Do you have low thyroid function?
I feel that this is one of the more underdiagnosed conditions in our country today.
I see so much sickness and disability in my practice that is directly related to the thyroid. You may already have a diagnosis of hypothyroidism.
Two thoughts immediately come to mind.
The first is that patients are often not diagnosed with low thyroid function until long after they have begun to experience symptoms. On many occasions even the most basic laboratory testing has shown a problem long before the doctor decides to treat.
The second is that often patients are frequently underdosed in their thyroid replacement. Most physicians only manage one facet of the thyroid hormone spectrum, the TSH (Thyroid Stimulating Hormone.)
These providers don’t utilize measurements of the free thyroid hormones to assess the body’s levels. The Free hormones, Free T3 and Free T4, are the ones that are accessible to the tissues. They aren’t bound to carrier proteins in the blood, thus the “free” designation.
Has your doctor considered the clinical signs of low thyroid function?
We often tend to forget to ask the patient the most basic question.
“How are you feeling?”
As I take a patient’s history, I can practically hear them crying, “Help me, my thyroid is too low.”
It is important to remember that thyroid hormone doesn’t only set the body’s metabolic rate. It has numerous other functions in all of our tissues. Thyroid affects the bone and the brain, the stomach and the skin. It sets our metabolism, and keeps the motor going.
It should not come as a surprise that practically any symptom could tie into thyroid function.
We need to remember to treat the entire patient, not just the numbers
How the thyroid gland helped us to survive
Thyroid function nestles right in with the other energetic hormones: insulin and cortisol. It is a part of the symphony that manages energy. Energy is critical for life.
Unbalanced energy, on the other hand, is the foundation for all chronic disease.
To really understand how the thyroid gland relates to our health, we need to take a step back in time. In the not too distant past, we humans had a greater tendency to starve rather than overeat. Food was often scarce. The concept of a 24-hour McDonalds was unimaginable.
All of our biology is centered around managing energy for survival, repair and reproduction
When times were lean, we went into hibernation mode. This state of lowered metabolism was driven by the thyroid gland. A lowered metabolism kept us alive for longer.
Do you feel like you are hibernating? Do you have any of the following symptoms of low thyroid function?
- Low energy
- Cold hands and feet
- Sluggish thinking
- Slower bowel function
- Foggy thinking
- Hair loss
This all ties in to human survival. Imagine that you hadn’t been able to find a meal for a long time. The only fuel that your body had was literally carried on your bones.
In survival mode, it makes sense to lower the resting metabolic rate. Blood is shunted from the extremities to the core to keep our hearts and brain warm. We divert blood from the extremities, from our gut and from our reproductive organs.
We would not want to invest vital energy into luxurious hair or a frivolous romp. Thyroid suppression “in the wild” helped us to survive periods of stress. It should be no surprise when the libido and extra energy are some of the first things to go.
In times of starvation, there was little need to send blood to these less critical organs.
The thyroid gland is our barometer
The ability to react quickly and mount a stress response is governed by the brain and the adrenal glands. In the times of stress or danger, cortisol and adrenaline rise.
It all makes sense. Responding to stress should trump all other responses. Survival becomes a priority.
With transient high stress, like running from a tiger, we rely on the energy that is stored in our liver and muscle. The storage molecule glycogen is rapidly broken down to glucose. We can raise our metabolic rate to make the escape.
No reason to lower our metabolism here. We are in it to win it.
When stressors persist, our physiology changes. With our big brains, we can maintain high cortisol levels long after the tiger chase is over. Short of the tiger attack, conflict or infection, our greatest foe was starvation.
With modern life, there are infrequent real tigers. But when high levels of stress and cortisol persist, our physiology reacts as if we are starving.
Subsequently we begin to shut down. With ongoing stress, we literally begin to hibernate.
How cortisol and stress lower thyroid function
In the previous paragraphs we saw how long-term stress tells the body to go into hibernation mode. The thyroid gland regulates this step.
In response to the pituitary hormone TSH, the thyroid gland makes the hormone T4. This is thought to be a precursor hormone. It may promote some biologic activity, but not much.
In the tissues, the T4 is converted to the active hormone T3. This is the thyroid hormone that keeps the home fires burning strong.
But in times of stress two things happen.
First, cortisol blocks this conversion of T4 to its active form, T3. I commonly see patients with a normal T4 and a low T3, particularly if stress is a large factor in the person’s life.
As stressors persist, our body tries even harder to preserve itself. The T4 can be converted to the evil twin of T3, known as Reverse T3 (RT3). RT3 blocks the T3 receptor and negates the activity of T3.
In this manner our metabolism slows down in response to the stress hormone cortisol.
To treat the thyroid, first evaluate the cause
If you are in a state of low thyroid function, you first need to correct this deficiency. This will likely require some form of hormone replacement. We’ll cover the best way to do this in another blog.
The more important question to ask, is “Why am I hypothyroid?” I don’t believe that a state of hypothyroidism just falls from the trees.
