Dr. Aarti Soorya
Dr. Soorya is a board certified Physical Medicine and Rehabilitation physician, who alongside the rest of the Natural Balance team, com... read more
The Thyroid Epidemic
Thyroid disorders affect an estimated 20 million of people in the U.S. Many people are not even aware that they have a thyroid problem, since the diagnosis is often missed. Thyroid disorders are considered to be on the rise, likely related to widespread nutrient deficiencies, exposure to environmental toxins, poor gut health, and the increasing prevalence of autoimmunity. Women are also much much more likely than men to develop thyroid disorders.
Not only are thyroid disorders often poorly diagnosed, they are often poorly treated. Conventional therapies often fail to address the underlying cause of disease. Even after being placed on thyroid medication for hypothyroidism (underactive thyroid), most commonly Synthroid (or levothyroxine), many patients will continue to suffer with symptoms. Their doctors may insist that if their blood levels are “normal” their symptoms can’t possibly be due to their thyroid. In my practice, I take holistic approach to treating thyroid, by searching for the root cause of disease, and using natural therapies to regain balance in the thyroid.
Functions of the Thyroid
So what exactly is the thyroid? It is a butterfly shaped gland that sits in the front of the neck and produces hormones which regulate the body’s metabolism. The hormones produced have far reaching effects that influence every system of the body. The main thyroid hormones are T3 and T4. T4 is the inactive form of the hormone and T3 is the active form. T4 must be converted to T3 in order to become active.
In general, thyroid disorders can lead to symptoms of either an under-active thyroid, known as hypothyroidism, and overactive thyroid, known as hyperthyroidism. When both sets of symptoms are present in varying degrees it is known as thyroid pendulum and is a good indication of autoimmune thyroiditis (Hashimoto’s Disease), see details below.
Hypothyroidism or under-active thyroid, symptoms may include:
Weight gain and difficulty losing weight
Thinning hair/hair loss
Swelling or puffiness
Hyperthyroid or overactive thyroid symptoms include:
Palpitations or racing heart
Weight loss and difficulty gaining weight
One reason that the diagnosis is often missed, is and incomplete lab work for thyroid disease. Many doctors will obtain only a TSH blood test, and if the level falls within the “normal” range then thyroid is considered to be working normally, even though this may not be the case. This is why I recommend obtaining a complete thyroid panel including TSH, free T3, free T4, Reverse T3, and thyroid antibodies levels. Of course, it is also important to look at other labs outside of the thyroid panel. When evaluating the TSH level and other labs, many physicians are looking to see only if it lies within the “normal” range and not necessarily the “optimal” range, which is also part of why many thyroid patients don’t feel “optimal.” Looking at the whole picture, including a patient’s symptoms and lab work, is necessary to accurately make the diagnosis and guide therapy.
Thyroid & Autoimmunity
The most common thyroid disorder is Hashimoto’s Disease or Hashimoto’s Thyroiditis. This condition affects one in eight women. Hashimoto’s Disease is an autoimmune condition, where your immune system attacks your own thyroid. The body produces antibodies against your thyroid tissue, as if it were foreign to the body, which leads to gradual destruction of the gland. It can cause hypothyroid symptoms AND hyperthyroid symptoms (thyroid pendulum) at varying times and can be very frustrating for patients. Hashimoto’s is diagnosed by elevated antibodies including thyroid peroxidase (TPO) and thyroglobulin (TGB) antibodies. Unfortunately conventional practitioners often fail to look for these antibodies on blood work. Why is this? Because it won’t change their overall treatment, whether you have hypothyroidism vs. hypothyroidism due to Hashimoto’s. But it will certainly change mine! In my opinion, this is a major failure of conventional medicine.
If you develop one autoimmune disease such as Hashimoto’s, it puts your at risk of developing another autoimmune disease, so further screening for other autoimmune conditions is also important. One very likely reason why autoimmune conditions are more and more prevalent by my observation is due to a condition known as “leaky gut” Food sensitivities are a common culprit or association with leaky gut. Certain foods in sensitive individuals can cause damage and inflammation to the absorptive surface of the gut, allowing larger molecules to pass from the gut into the blood stream that would not normally be able to pass. The flood of these “foreign” molecules kicks the immune system into overdrive, and the body will start attacking its own tissue such as the thyroid gland. Gluten is particularly common trigger for many people, especially as it pertains to Hashimoto’s. Other sensitivities include dairy, soy, corn, eggs, among others, which can be tested for with a food sensitivity panel. An important part of recovery is instituting an elimination/anti-inflammatory diet, getting rid of pathogens (if they are present) and repairing the gut in stages.
