Thyroid Concerns

Many Americans are suffering from thyroid problems.  Hashimoto’s Thyroiditis has been theorized that there are approximately 27 million people with thyroid conditions in the United States, both low and high thyroid function, and up to half of them have not been diagnosed.  And women have a much higher risk for thyroid dysfunction.

Women smiling

One Agora takes a comprehensive approach to thyroid concerns.  It is important to realize how complex thyroid function truly can be.

Hashimoto’s thyroiditis is a common autoimmune disorder also known as chronic lymphocytic thyroiditis or chronic autoimmune thyroiditis. Hypothyroidism occurs when your body doesn’t produce enough thyroid hormone or when your body fails to use thyroid hormone efficiently. There are many types of hypothyroidism, but Hashimoto’s thyroiditis is the most common.

In Hashimoto’s thyroiditis, we see an underactive thyroid (hypothyroid) with an overactive abnormal immune (autoimmune) response.

To fully understand this condition, it is necessary to understand both the function of the thyroid and the pathology of autoimmune conditions. Many people are suffering from thyroid dysfunction, but usually, physiology, assessment, treatment, and pathophysiology to manage the syndrome is not entirely addressed by the healthcare team.

If you start to understand how the thyroid works and what is going wrong than it is possible to make lifestyle changes and add in specific interventions that help to improve thyroid function.

How does the thyroid work?
The thyroid gland is a butterfly-shaped gland that sits at the base of the neck. It is part of the endocrine or hormone system. It is responsible for producing hormones that coordinate many of the body’s activities, including heart, brain, liver, kidney and skin function, and is especially important for metabolism and hormone balance. Clearly, though, it is vital for total health, wellness, and overall well-being.

Here is the breakdown of the different hormones and components of the thyroid:
• TSH (Thyroid Stimulating Hormone)- released from the brain (pituitary gland) to regulate the thyroid and thyroid hormones (T4 and T3). The primary controller of all of this activity is a part of the brain called the hypothalamus.
• T3 (triiodothyronine) and T4 (thyroxine)- The two major active thyroid hormones made by a healthy gland. T4 is produced in a significantly great amount from the thyroid gland than T3 (17:1 ratio). However, T3 is much more biologically active than T4 at the cellular level (300% more active).
• To look at this in another way. The primary hormone released from the thyroid gland is T4. The thyroid gland also releases T3, but a majority of T3 comes from converting T4 into T3 in the liver, gut, skeletal muscle, brain and thyroid gland itself.
• Hormones can be measured as free T4 and free T3 or total T4 or total T3. Most of T4 and T3 circulates in the blood bound to proteins, but a small percentage are free levels and not bound to proteins. Total levels are bound plus unbound measures of the thyroid hormone.
• Free hormone levels test the total hormone that is available in the body.
• Reverse T3 (rT3) is a test that shows the amount of active free T3 that can bind to thyroid receptors. Therefore, it is more of a measure to assess along with free T3 what the cells can use.

Clinically, hypothyroidism means that there are high levels of thyroid stimulating hormone (TSH) and low levels of the thyroid hormones (T3 and T4).

To have the autoimmune aspect of Hashimoto’s thyroiditis, antibodies in the blood must be increased. Testing both antibodies is important. The two antibodies are TPO antibodies and Thyroglobulin antibodies.

The above labs have to be ordered by a provider. There is a way for you to assess whether or not you might have low thyroid function concerns. You can take your basal body temperature in the morning. Your basal body temperature is your body temperature immediately in the morning before getting out of bed or doing anything else. Take it for at least five days in a row. If you are less than 97.8 degrees F, then it is very likely that you are hypothyroid.

