Healing Your Thyroid Naturally

CHAPTER 1

Thyroid 101

It has been estimated that thyroid issues have doubled or tripled since the 1950s. In fact, a medical textbook from the ’60s reported that “diseases of the thyroid are not common in medical practice.” It is now estimated that over 12 percent of the US population will develop a thyroid disorder at some point in their life. The most common reason for hypothyroidism is an autoimmune disease called Hashimoto’s thyroiditis. It is estimated that over 90 percent of people in the United States living with hypothyroidism have Hashimoto’s and many of them do not even know it because they have never been tested for the antibodies! These antibodies essentially attack the thyroid, and over time can cause thyroid damage.

The thyroid is a small but powerful butterfly-shaped gland located in the neck just below the larynx. In healthy individuals, the thyroid gland cannot be typically felt or seen by just looking at or touching the neck. The thyroid is only .79 inches (2 cm) thick and has two lobes connected by a narrow piece of tissue known as the isthmus. Each little lobe measures only about 1.8 inches (4.6 cm) in length and the total weight of the thyroid can be up to around 2 ounces. Despite its tiny size, the thyroid is known as the “body’s thermostat” and regulator of metabolism. In fact, it produces hormones that provide energy for every one of the cells in your body! These thyroid hormones control breathing, alertness, heart function, body temperature, cholesterol level, nervous system function, how easily you gain or lose weight, skin moisture, brain development, and menstruation. Needless to say, the thyroid hormones play an incredibly significant role in the body.

The two primary hormones produced by the thyroid are T3 and T4. The thyroid hormones are synthesized from the amino acid tyrosine and the mineral iodine. Approximately 90 percent of the hormone released by the thyroid gland is T4, also known as the inactive thyroid hormone, and 10 percent is the active hormone T3. When T4 is released into the body’s circulation, it is converted into the active form of T3 by way of a process called deiodination. This process of converting inactive T4 to active T3 happens in the liver, kidneys, and brain. (In some cases, instead of converting T4 into T3, the body changes T4 into the mirror image of T3, called reverse T3 [RT3]. Unfortunately, RT3 is not an active hormone and the body cannot use this form of T3. This is often more likely to happen when a person is fasting, is exposed to lots of toxins, has diabetes, is under a high amount of stress, or has a chronic illness.)

The body regulates the production of these important hormones by sending signals from the pituitary gland (located in your brain), by way of another hormone known as TSH (thyroid-stimulating hormone). This means that the thyroid hormones can exert a negative feedback on your TSH. When the T3 and T4 levels are too high in the body, TSH goes down; when the T3 and T4 hormones are too low, TSH increases to help produce more thyroid hormones. Typically, when the thyroid begins to function abnormally, the brain should respond by communicating to the thyroid and increasing or decreasing the amount of TSH released, and therefore either decreasing or increasing the amount of T3 and T4 hormones in the body.

One of the most common reasons for abnormal thyroid gland function in North America is the development of autoimmune thyroid disorders (AITD). When this immune disease develops in the body, antibodies develop and attack the thyroid gland. The most common antibodies that develop in Hashimoto’s hypothyroidism are thyroid peroxidase antibodies (TPOAb) and thyroglobulin antibody (TgAb). These antibodies can cause swelling and damage to the thyroid and can result in thyroid dysfunction.

TYPES OF THYROID DYSFUNCTION, SYMPTOMS, AND DIAGNOSIS

First up, here are the six most important blood tests that properly assess low thyroid function. Most conventional doctors only run one of these tests and this is part of the reason many cases of autoimmune hypothyroidism are not properly assessed. If you are suffering from symptoms of thyroid disease (see here) but your TSH is normal, you should have these other blood tests run. I will discuss markers specific to various thyroid conditions.

Hypothyroidism

Hypothyroidism develops when the thyroid gland becomes underactive and does not produce enough thyroid hormones. In turn, the TSH from the brain begins to increase in the body due to the reduction of T4 and T3 hormones in circulation. In essence, the brain starts to yell at the thyroid to “hurry up and make more hormones!” In developed countries, the development of AITD and Hashimoto’s thyroiditis is the most common cause of hypothyroidism. (In underdeveloped countries, lack of iodine intake is at the root cause of the development of an underactive thyroid. Due to the addition of iodized salt in Canada, the US, and Europe, lack of iodine is typically not thought to be an issue in these nations [however, this isn’t always so clear cut; read more about the iodine issue on here]. When someone develops hypothyroidism due to a lack of iodine, the thyroid often becomes swollen and can become visible by looking at the neck. Any swelling of the thyroid is referred to as a goiter and can also be present in individuals with Hashimoto’s, Graves’, or other thyroid diseases, even if the patient is not iodine deficient.)

