Migraines and thyroid

An interesting article on the role of an even slightly underperforming thyroid on migraines.

http://headaches.about.com/od/comorbidconditions/a/thyroid_comorb.htm

Has anyone here had a doctor investigate their thyroid? I've never had anyone bring it up. I think you need an endocrinologist to really understand it. I've found that every specialty seems to see the patient through their own lens, and this isn't what the typical nuero thinks about.

From past surveys on this site, quite a few of us have thyroid problems and yes I am fairly sure it does have an influence.

Unfortunately/fortunately?? my thyroid does still produce enough hormone within the standard range and I am not medicated. My thyroid is just under attack from my own antibodies (Hashimoto's).

I am wondering though, for those other sufferers whose tsh is outside range, has thyroid suppliments helped with the migraines? Would actually be very interested in answers.

My thyroid stopped functioning altogether after the birth of my third child. The thyroid gland itself has withered away over time and I have no function in it at all. I have been on thyroid replacement medication, both T3 and T4 for 28 years and have maintained ''normal'' levels throughout that time.

Supplementation with T3 and/or T4 has made absolutely no difference in the occurrence and severity of my migraines and daily headaches, which I have been suffering since I was 10 years of age. I wish I had some positive outcomes to report for you but that is how it has been for me.

Low thyroid levels certainly made me feel as if I was going totally mad. I could not remember anything, my house was full of post-it notes to jog my memory. I was extremely cold and tired and very depressed. My hair was falling out and my skin was dry. I was living a very miserable existence until hypothyroidism was diagnosed.

I have read several books on thyroid that basically say the "normal limits" established for thyroid production are not well founded. That low functioning thyroid even within what is called normal range can lead to a whole host of problems. I am not taking a thyroid supplement. Just iodide which is supposed to help the thyroid, but I don't know if this is sufficient. Hard to find doctors who really know about this.

Marion.

I have Hashi's, Hypothyroidism, and thyroid nodules. I am treated for it, and unfortunately, no it doesn't seem to help with the migraines.

Dawn

Well I guess that puts a wet blanket on the idea that thyroid medication might help.

Head hasn't been too bad lately, neck is being the proverbial pain in the neck. It seems the more the neck hurts, the less the head hurts. How totally illogical is that.

Looking forward to Christmas and no work for two weeks. Soo looking forward to that.

marion wrote:
Head hasn't been too bad lately, neck is being the proverbial pain in the neck. It seems the more the neck hurts, the less the head hurts. How totally illogical is that.

I experience the same issue Marion although as my neck gets worse, it will eventually trigger a migraine. Sometimes although the neck pain is chronic, its nice not to have a full on migraine for a few days. Takes the fogginess away from the head. sigh....stupid bodies!

Hi Everyone...
What I am hearing is that so many are tired of grasping for straws to find one more thing that didn't work....

I empathize....

What I've noticed is that most conditions, including migraines, require more than just one approach. My specialty is Hashimotos which can never be resolved by doing just one thing. I requires an approach from several fronts and sometimes just one more thing suddenly turns everything around.

Yes, sometimes improving or optimizing thyroid hormones doesn't really shift a person's health a great deal and then you add some progesterone and something shifts, and they feel a lot better.

The body is so very complex... it wasn't until just recently that we discovered thyroid hormone receptors on ovaries AND progesterone receptors on thyroid cells... it's a friggin' symphony and any kind of linear thinking has obvious limitations.

So I suppose my message is looking at this from another perspective. If my thyroid hormone production is low why wait until it is so low that I'm finally given a diagnosis of Hypothyroidism. Use some iodide, selenium, zinc and iron to feed the thyroid so it has what it needs to make its hormones.

Have your progesterone and estrogen levels checked through saliva hormone testing and find a way of getting some oral progesterone rather than just the cream. The oral P is metabolized into hydroxy-progesterone which for some people suffering from migraines has made a tremendous difference.

If you have chronic fatigue from chronic pain find out if your adrenals can still make any cortisol, the hormone produced by our adrenals which is our natural anti-inflammatory and helps to increase endorphins. You can check this through saliva hormone testing of your morning saliva and evening. If it is low then consider ways to improve cortisol levels. This can be done through supplements (Cytozyme AD from Biotics Research) or through pharmacy (Cortisol in extremely low doses... Read Dr. William Jefferies, MD "Safe Uses of Cortisol."

