The thyroid gland is a butterfly-shaped gland that is positioned at the front of the neck near the Adam’s apple, producing thyroid hormones called T4 and T3. The thyroid gland has effects on not only the metabolism, but also on the heart, brain, bones, colon, and skin/hair. The thyroid makes the hormones that circulate around the body and do their thing.
What Does the Thyroid Do?
The thyroid gland governs our metabolism. Metabolism is the process that is going on in our bodies every moment and is responsible for turning food and drink into energy. It all happens in our cells and the rate of energy expenditure is regulated by the thyroid hormones.
The two main abnormal states of the thyroid gland (thyroid disorders) are either hypothyroidism (under functioning thyroid gland) or hyperthyroidism (over functioning thyroid gland). Hypothyroidism is more common than hyperthyroidism and sometimes they overlap, especially when a woman has Graves’ disease and is transitioning into a hypothyroid state. One in 13 Americans have thyroid disorders, and one in 20 are undiagnosed in the US. Whereas, one in 100 women are diagnosed with hyperthyroidism in the US.
In hypothyroidism, the levels of T4 and T3 are low so the brain gets a signal that there is not enough hormone and it signals the thyroid to make more. This signal from the brain is called thyroid stimulating hormone (TSH), so TSH goes up. In hyperthyroid states, there is a lot of T4 and T3 circulating around, and the brain then shuts down communication to the thyroid gland and TSH goes down.
- Mental fog/depression
- Inability to lose weight despite effort
- Hair shedding
- Dry skin/dryness all over
- Irregular menstrual cycles
- Cold intolerance
- Raynaud’s disease
- Mental fog
- Increased sweating
- Weight loss despite eating a lot
- Hair loss
- Heart racing
- Shortness of breath
- Bulging eyes
- Blood glucose irregularities or what feels like hypoglycemia
How to Test for Thyroid Issues
Testing for thyroid disease is very simple and serum blood testing is best. I recommend that patients have blood tested without their thyroid medication on board and first thing in the morning. However, timing is everything and consistency is also important, so do it the same every time. Also, it is important to avoid Biotin, L carnitine and iodine supplements for one week prior to the blood draw.
When testing for thyroid disorders my go-to lab testing includes but is not limited to:
- Free T4
- Free T3
- Reverse T3
What Causes Hypothyroidism?
Hypothyroidism can be caused by autoimmune antibodies to the thyroid gland such as Hashimoto’s thyroiditis (1-2% of middle aged women in the US have this type). It can also be caused by the following:
- Too much iodine or too little
- Toxic exposure/environmental toxins
- Surgical removal of the thyroid
- Viral infection/inflammation
- Certain diseases such as hemochromatosis, sarcoidosis or amyloidosis
- Brain injury that affects the pituitary gland
I am always curious about why so many middle aged women are diagnosed with Hashimoto’s in particular and know that there must be other hormones involved that science has yet to figure out.
In my practice, when a woman comes in for Hashimoto’s treatment, I almost always use the pharmaceutical T4 and T3 products such as Tirosint and Cytomel, and infrequently use Armour or other desiccated thyroid products. The reason for this is that the proteins in the natural products can stimulate the antibodies of the patient’s immune system which often renders her feeling overstimulated and inflamed as well as under treated.
Lab values will also be unpredictable. In my practice I have used many variations of products to support the hypothyroid woman and have been known to combine the natural and pharmaceutical products. I do whatever it takes to optimize her quality of life as well as lab test parameters.
Thyroid Disorder Treatment
Treatment options for the hypothyroid patient are much more abundant than those of the hyperthyroid state. For hyperthyroidism, I have had great results using herbal tinctures specifically for hyperthyroidism. In addition, L carnitine can be very helpful, along with improving digestion and addressing adrenal function. Iodine can be considered, and I do this on a case-by-case basis.
The prescriptions Propylthiouracil and Methimazole, are great solutions for patients who cannot find relief from these foundational approaches. These drugs do inhibit biochemical enzymes in the thyroid gland and in other cells to prevent T4 and T3 action or manufacturing.
The thyroid hormones, T4 and T3 are simply a tyrosine molecule surrounded by iodine (T4 is Tyrosine with 4 Iodine molecules and T3 is Tyrosine with 3 Iodine molecules). Contrary to what Dr Google or the rumor mill says in doubt of the pharmaceutical industry, the commercial ‘synthetic’ products such as Synthroid, Tyrosint, and Cytomel are nearly bioidentical. These amino acid-based hormones are very simple, and outside of binders and fillers and some synthetic coloring for marketing purposes, the actual hormone preparations are just like what our body makes. The cleanest products are Tyrosint and Cytomel, but the 50 mcg Synthroid also has no food coloring in it.
The glandular or ‘natural’ thyroid products such as Armour thyroid are wonderful products as well. I find it interesting that Armour thyroid has such a bad reputation. Is it because it is a patented product that the pharmaceutical industry makes? I love the product and it is reliable for dosing. Sure, it has more fillers and binders than some of its competitors and I do love the other products as well and use them preferentially when they are available. But, as long as the pharmaceutical world continues to fight one another over equal rights, products will come and go, so it is important to be flexible and to find a doctor who can shift to other solutions when labs, patient symptoms, and product availability change.
Balancing Thyroid Hormones and Treatment Options
Having had Hashimoto’s thyroiditis myself, I feel strongly about ensuring that each of my patients’ treatments are optimized for the best symptom relief. I competed nationally, went to medical school, and had children with an undiagnosed and untreated thyroid condition. Eventually, when I did start treatment (Synthroid/Cytomel) over 20 years ago it was like a switch was flipped and the lights of my life turned on. Prior to that I struggled so much with everything, and in hindsight I realized the impact that a lack of diagnosis and a lack of treatment had on many aspects of my life. I do not want any woman to experience this as there is no reason they should.
When a patient comes to see me and may need thyroid support, it is an individualized process in which we engage. I look at comprehensive blood work, do a physical exam, and listen carefully to the patient’s symptoms. I discuss all the options and together we begin working on a plan to establish balance in thyroid function.
I use a combination of lab results and symptoms to come up with a treatment plan. For those afraid to take medications, I support their choices and give my advice medically on how to optimize function naturally, if possible. However, sometimes that is not an option. Medications can be helpful, and they are safe. Either way, foundational work on diet which impacts the thyroid greatly, supplements, and balancing the overall hormone cascade is essential.