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Thyroid Overview

What is the Thyroid, Anyway?

One of the most important glands in our body, the thyroid has a hand in virtually every body system, which means that what might seem to be a problem with the thyroid may not be the result of a diseased thyroid gland at all. Any number of other endocrine glands, such as the adrenals could be the culprit or fluctuating blood sugar levels, or too much estrogen. To treat these different conditions, one must entertain healthy lifestyle changes, exercise, and specific nutritional and herbal support based on one's individual chemistry. 

The thyroid is a butterfly-shaped gland located in the front of the lower part of the neck. The two lobes on either side of your neck are connected by a small band of tissue called an isthmus. It is difficult to feel unless you are thin or have a growth or enlargement of the thyroid. 

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Your thyroid gland produces hormones that ultimately fuel every cell of your body. These hormones are called thyroxine or "T4" and triiodothyronine or "T3". 

Your thyroid provides your body with a kind of furnace or power source; without it you would feel very cold and sluggish. The hormones it secretes travel throughout the body and play an important role in your digestion, reproduction, body temperature, liver and numerous other body functions. The thyroid gland also produces calcitonin which helps regulate calcium levels in the blood and affect bone formation. This becomes important when we evaluate the function of the thyroid gland: we look at the calcium, potassium and selenium levels in your system as well as the calcium to potassium ratio in your hair analysis. 

An underactive or slow thyroid (hypothyroidism) means that vital cell functions are slowed down and your entire body suffers from a lack of much needed fuel and energy. When the thyroid gland becomes overactive, all the normal functions it affects go into overdrive (we call it hyperthyroidism) causing what can sometimes be a life-threatening condition. It is important to understand that nobody wakes up one day with hypothyroidism or even hyperthyroidism.

Hypothyroidism

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Clinical hypothyroidism affects up to 17% of all women between the ages of 30 and 50 which translates into nearly 17 million people. 

Hypothyroidism also affects nearly 8% of women following a normal pregnancy. It affects men, too, but at a much lower rate. 

These numbers are just the data for clinical hypothyroidism which is clearly defined by abnormalities in blood chemistry and abnormal physical examination. If all medical doctors adhered to the newly revised normal reference ranges, that number would be far greater. In reality, the condition we refer to as sluggish thyroid condition likely affects a great many more.

The Spectrum of Hypothyroid Diseases
There are many more reasons an individual can become hypothyroid than can become hyperthyroid. The symptoms are more subtle and more likely to be overlooked by healthcare practitioners not savvy to the different ways the thyroid gland can affect the body (or vice versa) and the different testing methods available. Let's talk about the various ways a person can become hypothyroid. 


Primary Hypothyroidism---In this case the thyroid has been attacked and destroyed by a toxin or a medicine. Most people can think of no obvious reason for having such a low thyroid condition. Without functioning thyroid tissue, very little T4 and T3 is produced. In this situation, an individual will demonstrate an elevated TSH because the pituitary gland is continually trying to signal the thyroid gland to turn out thyroid hormone. The earliest symptoms of this disease include having brittle, ridged nails or thinning hair.

Secondary Hypothyroidism---The thyroid gland can "fail" in a sense, not because there is anything wrong with the gland itself, but rather because the hypothalamus or pituitary gland is damaged and isn't sending out any signals to make thyroid hormone. The thyroid gland is ready but doesn't know the body needs any of its hormones.

Underconversion of T4 to T3---The thyroid gland may be producing sufficient amounts of T4 but since it is relatively inactive, its conversion to T3 is crucial. Problems with the adrenal gland or the liver, particularly, can affect this conversion and result in a functionally hypothyroid state even though T4 levels are normal. A condition known as Wilson's Syndrome involves a persistent but reversible inability to convert T4 to T3 due to stress. It isn't very common, however.

scale.jpgHashimoto's Thyroiditis---This is an autoimmune disease like Grave's Disease.  Your body's immune system becomes disorganized or confused and starts to attack and destroy the thyroid gland; however, it has one crucial difference.  Persons with Hashimoto's Thyroiditis usually create anti-thyroid peroxidase  antibodies (anti-TPO) that inflame the thyroid tissue just like Grave's Disease resulting in the transformation of healthy tissue into fibrous or scar tissue that doesn't produce thyroid hormone at all. In the beginning stages of the disease there can be a temporary elevation of thyroid hormone because as the cells break down, they release the thyroid hormone into the blood stream that was stored in those cells. This disease affects only about 3-4% of people over 30. Interestingly, Hashimoto's Thyroiditis and Grave's Disease cluster with other diseases such as Diabetes mellitus type 1, lupus erythematosis and rheumatoid arthritis, all of which are autoimmune diseases. 