Symptoms of hypothyroidism include:

It is important to note that many individuals with hypothyroidism may only have one or two of the listed symptoms.

Common Blood Tests to Diagnose Hypothyroidism

TSH: Less than 4.0 to 4.5 mIU/L¹ is indicative of an underactive thyroid gland.

T4 hormone: Less than 9 pmol/L indicates that the thyroid gland is not making enough T4 hormone.

T3 hormone (not as commonly tested): Less than 2.6 pmol/L indicates that the thyroid gland is not making enough T3 hormones.

Reverse T3 (RT3): As mentioned earlier, RT3 can be produced by the body when it is trying to convert T4 into the active T3 hormone and instead produces RT3, a form of T3 that the body cannot utilize. Ideally, we want to make sure that RT3 levels are low in the body, otherwise many patients still experience symptoms, especially related to energy and weight gain. I often test RT3 with a full hormone panel for people who are suffering from hypothyroid symptoms (whether they have previously been diagnosed with hypothyroidism or not), as it can be very helpful to guide treatment. Normal RT3 levels are 9.2 to 24.1 ng/dl.

Subclinical Hypothyroidism and Overt Hypothyroidism

Subclinical hypothyroidism is often considered a “mild” form of hypothyroidism, whereby the TSH becomes elevated but the T3 and T4 thyroid hormones are still within normal levels. Oftentimes, especially if the TSH is only mildly elevated, patients are told they will be monitored but no medical intervention is necessary. Usually medical doctors wait to treat the patient with medication until the patient is “overtly hypothyroid” (increased TSH and decreased thyroid hormones). Once a patient is on thyroid medication, it can be very difficult to discontinue the medication as the thyroid gland becomes “lazy” and stops producing its own hormones. As a naturopathic doctor focused on preventative medicine, I find this extremely frustrating! Many patients still have annoying and debilitating symptoms of hypothyroidism when they are only “subclinically hypothyroid” and may likely be mounting an autoimmune response that has yet to be uncovered with blood tests. I honestly believe that if I had had my thyroid antibodies tested in my early twenties when I first was experiencing thyroid symptoms, I may have been able to reduce the progression to full-blown Hashimoto’s by addressing my immune response. I have seen countless patients who have complained to their doctors for years about thyroid symptoms despite their TSH levels being normal. When they arrive in my office and we test antibodies, I am never surprised to see them elevated.

Hashimoto’s Thyroiditis

As previously mentioned, Hashimoto’s is an autoimmune disease and the most common reason in the Western world for the development of hypothyroidism. Individuals with Hashimoto’s may have very mild symptoms of hypothyroidism at the beginning stages of the disease. In these early stages TSH, and T3 and T4 hormones, will likely be normal, but thyroid antibodies will be elevated in blood test results. As the disease progresses, TSH often becomes slightly elevated and the T3 and T4 hormones may still read in the normal level. This is often referred to as subclinical hypothyroidism. As discussed, because thyroid antibodies are not as commonly tested, many individuals in the early stages of Hashimoto’s will be told there is nothing wrong despite their mounting symptoms of hypothyroidism. As the disease progresses, TSH, T3, and T4 will eventually become abnormal. People who are already diagnosed with an autoimmune disorder, such as lupus, rheumatoid arthritis, Addison’s disease, vitiligo, pernicious anemia, type 1 diabetes, or if they have a family history of autoimmune disorders are at greater risk of developing Hashimoto’s.

Common Blood Tests to Diagnose Hashimoto’s Thyroiditis

TSH: Normal in early stages of disease; greater than 4 to 4.5 mIU/L in later stages of Hashimoto’s disease.

T4 hormone: Less than 9 pmol/L indicates that the thyroid gland is not making enough T4 hormone.

T3 hormone (not as commonly tested): Less than 2.6 pmol/L indicates that the thyroid gland is not making enough T3 hormone.

TPO antibody: Over 30 kIU/L indicates that the body is making an abnormal number of antibodies against TPO.

Tg antibody: Over 40 kIU/L indicates that the body is making an abnormal number of antibodies against Tg.

