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As well as being on the correct type of thyroid medication for you and finding the optimal dosage, it’s also important to address other factors that can be contributing to you feeling unwell.
I thought for a long while that once I got my thyroid levels optimal (on NDT medication), I would return to the level of health and fitness that I had before, but I didn’t.
Even with optimal thyroid hormone levels, I still had ongoing fatigue, poor stamina, cystic acne, irregular periods and more, which suggested that I needed to look at other issues and imbalances within my body. After all, there is often so much more to the thyroid jigsaw puzzle than thyroid medication alone.
A lot of research led me to many possibilities, but I soon learnt that I had adrenal fatigue (though it is more accurately referred to as hypothalamic-pituitary axis dysfunction), partnered with a sex hormone imbalance (oestrogen dominance) and leaky gut (Candida).
Leaky gut is a very common issue for thyroid patients, especially those of us with Hashimoto’s and in fact, various sources such as Thyroid Pharmacist Izabella Wentz, state that a leaky gut needs to be present for Hashimoto’s to even be triggered. 
But what is it?
What is Leaky Gut?
Hippocrates, a Greek Physician often considered to be one of the most outstanding figures in the history of medicine, said “All disease begins in the gut” and 2500 years later, we’re just beginning to understand how right he was!
Poor gut health can suppress thyroid function and trigger Hashimoto’s, yes, but low thyroid function can also lead to leaky gut, so it works both ways. Chances are, most of us with Hashimoto’s have some degree of leaky gut.
‘Leaky Gut’ is used to refer to when the intestinal barrier of the gut becomes permeable from hypothyroidism, infections, food intolerances (especially gluten) or even stress, which then goes on to cause other problems and symptoms.
Symptoms of leaky gut can include:
- Impaired metabolism
- Ongoing fatigue
- Mental health struggles
- Weight gain/inability to lose weight
- A coating on the tongue
- A large, scalloped tongue
- Heartburn/acid reflux
- Bad breath
- Nutrient malabsorption
- Skin conditions
Symptoms can be quite tailored to the individual and for me, I experienced the fatigue, poor stamina, cystic acne, mental health issues, scalloped tongue and irregular bowel movements.
I suspect I’ve had gut issues since being a teenager, and this likely contributed to the triggering my Hashimoto’s at sixteen-years-old.
Why Is the Gut Important in Thyroid Health?
The gut assists in converting inactive thyroid hormone T4 to active T3 (what we need for energy and many functions within the body), which requires an enzyme called intestinal sulfatase.
However, this enzyme comes from healthy gut bacteria. Bad gut can = a lack of this important enzyme.
Intestinal dysbiosis is an imbalance between pathogenic and beneficial bacteria in the gut, which can significantly reduce thyroid hormone conversion – just one reason why people with poor gut health may have thyroid symptoms but ‘normal’ test results. 
Constipation from poor gut health can also have knock on effects. It can impair hormone clearance from the body, which causes oestrogen levels to rise. These high oestrogen levels then decrease the amount of thyroid hormones available, making you feel more hypothyroid and fatigued. 
It’s a real catch-22 situation. And we know that constipation/non regular bowel movements are a common symptom of hypothyroidism.
Any inflammation within the gut can also lead or contribute to adrenal dysfunction (something else I have experience with!)
A response from the adrenal glands in the face of stress, prolonged over a lengthy course of time, can go on to cause long term adrenal dysfunction. ‘Adrenal fatigue’ can cause a whole list of symptoms on its own but does also impact thyroid function since they’re both part of the endocrine system. ‘Adrenal fatigue‘ is a common, separate condition, that many thyroid patients also have, often without knowing.
Candida (Yeast Overgrowth)
Candida, the most common form of leaky gut, means you have an overgrowth of yeast in your body, causing all kinds of issues.
Yeast exists in the gut naturally and, in the right amount, isn’t an issue, but high stress, antibiotics and sugar can cause it to thrive and become power hungry.
Do you have hormonal issues? Still feel fatigued despite being on thyroid medication? Feel stressed a lot? Have any other ongoing symptoms? Please do check for candida.
The Signs I Had Candida
For me, my usually regular periods started to become massively irregular and could come at any time. At twenty-two, I also began breaking out in severe, cystic acne. I’m not talking a few pimples, I mean that so much of my face was covered in these deep, painful cysts that they joined up to cause mountains of pain on my cheeks. They left deep scarring and bruising that lasted months.
Having leaky gut with a sex hormone imbalance isn’t unusual, since with leaky gut, often excess hormone isn’t being cleared from the body effectively, and leaky gut itself can lead to adrenal dysfunction which also impacts, causes and worsens hormonal imbalances such as that of oestrogen and progesterone. It’s a bad cycle!
A candida overgrowth, often caused by a high sugar diet, high stress levels, anxiety and antibiotic use, is very common in thyroid patients.
In my case, dysbiosis had occurred following extremely high stress levels for years (both mentally and physically) and various rounds of antibiotics.
My first appointment with a functional medicine practitioner confirmed the overgrowth but trying to pin-point when exactly it started was hard, since I’d never gone to the loo regularly enough (just once every 1-2 weeks my whole life) and it was most likely in place to trigger my Hashimoto’s at sixteen-years-old.
So, How Do You Treat Candida?
Since being confirmed as having a leaky gut in the form of candida, I’ve been taking probiotics daily to replenish the good bacteria in my gut, Epsom salts in my baths to detox, digestive enzymes to help move things along and absorb nutrients from my food properly, apple cider vinegar and Grapefruit Seed Extract / oregano oil – a natural remedy to clear my body of the excess yeast. I also drank bone broth daily to health the gut lining. I have had my functional medicine practitioner to guide me on all of these and the correct protocols.
I’ve also cut out alcohol, am following a very low sugar diet (see this link on the exact foods my functional medicine practitioner included on my candida diet/cleanse), and implementing helpful foods such as anything high in protein, chia seeds, coconut oil, turmeric, cinnamon, flaxseed, hemp oil, oregano and garlic, all to support my gut health and the process of overcoming candida.
Supplements that can also boost the body’s resistance to yeast include folic acid, Vitamin C, Zinc, Pyridoxal-5-phosphate, Vitamin A, riboflavin, magnesium and selenium. Caprylic acid is a naturally occurring anti-fungal found in coconut oil which can also help combat candida, as it kills off bad organisms but doesn’t affect useful organisms. Handy!
Zinc supplementation can also help to tighten the intestinal junctions of those with leaky gut.
How Long Does it Take To Overcome?
For most patients, following this kind of treatment for a few months is long enough to restore the correct balance of yeast and good bacteria in the gut, but for some, it can take longer. It of course also depends on how strictly you’re following the advice of your healthcare team (I see a functional medicine practitioner) and how severe your case is.
After the balance has been restored, you can often reintroduce more foods, but bearing in mind that you’ll need to promote good gut health going forward, so as not to relapse again.
Overcoming a leaky gut and especially candida, can result in much improved energy levels, skin complaints resolving, sex hormones in better balance and even better mental health.
Do you have experience with leaky gut?
You can click on the hyperlinks in the above post to learn more and see references to information given.
Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing her Thyroid Family email newsletters and speaking on podcasts, as well as being a founding board member for the American College of Thyroidology. She is well-recognised as a crucial contributor to the thyroid community and has a large social media presence. Her books include “Be Your Own Thyroid Advocate” and “You, Me and Hypothyroidism”.