by Dr. Will Cole
Your thyroid regulates a surprising number of systems and processes in your body. It influences your brain and heart as well as your hair, nails, and sex drive. Oh, and add your metabolism and digestion to that list too. No other hormone can claim so much widespread influence. It’s no surprise then that when your thyroid isn’t working well, nothing seems to be working well.
But thyroid physiology is complex and unique to the individual, so when you have thyroid-related symptoms such as fatigue or weight gain, your problem may be more complex than something that can be fixed with a simple thyroid hormone replacement drug. (And no, thyroid dysfunction is not a sign of “just getting older,” as you may have been told.) You may even have thyroid symptoms despite “normal” labs.
Unfortunately, there’s no such thing as a magic thyroid-fixing pill for everyone. Instead of diagnosing “low thyroid,” functional medicine doctors prefer to make a more comprehensive diagnosis, to gain insight into why someone is struggling with the symptoms they have.
Here are six hidden thyroid problems we need to start talking about and what to do about each one:
1. Autoimmune thyroid problems
Research estimates that up to 90 percent of all cases of hypothyroidism are autoimmune in nature, with the most common manifestation being Hashimoto’s disease. When this happens, your thyroid is not the source of the problem, but the victim of a misguided immune system attack, in which your body mistakes your thyroid for a virus.
In mainstream medicine, you typically receive the same thyroid medication whether you have true primary hypothyroidism or an autoimmune disease attacking your thyroid, but in functional medicine we tend to treat autoimmune thyroid problems more naturally and can be different for each individual – since every person has their own unique biochemistry.
Labs to run: Thyroid peroxidase and TBG antibodies
What to do: There’s a lot you can do to naturally manage this condition. I recommend healing the gut with tools such as the elimination diet as well as taking in natural compounds such as Baicalin to promote regulatory T cell (Treg), to balance the immune system.
2. Thyroid resistance
This thyroid dysfunction is also not a primary thyroid problem but a cell receptor issue. Every cell of your body depends on thyroid hormones to function the way they should, but if your cells receptor sites are blunted because of inflammation or toxins, your body will feel the effects of hypothyroidism despite having adequate hormone production, since those hormones aren’t getting where they need to go. In this case, your TSH test will be “normal” but you’ll feel miserable.
Labs to run: Markers such as CRP and homocysteine as well as reverse T3 can shed light on inflammation levels as well as hormone receptor site availability. High triglycerides and low HDL can be signs of insulin resistance, which is another clue because it typically occurs with thyroid resistance.
What to do: Liposomal turmeric and resveratrol are two of my favorite supplements for quelling excessive inflammation.
3. Elevated thyroid-binding globulin
This is a common scenario when a woman has high estrogen levels. I also see it in women using birth control pills or estrogen creams. All hormones get transported throughout the body on protein carriers. The thyroid’s specific transport carriers are called thyroid-binding globulins (TBG.) When TBG levels are elevated, this could cause an increase of protein-bound thyroid hormones, which can’t be used by your body.
Labs to run: TBG, Free T3, and T4 as well as an expanded female hormone panel.
What to do: Clear excess hormones by supporting detoxification pathways with herbs such as milk thistle, and by supporting methylation pathways with activated B vitamins.
4. Hypothyroidism second to pituitary hypofunction
Your thyroid only does what your brain tells it to do, and if your pituitary gland isn’t working well (this could be due to chronic stress, chronic infections, or even a benign pituitary tumor), the hypothalamic-pituitary-thyroid (HPT) axis will malfunction. This is the communication line between your brain and thyroid. When the pituitary gland, which sits at the base of your brain, isn’t communicating with your thyroid gland, then the thyroid may be just fine. It’s just that nobody is giving the signal that it’s time to get to work!
Labs to run: Look for low levels of T4 and T3 despite a normal-to-low TSH, and possibly viral labs, such as the one that checks for the Epstein-Barr virus (EBV.)
What to do: To support pituitary health and optimal HPA communication, I recommend natural brain-immune support tools, such as astragalus, olive leaf, rubidium, sage leaf, L-lysine, zinc, and vitamin C. Read my article here for more recommendations.
5. Thyroid under-conversion
This pattern, also called low T3 syndrome, is common with chronic adrenal stress and its related elevated cortisol. The majority of thyroid hormone comes in the form of T4, which is largely metabolically inactive and has to be converted to T3 for use in the body. It’s estimated that 80 percent of thyroid conversion happens in your liver and 20 percent in your gut.
Through this process, a special enzyme called 5′ deiodinase takes one iodine molecule off of T4 to make it the active T3. This pattern has been covered in medical literature for years but is not effectively alleviated by the thyroid replacement hormones. Most thyroid drugs are synthetic T4, which isn’t the problem in this pattern.
Labs to run: Free and total T3, liver enzymes, microbiome testing, and nutrient testing of selenium, magnesium, and zinc.
What to do: In addition to getting your adrenal fatigue, gut, and liver health under control, foods rich in selenium, zinc, and magnesium help make the enzyme needed for healthy thyroid conversion. Brazil nuts and shellfish, such as oysters, are some of my favorite options.
6. Thyroid over-conversion
This thyroid pattern is sometimes found in people with elevated testosterone levels, insulin resistance, type 2 diabetes, and in women with PCOS (polycystic ovarian syndrome.) You would think that if the body produces more T3, the metabolically active form of thyroid hormone, it would be a good thing. However, as with just about everything, too much of a good thing isn’t such a good thing. Over-conversion of T3 can overwhelm your cell receptors, leading them to become resistant to the T3, so even though you have a lot, once again, you aren’t able to use it.
Labs to run: Free and total T4 and T3, free and serum testosterone, fasting blood sugar, and HbgA1c.
What to do: In addition to eating a clean diet consisting of lots of vegetables, fruits, meats, and healthy fats, I recommend natural medicines such as alpha-lipoic acid and chromium supplements, along with cinnamon, all of which can act as blood sugar balancers.
As for general thyroid health, sea vegetables such as dulse, nori, and arame are great nutrient sources, including the vitally important iodine. You need iodine from foods to fuel thyroid hormone production.
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