At least 30 million Americans have a thyroid disorder and half15 millionare silent sufferers who are un diagnosed, according to The American Association of Clinical Endocrinologists. Women are as much as 10 times as likely as men to have a thyroid problem.
Feeling tired and having no energy are issues associated with lots of conditions, but they are strongly linked with hypothyroidism, the disorder that is the result of too little thyroid hormone. If you are still tired in the morning or all day after a full nights sleep, that is a clue that your thyroid may be underactive. Too little thyroid hormone coursing through your bloodstream and cells means your muscles aren’t getting that get-going signal. Fatigue is the number one symptom I see, says Dr. Miller. It is the kind of fatigue where youre still tired in the morning after a full nights sleepthat is a clue that youre not simply sleep deprived; your thyroid may be underactive.
The classic signs of a sluggish thyroid gland include weight gain, lethargy, poor quality hair and nails, hair loss, dry skin, fatigue, cold hands and feet, and constipation and these symptoms are relatively well known.
However, some of the conditions you might not associate with your thyroid include:
Skin conditions such as acne and eczema
And there are, in fact, many more conditions that can be associated with poor thyroid function. Your thyroid plays a part in nearly every physiological process. When it is out of balance, so are you. This is why it is so important to understand how your thyroid gland works and what can cause it to run amok.
The sad fact is, half of all people with hypothyroidism are never diagnosed. And of those who are diagnosed, many are inadequately treated, resulting in partial recovery at best.
Hypothyroidism: The Hidden Epidemic
Hypothyroidism simply means you have a sluggish or underactive thyroid, which is producing less than adequate amounts of thyroid hormone.
Subclinical hypothyroidism means you have no obvious symptoms and only slightly abnormal lab tests. I will be discussing these tests much more as we go on since they are a source of great confusion for patients, as well as for many health practitioners.
Thyroid problems have unfortunately become quite common.
The same lifestyle factors contributing to high rates of obesity, cancer, and diabetes are wreaking havoc on your thyroid sugar, processed foods, stress, environmental toxins, and lack of exercise are heavy contributors.
More than 10 percent of the general population in the United States, and 20 percent of women over the age of 60, have subclinical hypothyroidism. But only a small percentage of these people are being treated.
Why is that?
Much of it has to do with misinterpretation and misunderstanding of lab tests, particularly TSH (thyroid stimulating hormone). Most physicians believe that if your TSH value is within the range of normal, your thyroid is fine. But more and more physicians are discovering that the TSH value is grossly unreliable for diagnosing hypothyroidism.
And the TSH range for normal keeps changing!
In an effort to improve diagnosis of thyroid disease, in 2003 the American Association of Clinical Endocrinologists (AACE) revised the normal TSH range as 0.3 to 3.042. The previous range was defined as 0.5 and 5.0, which red-flagged only the most glaring hypothyroidism cases.
However, the new range is still not wholly reliable as the sole indicator of a sulky thyroid gland. You simply cannot identify one TSH value that is normal for every person, regardless of age, health, or other factors.
Having said that, though, most physicians who carefully follow this condition recognize that any TSH value greater than 1.5 could be a strong indication that an underactive thyroid is present.
Your TSH value is only part of the story, and your symptoms, physical findings, genetics, lifestyle, and health history are also important considerations. Only when physicians learn to treat the patient and not the lab test will they begin to make headway against thyroid disease.
Understanding How Your Thyroid Works Is Step One
The thyroid gland is in the front of your neck and is part of your endocrine, or hormonal, system. It produces the master metabolism hormones that control every function in your body.3 Thyroid hormones interact with all your other hormones including insulin, cortisol, and sex hormones like estrogen, progesterone, and testosterone.
The fact that these hormones are all tied together and in constant communication explains why an unhappy thyroid is associated with so many widespread symptoms and diseases.
This small gland produces two major thyroid hormones: T4 and T3. About 90 percent of the hormone produced by the gland is in the form of T4, the inactive form. Your liver converts this T4 into T3, the active form, with the help of an enzyme.
Your thyroid also produces T2, yet another hormone, which currently is the least understood component of thyroid function and the subject of much ongoing study.