Maybe one approach is simply to ask, "How can I improve my health?" I hope I don't sound pretentious... I have been blessed with health my whole life and I'm just wanting to help.

Dr. Alexander Haskell

Dr Haskell,

Thanks for your post on this. I agree with you that thyroid is often overlooked or misunderstood.

My thyroid was enlarged at my physical last month. A scan shows a small nodule on it which the radiologist and my doctor both think is probably not significant. My thyroid hormone test also was high indicating an under performing thyroid.

My doctor had me stop taking the iodide I had been on for about 8 months thinking it might be aggravating the thyroid or overtaxing it. I just got retested 1 month later and my thyroid now tests normal. He says to stay off the iodide.

So now I don't know what to do. I do take oral progesterone, magnesium, and vitamin D which have helped a great deal. They have reduced my daily headaches from about 80% of the month to 2-3 per month, which is much better, but not eliminated. I thought thyroid supplements might help, but now that is out. I do have low temperature (97 degrees) and recent weight gain which are signs of a problem.

Hi Migrainegirl...
Thanks for responding... sending information out into the universe.... you never know if it's kind of a waste of time... so thanks for staying in touch...

Would you mind sending me your thyroid values? Have you been checked for thyroid antibodies?

Look forward to hearing from you... again.
Dr.H

T3 = 3.0
T4 = 6.0
Thyroid antibody = <10 (microsomal TPO-Ab), <20 (thyroglobulin antibodies)
TSH = 2.44

All show to be well within the normal range now.

Hi MGG...

Here are a few thought on your results which may add a bit of clarity...

The TSH is just about right... not too hot... not too cold....just slightly higher than optimal which is about 2.0-2.2...
The T4, even though it's within the reference range of the lab should optimally be around 8.5-9.0.
But I see that the T3, which I'll assume is Free T3, is just about in the middle of the reference range.

So I ask, how is it possible for there to be suboptimal levels of the thyroid hormone T4 (thyroxine) with very good levels of T3. Know that T3 is produced by the thyroid gland but it primarily comes from removing one of the iodines from T4 to make T3. So how can T4 be low and T3 be OK?

Remember that these results are measuring what is in the blood. Only the free forms of T4 and T3 are able to leave the blood stream and even then, these hormones must cross the membranes of our cells to actually attach or bind to their receptor sites within the nucleus.

So what I've noticed is that when Free T4 is low and Free T3 optimal or higher I consider that there may be a problem with these nuclear receptors or getting the thyroid hormones into the cells and onto their receptors.

These nuclear receptors are made of a protein, vitamin A and vitamin D. A deficiency of either vitamins will cause a low population of these receptors. Inadequate receptors can be one cause of low thyroid hormone symptoms.

Vitamin D deficiency is very common and it can lead to low thyroid hormone symptoms even though the person may have perfect lab results.

There's another hormone which our adrenals make called cortisol. Cortisol is really important for our health and has a lot to do with thyroid hormones. Cortisol helps to convert T4 to T3. Cortisol assists thyroid hormones to cross over the cell membranes to enter our cells. And most important it primes these nuclear receptors so that thyroid hormones can bind. I have seen this often, of getting a person's thyroid hormone levels optimal, them not feeling that much better, and then a dramatic improvement when they were put on low dose cortisol.

This work on cortisol was primarily from the research and clinical insights of a Dr. William Jefferies, MD, who wrote a phenomenal book called The Safe Uses of Cortisol.

I hope I have added some clarity and not simply stirred the pot to make it more murky...

All the best.
Dr. Haskell

Dr Haskell,

My 28-year-old daughter is seeing her endocrinologist in April. Her last testing was done in 2009. At that time:

TSH: 1.11
FSH: 4.8
T4: 1.2
Cortisol: 1
Prolactin: 36.6

Her highest TSH was in 2005 (5.48)

Her highest cortisol was in 2006 (21)

Her said these results were ok, except for low cortisol. She cannot tolerate steroids. She has tried steroids very short term, and the results were never good.

