Marsha is tired all the time. She wakes up with a dull headache and needs coffee before she can be civil with her husband and kids. Her skin is dry despite practically soaking in lotion. Her hair is getting thinner and more brittle. She has gained a lot of weight and feels cold much of the time, so much so that she wears socks to bed.
Janet also feels tired but in her case, she feels wired and tired. Her pulse is fast and her skin is moist. She feels anxious and irritable. She has a hard time sleeping. What do these two women have in common? They both have thyroid problems.
Of course, men can have thyroid problems too. It’s just a lot more common in women. According to the American Thyroid Association, “Women are five to eight times more likely than men to have thyroid problems.” They go on to say, “One woman in eight will develop a thyroid disorder during her lifetime.”i
The following article will help you understand how your thyroid works, what the lab tests mean and what you can do to improve your thyroid function. I have included enough detail to make you an expert. I suggest you read the whole article, skimming any sections that seem too technical. Take what information you need and can use. You can always come back to this article to answer any questions that may arise.
Please note – I am not an endocrinologist or even a medical doctor. Use this article as a resource while working with your physician.
Where is my thyroid?
The thyroid gland is located just above the sternum. It is a butterfly shaped gland, wrapped around the trachea. Inside the thyroid are the parathyroid glands. The thyroid is part of the “fight or flight” nerve and hormone system. Thyroid hormones increase energy, speed and body heat. The parathyroids are part of the “rest and digest” system. Parthyroid hormone helps the body to nourish and repair itself, primarily by directing calcium back to the bones when it is not needed elsewhere. The function of the parathyroids has to be replaced in the case of thyroidectomy (removal of the thyroid) because the parathyroids are embedded in the thyroid gland.
What is thyroid hormone made of?
The thyroid gland produces thyroid hormones, primarily T4, though also smaller amounts of T3 and T2 respectively. T4 is made of an amino acid called Tyrosine plus four molecules of the mineral Iodine (Hence the name, T4). T4 is the transport form of the hormone. T3 is Tyrosine plus three Iodine molecules and T2 has two molecules of Iodine. T3 is the active form of the hormone.
One of the causes of hypothyroidism is insufficient Iodine in the diet. Many parts of the world don’t have sufficient Iodine in the soil, so the foods grown in that soil or the animals that depend on that food are deficient in Iodine. People eating those grains, vegetables and animals therefor don’t get enough Iodine. A severe form of mental retardation called Cretinism was common before Iodine was added to salt. Subclinical Iodine deficiency is still common.
The amino acid Tyrosine is a normal component of the diet and should not need to be supplemented, though there are some people with insufficient enzymatic ability to split Tyrosine molecules off from the rest of the protein in their food and thus do have a need for Tyrosine supplementation. These people are the exception and can be identified by testing serum amino acids. Clues that helped me to find Tyrosine deficiency in a few patients were the failure to produce endorphin in response to acupuncture, general lack of zest for life and extreme sensitivity to air pollution. The poor response to acupuncture and lack of joy is because Tyrosine is also needed to make endorphin, dopamine and norepinephrine – hormones that cause pain relief, reward and excitement. The exagerated response to air pollution (extreme fatigue) is because certain pollutants block the conversion of Phenylaline (another amino acid) into Tyrosine, resulting in low levels of the substrate needed to make endorphin, dopamine and norepinephrine as well as thyroxine.
What does thyroid hormone do?
In brief, thyroid hormone raises the metabolic rate of the cells, that is, the rate at which cells burn fat and oxygen to make energy. Thyroid hormone does this by making the cell sensitive to adrenal hormones. Adrenal hormones in turn, speed the metabolic rate.
You might wonder why thyroid hormone is needed since adrenal hormones actually control the burn rate of fat and oxygen. The answer is that adrenal hormones come and go in little spurts that would make your energy level rise and fall like someone driving a car by pumping the gas pedal up and down. Thyroid hormone smoothes and regulates the overall rate of metabolism. If there is not enough thyroid hormone, the “gas” doesn’t reach the “engine”. You can think of thyroid hormone as the “cruise control”, setting the overall rate of energy production.
In general, men have larger adrenal glands and more muscle mass than women and thus can tolerate a lower functioning thyroid and not have symptoms.
How does thyroid hormone get where it needs to go?
Most of the hormone produced by the thyroid gland is in the form of T4 (In fact, fourteen times more T4 than T3). T4 is a very stable form of the hormone, but because T3 is the active form of the hormone, T4 must be converted to T3 in the tissues.
Ninety-nine point five (99.5) percent of the T4 and T3 are bound to proteins called thyroid-binding globulin (TBG), transthyretin (TTR) and albumen. Of these, TBG binds 75% of the thyroid hormone, TTR 20% and 5% is bound to albumin. These are very stable molecules that serve as a reservoir of thyroid hormone outside the thyroid gland itself. If there were no pool of circulating protein-bound thyroid hormones, depletion of the hormones could occur within hours of the thyroid ceasing production. As it is, the thyroid could stop making hormone for 24 hours and amount in the blood would only decrease by 10% and 40% for T4 and T3 respectively. This allows thyroid production to fluctuate without affecting available levels of the hormones. Another advantage to being bound to large protein molecules is that there is less loss of the hormone in the urine than there would otherwise be.
