Getting to Know Your Thyroid Health
Our endocrine system is the system of hormone producing glands in the body responsible for: growth, reproduction, metabolism, energy and repair. The thyroid is the “master gland” of the endocrine system due to its far-reaching effects. Thyroid hormones function to maintain the body’s metabolism by modulating cellular metabolism, circulation and oxygen consumption. Clinically, these hormones help to maintain all components of the metabolism including; mood, bowel movements, thermoregulation, energy, weight levels and heart rate. Considering the far-reaching effects of thyroid hormone, optimizing levels is essential for overall health.
The thyroid is a butterfly-shaped gland in the middle of the neck, located below the voice box and above the collarbones. The thyroid combines the mineral Iodine with the amino acid Tyrosine to produce the hormones triiodothyronine (T3) & thyroxine (T4). It does so with the help of mineral cofactors Zinc and Selenium. T3 is the more metabolically active hormone while T4 is most abundantly produced. After leaving the thyroid, T4 is converted to T3 in the tissues with the help of cofactor nutrients like iron. Thyroid function is regulated by the pituitary - another gland located just below the brain. The pituitary produces thyroid-stimulating hormone (TSH), which stimulates the thyroid to produce T3 and T4. TSH is one of the most commonly ordered blood tests to assess thyroid function.
Thyroid Hormone has Direct Effects on your:
GI tract & Digestion
Bone metabolism (building and breaking down properly)
Nervous & Muscular system function
Hormone synthesis and metabolism
Red blood cell health and metabolism
Thyroid Testing and Functional Lab References
Thyroid issues often go undiagnosed because doctor’s tend to rely solely on TSH (and maybe free T4 if they’re highly suspicious) and outdated reference ranges. Oftentimes when someone goes to the doctor and complains of one of the symptoms of a thyroid imbalance (see below) they are given a prescription for the symptom and sent on their way. They may be given an antidepressant, sleep aid, laxative or told to just eat fewer calories when in actuality what they need is to support their thyroid.
Optimal Lab Ranges for Thyroid Function
Free T3: 3.2-4.2pg/mL
Free T4: 1.1-1.8ng/dL
Reverse T3: 90-350pg/mL OR <10:1 ratio of RT3:FT3
Thyroid Stimulating Hormone (TSH): 0.9-2.0 mU/L
Thyroid Peroxidase Antibody (TPOAb): <4 or negative
Thyroglobulin Antibody (TPOAb): <4 or negative
Thyroid Stimulating Immunoglobulin (TSI): <1.3 or negative
Note on Reverse T3: Reverse T3 is not very commonly tested by standard medical practitioners. RT3 can block T3 receptors leading to low responsiveness and utilization to Free T3. RT3 can be elevated in those with HPA axis dysfunction or those chronically in high stress situations such as; nutrient deficiencies, infections, high psychological stress. RT3 can be an indicator of thyroid hormone resistance in the body.
Other tests to consider when evaluating thyroid function
Complete Blood Count (CBC) and Comprehensive Metabolic Panel (CMP)
ANA and autoimmune panels
Food sensitivity or allergies
Nutrition testing for vitamin, mineral and fatty acid imbalances
At-home basal body temperature monitoring
Thyroid Dysfunction Risk Factors
Factors That Increase Your Risk of Developing or are linked to Thyroid Dysfunction (Hypo- or Hyper-):
Coexistence of other Autoimmune disorders (ex. Rheumatoid Arthritis, Alopecia, Celiac, Raynaud’s, Multiple sclerosis)
Family History of autoimmune disorders, especially Hashimotos
Nutrition imbalances - too much or too little iodine in the diet. Mineral deficiencies, inadequate caloric intake.
HPA Dysfunction - chronic high stress and burnout
Leaky gut, irritable bowel syndrome
Pregnancy - note that thyroid function should be monitored as a part of preconception care and throughout the pregnancy. Monitoring and treatment of thyroid imbalances can prevent complications such as preeclampsia, early delivery, miscarriage and a condition known as cretinism.
Increased oxidative stress and inflammation
Smoking increases the risk of Grave’s Disease specifically
Heavy metal toxicity
Environmental and Occupational exposures to toxins like certain plastics, chemicals and pesticides
While just one of these factors may not directly cause thyroid dysfunction, a combination of a few (which frankly is common in our society) can certainly lead to it.
