Your thyroid gland is the command center for metabolism in your body. Located at the base of your neck, it releases hormones that control many important processes in almost every cell of your body. The two types of hormones released by the gland are T3 thyroid and T4 thyroid. T3 can exist in two forms which are: T3 (free or bound to a protein) and reverse T3.
Testing the thyroid is an important component of your annual basic blood work.
A thyroid panel may include the following tests: TSH (thyroid-stimulating hormone, which comes from the brain), free T3 (active thyroid hormone + reverse thyroid or inactive thyroid hormone), and free T4 (mostly inactive thyroid hormone that is bound to a protein and can convert into active, free T3 thyroid).
High TSH means the brain is having to work harder to encourage the gland to work, this is often an early sign of hypothyroidism or an underactive thyroid.
Low TSH is seen commonly in hyperthyroidism, where there is too much thyroid hormone in the circulation which then creates a negative feedback loop telling the brain to halt in telling the gland to make hormone.
Your doctor should always order free T3 and free T4 in order to see what the gland itself is doing. This can tell us exactly how it is functioning. The last test is called reverse T3. As mentioned, T3 is comprised of active T3 and reverse or inactive, T3. If we do not do both of these types of T3 tests you can look like you have normal function but actually be hypothyroid.
Ideally, we want your Free T3 to be around 3, and your reverse T3 below 15.
I’d like to learn more about:
Hyperthyroidism & Graves Disease
Hypothyroidism refers to when the thyroid gland is underactive. This may be due to low signaling of TSH from the brain, as a result of nutritional deficiencies- iodine in particular, medication-induced, autoimmune thyroiditis, and more.
Signs of low thyroid/ hypothyroidism:
Fatigue, menstrual irregularities, depression, increased serum cholesterol, menorrhagia, cold hands/feet, eczema, acne, dry skin, dry brittle nails, edema, hair loss, weight gain, hoarseness, constipation, cottonmouth, stiff muscles.
Subclinical hypothyroidism is where you may have the clinical symptoms of hypothyroidism but your labs (specifically T4, and T3) do not reflect it. Under these circumstances, it is important to check reverse T3.
In order to make T3, the body uses a pathway called the 5’ Deiodinase pathway. This pathway requires selenium, zinc, and other vitamins in minerals. If the 5’ Deiodinase pathway is hindered, the body will shunt production away from T3 and shunt down the 5 Deiodinase pathway to reverse T3.
Treatment for subclinical should be individualized. Look for the cause first, and address that. For example: Are you under stress? If so, you might look at serum cortisol. I often recommend testing cortisol in the am, midday, and then again in the evening right before bedtime.
Once the cause has been identified and is addressed, there are fabulous nutrients to push production back down to the 5’ Deiodinase pathway so that your gland can make active T3 hormones.
Hyperthyroidism & Graves Disease
Hyperthyroidism is when the gland is overactive and therefore overproduces thyroid hormone. The most common cause of hyperthyroidism is Graves Disease, however, there many causes of Hyperthyroidism, here are some examples:
- Thyroid tissues are exposed to excess thyroid hormone (Elevation T3).
- Overmedicating with T3 hormone.
- Toxic diffuse goiter or Graves disease (as mentioned, this is the most common cause of hyperthyroidism).
- Toxic multinodular goiter: This is where multiple areas in the gland overproduce thyroid hormone independently of TSH stimulation.
- Toxic uninodular goiter (adenoma): This is a solitary nodule in the gland that overproduces thyroid hormone independently of TSH stimulation.
- Subacute thyroiditis: Usually we do not know the cause of this, but sometimes can be the result of virally mediated inflammation and destruction of the gland. Consequently, stored thyroid hormones are released into circulation, causing a transient thyrotoxic state and pain.
Signs of high thyroid/ hyperthyroidism:
- Diarrhea, hot flashes, trembling, anxiety, panic, insomnia, restlessness, high blood pressure, quick pulse, exophthalmos (the eyes bulge forward in the eye sockets), heat intolerance, panic attacks, etc.
- The test for hyperthyroidism is T3 and T4 thyroid hormone. In hyperthyroidism, we see elevations in these levels. If TSH is run, in hyperthyroidism, TSH will be reduced.
- Diagnosing Graves Disease may be easily done by doing a blood test and examining the blood for Thyrotropin Receptor Antibodies (TRAb) otherwise known as thyroid-stimulating immunoglobulin.
Integrative Treatments for Graves Disease and Autoimmune Thyroid:
- Identify and address the root cause and remove the causal factor.
- Rule Celiac Disease, and conduct gluten and wheat sensitivity IgG testing.
- Rule out candidiasis and test for food allergies.
- Start immunomodulating herbs like Ashwagandha, curcumin, and aloe.
- Take high dose antioxidants.
