INTRODUCTION This guide is intended to be a useful resource for your journey through thyroid disease. It includes tips and strategies for your overall wellbeing including what tests to ask for, how to find the right doctor, how to talk with your doctor, tips for self-care and stress management, supplement considerations and lifestyle and healthy eating suggestions. I want you to know that I created this guide and the companion eBook with a lot of tender loving care, because I want you to believe there is hope for healing. It’s not always an easy path, but regardless what “shade” of thyroid disease you are experiencing and no matter where you started, believing you can be healed is the first step – and with faith, trust, love, forgiveness, commitment, and God’s help, all paths will lead to victory. I had a very resistant case of Hashimoto’s and ultimately turned to low-dose naltrexone (LDN) and am now in remission. However, I did begin to feel significantly better after I committed to lifestyle changes. Many women have been able to conquer thyroid disease through lifestyle and dietary changes, others have needed a more aggressive approach. The truth is although there are commonalities, no two women’s thyroid disease is identical. If I can do it, I know you can too. † I begin with showing you the various traditional and functional medicine tests you should consider pursuing. These are the gold standard for diagnosing thyroid disease and associated factors such as food intolerance & sensitivity issues, the genetic mutation known as MTHFR (a common gene SNP in Hashimoto’s), adrenal fatigue, hormone imbalance, Candida overgrowth, and specific infections commonly seen in autoimmune thyroid disease. If you have not yet been officially diagnosed with a thyroid disease and suspect you may have one due to symptoms, or are newly diagnosed you definitely will want to review pages 3-8. Following the test considerations, you’ll find many helpful resources and tips to help you understand thyroid disease in general so that you can contribute to the conversation with your health and wellness team with confidence. Should you ever need personalized support and guidance please don’t hesitate

to contact me through email:

info@shannongarrettwellness.com, or by scheduling an appointment via my online Schedulicity calendar by visiting

https://www.schedulicity.com/scheduling/SGWDFK.

GOLD STANDARD THYROID LAB TEST PANEL You can request the following blood tests from your doctor, or self-order them from any of the lab facilities from the resource list below.

Free T3

Free T4

Reverse T3

Thyroperoxidase (TPO) antibodies

Thyroglobulin (TGO) antibodies

TSH

Vitamin D3, 25-OH

Ferritin, Iron, & TIBC

Vitamin B12

Sex Hormone Binding Globulin (SHBG)

Glutathione

Magnesium, Red Blood Cell (RBC magnesium) Lab Facilities that offer direct private self-ordered lab tests:

LabCorp via the Life Extension Foundation, www.lef.org → Products → Blood Tests. Place your order online & you will receive a lab requisition form to take to your nearest LabCorp facility.

Any Lab Test Now http://www.anylabtestnow.com/ search by zip code for a test facility nearest you; accepts walk-ins and appointments.

My Med Lab www.mymedlab.com, you will receive a test kit to take to a lab facility such as LabCorp.

Personal Labs www.PersonalLabs.com also offers online ordering of lab panels. I have not used this lab personally.

Canary Club www.canaryclub.org with free membership you will receive discounts on lab testing. I have not used this lab personally.

FUNCTIONAL MEDICINE THYRIOD TEST

PANELS

Adrenal & Hormone

Food Sensitivity/Intolerance

Gut Pathogen w/H. pylori

Micronutrient Testing

MTHFR Gene Mutation

Elements Profile Urine Test for Iodine, Bromine, Arsenic, Selenium, Creatinine, & Mercury

Gluten cross-reactivity test

Tests for infections such as Yersinia enterocolitica, Epstein-Barr and Helicobacter pylori

Rule out Celiac and Lyme disease With the exception of the tests for infections, these types of tests are not typically covered by insurance. If you have a Flexible or Health Savings Account you may or may not receive reimbursement so be sure to check with your plan administrator. If budget is a concern, space them out accordingly and begin testing in the order in which they appear in the list.

FUNCTIONAL MEDICINE LAB TEST RESOURCES

Adrenal & Hormone Testing

ZRT Laboratory Female Saliva Profile III

Tests estrogens, progesterone, DHEA-S, and 24-hour cortisol

The thyroid, adrenal glands, & the glands that produce the sex hormones make up a “three-legged stool.” When these are out of balance it is nearly impossible to feel your best, and when one area is off balance, it is likely the other two are as well. Even if you’re not experiencing symptoms, it is wise to test for baseline values.

