 This is Dr. Ruscio, and let's discuss if Synthroid contains gluten. If you have hypothyroid or you're on thyroid medication and you've been doing some reading on the internet, you've likely heard some connection between gluten and hypothyroidism. Because of this, there is concern, rightfully so, that's been voiced potentially about different medications, thyroid medications, like Synthroid, and if they contain gluten or not. I wanted to present to you a study that recently looked at this issue to help dispel any misconceptions out there and to help you know that if you have gluten intolerance or if you have celiac, and you're trying to avoid gluten, if Synthroid does or does not contain gluten. And I'll put the study abstract up here on the screen, entitled, Gluten and Aluminum Content in Synthroid. To quote, these data demonstrate that Synthroid tablets are not a source for dietary gluten and are a minimal source of aluminum. They assessed multiple batches and essentially found that there was no detectable gluten in any of the batches assessed. So this is comforting, and this may run counter to what you've heard before, and this may be because according to my knowledge, there was gluten in Synthroid or Levothyroxine tablets before, but this is no longer the case. So this can be comforting if you're someone who is gluten insensitive or gluten intolerant or have celiac, and you're trying to make sure you avoid gluten. Now what if you're listening to this and you're saying, I've been on Synthroid or Levothyroxine or a thyroid hormone, and I'm not feeling any better? Because it's important that you understand some of the effective treatments or interventions that can be done to help you feel better if you're not feeling well, and not to get pulled into an elaborate sea of testing in the hope that that is going to actually tell you what to do to improve your health. Because a little bit of testing can be helpful, but sometimes excessive testing does nothing more than waste money. So I wanted to offer a few guidelines. So first of all, it is possible that you may be on Synthroid or Levothyroxine and not feeling better, and sometimes people may feel like their doctor is telling them that that shouldn't be happening, yet their personal experience clearly indicates that they're on thyroid hormone and they're not feeling better. That can happen. So let's look at a few things that you can do if that does happen. First you want to establish if your dose is correct. The initial thing to look at may be a very simple one, which is you may be under dose, you may be overdosed, and a simple dose adjustment that you can do under the supervision of your doctor by looking at your lab work can be very easy to do. So that's number one. Now if it's been challenging to find a stable dose, then malabsorption might be the problem. And what this means is you're taking the pill, but you're not consistently absorbing the pill. And so you're getting inconsistent amounts into your bloodstream, and therefore your hormone levels are inconsistent and your testing is inconsistent. And oftentimes when this happens, it can be an underlying gut issue. Now if you're eating foods around the same time of your medication, that may be interfering with the absorption also. So that's important to mention, but I'm assuming most people understand that you should not be eating with your thyroid medication. And so if you're not eating with your thyroid medication, but you're still inconsistent in your dose, or your dose is level, but your levels are inconsistent and so your doctor keeps trying to adjust it, then you may not be absorbing the medication effectively or consistently. And this may be caused by malabsorption in the gut. And the answer or the solution to that problem is to fix any underlying problem in the gut. If there's IBS, treat the IBS. If there's SIBO, treat the SIBO. If there are ulcers or GERD, see those through to resolution. Now moving on. You may want to also try a liquid form of thyroid hormone. Let's say you do have a case of mild or severe IBS or maybe inflammatory bowel disease or maybe SIBO, small intestinal bacterial growth, it's very hard to resolve. And you have this ongoing inflammation or maybe you have ulcers that are chronic, then you may want to try a form of thyroid hormone that is liquid, that is much more easily absorbed. And there have been trials done in patients with various gastrointestinal conditions that were struggling on normal synthroid or levoteroxin. And then when switching to the liquid form, their dose became more stable and their symptoms improved also. And there's one under the trade name of tyrosin, which is a liquid gel cap that can be helpful in these cases. OK, so moving through our list. If your hormones are generally in the normal range, then what do you do then? Well, in that case, you may want to consider a trial of a T4-T3 medication. What ends up happening with some patients is about 20% of patients prefer a T4-only medication like levoteroxin, according to one study. And about 43% of patients actually prefer a T4-T3 combination. So you may have your levoteroxin and you add cytomyl. Or you may switch from levoteroxin to something like Westeroid or naturophoid that has a combination of T4 and T3. And some of the studies that have been done, there is a clear documented benefit. And this was not based upon people's lab work. It was simply a trial, a trial of a different form or a balance of the medication, meaning instead of just giving a T4, a balance of T4 and T3 was administered. So it can be a simple thing to do with your doctor on an experimental basis to see if that aids. Now, what also may be happening is the problem is no longer your thyroid. And this is very important to understand. Because unfortunately on the internet, there's so much information about thyroid and the thyroid symptoms are so nonspecific that people oftentimes are chasing after the thyroid as a root cause of their problem and overlooking the fact that it's actually a problem in the gut that's driving their symptoms. So this is very important. So if you've gone through some of these basic, simple steps for your thyroid and you're still not feeling better, the thyroid symptoms that you are concerned about may actually not be thyroid symptoms, but maybe symptoms that are being driven by a problem in your gut. And it's manifesting as what looks like thyroid symptoms. Because remember, many of the thyroid symptoms are nonspecific. Weight gain, fatigue, constipation, depression, dry hair, skin and nails, those can all be caused by a problem in the gut or they can all be caused by a problem in the thyroid. So if you've gone through some of these thyroid basics or I should really say fundamentals and not responded, then I would caution you about not going too far down in the thyroid rabbit hole but rather have a thorough gut evaluation and optimize the health of your gut and see if that improves the symptoms that may have been falsely attributed to being caused by your thyroid. So here are some things that can be helpful to help you feel better if you have a thyroid condition or a suspected thyroid condition and you haven't. Also remember that if you're gluten sensitive or celiac that centroid or levothyroxin has been shown not to contain gluten so that may be comforting and make your life a little bit easier. This is Dr. Ruscio and I hope this information helps you get healthy and get back to your life. Thanks.