The intricacies of thyroid testing discusses whether you have a thyroid issue, or contentiously, if the thyroid is simply responding to a range of underlying conditions, as it can in Hypothyroidism (an underachieve thyroid). It is important that you should always respond medically to Hyperthyroidism (an over-functioning thyroid) as it is an acute medical situation, or if you have noticeable swelling around your thyroid at the front of your neck.
The differences between Hypothyroidism and Hyperthyroidism and their symptom pictures are discussed later in the blog, while the graphic below can show you a quick visualisation of some of the symptoms.
Damage to the thyroid gland can be from the long-term effect of altered physiology to the thyroid gland, from a process called the 'cell danger response' in our bodies. The cell danger response is often from chronic, low grade inflammation which is a prominent condition in today's society, and its presence causes our cells to sense danger and alter their function. Our thyroid can be reacting in an adaptive, defensive and protective function to these chronic, low grade inflammatory stressors.
The thyroid regulates the metabolism of virtually all cells and organs, and as such is the messenger of everything going on in your body. As our body systems don't act in isolation, if we were to ignore the messages, this may well result in eventual damage to the actual thyroid gland. This is not the beginning of the issue, but the end stage.
Intricacies surrounding Thyroid Testing
What are we really looking at when we test for thyroid physiology? For Hypothyroidism, you may be surprised to know that it's less about what's happening in the thyroid, but what is actually happening in all the cells in our body. Thyroid issues are 'the end game', not 'the start' of issues. In other words we are generally not born with a problematic thyroid gland. The thyroid gland is simply conveying messages that all is not well in our bodies. Often, issues with the thyroid are more about fixing other issues in our body, and as a result, thyroid issues will correct themselves after the other issues are treated. In this light, the thyroid is simply the messenger of bad news. It requires digging deeper to find out where the bad news is coming from.
What is the Thyroid?
The thyroid gland lies in the middle of our neck, and contains tissue filled with sticky colloid which is where our thyroid hormones are produced. While the thyroid has a big job of maintaining our body's health, issues with the thyroid can stem from parts of our body far away from the thyroid.
Thyroid Disorders can be broken down into disorders of the thyroid gland, and disorders away from the thyroid gland.
Disorders of the Thyroid Gland:
Hyperthyroidism - where too much thyroid hormone is produced. Hyperthyroidism and Grave's Disease (an Autoimmune cause of Hyperthyroidism) can be fatal if not treated medically. See below for symptoms and ensure you see a medical doctor.
Hypothyroidism - where too little thyroid hormone is produced. The most common cause is Hashimoto's Thyroiditis (an autoimmune disease). Iodine deficiency can also cause hypothyroidism, but iodine levels need evaluating before jumping to therapeutic conclusions as incorrect iodine supplementation can actually cause thyroid issues or make existing thyroid issues worse. As you'll read below there are far more common causes of hypothyroidism, and this is where a qualified naturopath can assist you.
Thyroid Cancers - any swelling in the neck (goitre), or lump (nodule) should be investigated medically. Most cases are not cancerous, but need investigating medically.
Disorders of Thyroid Physiology away from the Thyroid Gland:
Central Hypothyroidism - issues from the pituitary or hypothalamus (both in the brain) impacting on the thyroid. Needs investigating medically.
Euthyroid Sick Syndrome (also known as non-thyroidal illness syndrome or low T3 syndrome) - where low levels of T3 are found. This would be assessed medically.
How does the Thyroid work?
Many steps are involved in the generation of thyroid hormones:
The hypothalamus in the brain releases a hormone that stimulates the pituitary in the brain to release TSH (Thyroid Stimulating Hormone). This TSH hormone is what is assessed as a screening test when you have your thyroid hormone checked.
TSH is released into our bloodstream and targets the thyroid gland to release thyroid hormones via a number of steps:
TSH triggers the transport of iodine into the thyroid
Thyroglobulin (TG) is produced and transported into the thyroid. Thyroglobulin is the backbone of thyroid hormone.
An enzyme called thyroid peroxidase enzyme (TPO) links the iodine to thyroglobulin.
After the iodinated thyroglobulin is transported to a different area of the thyroid gland, it is broken down into individual thyroid hormones - Thyroxine (T4) and Triiodothyronine (T3).
T4 and T3 are released into the blood and bound to carrier proteins (a.k.a police-guard), that are produced in our liver, like albumin and thyroid-binding globulin, to be transported to our cells all throughout our body.
When T4 and T3 arrive at the cells, they are separated from the carrier proteins and become free T4 (FT4) and free T3 (FT3) and are the hormones that have a physiologic effect on us.
