Is it my thyroid?

It is theorized that it takes the average patient 10 years and they see 7 different physicians to have a clear understanding of thyroid disorders.  Of course sometimes it is picked up earlier, but it is often frustrating to patients no matter how quickly it is diagnosed.  The more obvious symptoms are skin and hair and bowel changes make it easier…but when weight gain and fatigue are the presentation

then it gets much harder to diagnose.  Worse yet, hormones like thyroid do not act in solitude but are often related to a cascade of other hormones and exposures and circumstances.  It is these situations that often delay the diagnosis or even miss the root causes of the problem.

Hormones in Balance

For example, constant production of adrenaline and cortisol start affecting other aspects of the endocrine system and this is usually one of the root causes of endocrine imbalances. The adrenals send messages back to the hypothalamus and pituitary that things aren’t going well. Based on that feedback, the hypothalamus and pituitary send messages to the thyroid telling it to slow down the metabolism to conserve energy.   In this way, stress and sensitivities (usually to foods like gluten) can create a cascade.

Functional Medicine Approaches

In functional medicine we think of the thyroid as the canary in the coal mine. Miners would take canaries or small birds into mines to warn them about poisonous gas leaks or other threats in the mine.  If the canary died, the miners knew to get out of the mine and out of danger. What they didn’t do was get a new canary and pretend everything was fine. When your thyroid begins to act up, either in its shape or in your lab values, this is a warning that something bigger is going on. Take heed of this and explore the mine, your body, for abnormalities, and don’t settle for the traditional medicine role of replacing the canary and missing the deeper problem.

The Thyroid and How it works

The thyroid, a butterfly-shaped gland in your neck, produces hormones that play a key role in controlling your metabolism. You can think of your thyroid as your body’s thermostat, turning your metabolism up or down as needed. Your thyroid is a good example of how your hormones are linked in feedback loops. In simplified terms, the pituitary gland signals the thyroid to produce thyroid stimulating hormone (TSH).  In turn, TSH controls your production of two thyroid hormones, T4 and T3. (Why these names? Because in medicine we’re not very creative. T4 has four iodine molecules in it; T3 has three.) The T4 hormone is inactive; the T3 hormone is active. These two hormones are like a present inside a box. The T4 is the box, while T3 is the gift inside. You can’t really use the box by itself—you have to open it to get to the gift. That’s complicated enough, but when you’re constantly producing too much cortisol, your production of T3 can get out of balance. The iodine molecules end up in the wrong place, and you produce reverse T3 instead. It’s like a glove that should fit your right hand but ends up being left-handed instead. The reverse T3 hormone doesn’t fit into any of the normal T3 receptors, but it works just well enough to send feedback that shuts off the thyroid stimulating hormone.  When the thyroid feedback loop gets out of balance and you don’t make enough thyroid hormones, you feel tired and sluggish, your skin gets dry, you gain weight, you feel cold all the time, and you may have menstrual irregularities. You might have hypothyroidism, or low thyroid function. Or you might have Hashimoto’s thyroiditis, an autoimmune condition that slowly destroys the thyroid gland.  Hashimoto’s thyroiditis is fairly common; in my experience it is usually the cause of low thyroid function, especially in women.  Low thyroid function can be treated by taking a synthetic thyroid hormone to replace your missing natural hormones.

Exploring the Root causes

Before going to that step, however, I work with my patients to boost their thyroid hormones naturally. Inflammatory foods, especially gluten, are linked to immune responses in the system.  Sometimes there is a cross reaction in the process called molecular mimicry…and an auto immune disease, like Hashimoto’s can present.  And when it comes to calming down the immune system, the first step is to cut back on these foods and treat the largest part of the immune system, the gut.  We often see leaky gut syndrome as a result…and that needs to get cared for and reversed.  Anti-inflammatory botanicals, especially rosemary, ashwaganda, and turmeric are a good first step.  Antioxidant vitamins like zinc, selenium, vitamin C, and minerals work well along with the botanicals for underlying problems related to the thyroid or the thyroid itself.  Unfortunately, by the time many of my patients are finally diagnosed with Hashimoto’s thyroiditis, so much damage has been done to the gland that we have to go to thyroid supplements. The supplement works better at a smaller dose if it is combined with the natural approach.

Collecting Information to Solve the mystery

In the end, it is essential to get a detailed story and get detailed labs for analysis.  At minimum, the following should be checked.

TSH : Thyroid-stimulating hormone is a pituitary hormone that stimulates the thyroid gland to produce thyroxine

T4: Thyroxine, one of the thyroid hormones, that has 4 iodine molecules

T3: Triiodothyronine, another thyroid hormone that has 3 iodine molecules

Reverse T3:  a thyroid hormone that is an isomer (a mirror molecule as it were) of triiodothyronine

Anti-thyroid peroxidase antibodies:   Antibodies to thyroid peroxidase (TPO) which is an enzyme in the thyroid.

Anti-thyroglubulin antibodies:   Antibodies to thyroglobulin, a key protein in the thyroid gland.

It is only when we collect all the information in the story that we can solve the mystery of the thyroid imbalances and then begin to treat the root causes and correct the imbalances.

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