Hypothyroidism – Thyroid Hormone Imbalances
The thyroid gland is located in the lower part of the neck near your Adam’s Apple. It secretes two essential thyroid hormones: triiodothyronine (T3 ) and thyroxine (T4 ) which are responsible for regulating cell metabolism in every cell in your body. They promote optimal growth, development, function and maintenance of all body tissues. They are also critical for nervous, skeletal and reproductive tissue as well as regulating body temperature, heart rate, body weight and cholesterol.
In a healthy patient a normal thyroid gland secretes all of the circulating T4 (about 90 to 100mcg daily) and about 20% of the total circulating T3 (about 30mcg daily). The T4 made by the thyroid gland circulates throughout the body and is converted into roughly equal amounts of T3 and reverse T3. All of the biological activity of thyroid hormones is due to T3. Because 80% of serum T3 is derived from T4 in tissues such as the liver and kidney, T4 is considered a pro-hormone. No receptors have ever been identified for T4. Normal physiological production ratio of T4 to T3 is 3.3:1. Reverse T3 is virtually inactive having only 1% the activity of T3 and being a T3 antagonist binds to T3 receptors blocking the action of T3. Normal metabolism of T4 requires the production of the appropriate ratio, or balance, of T3 to rT3. If the proportion of rT3 dominates then it will antagonize T3 thus producing hypothyroid symptoms despite sufficient circulating levels of T4 and T3.
The synthesis and secretion of the two thyroid hormones is influenced by a hormone released by the pituitary gland called thyroid-stimulating hormone (TSH). The synthesis and release of TSH from the pituitary gland is influenced by thyroid hormone levels as well as a hormone released from the hypothalamus called thyrotropin-releasing hormone (TRH). The activity of the thyroid gland is regulated by a negative feedback loop, in which thyroid hormones interact with receptors in the pituitary gland to inhibit TSH and at the hypothalamus to inhibit TRH secretion.
Hypothyroidism is a condition resulting from insufficient production or diminished action of either T3 and/or T4 thyroid hormones. Hypothyroidism is characterized by a generalized reduction in metabolic function that most often manifests itself as slowing of physical and mental activity. The most common signs and symptoms of hypothyroidism are: weight gain, fatigue, lethargy, sleepiness, cold hands and/or feet, low body temperature, depression/anxiety, constipation, headache, menstrual problems, reduced sex drive, hair loss, swollen eye lids and general fluid retention, poor memory and concentration and dry skin, hair and/or nails.
During later stages as your metabolism slows down with declining thyroid hormones your adrenals have usually also been affected which compounds your fatigue symptoms even further and so your body attempts to compensate by up-regulating your nervous system so you are fueled by your nervous system to keep you going. At this later stage anxiety gets worse, insomnia, inability to relax, nervousness and a racy mind may also occur and in more severe cases breathlessness, palpitations and even tremors may manifest.
Low thyroid gland production of T4 may be caused by genetic defects, insufficient substrates (tyrosine, iodine, etc), autoimmune reactions, oxidative damage, toxicities and stress (high cortisol levels depresses TSH and inhibits conversion of T4 into T3). As with other hormones thyroid production also declines with age.
Reverse T3 dominance, functional hypothyroidism also Known as Wilson’s Syndrome is a condition that exhibits most hypothyroid symptoms although circulating levels of T3 and T4 are within normal test limits. This is a condition when T4 metabolism produces an excess of reverse T3 in relation to T3, thus being a problem with T4 activation rather than a lack of thyroid production. Periods of prolonged stress may cause an increase in cortisol levels as the adrenal glands respond to the stress. The high cortisol levels inhibits the conversion of T4 into T3 thus reducing active T3 levels. The conversion of T4 is then shunted towards the production of the inactive reverse T3. This reverse T3 dominance may persist even after the stress passes and cortisol levels have returned to normal as the reverse T3 itself may also inhibit the conversion of T4 to T3. Reverse T3 has the same molecular structure as T3 however its three demensional arrangment of atoms is a mirror image of T3 and thus fits into the receptor upside down thus preventing or antagonising the active T3 from binding to the receptor and activating the appropriate response.
Unfortunately standard blood tests such as TSH, T4 and T3 will NOT be able to diagnose this condition. To overcome this diagnostic problem there is a special test that specifically measures reverse T3 alone and should be requested to rule out reverse T3 dominance. Both T3 and reverse T3 need to be ordered and their values compared as the ratio is of most importance and not their respective numbers. For more information click here.
Factors that adversely affect conversion of T4 into T3 include: nutritional deficiencies such as selenium, zinc, iodine, VIt B6, B12 and E, antibody reactions, insulin resistance, toxicities such as heavy metals and environmental toxins.
Functional Hypometabolism or thyroid resistance occurs in some patients where they still suffer from hypothyoid symptoms despite the fact that thyroid hormone levels are optimal and normal hormone binding and metabolism occurs. Causes may include suboptimal levels of Vit D which is required for receptor response, suboptimal Iron (measured by Ferretin levels) which is required by thyroid peroxidase activity, high or low cortsiol levels, genetic defect with receptors, receptor dysfunction associated with toxicities. Unfortunately there are many patients with thyroid resistance that are not properly diagnosed and subsequently their dose of T4 gradually escalates over time with little benefit which can actually aggrevate this condition even further as it only increases binding and thus reducing the free and active form.
