Hypothyroidism - How Did We Get Here and How Can We Fix It?
Thyroid issues. They’re extremely common these days.
And, there’s a lot of reasons why thyroid issues are so prevalent.
But what’s worse is the that standard medical practice largely ignores you if your thyroid stimulating hormone (TSH) levels fall neatly into the conventional range of roughly 0.5 to 4.5.
I can’t tell you how many times I’ve had a person come into the clinic who tells me they’ve suspected thyroid issues, had a TSH done by their doc, and was told that everything’s normal - yet they still feel like they’re hypothyroid! I’ll get to that in a minute, but first some basics:
Located about where you’d wear a bowtie, the thyroid gland plays a vital role in overall cellular metabolism. Meaning, it sets the rate at which the many thousands of ongoing chemical reactions occur in each cell of the body. It does this by manufacturing specific hormones that are tightly regulated.
There are numerous conditions that affect the thyroid, either causing it to speed up or slow down. In general, when the thyroid runs more slowly than normal, this is referred to as hypothyroidism, while hyperthyroidism refers to a situation in which the thyroid runs much faster than normal.
By far the most commonly encountered thyroid issue is hypothyroidism.
Hypothyroidism occurs when too little thyroid hormone is produced. About 10 million people in the U.S. are affected with it, and as many as 10% of women are hypothyroid (and while researchers are unsure why more women have hypothyroidism, women are also more affected by autoimmune conditions as one possible cause).
Additionally, hypothyroidism can ‘run’ in families. If you have a 1st degree female relative (mom, sisters) that is hypothyroid, chances are pretty high you’ll experience it as well.
Are Athletes Disproportionally Affected by Hypothyroidism?
A few years ago an article in the Wall Street Journal seemed to imply that elite runners were being treated for hypothyroidism as a performance advantage – the doctor featured in the article claimed he was treating lower-ranging thyroid hormone levels in his elite runner patients.
I’ll come back to this in a minute – at the same time the article raised the question of whether elite levels of training actually sets athletes up for hypothyroidism.
As of now, there isn’t a lot of convincing research that says extreme training will induce hypothyroidism. It has been shown to transiently decrease one thyroid hormone known as T3. (1,2) And currently there aren’t any studies demonstrating long term thyroid suppression from elite training levels. (T3 is transiently decreased, at least in these studies, because acute stressors will do that).
Now back to the doctor who treats lower-ranging thyroid levels in elite athletes. I have no way of knowing at what level of which thyroid hormone he initiated treatment in his athletes, but I’m willing to bet he took a more conservative approach in analyzing a combination of thyroid hormones (TSH, free T3 and free T4, among others) as many functional medicine practitioners like myself do.
The performance enhancing effects of thyroid medication are dubious – it’s not regulated by the World Anti-Doping Agency, the body responsible for monitoring performance-enhancing drugs.
Yet, by treating a functionally hypothyroid athlete, we can expect that athlete’s performance to improve only because they’ve achieved normal thyroid hormone levels just as their healthy competitors already have.
Standard Thyroid Hormone Ranges:
TSH: 0.45 – 4.5 µIU/mL FreeT4: 0.82-1.77 ng/dL FreeT3: 2.0-4.4 pg/mL
Taking a functional medical approach to thyroid lab values simply means that we take a finer tooth comb, so to speak, to the established “normal” thyroid hormone ranges. This, combined with a detailed assessment of the patient’s symptoms (and taking into account adrenal and reproductive hormone levels) we often end up addressing thyroid problems that had been missed by conventional methods.
Functional Thyroid Hormone Ranges:
TSH: Optimal levels are 1.0-2.0 µIU/mL FreeT4: Optimal levels are 1.45-1.77 FreeT3: Optimal levels are 3.4-4.2 Reverse T3: 9.2-24.1 ng/dL (this test is rarely run…) Thyroid antithyroglobulin antibodies (TAA): Less than 20 IU/mL Thyroid perioxidase antibody (TPO): Less than 35 IU/mL
(Remember, a lower TSH generally means your thyroid is running faster. If it’s too low, then we have hyperthyroidism which is of course treated a lot differently than hypothyroidism).
This isn’t to say that only elite athletes need a functional approach to thyroid health; everyone does! Too often people with hypothyroid symptoms are left to suffer because their doctor adhered to the standard lab values, and finding them “normal” despite the patient’s hypothyroid symptoms, did not initiate treatment.