Note: The deiodinase enzymes activate or deactivate our thyroid hormones. For example, if the enzymes sense the environment isn't safe they will store the hormone FT3 in a 'safe parking lot' called reverse T3 (rT3). It is this sensing that is critical to the functioning of our thyroid hormones, and is the link to the 'cell danger response'. The health of the liver, the gastrointestinal tract (GIT), as well as our muscles, are pivotal in determining how these enzymes work!
The roles of Thyroid Hormones
The thyroid hormones influence our metabolism, they control gene regulation, the production of reproductive hormones and other enzymes, and ensure we remain 'sensitive' (able to respond) to other substances like adrenalin and noradrenaline. Additionally, they are crucial for healthy foetal development.
In terms of our metabolism, thyroid hormones control our metabolism by binding to receptors in our mitochondria located in our cells. Mitochondria are the suppliers of 'fuel' for energy for our body. Thyroid hormones turn on genes that regulate how we burn calories with the fuel (metabolism) in a process called glucose oxidation.
Thyroid hormones functioning well are critically important for our overall health, not just the health of the thyroid.
Testing of the Thyroid
When you are initially medically tested for thyroid issues, you will only be tested for TSH as a screen. If it's abnormal, then further testing of Free T4 and possibly Free T3 hormones will occur. When TSH is abnormal, but FT4 and FT3 are normal, it is considered subclinical. Once TSH, FT4 and FT3 are all abnormal, it is considered clinical. If TSH appears 'normal', no further testing will occur medically. Sometimes, TSH appears normal, but there are symptoms present, and sometimes underlying autoantibodies. It's complex.
It is important to know more about the TSH cut-off value for what is considered 'normal' or not. Although a subject of debate in scientific literature, there is contention around what the upper limit of TSH should be set at. Medically, TSH is set at around 4.5mU/L at which point values above will be managed with medication. Naturopaths however, are looking at prevention, and looking at your symptoms, and are looking to address sub-clinical Hypothyroidism at a TSH level greater than 2.0 mU/L, and to understand the possible causes in the attempt to ward off the necessity for medication, and to prevent thyroid dysfunction. Act early before you have a thyroid issue. Thyroid issues, in particular Hypothyroidism issues, are the end stage of stressors occurring in your body, and not the beginning.
To comprehensively test for the underlying causes of thyroid issues it is best to test for TSH, FT4, FT3, rT3, Urinary Iodine, Plasma Selenium, and thyroid autoantibodies - TPO and TG (for Hypothyroidism) and TSI (for Hyperthyroidism). Iodine and selenium are essential nutrients for thyroid health as discussed below so we need to know their levels. Additionally, a full work-up of other routine pathology markers is required for supportive evidence on the underlying causes.
TSH | FT4 | FT3 | Interpretation |
Normal | Normal | Normal | Normal thyroid function |
Elevated | Normal | Normal | Sub-clinical Hypothyroidism |
Elevated | Decreased | Decreased (or Normal) | Hypothyroidism |
Decreased | Normal | Normal | Subclinical (or mild over-active) Hyperthyroidism |
Decreased | Elevated (or Normal) | Elevated (or Normal) | Hyperthyroidism |
Decreased | Decreased | Decreased | Non-thyroidal illness (central hypothyroidism) |
Table highlighting Thyroid Results
The secret to understanding thyroid-related issues is to understand the underlying stressors, and focusing on that, while at the same time supporting our cells, thyroid and full body to recover. The use of supplements should also never be seen as a forever therapy, as they, like medication, don't fix the problem.
What are the Stressors of the Thyroid?
