Kris Carr

Blog Post

Thyroid Health: Symptoms, Diagnosis & Healing

Hi Sweet Friends,

I’m usually a chirpy and peppy gal, so when I started feeling sluggish on a regular basis, I put on my detective’s hat and headed to my regular investigative hot spots—the doc’s office and the bookstore. After looking under the hood and between the lines, it turned out that my adrenals (and some plain ole stress) were the major culprits. But through my sleuthing I learned a lot about thyroid health and discovered that it’s a large contributor to many of the chronic physical and mental issues people face today.

OK, let’s get glandular. So many of my readers ask about how to find their way back to wellness, especially when they’re experiencing daily discomforts and they aren’t getting answers at the doctor’s office. Symptoms such as depression, aches and pains, low sex drive, unexplained weight gain, relentless colds, brittle hair and dry skin are very common and could be the result of thyroid problems.

Perhaps you’re just starting to connect the dots when it comes to your health or maybe you’ve been down this road before and still don’t have answers—regardless, please don’t give up! Often, a deeper, more holistic look is needed to find a longterm solution. Hopefully, what you’re about to read will equip you with the knowledge you need to go on that quest with confidence, whether your thyroid gland is the root of your challenges or just something to explore along the way. And because I take your health (and mine) very seriously, this blog was highly researched and vetted by three well-respected RD’s. Dang!

Read on to learn what the butterfly-shaped thyroid gland does, how to figure out whether it’s on the fritz, and, if that’s the case, how to get your thyroid (and your well-being) back on track.

Getting to know your thyroid gland

Your thyroid is two inches long and its “wings” are wrapped around your windpipe (near your Adam’s apple in your neck). It’s an important little bugger that produces several hormones including two that are key in regulating growth and metabolism: T3 (triiodothyronine) and T4 (thyroxine).

T3 and T4 hormones are essential because they:

  • Help cells convert calories and oxygen into energy
  • Determine growth and development of many tissues in the body, including the brain and skeleton
  • Work to increase Basal Metabolic Rate—the amount of energy you burn just sitting still

The pituitary gland produces TSH (Thyroid Stimulating Hormone), which stimulates the production of thyroid hormones T3 and T4. The production of the Ts is dependent on sufficient iodine intake from foods and supplements. The hormones then work to regulate cell growth and development by converting protein, carbs and fat into energy. The catch? Vitamin D must be present for the Ts to do their important work. (We’ll talk more about iodine and vitamin D later!)

When we’re healthy and things are swimming along in our systems, the thyroid gland produces T3 and T4 hormones and does its job quite well. But what about when things get out of whack? In the world of the thyroid, both too much and too little of this typically good thing can cause major problems, which leads us to…


What’s the difference between hypothyroidism and hyperthyroidism?

Hypothyroidism: Underactive Thyroid Disease

Think of it this way: hypo means not enough, and hyper means too much. When your thyroid gland doesn’t make enough of the essential thyroid hormones (either one or both T3 or T4), symptoms of hypothyroidism eventually pop up. Hypothyroidism can be caused by removal of the thyroid gland, a hypothyroid condition present at birth, inflammation of the thyroid gland, radiation exposure, or an autoimmune disease called Hashimoto’s Disease.

You’re more likely to develop hypothyroidism if:

  • You’re a woman
  • You’re over age 60
  • You have a family history of thyroid disease
  • You have another autoimmune disease such as type 1 diabetes, rheumatoid arthritis, or lupus
  • You’ve been pregnant in the last six months

Symptoms of hypothyroidism include weight gain, difficulty metabolizing carbohydrates and sugars, joint pain, depression, infertility or irregular periods, tightness in the throat, sensitivity to heat and cold, panic attacks, high cholesterol, memory loss, vision problems, dry skin and hair loss.

Diagnosis for hypothyroidism is made by measuring blood levels of thyroid stimulating hormone (TSH). Generally, if the TSH level is above normal, it means hypothyroidism. A low T4 level also indicates hypothyroidism.

Hypothyroid treatment includes taking a synthetic hormone replacement (identical to T4). To determine the dosage, blood levels of TSH are tested regularly. Keep in mind that although adequate iodine intake is necessary for a healthy thyroid, excess amounts may cause or worsen hypothyroidism. See my section on holistic approaches for ways you can be proactive about your thyroid health.