Gut Pathogen Testing

Bio Health Laboratory GI Pathogen Screen with H. pylori

Tests for ova & parasites plus antibodies to the antigens of Giardia lamblia, Cryptosporidium parvum, plus bacteria, fungi, yeasts, occult blood, Clostridium difficile: Colitis toxins A & B and H. pylori antigen via a stool analysis test kit.

Micronutrient Testing

SpectraCell Laboratories http://www.spectracell.com/

Micronutrient testing measures how micronutrients are actually functioning within your white blood cells. These tests allow nutritional assessment for a broad variety of clinical conditions, general wellness and the prevention of chronic diseases including arthritis, cancer, cardiovascular risk, diabetes, various immunological disorders and metabolic disorders.

MTHFR Genetic Mutation Testing

Methyltetrahydrofolate Reductase involves a genetic mutation found to be common in autoimmune thyroid disease as well as in the general population. It is important information to know as it is a concern with respect to the forms of folic acid and vitamin B12 supplements one would need to consider. In addition, note the risk factors below that this gene SNP is associated with.

SpectraCell Laboratories http://www.spectracell.com/

23andMe DNA Analysis Service https://www.23andme.com/ is approved by the Centers for Medicare & Medicaid Services

Cell Science Systems/ALCAT Worldwide https://www.alcat.com/pages/mthfr/ The two mutations commonly tested are 677C>T (associated with cardiovascular disease, peripheral neuropathy, miscarriages, neural tube defects & other congenital birth defects, and 1298A>C which is most commonly associated with chronic disease, depression, fibromyalgia, CFS, migraines, IBS, Dementia, OCD, Bipolar, Schizophrenia, and more.

FOOD SENSITIVITY, INTOLERANCE, & ALLERGY TESTS

ALCAT – Cell Science Systems: https://www.alcat.com/ offers a variety of panels to choose from:

Platinum Plus • Comprehensive Wellness 1 • Comprehensive Wellness 2 • Comprehensive Wellness 3

Alletess: http://foodallergy.com/index.html also offers various panels from which to choose:

• Allergy & Sensitivity Panels • Comprehensive Food Panels

I offer the ALCAT Test through Shannon Garrett Wellness, Inc.

The ALCAT panels test for food and chemical sensitivities, not allergies. White blood cells are exposed to certain foods and medications to test for inflammatory reactions. The Alletess test is a food allergy test. For people with thyroid disease or other inflammatory conditions, I personally believe knowing ones food sensitivity or intolerance issues is beneficial information. ALCAT’s Platinum Plus panel tests 357 items: 237 foods, 50 functional foods, 20 food additives/colorings, 10 environmental chemicals, 20 molds, 20 antibiotics/anti-inflammatory medications. Aletess offers comprehensive IgE & IgG food panels ranging from 12 to 184 foods tested.

Elements Profile Testing

Iodine, Bromine, Arsenic, Selenium, Creatinine & Mercury

Women who have been experiencing symptoms of thyroid dysfunction but have been told their thyroid was OK, may be a result of nutritional deficiencies or excessive exposure to environmental pollutants that block thyroid synthesis and function.

I offer the Elements Profile Test through Shannon Garrett Wellness, Inc.

Gluten-Associated Cross-Reactive Foods Testing

Tests approximately 25 foods that may be “cross-reacting” for gluten in your body. For example, coffee is sometimes tagged by the immune system as a gluten molecule. If you have been gluten-free for a while and still not making progress or, you would like to know objectively what your body thinks is gluten but isn’t, this test is highly recommended. This is a blood test ordered by your doctor & drawn at a Cyrex Labs contracted facility.