Thyroid hormones work in a feedback loop with your brain particularly your pituitary and hypothalamus in regulating the release of thyroid hormone. Your pituitary makes TRH (thyroid releasing hormone), and your hypothalamus makes TSH. If everything is working properly, you will make what you need and youll have the proper amounts of T3 and T4.
Those two hormones T3 and T4 are what control the metabolism of every cell in your body. But their delicate balance can be disrupted by nutritional imbalances, toxins, allergens, infections, and stress.
If your T3 is inadequate, either by insufficient production or not converting properly from T4, your whole system suffers.
You see, T3 is critically important because it tells the nucleus of your cells to send messages to your DNA to crank up your metabolism by burning fat. That is why T3 lowers cholesterol levels, regrows hair, and helps keep you lean.
How to Know if You Are Hypothyroid
Identifying hypothyroidism and its cause is tricky business. Many of the symptoms overlap with other disorders, and many are vague. Physicians often miss a thyroid problem since they rely on just a few traditional tests, so other clues to the problem go undetected.
But you can provide the missing clues!
The more vigilant you can be in assessing your own symptoms and risk factors and presenting the complete picture to your physician in an organized way, the easier it will be for your physician to help you.
Sometimes people with hypothyroidism have significant fatigue or sluggishness, especially in the morning. You may have hoarseness for no apparent reason. Often hypothyroid people are slow to warm up, even in a sauna, and do not sweat with mild exercise. Low mood and depression are common.
Sluggish bowels and constipation are major clues, especially if you already get adequate water and fiber.
Are the upper outer third of your eyebrows thin or missing? This is sometimes an indication of low thyroid. Chronic recurrent infections are also seen because thyroid function is important for your immune system.
Another telltale sign of hypothyroidism is a low basal body temperature (BBT), less than 97.6 degrees F4 averaged over a minimum of 3 days. It is best to obtain a BBT thermometer to assess this.
How about your family history? Do you have close relatives with thyroid issues?
Some of the family history that suggests you could have a higher risk for hypothyroidism includes:
High or low thyroid function
Prematurely gray hair
Autoimmune diseases (rheumatoid arthritis, lupus, sarcoidosis, Sjogren, etc.)
Crohns disease or ulcerative colitis
Multiple sclerosis (MS)
Elevated cholesterol levels
It might be useful to take an online thyroid assessment quiz, as a way to get started. Mary Shomon has a good one, found here. Some of the classic symptoms are mentioned above, but there are many more too many to list here.
If you suspect you might be hypothyroid, you should see a healthcare provider who can evaluate this, including ordering the basic lab tests for thyroid function.
Even though lab tests are not the end-all, be-all for diagnosing a thyroid problem, they are a valuable part of the overall diagnostic process. The key is to look at the whole picture.
New studies suggest a very high incidence of borderline hypothyroidism in Westerners. Many cases are subclinical, and even sub laboratory, not showing up at all in standard laboratory measurements.
Coexistent sub clinical hypothyroidism often triggers or worsens other chronic diseases, such as the autoimmune diseases, so the thyroid should be addressed with any chronic disease.
Many physicians will order only one test a TSH level. This is a grossly inadequate and relatively meaningless test by itself, as well as a waste of your money. It would be like saying you know your water is pure because it tastes fine.
I recommend the following panel of laboratory tests if you want to get the best picture of what your thyroid is doing:
TSH the high-sensitivity version. This is the BEST test. But beware most all of the normal ranges are simply dead wrong. The ideal level for TSH is between 1 and 1.5 mIU/L (milli-international units per liter)
Free T4 and Free T3. The normal level of free T4 is between 0.9 and 1.8 ng/dl (nanograms per deciliter). T3 should be between 240 and 450 pg/dl (picograms per deciliter).
Thyroid antibodies, including thyroid peroxidase antibodies and anti-thyroglobulin antibodies. This measure helps determine if your body is attacking your thyroid, overreacting to its own tissues (ie, autoimmune reactions). Physicians nearly always leave this test out.
