Everything Thyroid
A Little Anatomy
The thyroid is a butterfly shaped gland that sits just below your Adam’s apple in the center of your neck. It is not normally visible when healthy, but you can see its outline if you try to swallow and observe your neck. When enlarged, it becomes so obvious that you do not need to swallow, other than to confirm that it does move with swallowing, unlike a lymph node that does not. It communicates with your master endocrine gland controllers in the brain, known as the hypothalamus and pituitary glands through feedback loops.
Since the master glands control all the endocrine glands, they affect how each gland talks to another. In this respect, the interaction between the thyroid gland and the adrenal glands is crucial in maintaining your energy output and metabolism. Think of your endocrine system as the communication system in your body that coordinates functions between organs. This is why life is chaotic without a proper functioning endocrine system - as if the body went into a state of attention deficit!
What is unique about the thyroid gland is the hormones that it makes - T4 and T3 are a single amino acid, Tyrosine, bound to either 4 or 3 iodine molecules respectively. Most endocrine glands make hormones that are either polypeptides, a long protein, such as insulin, or are steroids, such as estrogen, testosterone or adrenal hormones.
Because it is a single amino acid, it is very stable when taken orally as long as it is not competing with other proteins and minerals that can prevent its absorption. This is not the case with other polypeptide hormones. To this day, insulin or growth hormones needs to be injected. Even nasal preparations have failed to be properly absorbed.
Understanding Thyroid Hormones
The thyroid gland makes 2 major hormones, T4- thryoxine and T3- liothyronine.
T4 is relatively inactive and needs to reach a cell to be converted to T3. When the cell is stressed, T4 can also make another hormone called reverse-T3, which looks like T3 but cannot act like it. Think of T3 as the accelerator pedal of your metabolism and reverse-T3 as the brake. Too much braking can result in a clincal hypothyrodism with normal T4 and T3 levels. We normally measure Free T4 and Free T3 levels to measure thyroid hormones, and can also measure reverse-T3.
These hormones are in a feedback loop with the pituitary gland through another hormone called TSH. When T4 and T3 are high, these have a negative effect on TSH levels, i.e. TSH drops as in hyper-thyroidism and when T4 and T3 are low, they raise your TSH, a positive feedback loop in hypo-thyroidism.
TSH stands for Thyroid Stimulating Hormone and is made by your pituitary gland. It is not actually a thyroid hormone, yet physicians use this to gauge your thyroid as it is most often elevated when you are low in thyroid and suppressed when you are high in thyroid hormones.
You can click here to view a PDF from the Institute of Functional Medicine with a diagram that shows the factors that can promote or disrupt thyroid function. Too much reverse-T3 has the same effect of being hypothyroid without a low T4 and T3. You can see how similar the list of inhibitors to thyroid production are to those that increase reverse-T3 production, listed in red, both of which lead to hypothyroid state. I would add omega-3 fatty acids to factors that improve sensitivity to thyroid hormone.
Hypothyroidism
Hypothyroidism is also referred to as an underactive thyroid. Hypothyroidism happens when the thyroid gland does not make enough thyroid hormone. Common symptoms associated with this condition can range from fatigue, weight gain, feeling cold, brain fog, depression and constipation. Since the thyroid is not releasing enough thyroid hormone into the bloodstream, the metabolism slows down.
There are many causes for hypothyroidism:
Allergens- especially food based, such as gluten, eggs and soy
A viral hit to your thyroid, e.g. COVID, EBV- Reidels Thyroiditis
Nutrients, such as too much iodine or even insufficient iodine, too little selenium, iron and zinc
Stressors that make your cells convert T4 to Reverse-T3
Malfunctioning pituitary gland- e.g. a benign tumor of the pituitary gland
Autoimmunity targeting key proteins and enzymes that make thyroid hormones
Toxins that impair enzymes that make thyroid hormones
Surgical removal or radiation of the thyroid that may be a treatment or accidental radiation to the thyroid, as in Chernobyl or lab experiments conducted with radioactive iodine
Hypothyroidism is diagnosed by lab testing that ideally shows an elevated TSH, and low Free T4 and Free T3. Once we have a diagnosis, then we need to know what caused it to malfunction. This is where Functional Medicine excels, in that it checks for the causes and also then works diligently and in step-wise pattern to correct nutrients, repair your gut, eliminate allergens, help your adrenals by managing stress, and finally measure toxins and help your weight reduction.
One of the most common causes of Hypothyroidism is called Hashimoto’s Hypothyroidism. This refers to an autoimmune attack to either thyroid peroxidase enzyme or thyroglubin, known as TPO and TGA antibodies, which then results in reduced thyroid function (hypothyroidism).
While waiting for labs, it is important to help the thyroid by replacing its hormones. Thyroid hormones can be bio-identical with synthetic T4 and T3, or we can use Porcine thyroid hormones that are standardized to contain T4 and T3. Each one differs on how they respond to hormones and therefore, I believe that it is important to try the different types based on how the patient feels and by monitoring their labs.
It is possible to get off thyroid hormones if we are able to correct the underlying issues.
Using Functional Medicine tools, regardless of the cause of the thyroid problem, we examine whether your problem lies in the inability to make thyroid hormone, the inability to covert T4 to T3, whether you are making too much reverse-T3, or you lack sensitivity to thyroid hormones. These are tested through a combination of regular labs and specialty labs.