COMMON INFECTIONS FOUND IN THYROID

DISEASE

Three stealth infections all thyroid patients should consider being tested for are:

Yersinia enterocolitica

Epstein Barr virus

Helicobacter pylori (H. pylori) Even in the United States, patients with thyroid disorders have a higher prevalence of antibodies to Yersinia than normal subjects (according to research studies) or patients with other disorders. Often, treating the virus results in the termination of thyroid disease. Stool testing is not reliable when testing for Yersinia. . . it should be tested by a blood test to determine if there are elevated antibodies. Grapefruit seed extract (GSE) can rid the body of Yersinia when used under the guidance of a qualified healthcare practitioner. Epstein Barr is commonly seen in patients with autoimmune thyroid disease and is often overlooked even with lab testing depending on which antibodies were tested, or if the practitioner overlooked early antigen IgG antibodies as being normal. The reason this can happen is because IgG antibodies are going to appear and remain high, sometimes for a lifetime; however, if the EBV Early Antigen IgG antibody is elevated, it does indicate an active infection requiring treatment. A value of less than 9 is normal, but a anything >11.2 is high. H. pylori is a bacteria that infects the stomach and is more common in Graves’ disease than in Hashimoto’s. Stool testing is the gold standard for H. pylori and is included as a part of the GI Pathogen at home test kit available from Bio Health Laboratories. Resource: Hedberg, N. (2015) Thyroid Disorders 2015 Research Update & Clinical Pearls [22 Apr Webinar and PowerPoint Presentation].

TIPS & RESOURCES ON FINDING A DOCTOR

Finding a good doctor for thyroid disease can often be a challenge. Sometimes you have to “test” different doctors to see who meets what you are looking for as a provider for your thyroid care. Look for a physician who values you as an equal contributing member to your health & wellness care. Criteria to Look for in a Doctor:

Listens to you & places great emphasis on your experience, reported symptoms & wisdom about your own body & does not only treat your lab numbers.

Tests full thyroid panels – not simply T4 & TSH. Refer to the Gold Standard Labs suggested at the beginning of this guide.

Agrees to prescribe if your preferences for natural desiccated thyroid hormone, synthetic T3 only or compounded T4/T3 hormone if indicated.

Understands how to treat associated conditions with thyroid dysfunction including autoimmune disease, hormone imbalances, adrenal dysfunction, co- infections, PCOS, and diabetes. How to Find a Doctor:

Word of mouth of a friend who also has thyroid disease is sometimes a good option. You can also call a local compounding pharmacist & request names of physicians who prescribe natural desiccated thyroid hormone (this is usually a good indicator). There are also websites that offer a database of physician’s names usually by zip code.

Life Extension Foundation www.lef.org →Health →Doctors & Practitioners.

Thyroid Change Patient Recommended Doctor Lists www.thyroidchange.org →Find A Doctor.

The Institute for Functional Medicine www.functionalmedicine.org/practitioner_search.aspx?id=117.

Stop The Thyroid Madness http://www.stopthethyroidmadness.com/how-to-find- a-good-doc/ offers excellent & credible tips for how to find a good doctor and more.

TIPS & RESOURCES ON FINDING A DOCTOR

Like many thyroid patients, I have experienced frustration during and after a doctor’s appointment. I’ve even walked away many times thinking “what the heck just happened?” when the appointment did not go the way I had anticipated, or I was upset with myself for not remembering everything I needed to say. I’ve had clients tell me they feel as though they are on a never-ending merry-go-round when it comes to communicating with their physician and are frustrated. With tight schedules most doctors offices are on these days out of obligations to see so many patients, the amount of time we as patients have to speak, listen, and be heard can be less than 20 minutes. This is why it is important to prepare ahead of time, every time. Taking the time to prepare for an appointment with a doctor is a proactive habit we all should do because the truth is, no one in this world is going to care more about your health than you do! It is important that you not give away your power and wisdom in the doctor’s office by being unengaged, unprepared, or passive. Don’t assume your doctor knows everything about your health simply based on your lab numbers, or that you’ve been a long-term patient. Also don’t assume that your doctor is the end all for knowledge about thyroid conditions and will tell you everything you need to know. I want to share with you a form of communication I originally learned in nursing as an effective method usually reserved for healthcare professionals, but I’ve since learned that it can be applied to the patient-physician relationship too!