Diagnosis
TSH Debate
Physicians routinely require blood analysis when diagnosing hypothyroidism. The most common test is the TSH test. Hypothyroid state may first manifest itself with elevated TSH levels. This is because “theoretically” as thyroid hormone levels begin to decrease, the brain registers this decrease and tries to compensate by increasing TSH secretion in order to stimulate the thyroid gland to produce more thyroid hormones. In practice the TSH test is not the most accurate indicator of thyroid problems and is considered by several experts as a scientifically outdated method of diagnosis. It may be inaccurate if there is inflammation, infection, stress, dieting, or the patient is older. TSH is only validated as a screening test and it is not supported anywhere in the literature to be used to diagnose or adjust dosage, although this is the common practice. TSH is a test that in my opinion should be outlawed as it probably does patients more harm than good as we routinely encounter blood test results where the TSH is within the “normal range”, indicating a normal functioning thyroid gland, however when T3 and T4 levels are checked they are often low with the patient presenting with many signs and symptoms of hypothyroid. Therefore if we relied totally on the presence of elevated TSH results a mis-diagnosis would have occurred. It has also been shown that pituitary TSH production is inhibited by cortisol therefore many hypothyroid patients whom also suffer from stage 1 adrenal exhaustion (high cortisol levels) may be suppressing the much needed TSH production required for hypothyroid states and thus falsely reducing TSH test results. In addition there is a lot of debate as to the validity of the so called “normal range” and how it should be applied to specific individual cases. Most laboratories indicate the “normal range” of TSH is from 0.3 to 5mIU/L however investigations have shown that levels equal or greater than 2 may actually indicate adverse health risks. For more detailed information refer to the work of thyroid specialist Dr Lowe.
Many patients therefore are incorrectly diagnosed as their TSH levels are in the “normal range” failing to reflect the true state of thyroid affairs.
For a more accurate method of diagnosis you should ask your doctor to order the following blood tests as a more accurate assessment of thyroid function can be made: TSH, T4, T3, reverse T3, anti-thyroglobulin, anti-microsomal antibodies, 24hr iodine urine excretion test and Vit D.
The correct interpretation of your results is essential for appropriate treatment. Click here for details. T3 and T4 levels should as a generalisation ideally be within the upper one third of the “normal” physiological range with a 1:3.3 ratio while reverse T3 and T3 should be appropriately balanced.
Anti-thyroglobulin and anti-microsomal antibody tests will determine if the immune system has waged battle on the thyroid gland causing thyroiditis, Graves disease or Hashimoto’s while low iodine levels may be responsible for low thyroid hormone production.
To complicate things further there appears to be a subgroup of patients whom exhibit many signs and symptoms of hypothyroidism yet their T3/T4/rT3 test results indicate that their current levels are within the “normal range”. Many of these patients respond well to thyroid supplementation. This is due to the fact that blood tests only measure the levels of thyroid hormones in the blood stream and not in tissue where they actually have their effect, thus not giving a true measure of thyroid function. In this case there would appear to be a thyroid receptor problem. Deficiencies in VIt D and iron can cause receptor uptake problems and should be treated if found to be low. Therefore the limitations of blood tests should be well understood by the physician and not relied upon 100% to determine their coarse of action. Signs and symptoms of the patient in addition to body temperature (discussed below) and blood tests should all be used together in order to gain a bigger picture and thus determine the appropriate therapy.
As mentioned above thyroid function can also be estimated by measuring your underarm body temperature. If your underarm temperature is consistently subnormal (below 36.5 C) for 3 days or more your thyroid function may be low. But do not forget that adrenal function also influences your metabolic rate and therefore body temperature. So adrenal function must also be considered if you have low body temperature. This fact is often ignored by many.
An integrated approach should be taken when diagnosing hypothyroidism making use of all the diagnostic tools as well as using signs and symptoms of low thyroid function. If doctors rely totally on the TSH test without considering signs and symptoms, which has become common practice, then many patients with a sluggish thyroid go undetected and are therefore not treated appropriately.
If the thyroid is under active then usually the adrenal glands get overworked and run down while trying to compensate for the low thyroid hormone levels resulting in adrenal exhaustion. If you tend to be jittery on thyroid medication or if you are generally overly alert at night, have rapid mood swings, have sugar or salt cravings, feel tired all the time, have dark circles under your eyes and are easily stressed then your adrenal glands may also need help. Your adrenal function can be determined by measuring DHEA and cortisol levels. If it too is under active it will also require treatment. By addressing all hormones that are out of balance ensures a more complete treatment instead of addressing only one or two of them. Remember all of our endocrine glands are intimately connected and if one hormone is out of balance a cascade effect can occur which will throw them all out if left untreated.
Treatment
In mild to moderate cases certain nutrients may be used to either improve thyroid hormone production or to improve conversion of T4 into the active T3 form. Test results would determine which would be more suitable.
Moderate to severe cases may be treated with appropriate compounded bioidentical thyroid hormone combinations or thyroid gland extract. We also strongly recommend adrenal support, if tests indicate the need, along with nutritional support. Many thyroid patients we see also have adrenal problems and both need to be addressed for a full recovery.
If the autoimmune system is involved then certain steps should be taken in attempt to control it. Conditions such as Hasimoto’s disease and Graves disease may benefit from removing any foods that cause food allergies or intollerance reactions such as gluten, dairy and yeasts, heavy metals must be removed, any digestive or leaky gut issues need to be treated, adrenal, thyroid and sex hormones need to be appropriately balancedalong with the use of certain supplements.
Compounded thyroid replacement allows for avoiding fillers such as lactose which inhibit thyroid absorption which is still used in many other poorly formulated commercially available products. In addition compounded thyroid medication can also provide T3 and T4 combinations in physiological ratios tailor made to suit your individual requirements.
Finally thyroid problems energetically are the result of a stagnation of energy in the throat area as a result of not expressing yourself, holding back or not saying what you really think and/or feel. Therefore in order to energetically heal your thyroid problem you need to start speaking your truth and not hold back out of what ever fear you may have of expressing yourself.
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