Do you feel exhausted and sluggish despite having a full night’s sleep? Do you lack motivation to do anything and just want to go to bed and rest? Do you also find yourself increasingly forgetting where you parked the car, where you placed your keys, or why you went to the fridge or pantry? Do you suffer from other symptoms such as hair loss, cold hands, difficulty losing weight, depression, or anxiety, constipation, and hormonal imbalances? Do you need to know what’s going on and why?
If this is you, you might have already attended your doctor’s clinic, and after having a blood test, received a diagnosis of hypothyroidism. You most probably felt relieved at finally receiving a reason for your symptoms, and comforted when given a prescription for medication (usually synthetic thyroxine). You undoubtedly left the clinic with hope that once again you will feel “normal” again… at least sometime in the near future.
However, after some short-term relief and improvement in your symptoms, your symptoms may have returned, accompanied by new ones, which were not there previously, despite the hormone levels looking better on test results. Also, your doctor, more often that not, may be struggling to find the right dosage and the right thyroid medication for your condition.
What is the thyroid and what does it do in your body?
SLXLM
Before we can understand why you are feeling so unwell, lets start learning the basics of what the thyroid gland is and how it functions. This gland is a butterfly-shaped organ located in the base of your neck. It is your body’s engine as it secretes hormones that control your metabolism i.e. the way your body uses energy. Accordingly, these hormones are involved in the regulation of your heart rate, breathing, body temperature, body weight, cholesterol and blood sugar levels, menstrual cycle, muscle strength, the function of your central and periphery nervous system, and much more.
This gland uses the iodine present in the foods we consume, to make the thyroid hormones, Thyroxine (T4), and Triiodothyronine (T3). T3 is the main active hormone and approximately 5-times more powerful than T4, and is produced by the conversion of T4 to T3 by an enzyme that is selenium-dependent. When the blood levels of these two hormones are low, the hypothalamus, in the brain, produces Thyrotropin Releasing Hormone (TRH) that is responsible for signalling the pituitary gland to secrete increased amounts of the hormone, Thyroid Stimulating Hormone (TSH). The function of this latter hormone is to alert the thyroid gland to produce more T4 and T3. Conversely, if the blood thyroid hormone levels are high, less TSH is released to slow their production. Therefore, in summary, a high TSH is usually an indicator of hypothyroidism and low blood hormone levels, and a low TSH, an indicator of hyperthyroidism and high blood hormone levels.
Often the doctor gauges how the thyroid is doing by testing levels of TSH alone (most of the time) or coupled with T4. From the above, this makes perfect sense, as does the prescription for levothyroxine (synthetic T4 or L-T4), to increase the T4 blood levels and get the body back into balance. So then, why are you not feeling better? Shouldn’t the medication bring the hormone levels back to normal and eliminate the presenting symptoms? You would think so.
Why am I not feeling better?
L-T4 is NOT a magic pill. Although low levels of thyroid hormones can definitely produce symptoms, and hormone replacement might very well reduce their impact, the low levels of T4 may not be the cause of the condition, just a consequence of it. Accordingly, taking the prescribed medication may not address the underlying root cause, leading to a progression of the condition, despite the doctor’s best efforts.
Indeed, thyroid medication rarely addresses an autoimmune condition. Hashimoto’s Thyroiditis (HT) is the number one cause of thyroiditis (inflammation of the thyroid gland), the most common autoimmune disease, the most common endocrine disorder, as well as the most common cause of hypothyroidism, and yet frequently goes undiagnosed with only a standard TSH and T4 blood test. This condition, which affects women 7 times more than men, is characterized by the production of autoantibodies, such as Anti-Thyroid Peroxidase (Anti-TPO) and Anti-Thyroglobulin (Anti-Tg) antibodies, and the immune system attack of healthy thyroid tissue. Over time this causes inflammation and the progressive destruction of the gland, thus decreasing its ability to produce thyroid hormones. Why does this happen? One major reason could be if you are suffering from a leaky gut. If this is the case, partially digested food particles, microbes, viruses, bacteria, and toxins are able to escape from the gut into your bloodstream triggering an immune system response, which might eventually mistakenly attack your thyroid tissue. Therefore, as this is a disease of the immune system rather than of the thyroid, replacement with thyroxine will not halt the immune attack, and the ultimate progression of the condition. In other words, L-T4 is a symptomatic treatment, rather that one that addresses the pathogenesis of HT. Furthermore, if your TSH level is in the normal ranges, and the doctor has failed to test for autoantibodies, you might be told you are “fine” and sent home with an antidepressant and no explanation for all your symptoms.
So does that mean that I have HT?