If stressors aren't dealt with and become chronic scenarios, we can end up with thyroid issues. Some of the stressors include:
Insulin Resistance
Obesity (BMI>30) as excess fat is considered a goitrogen (a disruptor of thyroid hormones)
Over consumption of carbohydrates (Obesity)
Polycystic Ovarian Syndrome (PCOS)
Very restrictive consumption of carbohydrates (Starvation)
Malnutrition (insufficient provision of required nutrients)
Heavy metals e.g. mercury amalgams, lead pipes
Mould and mycotoxin exposure
Anaemia
Endocrine disrupting chemicals e.g. fragrances, candles, plastics
Fluoride (in unfiltered water)
Fatty liver (either alcoholic or non-alcoholic causes)
Poor phase II liver detoxification (glucuronidation, sulphation)
Pesticide exposure e.g. glyphosate
Acute and chronic illness
Post-partum
Sarcopenia (loss of muscle mass from inactivity)
Medications (Glucocorticoids, amphetamines, beta blockers, antidepressants etc)
Insufficient sleep and poor sleep regulation
Over-consumption of green smoothies with high goitrogen levels
Over-consumption of cured meats with nitrates in them e.g. bacon
Gut dysbiosis with beta-glucuronidase enzyme producing bacteria
Post viral infections and resultant potential high levels of inflammation from IL-6
Perimenopause and menopause
Smoking
Excess soy consumption
Chronic Fatigue Syndrome (or mitochondrial dysfunction where the energy powerhouse doesn't work well)
Sleep apnea
Unhealthy food and lifestyle choices
Nutrients required for Optimal Thyroid Performance
Nutrient | Comments |
Iodine | Thyroid hormone production relies on sufficient amounts of iodine. Too little iodine can cause issues with our ability to form thyroid hormones that can lead to goitre and hypothyroidism. It can also lead to mental retardation which can be seen in developing countries. However, excess iodine can similarly cause issues with our immune response regulation (TReg cells) and invoke autoimmune disease. CAUTION: Too much or too little Iodine can cause serious issues so please don't self prescribe. A Urinary Iodine test that is corrected for Creatinine needs to be performed to assess levels. Seaweed (Nori flakes) sprinkled in meals helps boost levels naturally. |
Selenium | Selenium is a vital co-factor for the enzyme that converts T4 to T3 (which is the active hormone we need). Selenium is a nutrient we use a lot of when our body endures oxidative stress. It supports glutathione production (our body's major antioxidant). Without adequate Selenium, our body is subject to destruction from inflammation where hydrogen peroxide is produced, and in the thyroid this means the thyroid gland is destroyed. It is best to understand what is causing this oxidative stress while supporting with Selenium. CAUTION: Once again, Selenium can be toxic at a high daily dose level, so please don't self-prescribe. Eating just 1 Brazil nut a day to boost levels naturally can help. |
Vitamin B2 (Riboflavin) | Vitamin B2 is required for iodine absorption, and is best utilised in the active form (and taken in a B-complex formula if supplemented) when there is an under-active thyroid issue. |
Iron | Iron is needed to enable the effectiveness of iodine for the creation of thyroid hormones (T4). Oysters are a great source. |
Zinc | Zinc is needed as a cofactor for T4 and T3 production as well as TSH. Zinc needs to be in a 1:1 ratio with Copper. Zinc deficiency drives reductions in iron, HCl acid to break down our foods, Vitamin A which the drives copper and iron deficiency. If you're zinc deficient, we need to find out why. Oysters are a great way to balance zinc and copper and help iron. |
Vitamin A | Required for TSH production. Enjoy your orange vegetables. |
Vitamin D | Acting more as a hormone, Vitamin D is needed to protect against autoimmune issues. Get some sun in the early morning or late afternoon to avoid skin cancer. |
Magnesium | Required for mitochondria in our cells. Magnesium is required in nearly everyone and may need supplementation in our modern world. |
Inositol (sometimes referred to as Vitamin B8) | Influences the regulation of hormones, including regulating insulin resistance, which can be a trigger for thyroid issues. It also regulates reproductive hormones including androgens which may be in excess, especially if you are insulin resistant. It can also lower triglycerides present in fatty liver. Enjoying your citrus fruits can help. |
Table highlighting the required nutrients for thyroid hormone production
Thyroid Symptom Picture
Hypothyroidism
Hypothyroidism symptoms, can be present for a long time before your pathology results go awry. As well, there is the contention over what the upper limit of TSH sceening results should be.
Symptoms of Hypothyroidism can include:
Low Basal Body Temperature (<36.4 degrees Celsius)
Weight gain
Fatigue
Thinning hair
Nails won't grow
Brain fog
Constipation
Voice becomes hoarse
Speech slows
Muscle weakness and aches and pains
Cold intolerance
Cold hands and feet
Depression and other neurotransmitter disorders
Joint pain
Goitre
Dry, and thickened skin
Poor memory
Puffy face, eyes, hands and feet
Thinning of outer third of eyebrows
Menstrual disorders
Fertility problems
Poor digestion and motility
Gut dysbiosis
GORD (Gastro Oesophageal Reflux)
Low libido
Fatty liver disease
Elevated cholesterol and elevated LDL
If Hypothyroidism is present but there are sufficient levels of iodine, then Hashimoto's Thyroiditis, the autoimmune condition may be present. What's triggering that? Autoimmune diseases are generally described as the body going rogue and attacking itself, but what is the real reason? Our immune system relies on knowing what should be in certain parts of our body, and what shouldn't be. If something (a stressor) is present where it shouldn't be, we mount an acute inflammatory response. This is good and clears infections etc quickly. If the presence of the 'stressor' remains and is chronic, be it an organism, a toxin, a food, emotional stress, too much physical stress etc, then the body will continue to mount an inflammatory response. This can trigger an imbalanced immune response resulting in an autoimmune response.
