A 39-year-old female diagnosed with Hashimoto’s after first baby—that’s the most common time of diagnosis in women —also tested positive with Blastocystis. Functional doctor prescribed LDN, but she didn’t take it, did a reset with antimicrobials. She has had two miscarriages since second baby. Obstetrician thinks it’s thyroid causing it and advised going on thyroxine low dose. The patient is unsure if they’ll try for another baby but does want to know if it’s the best option or if should she do LDN or the Armour. Open to getting her stool screened again to see if Blastocystis is still there. Currently follows Paleo but include eggs, nightshades, and full-fat raw dairy. Scared to give them up because she loves them. Also wants to know even if she doesn’t have any more kids should she be on something for thyroid considering she can’t get the antibodies completely down through diet supplements and lifestyle.

Chris Kresser: Okay, lots of questions in there. First is if she’s not willing to try —if a patient has an autoimmune disease like Hashimoto’s, I definitely recommend trying at least once an autoimmune Paleo protocol. As you know, I don’t believe that everyone who has an autoimmune condition has to be on an autoimmune protocol forever. I just think it’s worth a try, especially if antibody production is still high. If she’s not willing to do that, then trying low-dose naltrexone is certainly worthwhile. It’s very effective in many cases and quite safe and well tolerated. I think that’s worth looking into. In terms of whether a replacement a hormone makes sense, you really have to look at TSH and then free T4 and free T3 to make that evaluation. I don’t really see the logic in treating patients with Hashimoto’s that have optimal TSH and optimal T3 with thyroid hormone, because in that case, they may have antibody production, but it doesn’t seem to be affecting their actual hormone production. It’s important to note that I think there’s a lot of hysteria about thyroid antibody production as if it’s a disease that has a guaranteed outcome. The truth is majority of patients with elevated thyroid antibodies don’t progress to clinical hypothyroidism. They certainly have a dramatically higher risk of doing that compared to patients without thyroid antibody production, but that risk is nowhere near 100 percent. It’s not even 50 percent. I think it’s 25 or 30 percent. When a patient has antibody production but normal thyroid hormones, the main focus needs to be quelling the autoimmune response and doing that ideally first with diet and then other supportive interventions depending on what’s going on and then you could consider things like LDN, glutathione, optimizing vitamin D levels, etc., certain immune-regulating herbs etc.