“The art of medicine consists of amusing the patient while Nature cures the disease.” -Voltaire
Are you someone who is consistently fatigued, depressed, losing your hair, gains weight even after adhering to a low-calorie diet, has cold hands and feet, suffers from constipation or often has trouble getting out of bed in the morning, even after eight or more hours of sleep? This post will explain how thyroid disease relates to all of these symptoms and more, as well as provide you with information on which tests are more informative and useful in evaluating your thyroid overall.
But first…why the thyroid?
If you’ve ever had a consultation with me, than you’ve definitely been asked about your thyroid. Why? Well, for a couple reasons actually:
For starters, the thyroid gland (the butterfly-shaped gland located at the base of the throat) has many functions. In fact, every cell in the body has receptors for thyroid hormone. It is involved in all areas of metabolism (fat, protein, carbohydrates, and even cholesterol), body temperature regulation, gall bladder/liver function, steroid hormone production, and blood calcium regulation (the thyroid gland manufactures and stores calcitonin-a calcium regulating hormone) to name just a few! Secondly, thyroid diseases are becoming more prevalent, and are now estimated to affect around 27 million Americans-about 8.6% of the population! ( 1, 2) Last, the thyroid gland itself and how it operates is directly influenced by nutrition. When we’re talking about nutrition and disease we are ultimately talking about how compounds from the foods we consume relate to our individual biochemistry. In this case, for instance, we are talking about thyroid hormones. This hormone is synthesized from proteins-more specifically in this case the amino acid, l-tyrosine. The backbone of thyroid hormone is composed of four iodines-a trace mineral found most abundantly in sea vegetables such as kelp, kombu, dulse, and nori. Other minerals such as selenium, zinc, copper and magnesium also play a role in thyroid hormone production. So right off the bat, when discussing issues with the thyroid gland, we’re talking about amino acids (l-tyrosine) and mineral co-factors, all of which are obtained through foods.
In the case of autoimmune thyroid disease (such as Hashimoto’s or Grave’s), the patient’s own immune system attacks enzymes produced by the thyroid gland which help regulate hormone production and metabolism. In some cases, ‘molecular mimicry’ can occur (3)-which regarding thyroid diseases, means the immune system can mistakenly attack the thyroid tissue itself! This can be due to proteins in foods (such as gliadin from gluten and casein from dairy) or various infections such as the bacterium Yersinia enterocolitic which can be obtained from contaminated food or water. In this study, prevalence of Yersinia antibodies was 14-fold higher in people with Hashimoto’s thyroiditis than in the control groups, suggesting a causative relationship between Yersinia enterocolitica infection and Hashimoto’s. (4) Hepatitis C, Lyme disease or an Epstein-Barr virus (‘mono’) can also induce autoimmune thyroid attacks. (5) Even in the cases of autoimmune thyroid disease and molecular mimicry, nutrition can still lend a helping hand. Here is a review of common thyroid disorders, and how they are influenced by nutrition. Afterwards I will recommend one single lab that can test for all of them in one panel-so that you can have a better understanding to the health of your thyroid overall.
Hypothyroidism is the most common thyroid disease in America. This condition involves an ‘underactive’ thyroid gland that fails to produce an optimal amount of thyroid hormone which-as listed above-is necessary for so many functions-from hair growth, to metabolism and energy, to detoxification, and even DNA production and repair.
Hypothyroidism is more common in women, people with other thyroid problems, and those over 60 years old. (6) Hashimoto’s disease, however, is the most common cause of an underactive thyroid (7) and can affect a more broad age range: adolescents can even develop Hashimoto’s, although it is more commonly diagnosed between 30 and 50 years of age. (8)
Hypothyroidism is often characterized by the following symptoms:
- Weight gain/inability to lose weight
- Dry/Itchy skin
- Cold hands and feet
- Dry, brittle hair and nails
- Frequent headaches or migraines
- Overly sensitive to cold temperatures
- Slow wound healing
- Unrefreshing sleep
- Digestive issues (due to low stomach acid)
- Hair is falling out
- Water retention
- Consistent muscle cramps
- Edema, especially facial swelling
- Thinning of the outermost portion of the eyebrow
- And more!