The different carrier proteins also direct the delivery of thyroid hormone to particular parts of the body. Most notably, transthyretin (TTR) delivers thyroid hormone across the blood-brain barrier to the brain and nervous system, and across the placenta to the fetus.
As noted earlier, there is a small amount (0.5%) of unbound T4 and T3 in the bloodstream. The T4 and T3 must become free of the transport protein in order to enter the cells of the target tissues. In lab tests, the free T4 and T3 fractions can be measured separately from total T4 or total T3.
Once at the cell membrane, T4 and T3 must cross the cell membrane with the help of cellular thyroid hormone transporters and then bind to the nuclear thyroid receptors in the nucleus of the cell. Thyroid disruptors like PCB’s, BPA, dioxin and flame-retardants can block crossing the cell membrane.,
Conversion of T4 to T3.
Once inside the cell, T4 must be converted to T3. This occurs with the help of enzymes called deiodinases. There are three types of deiodinase, designated as Type I, II and II Regardless of which type is involved, for deiodination to result in metabolically active T3, one molecule of iodine must be removed from the outer ring of the T4. Removal of an iodine molecule from the inner ring produces an inactive form of T3 called “reverse T3” or rT3. Types I and II produce metabolically active T3. Type III produces rT3. Type III is used to reduce excess levels of T3 in the brain and in the placenta and fetus. Excess T3 could stimulate abnormal cellular differentiation, particularly in the fetus.
Type I deiodinase is produced in the liver, kidney, thyroid, pituitary and heart but primarily in the liver. The liver is thought to be the main source of peripheral T3 production and also the main location for clearance of plasma reverse T3. Type I is the most dependent on adequate selenium levels of the three types.
Type II is produced in the central nervous system, pituitary, skeletal muscle, cardiac muscle and brown adipose tissue. Both Types I and II are blocked by the presence of mercury, arsenic, cadmium, lead, PCB’s, FD&C red dye #3, the pesticide methoxychlor and a UV agent used in sunscreens called octylmethoxycinnamate. Blocking the action of Type I or II deiodinase results in less T3 and thus lowered metabolism.
How does thyroid hormone raise energy level?
T3 increases transcription of beta-adrenergic receptors and decreases transcription of alpha-adrenergic receptors on the cell membrane. Beta-adrenergic receptors bind with circulating catacholamines such as norepinephrine (adrenal hormone), stimulating glycolysis and glycogenolysis (the burning of glucose and glycogen to make energy). In contrast, when catacholamines bind with alpha-adrenergic hormones, metabolism is reduced. Thyroid hormone is also an insulin antagonist. It stimulates lipid turnover, free fatty acid release and cholesterol synthesis. In short, T3 encourages converting both fat and glycogen into energy.
Additionally, thyroid hormone maintains calcium mobilization and is necessary for the contractility of mysosin filaments in the muscles. It is necessary for central nervous system, skeletal and sexual maturation and is also required for protein synthesis and the formation of apoenzymes.
From this it is easy to understand how lack of thyroid hormone activity causes poor muscle and ligament development, low energy, cold body temperature, inability to think clearly, accumulation of fat, etc. Beyond the obvious, energy is required to power every metabolic process. Low energy equals reduced health in every respect.
How is the production of thyroid hormone regulated?
The short answer is that the pituitary produces a hormone called thyroid-stimulating hormone or TSH, which in turn stimulates the thyroid to produce more thyroid hormones. The production of TSH is in turn regulated by hypothalamus. The hypothalamus makes thyroid-releasing hormone (TRH). TRH causes the pituitary to produce TSH.
The hypothalamus is in turn influenced by the weather (prolonged cold causes increases in TRH production), the amount of circulating iodine in the blood, fasting (lowers metabolism to conserve energy) and other factors. Think of the hypothalamus as a little lab in your head, constantly measuring blood chemistry and other information and deciding what hormones are needed. The hypothalamus sends this information to the pituitary. In turn, the pituitary issues the orders to the glands to make appropriate amounts of hormones needed to deal with current environmental conditions.
With such a beautifully balanced system, what can possibly go wrong?
Hmm, let me count the ways…
Excluding pathology such as tumors of the pituitary, genetic abnormalities, infectious disease, etc., the most common conditions of the thyroid are hypothyroidism and hyperthyroidism. Let’s start with hypothyroidism.
Hypothyroid means low-functioning thyroid. Remember, a low functioning thyroid results in low energy production. Hypothyroidism can be caused by
- Inadequate stimulation by the pituitary.
- Inadequate production of T4 by the thyroid gland (Primary hypothyroidism).