She has had brain surgeries for Chiari Malformation and has a history of high intracranial pressure and a probable long term CSF leak (two years) from a shunt. Constant and severe HA since 2003.

Any advice?

Dr Haskell,

Thanks so much for that very enlightening response. It certainly sheds more light on the whole thyroid function which is rather complex. Since I am taking 5000 mg of vitamin D a day, and my levels for D are in the normal range, I am guessing that is most likely not the culprit. So I will definitely look into the Cortisol angle and see if that helps.

Thank you again.

MG

Hi Anna's Mom....
This, to me, is a sad situation, when someone is consulting with an endocrinologist that doesn't understand how to intrepret lab tests in a practical way to help their patient.

Your daughter has a TSH of 1.11. Ideally it should be around 2.0. When it comes to health we must think about what is optimal and not be governed by lab reference ranges which are often far too wide. But anyway.... with a TSH on the lower side of normal you would have to think that her thyroid hormones (T4- which I'll assume is Free T4) should at least be optimal but they are not.

Normally when TSH is low it should mean that there's more than enough thyroid hormones... and when TSH is high it means that this hormone is trying to stimulate the thyroid to produce more thyroid hormones. In your daughter's case she has low thyroid hormones and so TSH should be at least 2 if not a little higher to get her thyroid pumping...

Then the question is, why is her TSH not higher? This could be because it has had to work overtime and is just worn out.
Her T4 could be low because it just isn't getting the stimulation it needs since her TSH is low. It could also be because her thyroid is not getting the nutrients it needs to make its hormones. If the thyroid doesn't get the nutrients there's no way it can make its hormones.

I suspect the first step years ago was that her thyroid didn't get the nutrients so the production of thyroid hormones declined.. then TSH went up trying to stimulate more thyroid hormone production... and TSH remained high for years... but now it's just lying on the couch.... needing a nap.

There is a way to accomplish both an increase in TSH and increase in thyroid hormones using nutrients. BUT you must be sure that she does not have thyroid antibodies, both TPO or Thyroperoxidase and TGA or Anti-thyroglobulin antibodies.

Iodide and iodine will stimulate the production of TSH and iodide is an essential nutrient which thyroid cells need to make their hormones. The thyroid also needs selenium, zinc and iron as well but iodide is the most important and often the most deficient.

The reason why you need to know if she has antibodies is because if you increase TSH using iodide and iodine, this hormone will stimulate thyroid cells to make hydrogen peroxide which converts iodide into iodine, the form used to make thyroid hormones. If she has thyroid antibodies (Hashimotos Thyroiditis) then this higher levels of TSH will lead to more and more hydrogen peroxide production causing even more thyroid inflammation.

Whew.... now for the cortisol.... this is really, really important. I have no idea about your daughter's health and the reasons for her not being well, but cortisol is so very important for so many reason. I understand her reaction to the various hydrocortisone prescriptions which I'm sure were either prednisone or dexamethasone or some other derivatives, and so many people have negative reactions to these.

But what will help her tremendously since her levels are so very low is the use of USP hydrocorisone which is miniscule in comparison to these other forms. I really suggest you read the book by Dr. William Jefferies, M.D. called the Safe Uses of Cortisol and then you'll understand why I'm making this suggestion. I'm talking about 5mg 3-4 times daily. This is far less than the typical 20mg of prednisone which is equivalent to about 80mg. This is far too much.

Our adrenals make about 30-40mg a day and so the low dose approach of adding on about 15-25 mg is only to optimize her levels. This is considered the physiological approach to using cortisol rather than the pharmacological approach which ALWAYS has side effects.

I wish you all the best with finding someone who truly understands the endocrine system and how to optimize thyroid and cortisol levels....

Dr. Haskell

Thank you, Dr. Haskell, for taking the time to write to me.

The endocrinologist we see tells me he is the most progressive endo in our state because he is the only endo who will prescribe Armour.

I took my daughter to a different endo in 2009 who said her problems are unique and beyond the experience and scope of his practice. He said I was doing the right thing in taking her out-of-state to specialists who see many patients with her conditions (Chiari and high intracranial pressure).

But all the endo visits, anywhere we go...they don't want to do anything for her.

