Your thyroid is an amazing organ that produces thyroid hormone. Under certain conditions, your body can produce too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism). Due to the fact that every cell in your body has a receptor for thyroid hormone, any imbalance with this gland can cause a variety of symptoms. These can range from fatigue, digestive distress, abnormal periods, mood issues, skin disorders, vascular disorders, and more. Below is a video reviewing the types of thyroid disorders, symptoms, and the current standard of care.
It is estimated that approximately 3-5% of the US population has hypothyroidism. In the United States, the number one cause is an immune condition that attacks the thyroid. Worldwide, the cause of low thyroid function is due to a deficiency of iodine in the diet. Iodine is a mineral that is imperative in making thyroid hormone.
Hypothyroidism is defined as a disorder that manifests when your body doesn’t make enough thyroid hormone for its needs (NIDDK)(1-3). Therein lies the rub.
Hypothyroidism is based on lab values of thyroid stimulating hormone (TSH) which exceed 4.5 mIU/L. TSH is a hormone that is secreted by the pituitary gland, a pea-sized structure that is located in your skull. This busy little gland has a lot of responsibility. It receives signals transferred down from your hypothalamus. Your hypothalamus is continuously scanning the blood levels of various hormones in order to regulate them. This is similar to an operator in an airplane control tower evaluating the number of planes that can land at one time. The pituitary then gives the message to stop or start hormone release to the targeted organs.
So, it makes sense for doctors to use the reasoning that if your pituitary’s signal level (TSH) for more thyroid is within “normal range”, that your level of thyroid hormone in the blood is efficient, right?
There are a few problems with that reasoning:
1. The lab value range itself:
First of all, the lab value range that defines hypothyroidism has been criticized by many experts for being too broad. Integrative clinicians feel that these lab values which define “normal” should not be based on levels calculated from unhealthy and healthy individuals as they currently are. Rather, they should be adjusted to what healthy people’s levels are.
As I wrote in my article on Hashimoto’s Thyroiditis (HT), “In 2003, a task force of the American Association of Clinical Endocrinologists (AACE) revised current normal ranges of TSH from 0.5-5.0 mIU/L to 0.3-3.0 mIU/L.” This was in part due to the conclusion of the National Academy of Clinical Biochemistry (NACB) which believed that any level above a 2.0 mIU/L can be a flag for further thyroid evaluation (4). In other words, “normal” levels for TSH may be set too high to determine if someone is hypothyroid.
2. Optimal levels of (TSH) doesn’t always translate to healthy thyroid hormonal functioning
In other words, the planes may be in flight but on the wrong route, some may never reach their destination, some may be malfunctioning yet are still registering as “in flight”, or others may really be unidentified flying objects that look like planes but they aren’t. Let me take this analogy to your thyroid levels.
Nice plane, but where is it or why didn’t it land?
TSH is stimulated when the hypothalamus registers low levels of T4. This means that you may have enough planes, but they may not be reaching their destination. In other words, the inactive form of thyroid hormone, T4, isn’t turning into its active form, T3. (The “T” stands for the amino acid tyrosine and “4” is how many iodine molecules are attached to it).
T4 gets activated when an iodine is removed from the tyrosine in order to get into cells. This converts it into T3 (tyrosine with three iodine molecules attached) . If T4 doesn’t get an iodine removed when it should, thyroid hormone cannot enter into the cells and produce all the amazing metabolic functions that thyroid hormone does when it’s active.
Reasons why thyroid hormone might not convert include:
- Lack of nutrients to fuel the enzymes to produce T3, such as low levels of selenium, iron, B12, iodine, or vitamin D.
- An infection or inflammatory issue which produces the wrong kind of T3, a reverse form of T3 (rT3). rT3 is an inactive form of T3 that can’t enter the cell. The body makes T3 inactive because it doesn’t want to speed up metabolism in a sick system.
- A disordered digestive track (“leaky gut” or “dysbiosis”) or a “clogged” liver. Both are responsible for over 20% of efficient thyroid conversion.
- Stress and adrenal dysfunction can block T4 from becoming T3.
- Genetic predispositions or markers that increase one’s risk of getting an autoimmune thyroid disorder which prevents optimal thyroid levels.
- Environmental toxins that stop thyroid hormones from getting into the cells.
3. A messed up traffic control regulator
Other issues with just measuring TSH levels, is that the pituitary itself could be playing naughty and not listening to the hypothalamus to stop or start stimulation to the thyroid. Or, the hypothalamus could have a disorder preventing its ability to accurately measure T4 levels.
4. An immune attack
As mentioned, the most common cause of hypothyroidism is an autoimmune disorder. This means that the problem isn’t with the thyroid itself, but with the immune system attacking the thyroid preventing it from functioning optimally. This causes levels of thyroid hormones to fluctuate or appear normal because little immune bombs, or antigens, are sitting on the thyroid gland or pituitary. They can de-regulate secretion of either TSH or thyroid hormones, producing values of TSH or thyroid hormones that aren’t effectively reflecting actual need for thyroid hormone.
So, now you realize that many people may appear to have “normal” thyroid levels but may have hypothyroid symptoms. For this reason, it’s important to check more than TSH levels to determine if levels of thyroid hormone are being converted to their active forms or if the immune system is preventing healthy functioning.
These tests include:
2. Total T4 and Total T3 (the bounded form of thyroid hormone that is traveling in blood)
3. Free T4 and Free T3 (the unbounded form of thyroid that is not attached to protein that can enter into the cells)
4. Antibodies to the thyroid: Anti-thyroid peroxidase antibodies (TPO), thyroglobulin antibody (TgAb), thyrotropin receptor antibodies (TRAbs), Thyroid stimulating immunoglobulins (TSI), Thyroid growth immunoglobulins (TGI), Thyrotrophin Binding-Inhibiting Immunoglobulins (TBII)
How to Treat the Hypothyroidism
There are three options:
1. Give more thyroid hormone (conventional medications that supplement with T4 or T3)
2. Treat the cause by looking to see why thyroid hormone is low to begin with
3. Either or both of the above options as needed
Optimizing thyroid levels and getting to the cause can be done by working with a naturopathic or functional medicine practitioner. They will guide one to address all the issues in thyroid hormone metabolism and production.
Read my continuation on thyroid health series here and discover what I learned by listening to the first few days of the Thyroid Sessions Webinar Series with Sean Croxton, host of Underground Wellness Radio.
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1. Mayo Clinic Staff. Diseases & Conditions: Hypothyroidism. Mayoclinic.org. Accessed May 5, 2014.
2. Medscape. Hypothyroidism. Emedicine.medscape.com. Accessed May 5, 2014.
3. National Endocrine and Metabolic Diseases Information Service (NEMDIS). Hypothyroidism. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): National Institute of Health. Accessed May 5, 2014.
4. American Association of Clinical Endocrinologists. Thyroid awareness month 2003: TSH level explanation. http://www.aace.com/public/awareness/tam/2003/explanation.php. Updated September 2005. Accessed January 4, 2010.
5. Sean Croxton presents The Thyroid Sessions. Thyroidsessions.com. Webinar Series. May 4-May 15th 2014.
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