- Inadequate conversion of T4 to T3 in the tissues (Peripheral thyroid resistance).
- Auto-immune destruction of the thyroid gland or its hormones (covered in a following section).
Let’s take these one at a time.
Inadequate stimulation by the pituitary.
The pituitary produces thyroid-stimulating hormone (TSH). The normal range for TSH in the blood is .4 – 4.5 mlU/L. Symptoms of hypothyroidism in patients whose blood levels of TSH are under .4 indicate under-production of TSH by the pituitary. Blood levels of TSH over 4.5 in persons with symptoms of hypothyroidism indicate that the patient’s thyroid gland is not responding to the TSH.
It should be noted that the current lab standard of up to 4.5 mU/L may be missing many people who are clinically hypothyroid. The National Academy of Clinical Endocrinology recommended in 2002 that the target TSH level for thyroxine replacement should be between 0.3 and 3.0 mU/L. Adopting this new guideline would bring the number of people with abnormal thyroid function to as much as 20 percent of all adults, up from 4.6 percent under the current guidelines. In guidelines published by the National Academy of Clinical Biochemistry the report states, “In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 because 95 percent of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mU/L”.
What does TSH do?
TSH stimulates a plasma membrane transport system called NIS that allows sodium to be pumped out of the cell and iodine pumped in to the cell. This allows the cell to concentrate iodine 20 to 40 times more than the level found in the plasma. A number of thyroid disruptors, chiefly perchlorate, thiocyanate, bromate and nitrate, compete with iodine for binding to the NIS protein. This competition results in less iodine getting into the follicular thyroid cell and thus less production of thyroid hormones.
Inadequate production of T4 by the thyroid gland.
To produce thyroid hormones, the thyroid gland must have adequate supplies of iodine, protein (chiefly Tyrosine) and several co-factors, including selenium, zinc, Vitamins C, A, E, B12 and alpha-lipoic acid (also known as ALA or Thioctic Acid). The most common limiting factor is Iodine.
For over fifty years, iodine deficiency has been known to be the primary cause of hypothyroidism. While most people believe that iodized salt has solved the problem of iodine deficiency in this country, many researchers do not believe this to be the case. For one thing, only about half the population uses iodized salt. For another, many people are on low-salt diets. More importantly, iodization of salt assumes the standard need for iodine to be 150 micrograms per dilution for adults. Compare this to the average ingestion of 13.8 mg Iodine consumed in Japan. Best case, the average American is getting 1 percent of the Iodine as the average Japanese person.
A further problem with Iodine is that we are no longer getting Iodine in all our baked goods. Up until the 1980’s, Iodine was added to flour to strengthen the dough and allow for greater rise. So for example, in the 1960’s a slice of bread contained 150 micrograms of Iodine. Since the 1980’s, Iodine has largley been replaced with Bromine. The National Health and Nutrition Survey (NHANES) found that Iodine levels have declined 50% in the United States during the period from 1971 to 2000. Worse, Bromine binds to the same receptor sites as Iodine but Bromine is a carcinogen. Since the breasts, ovaries and prostate (in addition to the thyroid gland) concentrate Iodine or Bromine, this may be at least partially responsible for the increased rates of cancer in these organs since the 1980’s. Fortunately, England and Canada ban the use of Bromate in flour and California lists it as a carcinogen. For this reason, many bakers and millers (such as King Arthur Flour) only use iodated flour.ii
Bromine is one of a group of similar chemicals. Iodine, Bromine, Fluorine and Chlorine are collectively known as halogens (Latin for “Salt formers”). These molecules share characteristics that make them able to interact with the same receptor sites in the body. What this means is that in place of Iodine, one of these other molecules can bind to that spot, preventing Iodine from doing it’s job.
Bromine (also bromate or bromide) is not only found in breadstuffs, it is in flame-retardants and thus is found in most furniture fabrics, carpeting, etc. It is used as a fumigant on crops and also a disinfectant in swimming pools. It can also be found in sodas and many prescription items.
Fluoride is added to the water supply and to toothpaste. In addition to interfering with thyroid hormone function, fluoride is implicated in causing rickets, hip fractures, bone cancer and death. Sodium fluoride is used as rat poison.
Chlorine is a widely used disinfectant (also added to our water supply), is in many cleaning products (such as Cloroxtm) and is found in many pesticides and other environmental pollutants. These pollutants are ubiquitous. One study of 5,994 Texans found that 99.5% of those tested had significant levels of organochlorine pesticide (DDE) residues in their blood. An Environmental Working Group study tested cord blood from 10 infants born in US hospitals in 2004. A total of 287 toxic compounds were found, including 147 PCB’s (polychlorinated biphenyls) and 212 chlorinated pesticides. These toxins bio-accumulate in the fat stores of the body, becoming increasingly concentrated with age.