Note: Although Tg antibodies can be elevated in Hashimoto’s, TPO antibodies are the most commonly elevated antibody.

Complications of Untreated Hypothyroidism

As the thyroid gland is responsible for so many vital processes in the body, leaving thyroid disease untreated can result in some serious side effects. First and foremost, the heart can become negatively affected when there are not enough thyroid hormones in the body. Thyroid hormones control every component of the cardiovascular system necessary for normal healthy heart function. Typically, when cardiovascular disease is first identified in a patient, thyroid function tests are usually examined to see overt thyroid disorders or even whether subclinical thyroid dysfunction exists. The kidneys are also controlled by the thyroid hormones and therefore lack of sufficient hormones can lead to renal complications and kidney disease. Neurological changes, such as severe anxiety, headaches, memory losses, and tremors, can also be a result of low levels of thyroid hormones.

Untreated hypothyroidism also reduces fertility in both women and men. This is because the T3 and T4 thyroid hormones regulate the metabolism of sex hormones, estrogen and progesterone, which affect the production of eggs and sperm. When thyroid levels are too low in men, sperm can become abnormally shaped, libido can decrease, and even erectile dysfunction can result. Women with hypothyroidism may have abnormal periods or reduced levels of progesterone (important for conception) and may experience menstrual cycles with no ovulation. Interestingly enough, research has shown that even subclinical hypothyroidism may affect a woman’s ability to conceive.

Hyperthyroidism and Graves’ Disease

Hyperthyroidism develops when the thyroid produces too much thyroid hormone and becomes hyperactive. Typically, as the body’s metabolism begins to go into overdrive, individuals can experience rapid heartbeat, increased sweating, and anxiety. As a result, the TSH released from the brain slows as the body attempts to reduce how much thyroid hormone is made from the thyroid gland. Graves’ disease, another AITD, is the most common reason someone develops hyperthyroidism. Because Graves’ is also an autoimmune thyroid condition, some individuals may develop Hashimoto’s as a result of Graves’ syndrome or may develop Graves’ as a result of Hashimoto’s.

Common symptoms of hyperthyroidism include:

Common Blood Tests to Diagnose Hyperthyroidism and Graves’ Disease

TSH: Less than 0.4 mIU/L is indicative that the thyroid gland is overactive.

T4 hormone: Over 19 pmol/L indicates the thyroid gland is making too much T4 hormone.

T3 hormone (not as commonly tested): Over 5.8 pmol/L indicates the thyroid gland is making too much T3 hormone.

Thyroid-stimulating immunoglobulin (TSI): This antibody is diagnostic for Graves’ disease and therefore a positive result suggests Graves’ disease.

Thyroid-stimulating hormone receptor antibody (TrAb) Less specific for Graves’ disease; however, a positive result also often indicates Graves’ disease.

TPO antibodies: May be elevated in Graves’ disease, as well as Hashimoto’s disease. (Over 30 kIU/L indicates that the body is making an abnormal amount of antibodies against TPO.)

Other Tests to Diagnose Hyperthyroidism and Graves’ Disease

Radioactive iodine uptake (RAIU): This test requires individuals to swallow either a pill or a liquid containing radioactive iodine. Because the thyroid gland requires iodine to make thyroid hormones, the iodine will naturally accumulate in the thyroid gland. In individuals with “hyperactive glands,” more iodine will accumulate and can be indicative of hyperthyroidism or Graves’ disease. After a stated period of time, a special scanner is placed over the thyroid and the amount of radioactivity is compared to the amount that the patient ingested.

As this test exposes the body to radiation (albeit small amounts), some patients decline this test. Additionally, if people have shellfish allergies, they may react to the iodine substance. It is thought that allergies to shellfish could be a result of the iodine found within the shellfish. Due to the radiation, this test is also not recommended for women who are pregnant or breastfeeding.

Ultrasound: Ultrasounds are often run to check whether the thyroid gland is enlarged, or for patients who are not taking the radioactive iodine test.

THE IMMUNE SYSTEM AND THE DEVELOPMENT OF AITD

As I am sure you realize by now, autoimmune disease has become the most common reason for abnormal thyroid function. Autoimmune essentially means that molecules created by the immune system begin to attack your own body, instead of a foreign invader, such as germs and other microbes. To truly understand why autoimmune disease develops, we need to address first how the immune system operates.