TIPS ON HOW TO TALK TO YOUR DOCTOR

We need to remember that physicians are human and although they are trained in the art of managing hectic patient appointment schedules, I want you to imagine for a moment what it must be like to be in their shoes…patients coming and going every 10 minutes and in that short time the average patient arrives unprepared; however, is prepared to communicate a long litany of subjective complaints like “I’m tired, I just don’t feel well, or I’m not myself.” These are vague but common descriptions for many health issues and are the same complaints healthcare providers hear all day. Compound this scenario to multiple patients per day and it fosters the potential to become somewhat of a blur because each patient’s story for the most part is so similar. I’m not making excuses, here, I’m simply trying to underscore my rationale for why we as thyroid patients must be very prepared in advance of our doctors appointments. In my list of items you should never assume, I need to add that you should not assume your doctor actually remembers every detail about you and your health issues visit-to-visit. It is remarkable when they do but again, they’re human.

SBAR is a form of communication used in the healthcare industry borrowed from the U.S. Navy as an effective and concise way to communicate. This form of communication was adopted by hospitals and healthcare facilities as a simple but effective way to standardize communication between care givers. But, as previously stated, patients can adopt SBAR principles and apply it when communicating with their physician. I promise when you try SBAR, your doctor’s ears will perk up! It works because it is the form of communication they are already trained to understand and are familiar with. To prepare for an appointment and use SBAR as a communication tool, you will summarize your objectives and rewrite them in SBAR format either on individual index cards for each letter or on a loose sheet of paper.

S = Situation: This is the “why” you are seeing the doctor, symptom-wise. For example, “I’m having increased fatigue and feelings of being cold all the time.” B = Background: This should include details to support the Situation. “I’ve been checking my morning temperature for the past two weeks under my arm & it’s been 96.0 to 96.2. A = Assessment: Communicate what your thoughts or research indicates about your condition? “I think I may have a thyroid problem.” R = Recommendation: This is your opportunity to state what it is you feel you need or want, e.g. further testing or other diagnostics, medication, etc. “I would like to have some labs done to test my thyroid (and go over the list of labs you are requesting (see the Gold Standard Thyroid Labs list) and I would also like a thyroid ultrasound.” Notice there are no emotional or subjective comments included in this SBAR communication for a suspected thyroid issue. It is specific and to the point. I hope you see how SBAR could apply to any health issue. You simply state your situation (briefly), share some background (objective date is nice if you have it) related to the situation, share your assessment based on your knowledge and insight about your body for what you think may be going on, and then a recommendation, which is what you expect to get out of the appointment. The recommendation is your opportunity to ask for what you want from the visit. The first time I used SBAR with my physician, it really changed the way we communicate for both parties. I hope you give SBAR communication a try too. “I am often asked about my daily routine…clients seem to want to know exactly what I do to take care of myself. Those who have known me for a long time see how much I’ve improved as compared to the years I wasn’t really functioning very well. Basically, I wake up every morning between 6-6:30 AM without an alarm clock. I have my morning lemon water with sea salt and a little stevia, take my vitamin C and a probiotic. By 7:30 I either go for a walk or head to the gym to do water aerobics, elliptical, or weight train. I don’t do any heavy exercise – my adrenals don’t like that. After working out, I’ll have either a protein smoothie for breakfast or egg yolks with avocado, spinach and chicken sausages. I take a moderate amount of supplements with breakfast, lunch & dinner, which I detail in the following pages. If it is a focus day, (Mon & Fri) I’ll attend to business matters, read a research journal, work on my blog or clients lifestyle & wellness care plans. Tues-Thursdays are the days I actually meet with clients usually via Skype or phone which I always enjoy. Lunch is typically a salad or veggie soup with protein. A cup of tea with local honey or homemade bone broth are my favorite afternoon pick-me-ups after which I sometimes take a nap or a light walk – it just depends on what my body needs that day. Dinner is always with my husband, my best friend in life & he usually prepares the protein & I prepare veggies or a salad. Bedtime in the Garrett home is between 9-9:30 PM so I’m fast asleep before 10:00 every night just after applying magnesium & essential oils to the soles of my feet & taking melatonin, PharmaGaba and low-dose naltrexone (LDN). I hope to be on LDN for life because it’s been a lifesaver for me. XOXO”

SUPPLEMENT & HEALTHY EATING

CONSIDERATIONS Supplements

Selenomethionine

Curcumin

Vitamin K2/K3

Magnesium, including Magnesium oil, lotion and bath flakes

N-Acetyl Cysteine (NAC)

Omega 3 Fatty Acids – if fish oil upsets your stomach, look for EFA supplements derived from borage seed, walnut, hazelnut, sesame, apricot kernel or flax seed oils