An autoimmune condition that causes pure hyperthyroidism, is known as Grave’s disease. The conventional therapies for this condition, include anti-thyroid medications, propylthiouracil and methimazole, radioactive iodine, and surgery. A functional medicine approach, necessarily approaches the same core issues as with Hashimoto’s disease, including leaky gut, toxins, infections, and nutrient deficiencies. In both of these autoimmune conditions, as well as any others that may be identified during a medical work up, it is important to support the immune system, which can be done with select nutraceuticals.
Another major problem with conventional thyroid treatment is that most thyroid patients are treated the same. As a rule hypothyroid patients are placed on Synthroid (or levothyroxine) which is T4, the inactive form of hormone. It is easy to see why this could be less than ideal, especially if the body has difficulty converting T4, the inactive form to T3, to the active form. High levels of Reverse T3 can also indicate a problem, since this is also an “inactive” form of thyroid hormone that essentially block thyroid function. Reverse T3 (RT3) levels can become elevated, especially during times of stress to conserve energy and lower metabolism. RT3 levels can also be elevated with other problems such as heavy metal toxicity, so they can also be a red flag that there are other (potentially worse) problems lurking elsewhere.
As you can see there is a lot more to thyroid disorders, that when looked at carefully, can lead to better (and more exact) treatment options and/or diagnostic clues.
Essential Nutrients for Thyroid Function
Iodine is an essential nutrient for the production of thyroid hormones. It is typically obtained through the diet in foods such as fish, sea vegetables, iodized salt, beans, nuts, seeds, and certain vegetables. One reason that hypothyroidism is so widespread, is related to deficiencies in this key nutrient. Not only are we not taking in enough iodine in our diet, other elements including fluoride, chlorine, and bromine compete with iodine in the body, and can displace iodine from the thyroid gland. Chlorine and fluoride are often found in the water supply, and bromine in flour and bread products. Not only is iodine important for thyroid function, it is critical for breast and ovarian health. Iodine deficiency can play a key role in the progression of both hypothyroidism and hyperthyroidism, and it is important to restore the levels of this nutrient if needed based on testing through an iodine loading test. Other nutrients are also integral to thyroid function such as selenium, iron, B vitamins, and zinc. Individualized supplementation with nutrient therapy plays an important role in supporting thyroid function.
Stress & Hormones
The Hypothalamus, Pituitary, and Adrenal (HPA) axis, and more specifically the Adrenal gland which regulates the primary stress hormone, cortisol, among others, is also intimately tied to thyroid function. Deficiencies in cortisol, commonly known as adrenal fatigue (or HPA axis dysfunction), the extreme of which is known as Addison’s disease, has many overlapping symptoms with thyroid disorders. Very often both the thyroid and HPA axis need to be evaluated and treated in concert to obtain maximum benefit from treatment. In fact, because all hormones impact each other, an imbalance in one hormone, often causes an imbalance in another. So it is also important to evaluate the sex hormones (testosterone, estrogen, progesterone, pregnenolone, and DHEA) to see how imbalances in this area might also be impacting the system as a whole. I will typically use a combination of saliva, blood, and urine, to get the most complete picture of the thyroid, adrenal, and sex hormones in any patient presenting with a primary complaint related to thyroid illnesses of any kind.
Thyroid Hormone Replacement
If supplementation with thyroid hormone is needed, patients often have a good result using a natural or bioidentical forms of thyroid, which I commonly use in my practice. This is typically derived from animal thyroid, and therefore contains all the hormones your own thyroid would naturally produce, including T4 and T3. Other times, we can use a compounded version of thyroid replacement, which still contains a combination of T4 and T3, and is free of animal products. Still others may need a different approach. Therapy is guided by a patient’s response, including improvement of symptoms, as well as following lab tests. It is my philosophy that each thyroid patient is unique and therefore should be treated based on individualized needs. My goal is to help thyroid patients regain their vitality, by working together to address all aspects thyroid health in a very ‘precise’ way.