For more difficult casesTRH (thyroid releasing hormone) can be measured using the TRH stimulation test. TRH helps identify hypothyroidism thats caused by inadequacy of the pituitary gland.
Other tests that might be indicated for more complex cases are a thyroid scan, fine-needle aspiration, and thyroid ultrasound. But these are specialized tests that your physician will use only in a small number of cases, in special situations.
Even if all your lab tests are normal, if you have multiple thyroid symptoms, you still could have subclinical hypothyroidism.
Keeping Your Thyroid Healthy in a Toxic World
Now that you have some understanding of the importance of your thyroid and how it works, lets take a look at the factors that can readily cause problems with your thyroid gland.
Your lifestyle choices dictate, to a great degree, how well your thyroid will function.
If you follow my plan to eat for your nutritional type,5 and my nutritional plan your metabolism will be more efficient, and your thyroid will have an easier time keeping everything in check. Eating for your type will normalize your blood sugar and lipid levels and enhance your immune system, so that your thyroid will have fewer obstacles to overcome.
Eliminate junk food, processed food, artificial sweeteners, trans fats, and anything with chemical ingredients. Eat whole, unprocessed foods, and choose as many organics as possible.
Gluten and Other Food Sensitivities
Gluten and food sensitivities are among the most common causes of thyroid dysfunction because they cause inflammation.
Gluten causes autoimmune responses in many people and can be responsible for Hashimoto thyroiditis, a common autoimmune thyroid condition. Approximately 30 percent of the people with Hashimoto thyroiditis have an autoimmune reaction to gluten, and it usually goes unrecognized.
I recommend using sea kelp, natural desiccated thyroid, bio identical thyroxin with the Performance Pack metabolic to balance Thyroid Function.
More than one-quarter of women in perimenopause are diagnosed with hypothyroidism, in which insufficient amounts of thyroid hormones are produced.
Thyroid hormones are used by every cell of your body, which is why the symptoms can vary so widely. For example, thyroid hormones regulate metabolism and body weight by controlling the burning of fat for energy and heat.
Thyroid hormones are also required for growth and development in children. They signal the production of virtually all growth factors in your body, including:
Somatomedins (skeletal tissue growth)
Erythropoietin (involved in the development of red blood cells)
Nerve growth factor
Epidermal growth factor
In pregnant women, thyroid hormone is also involved in the production of prolactin, a hormone responsible for milk production.
Poor thyroid function has been linked to a wide array of serious health conditions, from fibromyalgia and irritable bowel syndrome, to infertility, autoimmune diseases, and thyroid cancer.
This is why it’s so important to understand how your thyroid works and what can cause it to dysfunction.
Understanding How Your Thyroid Gland Works
The thyroid gland is a butterfly-shaped gland found inside your neck, right under your larynx or voice box. A two-inch long, highly vascular gland, it has two lobes located on each side of the windpipe, connected by a tissue called the isthmus.
Your thyroid is responsible for producing the master metabolism hormones that affect virtually every function in your body. It produces three types of hormones:
Hormones secreted by your thyroid interact with all your other hormones, including insulin, cortisol, and sex hormones like estrogen, progesterone, and testosterone.
The fact that these hormones are all tied together and are in constant communication explains why a less-than-optimal thyroid status is associated with so many widespread symptoms and diseases.
Almost 90 percent of the hormone produced by your thyroid is in the form of T4, the inactive form. Your liver then converts the T4 into T3, the active form, with the help of an enzyme.
T2 is currently the least-understood component of thyroid function and the subject of a number of ongoing studies.
If everything is working properly, you will make what you need and have the correct amounts of T3 and T4, which control the metabolism of every cell in your body.
If your T3 is inadequate, either by scarce production or not converting properly from T4, your entire body will experience the consequences.
Thyroid Disruptors Abound…
It’s important to realize that thyroid dysfunction is a complex issue with many variables and many potential underlying causes, including the following.
If your thyroid dysfunction is caused by factors such as these, detoxification and changing your lifestyle to avoid hormone disrupting chemicals may be key components of successful intervention.
Estrogen dominance, Midlife hypothyroidism can be related to underlying estrogen dominance, in which case taking thyroid hormone fails to address the root of the problem.
