JANUARY is Thyroid Awareness Month
Thyroid disorders are becoming an increasingly common health concern today, especially among women. In my naturopathic family practice, I see many individuals that have a diagnosed thyroid disorder but also many others who have sub-optimal thyroid hormone levels that can explain their symptoms even though they haven’t received a formal diagnosis from their medical doctor as their levels on their blood test are within ‘normal reference ranges’. In 2014, as per an article on Medscape, levothyroxine (Synthroid) was the most prescribed drug in the USA and the third most prescribed drug in the UK (Davenport, 2016).
The most common thyroid imbalance is hypothyroidism, when your thyroid hormones and/or thyroid function is low. If your doctor is just testing your TSH levels, it is important to speak to him or her and ask for your free T4 and free T3 to be tested as well otherwise you may not catch thyroid abnormalities until they become more advanced. T3 is the biologically active hormone that is responsible for binding to thyroid hormone receptors and regulating metabolism and other aspects of physiology. It is also possible for one to have normal TSH and free T4 but low T3 and have symptoms as stress (cortisol levels), iron deficiency, heavy metal toxicity, and other factors can influence the T4 to T3 conversion rate. The most common medication for hypothyroidism prescribed is Synthroid (levothyroxine) – this is only T4 and can work wonders for some people and some people need this. The problem with this is that your body still has to convert it into T3 and if your conversion mechanism is impaired, many will still not feel at their best. Cytomel (liothyronine) is T3 which is another medication that may be prescribed. Dessicated thyroid (Armour) comes from a porcine source and contains both T3 and T4 however, many MDs are reluctant to prescribe this form.
Hyperthyroidism is a thyroid disorder characterized by too much thyroid hormone. If you are diagnosed with hyperthyroidism, the medication most often prescribed is tapazole (methimazole). Sometimes propylthiouracil (PTU) is prescribed but PTU has a higher risk of elevating liver enzymes compared to methimazole. If your thyroid hormones are very high and you are very symptomatic, your doctor may even recommend radioactive iodine which shuts down the thyroid, essentially “zapping” it. Surgery to remove the thyroid gland is often another option. Once either of these invasive procedures are done, one could become hypothyroid and then be prescribed Synthroid “for the rest of their life”.
The four major contributors that can lead to a thyroid disorder are:
- Nutrient deficiencies: Thyroid hormones contain iodine and in developing countries, where iodine deficiency is common, this is a leading cause for hypothyroidism. With the advent of iodized table salt in North America, it reduced the incidence of hypothyroidism however, with the exposure to heavy metals and other environmental pollutants, this can decrease the ability of iodine to accumulate in the thyroid gland and form thyroid hormone. The reduction in table salt usage may decrease iodine consumption as well. Other nutrients like tyrosine (amino acid), zinc, copper, iron, vitamin B12, vitamin A and selenium are necessary for forming T3 and T4 thyroid hormone.
Should everyone just take iodine then? Not necessarily. Increased iodine levels can decrease thyroid function or induce hyperthyroidism. Caution is necessary if you have an autoimmune thyroid condition such as Hashimoto’s as iodine may induce hypothyroidism (2). Seeing a licensed healthcare provider can help you determine if iodine and tyrosine are necessary for improving your thyroid function or if optimizing other nutrients are necessary. Naturopathic doctors offer functional testing to assess for environmental toxins, chemicals, and heavy metals in the body.
- Adrenals: During times of stress, these adrenals are in overdrive overproducing cortisol which can decrease levels of the other adrenal hormones. Cortisol can affect conversion of T4 to T3 and has also shown to affect peripheral tissue activity of T3. If T4 to T3 conversion is impaired, this can produce rT3 which is T3’s cousin that nobody wants around because it is just there but doesn’t do anything but make the problem worse. Excess cortisol can also affect estrogen metabolism and excess estrogen in the body can increase the protein in the blood that binds up thyroid hormone lowering free T4 and free T3 leading to hypothyroid symptoms. Through a careful naturopathic history and some functional laboratory testing, you are able to get a picture of what is going on with your adrenal and hormonal function. Your thyroid problem may not be an isolated thyroid issue but more of an adrenal problem!