Hypothyroidism is generally the result of another metabolic or emotional process that tells the rest of the body to shut down for the common good.
What stressors have you exposed your body to recently?
- Unending emotional stress
- A low calorie diet
- Intermittent fasting
- Cardio-X, Iron-flex Bicep-tribe or another similarly named high-intensity workout
- Restriction diets
All of these choices are relatively self-imposed. Have you had a recent infectious illness, trauma or surgery? These may be influencing your thyroid function as well.
Are you able to track your thyroid results over the last several years?
Can you identify a place or time when some degree of increased stress could have driven your body to a state of recovery? I have found that lowered thyroid function often parallels times of significant stress in a person’s life.
How to heal your thyroid gland
Thyroids can heal. They can resume making thyroid hormone again. They can make the good stuff, T3, and not just T4 or RT3.
Replacing thyroid hormone today does not mean that you will always need to use it. Be sure to look and see if there are other factors that could be maintaining your body in a state of increased stress.
This is the first step to healing. If your low thyroid hormone levels are not due to surgery or Hashimoto’s, they can be made well again.
Hypothyroidism is a transient state in response to an ongoing stressor
For the time being, if you are suffering with low thyroid function, you may need to use thyroid hormone replacement. We can work on the state of stress, infection or inflammation that is driving the hypothyroidism over time.
The first and most important step is to measure thyroid hormone levels correctly. When we have better data we can then take better steps to address the problem.
Be sure to measure your thyroid status both clinically and chemically
To really fully understand your thyroid function, first get more data.
Here are the clinical data points that I use with all of my patients
- Measure your basal body temperature (BBT). Use a good digital thermometer, and check your temperature upon rising. This give a good idea of your underlying metabolic rate. A good rule of thumb is that a normal BBT is 97-97.5 degrees. A persistent body temperature less than 97 degrees may imply a degree of hypothyroidism.
- Measure your pulse. A “Normal” pulse rate is defined as 60-100 beats per minute. Generally a lower pulse is associated with better health. As you replace your thyroid hormone, an increased pulse may be a sign of overcorrection of the hormone. Look into a phone app like Heart Rate Plus to record and graph your pulse.
The following chemical studies are obtained through the blood:
- TSH. This stands for Thyroid Stimulating Hormone, and is a measure of the signal that your brain is sending to the thyroid gland. The higher the number, the more that the brain perceives the need for increased thyroid hormone. Most normal ranges are between .5 and 5.0, but in my clinical practice I find that an optimal TSH is around 1.
- Measuring TSH alone will not correctly assess your thyroid function.
- Free T3 and Free T4. These are measurements of the levels of thyroid hormone in the blood that are “seen” by the tissues. I find that all hypothyroid patients feel best when the free hormones are in the upper half to upper quartile of the lab’s normal range.
- Reverse T3. I tend to measure this when someone is under significant stress, has disordered cortisol secretion, or is on high doses of T4 (Synthroid or levothyroxine).
- Autoimmune markers. I like to measure these on almost all of my patients. Research shows that we can start to mount an immune response against a tissue up to 7 years before a ‘symptom’ occurs. If your TSH is greater than 4, be sure to look for underlying autoimmunity. I recommend measuring for antibodies to thyroid peroxidase (anti-TPO) and thyroglobulin (anti-TG).
In summary, TSH reflects the overall state of the brain-adrenal-thyroid system. My patients do best when we follow the free hormones, and keep their free thyroid hormone levels in the upper ranges.
We also follow how they feel, along with the clinical signs, like energy, BBT and pulse.
Measuring TSH alone will never give a complete picture of the body’s cellular needs
Thyroid hormone dysfunction is rarely an isolated condition. We need to recall that a state of low thyroid function is a reflection of other stressors on the body.
In the following post I will draft out exactly how I like to manage thyroid hormone. Here you will find the tools to work with your doctor to get your thyroid spot on.
Take-home points for thyroid hormone health
- Short of surgery or autoimmunity (Hashimoto’s thyroiditis), low thyroid function is likely a response to an ongoing stressor. A stressor can be emotional, infectious or metabolic.
- When we identify these stressors, we can begin to relieve the pressure on the thyroid gland to be suppressed. Have you been sick, dieting, stressed or overtraining? Each of these activities can cause your thyroid gland to make less hormone.
- Be sure to measure your thyroid status correctly. This requires checking the TSH, in addition to the free hormones, T3 and T4. Work to keep these in the higher ranges, and you will begin to feel so much better.
- Are you being treated with ever-increasing doses of T4 (Synthroid, levothyroxine)? Be sure to ask your doctor to measure RT3.
- Consider checking for Hashimoto’s thyroiditis with TPO and TG antibodies. I like to look for these antibodies even when the TSH is in the high-normal range.
In the next blog, I’ll offer some practical tips for thyroid hormone replacement. Read about protocols, practices and tips from a physician who has been optimizing thyroid hormone in his patients for 20 years.