I'd be hard pressed to think of anything that can impact your overall health, in every possible aspect, like the thyroid does. The thyroid gland is THE master of metabolic function; affecting the body on a cellular level to regulate:
You can see why something this important cannot be neglected when trying to optimize health. And yet, it's woefully overlooked in our current medical model. When it is addressed by doctors, it's often medicated ineffectively and any underlying issues are not discovered. Ask yourself, do you struggle with any of these symptoms?:
Feeling cold all the time
Irritability and foggy thinking
Unexplained exhaustion or depression
Constipation, bloating, digestive issues
Dry skin, brittle nails
Excessive hair loss
Resistance to weight loss
These are not nearly an exhaustive list of symptoms related to thyroid disorder, but I bet every one of you was able to identify with at least one or two of the above list. And yet, when you ask your doctor about checking your thyroid, you get one test for TSH (more on this later), and are told you are "fine."
I don't know about you, but I don't want to be "fine." I want to be great! And to be really honest, those symptoms listed above ARE NOT FINE!!! So, what can you do about it? If you're ready to learn more about optimizing your thyroid health, and therefore overall health, read on.
But first, the basics:
The butterfly shaped thyroid gland is located just over the Adam's apple. And while it may be small, the thyroid works in conjunction with your brain, adrenals, liver, and gut to keep your metabolism on point! The system is intricate, but I think we can break it down into some simple steps to help you understand.
Hypothalamus releases "thyroid releasing hormone" (TRH) to the Pituitary gland. TRH is a signalling hormone needed to spur the body to release thyroid hormone.
The Pituitary gland is signalled by the Hypothalamus to then release "thyroid stimulating hormone" (TSH). TSH is another signalling hormone that tells the thyroid it is time to release thyroid hormones into circulation.
The Thyroid Gland is spurred by the Pituitary to release the hormones (T1, T2, T3, T4, and Calcitonin).
For the purposes of this discussion, we are going to focus mainly on the hormones T3 (triiodothyronine) and T4 (thyroxine). Most of the hormones released by the thyroid are T4 (90%), and about 10% are T3.
Within each follicle on the thyroid gland, thyroglobulin is produced. This thyroglobulin (TGB), along with tyrosine (an amino acid) and an enzyme called thyroid peroxidase (TPO) binds to iodine. If the final hormone has three iodine molecules and one tyrosine, we get T3 (triiodothyronine). If it has four iodine molecules, we get T4 (thyroxine).
As I mentioned earlier, most of the thyroid hormone produced in the thyroid gland is actually T4 (90%). What's interesting about this, is that T4 is NOT the usable form of thyroid. Our bodies have to further convert T4 to T3 in order for the cells to be able to utilize thyroid hormone. And yet, most thyroid replacement medication (Synthroid) is T4 only.
Okay, so now we have some thyroid made, how do we get it around the body to the various cells that need it? And...how the heck does it get converted to the usable form, T3? First of all, the newly formed T4 and T3 molecules will get bound to something called Thyroid Binding Globulin (TBG). TBG is a like a bus that transports the thyroid molecules to the various places it needs to go. Any thyroid molecules NOT bound to TBG are called "free." So, if you've ever seen a result on your thyroid test for "free T3" or "free T4" this is what they are referring to. "Free" thyroid is available for use in various metabolic processes.
You now know that you need some free thyroid hormone, and that the only usable form of it for your cells is T3. With 90% of the thyroid hormone made being T4, how do we get it changed into the usable form?
This brings us to "Conversion"....
Conversion of T4 to T3 happens primarily in the liver and gastrointestinal tract. And not to bore you, but this just means an enzyme cleaves off one of the iodine molecules. With 60% of conversion happening in the liver, and 40% in the gut, you can see why optimal health in those tissues is critical to your metabolic health. Once T4 is converted to T3, it can then be circulated to the cells to be used for metabolic functions.
