Everything You Need To Know To Help Your Thyroid Heal Naturally.
Hypothyroidism is one of the fastest rising health conditions with an estimated 27 million Americans having some form of thyroid disease. Fatigue, weight gain, brain fog, anxiety, depression are just some of the most common symptoms experienced by men and woman. Thyroid disease is also one of the most misdiagnosed conditions with upwards of 60% of those with thyroid disease completely unaware of this condition. Much of this is due to poor testing and screening methods and on an overreliance on a single marker thyroid marker called TSH.
The current statistics show that upwards of 12% of the US population will develop a thyroid condition during their lifetime with most of these being hypothyroidism (1).
The Importance of the Thyroid:
At the base of the neck under the top of the sternum lies the thyroid gland. A butterfly shaped gland, its purpose is to release hormones called T3 (triiodothyronine) and T4 (thyroxine). These thyroid hormones interact with every cell in the body.
Low levels of these thyroid hormone lead to a host of thyroid symptoms effecting all systems in the body. The thyroid gland is a central player in the complex web of human metabolism and is sensitive to even minor imbalances in hormone levels. The thyroid gland is the most common site for the development of an autoimmune disease.
Hashimoto’s thyroiditis is an autoimmune condition of the thyroid that is considered the most prevalent auto-immune condition (3). Hashimoto’s is said to account for up to 80% of all cases of hypothyroidism in the US (4).
Often, this condition is misdiagnosed and improperly treated because endocrinologists and general practitioners overemphasize the TSH test. When endocrinologists and general practitioners focus and rely only on the TSH marker Hashimoto’s disease and hypothyroidism is often missed in the early stages. Many patients’ health will continue to deteriorate as thyroid gland is destroyed by an overzealous immune system. As the thyroid slowly shuts down (indicated by low T3 and T4 levels), fatigue, changes in mood and cognitive function, sex hormones, cardiovascular health and gastrointestinal health all suffer.
Tip: Its very common to have a Normal TSH but have low T3 and T4 levels or have antibodies against the thyroid. This is often missed if your endocrinologists or general practitioners relies too much on TSH marker
The thyroid responds to messages from two important areas of the brain namely the hypothalamus and the pituitary gland. For your thyroid gland to release proper amounts of thyroid hormones its important that the communication between the brain and the thyroid gland work without interruption. Think about it like this.
The hypothalamus is like the thermometer of the body, it is constantly monitoring the levels of hormones, nutrients, neurotransmitters in the blood.
When the hypothalamus detects low thyroid hormone levels in the blood, it sends a chemical messenger called thyrotropin-releasing hormone (TRH) to the pituitary gland. These instructions tell the pituitary gland to release another hormone called TSH. TSH stands for Thyroid stimulating hormone (TSH). TSH then activates and instruct the Thyroid gland to start production of a protein called thyroglobulin.
TSH also activates an enzyme called thyroid peroxidase (TPO). This enzyme combines thyroglobulin, iodine, and hydrogen peroxide to create both thyroid hormones T3 and T4.
About 93% of the hormone made in the thyroid gland is T4 with 7% being T3 (5).
T4 travels to the liver where 60% of it is now transformed and converted into T3 through the glucuronidation and sulfation pathways. If the liver is inflamed or its methylation, glucuronidation and sulfation pathways are sluggish it will cause a problem in the T4-T3 conversion (6). This is also why it is so important to have a complete Thyroid panel done and not rely only on TSH.
While 60% of the conversion of T4 to T3 takes place in the liver, another 20% is converted by bacteria in our gut microbiome into reverse T3 which is permanently inactive. The final 20% is converted into T3 sulfate and T3 acetic acid which can then be further metabolized by healthy gut bacteria to produce more active T3 (6). If your endocrinologists or general practitioner only tests TSH and free T4, you can see how this conversion issue would be missed.
Problems with T4-T3 Conversion:
One common problem with hypothyroidism is a poor T4-T3 conversion which we just talked about above. As previously mentioned, the thyroid produces 93% T4 and then the T4 travels into the liver for conversion to T3 and reverse T3. In the liver thyroid hormones becomes activated and made into T3.
