Your Thyroid

June 20, 2018

The thyroid gland plays a major role in the metabolism (converting food to energy), growth and development of the human body and is part of the endocrine system that includes sex hormones, growth hormone and the adrenals (ACTH).   Many books, articles, etc have been written about the thyroid and can be very confusing and intimidating in its complexity however, let me see if I can simplify it a bit. 2 structures in the brain, the hypothalamus, determine if you need more thyroid hormone, (T4 and T3) and sends a message to the pituitary to release TSH (thyroid stimulating hormone) which tells the thyroid to make more T4 and T3, the 2 primary thyroid hormones.  For the thyroid to make the hormones the body needs Iodine (T4 has 4 iodines etc.) and historically we would get the iodine from our diet however, if you think about it where do we get iodine from? Unless we eat a lot of kelp and iodized salt or take a supplement we all tend to be iodine deficient.  Before I even consider putting a client on thyroid hormones I always try a thyroid supplement that includes iodine, zinc and selenium all critical for adequate thyroid function (ThyroMedica Plus is the supplement I use)..   The thyroid makes a lot more T4 than T3 as T4 is much weaker than T3 but ultimately T4 is converted to T3.  Important to note here, that T3 is what actually gets into the cells and impacts metabolism, etc, however theres is some evidence that T4 may also stimulate receptors making it a hormone versus a prohormone and there may be some value in adding T4 to a T3 protocol.  T4 also converts to reverse T3.  Reverse T3 has a very interesting role.  When within normal limits, it stays behind the scenes, but when the body has been exposed to extreme physical or emotional stress T4 makes a lot of reverse T3 which then competes with T3 at the cellular level thus minimizing the metabolic effects of T3 giving the body an opportunity to slow down. 

There are a number of common problems associated with a thyroid that is not functioning properly and include, hyperthyroidism  (too much thyroid and may present as anxiety, irritability, hyperactivity and hand trembling), hypothyroidism (too little and may present as insomnia, hair loss, fatigue and tiredness, depression, difficulty concentrating, muscle pain, dry skin, cracking nails etc.) and Hashimoto's and Graves disease.   These are autoimmune diseases where antibodies attack the thyroid.   Hashimoto's, in particular, has become very common, as I see it in a lot of my clients.  It can be easily detected by testing for thyroid peroxidase antibodies and anti-thyroglobulin antibodies (must test for both as one may be normal and the other positive).  So what causes this autoimmunity.  For the most part, in my experience, there appears to be 2 main causes.  The primary cause is associated with gluten (the gut) and going gluten free ( has a number of other benefits as well, but another story) for a period of at least 3 months seems to decrease the number of antibodies.  I have also found that viruses, in particular, Epstein Barr (EBV) has been shown to be a cause of autoimmune disease in general and associated with Hashimoto's.  So how do we treat these various thyroid related problems?

As I mentioned, with the exception of Hashimoto's and Graves, I prefer to start with the above mentioned supplement that frequently will normalize thyroid markers.   If I am treating Hashimoto's (Graves/hyperthyroidism is another story) I use something called low dose naltrexone (LDN) which addresses the EBV as well as the autoimmunity. There are a number of ways to treat hypothyroidism (here again can get pretty complex/confusing).  Endocrinologists and other primary care clinicians tend to use just T4.   More commonly, a glandular is used.  A glandular is extracted from animals (porcine in most cases) and contains everything found in a thyroid gland, i.e. T4, T3, T2, reverse T3, etc.  The clinician usually starts out with somewhat of an arbitrary dose to see how the patient responds. I prefer to start out with a low dose and allow the patient/client to titrate (slowly go up in dose) until they feel the benefit).  If there is an elevated reverse T3, I will just use T3 and titreat in the same manner however some folks "seem to feel better" with some T4 thus supporting the idea of a T4 receptor..  When monitoring, there are certain labs that I focus on using "functional medicine" ranges but more importantly, labs are secondary to how you feel.  Unfortunately, folks are dosed based on labs not symptoms, or lack of.

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