Thyroid Issues Are RARELY Thyroid Issues

When hypothyroid labs show up, the originating issue is rarely inherent to the thyroid. The thyroid is merely the place where the problem gets noticed. The real issue is not THAT you have hypothyroidism, but WHY. Assessing root causes expands understanding for your health and points you in the direction of change. 

Coke is IT! 

We live in a consumer society under constant competition for our attention and dollars. The science of marketing understands most successful brands sell us an identity. It isn't simply Coke versus Pepsi; it’s what choosing Coke or Pepsi says about you. Over time, we don't just purchase a brand, we are the brand.

That same psychology shockingly can creep into medicine, and with greater consequences. A diagnosis becomes more than a description of physiology; people absorb it as their identity. The message a patient can walk away with is: My thyroid is broken. My body is the problem. I will need medication forever. For some people, lifelong thyroid hormone replacement is absolutely necessary. But the diagnosis without root cause analysis can stop being a medical finding and become something much more powerful: an identity. You have been branded.

Hypothyroidism - Root Cause 

Your thyroid didn’t suddenly betray you. Let’s carefully consider the physiology of the thyroid. Hypothyroid means the TSH (Thyroid Stimulating Hormone) is elevated. This means thyroid hormone output is trying to be enhanced. Why would your thyroid be sluggish? There are several reasons. 

Maybe you just had a major event in your body. I once had a woman who had gone through a surgery 4 weeks prior to drawing her thyroid labs. Of course the labs were showing hypothyroid (elevated TSH), she JUST had surgery. Understandably, the metabolic healing response was being influenced by the thyroid. Supporting the thyroid with medication during a healing period is appropriate, but branding the person as life-long hypothyroid and proclaiming the need for permanent medication is the misstep. 

When someone presents with hypothyroidism, asking about major infections, hospitalizations, and stress events is vital, as the thyroid is responding to events in the body. Asking deeper questions to understand the dynamic will give you information to better create a timeline for restoration. This gets away from branding you as “broken” and your new identity as hypothyroid.

Stress 

Cortisol is a stress hormone secreted by adrenal glands (these live right above the kidneys). It naturally wakes us up at dawn and gradually decreases throughout the day, the lowest point being dusk when we can’t keep our eyes open and it’s bedtime. Under emotional stress, cortisol is released at various times along with adrenaline (epinephrine and norepinephrine). Prolonged stress has a major impact on the thyroid (https://pubmed.ncbi.nlm.nih.gov/233400/)

Cortisol and Reverse T3

T4 must convert to T3 in your tissues. T4 is an inactive thyroid hormone and must be converted into T3, which is the active thyroid hormone. Under stress, cortisol shifts this thyroid hormone production to make Reverse T3 (rT3) a permanently inactive thyroid hormone. You can measure the Reverse T3  in the blood, but unfortunately it is not commonly run with a normal thyroid panel. It is not expensive, the average cost is well under $50. 

Cortisol also has a major influence on the brain during times of stress by inhibiting the hypothalamus secretion of TRH (Thyroid Releasing Hormone) and pituitary secretion of TSH (Thyroid Stimulating Hormone). TRH encourages pituitary secretion of TSH, which stimulates the thyroid gland, as its name implies. We classically know TSH elevations indicate hypothyroidism, because the thyroid gland is not responding efficiently to the TSH. Think of a boss yelling at you because you are not doing enough work. However, sometimes the TSH is actually understimulating the thyroid, and is simply just low, as when cortisol is downregulating the brain’s response. When we NDs look at TSH, Free T3, Free T4, and Reverse T3, we assess all of this interconnectedness. With thorough thyroid lab testing, this can be achieved.

The Thyroid’s Groceries

One of the first things we think about when thyroid hormones are low, is nutrient depletion. The production of thyroid hormones depends on several key nutrients working together. The amino acid tyrosine is incorporated into thyroglobulin, the structural backbone to which iodine is attached. The number corresponding to T4 and T3 indicate how many iodines are attached to the thyroglobulin backbone. In fact, iodine is the rate-limiting-step for the formation of thyroid hormone. This means, if iodine is not present, thyroid hormone production does not happen. For example, consider baking cookies. If you run out of sugar, you cannot make more cookies. Sugar would be the rate limiting step. 

Iron is required for the activity of thyroid peroxidase (TPO), the enzyme used to make T4 and T3. Because TPO uses hydrogen peroxide for this process, selenium is essential for reducing oxidative stress inherent to this process. Selenium is also the cofactor or car key for converting T4 into T3 by Deiodinase, the enzyme that cleaves off an iodine from T4 to activate it to T3. Deiodinase is found in the thyroid and all over your body. Without selenium, this enzyme does not run. Often you will see a low or low-normal value for Free T3 in labs, compared to adequate or even high-normal Free T4.

Zinc contributes to normal thyroid hormone synthesis, TSH signaling, and thyroid hormone receptor function, while vitamin A supports regulation of the hypothalamic-pituitary-thyroid axis and normal thyroid hormone signaling. 

That is a lot of groceries! Iodine is found in seafood, seaweed, dairy foods, and eggs. Selenium-rich foods include Brazil nuts, seafood, meats and eggs. Zinc is abundant in oysters, beef, crab, pork and pumpkin seeds, while vitamin A and its carotenoid precursors are found in liver, orange vegetables and dark leafy greens. As you can see, some of these foods are not plentiful in the standard American diet. 

Autoimmune Issues

Antibodies to TPO and thyroglobulin elevate years before the thyroid gland truly malfunctions. In naturopathic medicine, we commonly pull these antibodies to determine what kind of stress can be influencing the thyroid. We actually try to prevent autoimmune hypothyroidism whenever possible. This is why we add the thyroid antibody study to a thyroid panel. When someone has developed an autoimmune programming on their thyroid is huge. It presents the main direction for therapies - see my article, “Why Eliminating Gluten and Dairy is Important for Your Thyroid”. Even if you have autoimmune hypothyroidism (known as Hashimoto’s) and have been put on medications, it is important to work on balancing the immune system.  Tracking the antibody changes as you work to heal the thyroid is a great strategy. You CAN reduce thyroid antibodies with diet change and immune adaptogens.

You are not broken! 

As you can see, assessing root cause gets you the information you need to understand your thyroid, stress, nutrition, immune response, and general health. Hypothyroidism is not your brand identity. Knowing the reasons why you are presenting with hypothyroidism is where you can empower yourself for healing and thriving. You are capable of change and healing! Don’t stop your investigation into the root cause at the diagnosis. 

See my recommendations for thyroid support here: 

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