Optimizing Your Thyroid

Every cell and organ in your body depends upon thyroid hormones for proper functioning.  It is the thyroid gland, a butterfly shaped gland at the base of the throat, that produces the hormones which regulate the basic metabolic rate of each cell—i.e., the conversion of oxygen and calories into energy.  Even a slight deficiency of thyroid hormone can have a significant impact on your health.  Signs of thyroid deficiency, or hypothyroidism, include the following:

FatigueFeeling coldLow sex drive
ConstipationPoor concentrationMenstrual irregularities
Weight gainBrittle nailsAches and pains
Dry skin & hairDepressionHair loss
ForgetfulnessAnxietyNeck and throat complaints

If those aren’t enough, underactive thyroids have also been associated with high cholesterol, heart disease, carpal tunnel syndrome, fibromyalgia, and impaired immune function.

We know that 20 million Americans are afflicted with some type of thyroid disorder, mostly an underactive thyroid.  This is one of those endocrine disorders that strikes women 5-7 times more often than men.  It is estimated that 1 in 8 women between ages 35 to 65 are affected, and after the age of 65 about 20% of women can be affected.  Of these numbers, millions who are diagnosed as hypothyroid are being undertreated or inadequately treated. They have been diagnosed and put on medicine, yet they still experience many of the above symptoms which took them to the doctor in the first place.  Just as unfortunate are the millions of individuals who are both undiagnosed and untreated.  They either are just living with their problems, or their trip to their doctor was fruitless in turning up a correct diagnosis of hypothyroidism.

To understand why so many people with underactive thyroids are undiagnosed or undertreated, let’s look at both the current understanding of how the thyroid system works and at the conventional medical approach to diagnosing and treating hypothyroidism. We’ll start with the basics of how the thyroid works.

The thyroid gland produces, stores and releases two key hormones: thyroxine (T4) and tri-iodothyronine (T3).  Depending on which text you read, they are produced in a ratio ranging from 80-95% of T4, to 5-20% of T3.  These hormones are made from the amino acid L-tyrosine combining with iodine.  The “4” and the “3” numbers refer to the number of iodine molecules in each thyroid hormone.  A key point about T4 and T3 is that T3 is several times more biologically active than T4.  In a process sometimes referred to as ‘T4 to T3 conversion’, the less biologically active T4 gets converted to the more potent T3 in the brain and body tissues.  

The thyroid ‘knows’ how much hormone to produce, store and release because of the influence of the pituitary and hypothalamus in the brain.  These are tiny organs in the brain that monitor bodily functions. Depending on what they sense, they release their own hormones that go on to further instruct the thyroid gland.  The hypothalamus makes thyrotropin releasing hormone, TRH.  This hormone goes to the other brain organ, the pituitary, to give it’s input on what the thyroid needs to do. Then, depending on what the hypothalamus ‘tells it’ and what it monitors of the thyroid hormone blood levels, the pituitary gland will produce thyroid stimulating hormone, TSH.  TSH goes to the thyroid gland where it causes the production, storage and release of more T4 and T3.  It’s like a circular biofeedback system.  Hopefully you followed this explanation and can now see how things can go wrong at several levels.

The conventional medical approach views an under-functioning thyroid almost solely as that of a damaged gland that doesn’t make enough thyroid hormone.  They diagnose hypothyroidism by checking the TSH value. The more severe the hypothyroidism, the higher the TSH, and the lower the T4.  In their world a normal TSH value is equal to thyroid health.  If the TSH is high, conventional practitioners will then prescribe a synthetic T4 (levothyroxine) to reduce the TSH value to normal, and to replenish the presumed too low levels of T4.  In their mind, once the TSH value is normal, the hypothyroid condition has been corrected and the symptoms should be resolved.  For many patients this approach works well enough.

Unfortunately, there are a significant number of people with under-functioning thyroids in which this approach will fail them.  The first big hurdle in failing to correctly identify an individual with hypothyroidism is the ‘tyranny of the TSH’ value.  A person may have classic signs and symptoms of hypothyroidism, but if their TSH values fall within the normal range, treatment is denied.  Even mainstream endocrinologists have questioned whether the range of the TSH lab values is too broad or interpreted too rigidly. The usual range of TSH values are from 0.3 to 5.5, however <2 is regarded by some experts as the value closest to normal.  A level near the upper limits of normal should be viewed with suspicion as it may indicate low-grade hypothyroidism.  If your TSH test is normal or high normal and you believe you may have hypothyroidism you may want to find a physician who will do additional tests—such as the TRH test or the antibodies test—to better evaluate your thyroid status.

Before labs were widely available, hypothyroidism was diagnosed by physical signs and symptoms, including one’s body temperature.  Although it is medically accepted that a lowered body temperature is a symptom of hypothyroidism, it is controversial to use that as a diagnostic tool.  Part of the objection is that there are other medical causes for lowered body temperatures.   Nonetheless, it is used by patients and less conventional physicians as a free diagnostic and monitoring method.  Dr. Broda Barnes popularized the use of the axillary  (underarm) basal body temperature (BBT), done with a mercury thermometer before arising in the morning (www.brodabarnes.org).  However, Dr. Denis Wilson advocates several daytime temperatures averaged over several days (www.wilsonssyndrome.com).