Thiocyanate inhibits Iodine uptake into the thyroid by interfering with the NIS. The half-life of thiocyanate is around six days. Brassica family vegetables (broccoli cauliflower) contain thiocyanate. Thiocyanate is reduced by cooking and only about half of it is absorbed in the GI tract. Cigarettes on the other hand are a greater source of thiocyanate. The breast milk of smokers has been found to have four times more thiocyanate than that of non-smokers and half as much Iodine. The take-home message is to avoid smoking and second-hand smoke, and to cook brassica family vegetables.
Nitrates are found in many good foods such as lettuce, beans, squash, beets and carrots. Nitrites are added as a preservative to prepared meats and fish, and nitrate runoff from agriculture is in the water supply. Nitrates also interfere with Iodine uptake by the thyroid but their half-life is about five hours. Cooking also reduces the nitrate content of vegetables. Using a water filter and cooking vegetables can reduce nitrate load. Consuming additional Iodine can counter the effects of thiocyanates and nitrates.
Inadequate conversion of T4 to T3 in the tissues.
As discussed earlier, conversion of T4 to T3 requires a selenium-dependent enzyme called I 5’ deiodinase (Type I). Deficiency of selenium can result in a lack of this enzyme and as a result, a lack of T3 despite normal circulating levels of T4. Besides selenium deficiency, many other substances can block the activity of I 5’ deiodinase, including cigarette smoke, pesticides, plastics, heavy metals and even some foods.
Of the factors listed above, the most important blockers are the heavy metals, mercury, cadmium and arsenic). This is because these heavy metals bind with the enzyme I 5’ deiodinase and prevent it from removing one iodine from the appropriate ring of the Tyrosine-Iodine complex (T4). While healthy foods like tofu and broccoli weakly bind with the enzyme, heavy metals form very tight bonds that are slow to release. The half time of mercury excretion from the body is over two years. That means if you are exposed to mercury today, in two years, half of it will still be in your body. In four years, one quarter of that mercury will still be in your body!
After iodine deficiency, the most important nutrient deficiency is selenium. This is because the enzyme I 5’ deoiodinase is made from selenium. Deficiency can cause a “14-fold decrease” in T4 to T3 conversion.iii Though Selenium deficiency must be severe to cause a deficiency of I 5’ deiodinase,iv insufficient Selenium increases risk of auto-immune thyroiditis because Selenium is needed to make the protective anti-oxidant enzyme glutathione peroxidase.
The next most important group of thyroid disrupters is plastics and pesticides such as DDE, BPA, Dioxin, bromates, etc. These also have a very long life. For example, DDE, a breakdown product of DDT (which was banned in 1972) has been found in samples of breast milk around the world, sometimes at levels exceeding what would be allowed on the market in a commercial milk product. These toxins accumulate in fat stores and concentrate up the food chain, ultimately in animal products that we consume.
There is some evidence that elevated levels of the stress hormone cortisol and also of insulin can inhibit the conversion of T4 to T3.v
Auto-immune destruction of the thyroid gland or its hormones.
Hypothyroidism is frequently the result of auto-immune destruction of the thyroid gland or it’s products. The auto-immune diseases of the thyroid are Grave’s disease and Hashimoto’s thyroiditis. The lab tests to detect and monitor these conditions are anti-thyroglobin antibodies and antimicrosomal antibodies.
What are the symptoms of hypothyroidism?
Since thyroid hormone is necessary to make energy, the primary symptoms are fatigue and cold. However, thyroid hormones have many other direct effects and also affect activity of other hormones.
I created a symptom survey to use with my patients. The way I use this survey is to total the answers in the “Yes” column. A total score over 10 is suggestive of hypothyroidism. Count the number of “Yes” answers. A number greater than 10 suggests further investigation is warranted.
|I am tired much of the time||Yes||No|
|I often have headaches in the morning that wear off during the day||Yes||No|
|My skin is dry||Yes||No|
|My hair is thin||Yes||No|
|I feel stiff and achy in the morning||Yes||No|
|I waer socks to bed to keep my feet warm||Yes||No|
|I use moisturizing lotion on my arms, legs or body||Yes||No|
|I have difficulty losing weight or avoiding weight gain||Yes||No|
|I tend towards constipation (less than one bowel movement a day)||Yes||No|
|My fingernails are brittle||Yes||No|
|I am not very interested in sex||Yes||No|
|My hair seems thin and breaks easily||Yes||No|
|I feel depressed||Yes||No|
|I have difficulty thinking quickly||Yes||No|
|My reaction time seems slow||Yes||No|
|Moderate exercise makes me short of breath||Yes||No|
|I feel achy and stiff unless I exercise or take a hot shower or bath||Yes||No|
|My skin feels puffy or swollen||Yes||No|
|I feel best with more than 8 hours of sleep per night||Yes||No|
|I feel heart palpitations or have been told I have mitral vale prolapse||Yes||No|
|I have to urinate frequently (more than 6 times per day)||Yes||No|
|I have difficulty remembering things||Yes||No|
|The outer third of my eyebrows has thinned or disappeared||Yes||No|
|My pulse rate is below 65 even though I don’t exercise extensively||Yes||No|
|I feel sleepy during the day||Yes||No|
|I need coffee, cola or tea to think clearly in the morning||Yes||No|
|My feet and ankles appear puffy or swollen||Yes||No|
|My knees lock when I stand (rather than being slightly flexed)||Yes||No|
|I feel light-headed if I stand up too quickly||Yes||No|
|I am double jointed (such as bend my thumb back towards my wrist or do the splits)||Yes||No|
|(Men only) I have difficulty achieving or maintaining an erection||Yes||No|
|(Women only) I have very painful menstrual cramps||Yes||No|
Beyond symptoms, how do we test for it?