This is actually a huge problem in medicine today as there is definitely a paradigm shift occurring in this area. By taking this approach, many people who actually have some form of hypothyroidism and ‘unexplained’ low thyroid symptoms can be treated, with success.
Typical Hypothyroid Symptoms:
Weight gain or inability to lose weight
Hair loss, brittle, or dry hair
Abnormal periods - short, bleeding in between, prolonged, etc.
Muscle aches and cramps
Cold intolerance (can’t tolerate cooler temperatures)
Depression, irritability, anxiety
Labs to Run - How to Get To The Bottom Of It!
If you’re concerned about your thyroid status, get it tested! But don’t just get a TSH done – you need to ask (well, probably demand!) for a full thyroid panel (as listed below).
It’s also really important to test for autoimmune-induced hypothyroid conditions. You’ll need both antibodies (TPO and TAA) to rule this out.
I’m always amazed at how many fatigued people come into the clinic, have had some bloodwork done yet no one looked at their thyroid status! And, if they did it was only a TSH.
That single lab alone won’t tell the whole story.
You need to have all of the following labs to get a complete picture of your thyroid function. Next, you need to find a doctor who is familiar with a functional approach to thyroid conditions, in the event you need some help.
A Full Thyroid Panel Includes:
TPO (thyroid peroxidase antibodies)
TAA (anti-thyroglobulin antibodies)
The causes of thyroid problems are often complex, and rarely the result of one single event. Other medical conditions, prescription medications, toxic environmental exposures and autoimmune disease are some of the leading causes of thyroid problems.
The most commonly encountered thyroid disease is hypothyroidism (the thyroid runs too slow). Here are some of the most often overlooked causes of hypothyroidism.
Halogens are a family of elements – a grouping of specific atoms that behave in similar ways. They include fluorine, chlorine, bromine and iodine. Perhaps you’ve heard of each of these:
Iodine is essential for thyroid function. Chlorine is an antibacterial put in our water system. Bromine is used as a fire retardant in textiles (clothing, fabrics, etc), and is added to a lot of foods as a dough conditioner, a pesticide, and to enhance the appearance of colored sports drinks, to name a few. Fluorine, or rather its compound form fluoride, is also found mainly in our water as an antibacterial compound.
We’re concerned about Halogens because it’s thought they can compete with the uptake of iodine into the thyroid gland. Because other halogens are found throughout our environment, there is concern they negatively affect thyroid function.
You can try to avoid taking in excess halogens in your body by filtering your drinking water (make sure you review the filter’s specifications to see if it removes chlorine and fluoride), avoiding prolonged contact with new carpet and new car smells, and wash any new clothing you buy a few times before wearing it, for starters.
2. Iodine As I mentioned previously, iodine is vital for thyroid function. Too little causes serious medical conditions, as does too much. If you eat a healthy, whole food diet (roots, tubers, eggs and seafood including seaweed) you are getting plenty of iodine. Please DO NOT start taking massive amounts as is often suggested across the internet. Excess iodine can worsen hypothyroidism, and can lead to toxic thyroid or tumors of the thyroid.
3. Adrenal Stress & Cortisol When a person is under chronic stress, they produce excess amounts of cortisol. Cortisol can then impede conversion of the thyroid hormone T4 (which is mostly inactive) into its active form T3.
In some cases a very stressed person will appear to be hypothyroid when really the problem lies in the stress effect from the adrenal glands. Getting cortisol (and stress!) under control would improve thyroid function in this case. Adrenal function is easily tested using a saliva test kit at home.
4. Thyroid Hormone Conversion
While we’re talking about thyroid hormone conversion, sometimes a person’s individual biochemistry prevents them from properly utilizing prescription thyroid medication.
Synthroid is a popular hypothyroid prescription medication that is made soley of T4. T4 must be converted into active T3 at the cellular level. If a person doesn’t convert efficiently, they’ll end up being told they’re on adequate amounts of thyroid medication, yet still have all their thyroid symptoms!
This is why functional and integrative doctors like to prescribe a mixture of T4 and T3 medications. It can make a huge difference in how a person feels.
Which leads us to how we look at thyroid lab studies….
