You are exercising, eating healthy and reduced your portion sizes but you still cannot shake off those pounds. Does this sound like you? If you answered yes, it might be time to look for other reasons why the weight loss isn’t as easy for you as your friend who loses weight just by changing his or her eating habits and exercising. Hormonal imbalances and inflammation are two areas to consider. One of the important hormones to look at when someone is struggling to lose weight is thyroid function. Suboptimal thyroid hormones can affect your ability to lose weight.
Thyroid disorders are becoming an increasingly common health concern today, especially among women. In 2014, as per an article on Medscape, levothyroxine (Synthroid) was the most prescribed drug in the USA and the third most prescribed drug in the UK (Davenport, 2016). In my naturopathic family practice, I see many that have a diagnosed thyroid disorder but also many who have suboptimal levels of thyroid hormones that can explain their symptoms even though they haven’t received a formal diagnosis from their medical doctor as their levels on their blood test are within ‘normal reference ranges’.
The function of the thyroid (as with other hormones) operates at three levels. The hypothalamus in the brain produces Thyrotropin Releasing Hormone (TRH) which communicates to the pituitary gland in the brain to produce Thyrotropin Stimulating Hormone (TSH). TSH is the communicator telling the thyroid gland to produce T4 and T3 thyroid hormones. T4 and T3, specifically T3 is your active thyroid hormone. Problems at the hypothalamus, pituitary, and thyroid gland level can impact thyroid hormone production.
This is why when you ask your family doctor to test your thyroid, they will test your TSH and if it is within normal, will tell you your thyroid is fine. The problem with this is that the normal range is so large and your level might not be at the optimal level for you. We really need to be testing and looking for those free T4 and T3 thyroid hormones because even if TSH is normal, if there is insufficient free T4 and/or free T3 levels , you will have symptoms of low thyroid function including an ability to lose weight. This is why I always like to requisition all 5 thyroid blood tests when I want to assess the thyroid.
Dr. Suhani’s 5 Thyroid tests that are important for fully assessing thyroid function. Ask your doctor for testing these:
- Free T4
- Free T3 (active thyroid hormone that regulates metabolism)
- TSH (The reference range is quite large but I review optimal ranges which should be somewhere between 1-2.5 mIU/L)
- Anti TPO antibodies (thyroid peroxidase) to rule out autoimmune thyroid conditions
- Anti TG antibodies (thyroglobulin) to rule out autoimmune thyroid conditions
- **TSH receptor antibodies (only if thyroid hormones are elevated for ruling out Graves Disease)
(6) From the National Cancer Institute from the National Institute of Health.
The most common thyroid imbalance is hypothyroidism when your thyroid hormones are low resulting in decreased metabolic activity which may contribute to weight gain. Hypothyroidism can be PRIMARY (originating at the thyroid gland); SECONDARY (originating in the pituitary); or, TERTIARY (originating in the hypothalamus).
The most common medication prescribed is Synthroid (levothyroxine) – this is only T4. The problem with this is that your body still has to convert it into T3 and if your conversion mechanism is impaired, many will still not feel at their best resulting in your MD constantly increasing your dose until you start making sufficient T3 to feel good. Cytomel (liothyronine) is T3 which is another medication that may be prescribed. Desiccated thyroid (Armour) comes from a porcine source and contains both T3 and T4 however, many MDs are reluctant to prescribe this form.
Hyperthyroidism is not as common but this is where you have excess thyroid hormone production. Similar to hypothyroidism, you also have primary/secondary/tertiary hyperthyroidism except for this time that particular tissue is producing an excess of its respective hormone (see above for which organ is affected at each level). The most common cause of primary hyperthyroidism is Grave's Disease, an autoimmune disorder.
The medication most often prescribed is tapazole (methimazole). Sometimes propylthiouracil (PTU) is prescribed but PTU has a higher risk of elevating liver enzymes compared to methimazole and MDs will prefer to prescribe methimazole (2). If your thyroid hormones are very high and you are very symptomatic, your doctor may even recommend radioactive iodine which shuts down the thyroid, essentially “zapping” it. Surgery to remove the thyroid gland is often another option. Once either of these invasive procedures is done, one could become hypothyroid and then be prescribed Synthroid “for the rest of their life”.
CAUSES OF SUBOPTIMAL THYROID FUNCTION
The four major contributors that can lead to abnormal thyroid hormones are: Nutrient deficiencies; Adrenal dysfunction; Autoimmune; and, Cancer. While allopathic medicine can help increase or decrease your T4 and/or T3 levels through medication, there is not much in allopathic medicine currently for lowering thyroid antibodies or addressing suboptimal adrenals if it isn’t overt Cushing’s syndrome (most common cause is iatrogenic – caused by too many corticosteroid medications) or Addison’s disease (rare). MDs may recommend vitamins or minerals if they suspect your low thyroid hormone levels are due to an iodine or iron deficiency.
NUTRIENT DEFICIENCIES: Thyroid hormones contain iodine and in developing countries, where iodine deficiency is common, this is a leading cause for hypothyroidism. With the advent of iodized table salt in North America, it reduced the incidence of hypothyroidism, however, with the exposure to heavy metals and other environmental pollutants, this can decrease the ability of iodine to accumulate in the thyroid gland and form thyroid hormone. Other nutrients like tyrosine (amino acid), zinc, copper, iron, vitamin E, vitamin B2, vitamin A, and selenium are necessary for forming T3 and T4 thyroid hormone.
