This month I am continuing a topic I covered in part one of this series: the thyroid gland. I am sharing this important information, because thyroid-related problems are both common and complicated.

Arguably, one of the most important and poorly understood glands in the human body, the thyroid relies on an interplay with other glands to function properly. There can be multiple “breakdowns” in the production and metabolism of thyroid hormones. Yet, conventional medicine rarely looks beyond the thyroid itself to identify whether or not there is deeper problem in the system. What surprises me is the number of patients I see that have been prescribed medication without ever checking for an underlying issue.

For instance, disfunction may in fact start in glands in the brain called the hypothalamus and the anterior pituitary. The pituitary gland secrets hormones that play a crucial role in the regulation of important physiological functions, specifically the thyroid-stimulating hormones (TSH). TSH stimulates the production and secretion of the thyroid’s hormones (T1, T2, T3, or T4), which then play a vital role in regulating metabolism, energy balance, growth, and nervous system activities. An aberration in this pathway of hormone production (often referred to as the hormone cascade) can impede the thyroid. Elevated TSH would indicate hypothyroidism, and low TSH levels would indicate hyperthyroidism.

Perhaps you feel I am getting a little too far in the weeds. Stay with me though, as I would like to discuss now how conventional medicine diagnoses issues with the thyroid gland, particularly hypothyroidism caused by Hashimoto’s thyroiditis.

STANDARD PROCEDURE

The diagnostic process begins with a good case history of the patient and visual examination. Patients might complain of fatigue and sluggishness, difficulty losing weight, hair loss, and loss of eyebrow hair especially from the outer aspects of the eyebrows. These are all signs of a potential thyroid issue.

A physical examination may demonstrate enlargement of the gland (goiter) or palpable nodules. Sometimes, if the goiter is large enough, it will be visible or the patient will complain of difficulty swallowing.

Then, specific symptoms will call for specific blood tests. Blood testing is essential for an accurate diagnosis of thyroid issues. Conventionally a TSH test is run and sometimes a level of the free T4 may be run as well.

WHERE TROUBLE BEGINS

Here is where, in my opinion, the problem begins, because it is also where the diagnostic testing typically ends.

Conventionally, a poor test result triggers the primary form of treatment for this condition: the prescription of synthetic thyroid hormone (T4) in the form of either Synthroid or its generic cousin, Levothyroxine.  

Typically, this prescription will be used for the rest of the patient’s life. It will be adjusted periodically based on routine TSH testing. If the TSH blood level increases above the top limit conventionally (typically somewhere in the vicinity of 4.45 uIU/L) then the level of prescription will be adjusted up. The reverse is applied if the level of TSH drops below around 0.45 uIU/L.

In many instances, the medication is necessary. However, alternatively, Functional Medical practitioners typically want to assess the thyroid beyond just TSH levels. This is done in order to gain a better picture of the thyroid gland’s production of not only T4, but also levels of all forms of T4 and T3. 

In most instances it is necessary to assess multiple hormone levels relative to thyroid function in order to get an accurate picture of how well the thyroid gland is functioning. Thus, additional diagnostics must also be considered. While not all of these are necessary in every case, the appropriate facts must be gathered in order to create a prudent and well-thought-out treatment plan.

One must check for thyroid “auto-antibodies.” These are the autoimmune antibodies that will be present in Hashimoto’s since this is an autoimmune condition. Typically, in the Center we will test not only for TSH and free T4, but also thyroid antibodies, total T4, total T3, free T3, reverse T3, and a couple of other thyroid indicators. This gives us a pretty good idea of whether or not the patient’s condition is autoimmune and if there is a breakdown in production of thyroid hormone or the conversion of inactive thyroid hormone (T4) to the active form (T3).

A non-invasive ultrasound may be ordered if the treating doctor is concerned about a goiter or thyroid nodules to determine the size and appearance of the gland tissue.

A fine needle biopsy may be ordered in order to get a tissue sample and to look for any signs of cancerous growth. The sample could also be evaluated to further determine if there is specific white blood cell activity (lymphocytes), which occurs in when the autoimmune process is occurring.

Further, one might also consider:

• Overall immune health via a complete blood count (CBC).
• Deficiencies in other minerals and micronutrients that may adversely affect thyroid function. This includes vitamin D, iodine, selenium, zinc, and essential fatty acids, which should be included in treatment to support the thyroid gland.
• Gut health–specifically the health of the microbiome in relationship to overall immune health–via stool testing for gut flora to see if the natural immune function can be maintained and supported if needed.
• Potential food intolerances and toxic substance exposure, since certain foods and toxic materials can affect overall immune function and specifically autoimmune thyroid function.

In functional medicine, substances that contain some T3 may be utilized, such as a compounded bioidentical form of thyroid hormone. Supplemental thyroid hormone might contain varying levels of T4, T3, and also the two hormones produced by the thyroid gland at far lower concentrations: T1 and T2.

In some instances, I have seen synthetic T3 prescribed in the form of liothyronine.

Since diet can impact thyroid gland function–as with any autoimmune condition–it should be a top goal to keep inflammation in the body down. It is important to avoid inflammatory foods that contain Omega 6 fats and to increase the consumption of Omega 3 fats. This means avoiding a lot of grain-based (wheat and corn) carbohydrates and consuming grass-fed meats and fish (Omega 3 rich). High sugar and processed foods should also be avoided as well.

Proper gut health can be improved with a good probiotic and prebiotic. Consumption of fermented foods such as sauerkraut and kombucha would be advisable. Yogurt can be helpful for those who do not have an issue with dairy, as long as “candy yogurts” (high in sugar and simple carbs) are avoided. Start with plain, unsweetened yogurt and add some berries yourself.

It is also wise to avoid alcohol. We are learning more and more about the negative health effects of alcohol, including the higher incidence of certain cancers when alcohol is consumed, even at a low or moderated level of a few drinks per week.

In some cases, gluten may be an issue; there is a definite link between individuals with celiac disease and autoimmune thyroid conditions. Some of my colleagues believe that all patients diagnosed with autoimmune thyroid conditions should be evaluated for celiac as well. The jury is still out on some of this, but the relationships are definitely present in some cases.

TO LEARN MORE

I trust that this two-part series has shed some light on thyroid anatomy, function, and interplay with other glands in the body and with multiple metabolic functions of the body.

Should you be interested in exploring possible issues or want further evaluation of your personal thyroid gland function, call to schedule a consultation at the Center for Nutrition and Wellness. First, we will discuss your concerns and questions. Then, we might discuss further testing and the potential for additional support that could be helpful regarding your lifestyle and diet, as well as suggestions regarding your current or recommended supplementation.

As always, we're here for you.