The gut converts the other 20% of T4 into T3. Keep in mind that T4 is inactive and does not impact your cells. T4 must be converted into T3 to be used by the cells. T3 plays a main role in how your body uses energy, internal temperature, skin, hair, and nail growth as well as your metabolism.
- Liver Problems:If the liver is sluggish you could be losing as much as 60% of T4-T3 conversion. There are many reasons for a sluggish liver but some of these reasons may include liver disease, viral infections like Hepatitis, Epstein Barr Virus (EBV), Cytomegalovirus (CMV), COVID, High heavy metal burden, nutrient deficiencies, Mold, medications, problems with methylation and Oxidative stress, etc. (7, 8). Signs of a sluggish liver include low T3, headaches, brain fog, hot flashes, acne, elevated lipid profile including cholesterol and triglycerides.
Another common problem for a sluggish liver includes estrogen dominance. Estrogen and progesterone work well together to prevent the lining of your uterus from getting too thick. Some people’s bodies don’t make enough progesterone, leading to what’s called unopposed estrogen. Unopposed estrogen is called estrogen dominance in some medical literature. Without progesterone’s balancing influence, estrogen can work overtime in your body and cause cell overgrowths, like tumors in your uterine lining. Too much estrogen or low levels of progesterone can have negative impact on your thyroid.
What causes estrogen dominance? Estrogen dominance can happen when an individual has had frequent and repeated exposure to exogenous estrogen compounds found in the environment. This exposure can come from food, plastics, cosmetics, and even oral contraceptives, like “The Pill” and HRT. This can cause the liver to become sluggish and unable to perform proper T4-T3 conversion. (9, 10).
- High Stress:Chronic stress regardless of whether it’s real or perceived can affect thyroid function in several ways. Remember earlier when we were talking about the Pituitary gland and how it releases TSH (the hormone message that instructs the thyroid gland to make thyroid hormones)
It turns out that high levels of stress or prolonged periods of stress affect the adrenal glands. In response to this stress response the adrenals release another hormone called Cortisol. High levels of Cortisol can suppress pituitary function and prevent the brain from releasing thyroid-stimulating hormone (TSH). Low levels of cortisol can also affect the thyroid gland by increasing TSH levels.
There are few other ways “Stress” impacts the Thyroid. When someone has high stress or trauma, they will often overproduce Reverse T3 (rT3). Elevated rT3 is inactive and it functions to slow the body down (thyroid has a speeding up effect) which is necessary in times of stress or trauma for the body to heal.
Chronic stress can drive reverse T3 (rT3) up for a prolonged period of time which results in less T3 activity with the cell and a functional hypothyroidism (11, 12). There are 5 many reasons for elevated rT3 that are worth understanding.
TIP: If your labs show a high reverse T3 level this means that you are converting most of your T4 into reverse T3
From a nutritional point of view, Low levels of selenium and zinc can also raise up rT3 levels. Other causes of high rT3 may include iron-deficiency anemia and low B12 (13, 14, 15). You can learn more about the main causes of Reverse T3 (rT3) here
- Gut Dysbiosis:We are still talking about reasons behind Low T3. Remember from earlier we said that 20% of the active T3 is formed by bacteria in the gut. Gut health is another important area that needs support when you struggle with thyroid levels that are all over the place and won’t stabilize.
Gastrointestinal problems like parasites, Small Intestinal Bacterial Overgrowth (SIBO) or Candida (yeast) can all cause an overgrowth of bad microbes or intestinal dysbiosis, which can result in lowered T3 production or Low T3 syndrome. (16).
Tip: If you were looking at your thyroid blood work and your doctor ran a complete thyroid panel, you might see something like this;
- Normal or high TSH
- Normal T4
- Low T3
- Low Free T3
- Low T3 uptake
- High or High normal rT3.
Free & Bound Thyroid Hormone:
Free hormones, protein bound hormones what’s the difference? Why do they matter?
Thyroid hormones (T4, T3, and RT3), and all hormones for that matter exist either as protein bound or in a free form state. I like to think about them like this, Protein bound hormones reflects what is produced but can’t be used, while free form hormones reflect what the body can use at the cellular level. One is active and the other is not.
The main protein that binds them is called Thyroid Hormone binding globulin (TBG) which acts as a sponge or taxi cab to which hormones bind and then can be freed.
