about a month after not taking any meds. 

When you deal with a functional medicine practitioner they have a functional range anywhere between 1-3 TSH. Personally, I feel best at 1 or below which is where my free T3 is optimal. 

Hopefully the wheat issue will have been answered by the celiac info but you should definitely be gluten free, 100%- always. 

The functional range for free T4- the amount of active T4 in your blood, should be around 1-1.5 ng/dL- you are at .95 which is a little low for functional medicine. This means you don’t have enough Free T4 in your blood for your body to convert to free T3.

Your free or total T3 is .99. I don’t know what value of measurement that is in so check your labs against what I am saying here and again, you can see the transcript on my website to make it easier to see numbers and amounts. If that is in pg/mL then you are quite low. This means your cells are not getting enough free T3 which is why you feel the way you do. 

Free T3 is the best indicator of what is available for your cells to use. The functional range is around 300-400 pg/mL and if the measurements are not the same you can find a converter for pg/mL on google. 

You have antibodies which means if I were a medical professional I would diagnose you with hashimoto’s which is autoimmune in nature and means your immune system is the problem causing your hypothyroidism or subclinical hypothyroidism as they are calling it. I am not a medical professional though which means I do not diagnose or treat anyone for anything. I do however help people bring their body back in to balance so that it can operate properly and bring you back to a state of health.

It may be possible that you can handle this with diet and lifestyle changes if there has not been significant damage to your thyroid. This might be your first step in trying to feel better especially if your doctor won’t put you on medication.  You may want to try GTA from Biotics Research at www.getbiotics.com using code DFILC163- this is my account with them. I would take one capsule 1 time per day to start and see if it makes you feel better. GTA has porcine glandular or thyroid gland tissue from pigs in it with the T4 removed and selenium. Both nutrients that can be helpful to thyroid. I would not supplement with much more until you know your digestion is working well. No point in taking a bunch of supplements if your gut is not healed and you don’t really know what will work for you as we are all bio-individuals. If you take GTA you must have your thyroid tested regularly. 

Here is the thing with taking thyroid medication with hashimoto’s. You might feel better initially- like for a couple of weeks to a month. Your TSH might be brought in to the normal range but your symptoms will come back and you might even feel worse. This is what happened to me- I think I needed medication for sure because upon initial diagnosis my TSH was at 150- that is all that was ever tested on me until I worked with a naturopathic doctor. 

Hashimoto’s is an immune system issue first and is not a thyroid condition- it causes the thyroid condition. If the immune system is not addressed, you will certainly develop other autoimmune conditions as time goes on. 

The last episode- episode 28 discusses the immune system but we will go over some components right now. I’m going to use the analogy from Datis Kharrazian’s book Why Do I Still Have Thyroid Symptoms.  

You are a house. A house has walls to protect you from the outside- windows, doors and a roof. You too have things that protect you from the outside world. Your skin, your digestive tract, your lungs and brain. If our house has a leaky roof, the window are cracked so that wind and bugs and rain get through them and you have some holes in your walls where elements from the outside can get in quite easily. 

The same thing can happen when your body’s protective barriers have holes, cracks or leaks in them. Think of a cut on your skin- that is allowing the outside world direct access to your insides.  Your immune system reacts pretty quickly to a cut to work to keep invaders out of your body by clotting your blood and creating inflammation and then a scab which eventually heals and the cut is gone. 

When your gut or small intestine has cracks or holes it is leaky or permeable. Things called antigens come through the holes and your immune system is activated. Antigens are things like undigested food particles, bacteria, parasites, mold, toxins. You have immune cells called macrophages that are in your tissues waiting to eat up things that don’t belong. When a macrophage engulfs the antigen it sends a signal to the rest of the immune system to help it out. T-helper cells come first and organize the rest of the immune system in the attack on the antigen. Natural killer cells and cytotoxic T-cells arrive next and kill the invader. T-regulator cells make sure there are enough T-helper cells that help regulate the immune system and T-suppressor cells that stop the attack once the antigen has been destroyed. The B-cell antibodies are enlisted to remember all the information about that antigen so that when or if it invades the body again, it can remember to attack it. 

When you have autoimmune disease, somewhere along the line, something with these immune cells has gone awry. If you don’t make enough of the T- suppressor cells, the immune attack will continue and in the case of your thyroid, it can be mistaken for the antigen that was originally supposed to be attacked. 

This is just one scenario of many that can be the issue and is certainly part of why diet is so important. Removing inflammatory foods like gluten and dairy, managing blood sugar, ensuring your adrenals are optimal, managing sleep etc. It is multifaceted and about the whole body, not just one thing. 