Do any of these apply to you? Do multiple symptoms apply to you? If so, perhaps you should really consider a comprehensive thyroid panel if you haven’t already. Note: I am not talking about a TSH test! The TSH test has been the gold standard for assessing thyroid function but it is not very accurate. Why? Because it doesn’t test for the amount of activated thyroid hormones you have in circulation, in fact, TSH doesn’t even test thyroid hormones at all! So what is TSH and what is its purpose? To understand that, here is a simple break-down of how we create thyroid hormone:
- This works on a ‘feedback loop’ that starts in the brain: The hypothalamus sends Thyroid Releasing Hormone (TRH) to the pituitary gland.
- This TRH tells the pituitary gland to release Thyroid Stimulating Hormone (TSH). This is what most conventional labs are testing for. Thyroid Stimulating Hormone is not an active thyroid hormone, it’s more of a ‘middle-man’. If you’re a DEA agent and working on a big drug bust, your main objective isn’t to just obtain the middle man (TSH), you want to get to the head-honcho (activated thyroid hormones). TSH does serve its purpose though: Once TRH tells the pituitary to release TSH, the TSH then tells the thyroid gland to use iodine to start creating T4 and T3 hormones. These are the hormones that thyroid panels should be testing for! T4 is an inactive form of thyroid hormone, and T3 is the activated form of thyroid hormone. (The ‘T’ stands for ‘tyrosine’ and the numbers 4 or 3 represent the number of iodines attached. T4 is a tyrosine with four iodine molecules attached, and T3 is a tyrosine with three iodine molecules attached).
- 60% of T4 is converted to activated T3 in the liver. (So liver health is also key to thyroid health). 20% of T4 gets converted to T3 in the gastrointestinal tract (so gut health and healthy gut flora are also key to thyroid health) and the remaining 20% either gets converted to reverse T3 (an inactive form of T3, often times which occurs due to excessive cortisol from chronic stress) or gets converted to activated T3 in peripheral tissues.
- So a healthy liver, a healthy gut, and managing our stress are three huge factors in the production of activated thyroid hormone (T3). What about nutrition? It turns out nutrition also plays a MAJOR role in converting inactive T4 to activated T3 as well. Minerals such as selenium, zinc, and iron are involved in converting T4 into active T3 thyroid hormone. That’s because the enzyme (known as 5’deiodinase) responsible for removing iodine atoms during the T4 to T3 conversion is dependent on these minerals. (9, 10, 11)
Selenium rich foods: Brazil nuts, crimini mushrooms, tuna, hablibut, and sardines.
Zinc rich foods: Oysters, sirloin steak, crab, and pumpkin seeds.
Iron rich foods: Clams, beef liver, parsley, ground beef, and chicken.
It’s important when testing your thyroid hormones that you are testing free T4, free T3 and reverse T3. You can be hypothyroid for a number of reasons; and one of them is that your thyroid hormone can be bound to a protein that carries them through the bloodstream to be used where they are needed. These hormones are referred to as ‘bound’ and are inactive until they are delivered to the cells where they are ‘free’ to carry out their functions. So when you’re testing your T4 and T3, always make sure they are free T4 and free T3.
Reverse T3 occurs when the enzyme, 5’deiodinase cleaves off the wrong iodine molecule when converting T4 into T3 as shown in this figure:
When the wrong iodine molecule is removed, T4 becomes what’s known as reverse T3, which the body cannot use. Reverse T3 usually occurs due to cases of extreme stress such as major trauma, surgery, severe chronic illness or even just chronic stress in general. The stress hormone known as cortisol that is released during times of stress can be detrimental to our health if it is chronically elevated (or in other words, if we are constantly stressed out and not taking time out of our day to relax and find inner-peace). Consistent stress and cortisol causes an inflammatory response in our body-by releasing what’s known as inflammatory cytokines. In a study where human subjects were injected with these inflammatory cytokines, they noticed a rapid reduction of serum T3 and an increase in reverse T3 (an inactive form of thyroid hormone). (12) So it is very important to test for reverse T3 as well. If you notice your T3 is low and your reverse T3 is high, than some mind-body techniques such as yoga, tai chi, deep breathing exercises or meditation are going to be key for balancing your stress and slowing down the creation of reverse T3. Supplementing with adaptogenic herbs such as ashwagandha or holy basil may be beneficial for managing your stress response as well. (Note: work with a healthcare professional before supplementing with these herbs).