Hormones in free form are then available to interact with a cell’s receptor site to produce its hormonal effect. It is only the free form hormone that is biologically available or active.
Most of the hormones in our body are bound to protein carriers.
- TBG Thyroid Binding Globulin
- CBG- Cortisol Binding Globulin
- SHBG- Sex Hormone Binding Globulin
The reason this is important is that if these levels are too high or low, we can start investigating why they are high or low. If your doctor never runs a complete Thyroid Hormone panel, he or she is losing out on some very important clues.
Thyroxine-binding globulin (TBG) is one of three major transport proteins, which are primarily responsible for binding to and transporting thyroid hormones to the necessary tissues. The other two serum transport proteins include transthyretin and human serum albumin (17).
It is important to differentiate and look at both Total T3 & T4 as well as free T3 & T4 and TBG to understand how well these hormones are interacting.
In cases of high TBG, more thyroid hormone will be bound, decreasing free hormone in the blood. This will lead to the increase of TSH, and more thyroid hormones will be produced. The total thyroid hormone level will be high, free thyroid hormone levels will be normal and TBG will be high (18).
Auto-Immunity and Hypothyroidism
As we described earlier, Hashimoto’s disease is an autoimmune disorder. The immune system creates antibodies that attack thyroid cells as if they were bacteria, viruses, or some other foreign body. The immune system wrongly enlists disease-fighting agents that damage cells and lead to cell death
The autoimmunity can be to either be to thyroid peroxidase (TPO antibodies) or to thyroglobulin (TGB antibodies). In some cases of severe autoimmune thyroid disease,antibodies to T4 and T3 can also develop (19).
One of the things worth repeating, is that it is absolutely critical for anyone who has hypothyroidism or suspects Hashimotos to test for thyroid antibodies. Unfortunately, thousands of patients around the world are left with the wrong diagnosis because most doctors won’t run these tests. In the medical system, an auto-immune condition, a sluggish thyroid, a burned out pituitary gland and a T4-T3 conversion problem are all treated the same way, with synthetic T4 such as Synthroid or a T3 medication like Cytomel.
Because the treatment is the same, most doctors do not concern themselves with testing for thyroid anti-bodies nor are they concerned about reactions from the thyroid binders and fillers. From a Functional Medicine perspective it is especially important to understand if the cause of hypothyroidism is caused by the immune systems destruction of the gland or if the hypothyroidism is caused by a sluggish liver, sluggish pituitary gland, elevated Estrogen sex hormones, reaction to binders and fillers, a gut problem or from medications. None of these things are revealed if all your doctor evaluates is TSH and T4.
Functional Lab Testing:
TSH: Reflects the blood level of thyroid stimulating hormone. Although clinical ranges are 0.5 – 5.0, the optimal function range is 1.8 – 3.0.
Total T4: Reflects the total amount of T4 present in the blood, i.e., the protein bound (unavailable) T4 and the Free T4. Estrogen dominance can create an effect where you have high total T4 even though you may have low free T4. This could be inaccurately diagnosed as hyperthyroidism.
Total T3: Reflects the total amount of T3 present in the blood, i.e., the protein bound (unavailable) T3 as well as the Free T3. Again, estrogen dominance creates the same effect as mentioned in relationship to T4 above.
Free T4: Reflects the biologically active (free) form of T4. This T4 can be converted to T3 or RT3.
Free T3: Reflects the biologically active (free) form of T3 that can generate production of energy (in the form of ATP).
T3 Uptake: This measures the sites for active or unbound T3 to bind with proteins. The more binding sites that are open, the lower the uptake result will be. High testosterone can cause high T3 uptake because it lowers binding sites. Meanwhile, estrogen dominanceincreases binding sites leading to higher T4 and lower T3 uptake.
Free Thyroxine Index: This test looks at total T4 and T3 uptake to measure the activity of free or unbound T4. If Total T4 is low than T3 uptake should be high and if TT4 is high than T3 uptake should be low.
Antibodies: Autoimmune thyroid disease falls into two main categories: Hashimoto’s Thyroiditis and Grave’s Disease. Hashimoto’s Thyroiditis is typically identified by checking antibodies that attach the thyroid tissue.
