Hormone Imbalances 101: Thyroid
Welcome back to the third week in our Hormone Imbalance 101 series where we’re diving in to common hormone imbalances and how to identify associated symptoms so you can make the first step towards feeling alive again.
Last week we talked about estrogen dominance, what that means, and common symptoms associated so if you missed that, check it out here.
This week we are covering the hormones and disorders associated with the pituitary gland, a gland that produces a hormone essential for thyroid function, and of course, the thyroid, a butterfly-shaped gland in your neck that produces essential hormones responsible for regulating blood pressure, body temperature, heart rate, and metabolism.
These disorders can lead to your thyroid producing either too little (hypothyroidism) or too much (hyperthyroidism) hormone. Since thyroid hormones affect everything from heart rate and mood to metabolism and bone health, any imbalance can have widespread effects on your body.
Understanding Thyroid Functions and Disorders
The thyroid produces essential hormones like T3 (triiodothyronine) and T4 (thyroxine). These hormones regulate blood pressure, body temperature, heart rate, and metabolism. The gland also makes calcitonin, which helps bones absorb calcium. However, the thyroid doesn’t work alone; it is closely regulated by the pituitary gland, a small gland at the base of the brain. The pituitary releases thyroid-stimulating hormone (TSH), which signals the thyroid to produce T3 and T4. If the pituitary gland isn't functioning properly, it can affect TSH levels and subsequently disrupt thyroid hormone production.
Common Thyroid Disorders
Hyperthyroidism: This condition, often leading to Graves’ disease, involves an overactive thyroid. Symptoms can include sweating, irregular heartbeat, weight loss, bulging eyes, and nervousness.
Lab Trends: TSH low, T4 and T3 high
Hypothyroidism: With this condition, the thyroid doesn't produce enough hormones, leading to symptoms like fatigue, weight gain, and depression. The most common cause is an autoimmune reaction where the body attacks its own thyroid.
Lab Trends: TSH high, T4 and T3 low
Hashimoto’s Thyroiditis: This autoimmune disorder causes inflammation in the thyroid, potentially leading to a goiter (swelling in the neck). Symptoms include weight gain, fatigue, hair loss, dry skin, irregular menstrual cycles, depression, and constipation.
Lab Trends: same as Hypothyroidism, but with presence of thyroid peroxidase antibodies (TPO) and thyroglobulin antibodies (TgAb)
Reasons Why Thyroid Conditions, specifically Hashimoto’s, Gets Missed in Conventional Medicine
Thyroid Levels Not Tested
Hashimoto’s disease often presents with symptoms that can be vague and easily attributed to other causes like stress, aging, or unrelated health issues. Consequently, doctors may dismiss these symptoms as common "women's issues" or attribute them to other conditions like iron deficiency-related fatigue, especially in younger patients. Typically, doctors don’t start checking thyroid levels until patients are in their 40s or 50s. Additionally, if a patient has another autoimmune disease, doctors might focus on that condition, neglecting to check thyroid levels.
Incomplete Thyroid Panel
Even if your doctor runs a thyroid test and finds your thyroid levels normal, they might not have conducted a comprehensive panel. Conventional doctors usually check only Thyroid Stimulating Hormone (TSH) levels, the standard test for diagnosing and treating thyroid dysfunction. However, TSH alone doesn’t provide a complete picture. For a thorough diagnosis, Free T4, Free T3, and Reverse T3 levels should also be tested.
Here's what each measurement indicates:
Free T4 (FT4): The storage form of thyroid hormone, indicating how much T4 is available in the bloodstream for conversion to active hormone.
Free T3 (FT3): The active form of thyroid hormone, essential for cellular metabolic processes. Low conversion from T4 to FT3 can cause hypothyroidism symptoms.
Reverse T3 (RT3): Acts as a brake on metabolism by blocking FT3 receptors, which can lead to hypothyroid symptoms if RT3 levels are high.
Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb): Elevated levels of these antibodies suggest Hashimoto’s disease, an autoimmune condition attacking the thyroid.
A complete thyroid panel includes tests for TSH, Free T4, Free T3, Reverse T3, TPOAb, and TgAb.
Optimal Reference Ranges Not Used
Even with a complete thyroid panel, results might not indicate Hashimoto’s or thyroid dysfunction if your doctor relies on outdated “normal” reference ranges, which can be too broad. These ranges were initially established using data from individuals who already had thyroid dysfunction. In 2003, the American Association of Clinical Endocrinologists recommended narrower reference ranges, yet many doctors and labs haven’t adopted these updated standards.
For optimal thyroid health, consider these reference ranges:
TSH: 1-3 uIU/mL
FT4: 1-2 ng/dL
FT3: 3-4 pg/mL
RT3: 25-30 ng/dL
TPOAb: Less than 9 IU/ML or negative
TgAb: Less than 116 IU/mL
These tighter ranges focus on achieving optimal health and aim to identify imbalances or signs of dysfunction, even if the results are within the broader, conventional reference range that conventional doctors do not see as problematic.
Managing Thyroid Health
Diet Changes
Your diet should revolve around whole, unprocessed or minimally processed foods whenever possible.
Food intolerances that can cause an inflammatory response should be taken into account and removed from diet.
Should you go gluten or dairy free?
Some functional practitioners will reference studies that suggest the removal of these food groups being a key part of putting Hashimoto’s into remission, however there are flaws in these studies including methodology of how the study was conducted and sample size. A meta-analysis as recent as 2022 cited “doubtful justification of the gluten-free diet in the course of Hashimoto’s disease” after reviewing many of these cited studies.
The meta-analysis mentioned the reasoning behind this interpretation being due to the presence of other comorbid autoimmune diseases in this population — such as celiac disease.
Multiple studies have found that around 2-4% of people with Hashimoto’s disease also have celiac disease, in which case gluten should be completely eliminated.
This is going to be different person to person and if someone specifically has an intolerance to these foods. An elimination diet protocol can be completed to determine which foods cause adverse reactions, such as GI distress including bloating, constipation, diarrhea, and gas. Adverse reactions are not limited to GI distress, it can also present with skin rashes or acne, and even poor cognitive function often referred to as brain fog. If you notice these symptoms when adding certain foods back in, avoid them in the future to manage symptoms.
Reducing or cutting out alcohol and/or cigarettes completely.
These changes will reduce inflammation and help aid your journey in achieving remission of Hashimoto’s symptoms.
Lifestyle Changes
Stress Management through restorative activities like spending time outside and yoga, allowing yourself to rest if not feeling up to the challenge
Getting plenty of sleep, allowing your body to recover each day
Staying active, primarily through low to moderate intensity exercise like strength training, although this is a general statement and can be different for each individual.
Medication and/or Supplementation
Medication (pharmacotherapy): regular intake of your prescribed thyroid hormone medication with routine bloodwork to monitor hormone levels and ensure dosage is effective.
Supplementation
Vitamin D, B12 — there is a high incidence of low vitamin D and/or B12 in people with Hashimoto’s. A blood serum test can be done to determine if supplementation is needed.
Zinc and Selenium — these have anti-inflammatory benefits and are used in the conversion of T4 to T3 and has been shown to reduce TPO antibody levels.
N-Acetyl Cysteine (NAC) — has been shown to reduce thyroid antibodies, support detox pathways and improve overall gut function.
Disclaimer: always consult with a trusted physician prior to a change in diet or adding new supplements to your routine.
If you suspect you have a thyroid disorder, consult a qualified health professional. You can also contact our team for testing needs and guidance in making changes to help manage this condition.
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See ya next week when we talk about Polycystic Ovary Syndrome (PCOS)!
xx,
Ashley Trawick | Owner & Head Coach
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