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Your Thyroid is a gland that is located in the front of your neck and extends in a butterfly fashion to both sides. Being a gland, it produces hormones that are excreted into your blood, which then travel to all the parts of your body effecting their function. The main function of thyroid hormone is to produce energy for the body. It does this by many physiologic effects on various organs and cells throughout your body.
Hypothyroidism (low thyroid) is a very common disorder and anyone can develop it, but people who are most at risk include those who are over age 50 and female. However, only a small percentage of people have full-blown hypothyroidism. Many more have mildly under-active thyroid glands (sub-clinical hypothyroidism).
The most common cause of hypothyroidism is an inflammation of the thyroid gland called Hashimoto’s Thyroiditis. This inflammation is characterized by the body’s production of antibodies that attack and destroy the thyroid gland. It is essentially an autoimmune disorder. There are known causes that produce these antibodies, which can often be reduced utilizing a Functional Medicine approach.
Other causes include a viral infection that attacked the thyroid gland. Radiation to the neck can damage the thyroid cells. Radioactive iodine that is used to treat an overactive thyroid gland typically destroys the gland, which then makes it under-active. Certain medications can interfere with the production of thyroid hormones directly or by causing a reduction in the required nutrients that produce the thyroid hormones. A decreased amount of the required nutrients, due to poor dietary intake, can also cause low thyroid activity. Adrenal stress is another major issue that can cause thyroid problems and must be addressed in order for the thyroid to properly function.
Adrenal issues can be a major problem for some individuals. Your adrenal glands secrete cortisol whenever you are stressed. High cortisol levels impede the conversion of T4 to T3. If this issue is not corrected, you may feel worse when taking a thyroid hormone supplement.
Being the thyroid is the main gland that produces energy, the symptoms of an under-active thyroid are correlated with the body’s loss of that energy.
• Weight gain, despite diminished appetite
• Dry skin
• Brittle nails
• Coarse hair, hair loss
• Feeling cold, cold hands and feet
• Menstrual irregularities/PMS/infertility/endometriosis, heavier/lighter periods.
• Decreased memory and difficulty concentrating
• Low sexual desire
• Muscle and joint pain
• High cholesterol
• Swollen legs, feet, hands, abdomen and face
• Hoarse voice
The thyroid gland is stimulated by Thyroid Stimulating Hormone (TSH), which is produce by the pituitary gland. This stimulates the thyroid gland to produce thyroxine (T4). The T4 is then converted, primarily in the liver and other places, to triiodothyronine (T3). T4 is inactive and considered the storage form of thyroid. T3 is the active thyroid hormone in your body. Just from this, you can see where issues can arise that will cause a low T3 in your body. Is the thyroid being stimulated to produce hormone? If it is stimulated, can it make T4? If it makes T4, can the body convert it to T3?
As one can see, there are various places for things to go wrong that would cause the body not to obtain the needed active T3. A major issue can be a deficiency in the nutrients and or enzymes that are required all along the way to get to T3.
Another very important, and often overlooked, issue is the production of reverse T3. Normally, the majority of T4 is converted to active T3. T4 can also be converted to reverse T3. Some of this occurs naturally, but when done in excess, it will cause all the symptoms of hypothyroidism as it blocks the active T3. Unfortunately, many clinicians do not measure the reverse T3.
Thyroid hormone conversion problems can be caused by a number of common issues, including significant stress, depression, a history of dieting, insulin resistance, obesity, diabetes, chronic fatigue syndrome, fibromyalgia, autoimmune diseases, chronic inflammation, chronic infections, PMS, iron deficiency, and many more. Any one of these issues could cause a patient to have too much RT3 or an improper T3/RT3 ratio.
The first thing is to find a clinician that understands, and measures reverse T3. A common issue is that a patient will be given T4 supplements, for a low thyroid diagnosis, yet continues to feel bad and can even become worse on higher dosages of T4 supplementation. Why? Because by giving pure T4 to a person that is unable to correctly convert it to active T3 will only push the conversion to inactive or reverse T3. The lab work obtained will continue to look “normal”, you will be told you are ‘normal”, but you will continue to feel bad.
Most physicians prescribe synthetic thyroxine, T4. Although this may adequately treat some people, this approach will not work for people who have difficulty converting T4 to T3 or those who convert to reverse T3.
First of all, adequate testing must be obtained. That means obtaining not just a TSH and T4 level, which unfortunately are the most common and only screening tests used by clinicians for evaluating thyroid disease. Once the results of the full testing are obtained, a proper course of treatment can then be initiated.
Treatment can range from just nutrient replacement to thyroid hormone supplementation, treating gastrointestinal issues causing nutrient deficiencies or treating adrenal stress issues.