Hyperthyroidism: Overactive Thyroid Disease

You can think about hyperthyroidism as your lovely butterfly gland going on a nectar bender. When the thyroid gland makes more thyroid hormone than you need, many bodily functions speed up—including metabolism.

You’re more likely to develop hyperthyroidism if:

  • You’re a woman
  • You’re over age 60
  • You have a family history of thyroid disease
  • You have type 1 diabetes
  • You’ve been pregnant in the last six months
  • You have a vitamin B12 deficiency

Symptoms of hyperthyroidism include: insomnia, nervousness, weight loss, mood swings and irritability, rapid and irregular heartbeat, heat intolerance and the development of a goiter (an enlarged, swollen thyroid gland). Hyperthyroidism can be caused by Graves’ disease, thyroid nodules (lumps in the thyroid), inflammation of the thyroid, consuming too much iodine, or taking too much synthetic thyroid hormone to treat hypothyroidism.

Diagnosis for hyperthyroidism is made after your doc does a few blood tests. The following factors point to a batty butterfly:

  • TSH levels are very low
  • T3 and T4 levels are high
  • Radioactive Iodine Uptake is abnormal

Radioactive Iodine Uptake (RAI-U) testing is just what it sounds like: the test shows how much radioactive iodine your thyroid can absorb four to six hours and then 24 hours after consuming a dose of iodine (tasty, no?). This is important because it helps determine what exactly is sending your thyroid into overdrive. Health professionals will also feel for an enlarged thyroid, listen for heart palpitations, and measure for weight loss as they diagnose hyperthyroidism.

Treatment of hyperthyroidism is trickier and more individualized depending on the cause of the hyperthyroidism and the severity of it. Treatment often includes radioiodine therapy, surgery, and/or medication to ease the many health challenges that arise from an overactive thyroid. Although there may not be holistic treatments for hyperthyroidism, there are still many diet and lifestyle upgrades you can make to improve your overall thyroid gland health. More on that soon!

Additional information on diagnosing hypothyroidism and hyperthyroidism

I was pretty confused about diagnosing these issues until I read Frank Lipman MD’s take on thyroid health in his book, Revive. Dr. Lipman suggests three approaches to checking thyroid function: your symptoms, underarm temperature and blood test results. To avoid being misdiagnosed or having a thyroid problem overlooked, make sure you’re working with an open-minded practitioner who is looking at all three of these factors.

Also, ask your doctor about the blood tests he or she is requesting (you have the right to know!). Dr. Lipman suggests the following tests for a full thyroid panel:

  • Thyroid-stimulating hormone (TSH)
  • Free T4 (free thyroxine)
  • Free T3 (free triiodothyronine)
  • Reverse T3
  • Antithyroglobulin antibodies (anti-TG)
  • Antithyroid peroxidase antibodies (anti-TPO)

Holistic Approaches to Improving Your Thyroid Health

As I mentioned earlier, holistic approaches to treating hypothyroid and hyperthyroid issues are few and far between, but there are some proactive things you can do to boost your overall thyroid health:

  • De-stress through meditation, yoga, chamomile tea, more sleep, and/or exercise. Under times of stress, the hormone cortisol suppresses TSH production. Managing stress is one of the best ways to ensure your thyroid gland doesn’t slow down.
  • Exercise! Low-intensity and regular aerobic exercise can stimulate the production of thyroid hormones.
  • Eat organic to reduce exposure to environmental toxins. Some recent research suggests that pesticides and polychlorinated biphenyls (PCBs) lower T3 hormone.
  • Get sweaty. Saunas (I adore my far infrared Sunlighten Sauna) or steam baths may help to detox pesticides or PCBs from your system.
  • Get your nutrients. Selenium, iodine, and vitamins A, C, D, and E are all important for thyroid hormone production. Vitamin D is essential for thyroid hormone’s efficacy in your body’s cells. If your diet is lacking in any of these nutrients, consider supplements.
  • Go easy on gluten. Like other foods that can cause inflammation, gluten is a sticky subject (one on which I’ll do a whole, separate post soon!). People who have celiac disease might find that gluten aggravates autoimmune thyroid issues, so it’s best to steer clear.

