If you want to feel great energy, consider how thyroid hormone, and thyroid function, fit into your overall picture of health.
Low thyroid hormone, hypothyroidism, seems to be all the rage these days on the Internet. Everyone is a thyroid expert. And you can be, too. Just take a few minutes of your time to look over this blog.
The biology and biochemistry of thyroid hormone must be considered within the triad of the body’s energetics. Thyroid hormone never works in a vacuum. It is like one of three legs of a stool, working along with insulin and cortisol, to keep us alive and well.
The thyroid gland is a small, butterfly-shaped gland that lives at the base of the neck. It fans out over the lower trachea (the windpipe) and sits just above the collarbone. Its job is to make thyroid hormone, which is our body’s thermostat.
Depending on our needs, we may need to turn the heat up, with increased thyroid hormone, or down. Our metabolic rate goes up with increased thyroid hormone, and down as the amount of hormone in the bloodstream decreases.
Sometimes our body needs less thyroid hormone. We occasionally need to cool the body down, and rest.
This all makes sense. When times are good, with low stress and plenty of food, we can burn the engine a little hotter. Conversely when we have significant stressors, like illness or starvation, our thermostat is turned down.
A slower metabolism allows us to live a little longer when the pressure to survive is really on.
The meaning of life. Stay alive, and reproduce
All of our biochemistry has one purpose: to keep us alive. If this single condition is met, we might be able to reproduce, and pass on our genes to the next generation. But if we are barely holding on, for reasons of stress , starvation or illness, reproduction takes a backseat.
Thyroid hormone directs our energy expenditures to keep us alive
Every biological system is modified by thyroid function, and each cell in the body is thought to have a receptor for thyroid hormone. Consider the list of symptoms that might arise from low thyroid function.
- Weight Gain
- Foggy thinking
- Cold hands and feet
- Changes in the skin, hair or nails
This list is one of symptoms, not diagnoses. We can then add known medical diagnoses that are known to be associated with low thyroid function:
- Cardiovascular disease
- High lipids and cholesterol
Are any of your symptoms, or medical diagnoses included in the two lists above? Is it possible that a long-standing condition, illness, or symptom could all be related to low thyroid function? Is it possible that your doctor has never really considered the importance of thyroid hormone on your health?
Hypothyroidism is simply a reflection of our body’s quest to keep going, and stay alive. With suppressed metabolism we can last a little longer. Drive a bit more slowly and cautiously, and the remaining few drops of gasoline might get you to the nearest pump.
The body works the same way.
It is ironic that primary mechanism we have to keep us alive does so at the expense of making us feel really bad, and potentially making us really sick. If we can just stay alive in the present, and we may get to see a more abundant harvest in the future. Our physiology seems to “pay things forward,” not back.
Why humans have a hibernation hormone
We all know that bears hibernate. They turn down their metabolism at the onset of the Winter, hunker down in the den, and hope to wake up in the Spring. To do this, one of the changes that they make is to suppress thyroid hormone production.
Only the very basics for survival are maintained. All of the bear’s movement slows, as does her heart, breathing and digestion. All of the major organs make a contribution to the animal’s health. Everything slows down.
We do the same thing, kind of.
When our thyroid hormone isn’t working well, we need to ask ourselves why. There may be some reason that our body feels the need to put the brakes on It doesn’t just happen.
Are you in hibernation mode when you don’t want to hibernate?
Sally is not an actual patient, but a composite of hundreds of patients that I have seen over the years. You may possibly even see a little bit of yourself in her description.
Sally has always been a “go getter.” She is always on the run, and seems to juggle so many things: a family a job, a couple of kids, her fitness routine.
But Sally is getting more and more tired. Sure, she keeps up all of her responsibilities, but after a while she begins to feel like the circus performer spinning plates on poles.
She keeps on adding plates, and knows it is just a question of time before they start tumbling down.
Her complaints sound like this:
- “Doc, I am not sure what’s wrong. All my life I have been able to keep up this pace, but now I feel as if things are slipping. I am gaining weight, in spite of going to the gym regularly and watching my diet
- “My thinking isn’t as clear as it once was. Just last week I went to a party and forgot the name of one of the guests who I have known for years
- “My libido is down, too. I love my husband, but sex seems more of a chore. I just don’t have the sexual drive that I had before
- “And the strangest thing happened the other day. My hairdresser commented that my scalp seemed much drier than just a few months ago. I have noticed it too. My hair seems thinner, and I am losing it in the shower
- “I have been feeling a bit depressed. My doctor has suggested putting me on some medication to help”
Then she proceeds to tell me that her doctor has measured her thyroid hormone levels, and they were “normal”. “The TSH levels were fine,” she says. “There is nothing wrong with my thyroid gland.”
Does TSH alone reflect our body’s thyroid hormone requirements?
I recall a teaching experience that I once had in medical school.
A noted professor told us that thyroid management was simple.
“You only need to measure the TSH” he said. “If the TSH is between .5 and 5 you are finished. The thyroid is normal.”
That was it. My thinking could end there. A TSH between .5 and 5 meant normal thyroid function.
Fast forward a couple of decades.
My 25 years of clinical practice, working with thousands of thyroid patients, has shown me otherwise. I feel that in 2018 we are still restricted by this outdated “follow the TSH” mindset.
We are failing our patients by only utilizing a single, incomplete test to assess their thyroid health.
TSH stands for Thyroid Stimulating Hormone. This hormone is released by the pituitary gland, which is a part of the brain’s control center. If the thyroid’s production of hormone drops, the pituitary begins to signal the need for more by releasing more TSH.
