Hypothyroidism, or underactive thyroid, is extremely common in the United States. The condition is currently diagnosed in about 5 percent of the population and thought to be undiagnosed in another 5 percent. Given that the current diagnostic laboratory ranges are not ideal, I believe that this number is likely much higher. Even mildly reduced levels of free thyroid hormone can lead to significant reductions in quality of life. Not to mention that ignoring early hypothyroidism because the numbers are “still in the normal range” can lead to a rapid decline in function and lifelong issues.
The functional medicine approach to thyroid conditions is drastically different as compared to the traditional approach. Read on to find hope for true healing!
What are Thyroid Hormones?
The thyroid is a butterfly-shaped gland located at the anterior neck. It is stimulated by the pituitary gland’s thyroid stimulating hormone (TSH) to produce thyroid hormone (T4). T4 is then converted to active thyroid hormone (T3) in the body, largely in the liver and intestines. T3 is responsible for the regulation and control of your metabolism. It affects the function and maintenance of your heart, brain, digestion, bones, and much more.
How are Thyroid Hormones Assessed?
Most doctors check only blood TSH levels when evaluating thyroid function. The issue here is that TSH levels truly only tell us what your pituitary gland is doing. Even though your pituitary gland might be secreting the right amount of TSH, this does not mean that your thyroid is appropriately responding or that the hormones are being released, converted, and used ideally.
When assessing thyroid function, total and free T4 and T3 levels should be checked in addition to TSH. For a deeper assessment, T3 uptake and reverse T3 levels provide information regarding the conversion and utilization of thyroid hormone. Additionally, I always check thyroid antibodies as these are elevated in Hashimoto’s thyroiditis, an autoimmune condition that leads to hypothyroidism (more on that below).
You should also know that the endocrine or glandular system is extremely interconnected. Your thyroid is therefore affected by the health of the other glands in your body, particularly the adrenals and ovaries or testes. Therefore, when assessing thyroid function, it is also helpful to take a look at cortisol and sex hormone levels.
What are the Symptoms of Hypothyroidism?
When your thyroid hormone levels are low, you will have symptoms of a low metabolism. Basically, everything slows down! Here are some common signs:
- Fatigue
- Hair thinning/loss
- Constipation
- Feeling cold a lot
- Weight gain and/or difficult weight loss
- Depression
- Muscle and joint pain
- Heavy, irregular, or absent menstrual periods
- Brain fog
- Brittle nails
- Enlarged thyroid gland
- Swelling
Why does hypothyroidism happen?
Traditionally this question is not asked. An individual with an exceptionally high TSH (above 5-10) is assumed to have low thyroid function and is placed on thyroid replacement hormone therapy such as levothyroxine. They will likely be on this treatment for life.
I want to know why, and I hope that you do too! There are absolutely ways to intervene here and improve thyroid function, possibly even completely reversing the issue. It is very important to take action early for the best chance of recovery.
Here are some potential causes of hypothyroidism:
- Chronic infection such as Lyme disease and Epstein Barr virus (mononucleosis)
- Extreme and/or long-term stress (adrenal dysfunction)
- Nutrient deficiencies (particularly iodine and selenium as these are used by the thyroid to make hormone)
- Gut dysbiosis and permeability
- Toxicities
- Food sensitivities (especially gluten)
- Genetics can also play a role, but usually one of the above triggers is needed for the condition to be expressed
What About Hashimoto’s?
Hashimoto’s thyroiditis is the most common cause of hypothyroidism. It is caused by thyroid-directed autoimmunity, which means that the immune system is mistakenly attacking and destroying the thyroid tissue. This results in thyroid gland inflammation and a decreased ability to produce thyroid hormone. It is caused by one or more of the above triggers and does have a genetic link as well.
If you have antibodies against thyroid tissue present in your blood, then you will know that your immune system is mistakenly attacking the gland. There are two thyroid antibodies which can be checked: Thyroid peroxidase (TPO) and Thyroglobulin (TGB) antibodies.
Traditionally, Hashimoto’s is treated with thyroid hormone replacement while the autoimmune response is allowed to continue. This means that the glandular tissue will eventually be completely destroyed, and the individual will be dependent on thyroid hormone replacement medication, such as levothyroxine, for life.
What is the Functional Medicine Approach to Treatment?
The functional medicine approach is different! We will look for the root cause(s) as listed above. These can be treated individually. Your thyroid hormones and thyroid autoantibody levels will be tracked so that we can assess your progress. It is important to avoid inflammatory foods during this time. The most important considerations are to avoid dairy, gluten, and sugar as well as any other foods to which you are reactive.
The end result of treatment depends on the root cause of the issue. In cases of Hashimoto’s, it is important to consider how long the autoimmunity has been taking place because this correlates with how much thyroid tissue remains. While we cannot usually regenerate damaged tissue, we CAN save what is left! Given the dangers of long-term autoimmunity and the hormone cascade that can impact the function of other glands, I do not wait until TSH and thyroid hormone levels are completely out of range to treat. Early intervention is key!
Thyroid replacement hormone (levothyroxine and others) may still be needed if levels are very low and if the problem has been present long term. Oftentimes this is temporary until the root cause is treated. Sometimes a dose is needed ongoing depending on the extent of damage, especially in cases of chronically untreated Hashimoto’s. There are numerous options for pharmacologic treatment, some better tolerated by certain individuals. This is a very personalized discussion, and one that I can help with. If conversion of T4 to T3 is an issue, you might benefit from an additional medication containing the active thyroid hormone T3 (as opposed to levothyroxine which is T4 and requires conversion). Additionally, support for the liver and gut can naturally improve this process.
As with all functional medicine, the goal is resolution of the root cause and restoration of optimal thyroid function. This is possible in many cases, especially with early treatment. If you are suffering from the above symptoms, do not hesitate to reach out! I would be honored to partner with you in your journey to health.