Key factors that may impact your thyroid health


The cells in the thyroid are the only ones in the body that can absorb iodine. Iodine is necessary for the production of both T3 and T4 hormones and is found in almost every living plant. Since we know how important these hormones are to our health, it’s essential to make sure you’re eating enough iodine-rich foods. The best sources of iodine include seaweed (such as the nori wrapped around a veggie California roll) and kelp. Many people use iodized salt or supplements as their main source of iodine.

How much iodine do you need? Recommended intakes are 150 micrograms daily for adults, 220 micrograms per day for pregnant women, and 290 micrograms per day for lactating women. One-quarter teaspoon of iodized sea salt (which doctors recommend in place of table salt) contains about 95 micrograms of iodine, and one six-inch by six-inch sheet of nori contains about 58 micrograms of iodine. If your iodine intake is low, you may experience fuzzy thinking, fatigue, depression, high cholesterol, weight gain or develop a goiter.


The cancer-fighting isothiocyanates in cruciferous veggies (kale, broccoli, cabbage, Brussels sprouts, cauliflower, kohlrabi, mustard greens, rutabaga and turnips), and the isoflavones in soy products are goitrogens: substances that may interfere with the production of thyroid hormone. In folks who don’t have thyroid challenges, eating goitrogens is A-OK, since cruciferous veggies can be very beneficial to the immune system and in fighting off cancer. In moderation, the same goes for soy foods (in whole or minimally processed, organic and GMO-free forms), especially when it comes to heart health and cancer prevention and survival.

But if your thyroid is underactive you should be very mindful of your cruciferous vegetable and soy food consumption. Some endocrinologists recommend that people with underactive thyroid disease avoid eating these foods completely. However, cooking seems to deactivate about one-third of the goitrogenic compounds, so you may be able to continue including them in your diet just by reducing your consumption of raw or juiced goitrogenic foods. For example, Jennifer Reilly, RD generally advises her clients to avoid excessive amounts of these foods by limiting raw cruciferous veggies like kale in juices and smoothies, rather than cutting them out altogether. And when it comes to eating soy foods, always check with your doc since soy could interfere with synthetic hormone medications.

Other researchers have found that only in the case of iodine deficiency are goitrogenic foods problematic for hypothyroidism, and as long as iodine intake is sufficient, the goitrogenic foods have little or no negative effect on hypothyroidism. This group of researchers recommends simply increasing iodine intake along with goitrogenic foods to maintain a healthy balance for a healthy thyroid. So, salt those Brussels sprouts and make sure you are working with your doctor to adjust your diet if you’re dealing with underactive thyroid issues.

Vitamin D

Vitamin D is a hormone, and aside from boosting the immune system and assisting with bone health and calcium absorption, it is also essential in the last metabolic step. During the final moments of the metabolic process, thyroid hormones are responsible for getting energy and oxygen into the body’s cells. (Pretty important!)

But without sufficient vitamin D, thyroid hormones won’t work properly. This is why vitamin D deficiency has been associated with autoimmune thyroid diseases such as Hashimoto’s and Graves’, and it is even thought that vitamin D deficiency may trigger thyroid disease. Luckily, getting adequate vitamin D is as easy as working 20 minutes of daytime sun into your life three times per week (and if that isn’t enough to boost your levels, supplements are available). You can make sure that you have adequate vitamin D levels with a simple blood test. Pro tip: your levels can change year-to-year, so keep current! Getting too much vitamin D can be toxic for your body, so don’t go on supplementation autopilot.

I know this is a lot of information. So if this post resonated with you and you don’t know where to start, just remember to take one step at a time.

Your turn: If you’ve experienced thyroid health issues, please share what has helped you along the way!

Peace & butterflies,

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  1. Astrid Womble says:


    You start out by mentioning your adrenal issues……but then speak only about the thyroid. How did you address your adrenals? My daughter exhibits the signs you spoke about for hypothryroid condition but it did not show up in her bloodwork. She did test positive for adrenal fatigue. I would be interested in hearing more about the adrenals.

    Thank you

  2. Thanks for this Kris! I’m working w a supremely knowledgable nutricianist now after 25 years battling candida. She’s seeing intestinal permeability (nearly always causing gluten sensitivity) as the possible underlying cause of the body’s autoimmune response and its attack on the thyroid in the form of Hashimoto’s Thyroiditis, dry eye syndrome, etc. She recommends those with Hasimoto’s to avoid gluten permanently… I’m finding this a challenging but totally miraculous step toward overall health, weight loss, joint comfort, and clarity if thought. I’d love your thoughts on this.

