Could it be My Thyroid?

Written by Dr. Michelle Williams
So many of our patients come in complaining of the same symptoms; fatigue, weight gain, feeling cold and sluggish, interrupted sleep, foggy brain, low libido, hair loss... and the list goes on. Often these patients are seeking out naturopathic medicine as the last resort to find out why they continue to suffer from the symptoms their medical doctor has told them is probably their "normal". These symptoms are not "normal" and could be attributed to an under-active thyroid!

As naturopathic doctors, we pride ourselves on looking deeper into the biochemistry and physiology of the body and outside the conventional ranges and treatments to help our patients reach optimal health. With the thyroid this is imperative because, the majority of patients showing up at our office either have overt or "sub-clinical" hypothyroidism. We will go into more on that in a bit... first we want to talk about what the thyroid is, why is it so important and what to do if you may think your thyroid is functioning at sub-optimal levels.

What is the thyroid and what does it do? 
The thyroid is a butterfly shaped gland located in the neck above the sternum. The two lobes of the thyroid hug the trachea just below the Adams apple. The thyroid is a vital part of our endocrine system and is responsible for a bunch of metabolic processes that keep our bodies running efficiently such as heart beat, childhood growth, hormone production and metabolism, fat burning, libido, sugar regulation, stress response and mood support.

The thyroid gland is in direct communication with the hypothalamus and pituitary gland in our brain. The hypothalamus sends a hormone called thyrotropin releasing hormone (TRH) to the pituitary gland to signal the release of thyroid stimulating hormone (TSH) when we have low levels of thyroid hormone in our circulation. Once TSH is released it travels to the thyroid gland to stimulate production of 2 important thyroid hormones triiodothyronine (T3) and thyroxine (T4). The thyroid also produces another hormone called calcitonin which is responsible for calcium homeostasis, but that's not what we are talking about in this post so we will leave this one out of the conversation for now...

Once production of T3 and T4 is signaled from the pituitary by release of TSH, the thyroid gland starts to work tirelessly to produce enough of the hormone to send out into circulation to fulfill all the many jobs it has. The main hormone produced in the thyroid is T4, this is not the active form and has to be converted into T3 once it has reached the vital organs requiring it. Both T3 and T4 are not free in circulation but bound to proteins until they are needed.

So the thyroid has up-regulated the production of T4 and T3 and released it into circulation bound to proteins, now what? The bound thyroid hormone starts moving through the body in the blood, searching for cells signaling they are in need of active hormone. Once the signal is received, the bound thyroid hormone attaches to a transporter on the wall of the cell and is taken into that cell and utilized for the specific cellular processes needed in that particular tissue. Once all the cells have adequate thyroid hormone they stop signaling, resulting in an increased amount of unused hormone in circulation. This increased hormone level signals the hypothalamus to stop producing TRH which then stops the pituitary release of TSH and ultimately halts thyroid production. This is called negative feedback.

When this system is working optimally there's nothing to worry about but what about if it is not or there is another process affecting the efficiency of this system? This is where you can see the above mentioned symptoms begin to show up. There are several different conditions that affect the thyroid and these can increase production or slow production. For this blog I am going to focus on the reduction of thyroid hormone. This is called hypothyroidism...

What is hypothyroidism, what does it mean, why does it happen and can it be treated?
Hypothyroidism is diagnosed when the pituitary gland continues to release TSH into circulation and the thyroid doesn't respond or the negative feedback cycle is "broken". So in order to be diagnosed as hypothyroid in conventional medical terms, a person's TSH must be HIGH.

So if the TSH is high and the thyroid hormone level is low, the cells signaling the thyroid hormone are not getting adequate supply and will begin to malfunction. This is when people start to see changes that seem a little off or weird for them. Most often the first signs of hypothyroidism are fatigue, weight gain and reduced libido and over time if not corrected they may see worsening brain fog, dry skin, increased blood sugar levels, menstrual irregularities, depressed mood, hair loss/thinning, constipation and difficulty maintaining temperature.

So why do we see this happening in some people and not others you might ask? There are several causes of hypothyroidism and many are avoidable and very much treatable. There are essentially two types of hypothyroidism, one being due to nutrient deficiencies or other factors and the other is autoimmune.

One of the most common causes of non-autoimmune thyroiditis is due to a deficiency of idodine in the diet. Iodine is essential to the production of thyroid hormone and is easy to supplement in the diet. Historically, iodized salt made an appearance for this reason. Another nutrient is selenium, a deficiency in selenium will make it more difficult for the active thyroid hormone to be utilized by the cells in the body. Other factors that can lead to hypothyroidism are repeated stress, genetic predisposition and drugs that increase the release of dopamine, glucocorticoids and growth hormone.

Autoimmune thyroiditis, Hashimoto's Thyroiditis, is hypothyroidism caused by antibodies produced in a person's body that attack the circulating thyroid hormone. This attack depletes the body of active thyroid hormone leading to a rise in TSH. This rise in TSH ramps up the thyroid hormone production and causes the thyroid to work harder and harder. Eventually, the thyroid becomes so "overworked" that it sometimes stops functioning altogether. Diet and lifestyle can greatly affect the pathogenesis and outcomes of Hashimoto's Thyroiditis. 

At Sirona Integrative Health, our naturopathic doctors work with our patients to obtain a complex health history coupled with laboratory evaluation of hormones and thyroid. We utilize the standard laboratory values provided and determine what the functional range is for each individual patient based on symptom picture. We also take into account all the factors that could be contributing to the thyroid dysfunction including but not limited to; diet, lifestyle, stress, family history and internal and external pollutants. 

Our treatment for hypothyroidism depends on the cause and level of dysfunction and the external causative factors and barriers determined in our initial workup. We utilize targeted nutrient therapies, diet and lifestyle modifications, botanical medicine, mindfulness and stress management as well as pharmaceutical interventions if indicated. 

If you are finding yourself with one or several of the complaints outlined in this post, you can schedule an appointment with Dr. Michelle Williams to start you on the path to optimal health. If you know someone who might benefit from reading this post please share it. If you are reading this and are NOT residing in Washington or Oregon, search for a Licensed Naturopathic Doctor near you to get started on your journey!

Any information relayed in this post is for educational purposes only and is not intended to diagnose or treat.