Glutathione – transdermal cream (I like Glutathione Plus by NeuroBiologix)

My Top Brands: Douglas Labs, Designs for Health, Biotics, Xymogen, & Thorne Top Inflammatory Foods to Avoid

Eliminate gluten, corn, peanuts, soy and dairy (all are inflammatory even if you don’t have an allergy or sensitivity

Avoid processed foods, sugar, refined grains, flour, food additives/colorings, high-fructose corn syrup, sweeteners & yeast

Avoid feedlot-raised meat, red & processed meat

Avoid trans fats (margarine, vegetable oil/shortening, partially hydrogenated oil

Avoid nightshades (peppers, tomatoes, Goji berries, eggplant, paprika, potatoes [but not sweet potatoes], pimentos, tomatillos, etc)

Avoid goitrogenic foods unless steamed or cooked (avoid strawberries)

Avoid vegan or vegetarian diets

Avoid alcohol and sodas

Avoid bottled & packaged salad dressings

Avoid legumes, couscous, pasta, fried foods, dried fruit, roasted nuts, fast food, and store bought fruit juices

If eggs are a problem for you, try the yolks instead

Supplements

Zinc picolinate

Ferritin (if blood test indicates low iron)

Vitamin A

Vitamins B2 and B3

Vitamin B12

Vitamin C

Vitamin D3 – liquid drops

Quercetin

CoQ10

Supplement for any deficiencies per lab tests

Probiotics

Pancreatic or digestive enzymes

TruFiber Healthy Food & Beverage Choices

Variety of frozen organic fruits, especially dark berries (raspberries, Wild blueberries & blackberries) but keep to ¼-1/2 cup servings per day due to sugar content

Variety of organic fresh or frozen vegetables, especially whatever is in season (choose the colors of the rainbow, & look for a 5 digit label that begins with “9”

Lean proteins, e.g. organic pastured cage-free chicken, grass-fed beef, wild-caught fish (especially Alaskan & Coho)

Health fats: avocado, unrefined organic coconut oil, extra virgin olive oil, macadamia nut oil, raw, organic almonds, walnuts, unsalted sunflower seeds & pumpkin seeds, ghee, sugar free sunbutter, gluten free almond butter

Lemon Water with ¼ tsp sea salt

Braggs apple cider vinegar w/local honey

Gluten-free quinoa

Homemade bone broth

Non-dairy milk: unsweetened almond, coconut (full fat) or rice milk

Herbal tea

Fresh herbs for cooking

Gluten & dairy free protein powder for smoothies

Superfoods: Cacao, camu camu, maca, hemp hearts, and chia seeds

SELF CARE IDEAS

Review the self-care possibilities in the image below & see if there is anything appealing to you…something you could commit to & enjoy on a daily basis. In addition to these ideas, you might also consider:

Try taking ½ tablespoon of coconut oil before bedtime. Coconut oil coats the myelin sheath of nerve cells and is calming. Honey, believe it or not, is also calming to the immune system.

Breath Therapy is one of my personal favorites for reducing stress & calming the body + it’s free! Most people don’t breathe correctly. Refer to the next page for an easy abdominal breathing exercise.

Laughter is a good exercise for the breathing muscles. When you laugh, the upward & downward movement of the diaphragm is particularly intense & massages your internal organs.

When was the last time you danced? Moving to music that inspires you gives a sense of freedom. Through dance therapy, it is possible to get in touch with blocked feelings & hidden abilities. Give it a try!

SELF CARE TIPS

Breath Therapy – Abdominal Breathing This exercise will help you breathe from your abdomen.

1. Lie down on the floor with your calves resting on a chair or stool.

2. Place 3 books on your abdomen over your navel. Breathe deeply & calmly. Feel the weight of the books on your tummy.

3. Remove 1 book. Notice that your tummy feels lighter & your breathing is deeper. Remove the other books, 1 at a time, pausing in between to focus on the feeling of breathing deeply.