    • Deb says:

      Mary, that has been my experience also. I have been on gradually increasing doses of thyroid hormone for about 15 years, with continued fatigue, progressive weight gain, and memory loss/brain fog. Only in the last 7 months, after going gluten-free (and also dairy/soy/refined-sugar-free) have my symptoms abated. I’ve since lost 45 pounds, have renewed energy for yoga, Pilates and Zumba, and feel better than I have in many years. I’m so thankful to have found the right information about the correlation between Hashimoto’s and gluten, and to have finally found a more holistic, knowledgeable (functional medicine) physician!

  3. Love the mount of info in this blog!

    I’ve been hearing a lot about iodine lately (a bit from Dr. Christiane Northrup show on Hayhouse) but I would be unsure as to what I really need and if I really need it. (I would be using it for breast cancer prevention).

    In any case, I feel the best way to get really clear one’s specific needs (dosage of iodine, vitamin D or anything else related to health really) is to work closely with a functional medicine doctor.

    Luckily, I know (and work with) of one of the best in Montreal and luckily, functional medicine is getting known enough for anyone to have access to this amazing & ground braking holistic approach.

    • Marlène says:

      Caroline, could you please give me the name of the doctor you mentioned. Thank you.

    • Enrica says:

      Hello Caroline,
      In an old post you mention a Montreal functional medicine doctor that has helped you with thyroid issues. I am in Montreal and have recently been diagnosed with Hashimoto’s but don’t know where to get the appropriate help since my GP is not very helpful or knowledgeable about this disease.
      Appreciate any info.

      • cassie says:

        I am also in Montreal and desperate to find a doctor that will prescribe natural (porcine) hormones… Any names?
        Thank you soo much!

  4. Judy McAninch says:

    Thank you for the interesting article on the Thyroid. Both my sister and I have Thyroid health issues. Both of us were Hypo and now she is Hyper and I am still Hypo. My doctor already has me on a vitamin D supplement. I will be going to my local health food store today to purchase the Nori. Sunshine, lack of it also effects me terribly from September through April or May. So I also suffer from Seasonal Affective Disorder or also known as SAD. I have noticed that during SAD season my thyroid T count becomes unstable and the numbers are all over the place. That means that I am going for blood work roughly every 6 weeks which usually results in changes made in the dosage I am taking. I have told my doctor that if you look back at my history this is a fact, unstable T numbers. SAD is the reason for this issue. Any insight on Seasonal Affective Disease? Thank you.

    • rebecca says:


      In order to fight off SAD during those dark winter months, I have a friend who spends 20 minutes every evening under a sun lamp. I am not aware if a sun lamp poses any other unwanted issues, but I do know he has not suffered from SAD in years! Perhaps you want to explore this option. Good luck.


      • Skii Fleeton-Essenfeld says:

        Here in the Netherlands many many of my Dutch friends have sun beds and lamps to fight off SAD. They all swear by them. Being Australian, I am hesitant to use them but I have been suffering symptoms of either hypothyroidism or Vitamin D deficiency and the Dr can currently not diagnose it. Perhaps I need to cut the gluten out too.

  5. Victoria says:

    Thanks for this, Kris!

    My blood tests came back with alarmingly low thyroid levels a few years ago. My doctor instantly wanted to put me on synthetics but I just had a feeling, and I said no. I started taking natural thyroid supplements (kelp pills) and six months later, my levels were better, but still off.

    I then started researching the connection between gluten intolerance and thyroid issues. I cut out gluten, and my levels became normal, my hair started growing back, and I’m no longer experiencing a lot of the issues I had before.

    • Carmel says:

      Do you still need to take the kelp and vitamin d etc or is it rectified and sorted now? Would very much appreciate a reply. You can email me at r y c h h mo at a o l dot co m without the spaces. Thank you.

  6. Thank you so, so much for this article, Kris- I’ve been looking for a clear and informative article like this on Thyroid health for a while now. Fantastic insights- thank you!

    Katie x

  7. Livia says:

    Dear Kris,
    thank you so much for this post. I’ve been diagnosed with autoimmune hypothyroidism in 2009 and I’ve been looking for ways to get my thyroid work, but it just doesn’t seem to. This artcle really helped me get an idea of what I should look for and look out from.