The relationship looks a bit like this:
The idea is that as the thyroid makes less of the hormones T3 and T4, the brain responds by making more TSH. In theory, this boosts the stimulation of the thyroid hormone, increasing the thyroid’s production of the hormones. The increasing hormones then feedback to the pituitary, which in the face of the higher hormone levels then decreases the TSH secretion.
The thyroid and pituitary work demonstrate a classic negative-feedback loop.
TSH does not measure the amount of thyroid hormone that the organs and tissues are seeing. It only shows what the brain is telling the thyroid gland to do
For this reason, the TSH alone does not reflect the effects of the thyroid hormone on the target tissues. What are the target tissues? Scroll back up to the list above to see the potential effects of low thyroid hormone on the body. Organs, nerves, muscles, blood vessels and brain cells all depend on the right balance of thyroid hormone.
Let’s take a look at an actual lab result. You will notice that this lab has correctly redrawn the range of TSH to show a narrower “upper end” with an upper level of 3, not 5.
The lab also tests the free, bioavailable hormones in addition to the TSH.
If one were to only look at the TSH, even within the “modified” range used by ZRT labs, one might say that this person had “normal” thyroid function.
T4, the weaker precursor to T3 is barely in range. And T3, the biologically active of the two hormones, is well out of range.
This example shows that even with a “normal” TSH, the target organs may not be getting the full thyroid signal, and these organs may be underperforming.
One of my better medical school professors taught me: “Don’t treat a lab result. Treat the patient.”
In this case, the patient presented with:
- Poor sleeping
- Dry skin
- Low libido
- Cold hands and feet, and
His symptoms are reflected in the lab study shown above. He is currently being treated with thyroid hormone.
We are using a combination thyroid hormone, containing T3 and T4 to raise his levels to within a more physiological range. I am hopeful that over time he will resolve his symptoms.
A follow-up lab test is pending. We will be working to move the levels of his free hormones to the upper half of the lab range, and to follow his symptoms with the lab work.
Understand your thyroid in the privacy of your own home
Collect this information, and share it with your doctor.
- Ask yourself some questions. Go back to the bulleted list that I outlined at the onset of this blog. Do any of these symptoms potentially apply to you? You may find, as I do in my clinical practice, that several of the symptoms apply. This is the first step to thinking about how hypothyroidism may be affecting your health.
- Do a simple, home exam. Look in the mirror. Your thyroid gland lives above where the collar bones join at the base of the neck, and below the Adam’s apple. Do you have a fullness in this area? Now run your fingers over this area on either side of your windpipe. Do you feel a fullness, an asymmetry? Thyroid glands are only really felt when there is a fullness, cyst or mass.
- Check your reflexes. Sit on a chair with your feet off of the floor. Using the side of a hairbrush, tap about an inch down below the kneecap. Slow reflexes are associated with hypothyroidism. Your lower leg should kick away with the reflex. This may take a few tries. If it doesn’t move with a well-aimed strike, you may be hypothyroid.
- Measure your thyroid levels. Get the full thyroid test that is shown above. Many reading this blog have been to their primary care doctor, only to be told that their thyroid was “normal.” Is yours really normal, or is your TSH blood test just between .5 and 5? Get more information! Testing your thyroid at home is as easy as going to ZRT.com, and clicking on the thyroid panel. In a matter of days you will know where you stand with a full panel including a TPO, a marker for Hashimoto’s Thyroiditis.
Consider thyroid hormone as a part of the energetic triad.
Thyroid is essential for the production and maintenance of cellular energy. The hormone drives metabolism and increases our basal metabolic rate. In other words, it gives us energy.
But this hormone does not work in a vacuum. When addressing the symptoms of hypothyroidism, it is essential to think about the other legs of the energetic triad, insulin and cortisol.
I recommend that you read the post under balanced energy on my site. Here you will see how these three hormones relate to one another, and to our physiology as a whole.
Each of these three hormones can contribute to your fatigue, so it is important to consider all three to get a comprehensive picture of your health.
Remember that our body is tuned to address threats to survival. In our modern lives, we usually don’t need to look far to find food. As we begin to add stress, exhaustion, overtraining and excessive calories to our lives, these systems fall out of balance.
The body defaults to survival, regardless of how many calories are around. To survive, we slow down. To survive, we endure some fatigue.
How to talk to your doctor. Knowledge is power
A large premise of this website is patient education, with the hope of teaching the at-large medical community through the back door. That back door is you, the patient. You can teach your doctor. You can change the future of medicine for yourself and your community.
Most of your doctors were taught by the same doctor who taught me. They know to check TSH only, and to move on. But you may be the catalyst to make things change.
First, know what is real, and what is commercial hype. Theoretically one could supplement iodine, selenium and the amino acid tyrosine to boost thyroid hormone production.
I have had several patients try this for several months, only to find that the thyroid levels didn’t budge. Recall that thyroid function never occurs in a vacuum.
Other patients have used thyroid hormone as a “bridge” while working on other parts of their physiology. These individuals seem to have the greatest success in “fixing” thyroid function in the long run.
To really “fix” the thyroid, you must incorporate diet and nutrition, the health and function of the gut, stress reduction, hormone optimization and sleep.
Recall that there is no magic bullet to feel better and have more energy. You will need to consider all of the contributing parts of our physiology as you work to get well.
Understanding, measuring and optimizing your thyroid function is an excellent place to start.