- Rule out vitamin D deficiency, if you are low in vitamin D, supplement appropriately. Remember, Vitamin D needs to be dosed with Vitamin A, K, E, Calcium, and Magnesium.
- Test for Metals and non-metal toxicants have a strong impact on autoimmunity.
The term “Thyroiditis” refers to “inflammation of the thyroid gland”. There are many possible causes of thyroiditis. Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is the most common cause of hypothyroidism in the United States. It is an autoimmune disorder in which antibodies directed against the thyroid gland lead to chronic inflammation. It is not known why some people make antibodies, although this condition tends to run in families. Over time, however, this results in impaired ability of the gland to produce thyroid hormones, leading to a gradual decline in function and eventually becoming underactive (hypothyroidism). Hashimoto’s thyroiditis occurs most commonly in middle-aged women, but can be seen at any age, and can also affect men, and children.
Hashimoto’s Thyroiditis is the most common cause of thyroid “lumps” or nodules. Thyroid nodules are lumps that commonly arise within an otherwise normal gland. Most commonly, these abnormal growths of tissue do not produce any symptoms whatsoever. These nodules are usually found during a routine examination of the neck by a health care provider, or from X-ray studies obtained for other reasons. When nodules do produce symptoms it is either due to their larger size or their location within the gland. These nodules, which are located at the edge of the thyroid gland, can sometimes be felt as a lump in the throat or even seen as a lump in the neck when they occur in very thin individuals.
Primary hypothyroid: 95%. Hashimoto’s Thyroiditis is the most common cause of hypothyroidism.
Foods promoting autoimmunity of Hashimoto’s: Gluten- Celiac Disease is associated with Hashimoto’s thyroiditis
Fatigue, menstrual irregularities, depression, increased serum cholesterol, menorrhagia, cold hands/feet, eczema, acne, dry skin, dry brittle nails, edema, hair loss, weight gain, hoarseness, cottonmouth, stiff muscles.
Myxedema: Puffy face, Thick, large tongue, Dry tongue, mouth, Slurring words, Expressionless face (dt edema), Edema (i.e. ankles).
There are three tests that may be considered in any patient with a nodule. The first is a blood test in order to determine how much thyroid hormone is being produced and antibodies present: High TSH, Low T4 and fT4 (thyroxin), often low T3, and thyroid antibodies: Anti TPO (anti peroxidase ab), Anti TG (thyroglobulin).
Wilson Temperature Test: Check oral temperatures at 10 am, 1 pm, 4 pm for several days in a row. Your average daily temp should range around 98.6. Wilson’s thyroid syndrome is associated with hypothyroid symptoms in the face of normal TSH and other thyroid tests.
GENERAL GUIDELINES FOR TREATMENT
Nutrient support: If need to support 5’ DI (if too high rT3): Selenium, Zn, B12, antioxidants,
Herbal support: Withania, guggul, ginseng, bacopa, curcumin, ashwagandha root (anti-inflammatory, immunomodulating).
Thyroid replacement: eg: Levothyroxine/ Synthroid (has been shown to reduce thyroid antibodies).
- Eating principles: avoid wheat, eat low sugar, low fat, high fiber, low cholesterol
- Calorie percentages: 70% complex carbohydrates, protein 12-15%, fat 15-18%
- Therapeutic foods: oats, kelp, seaweed, artichokes, onions, garlic, dulse, Swiss chard, turnip greens, egg yolks, wheat germ, cod roe, lecithin, sesame seed butter
- Fresh juices: carrot, celery, and/or spinach with powdered kelp or dulse
- Avoid goitrogens (which can reduce thyroid function) unless cooked: broccoli, turnips, cabbage, carrots, kale, rutabaga, soybean, spinach, peanuts, yams, radishes, millet, green peppers, beets, celery, lettuce, cauliflower, Brussels sprouts, collards, kohlrabi, peaches, pears, strawberries, apples, apricots, blackberries, raspberries, prunes, cherries, honeydew, grapefruit, grapes, oranges, peas, sorghum, bamboo shoots
- Avoid known food sensitivities
- Short cold spray to thyroid after warm bath/shower OR
- Cold mitten friction to thyroid after bath/shower
- Alternating hot and cold compresses to gland daily: Hot compresses molded to the neck for 3 minutes hot followed by 30 seconds to 1 minute of cold compresses. Repeat 3-5 times
- Cold shower to middle and lower back to stimulate adrenals
- Constitutional Hydrotherapy treatment to help stimulate digestion
- Ensure your vitamin D is in range
- Consider heavy metal challenge as metal toxicity can lead to thyroid and autoimmune dysfunction.
- Consider gut dysbiosis/ candidiasis as these can lead to thyroid and autoimmune dysfunction.
- Do not use an electric blanket-the body’s metabolism will be slightly raised if the body must generate its own heat to keep warm
- Exercise daily to stimulate the gland and elevate the body’s metabolic rate
- Improve overall digestion and assimilation of food