    Is there any chance I’ll ever stop taking the synthetic hormones?


  8. Pam Payne says:

    Hi Kris,

    Love all the information that you research for those of us who followe your blog. I especially enljoyed the one today on the “throid” and wanted a copy of it to study. I have to first highlight the blog and this takes forever with my mouse and then print. Is there anyway that you could add a “print blog” at the end of your writing? It would be so much faster and much appreciated by your readers . .thanks! Pam

  9. Brianna says:

    Thank you so much!!!
    I’ve been unwell for years- dispite living the healthiest lifestyle out of anyone I knew. Always tired, cold, aches, belly pains and weight gain, despite yoga daily and an active lifestyle.
    In the past week I’ve been excessively tired and with a tightening in my throat- and I thought Thyroid!
    Now so many thyroid things are coming out of the blue!!
    Thanks for being another lead! Blood test results tomorrow!! Xo bpt

    • Linda says:

      Sounds like a wheat/gluten intolerance symptoms, too many processed foods and/or allergy.

    • Connie says:

      Hi Brianna,
      Do not be disappointed if your thyroid tests do not initially indicate an issue. It still could be (and truly sounds like) a thyroid problem. Look up Mary Shomon on google. She is one of the most respected resource people on all things thyroid. You will learn a lot and get very helpful information.

  10. Kate says:

    Thank you for this well researched article. I have had hypothyroidism for 18 years and have never heard some of the information you provided. Bravo! Also, I would be very interested in your thoughts on taking synthroid, or levothyroxine vs. amour thyroid. Thank you again!

  11. Susan says:

    Hi –
    Just took my first synthroid pill this morning- how appropriate!!!! I just saw my third endocrinologist on Friday and he Got it!! He didn’t care that my tsh levels were “normal”- he listened to my symptoms and saw I have a family history on both sides, have symptoms, and antibodies 7 x the norm!!! I hope this will help but at least I get the chance to try!!
    So- the take away is-keep changing doctors until you get the one who listens and isn’t a robotic “test” follower.
    Best- susan

    • Elizabeth says:

      Susan……..once you start Synthroid (or any thyroid medication)………you will be taking it for life.
      I would suggest doing it naturally with herbs, foods, acupuncture, etc………..I speak from experience. When first diagnosed, I used natural methods and was doing well. I later switched to Synthroid because it was cheaper………it may seem OK at first……then comes to a plateau…… does not solve all the problems and I cannot lose the weight after 4 years……….my thyroid has been further weakened due to Synthroid doing the work that the thyroid normally does. Knowing what I know now, I would never have begun thyroid medication. I have also read that working first on the adrenals & making them stronger would lead to a stronger thyroid……..or even working on them at the same time. Since the thyroid & adrenals are intimately linked, that makes sense, because what affects one affects the other. Good Luck ! I now realize how precious the thyroid is.

      • Carmel says:

        Would you consider taking nothing but a good serving of kelp/iodineto help you? I believe that taking the synthetic one makes the hormones lazy and maybe they sort of die if not used. So can see your point. I find that if I take the natural ones I become very depressed/sad/worried /tearful etc though, which is almost unbearable. r y c h h m o at a o l do t c om without the spaces.

  12. I’m going to throw a couple of kinks into the discussion–the first one based on advice from Dr. Jeanne Wallace, a PhD in nutrition who counsels people with cancer. She says that people with cancer who have low thyroid function appear to do better (by that she means survive longer) than those with higher functioning thyroids. For that reason, she recommends avoiding sea vegetables and supplemental iodine. Perhaps I should post a question to her for all of us on her Facebook page? (

    The other kink is seaweeds from Japan. Like mushrooms, freshwater fish and bottom feeding fish that eat near their Pacific shores, it’s probably best to avoid them. Japan’s finally owning up to what experts have been saying for a while now: That plant is still leaking.

  13. Serena says:

    Thank you so much for this! I had my adrenals tested through a saliva test and my cortisol level was very high so I’m on a natural supplement to help balance them out and had to fix my diet. I just emailed my doctor when I read your article and asked for a complete Thyroid Panel to be done this week and copied and pasted every level to have checked!

    Thank you so much! I love your articles and they are helpful as I am healing from an illness.

