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The thyroid is a butterfly shaped gland nestled in the throat right below the larynx. The significance of this unassuming gland can easily be forgotten in maelstrom of multi-system chronic illness. Nevertheless, accurately testing and effectively treating thyroid issues is essential to total body healing.
The Prevalence of Thyroid Disorders
According to the American Thyroid Association, an estimated 20 million Americans (about 6% of the population) have some form of thyroid disease and 12% of the U.S. population will develop a thyroid condition during their lifetime. Additionally, up to 60% of those with a thyroid disorder are completely unaware of it. Furthermore, women are five to eight times more likely than men to develop a thyroid condition, putting them at a much higher risk.
The Function of Thyroid Hormones
The thyroid gland uses tyrosine (an amino acid) and iodine (a mineral) to form T4 (also known as thyroxine). In a healthy body, enzymes convert T4 to the more bioavailable T3 inside the cells. T3 is a very important hormone; it affects metabolism, body temperature, and heart rate. That’s why people with hypothyroidism often experience fatigue, weight gain, and low body temperature, and people with hyperthyroidism often lose weight and have tachycardia (rapid heart beat).
Although T4 doesn’t have the far-reaching effects of T3, it is involved in the process of creating FAD (flavin adenine dinucleotide), which is integral to the methylation cycle, so patients with genetic mutations that impact their ability to methylate should pay particular attention to T4 levels.
How Chronic Illness Causes Thyroid Disfunction
The thyroid gland doesn’t function in a vacuum. Its health is directly dependent on the health of the entire HPA (hypothalamus-pituitary-adrenal) axis.
The hypothalamus is a section of the brain that has a number of important functions, including regulation of the ANS (autonomic nervous system) and hormone production. The hypothalamus produces a hormone called TRH (thyrotropin releasing hormone).
The pituitary gland is a pea-sized powerhouse that sits at the bottom of the hypothalamus. TRH from the hypothalamus signals the pituitary to release TSH (thyroid stimulating hormone). TSH is the chemical messenger that tells the thyroid to produce T4, so if that chemical signaling chain is broken at either the hypothalamus or pituitary gland, the thyroid will never receive the message to produce T4.
The adrenal glands are perched like little birds nests right on top of your kidneys. The thyroid and adrenal glands work in tandem to keep your energy levels optimal, but if one is struggling, the other will soon follow. Adrenals exhausted by stress, illness, or other trauma, will produce excess cortisol. Excess cortisol causes inflammation. This inflammation can prevent T4 from converting to T3 and can even cause it to convert to something called rT3 (reverse T3), an ineffective form of T3 that binds to T3 receptors, effectively blocking the much-needed free T3 from reaching its destination inside your cells.
Essentially, all chronic illnesses–Lyme, opportunistic infections, autoimmune disease, leaky gut, etc.–create an environment of inflammation and stress on the HPA axis, which can lead to a thyroid problem.
Let me cycle back here for a second and talk more about autoimmune disease, because this is something that is often overlooked in Lyme patients. Borrelia and other chronic infections can actually trigger autoimmunity through a process called molecular mimicry. The confused immune systems of some chronically ill patients may develop antibodies to various parts of the thyroid or enzymes that help produce thyroid hormone. This results in Hashimoto’s (autoimmune hypothyroidism) or Graves’ disease (autoimmune hyperthyroidism).
Symptoms of Thyroid Disorders
Symptoms of hypothyroidism include fatigue, depression, weight gain, constipation, dry skin, hair loss, low body temperature/sensitivity to cold, and muscle/joint pain.
Symptoms of hyperthyroidism include tachycardia, anxiety, weight loss, increased bowel movements, heat intolerance, and hyperhydrosis (excessive sweating).
Unfortunately, most of these symptoms overlap with possible symptoms of Lyme and co-infections, so it’s hard to rely on them for an accurate clinical diagnoses. I recommend using lab tests to pin down your diagnosis and inform your treatment plan.
Testing for Thyroid Conditions
Most doctors only test your TSH, which you will remember from earlier in this article, is actually a pituitary hormone. Many people have normal TSH levels (a healthy pituitary), but still have a thyroid condition. You need a complete picture of what’s going on with your thyroid hormones to make wise treatment decisions. Here are the essential tests you need to evaluate your thyroid function:
There are a couple of things you need to keep in mind with TSH testing:
- A normal TSH test doesn’t mean your thyroid is healthy. In fact, a normal TSH test doesn’t tell you much of anything except that your brain has enough thyroid hormone, but that doesn’t mean the rest of your cells are in the clear. An abnormal TSH test, on the other hand, means you’re in real trouble.