Not necessarily. There are several other reasons why hormone replacement may not be the panacea that we hoped, and why the underlying reason for your condition may go undetected with the standard blood tests. A few reasons might be:
- The thyroid receptors, located on every cell in your body, and essential for the uptake of thyroid hormones by the cell, may have reduced sensitivity. This can occur as a result of inflammation and damage to the cell membranes. The reduction in T3 uptake causes the pituitary gland, through its secretion of TSH, to repeatedly alert the thyroid gland to make more hormones in the hope that some will be utilised by the cells.
- You might be producing sufficient amounts of T4 but its conversion to T3 is poor. The ensuing low T3 levels in the blood may stimulate the production of TSH in the hope that the increased production of more T4 may ultimately raise the levels of the active hormone. These low T3 levels can be caused by increased chronic stress and inflammation, active infection, blood sugar imbalances, or poisoning with heavy metals such as mercury, lead and cadmium, pesticides and fluoride, as well as exposure to radiation.
- High stress levels and inflammation can elevate cortisol levels, resulting in the conversion of T4 into the inactive analogue of T3, known as reverse T3 (rT3), which blocks the thyroid receptors and renders T3 less active.
- The synthesis of thyroid hormones is dependent on adequate iodine intake from the diet, and conversion of T4 to T3 requires such cofactors as selenium and zinc. So a deficiency of these minerals can also cause low levels of the active hormone.
- The increase in cortisol levels, as a result of inflammation and stress, can affect, over time, the action of the pituitary, resulting in its reduced ability to release adequate TSH. This therefore is not a problem with the thyroid gland, but rather one of miscommunication between the brain and the thyroid.
- Your medication may have cross-reactive ingredients like corn or dairy. Indeed, traditional L-T4 tablets contain a variety of excipient ingredients, such as food dyes, magnesium stearate, alcohol, povidone and talc that can cause allergic reactions. If you form antibodies to these individual foods and substances, these same antibodies will react to the medication, causing you to feel unwell with headaches, fatigue, congestion and other symptoms.
- If you have a leaky gut and a sensitivity to gluten, the gluten antibodies produced may cross-react with the thyroid tissue causing its destruction. This occurs due to the similarity of the gland’s proteins to the fragment gluten peptides that have leaked into the blood stream from the gut .
- Thyroid hormones are transported in the blood by a protein known as Thyroid Binding Globulin (TBG). When thyroid hormones are bound to this transporter, they remain inactive, and not available for cell uptake. If the levels of TBG are high, there will be less metabolically active free T3 and T4 available, and more that are bound, leading to symptoms of hypothyroidism. In this case the levels of both TSH and T4 will be in the normal range. Interestingly, high TBG levels can be a result of high oestrogen levels often associated with the oral contraceptive pill or oestrogen replacement therapy. Accordingly, treatment for the hypothyroidism in this case, is the clearance of excess oestrogen, and/or the possibility of cessation of oestrogen medications.
So what can I do?
SLXLM
As you can see from the above, there are varied reasons for hypothyroid symptoms. It is therefore essential for your treating practitioner to uncover the root cause of your symptoms to ensure correct treatment. This is done by ordering a full thyroid panel that includes TSH, free T3, free T4, T4/T3 ratio, rT3, and thyroid autoantibodies. Testing for TBG, leaky gut and gluten sensitivity might also be beneficial. Furthermore, once the underlying cause has been discovered, treatment should be tailored for the individual and not just centered around hormone replacement. It should include diet, lifestyle, nutritional supplements and herbs that address the thyroid, adrenals, gut and brain. If there is a leaky gut, this should be repaired.
If you feel that this blog has touched a chord with you, and you would like to find out why you are experiencing these symptoms, please do not hesitate to contact me. Also, if you have still not read my other blogs, please click here. Furthermore, I have a facebook page that not only shares some of my blogs and videos but provides valuable health information. If you gain insight from some of the contributions, don’t forget to click on the “Like” button.
For references and further reading:
Caturegli P, et al, (2014). Hashimoto thyroiditis: Clinical and diagnostic criteria, Autoimmune Reviews,
http://dx.doi.org/10.1016/j.autrev.2014.01.007
Endocrine Web (2013). Hypothryoidism. What you should know about your treatment. Retrieved from: https://www.endocrineweb.com/conditions/hypothyroidism/hypothyroidism-what-you-should-know-about-your-treatment
Kawicka, A., & Regulska-Ilow, B. (2015). Metabolic disorders and nutritional status in autoimmune thyroid diseases. Advances in Hygiene & Experimental Medicine/Postepy Higieny i Medycyny Doswiadczalnej, 69.
Schilling, R. (2016). Low Thyroid (Hypothyroidism). Retrieved from: http://www.askdrray.com/low-thyroid-hypothyroidism/