  14. Gale Harpe says:

    Thank you for this information and your insight.

    Is 4000 IU’s of D3 acceptable in liquid form? I had a normally lower body tempt, a few years ago, which is considered a symptom of hypothyroid? But now I feel warm most of the time while others are cold! Does that make sense? Curious as to your knowledge?

    Thank you!

  15. Susan Strieter says:

    B. Richards Wellness resources: Metabolism Support Formula was the answer for me. Thank you for your information – more people need to see your info!

  16. Melissa says:

    I am a traditionally trained Physician Assistant and thought I was living a pretty healthy life. Being diagnosed with Hashimoto’s Disease– the autoimmune form of hypothyroidism– was the final wake up call for the amount of inflammation I had been living with. No more denial for me! I started reading everything I could get my hands on, including CRAZY SEXY DIET (as i had seen the Crazy Sexy Cancer documentary). Gluten and dairy were destroying my gut and when eliminating those didn’t completely reverse my disease, My integrative medicine doctor found a build up of environmental toxins in my urine. Sauna treatments– 30 min a day– are helping me eliminate those, and finally, I am seeing a reversal in the autoimmune ds! Yeah!
    I am so on the Kris Carr band wagon– I have never felt better and am able to truly LIVE life. Thank you for inspiring so many people.

    • Kris Carr says:

      You made my day Melissa! xo 🙂

    • Julie Budarick says:

      Hi Melissa,
      I have just started the CRAZY SEXY DIET. I also have Hashimotos and looking to reverse my disease with food, supplements and a less stressful life. I will try the steam baths too.
      I take Bio Identical T3 and T4 from an Integrated Practitioner. You didn’t mention if you have reduced your medication or are off it all together, since changing your diet.
      I would love to hear from you. Julie

  17. Reni says:

    Hi dear Kris 🙂
    I am so happy to read about Thyroid.
    I have this issue all my life.
    First I did have Hyperthyroid, after treat with Radio-active iodine I went to other side Hypo.
    I must say it’s not a joy :(, but I am doing well.
    Still can’t be myself. Every day is something different.
    Now I do have join problems, Uterine fibroid…….
    My vit. D was low , I did get some suplements, but here in The Netherlands the doctors, don’t give me any advice on some kind of diet . I just want to know what is the best to eat. I was vegy., but now I am not because I get iron deficiency.
    Can you help me please with some kind of info.
    I am taking Levotyroxine 137,5. I did find that a lot I just want to go down of the Levotyroxine, but everything what I am doing take me in other side. These days I am feeling better, but till when ?! 🙂
    Thanks in advance .

  18. Madeleine Lobos says:

    Thank you Kris. You’re amazing. Xx

  19. Jan says:

    Hi Kris (and your peeps),
    Does sea salt have iodine in it normally? I was diagnosed as hypo 10 yrs ago, took synthetic thyroid for 5 yrs. then started questioning. I just didn’t feel I was…not the standard symptoms and it can be confusing when you’re menopausal also. I first got my zinc levels healthy (with a homeopath) and went gluten free. Then a naturopath said my thyroid levels weren’t that bad and she had me take an adrenal supplement. My last blood work was ok, as my dr. didn’t call. Next, I’m going to start replacing mercury amalgams as I’m sure the heavy metal must affect the thyroid. So many variables but why all the thyroid issues?

    • Melissa says:

      My doctor just recommended me going all gluten free as he thinks the gluten is interfering with my body’s ability to absorb nutrients and my medicine (specifically my vitamin d is low). My sister has full Celiaic disease so I am learning from her the tricks and trades of living gluten free.

  20. Melissa says:

    I have been suffering from thyroid disease for about two years now and just recently this week it was determined that I was suffering from a vitamin D deficiency as well. I am amazed how quickly I was able to bounce back after taking the vitamin D supplement. I really thought I was losing my mind and going crazy. I was emotional, tired, stressed out, low sex drive, and literally having panic attacks (something I have never experienced) and everything under the sun was stressing me out (I cried about everything). My doctor upped my tirosent and is giving 2000 units of vitamin d a day. I am amazed as to how much better I feel. My goal now is to learn how to deal with this stressful job or either get rid of it, as sometimes I wonder if it is still serving me as much as I am serving it… Thanks for the article as I a learning the thyroid is the backbone to emotional and physical health.

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