Signs and symptoms- How do I know that I might have Hashimoto’s thyroiditis

• Decreased energy
• Negative mood, thinking and depression
• Difficulty thinking or focusing
• Dry, rough, pale skin
• Intolerance to cold temperature
• Muscle cramps, weakness, or fatigue
• Constipation
• Weight gain
• Hair loss
• Brittle hair and nails
• Swollen thyroid gland
• Swollen ankles, legs, or feet
• Puffy face
• Hoarse voice
• Trouble swallowing
• Irregular or heavy menstrual cycles

How are the thyroid hormones made and regulated?
Four things needed for proper thyroid function
1. Tyrosine
2. Iodine
3. Selenium
4. Antioxidant Support

Iodide has to be converted to iodine and attach to tyrosine to form thyroid hormones. For this conversion of iodide to iodine to occur, hydrogen peroxide is formed as a byproduct. Hydrogen peroxide production leads to an increase of free radicals and oxidative stress. This process of hormone production is a natural oxidative stress on the body, but there are problems if it is increased or uncontrolled. Moreover, this can be a problem especially if not controlled properly with the proper amount of antioxidants or if there are high levels of TPO antibodies.

Because of the role that there is an antioxidant called glutathione peroxidase that plays a significant role in allowing the production of thyroid hormone and preventing thyroid cell damage. For the body to make glutathione peroxidase the body needs selenium and glutathione. Therefore, it is beneficial to supplement. Glutathione levels are best increased by either IV glutathione or oral NAC supplementation that will convert over to glutathione.

Why does the body attack the thyroid gland in an autoimmune condition?
It is important to realize that Hashimoto’s Thyroiditis is not just about supporting the thyroid but also treating the underlying cause of the autoimmune concern. Therefore, it must be addressed that it is not just a thyroid condition but also an inflammatory autoimmune disease.

An autoimmune disease occurs when the body and the immune system attack its tissues. The immune cells, lymphocytes, and antibodies are produced against tissue in your body. In this case, it is against the thyroid or the thyroid enzymes responsible for converting thyroid hormone.

Triggers for autoimmune response
1. Hormone imbalances, including pregnancy and post-pregnancy
2. Nutrient deficiencies
3. Certain drugs
4. Immune imbalances- Th1 Dominance
5. Digestive inflammation and imbalance
6. Trauma
7. Environmental toxins, such as heavy metals, chemical irritants, and mold exposure
8. Viruses and bacterial infections, such as Epstein-Barr Virus or Lyme Disease
9. Stress including both emotional oxidative stress
10. Impaired biotransformation/detoxification

Antibodies are formed due to the immune system being stimulated by one of the above triggers. Naturally, for a comprehensive approach to be taken with Hashimoto’s thyroiditis, we need to focus on:
1. Addressing and reducing triggers
2. Eliminating intestinal inflammation
3. Supporting the body and providing nutrient support
4. Improving the function of the thyroid

orange type on Hashimoto Autoimmune

To answer this question, it is important to look at the current traditional treatment protocol and how it does not look at the full picture.

How does traditional allopathic medicine assess and treat Hashimoto’s thyroiditis?
The conventional medical treatment states that there is no cure for Hashimoto’s thyroiditis, and the progression of the disease varies from person to person.

Many times thyroid function is assessed and managed only by TSH (the hormone that comes from the brain- not the hormones that even come from the thyroid gland). As you can see, though, this is only one small component of thyroid function. Along with the TSH, sometimes T4 will also be assessed (remember that T4 is less biologically active than T3 but converts over to T3 in a healthy individual). However, it is rare to have a doctor test anything else besides TSH and T4 status.

Here is why T4 is measured?
The reason that T4 is regulated is because the typical treatment focuses on synthetic T4 based medication (thyroxine). This drug is known as Levothyroxine or by the brand names Synthroid, Levothroid, and Levoxyl. It only has the prohormone T4. Even though T4 is 300% biologically less active than T3, it is the only component of the traditional medication. It is assumed that the additional T4 will convert over to T3. But many thyroid patients have problems with conversion, and this needs to be taken into consideration.

At times, if Hashimoto’s thyroiditis is suspected than antibodies might also be tested to verify the autoimmune aspect. However, usually these are not measured again or monitored because it is thought once you have antibodies, you will always have them. Along those lines, doctors also believe that once you are on synthetic thyroid medication, you will always be on it. Therefore, treatment is focused on managing the hormone levels with synthetic T4 medication and not treating the underlying cause of the autoimmune disease.