As always, the Functional Medicine model applies, where we address the main systems that lead to imbalance in the body. Addressing toxin exposures, systemic inflammation, nutrient deficiencies and chronic stress are all approaches to enhancing thyroid health.
Real Patient Examples:
I had a young lady who had a lot of menstraul bleeding a year post giving birth to her first child. She was iron deficient and also iodine deficient. Correcting these issues not corrected her hypothyroidism but also slowed her menstraul bleeding. As she continued to lose weight and got down to a BMI of 25, her menstraul bleeding normalized, showing the connection between insulin and female hormones.
I diagnosed myself with hypothroidism 6 months post the birth of my first son. I had Hashimoto’s Hypothyrodism, was sensitive to gluten, low in zinc and iodine, had a leaky gut, was mercury and lead toxic, and insulin resistant! Over the course of 14 years, I was able to heal all of these and was able to stop thyroid replacement and also normalize my high TPO and TGA antibodies.
Hyperthyroidism
Hyperthyroidism is the opposite of Hypothyroidism. This is the condition happens when the thyroid gland is making too much thyroid hormone and is often referred to as an overactive thyroid. Symptoms that are experienced with Hyperthyroidism can range from weight loss, hand tremors, and rapid or irregular heartbeat as this condition speeds up the body’s metabolism.
This disorders also has many causes:
Sensitivity to foods, especially gluten and dairy
Viruses can initially lead to hyperthyroidism, before they settle down to either euthyroid or hypothyroidism
I have seen 2 cases of iodine hyperthyroidism from over use of iodine supplements. These same patients may need to reduce zinc or selenium or both
Autoimmunity- this is ususally an antibody to the TSH receptor called TRAB-TsHReceptor antibody that chronially stimulates the thyroid gland similar to TSH without a feedback loop
Hot nodules with the thyroid called toxic nodues- may be a single nodule or a multi-nodule and can lead to hyperthyroidism. The cause for these may be multiple, though they are usually known as idopathic (unknown cause).
Early Hashimoto’s can present as over activation of the thyroid initially, and then move towards hypothyroidism. These patients do not have thyroid receptor antibodies but will have one of two Hashimoto antibodies.
Diagnosis of hyperthyroidism, especially when the thyroid is enlarged, necessitates an ultrasound of the thyroid. If these is a single nodule or multiple nodules, a radio-active iodine scan test may be helpful to see where the uptake is happening.
Similar to the way Hashimoto’s is associated with hypothyrodism, Grave’s disease is an autoimmune disease associated with hyperthyroidism. Grave’s disease is when your immune system attacks your thyroid gland, causing it to make more thyroid hormone that your body needs.
Lab tests include all those for hypothyroidism and the addition of TR-antibody testing. I also frequently check an ECHOcardiogram, a bone density test and testing to determine breakdown of muscles called CPK. Functional Medicine testing will target gut health, inflammation and adrenal health, aka stressors of the body and toxins.
Treatment is to reduce palpitations with beta blockers, sometimes steroid to reduce inflammation, especially if viral, drugs such as methimazole, to slow the production of thyroid hormone. Finally, radioactive iodine is used to kill the thyroid followed by lifelong thyroid hormone replacement. I will usually postpone radioactive iodine until I have helped the patient eliminate toxins and clean up their diet and digestive health. This goes a long way in reducing symptoms and thyroid hormone level and could potentially mitigate the need for unnecessary radiation leading to a lifelong need for replacement of thyroid hormones.
Real Patient Examples:
A woman came to me who had a toxic nodule. She did not have autoimmunity but she was severly gluten intolerant. She also had a mouth full of amalgams (compounded metals with mercury this is used to fill oral cavities). Her mercury levels were high. She had her amalgrams replaced with composite amalgams in the hands of a capable dentist who knew how to guard against her swallowing and inhaling the mercury vapor as it was being drilled out. Following the dental replacements, her mercury was still high. She then went through a few years of chelation therapy (a type of detoxification treatment that removes heavy metals from the body) to remove the mercury and was able to rid her body of the toxic nodule and hyperthyroidism.
I have another patient with Grave’s disease, with very high levels of mercury and sub-optimal nutrition/digestion. After cleaning up her diet and improving her digestive health she is no longer hyperthyroid, though she still has unacceptably high mercury levels which is being cleaned out through chelation. Grave’s disease is something I have also seen develop due to past exposure to mold, especially in those that make trichothecense, a family of mycotoxins.
Thyroid Cancer
The most common thyroid cancer is Papillary Thyroid Carcinoma. Just like many cancers, this one too is on the rise. It is likely that the many toxic chemicals that disrupt the endocrine system, may be causative.
Once you have been diagnosed, you do not have a choice but to proceed with surgery and radiation. Once this is completed, you then can follow-up with proper functional medicine testing to help the body’s core systems function optimally so that the cancer does not recur.
If you have been following along these blog posts, you may now be beginning to see the repititious pattern of what causes imbalances in your body to lead to disease. Correcting these imbalances by managing nutrition, avoiding allergens, correcting inflammation, keeping an optimal weight, managing stress, and removing toxins will help bring you back to optimal health. This is the Functional Medicine way of thinking.