5. Using TSH Alone To Test Thyroid Function?
TSH and sometimes T4 are used as sole determinants of thyroid function in the screening process. However, there is increasing awareness among clinicians and growing evidence in the literature that TSH alone isn’t the best way to determine thyroid function. We always recommend a full thyroid panel that includes TSH, free T4, free T3, Thyroid Peroxidase Antibodies (TPO) and Anti-Thyroglobulin Antibodies (TAA) to start whenever thyroid function is a concern.
6. Estrogen and Progesterone in Women
When out of balance, these predominately female hormones can interfere with thyroid function, much the same way elevated cortisol can. Something I tell all my patients is that our hormones are like a symphony, when one is out balance it affects all the others. The idea that one hormone is “off” and has no repercussions elsewhere in the body is outdated. When estrogen levels become elevated, it can increase the production of thyroid binding globulin, which essentially ties up circulating levels of thyroid hormone. It also slows the conversion of inactive T4 to active T3.
Progesterone affects thyroid function in a different way; it “primes” thyroid hormone receptors on the cells, helping it gain entry into the cells and also supports conversion of T4 to T3.
When a woman is estrogen dominant (elevated estrogen or relatively elevated estrogen in comparison to lower progesterone levels), this sets her up for functional thyroid issues. Estrogen dominance can be seen in women of all ages; overweight, sedentary lifestyle and processed food diet are some of the main causes of estrogen dominance.
7. Thyroid-Specific Nutrients:
Lastly, the thyroid gland itself requires specific nutrients to run efficiently. Like a specialized factory, it needs these nutrients to do its job correctly.
These are the most important nutrients for the thyroid:
Vitamin D3: Anyone with a thyroid condition, especially autoimmune thyroid disease, needs to check vitamin D levels. Vitamin D is associated with autoimmune thyroid disease and can be of benefit in it as well. Vitamin D has an immune system-balancing effect.
Iodine: The most important nutrient for thyroid function. The thyroid gland is the only place in the body that uses iodine; it is used to manufacture the two main thyroid hormones Thyroxine (T4) and Triiodothyronine (T3). We can’t live without it, and too much can cause serious thyroid problems.
Zinc: When deficient, levels of T3 and T4 may be lower; replacing zinc to adequate levels can normalize levels of these hormones. It may also assist with conversion of T4 to T3.
Selenium: The thyroid concentrates more selenium than any other organ in the body. It’s a vital component of the enzymes that convert T4 to T3 – selenium is critical for activation of thyroid hormone. Low selenium has been associated with thyroid disease, and it plays an important protective role against oxidation in the thyroid gland itself.
L-Tyrosine: L-Tyrosine is an amino acid from which the thyroid hormone ‘backbone’ is made. Iodine is combined with tyrosine inside the thyroid to make thyroid hormones.
Ashwagandha: Ashwagandha is an adaptogenic herb, meaning it can help normalize metabolic functions. In other words, it can be used to elevate thyroid function in cases of hypothyroidism, and can be used to slow it down in cases of hyperthyroidism.
Guggul: Guggul is another botanical medicine that can normalize T4 and T3 levels, assists with iodine absorption into the thyroid, and supports the activity of enzymes in the thyroid that help make thyroid hormone.
Coleus Forskohlii: Coleus forskohlii is an herb with specific effects on certain cellular reactions – in the case of thyroid; it is theorized to help with the production of thyroid hormones.
Thyroid Support Complex contains all of these, and other thyroid-supportive nutrients to assist its normal function.
This is a lot of information!
The idea is that there’s a lot more to hypothyroidism than simply getting a TSH, being told it’s too high, and given a prescription for thyroid hormone. Hypothyroidism doesn’t just happen – with a little digging you can address other issues and lessen the burden on the thyroid, helping it function as it’s supposed to. Questions about this blog?
Send me an email.
Feel free to schedule a complimentary 30 minute consultation if you’d like to learn more about how we can optimize your health and performance!
In Health, Fitness and Endurance,
Dr. Jason Barker
1. Baylor LS, et al. Resting thyroid and leptin hormone changes in women following intense, prolonged exercise training. Eur J Appl Physiol. 2003 Jan;88(4-5):480-4.
2. Boyden TW, et al. Thyroidal changes associated with endurance training in women. Sports Exerc. 1984 Jun;16(3):243-6