But if you do go after the causing trigger then you can see these antibodies go down and even return to normal. Remember that this does take time. The half-life of IgG antibodies is 21 days, and they stick around in the body for about three months. Therefore, even when treating the underlying cause, it does take 6-12 months to see drastic changes in the antibody levels.

First of all, (and you will see this theme in many of my blogs) not all people with Hashimoto’s thyroiditis are the same. I recommend finding a practitioner that treats thyroid conditions in a functional manner. With my patients, I start with a comprehensive thyroid panel that includes TSH, total T3 and T4, free T3 and T4, rT3, and the antibodies. From that panel then It is possible to see exactly where the concerns with thyroid function occur allowing treatments to focus on supporting the thyroid function specific for the person.

The more important aspect of treatment is to go after the underlying cause. There is a reason that the immune system is attacking the thyroid gland and hormones.

Other options for thyroid support
I highly recommend that someone with thyroid concerns knows their choices. Many doctors and endocrinologist only use Levothyroxine. There are other options out there.

Desiccated (dried) thyroid is a more balanced combination of hormones that are normally produced by the thyroid gland. The three main types of desiccated thyroid are Armour, Nature-Throid, and Westhroid. Armour is the most common form, but it is not the best option most of the time.

Armour has been shown to be inconsistent among batches. Clinically, I see that I get better results with other forms of desiccated thyroid (I use mainly Nature-Throid) or working with my compounding pharmacist to build a particular compounding thyroid prescription based on lab values.


Importance of going completely gluten-free
I take all of my thyroid patients off of gluten immediately. Why? Research.

Research now connects celiac and gluten sensitivity to thyroid disease. When the body reacts to gluten and other proteins, then an autoimmune process is triggered. Since about 70% of the immune system is in the gut, when the body starts to view proteins that we are eating as foreign and a threat, then the immune system goes into overdrive. There is not the only destruction of villi of the small intestine and tissue of the digestive system, but it also triggers responses in other tissue. The thyroid is a common secondary tissue since it is extremely biologically active. When the immune system goes specifically after the tissue and enzymes of the thyroid and antibodies are present, then either a deficiency (hypothyroidism) or an excess of hormones (hyperthyroidism) can occur. This wrecks havoc on the body’s metabolism.

A growing amount of research now suggests that when people with celiac disease and an autoimmune thyroid disease go gluten-free, then there is an increased potential to improve thyroid function by reducing autoimmune reactions in the body. This can lead to both an improvement in thyroid hormones and a decrease in antibodies.

A growing amount of research suggests that when people with celiac disease and autoimmune thyroid disease adopt a gluten-free diet, not only do their celiac-related antibody levels improve, but their thyroid antibody levels also decrease.

A 2010 study in Journal of Pediatrics found that 11 of 15 children with celiac disease who had elevated thyroid-stimulating hormone levels at diagnosis with celiac disease saw thyroid numbers normalize after 12 to 18 months on a gluten-free diet.

Gluten grain also is high in phytates, also known as phytic acid. These bind up nutrients that can cause additional stress on the body and with the thyroid. They are known to bind to certain minerals including iron, zinc, manganese, and calcium. No matter if you are sensitive to gluten or not, the phytates bind essential vitamins and minerals that feed the body, especially the metabolically active thyroid.

This patient population, though, needs to be completely gluten-free. Many clinicians report that eating a gluten-free diet helps to improve thyroid markers in both celiac and gluten sensitive patients.

Need to Limit or Avoid Other Foods
• Sugar and coffee are two of the biggest culprits to thyroid exhaustion.
• Cruciferous vegetables: broccoli, cauliflower, Brussel sprouts, kale, bok choy, cabbage. These vegetables are goitrogens and can increase the size and concern of the thyroid gland.
• Any food sensitivities that you might have. The most common are dairy, gluten, refined sugar and soy.

Foods the Support the Thyroid
• Organic eggs
• Omega-3 fatty acids
• Fish
• Poultry
• Steamed Vegetables

Inflammation of the Gut and Food Sensitivities. Fix gut imbalances
Digestive concerns are extremely frequent in the United States. Gut issues include low probiotic levels, low HCl, leaky gut, increased permeability of the gut, inflammation, increased immune problems, bacterial and fungal infections, Candida, and parasites.