As an aside, about 20% of the T3 that comes from the liver is actually turned into something "reverse T3." 20% is what you find in the average person, but reverse T3 only gets higher when your stress is elevated. Reverse T3 is basically the opposite of T3- instead of energizing you, it steals energy. And when reverse T3 is circulating, especially in high amounts, it is fierce competition for T3 at your cells' receptor sites.
But what happens when things go wrong?
Let's review the above first:
To keep the metabolism working, the hypothalamus signals the pituitary gland via TRH (thyroid releasing hormone).
The pituitary gland signals the thyroid gland to start producing thyroid hormone via TSH (thyroid stimulating hormone).
The thyroid gland has follicles that have thyroglobulin (TGB) holding iodine and tyrosine which combine to form the basic building blocks of T4 mostly and some T3.
Then the little buses (thyroid binding globulin- TBG) transport T4 for conversion and T3 to the cells.
In the liver and gastrointestinal tract, most of the T4 is converted to the usable form T3. Some gets converted to reverse T3, which can slow metabolism.
TBG (buses) take final usable T3 to cell receptor sites all over
With all of these detailed steps to healthy thyroid function, you can imagine that a lot of things could go wrong along the way! Here are a few examples:
What if your brain wasn't picking up on the fact that you needed more metabolic boost? Might this dampen your TSH signalling?
What would happen if your thyroid wasn't quite getting the signal or responding to the signal of TSH?
What if you were deficient in iodine, tyrosine, (or selenium or vitamin D), and you unable to make enough T4 even if it was getting the signal?
What if diminished liver function or gut function meant that you were unable to convert T4 to T3? (hint- this is often an issue).
Oh, and what about stress? What if you were making way more reverse T3 than usable T3 due to stress?
So if aaaaaaallllllllll of these above things are ways thyroid function can go wrong, then why in the name of all things holy do most doctors only look at TSH????
One of the main reasons your average GP or endocrinologist won't look past a basic TSH reading is because they aren't equipped with the tools necessary to help you heal the body if there is something wrong elsewhere. What would you doctor do if they could figure out that your leaky gut was the reason you weren't converting thyroid? What would they do if they could ascertain that your gluten consumption was the reason your thyroid autoimmunity was ramped up?
Uncovering the underlying reasons for thyroid issues is exactly what a functional diagnostic nutrition practitioner CAN do. That's what we want to do!! And there is so very much we can accomplish with just diet, rest, exercise, stress, and supplementation!
For the purposes of this discussion I won't get into too much detail about the intricacies of how thyroid function is compromised. However, here is a not-so-complete list of the various aspects we would consider looking at in relation to thyroid health in conjunction with your overall health:
Hypothalamus Pituitary Adrenal Axis (HPA axis) Dysregulation: chronic stress from various aspects of your lifestyle can lead to issues with this intricate feedback loop.
Liver Congestion and Compromised Detoxification Pathways: inability to clear toxins and excess estrogens from the system will lead to issues with both conversion of thyroid as well as add to complications in slowing the metabolism down.
Toxic Burden: overexposure from our environment, personal care products, electronics etc. can impair iodine and selenium absorption, compete with thyroid receptor activity, add to gut dysbiosis, and introduce estrogen mimicking molecules to our easily fooled ancestral bodies.
Gut Dysfunction: Since 70% of our immune system resides in the gut (GALT- gut associated lymphoid tissue), an unhealthy gut means an unhealthy immune system. Hashimoto's and Graves are autoimmune diseases of the thyroid both exacerbated, or even potentiated, by gut dysfunction. An overabundance of LPS (lipopolysaccharide- a gram negative bacteria we don't want proliferating) can lead to decreased thyroid conversion, increased cortisol which leads to higher conversion to reverse T3, as well as interfering with thyroid receptor activity.
Blood Sugar and Insulin Dysregulation: Too many highs and lows in your blood sugar and/or insulin are inherently stressful. This leads to cortisol dysregulation which also hurts thyroid function. Overtime this also increases inflammation and damages the gut lining. Thyroid autoimmunity is also exacerbated.