I could take her to the Mayo Clinic endocrinology clinic...we live fairly close...but doctors there are conservative. I don't think their endos would do anything different. Or do you think I am wrong on that?

I took her to a major headache center in Chicago last fall, and she was hospitalized with them for three weeks. Their endo was called in, but she didn't even want to do new testing once she heard my daughter's endo test results had been normal for the past five years.

ND's cannot do blood tests here in Minnesota. I have thought about taking my daughter to a functional medicine M.D. in Minnesota.

I have wondered if N.D.'s can do blood tests in states near us: North Dakota, South Dakota, Wisconsin, Illinois. Do you happen to know that, Dr. Haskell? I've never looked it up.

As I said, she will be seeing her endo soon for new testing. But I have a feeling he won't "find" anything to treat.

There was another reason why the two Minnesota endos didn't want to prescribe steroids for her low cortisol (other than that steroids make her feel worse). She had gained 100 pounds, including a lot of fluid weight) in several years of being ill. No one could explain the fluid retention and weight gain, other than to blame migraine preventatives (Neurontin, Lyrica, Nortriptyline and such). They didn't want to prescribe steroids and have her gain even more weight.

She has lost over 60 pounds since last fall, and her weight loss continues. She is very ill, she doesn't eat much, but that has been her norm for several years. Why she is losing weight like this when for years she was gaining weight, I really don't know for sure.

Thanks for your help.

Cheryl

Hi Cheryl,
Your daughter's case is complex but I am sure there are a number of things that could help, thyroid and adrenals being two of them.

My license allows me to order labs in other states so this is a possibility for you.

I highly recommend pursuing the physiological low dose of cortisol. There is no other more effective way to get her levels where they should be as quickly as possible. I believe this would a lot with any further weight loss as well as decreasing any inflammation since this is the body's own natural anti-inflammatory.

You likely already have a lot of previous lab results. My suggestion would be TSH, T4, Free T4, Free T3, Reverse T3 and two tests to rule out Hashimotos... knowing she doesn't have Hashimotos helps to include some important nutrients to nourish her thyroid.

I don't know your daughter's age but you may also want to check her estrogen and progesterone levels. Best way is through saliva hormone testing which any ND in your area can help with. We can also ship a kit to you for home collection.

all the best,
Dr Haskell

Hi Cheryl,
Just one more thing, about why it's important to check her for Hashimotos.... Armour thyroid should not be taken by people with Hashimotos... the reason being that pig thyroid cells are almost identical to our own cells. This means that when they are digested they release the enzyme Thyroperoxidase and the protein Thyroglobulin. If we have these antibodies, TPO (Thyroperoxidase) and TGA (Anti-Thyroglobulin) antibodies, they will be activated by the pig thyroid gland prescription...

thanks...

Blood tests through LabCorp? Thanks for all the info. I'll look for that book.

I'll see what happens when she gets tested by the endo in April, and I will keep all of this in mind for after that. He just happened to mention to Armour thing, but he didn't say she needs it.

She is 28, and she has been on Micronor (progesterone) for years as a migraine preventative. So that is another factor for her.

Thanks so much, Dr. Haskell

Cheryl

Hi Cheryl...
Yes, LabCorp....
I understand how painful it can be so see our child suffer.... I have 5 myself...
Dr. Haskell

Hi Dr Haskell,

Thanks for all that information, can you add a bit about what to do for insane antibodies/hashimoto's and graves?

These results are from last year, and I only have one set of T3 and T4's as the health policy in Australia is that if your TSH is in range there is no need to go further.

IMMUNOGLOBULIN
IgE 3840 kU/L (0-100)

THYROID FUNCTION TESTS
TSH 1.7 1.8 1.7 mU/L (0.40-4.00)
Free Thyroxine (ft4) 13 pmol/L (10-20)
Free T3 5.3 pmol/L (2.8-6.

(T3/T4 results 10/05/10)

THYROID ANTIBODIES
Anti-Thyrogobulin Ab 30 59 U/mL (<60)
Anti-Thyroid Peroxidase Ab 1200 1200 U/mL (<60)
TSH Receptor Antibodies (or TSI) 2.6 U/L (<1.0) (PATHOLOGY LAB SAID SAME AS TSI)

And yes, my body is not a fan of iodised salt which was the gp's recommendation. It resulted in symptoms quite similiar to Meniere's which went away quite quickly after I stopped using.