The immune system works in your body to protect you from bacteria, viruses, fungi, parasites, and other foreign invaders. The immune system response is divided into two features: the innate response and the adaptive response. The innate immune system is the first responder if bacteria or toxins enter the body. It responds by creating inflammation to destroy the invader. This response should be quick, attacking the unwanted guest and then retreating from the scene. The acute inflammation that develops from the innate response often results as redness, swelling, and pain, which generally appear soon after the injury. The innate immune system has no memory but will react and attack every invasion that is deemed unwanted by the body. The adaptive immune response, on the other hand, has a memory of what has invaded the body in the past. This response also results in inflammation and creates a special system once it has been exposed to certain foreign pathogens, so it can attack them the next time they are identified in the body. However, sometimes this adaptive response gets confused and begins to attack “self-antigens.” When this happens, it is usually impossible for the immune system to then eliminate the antigen completely, and so a sustained inflammatory response occurs. The consequence is chronic inflammatory injury to tissues, and the development of autoimmune disease. Over eighty autoimmune diseases have now been identified and their occurrence is on the rise.

The reason one person develops autoimmune disease and another person does not often depends on genes, exposure to certain triggers, and the health of their gut.

Genetics play a large role in the development of an autoimmune disease. But even if you have inherited the genes, you may not necessarily develop the disease. In fact, research has been done in twins where one twin has Hashimoto’s and the other twin does not. It was discovered that in these patients with Hashimoto’s, only about 50 percent of the identical twins also had Hashimoto’s. This means genetics are only part of the puzzle. Exposure to certain triggers can increase the chance of developing autoimmune diseases.

However, research shows that intestinal permeability (otherwise known as leaky gut) helps control the way the immune system regulates itself and is a very important factor to the development of autoimmune disease. The intestines are protected by a single layer of special skin cells that are linked together by tight junction proteins. These tight junctions act as the gateway between your intestines and your bloodstream. Leaky gut is a consequence of intestinal tight-junction malfunction. When leaky gut begins, little cracks or openings through these tight junctions allow partially digested food, toxins, and bacteria to penetrate the tissues beneath it. When you have leaky gut, particles that should never be able to enter your bloodstream start to make their way through. Once these particles enter the bloodstream, inflammation and changes in the immune system begin to take place. Interestingly enough, the majority of our immune system is actually found in the gut! So, damage to the gut essentially damages an epicenter of immune functioning and therefore can present a large problem that may cascade into the development of autoimmune disease.

Leaky gut is so crucial to the development of an autoimmune disease that essentially, without it, even if you have the genes and have been exposed to the triggers, you may not develop autoimmune disease.

As Izabella Wentz, PharmD, and Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment at Massachusetts General Hospital, explain, you must have all three factors to develop autoimmune disease: the genetic disposition, exposure to triggers, and leaky gut.

Symptoms of leaky gut are often very similar to the symptoms of hypothyroidism (not surprisingly!) and include fatigue, headaches, bloating, constipation or diarrhea, memory changes, acne and other skin disorders, and food sensitivities.

Triggers for the development and progression of autoimmune diseases include the following:

If autoimmune disease has been triggered, addressing intestinal permeability may be a key factor in the recovery of AITD, as research has shown intestinal barrier function reestablishment can be used in prevention or treatment of autoimmune disorders.

INFLAMMATION AND AITD

To address the root cause of the most common cause of thyroid disease, we must address inflammation. When someone develops an autoimmune disease, the inflammation in the body becomes chronically elevated due to the immune system changes. In the case of Hashimoto’s disease, markers of inflammation in the blood, known as c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), can be elevated compared to the normal population. Additionally, the reaction from the immune system causes what is called lymphocytic infiltration, inducing thyroid tissue damage and causing inflammation of the thyroid gland. In conventional medicine, the symptoms of other autoimmune diseases, such as lupus or rheumatoid arthritis, are controlled with anti-inflammation or immune-suppressant medications. These medicines help reduce the inflammation in the body, but often come with many undesirable side effects. Although these medications are not commonly used in the treatment of AITD, addressing the inflammatory response through natural means can significantly reduce the symptoms of the disease and the need for increased medication, and in some cases may help reverse the thyroid disease altogether.

Dietary changes are vital when addressing inflammation. Not only is the conventional Western diet a trigger for inflammation and autoimmune disease, but changes in diet and nutrients have shown to reduce overall inflammation in the body and