When doctors evaluate the thyroid function, it is always a good idea to check for the presence of anti-TPO antibodies. We'll talk more about this when we discuss the various testing strategies for thyroid conditions.


The following drawing illustrates what can happen in Grave's disease, Hashimoto's Thyroiditis and other autoimmune diseases that involve the body making antibodies to itself:
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Adrenal Causes of Hypothyroidism---This is likely a more common cause of sluggish thyroid activity than we think. The adrenal gland produces the stress hormones called cortisol and epinephrine (adrenaline) and it does so when you are under some kind of physical or emotional stress. Elevated levels of these stress hormones block the conversion of T4 which is relatively inactive to the active form of thyroid hormone, T3. The conversion of T4-T3 occurs in the liver and requires zinc, selenium and the enzyme, 5' deiodinase. An elevation or decline in adrenal function can occur from emotional stressors, blood sugar dysregulation, sympathetic overflow, physical trauma, tissue damage, inflammation and pain. If this conversion is impaired, the thyroid gland and its hormonal capability are sub-par. The thyroid function is essentially shut down. This is sometimes called thyroid resistance.

Other causes of T4 to T3 Conversion Problems--- The conversion of T4 to active T3 is vital. It is also dependent upon the available amount of bodily selenium (a trace mineral). Without enough selenium, the thyroid hormone remains in its relatively inactive (T4) state. The conversion of T4 into the active T3 will be compromised.

Receptor status problems---In order for the thyroid hormone to act, it must bind onto the receptor sites (docking ports) of the cells it wants to work with. Many substances, estrogen being one of them, bind to the receptor sites so that the thyroid hormones have no place to park or "dock" themselves. Many of these "endocrine disruptors" are environmental toxins such as plastics, heavy metals, solvents and toxins in our packaged food and water. Once again, the thyroid hormones are ready to do the job but nothing happens inside the cells because the 
receptors are being blocked by foreign toxins or endocrine disruptors. 


Myxedema---This is technically not a new type of disease but is a state sometimes seen in very severe hypothyroidism. In the absence of thyroid function, a type of gel called mucopolysaccharide gel is deposited in the tissues of the face and legs. Water is absorbed into the gel and the individual with myxedema has a puffy face and swollen, edematous legs. Myxedema is a very serious condition. Its sufferers show marked slowing of mental capacity, extreme physical fatigue and unexplained weight gain.

Endemic colloidal goiter---Caused by an iodine deficiency, endemic colloidal goiter is extremely rare here in the United States where our salt is iodized. In coastal areas there is no lack of iodine due to the consumption of seafood and seaweed, but in some parts of central Europe, iodine is not readily available, and their salt is not supplemented. 

Idiopathic nontoxic goiter---This is a catch-all term for an enlarged thyroid gland for which there is no provable cause. Researchers speculate that environmental or food substances are the cause of this disorder. Anyone with an enlarged lump in the front of their neck needs to consider that something like idiopathic nontoxic goiter is involved. 

Thyroid Removal---If the thyroid has been removed due to cancer, nodules or hyperactivity, a severe lack of thyroid hormone would occur if the thyroid hormone isn't immediately replaced. This almost always requires thyroid replacement although I like to think we should keep the adrenal glands, the digestive system and the rest of the body's chemistry in balance in order to 
support the missing thyroid gland and the chemical reactions that occur with thyroid medication. If your doctor is using a T4 and T3 combination medication such as Armour Thyroid, your body will not have to convert as much Free T4 into Free T3. This is one less step that your body has to perform to create active T3 hormone. Remember, the conversion of Free T4 into Free T3 requires selenium. Using Armour Thyroid will allow you to replenish your selenium levels if they are already low. This is especially true in cases of thyroid cancer. It's been suggested that selenium will inhibit the growth of some types of cancers. If your thyroid has been removed, physicians will often try to keep your TSH at a very low level so that the thyroid hormone does not stimulate the cancer to reoccur.


Lymphocytic Thyroiditis---This is a rare condition where the thyroid becomes inflamed by your body's lymphocytes, a type of immune cell that, in this case, attacks the thyroid gland.

The Sluggish Thyroid
The sluggish thyroid syndrome is especially difficult to diagnose because the symptoms might be subtle, vague or few and far between. Very few people with functionally low thyroid syndrome actually check off many symptoms on the above lists. Remember, too, that full-blown hypothyroidism is not nearly as common as sluggish thyroid syndrome. This is why it is important to pay attention to what is going on in your body, keep a high level of suspicion that your symptoms might be from sluggish thyroid syndrome and have the proper testing done. 

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