Medications Certain medications, such as steroids, barbiturates, cholesterollowering drugs, and beta blockers can disrupt your thyroid function, in which case the most appropriate remedy may not be to add thyroid hormone.
Endocrine-disrupting chemicals Endocrine-disrupting chemicals like mercury, lead, phthalates, and bisphenol-A (BPA) have been linked to both early menopause and thyroid problems.
Bromine exposure. Bromines found in pesticides, plastics, bakery goods, beverages containing brominated vegetable oils (BVOs), and flame retardants also have a disruptive effect on thyroid function.
Bromine, chlorine, and fluoride are all in the same family as iodine, and all three can therefore displace iodine in your thyroid gland.
Fluoride, which is still routinely added to water supplies in many areas across the US, was used in Europe to reduce thyroid activity in hyperthyroid patients as late as the 1970s.
According to a 2006 report by the National Research Council of the National Academies,7 fluoride is “an endocrine disruptor in the broad sense of altering normal endocrine function.”
This altered function can involve your thyroid, parathyroid, and pineal glands, as well as your adrenals, pancreas, and pituitary.
Altered thyroid function is associated with fluoride intakes as low as 0.05 to 0.1 mg fluoride per kilogram body weight per day (mg/kg/day), or 0.03 mg/kg/day with iodine deficiency.
Fluoride has the ability to:
Mimic thyroid-stimulating hormone (TSH)
Damage the cells of your thyroid gland
Disrupt conversion from the inactive form of the thyroid hormone (T4) to the active form (T3)
Heavy metals Heavy metal toxicity is yet another factor that can be part of the problem.
Symptoms of Underactive Thyroid
Symptoms of hypothyroidism (underactive thyroid) may include but are not limited to the following:
Fatigue, loss of energy, and general lethargy, Cold intolerance, Muscle and/or joint pain, Decreased sweating
Depression, Puffiness, Weight gain, Coarse or dry skin and hair, Hair loss, Sleep apnea, Carpal tunnel syndrome Forgetfulness, impaired memory, and inability to concentrate, Decreased hearing Bradycardia (reduced heart rate)
Menstrual disturbances, Decreased appetite, Impaired fertility Constipation, Fullness in the throat, hoarseness Increased risk of heart disease, Increased “bad” cholesterol (LDL), Weakness in extremities, Emotional instability Blurred vision, and Mental Impairment.
The most common way to diagnose thyroid dysfunction is by measuring how much thyroid-stimulating hormone (TSH) your pituitary gland excretes. When your thyroid is not producing sufficient levels of thyroid hormone, your pituitary sends out TSH to encourage the thyroid to increase production.
Hence the higher your TSH level is, the more likely you are to have hypothyroidism. However, while the TSH test has become the gold standard for determining the activity level of your thyroid, this test may not be entirely adequate.
According to Dr. Raphael Kellman, an integrative medicine practitioner in New York City who specializes in thyroid disorders, many patients whose TSH level falls within the accepted “normal” range still exhibit classic symptoms of low thyroid. As noted in a recent Epoch Times article,9 the TSH test “frequently misrepresents what is happening in the thyroid and the pituitary.”
Part of the problem is that the TSH test fails to reveal the influence of endocrine disrupting chemicals, which can wreak absolute havoc on your hormone function.
As noted in the featured article:
“In order to detect a thyroid problem, a TSH test must assume that hormonal signaling in the rest of the system is functioning normally. Because endocrine disrupting chemicals may disrupt many points along the signaling system and not just the thyroid, it can be difficult to identify an imbalance with a TSH test alone. Kellman says this is a big reason why the conventional blood tests and reference ranges used to detect a thyroid abnormality can overlook real problems.
‘We have to realize that when it comes to endocrine disruptors the blood test can be elusive. It doesn’t show up as definitively as when you see the effects of the autoimmune process,’ he said. ‘It may not be as evident on blood testing. And blood tests can even look contradictory.'”