I am basically trying to eat only fresh fruit/veg/meat at the moment which has been quite successful in the CFS symptoms but I made the mistake a few weeks ago of trying fish oil and glococimen (sic) to help with the neck.

This resulted in the CFS symptoms stepping up and a doubling of rashes.

Any suggestions on a strategy to get these antibodies under control and stop attacking everything including me would be gratefully accepted!!!

Just putting a note on this thread to bump it back up to the top.

If you do come back Dr Haskell I really would appreciate any ideas on how to get these antibodies under control. As you probably have heard many times before, until my TSH goes out of range or my thyroid dies, I am stuck in no man's land as far as receiving any type of standard treatment.

Any advice very gratefully received.

Marion

Hi all!

I thought you'd be interested to know that my thyroid medication has had a direct impact on my silent migraines (although I didn't realize my symptoms of weak throbbing muscles, tingling limbs, burning scalp, extreme fatigue, and brain fog were the result of silent migraines at the time.)

I'd been having the migraine symptoms for two years, with 2-3 episodes a week, 2-3 really bad episodes a month that made it just about impossible to walk. I'd been taking Synthroid for about four years. My doctor said he wanted to try an additional thyroid medicine, as he said my body was not processing the Synthroid, and the second medicine would help it to do so. He put me on Cytomel, and I felt a difference within three weeks.

My thyroid is starting to fluctuate again (it's not completely dead yet), so I'm starting to have some episodes again, but honestly, since going on the Cytomel, I've gone almost three years with only a light episode here or there. If it wasn't the Cytomel, it was an really big coincidence.

Good luck to all!

Hi Marion....
This is pretty complicated but I'll give it a shot....

Even though the TSH is only 1.7, which is pretty ideal but not for Hashimotos, it will still need to come down.

If you did not have the TSH Receptor antibodies I believe that your thyroid hormones would be lower. This is because these abs are stimulating the TSH Receptors as if they were TSH. I really haven't the knowledge to speak about these abs so I don't know how to get them lowered.

If you were here I would suggest small doses of a thyroid medication (T4 & T3 Immediate Release), like 1/8 of what the normal dose would be and to slightly increase the dose every 10 days to get the TSH down. I don't know if this would effect the TSH Receptor antibodies or not.

Compared to the level of Free T4, the Free T3 is slightly on the high side. This can be due to an iodide deficiency (don't take it though) or a problem with T3 getting inside the cells of the body and not being utilized. The hormone cortisol helps T3 cross the cell membrane as well as priming the nuclear receptors allowing T3 to engage.

Vitamin D and vitamin A are also necessary for these nuclear receptors since they are make of protein, A and D.

There is often a direct connection between gut inflammation and thyroid inflammation. You have elevated IgE's which can be due to gut ecology problems. The first step is to avoid gluten food completely, 100%, and to avoid any other foods which you suspect you react to. The problem is that most of the time people don't know they are reacting to foods since they are often delayed hypersensitivities. Consider going on a hypoallergenic diet for 2 weeks and then introducing a new food for a couple of days to see if there is a reaction. One reaction to watch for is an increase in your pulse rate. If you pulse is 60bpm before eating the possible allergenic food and your heart is 70 about 20-30 minutes later this may help to make a confirmation.

Hope this helps and adds a bit of clarity to a somewhat complex situation.
Dr. Haskell

Dr. Haskell,
One more question please. I have been on and off Synthroid 3 times in the last 18 years.
My hair was falling out again so I had a full panel done. My TSH is always normal.
TSH normal
T4's low
I have always been fine with Synthroid but this time even at 25 mcg I started having Tachycardia, and feeling faint. I would cough or bear down to get back in a normal rate. The only thing that is different is I lost my last ovary in 2006 to a botched laparoscopy, severed artery, 5 transfusions with 2 emergency surgeries, 18 in pt for SBO, 6 surgeries, and I have a Estrogen patch.

I told my Endo.doc and he upped my dose. I finally quit taking it. It was nice to have my hair stop falling out.
What is that about?
kathy