- Demonstrating the flagrant illogic of our current medical system, the parameters for TSH test results are based on an unhealthy population. This means that your test may come back within “normal” parameters, even though the numbers themselves are far from healthy. Parameters may vary slightly depending on the lab you use, but WebMD defines a normal TSH level as 0.4 to 4.0 mIU/L. Now, let’s compare that arbitrary standard with actual medical science. According to a study of 25,000 healthy Norwegians, those with higher TSH levels within the normal reference range were far more likely to die of coronary heart disease than those with low TSH levels. Studies have also shown that women with high TSH levels within the normal reference range are more likely to miscarry and have breech births. Generally speaking, a TSH level of 0.5-1.0 is what you should aim for.
Free T4 is T4 that is not bound to a protein, meaning it’s free to be converted into T3. According to Suzy Cohen in her book Thyroid Healthy, free T4 levels will be high if you are unable to convert T4 to T3. She recommends a level of 0.8-1.8 ng/dl.
Free T3 is the most bioavailable form of thyroid hormone and it’s the most important test on this list. Cohen recommends a level of 3.5-4.3 pg/ml.
Excessive amounts of rT3 can prevent T3 from penetrating the cell, making you hypothyroid. Suzy Cohen recommends aiming for less than 15 ng/dl. She also recommends a T3 to rT3 ratio of greater than 2 and preferably between 10 and 20. You can use her thyroid hormone ratio calculator to calculate your ratio.
If you have a chronic illness, it’s especially important to test for thyroid antibodies. Here are a few antibody tests you should consider:
- Thyroid-Stimulating Immunoglobulin (TSI) – Ask for this test if you have symptoms of hyperthyroidism.
- Thyrotropin Receptor Antibody (TRAb) – Ask for this test if you have symptoms of hyperthyroidism.
- Thyroperoxidase (TPO) Antibodies – Ask for this test if you have symptoms of hypothyroidism.
- Thyroglobulin Antibody (TGAb) – Ask for this test if you have any symptoms of thyroid disfunction.
Iodine is an essential ingredient of T4. Suzy Cohen recommends doing a 24 hours urine catch and aiming for a level of 100-199 µg/l.
Aside from iodine, there are a number of nutrients that are essential to the process of creating and converting thyroid hormones. Selenium, iron, and D3 in particular play vital roles in thyroid hormone synthesis. Unfortunately, most blood tests only check the serum level of these nutrients, but nutrients don’t do a whole lot of good when they’re floating around in your blood. They need to be inside your cells to do their jobs properly. That’s why intracellular nutrient testing, or micronutrient testing, is key. Micronutrient testing is available through SpectraCell Laboratories.How #ChronicIllness Affects the #Thyroid + Testing for & Treating Thyroid Conditions Click To Tweet
Hypothyroidism is far more common than hyperthyroidism, so I’m going to focus on that. If you have hyperthyroidism, find a good thyroid doctor to find out about your treatment options (of course, you should do this if you have hypothyroidism as well). Just be wary if your doctor tries to prescribe a fluoride-based drug to suppress overactive thyroid function.
Most doctors automatically prescribe a T4 medication like Synthroid to their hypothyroid patients. Unfortunately, most chronically ill patients have impaired conversion of T4 to T3, so a pure T4 drug is unlikely to work. A combination T4/T3 formula like Armour Thyroid or a pure T3 medication like Cytomel will probably work better for you. You may also benefit from having your thyroid medication customized and prepared at a compounding pharmacy.
Unfortunately, many natural practitioners prescribe iodine supplementation, assuming that this along will solve patients’ thyroid problems. Iodine is an essential nutrient to be sure, but it doesn’t solve the difficulties of T4 to T3 conversion that many patients have. Additionally, too much iodine can actually hurt some patients and it must be balanced with selenium. Make sure you have healthy levels of these, as well as iron and D3. If you’re deficient, change your diet to include more of these nutrients or supplement with the oversight of a knowledgable doctor.
According to Suzy Cohen, probiotics can help convert T4 to T3, a major problem in most chronically ill patients. Supplementing and adding probiotic foods to your diet may help.
If you have a thyroid condition, especially Hashimoto’s or Grave’s disease, it’s absolutely essential to abstain from gluten and other allergens. You may need to give up dairy, soy, corn, and grains as well. The paleo diet might be a great option for you.
As I wrote before, the thyroid doesn’t work in a vacuum. It’s important–often essential–to treat adrenal exhaustion, estrogen/testosterone imbalances, and other damage to the HPA axis along with or before the thyroid itself.
Thyroid disfunction can be a big piece of the chronic illness puzzle in many patients. I strongly recommend reading Suzy Cohen’s book, Thyroid Healthy for a much more in-depth exploration of this topic. Get tested, find a competent doctor, and adjust your diet and supplementation to align with your thyroid goals.