The Case for TRH and Reverse T3 Testing
In cases where TSH is within normal range yet symptoms of low thyroid are still present, a thyrotropin-releasing hormone (TRH) stimulation test may offer additional clues. It involves getting an injection of thyrotropin (which is produced by your hypothalamus gland), in response to which your pituitary gland dumps all of its stored TSH into your bloodstream.
The TRH test basically tells you how much TSH your pituitary contains, in total, opposed to how much TSH it is sending out in any given moment. Having plenty of TSH stored in your pituitary yet showing normal levels on the TSH test is suggestive of a dysfunction in your pituitary gland, and underlying toxicity may be part of the problem. As noted by Dr. Kellman:
“Toxins don’t have to reach high levels in order to affect a delicate system that’s very, very vulnerable to toxicity. Especially the thyroid which I think is the most vulnerable component of the endocrine system.”
Dr. Jonathan Wright, pioneer in natural medicine, has also noted that elevated reverse T310 (RT3) levels tend to signal the presence of toxic metals. In his experience, most people who have elevated RT3 levels will see their levels revert back to normal after undergoing chelation with EDTA and DMPS, which draw out cadmium, lead, mercury, and other toxic metals. In essence, heavy metal toxicity can cause a functional form of hypothyroidism. As previously explained by Dr. Wright:
“It’s very well-known that lead and cadmium interfere with testosterone production. What’s not so well-known is that reverse T3 is stimulated by toxic metals, so up it goes. In effect, we can have levels that are so high, they way outnumber the regular T3. You’re functionally hypothyroid even if your TSHs and free T3s happen to be normal.”
Lab Tests to Assess Thyroid Function
To get a fuller picture of your thyroid health, I recommend using the following laboratory tests:
Biofeedback Test at our clinic to identify how healthy your Thyroid/Parathyroid and Thyroid Hormones.
CBC vlood test: TSH Test, The higher your level of TSH, the higher the likelihood that you have hypothyroidism. The ideal level for TSH is between 1 and 1.5 milli-international units per liter.
Free T4 and Free T3 The normal level of free T4 is between 0.9 and 1.8 nanograms per deciliter. T3 should be between 240 and 450 picograms per deciliter.
Thyroid Antibody Testing. This includes thyroid peroxidase antibodies and anti-thyroglobulin antibodies. These two measures help determine if your body is attacking your thyroid or overreacting to its own tissues (i.e., autoimmune reactions). Unfortunately, conventional physicians nearly always leave this test out. If your doctor refuses to include this test, you can get it done yourself through DirectLabs.com.
Basal Body Temperature Although there are a few different protocols, the most commonly used is the Broda Barnes system, which is a measure of your basal body temperature at rest.
TRH Stimulation Test For more difficult cases, TRH can be measured using the TRH stimulation test. TRH helps identify hypothyroidism that’s caused by inadequacy of the pituitary gland.
Reverse T3 While reverse T3 (RT3) is metabolically inactive, elevated levels may indicate that heavy metal toxicity is affecting your thyroid function.
Iodine Is Essential for Thyroid Health
Iodine is the key to a healthy thyroid and efficient metabolism. Even the names of the different forms of thyroid hormone reflect the number of iodine molecules attached T4 has four attached iodine molecules, and T3 (the biologically active form of the hormone) has three showing what an important part iodine plays in thyroid biochemistry. As your body cannot produce its own iodine, it must be obtained from your diet.
Unfortunately, iodine deficiency is extremely common these days:
More than 11 percent of all Americans and more than 15 percent of American women of child-bearing age have urine iodine levels less than 50 micrograms per liter (mcg/L),12 indicating moderate to severe iodine deficiency
36 percent of reproductive-aged women in the US are considered mildly iodine deficient (<100 mcg/L urinary iodine). The American Academy of Pediatrics recommends taking an iodine supplement during pregnancy, as most pregnant women are deficient.
Besides dietary deficiencies, toxins can also affect your iodine levels by displacing iodine. Iodine is a member of a class of related elements called “halogens,” which includes bromine, fluorine, and chlorine. When they are chemically reduced, they become “halides” (iodide, bromide, fluoride, and chloride). Most people today are exposed to these halogens/halides via food, water, medications, and environments, and these elements selectively occupy your iodine receptors, further deepening your iodine deficit.