We find Antithyroglobulin Antibody (TG Antibodies) in 70% of the cases and Thyroid Peroxidase (TPO) antibodies are found in 95% of the cases.
Grave’s Disease (Hyperthyroidism) is typically diagnosed using Thyroid-Stimulating Immunoglobulin (TSI) and TSH-Binding Inhibiting Immunoglobulin (TBII). These are different names for the same test. Testing for both sets of thyroid antibodies are critically important
Supporting Your Immune System
The number one cause of hypothyroidism is Hashimotos. Knowing this, our emphasis from a treatment point of view should be focused on the things that cause the immune system to mistakenly attack the thyroid gland. Keep in mind that if you have Hashimotos, your immune system is the problem not the Thyroid.
There are several key factors or Immune Triggers that must be addressed to stabilize the immune system. Let’s review just a few of these Autoimmune Triggers below.
- Poor Blood Sugar Stability:Blood sugar imbalances cause immune dysfunction, and this can exacerbate an underlying autoimmune disease. Stable blood sugar is critical for a healthy immune response and normal thyroid function.
- Low Vitamin D Levels:Individuals with low vitamin D3 levels (below 40 ng/ml) are at significant risk for developing osteoporosis, chronic inflammation and auto-immunity (20). We like to see Vitamin D levels around 80-90 nmol/L.
- Gut Dysbiosis:Intestinal dysbiosis caused by Standard American Diet, or by medications like birth control pills, antacids, antibiotics, antidepressants can lead not only to leaky gut syndrome and chronic inflammation (21) but also yeast overgrowth and SIBO. Healthy Thyroid function depends on gut health.
- Mitochondrial Dysfunction: The mitochondriaare the energy powerhouses found within each cell of the body. They are what keep cells alive and generating energy. They are critical to how the body handles oxidative stress. Dysfunction in the mitochondria leads to increased free radicals, increase lipid peroxides and ultimately oxidative stress. This damages the cell further driving chronic inflammation. This is a classic sign seen in Hashimoto’s autoimmune thyroid disease and other autoimmune disorders. (22).
- Low Glutathione Levels:When we see signs of oxidative stress it becomes important to support the antioxidant pathways. Glutathione is one of the major antioxidant players that quell the damage caused by oxidative stress. As mentioned earlier, low glutathione levels leads to chronic inflammation and to auto-immunity (23).
- Low Omega 3 Index:The average person consumed significantly more omega 6 fats than omega 3 fats. This shows up with a low omega 3 index on testing.
The Omega-3 Index test is simply a measure of the amount of EPA and DHA in the blood, specifically the red blood cell membranes When you take an Omega-3 Index test it gives you a percentage in the US, most people are at 4% or below – the highest risk zone. Being in the highest risk zone translates to a 90% higher risk of sudden cardiac death.
Low omega-3 levels are associated with a multitude of health issues such as heart disease, Alzheimer’s, eye disease, chronic inflammation, autoimmunity and much more.
While Omega 6 fats are very important it’s the ratio of omega 3 to omega 6 that becomes important to understand. The increased omega 6 stimulate the release of pro-inflammatory mediating prostaglandin molecules. This is a key factor in the development of chronic inflammation and auto-immunity (24).
- Environmental Toxins:Exposure to high levels of infectious microbes, environmental chemicals such as plastics, pesticides, herbicides, personal care products, heavy metals and biotoxins such as mold wear down the bodies glutathione levels, alter the gut microbiome and increase inflammatory activity in the body (25, 26, 27).
- High Stress and Adrenal Fatigue:Chronic ongoing emotional stress increases stress hormones like cortisol and deplete DHEA levels. When we see low cortisol and low DHEA this can be problematic on many fronts as it relates to autoimmunity. Stress is a major trigger for autoimmune dysregulation due to its impact on inflammatory cytokines. (28).
- Lack of Sleep: Sleep is essential for healing and the resetting of our neuroendocrine system. Poor sleep promotes immune dysfunction and increased inflammation because it disrupts our circadian rhythm and alters our melatonin levels. Good sleeping habits and optimal melatonin secretion reduce inflammation, counteracts the damaging effects of high cortisol and tissue repair. (29).