- Autoimmune: This is the hardest type of thyroid disorder to treat because it involves an inflammatory state and a hyperactive immune system that produces antibodies against certain enzymes or other thyroid gland proteins affecting the production of thyroid hormones. The two autoimmune thyroid disorders are: Hashimoto’s Disease ‘Hashi’s’ and Grave’s disease. The latter is associated with hyperthyroidism. In Hashimoto’s, one may start out in a hyperthyroid state and can ebb and flow between too little and too much thyroid hormone for a while but can eventually end up in a hypothyroid state. While conventional medicine doesn’t have anything to lower thyroid antibodies, naturopathic medicine aims at getting to the root cause and figuring out what part of your body decided to go “off-track”. This could be improving digestive health and/or hormonal imbalances, and working with you to shift your immune system to reduce immune hyperactivity, lower inflammation and lower thyroid antibodies. YES, imbalances in progesterone and estrogen can affect thyroid function and predispose one to autoimmune thyroid disorders. This is why many women will be diagnosed with a thyroid disorder in the perimenopause stage or even post-partum.
- Cancer: Yes, unfortunately, another factor to rule out if you have thyroid dysfunction is thyroid cancer. This is more common in females and most common in the 15-49 years range. Exposure to ionizing radiation, a family history of thyroid cancer, having a personal history of other thyroid disorders, obesity and tall height are risk factors (3). If you notice swelling on your neck in the thyroid region and your doctor assesses an enlarged thyroid or firmness over the thyroid during a physical exam, he or she will refer you to get an ultrasound. If nodules are found, you may be referred for a biopsy to rule out a malignant vs benign nodule. Benign nodules can be associated with autoimmune thyroid conditions and are monitored to ensure they do not become malignant.
IMPROVE YOUR THYROID HEALTH
Vitamins, minerals, and herbs can be utilized to treat patients with suboptimal thyroid hormone levels. Herbal supplements can be used to enhance thyroid function or to calm the thyroid but like medications, they can cause toxicity symptoms and adverse effects, which is why it is important to work with a trained healthcare provider so they can recommend treatments individualized to you.
Some steps you can take to improving your thyroid function today are:
- Speaking to your doctor about testing TSH, Free T4, Free T3, Thyroid peroxidase (TPO) and Thyroglobulin Antibodies, and, reverse T3 (rT3). Naturopathic doctors are able to test this for an extra fee if your family doctor (MD) does not.
- Steam your cruciferous vegetables – broccoli, cabbage, cauliflower, kale – as this deactivates the ‘goitrogens’ that can negatively affect the thyroid
- Reduce your intake of soy as the Isoflavones can affect your thyroid negatively
- Minimize your intake of gluten as gliadin antibodies have been shown to cross-react with thyroid tissue – eat whole foods (fruits, vegetables, protein, healthy fats)
- If you are not allergic or sensitive to nuts, eat a brazil nut per day to get your selenium intake – Selenium helps the thyroid in more ways than one!
Still curious about your thyroid? Your adrenals? Your doctor refuses to test all the thyroid markers? Perhaps you cannot lose weight, are always cold and intuitively feel like something is going on with your thyroid? Come in for an appointment and let’s figure out what is going on because it’s hard to figure out what is going on with your hormones by yourself because everything is so interconnected!
If you use the online booking system during the month of January, you get $5 of your visit!
Davenport, L. “Time for a U-turn on Levothyroxine? Overuse Is Rife, Say Docs” in Medscape Family Medicine. WebMD LLC:Nov 14 2016. Retrieved on Nov 13 2018 from https://www.medscape.com/viewarticle/871838?nlid=110752_1982&src=WNL_mdplsnews_161118_mscpedit_fmed&uac=159432FR&spon=34&impID=1237366&faf=1?src=soc_tw_
Chung HR MD. Iodine and thyroid function. Ann Pediatr Endocrinol Metab. 2014 Mar;19(1):8-12.
Canadian Cancer Society (2018). Thyroid Cancer. Retrieved on November 23 2018 from http://www.cancer.ca/en/cancer-information/cancer-type/thyroid/thyroid-cancer/?region=on