Persistent Hypothyroid Symptoms: The Missing Piece(s) of the Puzzle
What glands, organs, and organ systems are involved in hypothyroidism? (Other than the thyroid itself)
A. Immune system
B. Gastrointestinal system
C. Adrenal glands and the "HPA axis"
E. All of the above and probably more
Did you pick E? You're so smart.
As an ND, I was taught to always think of the body as a whole, never viewing a single part in isolation. There is beautifully, finely-tuned interplay between every tissue and organ in the body, and this is particularly true for the thyroid, whose job is to pump out hormone that exerts effects on every one of your cells. We rely on thyroid hormone to "stoke the fire" of the tiny cellular furnaces that create energy for us, which is why poor thyroid health manifests as such a wide array of different symptoms.
Of all the chronic conditions I see as a naturopathic doctor, hypothyroidism is the most common. I suspect this is not only because of its prevalence (one in eight women will develop a thyroid condition in her lifetime!) but also because many people, even when properly medicated with thyroid hormone replacement, still have symptoms. They are frustrated because despite faithfully taking their medication, they are still fatigued, gaining weight, losing hair, and feeling depressed. They leave their endocrinologist's office at a loss because they are told that their labs look good.
"I feel like maybe its all in my head," my clients will sometimes tell me, seeming defeated. "I just don't understand why I still feel so crummy when my doctor says all my tests came back normal!"
From a conventional standpoint, treatment is successful because the thyroid is viewed as an isolated organ that was misbehaving by not creating enough hormone (T4.) They replaced the hormone with medication, re-tested a few months later, and voila! The person's thyroid hormones are within normal limits. Sure, the person still has symptoms, but conventionally, there's not much more that can be done, other than experiment with different brands and hormone combinations.
Here's an analogy to consider.
If you go out to eat at a restaurant and you're not happy with your meal, it makes sense to blame the head chef, right? Your meal was so bad you call the manager over and tell them,
"My dinner was terrible, the head chef clearly isn't working hard enough! He should be replaced."
Seems reasonable. After all, he's the one that was responsible for making your food! But what if its not all his fault? What if his support staff was overworked and cutting corners? What if the restaurant management was bad? Maybe the server messed up your order, or his working conditions are poor. What if he's overworked and underpaid? If all that is true, then simply replacing him might improve the food quality temporarily, but in order for things to improve in the long-term, something would have to done about the restaurant as a whole, starting with where the problem came from in the first place.
One of the most essential questions to be asked about hypothyroidism is: where did it come from? What caused it? Worldwide, the most common cause of hypothyroidism is iodine deficiency, but in the United States, where nutritional deficiencies are uncommon, 90% of hypothyroidism is the result of an autoimmune process.
Read that again. 90% of hypothyroidism is a direct result of the person's own immune system attacking their thyroid gland.
Think of the chef in the metaphor above. How well do you think he could cook your food if someone was beating him up with a bat? Probably not very well.
Autoimmune thyroiditis, also called Hashimoto's disease, is a condition in which the immune system produces antibodies against thyroid tissue, causing destruction of thyroid cells and ultimately compromising the ability of the thyroid to crank out enough hormone to satisfy the needs of every cell in the body. In order to find out if this autoimmune process is taking place, two blood markers are drawn: anti-TPO antibodies and anti-thyroglobulin antibodies. If elevated, thyroid destruction is taking place.
Poor thyroid. It's not his fault!
Are you starting to see how simply replacing thyroid hormones is only one piece of a much larger puzzle that involves many other body systems as well?
1. Thyroid gland health: Enzymes within the thyroid must have the proper co-factors and nutrients to create thyroid hormone. Being shorted even ONE of these essential co-factors will gum up the whole process.
2. Immune system regulation & gut health: Intestinal permeability is associated with a wide array of autoimmune conditions. The creation of antibodies against thyroid tissue and thyroid gland destruction starts with chronic inflammation in the gut.
3. Adrenal health: Cortisol is a hormone produced by the adrenal glands in response to stress. High cortisol levels have been shown to negatively impact the the cross-talk between the pituitary gland in the brain and the thyroid.
4. Liver health: The hormone the thyroid produces, T4, is inactive. It must be converted to its active form, T3, in order to be of any use in the body. Guess who is responsible for 60-70% of that conversion? The liver!
5. Cell receptor sensitivity: Every cell in the body has receptors for thyroid hormone, but that doesn't necessarily mean uptake is always perfect. The density and receptivity of cellular receptors for thyroid hormone can increase or decrease depending on a wide array of factors.
As an ND, my goals are not to replace physiology, but to address the root cause of disease and optimize function so you can live your best possible life.
Want to work with me? Book your first appointment online or call 847-744-8484