One final note on stress, the inflammatory cytokines released during the stress response has also been shown to suppress thyroid receptor site sensitivity, which leads to what is known as thyroid resistance. (13) A standard thyroid panel cannot test for thyroid resistance-so this makes a strong case for minimizing our intake of inflammatory foods (refined vegetable oils, breads, pastas, table sugar, soda, fruit juices, conventional dairy, grains and other processed foods and sweets) and increasing our intake of foods that have anti-inflammatory properties (fatty fish, leafy greens, cooked cruciferous vegetables, olive oil, avocados, cooked starchy vegetables, fruit and coconut oil). Note: Because I absolutely despise general guidelines for nutrition, I do advise at some point conducting an IgG food sensitivity test or an ALCAT test to see specifically which foods are causing inflammatory responses for you. In general it’s good to consume fatty fish such as salmon, but some people react negatively to salmon. Some people react negatively to fruits. Some react negatively to onions, etc. Although these cases aren’t as common, to obtain the most efficient anti-inflammatory diet, I have to recommend eventually going through with this food sensitivity test. With inflammation playing a role in almost every modern disease, it will be well worth it in the long run.
People with hypothyroidism should also avoid consuming foods referred to as goitrogens. These foods have chemicals that decrease the uptake of iodine by the thyroid gland, and thus can ultimately produce a goiter (swelling of the thyroid gland) and can lead to underactive thyroid. Foods that have been shown to have goitrogenic effects include soy, millet, cassava, sweet potatoes, and raw cruciferous vegetables such as cabbage, broccoli, kale, cauliflower, collard greens, bok choy, and Brussels sprouts. The good news: cooking your cruciferous vegetables can reduce its goitrogen content (14) so instead of avoiding these foods, just cook them! Boiling crucifers for thirty minutes destroys about 90 percent of its goitrogens. Besides, goiter can occur not only because of iodine deficiency, but excess iodine consumption as well. (15, 16)
Hashimoto’s thyroid disease-sometimes also referred to as chronic lymphocytic thyroiditis-is an autoimmune disease. An autoimmune disease is a disorder in which the body’s immune system attacks the body’s own cells and organs. In this case, we refer to the thyroid gland. Hashimoto’s is actually the most common autoimmune disorder currently in the U.S. (17), affecting between 7-8% of the population. Hashimoto’s is also the most common form of hypothyroidism in the US (18), and some studies suggest that up to 90% of people suffering from hypothyroidism actually have Hashimoto’s. (19) These attacks on the thyroid gland eventually lead to low thyroid hormone production and hypothyroid symptoms (fatigue, depression, weight gain, cold hands and feet, etc.)
Traditionally when you think of low thyroid function, you think iodine deficiency. This can be true to an extent when you’re talking about traditional hypothyroidism. However in the case of Hashimoto’s, iodine may actually make the symptoms worse. That’s because one of the enzymes that initiates an immune attack (known as thyroid peroxidase or TPO) is produced by iodine. One study showed that 78% of patients with Hashimoto’s regained normal thyroid function by just restricting iodine alone! (20) This gets confusing for some because yes it is true that iodine deficiency is the most common cause of hypothyroidism for most of the world’s population, in the United States and other westernized countries however, Hashimoto’s accounts for the majority of hypothyroid cases. (21) Think about it this way, since America adopted iodized salt practices, autoimmune thyroid disease has increased (I’m not implying that this is the reason, but it appears to be contributing to these immune attacks). It has also been observed that when iodine is added to table salt in other parts of the world, the rates of autoimmune thyroid disease increases as well. (22)
Gluten has also been linked to autoimmune thyroid disease in several studies (23, 24, 25). In this study published in the European Journal of Gastroenterology and Hepatology, the researchers found that all the adults with autoimmune thyroid disease that were tested for Celiac disease, tested positive! (26)
The protocols regarding Hashimoto’s can be quite extensive-so I will dedicate a post in the future relating to just Hashimoto’s alone, because there are so many variables involved in its treatment nutritionally. It is also important to note that Hashimoto’s does not come up on a standard TSH test. Again, this test is not specific enough and does not regard the different possibilities for your disabled thyroid function.