What you might have noticed is that all the above are very much intertwined. In order to manage thyroid health and optimize overall metabolic function, we need to look at all the above and see where we can improve on multiple levels. For example: starting a yoga practice multiple times a week, getting an occasional massage, drinking bone broth and detoxifying teas, and making sure to eat well rounded meals with sufficient protein would be a simple way to start your journey to a healthy thyroid. This would aid in stress management, detoxification, decrease your toxic burden, help heal the gut, and keep your blood sugar under control. And nowhere in there was a single supplement added!!
A last, but not least note: Autoimmunity
Autoimmunity is the single most common cause of thyroid disease.
I cannot stress this enough. Even if you've had your thyroid antibodies checked and they are still low, there is likely some underlying autoimmunity that is still at play. This is why it is critical to do all we can to keep the immune system supported and not overactive.
Autoimmune disease of all sorts start the same way: a trigger (anything from genetics, to environmental, to diet and leaky gut) disrupts or confuses the immune system. The immune system mistakes this foreign molecule for the body's own tissue, and the attack begins.
90% of all hypothyroid cases are due to Hashimoto's Thyroiditis- autoimmunity to the thyroid gland: thyroid peroxidase and thyroglobulin are attacked leading to less production of T4 and T3. It is now thought that Hashimoto's is actually more prevalent than even Type II Diabetes!!
While less common, hyperthyroidism (excessive thyroid function) is mainly caused by Graves' Disease- autoimmunity that affects TSH receptors. The body overproduces TSI (thyroid stimulating immunoglobulins) which act like TSH and therefore cause an overproduction of T4 and T3.
No discussion of thyroid autoimmunity would be complete without a serious chat about gluten! While the gluten-free trend seems to be dying down, don't delude yourself that it's all hype. Regardless of whether or not you believe that gluten is harming you.... IT IS!
I will go into detail on gluten sensitivity at a later date, but here are the important nuggets you need to know regarding Gluten and Thyroid Autoimmunity:
Gluten sets the stage for increased gut permeability in everyone, regardless of gluten sensitivity status- that means EVERYONE! 100% of the population will have increased leaky gut from the ingestion of gluten regardless of whether they feel GI distress. Gliadin, gluten, and lectins found in these grains increase enzymes in the gut that separate the tight junctions of the small intestinal villi and microvilli.
Almost half of those with gluten sensitivity will manifest some type of thyroid dysfunction- HALF! The reason for this is that gluten very closely resembles thyroid, and the immune system cannot always tell the difference.
There’s almost a 100% correlation between Hashimoto’s and gluten sensitivity or celiac disease- that means if you are reacting to gluten in any way the chances of you having thyroid autoimmunity are very high! And, if you have thyroid autoimmunity you seriously have to stay away from gluten at all costs!!
And one final note, to those of you who think you can be "mostly" gluten free...or you avoid it but don't freak out about exposure:
One small exposure to gluten can set off an inflammatory reaction that can last for 6-8 months
If you've made it this far into this post, you clearly are concerned about your thyroid health. If you haven't already, reach out to your doctor and just ASK- can you please run a full thyroid panel?
But if you're not getting help, I'm here for you! Together we can:
Order a full thyroid panel
Discuss the various aspects of overall health and discover where your thyroid function has been compromised.
Work on a nutrition program that will optimize your thyroid and overall health.
Make lifestyle modifications to get autoimmunity under control.
Use strategic supplementation to support our efforts.
Decide if/when your thyroid should be medicated by an M.D.
Want to learn more? Ready to sit down and chat thyroid? Comment below or contact me directly: firstname.lastname@example.org
All data and notes adapted from "An Advanced Guide to Thyroid Function, Assessment, and Intervention" by Whitney Morgan , L.A.c, FDN-P
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