How Much Iodine Do You Need for Thyroid Health?
In Japan, the daily dose of iodine obtained from the diet averages around 2,000 to 3,000 micrograms (mcg) or 2 to 3 milligrams (mg), and there’s reason to believe this may be a far more adequate amount than the US recommended daily allowance (RDA) of 150 mcg. Some argue for even higher amounts than that, such as Dr. David Brownstein, a physician and author of the book “Iodine: Why You Need It. Why You Can’t Live Without It”, who recommends 12.5 milligrams (mg) on a regular basis.
I believe it would be prudent for most to avoid taking high doses unless you’re using it therapeutically, for a short period of time. There are potentially serious risks to taking too much iodine, which is why I generally do not advise taking large doses of iodine supplements like Lugol’s or Iodora long term.
I personally feel that getting iodine from natural sources is best, but if you do choose supplements, supplementation at a dose of a few mg, might be best for most. Iodine is particularly important for pregnant women, as it plays an important role in your baby’s brain and nervous system development. Research14 suggests having sufficient amounts of iodine during the first months of pregnancy can improve your child’s IQ by nearly 1.25 points.
Good natural sources of iodine include:
Sea vegetables such as kelp and algae
Seafood such as shrimp, sardines, Alaskan salmon
Seaweed called bladderwrack (Latin name: Fucus vesiculosus), which you can also buy in either powdered form or in capsules
Recommended Types of Thyroid Medications
When it comes to thyroid hormone replacement, you have two basic options:
Bioidentical thyroid hormones which is what I recommend using include Nature-Throid and Westhroid. They’re made from desiccated pig thyroid glands and contain the full spectrum of thyroid hormones: T4, T3, T2, and T1.
Synthetic hormones,15 such as Synthroid (generic brand: Levothyroxine), which contains only T4.
One of the trickiest parts of thyroid hormone replacement is finding the ideal dose. This typically requires fine-tuning over an extended period of time, with regular blood testing to see how the dose is affecting your thyroid hormone levels, and keeping track of your symptoms. Two key signals that you’re taking too much hormone are excessive sweating and rapid heartbeat or heart palpitations. If you get either of those symptoms, you’re getting too much thyroid, and you need to cut back on the dose.
It’s also worth noting that in some cases, if you’re borderline hypothyroid, you may only need an iodine supplement rather than an actual thyroid hormone replacement. Still, even with thyroid medication, some people still don’t see a major improvement in their symptoms, and there may be a number of reasons for this.
Why Is Your Thyroid Medication Not Working?
GreenMedInfo recently addressed this issue, listing several potential reasons why your thyroid medication isn’t providing the relief you expected.16 This includes:
Undiagnosed Hashimoto’s disease an autoimmune disorder in which your body is attacking your thyroid. As a general rule, signs of Hashimoto’s include TSH above 4.25 and thyroid peroxidase antibody (TPO) above 30.
Reduced thyroid receptor sensitivity, typically due to chronic inflammation. Once your thyroid receptor sensitivity is dulled, the amount of thyroid hormone required in order for your body to recognize and use it increases.
Poor thyroid hormone conversion. Your body converts inactive T4 to the active T3 form, and a number of factors can impair your body’s ability to perform this conversion (including certain nutrient deficiencies, listed below).
If your conversion rate is impaired, you’re dosage requirement goes up. Elevated reversed T3 (RT3) levels. High RT3 is not a sign of thyroid deficiency. It is a sign of high stress and/or potential heavy metal toxicity though, indicating you may need to address these two issues in order to return your thyroid to good health.
Iodine, selenium, iron, and/or cortisol deficiency. Without sufficient amounts of these nutrients, thyroid hormone metabolism and conversion cannot occur. (Selenium deficiency is particularly common in those with gastrointestinal disorders.) Gluten sensitivity. Gluten looks very similar to thyroid hormone, which is why those with Hashimoto’s disease are typically required to go on a gluten-free diet to quell the autoimmune response.
Some synthetic thyroid medications can contain gluten, so it’s important to make sure your medication is gluten-free, in addition to cutting gluten out of your diet.