Low stomach acid can be a huge concern. One of the major functions of stomach acid, HCl, is to denature and start the digestive breakdown proteins. If your body does not digest, absorb and utilize proteins correctly then your immune system will begin to attack these proteins. This overzealous immune response leads to autoimmune concerns throughout the body.

Wondering if you are low in stomach acid? Do the betaine HCl challenge. Find a pure betaine HCl from a local natural food store or any place that carries supplements.
• Take 1 Betaine HCl with a meal.
• If you don’t feel a light burn, then go up to 2 Betaine HCl pills at the next meal.
• Continue increasing by 1 Betaine HCl with each meal until you do feel a light burn.
• If you get to more than 3-4 or you are quite deficient in HCl production in the stomach.
• It is a good idea then to decrease the dose by 1 and take that amount of HCl with each meal. So if you felt the burn at 4 Betaine HCl then take 3 Betaine HCl pills with each meal from then on.

It is especially important to supplement betaine HCl in meals with higher amounts of protein.
It is also important to support the immune system with probiotics and prebiotics. If you suspect digestive issues, find a functional medicine provider near you that treats gastrointestinal concerns.

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The Link with Hormones
Estrogen and testosterone concerns will affect the levels of free T3. Remember this is the active form of iodine. It is important to make sure that your reproductive hormones are not interfering with your thyroid hormones.

Higher levels of estrogen or low levels of progesterone also lead to more autoimmune concerns. Hormone imbalance plays a role as a significant cause of inflammatory and autoimmune disorders. And it is a chicken and an egg situation because hormones affect the thyroid but the thyroid also affects reproductive hormones. Therefore, it is important to assess and balance your hormones whenever dealing with the thyroid and autoimmune conditions.

Halogen Havoc
So remember that periodic table and remember the halogen gasses. Specifically, remember chlorine, bromine, and fluorine. They line up in the same column as iodine. Therefore, they are similar elements that can interfere with the function of iodine in the thyroid. They can occupy the receptor sites and block iodine but just sit there and be useless. If they sit there and are useless than the thyroid will be useless too.

Don’t remember the periodic table and the halogen gasses. Look down below at the second column to the right. By looking at this periodic table, it might make more sense why the other halogen gasses of fluorine, bromine, and chlorine interfere with proper thyroid function. These elements are similar to iodine but not the same. Therefore, they can fit into the receptor for iodine, but they don’t activate the cells the same way that iodine would. In other words, they are close enough to iodine to confuse the thyroid.

This is one of the major reasons to avoid tap water, that is laced with large amounts of fluoride and chlorine, as much as possible. If you feel you have more considerable quantities of these halogen elements in your body than taking in, iodine can be beneficial. Make sure, though that you don’t have high TPO antibodies before taking in more iodine because you don’t want to create more oxidative stress in the body to shut down the thyroid more.

Because iodine is not a one size fits all treatment, let’s look a little closer at iodine.
Let’s get to the bottom of iodide/iodine.
The United States started to iodize salt in 1924. One of the big factors for iodizing salt is to improve thyroid function. It is known that iodine deficiency can lead to hypothyroidism, goiter, and brain damage.

The surprising fact, though, is that several studies have shown that excessive iodine intake can lead to Hashimoto’s thyroiditis. It is known that excessive iodine intake is an environmental trigger for Hashimoto’s thyroiditis. Moreover, Hashimoto’s thyroiditis was not recognized in the US before we started putting iodide in our salt. And other countries have shown an increase in this autoimmune disease with salt iodization.

One study in Korea even showed that healthy thyroid function was able to be achieved in a vast majority of Hashimoto patients after just three months of iodine restriction alone.

It is also important to realize that many times increased iodide supplementation can be detrimental to certain individuals with Hashimoto’s thyroiditis. Iodide gets oxidized to iodine by TPO. Giving iodine to someone with TPO antibodies is causing more problems because you are pouring gasoline on the fire.

Therefore, it is best to make sure that your salt is not iodized if you have Hashimoto’s thyroiditis. I recommend this as the first step before adding in any thyroid supplementation or medication. I also highly recommend that you use Himalayan salt because of its many positive health effects.