The most commonly used test is Thyroid Stimulating Hormone or TSH. This test measures the amount of TSH produced by your pituitary gland because presumably, the pituitary knows how much thyroid hormone you need. Doctors use this test to determine the correct dose of thyroid hormone to prescribe. If the TSH is high, this means that your pituitary is trying to raise your thyroid hormone production. If it is low, this means the pituitary is trying to reduce the amount of thyroid hormone production. As noted above, the ideal range of TSH is around .4 to 3.0 (not the upper limit of 4.5 recommended by most labs). In fact, for women wishing to become pregnant, a TSH greater than 2.5 is associated with implantation failure and early pregnancy loss.vi,vii
Most medical doctors begin by ordering a TSH. If that is normal, they generally look no further because the indication for prescribing replacement hormone is a high TSH. If the TSH is high (indicating that the pituitary thinks that thyroid hormone levels are low), then the doctor will likely order a T4 test next.
A more comprehensive panel may include; Free T4, Free T3, Thyroid Binding Globulin (TBG) and reverse T3 ( rT3). This gives a much fuller picture of where the dysfunction exists. Remember, T4 is the transport form of the hormone while T3 is the active form. While they are each bound to globulin (protein) they are not metabolically available. That’s why testing Free T4 and Free T3 gives a picture of the levels of hormone actually interacting with cells. Even this picture can be misleading because some of the T3 may be the inactive, reverse T3 (rT3) form because the deiodinase enzyme was disrupted by exposure to heavy metals, plastics or other pollutants. If rT3 is elevated, hair Mercury levels (Doctors Data) and serum GSH are additional tests that may be employed.
If auto-immune thyroid disease is suspected, these additional tests may be ordered;
Anti-Thyroperoxidase (TPO) Antibodies, TSH receptor antibodies (TRAb) and antithyrogobulin antibodies (Tg). particularly if the patient has hypothyroid symptoms despite normal TSH, Free T4 and T3 tests.
- The single most distinguishing sign of advanced hypothyroidism is thinning or loss of the lateral third of the eyebrows. This can advance to the point that only the medial third of the eyebrow remains.
- Thinning of head hair, both in terms of the number of hairs and the thickness of each individual hair is another strong indication.
- Dry skin is most readily seen on the calves and forearms, though frequently, the earliest indicator is dry, cracked heels.
- Obesity is another possible indicator, particularly if accompanied by fluid swelling in the feet and legs.
- Ligamentous laxity is another sign. You can test the tone of the ligaments by asking the patient to bend their thumb backwards or touch their palms to the floor.
- When testing reflexes, you may note slow reflexes in hypothyroid individuals.
- Low blood pressure is another sign. This can be felt in the pulse but can be quantified with a blood pressure cuff. A further test is to take blood pressure lying down, then standing. In a normal person, the blood pressure will not fall when rising from a lying to standing position and may in fact rise 5 mm Hg. In someone with adrenal fatigue/hypothyroidism/poor sympathetic tone (or a number of other medical conditions) the blood pressure will drop when rising to a standing position. A systolic drop of 20 points or a diastolic drop of 10 points is defined as orthostatic hypotension.viii (A drop of 20 points may indicate Cushing’s Syndrome (excessive cortisol production). Additional signs associated with Cushings Syndrome include a round or “moon” face, fat deposited above the collarbone and in the upper back “dowager’s hump”, dark pigmentation in the creases of the hands, purple stretch marks, obesity in the trunk but muscle loss in the arms and legs).ix
- Heart palpitations. More than two “skipped beats” per minute is abnormal and may be due to hypothyroidism.
- Multiple areas of point tenderness. Hypothyroidism is essentially the same as chronic fatigue syndrome and fibromyalgia.x
By far the most important test of all is to take your temperature every morning when you wake up and write down the number. Do this every morning for at least a week.
Normal temperature is 98.6 degrees. The range of normal is a full degree plus or minus 98.6. If the your temperature is consistently below 97.6, a hypo-metabolic condition is present. After a few days or weeks of intervention, this test can be repeated to get an indication of whether or not the treatment is working.
This test is cheap, effective and empowers you to track your progress. The importance of this test is that, regardless of blood test results to the contrary, if the temperature is low, the metabolism is low. An analogy I use is that, “You can measure the gas or oil in your car but if the engine is cold, it isn’t running”. If the temperature is low and you don’t feel good, keep looking until you find the problem.