- Methylation: Methylation is a key process that protects DNA, turns on and off genetic traits and helps to detoxify environmental chemicals. Over the last few years, we are starting to understand more and more about genetic SNPS or Genetic polymorphisms and how they can alter our hormones, inflammation, and neurotransmitter balances. These genetic SNPS affect our methylation pathways. Methylation plays a important role in T cell function and poor methylation is associated with the development of auto-immunity (30).
Environmental Toxins and Thyroid:
One of the most sensitive organs in the body to environmental toxins is the thyroid gland. The most common environmental toxins affecting thyroid function include:
1) Industrial Pollutants: This includes the various pollutants we find in our air, food and water that negatively affect the immune system and thyroid function. These come from our workplaces or our home residence. Vehicle emissions, industrial chemical waste, and chlorine and fluoride in our water supply. Pesticides, herbicides and artificial chemicals in our food supply (31, 32, 33) all have been shown to have damaging effects to our immune system. Just think Round up, Glyphosate, Atrazine.
2) Ionizing Radiation: We are exposed to these through medical devices such as CT scans and mammograms, microwaves, and cell phones. We also are exposed to ionizing radiation when we fly in an airplane.
There is also thought to be nuclear radiation from powerplant explosions that is around us in varying amounts depending upon our geography. All ionizing radiation has a negative effect on thyroid function (34).
4) Perfluorooctanoate (PFOA) These are dangerous chemicals found in non-stick style pans. Be sure to avoid all non-stick pans and especially those that are not labeled as PFOA free (38).
5) Fluoride: Fluoride is a halogen that competes with iodine uptake in the thyroid gland. Iodine is needed for the production of thyroid hormones. Fluoride is found in tap water, toothpaste, and many processed foods (39).
6) Bromide: Like fluoride, bromide is a halogen that competes for iodine uptake in the thyroid gland. Bromide is found in soft drinks and baked goods (40).
Key Nutrients Needed:
Iodine: Iodine is critical for thyroid hormone production in the body, but a mistaken and popular belief is that it is the primary cause of Hypothyroidism in the USA. The primary cause of hypothyroidism in the USA is Hashimotos. Too much Iodine can also cause hypothyroidism. I typically don’t recommend iodine as it could be problematic with individuals with Hashimoto’s – especially with patients who have elevated TPO anti-bodies.
Tyrosine: L-Tyrosine is an amino acid needed for the production of thyroid hormones. The “T” in T3 or T4 is this amino acid. T3 is one Tyrosine and 3 Iodine molecules. T4 is one Tyrosine and 4 Iodine molecules. Tyrosine is the backbone of thyroid hormone.
Vitamin A: Vitamin A is needed for intercellular transduction (41). In other words, Vitamin A is required for activation of thyroid hormone receptors and insufficient vitamin A not only depresses thyroid function. Animal models have shown that vitamin A deficiency interferes with thyroid health starting further upstream in the pituitary gland (42).
Selenium: Selenium is incorporated into key enzymes involved in several metabolic pathways implicated in thyroid hormone metabolism; additionally, it plays an antioxidant role in the regulation of the immune system. There are strong links between selenium deficiencies and auto-immune thyroid problems (43, 44).
Studies have indicated that individuals with lower selenium levels are at higher risk for low T3(45). Selenium has been shown to reduce rT3 levels and improve active T3 levels (46). It also reduces anti-thyroid anti-body formation (47). Selenomethionine has been found to be the most effective form of selenium for reducing oxidative stress
Zinc: Low zinc status has been shown to compromise T3 production. Zinc plays an important role in immune modulation which may reduce thyroid anti-bodies (48). Additionally, it is a key player in 5’deiodinase activity.
Riboflavin – B2: Hypothyroidism induces the symptoms of riboflavin deficiency. This is because thyroid hormone is needed for production of the enzyme flavin kinase, which is in turn needed to generate flavin adenine dinucleotide (FAD). Riboflavin deficiency and thyroid hormone deficiency lead to the same low FAD levels in both rats and humans.