Don’t blindly supplement iodine
There has been so much press about the role of iodine in conjunction with thyroid function. It is important not just to supplement or take in a large amount of iodized salt to treat the thyroid. This practice can have very adverse effects on the thyroid in autoimmune conditions.

If you have TPO antibodies, take out large amounts of iodine in your diet. Supplementing iodine will lead to more inflammation and dysregulation of the thyroid hormones.

Look to see what is in your supplements
Some of the fillers and binders used in supplements will hurt someone that is in an autoimmune condition. Make sure that there is no gluten, modified food starch, corn starch, soy proteins, or other proteins that you are reacting too.

Also, make sure that you have the nutrients that you need to support the thyroid. Nutrients required for proper thyroid function: antioxidants, selenium, tyrosine, iron, vitamin A, Vitamin E, glutathione, B Vitamins, potassium, iodine, and zinc.

Remember the role of zinc in both thyroid hormones and gut healing. Zinc deficiency prevents the conversion of T4 into the active T3 hormone.

The overlooked importance of selenium
I am not sure why more practitioners don’t push selenium with thyroid concerns. A matter of fact if you asked anyone with thyroid concerns if they know the importance of selenium in thyroid function, maybe 1% would say yes. Selenium has numerous positive effects on the thyroid.
1. First it is vital for the conversion of inactive T4 to biologically active T3.

2. It is a major antioxidant and protects the thyroid cells. In the normal thyroid function, iodide triggers the production of hydrogen peroxide to convert over to iodine. The iodine then is attached to tyrosine to make thyroid hormones. The hydrogen peroxide that is formed during this reaction is reactive and causes oxidative stress and free radicals. Because of this process, it is vital to have antioxidants available not to stress the body and thyroid.

3. In the presence of excessive iodide intake, more hydrogen peroxide will be produced. Therefore, to neutralize this reactive byproduct, more selenium (or glutathione) is needed for antioxidant support. Selenium levels are much easier to increase with supplementation than glutathione.

4. We tend to push iodide in both supplementation and food but do not balance this out with selenium. Therefore, we need more selenium.

The recommended dose is 200-400 mg/day. You can get a large amount of selenium in Brazil nuts have high levels of selenium. However, the amount varies widely by brand. Therefore, I recommend that my patients supplement selenium because it is so vital for thyroid function.

Research has shown that supplementation with selenium while on Synthroid significantly lowered antibody levels after three months. Also, it was noted that there was an improvement in mood and general wellbeing.

Other Supplement Ideas
• Myo-Inositol has also been shown in research to reduce TSH levels.
• Vitamin B Complex to improve oxygenation and energy in thyroid cells.
• Beta-Carotene to offer a potent antioxidant to the thyroid.
• Thytrophin PMG
• NAC- Glutathione precursor
• Curcumin
• Anatabine
• Vitamin D
• Folate to help with methylation
• Omega-3 Fatty Acids
• Selenium
• Zinc

Manage Stress
There is so much benefit to decreasing cortisol and supporting the adrenal glands. Stress in the body shuts down the conversion of the thyroid hormones and increases inflammatory messengers in the body. Both of these stress effects leads to trouble managing and healing the thyroid. Make sure that you have proper stress management and take good adrenal support during times of prolonged stress.

As you can see, thyroid function is complicated. If you put in an autoimmune attack on the thyroid gland, it becomes complex. Even though the point of this blog is to explore the function of thyroid and pathophysiology of Hashimoto’s thyroiditis, I realize that there might be a lot more questions or topics not explored in this blog. Please use this blog to continue the conversation.

Recommended Resources 
Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause by Izabella Wentz

The Paleo Approach: Reverse Autoimmune Disease and Heal Your Body by Sarah Ballantyne

The Thyroid Diet by Mary Shomon

Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD

The Autoimmune Solution: Prevent and Reverse the Full Spectrum of Inflammatory Symptoms and Diseases by Amy Myers

The Immune System Recovery Plan: A Doctor’s 4-Step Program to Treat Autoimmune Disease by Susan Blum and Mark Hyman

Why Do I Still Have Thyroid Symptoms? By Datis Kharrazian