BY TRACY McCUBBIN, MD, ABOIM, ABEM
Thyroid 101: The Basics
The American Thyroid Association estimates that 20 million Americans have a thyroid disease and up to 60% are unaware of their condition. Thyroid disease is more prevalent in women and up to 1 in 8 women will develop a thyroid disorder in her lifetime.
To understand what can go wrong with your thyroid, we must first understand how the thyroid works. It is a butterfly shaped organ that spreads over the esophagus and trachea in your neck. Think of it as your body’s power generator, it sends energy to every cell, by messaging with the hormones produced. This process begins in your brain.
The hypothalamus has a big responsibility. This part of the brain manages hunger, sleep, thirst, and body temperature. And it monitors the level of thyroid hormone in your bloodstream. If energy levels are too low, the hypothalamus sends thyroid releasing hormone (TRH) to the pituitary gland at the base of your brain which then releases thyroid stimulating hormone (TSH) to the thyroid gland. The thyroid will be prompted to make thyroid hormone by using the amino acid tyrosine and iodine.
The primary output of your thyroid is T4 (having 4 iodine atoms). This is a storage form of thyroid. A certain percentage is converted to T3 (by stripping away one of the iodine atoms). T3 is a much more active form of the hormone. If certain conditions are present, then reverse T3 is produced and is inactive.
Free T3 enters the cell membrane with the help of cortisol, zinc, and vitamin A. It basically tells your mitochondria (the power plant of the cell) how much energy to make. Think of FT3 as the gas pedal and rT3 as the brake pedal to slow things down.
Thyroid 201: Hypothyroidism
Incidence and prevalence
Hypothyroidism is when the production of thyroid hormones slows down too much and the body is unable to reach homeostasis. Hashimoto’s thyroiditis is the most common cause of hypothyroidism in adults in the US. It is estimated that 3.5 per 1000 women have Hashimoto’s. A study of 25,800 people in Colorado found that 9.5% had an elevated TSH, the vast majority were women. The prevalence increases with age.
Hashimoto’s thyroiditis is an autoimmune disease. This means your immune system gets confused and begins to attack your thyroid gland. The goal of treatment should be to calm and reeducate the immune system to stop making those antibodies!
What are the symptoms of hypothyroidism? The underproduction of thyroid hormone can create a wide array of symptoms that may seem unrelated but are all connected. Fatique, brain fog, weight gain or inability to lose weight, hair loss, constipation, infertility, low libido, depression and inability to regulate your body temperature are all symptoms.
To get a complete understanding of your thyroid health and medical needs, ask your doctor to order the TSH, FT4, FT3, Reverse T3 and the Thyroid Antibodies tests. We are seeking optimal levels not just “normal.”
Traditional allopathic physicians will recommend thyroid replacement likely in the form of T4. If you have high antibodies, you may want to consider a clean form called Tirosint. You can add a low dose of T3. Studies show that perimenopausal women feel better when taking some T3. If antibodies are negative, you can use a combination T4/T3 product called Armour thyroid.
However, this is only the tip of the iceberg. The real work comes in identifying the underlying factors that caused your thyroid disease and making healthy lifestyle changes to remedy the situation. Here are some examples that a functional medicine physician might recommend.
Heal your Gut
Did you know that 80% of your body’s immune system is located in your GI tract. Without a healthy gut, you cannot have a healthy immune system. Without a healthy immune system, you are susceptible to infections, inflammation and autoimmune diseases.
Over time things like stress, poor diet, too much alcohol and lack of sleep wear down the lining of our digestive system. When these tight junctions become loose and allow the passage of food, bacteria and pathogens into the bloodstream it can trigger an immune response that manifests in system-wide symptoms. This is called increased intestinal permeability.
I like the 5 R approach from the Institute for Functional Medicine (IFM) to heal intestinal permeability.
1. Remove the irritants – Generally for 3 weeks, we recommend taking out anything that negatively affects the environment of the GI tract such as inflammatory and toxic foods, alcohol, non-steroidal anti-inflammatory drugs like Advil and caffeine. Get rid of intestinal infections like yeast overgrowth or small intestinal bacterial overgrowth (SIBO).
2. Restore what is missing – perhaps you need digestive enzymes or bile salts to help metabolize proteins and fats in the diet.
3. Repair the lining – provide nutrients needed to help the gut repair itself.
4. Reinoculate with good bacteria – once the gut lining is healed, restore beneficial bacteria with probiotics to reestablish a healthy balance of your microbiome.
5. Rebalance – mindfulness is needed to manage stress and maintain a healthy Gi tract.
Tame the toxins
Your thyroid is quite susceptible to toxins in the environment. Toxins like heavy metals (lead, mercury, and cadmium), industrial chemicals and pollutants, pesticides and GMO’s. Unfortunately, toxins are also common in everyday products like shampoo, cosmetics and home cleaning products. Each exposure adds to your body’s toxic burden. The best way to lighten that load is to clean up your lifestyle. Avoid plastic water bottles and filter your water at home, buy organic, non-GMO foods when possible, filter your air and use personal care products that are free of phthalates, perfumes and parabens.
Hormone balancing from thyroid to adrenals to estrogen, testosterone, and progesterone is our passion at Radiance Functional Medicine. Dr. Tracy practiced Emergency Medicine for over 20 years before founding the Centers for Complementary Medicine at Kaiser Permanente. She went on to become board certified in Integrative Medicine and certified in Functional Medicine. This combination of knowledge makes her the perfect doctor to lead you in your journey to optimal health.