The second big hurdle to adequately treating under-functioning thyroids is the almost universal use of synthetic T4 (levothyroxine) for treatment.  As you will recall, it is actually T3 which the biologically potent thyroid hormone.  If you are being treated with T4 but can’t efficiently convert T4 to T3 then you’re going to be in trouble—thyroid trouble, and all the vague symptoms that can come with it.  The fact is that standard levothyroxine (T4-only) therapy leaves a substantial number of patients feeling sub-par, and they feel and function better when T3 is added.  This was established by a report in the New England Journal of Medicine, February 1999.  Interestingly, the most dramatic results of adding T3 were the positive effects on patients’ mental functioning.

To understand the historic perspective of why most physicians use only T4 preparations rather than T3, it helps to know that the company that produces the most popular form of synthetic T4 actually lost a multi-million dollar anti-trust lawsuit for teaching three generations of physicians a lie about natural thyroid.  The lie that they taught is that you can’t trust natural thyroid because the dosage strength varies from batch to batch.  However, that cannot be true because prescription medications must meet U.S. Pharmacopoeia standards, staying within 98-102% of potency.  However, most physicians never even heard of this lawsuit, so they continue to believe the lie and therefore continue to prescribe only synthetic T4, ignoring the potential benefits of adding T3.

There are several different ways T3 can be given to improve the well being of a person suffering form the effects of hypothyroidism.  It can be supplemented to the standard levothyroxine therapy in a synthetic form (Cytomel), or in a time-release form compounded at a pharmacy.  For many years a natural form of a T4/T3 combination made from desiccated animal thyroid (Armour, Westhroid, Naturthroid) has been successfully used.  There is also a synthetic version of a T4/T3 combination known as Thyrolar.  And in some cases a practitioner will use compounded time-release T3 alone.  The key is to find a practitioner interested and knowledgeable in prescribing these.

Once you have been diagnosed and begun on the proper medication in the proper doses there are still more things you can do to optimize your thyroid function.  To get the most from your thyroid medication, ensure the best absorption by taking it on an empty stomach in the morning about one hour before eating.  If you don’t take it this way at least take it in some consistent schedule so as to get stable blood levels of medicine.  Try to keep iron supplements and antacids 2 hours apart from your thyroid hormones, and calcium supplements 4 hours away.  The thyroid also seems to generally function better if a woman’s female hormones are balanced, especially having adequate amounts of natural progesterone on board.

You can also take steps to nourish and protect your thyroid.  Be aware that medications such as Lithium, corticosteroids, and the heart medication Amiodarone can interfere with your thyroid function.  Cigarettes contain thiocyanate, a chemical that acts as an anti-thyroid agent.  Some experts feel that the fluoride and chlorine in drinking water and the mercury in dental fillings can interfere with the thyroid’s ability to convert T4 to T3, resulting in hypothyroidism.  There are numerous other environmental toxins such as dioxins, PCB’s, perchlorates, and gasoline additives that are known to be thyroid toxic, but are so ubiquitous that they are difficult to control our exposure to.  This makes it all the more important that we take in the nutrients that can help support and nourish our thyroids.

If you have deficiencies in some key nutrients your thyroid may not function properly.  For instance, the trace mineral selenium is a crucial component of the enzyme that converts T4 to T3.  The following list provides guidelines for optimal daily intake:

Essential Fatty AcidsIodine 50-150mcgIron  10-15mg (if tested low)
L-tyrosine 500mgMixed carotenoids  5,000-10,000iuPyridoxine (B6)  25-50mg.
Riboflavin (B2)  15mgSelenium  100-200mcg.Vitamin C  1,000-2,000mg
Vitamin E  400iuZinc  20-30mg. 

Caution is particularly advised with your daily doses of iodine and selenium.  Too little, or too much of these nutrients will impair your thyroid function.  If you are taking iodine-containing herbs such as kelp, bladderwrack, bugleweed or glandular support formulas be careful of your total iodine level.  It may also be useful to avoid eating large amounts of raw foods containing goitrogens, substances that can impair the production of thyroid hormone.  Foods such as turnips, cabbage, broccoli, soybeans, peanuts, pine nuts, and millet are rich in goitrogens.  A nutritionist or nutrition oriented practitioner with experience in working with thyroid problems can advise you in the details of a total nutritional program that will support you thyroid function, and, in turn, your optimal health.   

If you suspect you are hypothyroid, or you are already diagnosed with it but feel there is room for improvement in your treatment, please find a practitioner who can properly assess and guide you towards more optimal thyroid function.  The proper medication in the proper doses, along with the right nutrients can do wonders for your mental and physical well being.

Useful resources: The Thyroid Solution, Ridha Arem, MD;  Living Well With Hypothyroidism, Mary J. Shomon, www.thyroid-info.com