OTHER THYROID DISORDERS:
Hyperthyroidism is a condition characterized by increased levels of thyroid hormones: T4 and T3. This leads to symptoms that are typically opposite of those suffering from hypothyroidism. These include: excessive sweating, weight loss and difficulty gaining weight, nervousness, heat intolerance, irritability, racing heartbeat, moist skin, loose stools, fluid retention, palpitations or insomnia.
Graves’ Disease is an autoimmune version of hyperthyroidism where the immune system creates antibodies against thyroid stimulating hormone (TSH) which leads to an overactive thyroid. Just like Hashimoto’s is the most common form of hypothyroidism in the United States, Graves’ Disease is the most common form of hyperthyroidism-accounting for about 85% of those suffering from hyperthyroidism, and is most common in women over the age of 20. (27)
WHICH THYROID TEST IS MOST ACCURATE?
Personally, I am currently a fan of Genova Diagnostics Comprehensive Thyroid Assessment which tests serum levels of TSH, free T4, free T3, reverse T3, anti-TG antibodies as well as anti-TPO antibodies. If you’re looking into getting your thyroid checked out, I highly recommend asking your doctor about this test!
- With thyroid diseases becoming more and more common, it may be worth your time and your money to invest in the proper screening. (Especially if you are consistently falling victim to the symptoms above).
- Thyroid hormone depends on nutrients such as tyrosine, iron, zinc, and selenium, so a protein-rich, nutrient-dense diet is key for maintaining optimal thyroid function.
- 60% of thyroid hormone gets activated in the liver, so liver health is also key. Glutathione is a combination of amino acids cysteine, glycine and glutamic acid. It is used by our liver to aid in elimination of toxins as well as acts as a potent antioxidant. Improving glutathione status has been shown to help those suffering with autoimmune thyroid diseases. (28) Glutathione supplementation may be beneficial for this reason.
- About 20% of thyroid hormone gets activated in the gut, so gut health is also key. L-Glutamine is an amino acid that helps with the regeneration and repair of intestinal lining-which ultimately can help increase absorption of nutrients, help prevent autoimmune attacks, as well as aid in how our gut functions overall. Supplementing with a probiotic may be beneficial for optimizing your gut health as well. (Talk with a well-versed healthcare practitioner or nutrition therapist to see which probiotics-if any-are right for you!)
- Avoid inflammatory foods such as refined vegetable oils, breads, pastas, table sugar, soda, fruit juices, dairy, grains and other processed foods and sweets for one month and see if they help rectify your symptoms.
- Stress management. I can’t hound on this point enough. We all get stressed, it’s a part of life, but balance is also very important. To help us achieve this balance, it’s great to incorporate some ‘mind-body’ techniques such as yoga, tai chi, meditation, breathing exercises or prayer into your daily routine. This can be an hour of yoga, or 10 minutes of deep breathing exercises (inhale for a count of five, exhale for a count of five, repeat). Remember, stress can lead to reverse T3, thyroid resistance, and can alter a cascade of other hormones as well. So stay calm, try to remain relaxed, and take some time out of your day to appreciate all you’ve been blessed with!
I will be posting more about specific thyroid conditions and ways to manage them through nutrition and lifestyle factors in future posts, so be sure to stay tuned!
19) ) Amino, N. (1988). Autoimmunity and hypothyroidism. Baillieres Clin Endocrinol Metab., 2(3),591–617. Retrieved from http://pmid.us/3066320
28) Rostami, R., et al. (2013). Enhanced oxidative stress in Hashimoto’s thyroiditis: interrelationships
to biomarkers of thyroid function. Clin Biochem., 46(4-5), 308–312. Retrieved