Hashimoto's thyroiditis typically occurs as a protective mechanism against long term chronic cellular stressors. The result is a slowed down metabolism, and autoantibodies against TPO and TG which can be seen in our blood tests, often before any other result is abnormal (including a TSH above 2.0 mU/L. If your are experiencing Hypothyroid symptoms and you want to be screened comprehensively, please see a qualified naturopath experienced in this like myself.
Hypothyroidism has been additionally linked to:
GIT issues
Bile issues
Fatty Liver issues
Glucose regulation issues
Adrenal hormone issues
Immune system issues
Sex hormone, ovulation, fertility issues
Neurotransmitter issues
Hyperthyroidism
A serious condition that needs urgent medical treatment due to the implications on the heart.
Symptoms of Hyperthyroidism:
Increased heart rate (tachycardia where there is >100 beats/ minute)
Heart palpitations
Heart arrhythmia
Shortness of breath
Increased sweating and heat intolerance
Unexplained weight loss
Increased appetite
Insomnia
Irritability, nervousness, anxiety
Tremors
More frequent bowel movements
Thyroid Eye Disease (bulging)
Like Hypothyroidism, something in the body can trigger the immune response to produce antibodies to the same triggers - physical, emotional, chemical, microbial etc. An autoimmune response can be triggered. In hyperthyroid conditions this is called Grave's Disease and is where an autoantiantibody (TSI) mimics TSH thereby overstimulating the thyroid gland to produce excessive amounts of thyroid hormones. Hyperthyroid conditions seen by the symptoms above should always be assessed by a medical doctor.
Summary
If you can see that there is a bigger picture where thyroid issues are more often linked to stressors like inflammation, obesity, insulin resistance, fatty liver, chemicals, hormone disruptors, mould exposure, heavy metal exposure, which are often lifestyle related issues, then you would be understanding that treating thyroid issues comes back to treating those underlying stressors.
Other pathology results can be indicators of stressors indicating inflammation and oxidative stress, showing potentially that multiple systems have been impacted. These may include:
Elevated cholesterol and triglycerides
Elevated MCV and RDW in a FBC
Uric acid elevation
Ferritin levels >25 (Ferritin is an inflammatory marker as well as an indicator of iron storage)
Elevated CRP, ESR, IL-6
Elevated Homocysteine
Elevated albumin
Low or elevated Bilirubin
Elevated fibrinogen
Low Vitamin D
Low B12, folate, iron, zinc, magnesium
Elevated HbA1c, insulin
Elevated prolactin
Elevated liver function enzymes ALT, AST, GGT while low ALP and LDH
Low sodium
Decreased eGFR
Fun facts and cautions
Did you know that the time of day you have your blood collected can also impact on your TSH and FT3 results? Aim to be at the collection centre before 9am, and less than 10 hours after you've fasted, ensuring you've had a glass of water beforehand and not performed strenuous exercise in the days prior. Delaying the time of collection is almost pointless as it can make hypothyroid cases look normal or even hyperthyroid. Additionally, if you check your thyroid results annually, try to ensure you are testing at the same time each year as the results can be affected by the seasonal changes.
What to do if you have thyroid issues
A lot of the time our health concerns are all linked. Some simple steps to begin to rectify this connection can be:
Eating whole foods and in season
Sleeping well and making it a priority
Diaphragmatic breathing and consciously not sitting and shallow breathing
Not letting stress live 'rent-free' in your head
Gentle exercise (not stressful)
Committing to small changes is usually the biggest thing we can do
A clean environment as much as we can control
Metabolic fitness by looking after our biochemical pathways with nutrition
Looking after the genes we've inherited, and nutritionally altering the not so good genes we've inherited, are all steps we can take.
"The journey of 1000 miles starts with the first step"
If you would like to discuss your personal circumstances and discuss your thyroid concerns, get comprehensive thyroid testing performed or review your existing results, and get on the road to improving your health, then please don't hesitate to make a booking with me.
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References:
R.K. Naviaux, "Metabolic Features of the Cell Danger Response," Mitochondrian 16 (May 2014):7-17, doi:10.1016.j.mito.2013.08.006. Pubmed 23981537
'The Thyroid Debacle' by Dr. Eric Balcavage & Dr. Kelly Halderman
Clinical Foundations Hypothyroidism, Bioconcepts Engage Education
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