(In the 1970’s, the basal temperature test was popularized by Broda Barnes MD, whose books, “Hypothyroidism – the Unsuspected Illness” and “The Riddle of Heart Attacks Solved” posited that as much as 40% of the US population was suffering from hypothyroidism and that cardiovascular disease, including high cholesterol is a result of hypothyroidism.)
Differential nutritional diagnosis
To treat the hypothyroidism nutritionally, we need to understand thyroid hormone deficiency from a biochemical point of view. That understanding allows us to diagnose and intervene in a more holistic way. The main nutritional interventions are to screen for and treat iodine deficiency and/or halogen excess, to screen for and treat problems with conversion of T4 to T3, chiefly heavy metal intoxication, and to screen for and treat organochlorine toxicity. We should also determine if the hypothyroidism is due to auto-immune thyroid disease such as Grave’s or Hashimoto’s.
Iodine deficiency/Halogen excess
Iodine deficiency can be screened using hair or whole blood trace-mineral analysis. These are also useful tests to screen for selenium and zinc deficiency as well as toxic amounts of mercury, arsenic, cadmium and lead. A more specific test for Iodine deficiency and halogen excess is the Urine Halides test. In this test (available through Doctor’s Data in Chicago), patients take 50 mg of Iodine by mouth, then collect their urine for 24 hours and send a sample to the lab. This test assumes that if the patient has all the Iodine needed, he or she will excrete 90% of the ingested Iodine in the urine. Greater percentages of iodine retained by the body suggest greater levels of Iodine deficiency.
T4 to T3 conversion
If T4 is not being converted to T3 by Type I or II deiodinases, Type III deiodinase will convert T4 to reverse T3 (rT3). A blood test for rT3 can be ordered from many labs.
Remember, converting T4 to T3 requires a selenium-dependent enzyme (Type II or II deiodinase). Tissue samples (hair or blood) can be examined by atomic absorption mass spectrometry to determine levels of normal nutrients such as selenium and also toxic elements such as mercury. These tests are also performed by Doctor’s Data. You can order test kits by calling 800-323-2784.
An indirect way to measure the level of organochlorine burden (from pesticides, plastics, flame retardants, etc.) is to measure GSH (Glutathione). GSH is the most abundant and most important intracellular antioxidant. GSH is involved in the detoxification of heavy metals, toxic halides and organochlorines. A low level of GSH implicates a high body burden of these toxins and predicts a difficult detoxification process. Doctor’s Data offers a blood test to accurately assess GSH levels. If levels are found to be low, supplementation with whey protein, alpha lipoic acid, curcumin, magnesium and N-Acetyl Cysteine (NAC) have been found to effectively increase GSH levels.
Supplementation and detoxification
In addition to drinking more water, consuming more fiber, getting aerobic exercise and taking the GSH supporting nutrients listed above, there are other nutritional interventions that may help protect and repair your thyroid funciton.
If Iodine levels are sub-optimal and other halides are high, the best treatment is to supplement with Iodine, either as tablets or as Lugol’s Solution. Lugol’s is potassium iodide in water. It was first compounded in 1829 and has been used as an antibiotic and disinfectant ever since. One drop of 5% Lugol’s Solution contains about 6.25 mg of Iodine. It is available over the counter in Canada and Mexico or online. Tablets equivalent to two drops of Lugol’s Solution are available under the trade name Iodoraltm. Dr David Brownstein MD uses between one and four tablets of Iodoral with his patients, dosed according to results of the Urine Halides test. I never use more than one per day.
Many people consume seaweeds (nori, kelp, hijiki, wakame) to get Iodine. These are available in Japanese restaurants, grocery stores and as powdered supplements. Seaweeds are a source of Iodine and other nutrients, including compounds that aid in detoxification. Unfortunately, they also contain Bromine. For that reason, I don’t recommend them as a treatment or preventative for hypothyroidism.
Unrefined salt such as sea salt is also helpful in eliminating toxic halides. Salt is mostly Sodium Chloride. The chloride portion can displace other toxic Chlorine compounds in the body. Sea salt contains all 72 minerals found in the sea and in your bloodstream in roughly the same proportions as are found in your blood. Traditional Asian foods that utilize sea salt are Miso and Tamari. These foods are made by combining beans, grains and sea salt in a jar and allowing them to ferment. The fermentation process forms complexes of the salts with the proteins of the beans and grains. Excess salt can cause high blood pressure, so again, I don’t think salt is as good as taking Iodine. With both salt and seaweeds, use them to taste, not as a medicine.
Heavy metal detox
Similar to the way halides like Bromine bind to receptors meant for Iodine, the heavy metals, Mercury, Arsenic and Cadmium bind to receptors meant for Selenium and Zinc. Raising levels of Selenium and Zinc helps to displace heavy metals. GSH precursors like whey protein and alpha lipoic acid can allow metal detoxification with minimal side effects.