Should everyone just take iodine, tyrosine, and iron then? Not necessarily. Caution is necessary if you have an autoimmune thyroid condition such as Hashimoto’s as iodine may induce hypothyroidism (3). Seeing a licensed healthcare provider can help you determine if optimizing nutrients is necessary and if functional testing for environmental pollutants and heavy metals (mercury, cadmium, lead, etc) should be considered.
ADRENALS AND HORMONES: This is a complex topic and there will be future blog posts regarding adrenal health. Your adrenal cortex produces the following hormones: cortisol, mineralocorticoids, DHEA, androgens (testosterone, etc), estrogen and progesterone. The adrenals also release epinephrine - "flight or fright" neurotransmitter which promotes cortisol secretion.
During times of stress, these adrenals are in overdrive overproducing cortisol which can affect levels of the other adrenal hormones. Cortisol can decrease the conversion of T4 to T3 and lower TSH production from your pituitary. This can be why you may find you have low thyroid symptoms but your TSH keeps coming back normal and your doctor refuses to test T4 and T3. Cortisol can also affect peripheral tissue activity of T3. If you are stressed and on Synthroid but not feeling the best, this may be the reason why!
Too much estrogen or estrogen dominance (imbalanced estrogen-progesterone ratio) can also lower free thyroid hormones (T4 and T3).
AUTOIMMUNE: This is the hardest type of thyroid disorder to treat because it involves an inflammatory state and a hyperactive immune system that produces antibodies against certain enzymes or other thyroid gland proteins affecting the production of thyroid hormones. The two autoimmune thyroid disorders are Hashimoto’s Disease ‘Hashi’s’ and Grave’s disease. The latter is associated with hyperthyroidism. In Hashimoto’s, one may start out in a hyperthyroid state and eventually end up in a hypothyroid state as the thyroid gland is damaged by the autoantibodies (4). MDs will treat these conditions the same way they treat general hypothyroidism or hyperthyroidism.
Naturopathic medicine aims at getting to the root cause and working with you to lower inflammation not just increasing/decreasing thyroid hormones. This could involve addressing your digestive health, hormonal imbalances, and working with you to shift your immune system to reduce immune hyperactivity, lower inflammation, and lower thyroid antibodies.
Identifying food sensitivities and optimizing digestive health is a key area to investigate for any autoimmune condition, not just Hashimoto's or Grave's disease. If you experience bloating, gas, acid reflux, and heartburn, there may be something going on in your gut.
CANCER: Yes, unfortunately, another factor to rule out if you have thyroid dysfunction is thyroid cancer. This is more common in females and most common in the 15-49 years range. Exposure to ionizing radiation, a family history of thyroid cancer, having a personal history of other thyroid disorders, obesity and tall height are risk factors (5). If you notice swelling on your neck in the thyroid region and your doctor assesses an enlarged thyroid or firmness over the thyroid during a physical exam, he or she will refer you to get an ultrasound. If nodules are found, you may be referred for a biopsy to rule out a malignant vs benign nodule. Benign nodules can be associated with autoimmune thyroid conditions and are monitored to ensure they do not become malignant.
NATUROPATHIC TREATMENT OPTIONS
There are many therapeutic options for supporting your thyroid health. In order to figure out the best supplement or treatment for you, an initial visit is important. This is where we will sit down and perform a thorough review of your health concern(s) and a head-to-toe review of symptoms which will help identify if it is a nutritional deficiency issue, a hormonal or a digestive issue that is leading to suboptimal thyroid function or we will do a workup to assess for thyroid dysfunction and assess the thyroid markers I mentioned above for an additional fee (many MDs will only run half of them or a reluctant to run anything else if TSH is in the normal reference range). During the naturopathic treatment, we can assess the need for functional testing as well.
Some tips you can start implementing right away at home to improve your thyroid health:
- Steam or cook your cruciferous vegetables - broccoli, cauliflower, cabbage, brussel sprouts - as this reduces some of the goitrogens that interfere with thyroid hormone production
- Eat brazil nuts if you are not sensitive or allergic to them - these contain selenium which supports thyroid function
- Find ways to reduce stress - meditation, music, dancing, being creative, exercise, etc - as this keeps your cortisol levels down
- Davenport, L. “Time for a U-turn on Levothyroxine? Overuse Is Rife, Say Docs” in Medscape Family Medicine. WebMD LLC:Nov 14 2016. Retrieved on Nov 13 2018 from https://www.medscape.com/viewarticle/871838?nlid=110752_1982&src=WNL_mdplsnews_161118_mscpedit_fmed&uac=159432FR&spon=34&impID=1237366&faf=1?src=soc_tw_
- Nakamura H et al. Comparison of methimazole and propylthiouracil in patients with hyperthyroidism caused by Graves’ disease. J Clin Endocrinol Metab 2007 Jun; 92:2157-62.
- Chung HR MD. Iodine and thyroid function. Ann Pediatr Endocrinol Metab. 2014 Mar;19(1):8-12.
- Ferry R, Jr. MD. Hashimoto's Thyroiditis Symptoms, Diet, and Treatment. Retrieved on November 24 2018 from https://www.medicinenet.com/hashimotos_thyroiditis/article.htm#what_are_the_signs_and_symptoms_of_hashimotos_thyroiditis
- Canadian Cancer Society (2018). Thyroid Cancer. Retrieved on November 23 2018 from http://www.cancer.ca/en/cancer-information/cancer-type/thyroid/thyroid-cancer/?region=on
- Thyroid gland image from: Don Bliss. (2001). Thyroid Gland from National Cancer Institute. Retrieved on November 23 2018 from https://visualsonline.cancer.gov/details.cfm?imageid=4368