4. At the end of the exercise, place your hands on your tummy & consciously breathe from your abdomen for a few minutes.

I have taught this and other forms of breathing exercises to countless patients & their families, fellow nurses, friends, and family who were faced with stressful situations, post-surgery pain, nausea, high blood pressure and fear. The primary role of breathing is to absorb oxygen and expel carbon dioxide through the movement of the lungs. When someone is under stress (perceived or real), whether it be emotional or physical, their breathing pattern changes (in reality, I have found most people don’t breathe correctly even when not stressed. Shallow over-breathing, or hyperventilation can prolong feelings of anxiety or fear by making the physical stress worse. Inducing the relaxation response through proper breathing can lower blood pressure & heart rate, reduce levels of stress hormones in the blood, reduce lactic acid build up in muscle tissue, improve immune system functioning, increase physical energy, increase feelings of calm and wellbeing, reduce pain, nausea, post-surgical anxiety and

oxygenates the brain and organ systems. Learning how to breathe correctly is one of the healthiest and easiest things you can do for yourself.

Acupuncture: acupuncture has been scientifically proven beneficial for Hashimoto’s & the immune system.

Reflexology: beneficial for fatigue, headaches & restoring proper fluid balance in the tissues.

Sauna: great for joint or muscle pain & for the immune system.

Castor oil packs: very easy & inexpensive to make; is relaxing & helps to eliminate toxins.

Massage therapy w/essential oils.

Epsom salt bath with essential oils such as rose, ginger, lavender or Frankincense.

Afternoon naps – if my mind or body needs it – always listen to the wisdom of your body!

Aromatherapy: I am a firm believer in the therapeutic benefits of essential oils including for thyroid health.

Meditation, relaxation, art, biofeedback, imagery, & visualization: I am a big visualizer & practice “seeing myself well.”

Prayer: Nothing is more uplifting, releasing, & brings a sense of joy and calm than lifting a prayer of gratitude for all things to God.

Journaling: Keep a gratitude & write down at least 20 things for which you are

grateful for every day (on a separate sheet of paper write down what you’re worried about & then say “I’ll worry about this tomorrow,” & toss the loose paper of worries in the trash. Hold on to the gratitude writings. See how you feel in 2-3 weeks. It’s amazing! There is healing in writing.

Sleep: Strive to be in bed and asleep by 10pm every night & get a good 8-9 hours of quality sleep. Because of the Circadian Rhythm, going to bed after 10pm is simply not the same as far as the body is concerned even if you sleep the optimal number of hours! During sleep is when our body heals, the liver does it’s main functions during sleep, the immune system and other systems work to repair themselves & it is also the time the body detoxifies. Sleep is by far #1 in terms of maintaining overall health & maintaining weight.

THANK YOU FOR REGISTERING FOR THE THYRIOD BUNDLE!!

To express my gratitude for registering for The Thyroid Bundle, I would like to offer you a free 30-minute Skype audio consultation with me. You will set the agenda in terms of what you would like to discuss: healthy-eating, lifestyle tips, or anything you read in Thyroid Happy: Tips & Strategies for Abundant Living or my eBook, Hashimoto’s: Finding Joy in the Journey. All you need to do is visit my online Schedulicity.com calendar: https://www.schedulicity.com/scheduling/SGWDFK Select the service “Thyroid Bundle” and you won’t be prompted to reserve with a credit card. In addition, I’d like to extend an invitation for you to participate in any one of my wellness programs at a 50% discount! This offer is valid for registrant’s of The Thyroid Bundle, and the offer ends July 21st. Participant’s of the 6 Week Thyroid Renewal will receive the following Designs for Health nutraceuticals & products absolutely FREE, a total value of $232!!

Women’s Twice Daily Essential Packs ($110 value) Probiotic Synergy Probiospheres ($68 value) PaleoMeal protein powder ($48 value) Blender bottle (BPA free) ($6 value)

No substitutions. Offer must be redeemed by midnight CST, July 21, 2015.

WELLNESS PROGRAMS OFFERED BY

6 Week Thyroid Renewal

12 Week Principles of Thyroid Wellness

Seasonal Clean-Eating Thyroid-Friendly Programs, 15-day, 21-day, 28-day, & 6 week programs, available as a DIY or guided program

Private wellness consults for thyroid & autoimmune concerns (women only)

Private VIP full day (9:00 – 4:30) session includes lunch, educational materials, one night stay at a Nashville hotel & transportation fees to & from my home (out of town clients only) (VIP days are excellent for busy music industry and other high profile professionals who need to cover a myriad of wellness concerns in one day. Must prequalify via an application for eligibility).