Supportive strategies include increasing dietary fiber, exercise, drinking water and sweating. Increasing dietary fiber traps toxins excreted by the liver through the bile. Exercise mobilizes fats, increasing turnover and release of stored toxins. Water dilutes toxins, facilitating elimination through the kidneys and skin. Sweating is a great way to eliminate toxins. Many holistic practitioners use far infrared saunas and other means to increase sweating.
Caffeine and Caffeine Substitutes.
As noted earlier, caffeine acts in a manner similar to thyroid hormone. Many undiagnosed hypometabolic people depend on coffee to wake up and do their work. In a perfect world, they might instead get 8 hours of sleep or reduce their stress, though I understand that is very unlikely to happen. I suggest that we think of coffee as a drug to palliate the effects of high stress and not enough sleep. Like all drugs, coffee has it’s side effects. Many people rely on coffee, caffeinated soft drinks, etc. to get through their day. If you need caffeine, I recommend green tea or chocolate instead of coffee or colas. Also, for people with intact thyroid glands that are just not performing up to par, the less we rely on taking thyroid hormone substitutes like caffeine, the less we are asking our thyroid glands to do on their own. Your thyroid will produce less thyroxine if you are drinking coffee or colas. This is not to say that anyone should quit drinking coffee suddenly. I am only suggesting that we take the lowest effective dose to maintain healthy function and that we choose the stimulant with the least side effects.
Other strategies include using chlorophyll and foods that contain chlorophyll to increase excretion of fat-soluble toxins in the feces. Additionally, polyphenols in white and green tea have been shown to increase the excretion of fecal fat, carrying those toxins out of the body. Green tea has a long history of safe use in Asian cuisine and medicine. In addition to helping to excrete toxins, the caffeine in tea acts like T3. This is because caffeine increases the circulating levels of the catacholamines epinephrine and norepinephrine and increases their intracellular effects. The intracellular effect occurs because caffeine inhibits the intracellular enzyme (phosphodiesterase) that inactivates cAMP (cyclic adenosine monophosphate). Less inhibition means less breakdown of cAMP. The resulting increase in cAMP prolongs the effects of catacholamines.
This means tea can be a helpful transition to a healthy metabolic state. You can use green tea to help you feel better while working to improve your thyroid function. However, any form of caffeine, including chocolate, can lose its beneficial functions when used regularly because the body adapts and becomes dependent. For that reason, I suggest only using caffeine as needed.
Green tea raises metabolic rate in an amount greater than can be attributed to its caffeine content. This may be due to the epigallocatechin gallate found in green tea. That compound plus theoflavins in green tea are thought to be responsible for reported anti-cancer effects.
Green or white tea is a far better source of caffeine than coffee for a variety of reasons. For one, the caffeine in tea is bound in a double molecule that has to disassociate before it can interact with your body. This makes the caffeine in green tea hit your system in a time-released manner compared to coffee. Coffee is not bound as a double molecule. Furthermore, coffee has a number of additional compounds that cause other health problems, everything from bladder irritation to irregular heartbeats.
Chocolate is in my opinion, even better. While the caffeine in coffee reaches peak levels in 30-60 and has a half-life of 2.5 to 5 hours, the half life of theobromine (the caffeine like substance in chocolate) reaches peak levels in 2-3 hours and has a half life of 7-12 hours. This is in part because it is fat-soluble rather than water soluble like coffee. Chocolate is also about a tenth as potent as coffee.
Additionally, very dark chocolate has many health benefits. A Canadian study of 44,500 people found that those who ate one serving of chocolate per week were 22% less likely to have a stroke than people who ate none.xi Even eating up to 100 grams of chocolate per day is linked to a lower risk of heart disease and stroke.xii Also, consuming chocolate also improves athletic performance in cyclists, probably due to the flavenoids in chocolate that enhance the release of nitric oxide in the blood vessels.xiii Nitric oxide dilates blood vessels and reduces oxidative damage in the blood vessels.
Avoiding tobacco smoke, using a water filter for all drinking and cooking water, using only organic fruits, vegetables and grains wherever possible, using iodinated bakery products can help prevent ingestion of thyroid disruptors. Goitrogenic foods should be eaten with moderation. These include soy, flax, kale, canola oil, and raw cruciferous vegetables such as broccoli, bok choy, cauliflower, cabbage, brussels sprouts, mustard greens and others. The cruciferous vegetables are healthy foods but should be eaten cooked rather than raw. Ground flax seed can be very effective in lowering your serum choleterol and reducing the risk of hormone dependent cancers, but I wouldn’t recommend more than 1 TBS per day. There is no reason to consume Canola oil other than it is added to so many prepared foods and is thus very hard to avoid. Additional measures include avoiding toxic chemicals like cleaning products and pesticides and using a sauna or exercise to increase sweating.