Vitamin B6: Pyrodixal 5’phosphate is a co-enzyme participating in more than 100 enzymatic reactions in the human body. Without this vitamin, the thyroid cannot utilize its iodine raw material efficiently to make the hormones. Pyridoxine B6 is needed even more by an overactive thyroid. Muscle weakness is very common in people with an overactive thyroid and in those who are also lacking in B6. (49).
Well-conducted experiments have shown that vitamin B6 deficiency leads to hypothyroidism. B6 supplementation also helps calm an overactive immune system which is helpful in cases of auto-immune thyroid disorders (50). B6 is also needed to make GABA which is a calming Neurotransmitter.
Vitamin C & E: These are both key anti-oxidants that protect the thyroid gland from oxidative stress and improve immune regulation.
If interested in more information regarding the nutritional deficiencies seen in thyroid diseaseread this article.
Blood Sugar Balance:
Blood sugar imbalances are major contributors to the development of hypothyroidism. When our blood sugar gets too high (hyperglycemia) the sugar molecules bind to proteins in the body and create Advanced Glycolytic Enzymes (AGEs) (51). The AGEs destroy cell membrane function, increase cellular inflammation and damage insulin receptor activity. These AGEs create a vicious cycle of elevated blood sugar and inflammatory immune imbalances.
AGEs bind to thyroid tissue causing injury. Elevated HgA1C which is a 90 day window of gucose control can be correlated to TSH levels. High HgA1C levels are associated with increased TSH and decreased free T3 & T4 (52).
Low Blood sugar is also a problem. When the blood sugar drops too low (hypoglycemia), it increases stress hormones like cortisol and adrenaline. High Cortisol directly inhibits the enzyme (5’-deiodinase) which converts inactive T4 into active T3. This can lead to low T3 levels (53).
In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are high enough, they may not be able to bind normally to receptor sites. And when this happens it doesn’t get into the cells. Cortisol will also increase the production of reverse T3 (rT3), which is inactive (54). Hopefully you can see that if you have thyroid disease or Hashimotos, you need to work on blood sugar stability.
The Microbiome and its Connection to Thyroid Disease:
The gut microbiome is made up of over 1000 different species of microbes and it plays a huge role in nutrient absorption, detoxification and the development and maturation of the immune system (55). Certain bacteria of the gram negative classification are known to release a potent inflammatory mediator called lipopolysaccharide (LPS).
Elevated levels of LPS have been shown to affect pituitary TSH stimulation, T4 production and TBG production.
Gluten and Thyroid Disorders:
Gluten is the protein found in wheat, barley, & rye. Gluten is a sticky, storage protein that can binds to the small intestinal wall where it can cause intestinal inflammation and damage to the intestinal villi.
Whether you have celiac disease (very common in patients with Hashimotos) or you have Non Celiac Gluten Sensitivity, Gluten is a major contributing factor with inflammatory and autoimmune diseases (58, 59).
Gluten sensitivity is highly associated with inflammatory disorders of all kinds (60). It is also a contributing factor in many autoimmune diseases such as Lupus, rheumatoid arthritis, type I diabetes, Hashimoto’s thyroiditis, autoimmune cardiomyopathy, lymphoma and dermatitis herpetiformis (skin disease) among others (61, 62). If you have thyroid disease or any of the autoimmune diseases listed above, a great place to start is a gluten-free diet.
Anti-inflammatory foods help modulate the immune system. Research demonstrates that anti-inflammatory diets reduce markers of inflammation in the body and the risk of chronic conditions. A 2016 review found that the Mediterranean diet reduced C-reactive protein — a test that indicates inflammation in the body — by 20%, and overall heart disease risk by 30%
This nutrition plan is rich in phytonutrient dense vegetables, healthy fat and clean protein sources. Non-starchy vegetables, herbs, & teas are great sources of antioxidants. Healthy fat sources include coconut products, grass-fed ghee, avocados, olive oil, nuts, seeds, & purified omega-3 fish oil supplements.
Healthy protein includes wild-caught fish, grass-fed red meat and free-range chicken, turkey and eggs (although these are usually eliminated for the first 30 days and then added slowly to see if the individual is able to tolerate them). In addition to an anti-inflammatory diet, if you have known food sensitivities to lectins, nuts, seeds, or other foods hidden food sensitivitiesyour diet will need to be personalized to your immune tolerance.
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