Hypothyroidism is the most common thyroid disorder. It is a condition in which the thyroid gland does not produce enough thyroid hormone (T3 and T4). In approximately 95 percent of cases, hypothyroidism is due to a problem in the thyroid gland itself and is called primary hypothyroidism. However, certain medications and diseases can also decrease thyroid function. It is estimated that at least 30 million women worldwide have Hashimoto’s (autoimmune hypothyroidism). An underactive thyroid can have harmful effects on weight, mental health and cardiovascular disease risk. Leaving hypothyroidism untreated and unchecked for many years can lead to an increased risk of cardiovascular disease later in life.
Signs and Symptoms of Hypothyroidism
Stubborn weight gain that doesn’t seem to budge with diet and exercise
Brain fog and difficulty concentrating
Constipation or sluggish digestion
Thinning of the lateral ⅓ of the eyebrows
Feeling cold easily when everyone else feels fine (low body temperature)
Diminished reflexes on physical examination
Fluid retention - face may look puffy
Dry skin and brittle nails that peel easily
Poor exercise stamina, achy joints
Irregular menstrual cycles or skipped periods
Yellowing of palms
Causes of Hypothyroidism
Autoimmune disease - Hashimoto’s - Hashimoto’s is confirmed by the presence of Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb). It is estimated that around 97% of cases of Hypothyroidism are due to Hashimoto’s.
Surgical removal of all or part of the thyroid (due to nodules, cancer, Grave’s disease)
Thyroiditis - inflammation usually secondary to autoimmune flare or viral infection (Ex. EBV)
Medication - certain medications can interfere with thyroid hormone production, especially in those who are already at an increased risk genetically for Hashimoto's.
Hyperthyroidism, or an over-active thyroid, is much less common than hypothyroidism but can wreak havoc on the body all the same. About ¾ or 75% of cases of hyperthyroidism are caused by an autoimmune attack on the thyroid called Grave’s Disease. An overactive thyroid can affect anyone, though it is about 10x more common in women than men, and typically happens between 20 and 40 years of age. Note that one individual can fluctuate between hypo- and hyper- states of the thyroid, particularly those with an autoimmune component.
Signs and Symptoms of Hyperthyroidism
Anxiety, irritability, lots of “nervous energy”
Difficulty falling and staying asleep
Feeling tired or burnt out all the time (wired and tired)
Feeling hot all the time when everyone else feels okay - always needing to shed layers and blast air conditioner
Diarrhea - loose, frequent bowel movements
Frequent urination and persistent thirst
Palpitations and high heart rate
Neck swelling at the area of the thyroid (goiter) that can make swallowing feel different or cause pressure when lying on your back
Weight loss despite an increased appetite
Hair feels coarse and may have some hair loss
Eye redness, dryness or vision problems
Causes of Hyperthyroidism
Autoimmune - Grave’s Disease - confirmed by the presence of Thyroid Stimulating Immunoglobulin (TSI)
Thyroid Nodules - often times thyroid nodules are benign masses and do not produce hormone - however, they can contain thyroid tissue and produce excess thyroid hormone
Increased levels of Iodine in the body - this can be the result of taking an Iodine-containing medication (ex. Amiodarone)
Thyroiditis - inflammation usually secondary to autoimmune flare or viral infection
Pituitary Adenoma - if the pituitary is inappropriately producing more TSH than needed, the thyroid will continue to respond to signal and produce more hormone
How We Help To Improve Your Thyroid Health
Evaluating the root cause of your thyroid imbalances. While thyroid hormone replacement can be a helpful tool in balancing out the system of those with hypothyroidism, it does nothing to actually solve the problem. Oftentimes people get stuck into a cycle of taking this hormone replacement forever in ever-increasing doses rather than using it as a patch while they work at the root cause. Please note that you absolutely should not suddenly stop or change your dose without consulting with the prescribing physician. Keeping them informed and present on your journey will only benefit you.
Lab testing beyond the standard measures - in addition to a standard thyroid panel, we also evaluate for nutritional imbalances, inflammatory markers, autoimmune antibodies, chronic infections and other root causes.
Personalized nutrition plans that meet you where you are at and grow with you. Diet plays a very significant role in supporting both the thyroid and the immune system - making it an essential tool for healing thyroid imbalances.
Herbal and nutritional supplements aimed to restore balance and fill gaps in nutrition while you make changes along the way.
Optimizing thyroid hormone production and peripheral conversion from T4 to T3.
Lifestyle counseling - finding routines and exercises that can help you remain active.
Addressing toxic load on the body and helping to identify and eliminate outside sources that can be harmful to thyroid health.
Improving digestive health - building a strong microbiome, reducing gut inflammation, addressing potential leaky gut and food allergies or sensitivities.
Implementing stress management techniques to improve mental health and overall wellbeing. Stress hormones like Cortisol can have an interesting effect on thyroid function.
Help you with information and referrals to other specialists, ensuring you receive complete care.