Acupuncture and Chinese herbs
Acupuncture is known to normalize neurotransmitters, cytokines, hormones and thus most bodily functions.xiv Traditional Chinese methods of point selection customized according to patient syndrome are the best guide in this regard. Moxa (a hot coal of Artemesia Vulgaris) is traditionally applied near REN4-6, ST36, SP6 and on the back at UB23 and GV4, with additional points added based on syndrome differentiation.
Many tonic formulas raise metabolic activity. In traditional Chinese medicine, symptoms and signs are the basis for prescribing, not lab tests. My favorite formula for hypometabolism (thyroid and/or adrenal insufficiency) is Ginseng and Astragalus (Bu Zhong Yi Chi Tang). It was traditionally used for weakness and fatigue after an illness.xv One of it’s indications is faintness upon rising from a recumbant or sitting position (blood pressure drop). The Astragalus in this formula also provides a lot of Selenium. Glutathione Peroxidase is a Selenium dependent enzyme that protects the thyroid gland from oxidative damage, reducing the risk of auto-immune thyroid disease. The whole formula is as follows:
Huang Qi (Radix Astragali)
Zhi Gan Cao (Radix and Rhizoma Glycyrrhizae Prep)
Bai Zhu (Rhizoma Atractylodis Macro)
Ren Shen (Radix and Rhizoma Ginseng)
Dang Gui (Radix Angelica Sinensis)
Chen Pi (Pericarpium Citri Reticulatae)
Sheng Ma (Rhizoma Cimicifugae)
Chai Hu (Radix Buplerui)
Shen Jiang (Rhizoma Zingiberis Recens)
Da Zhao (Fructus Jujubae)
The licorice (Glycyrrhizae) in this formula slows the breakdown of cortisol, delaying the onset of fatigue.
From a Chinese medicine perspective, thyroid hormone insufficiency is functionally equivalent to Chi Xu (energy deficiency) and Yang Xu (heat deficiency) with further diferentiation possible according to affected organ systems, i.e., Spleen Qi Xu would include digestive symptoms such as bloating, loose stools, hemorroids, poor appetite/craving for sweets in addition to the other symptoms associated with hypothyroidism.
The best way to get started is to take the symptom survey above and if your score suggests a problem, start measuring your basal temperature. If your temperature is consistently below 97.6, schedule a meeting with your doctor and bring the results of your basal temperature and symptom survey. You can then discuss whether lab testing would be appropriate.
In terms of labs, a TSH is helpful, but a panel including TSH, T4, T3, rT3, would give a fuller picture. If rT3 is elevated, consider the Hair Mineral Analysis (includes heavy metals) and Urine Iodine tests, both from Doctor’s Data. Adding GSH to the blood testing would quantify the ability of the body to deal with toxic load. Auto antibody tests could be added if auto-immune thyroid disease is suspected.
Nutritional treatment strategies including hair sample testing for deficiency of Iodine, Selenium, and Zinc, as well s testing for excess of the heavy metals Mercury, Arsenic and Cadmium. Iodine sufficiency can be tested more reliably with a provoked urine test. If mineral deficiencies are noted, supplementation can then be taken with re-testing six to twelve months later.
If heavy metals were found or if GSH blood levels were found to be low, detoxification with water, fiber, supplementation with whey protein, alpha lipoic acid, curcumin, magnesium and N-Acetyl Cysteine (NAC) may be helpful.
In all cases, mild aerobic exercise is recommended, starting slow and building up gradually. If you feel exhausted the day after exercise, you did too much. Cut your exercise level to the point that you feel better the next day, but by all means, don’t stop exercising.
Small amounts of coffee, tea or chocolate may be needed to get you through your day while your thyroid is getting stronger, but the ultimate goal is to minimize dependency. Chinese herbs may also provide a bridge to wellness, but again should not be used long term.
Getting 8 hours of sleep will cure many people of mild hypothyroidism.
If you are reasonably healthy and want to raise your metabolic rate, exposure to cold can be helpful. Like exercise, this has to be started slow and increased slowly.
Continue measuring your temperature and pulse rate to evaluate your progress. The goal is to get your temperature to 98.6 when you awake in the morning, without raising your pulse rate above 72 bmp. You will be able to track the effects of any changes you make in your daily routine, sleep, exercise, caffeine, supplements, etc. My goal in writing this article is to empower you to do the things you can do and assist your doctor in helping you to recover.
David Wells, D.C., L.Ac. MS (Nutrition).
vi Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum.
Stagnaro-Green A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R, Nixon A, Pearce EN, Soldin OP, Sullivan S, Wiersinga W, American Thyroid Association Taskforce on Thyroid Disease During Pregnancy and P ostpartum.
Thyroid. 2011 Oct; 21(10):1081-125.
vii Subclinical hypothyroidism and pregnancy outcomes.
Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG
Obstet Gynecol. 2005 Feb; 105(2):239-45.
xMetabolic Treatment of Fibromyalgia John Lowe, D.C. 2000