So after the long answer, the short answer is yes, a gluten free diet can help your antibodies go down. They are not super high so that is good but you certainly don’t want them to get higher and it is clear with your TSH going up that you are needing to do something. Once you go gluten free I would go back in 30 days for labs that include all you had before and possibly even Reverse T3 which will tell you if stress is causing some of the issue of T4 and T3 being so low. 

Thanks so much for writing in Katie. I hope you start to feel better soon. 

Okay. I got a request for me to talk about what I eat. It seems that meals are a struggle for a lot of you, including me. Some days I don’t eat very well and some days are low on veggies so you know, no one is perfect with their diet and that is okay. I do notice I feel so much better with an extraordinary amount of vegetables in my diet and a smaller amount of meat. 

I have been watching The Paleo Way with Chef Pete Evans on Netflix. It is really good and so inspiring to me when it comes to getting vegetables in my diet. Check it out if you have Netflix- I am sure he worked pretty hard to get Netflix to take his show. 

What have I eaten in the last week?  I have been doing a green juice most mornings blended in my vitamix. I have had that blender for over 10 years- when the second George Bush was in office. It still runs like new. I have had to replace my canister and they have excellent customer service. This is not an ad. I really just love my blender. Anyway, I put chopped celery, about ⅓ of an English cucumber sliced, parsley which I buy and freeze and just pull a chunk out, a lemon- whole but peeled, a chunk of ginger (to your liking) and a handful of greens- lately I have been using Power Greens which is a bunch of baby dark leafy greens like spinach, chard, and kale. I blend that with some ice and water and drink it almost daily. It makes me feel light and energized. 

I tried just a couple pieces of celery all by themselves with some water and ice and it was horrible. I got a gag reflex from it but finished it and then felt nauseous for about an hour afterward. This might be a sign that my liver or gallbladder was getting some benefit and clearing out some toxins. 

So I have that- I do have breakfast which consists of leftovers. Things like hamburger patties on a bed of lettuce with onion dressing from Nom Nom Paleo’s Ready or Not cookbook. So good.  Or I will have leftover soup. 

I made roasted chicken for dinner last week and turned the leftovers in to soup with chopped carrot, celery and onion sautéed and then I added in the leftover chicken, pulled off the bone and shredded a bit with a zucchini chopped in to bite sized pieces and bone broth.  

I bought some pastured local mild Italian sausage and sautéed that in coconut oil with an onion and half a small butternut squash cut into bite sized pieces with some dried sage- about a Tablespoon. I had that for breakfast after my celery juice and then some green juice and a whole bunch of homemade chocolate bark- cocoa powder, coconut oil, some honey, sea salt with pumpkin seeds and goji berries. I can’t stop eating that stuff. I don’t make stuff like that often because I don’t have a lot of self control with sugar. 

We had burgers last night and I had mine on a salad. I will put almost any leftover meat on a salad and if you like fish you can do canned tuna, sardines or salmon on a salad. I am not a fan of fish at all so that is not for me. 

I did chicken breast sautéed with lots of garlic, broccoli and carrot “noodles” and coconut aminos for lunch yesterday and will eat that for lunch today too. 

I love the Thai Beef Stew from Against All Grain. You can find that on her website if you google it. I will make a big batch of that and eat it for lunch and breakfast. I was away from home most of the day last Saturday so I had lunch and dinner at the same place because they have some good gluten free meat options which I knew would fill me up. I had pulled pork- like a pound for lunch and dinner and it was a little too much meat with no veggies so I ate way more veggies on Sunday. I don’t feel great eating too much fat and meat so I have to work harder at eating more veggies. 

I like veggies roasted best- the rest of my family hates when I do that. So I usually make a sheet pan of roasted veg just for me. Broccoli, cauliflower, and cabbage are my favorites roasted with olive oil and sea salt or Redmond Real Salt. 

I will do a segment in my newsletter of meals I’ve eaten over the week if that would be helpful. Head over to my website and sign up for my newsletter. 

If you have questions about todays episode go over to my website under Epidsode 29 and leave a comment on the blog post for this episode. I will do my best to answer it as quickly as possible. Was this information helpful? Do you need something clarified? Let me no so I can help you out. 

If you have a question you want addressed on the podcast you can fill out the contact form on my website. I can’t wait to hear from you. 

You can find me at outofthewoodsnutriton.com or helpforhashimotos.com- they are the same website, on facebook at Out of The Woods Nutrition and join my private facebook group Help For Hashimoto’s to get support on your journey. You can also find me on Instagram as @stephanieewalsntp

I’m going to do some live group coaching in January- does that sound like something you would be interested in? I also have room for a couple of new clients working on diet changes, seeing where your body is out of balance and addressing those imbalances so you can feel better. Reach out to me on my contact page if this seems like something you might be interested in. We can chat to see if we are a good fit for working together. 

Thanks so much for listening. See you next week.