Feeling tired? Thyroid imbalance a potential cause
By Dr. Martin Gleixner, MSc, ND
Our thyroid is fundamental for our metabolism. Maintaining a healthy weight and living with good energy levels rely heavily on thyroid function.
Yet, despite such a crucial role, thyroid imbalances are often under-diagnosed, missed or allowed to proceed without treatment for far too long.
How can this be?
As will be discussed in this article, we will see that:
- Laboratory tests to verify thyroid imbalances use reference ranges that are intended to determine the need for drug therapy and do not provide guidelines for optimal thyroid health.
- Certain causes of thyroid problems are missed because autoimmune disturbances are rarely checked.
- Thyroid hormone replacement therapy (usually Synthroid) is the only treatment considered for low thyroid function, despite evidence that the thyroid can be supported/treated in many ways before it’s ‘too late’. Prescribed medications are recommended to patients when thyroid function has deteriorated so far that the only way to help is by prescribing the hormone itself. This raises an important question: why do we wait so long before treating the thyroid?
The thyroid gland, which is located in the throat area, produces hormones that controls how quickly the body burns energy. Whether the thyroid is underactive (a condition called hypothyroidism) or overactive (hyperthyroidism), they can both have overlapping symptoms such as fatigue.
In fact, the most common presenting symptom for hypothyroidism is fatigue and exhaustion. This is followed by weight concerns, depression, anxiety, constipation, and brain fog or poor memory, as well as hair, nail and skin problems.
If you have low energy, you may have asked yourself one of the following questions:
- Is my thyroid out of balance and if so, how it is affecting my health?
- Can a medical explanation still exist to explain my symptoms (e.g. fatigue) even when my doctor says “your laboratory blood tests are all within normal range”?
In addition to low energy, you may be experiencing other symptoms related to the thyroid. You may be feeling depressed but not responding to standard anti-depressant medications. Or you may be finding it difficult to lose weight despite excess exercising and calorie counting. Or even still, you may be constipated despite adequate fiber, fluids and exercise.
I would like to propose a common sense 5-step approach to addressing thyroid problems:
Step 1 – Obtain a diagnosis that strives to optimize your health
Thyroid function is first evaluated by testing for TSH levels (TSH is released from pituitary gland to stimulate thyroid hormone production). Based on hospital laboratory guidelines, thyroid function is said to be normal if TSH has a value between 0.4 to 5 mU/L (note: values may vary slightly between different laboratories). A diagnosis of hypothyroidism is based on TSH values above 5mU/L (and on low thyroid hormones levels).
For many patients, these present laboratory standards for thyroid evaluations are too broad. In fact, the American Association of Clinical Endocrinologists (2003) stated that TSH level between 3.0 and 5.0 mU/L should be considered suspect. In my practice, I commonly observe patients who have hypothyroid symptoms despite TSH levels remaining below the cutoff of 5 mU/L.
Helping patients achieve optimal levels of hormone production (TSH of 1 to 2.5 rather than 0.4 to 5 for example) is one example that can alleviate many symptoms.
Naturopathic medical doctor Alan Christianson (a endocrinology specialist who practices in Arizona, USA), has coined the term “Clinical Hypothyroid Syndrome” for those who have symptoms of hypothyroidism but whose TSH is outside the optimal range of 1 to 2.5 (published in research article titled “Achieving Balance in the Thyroid” NDNR, August 2011). I strongly recommend that other medicals doctors and naturopathic doctors accept Dr. Christianson’s new diagnosis criteria.
I have always encouraged my patients not to wait too long to address their health concerns. Both conventional and naturopathic doctors have a deep understanding of the body’s physiology (the study of the functions of the human body). Recognizing when the body has shifted outside of physiological norms can be observed at any stage of disease. As doctors, this knowledge can help us treat patients even when laboratory results alone cannot explain symptoms.
Once it is established that the TSH is not optimal, it is equally important to determine often-overlooked causes of thyroid imbalances. Certain lab tests to rule out autoimmune thyroid disease are often not conducted by standard medical care. For those patients where this is possible, additional blood tests such as anti-TPO and anti-thyroid should be conducted. If an autoimmune disease is suspected, naturopathic strategies are very helpful to address the cause(s) of autoimmunity in the body.
Step 2 – Finding out the cause of thyroid imbalance(s)
Once it is determined how your body has shifted outside normal physiology or a diagnosis is obtained that explains your symptoms, the next step is to figure out why your body became out of balance in the first place. If hormone imbalances are observed, it is crucial to determine why this has occurred.
Although it is beyond the scope of this article to go into each cause in significant detail, here are some of the most important causes of thyroid dysfunction:
- IgG food sensitivities such as gluten (this can be determined via a blood test at the Moncton Naturopathic Medical Clinic).
- Dietary gaps. Common nutritional deficiencies including protein, tyrosine and iodine. Excess intake of foods that contain goitrogens (i.e. chemicals that block the thyroid’s ability to use iodine) such as soy and raw cruciferous vegetables (note that this occurs only in susceptible individuals).
- Chronic exposure to chemicals such as heavy metals, chlorinated compounds, phthalates, bisphenol A, and other xenoestrogens. The thyroid is very prone to the damaging effects of toxins.
- Adrenal gland imbalances. Cortisol, like thyroid hormones is also involved in maintaining our body’s metabolism.
- Physical or mental stress. This can affect your hypothalamus and your pituitary’s ability to properly stimulate the thyroid.
- Prescription drugs side-effects.
- Liver dysfunction (the liver metabolizes many hormones including cortisol, DHEA, estrogen, testosterone, progesterone, and thyroid hormone).
- Poor digestive health, malabsorption problems and absence of ‘good’ gut bacteria.
- Autoimmune disease where our immune system creates inflammation that affects your thyroid cells.
Step 3 – Support adrenal, liver and digestive function
The health of the thyroid gland is strongly dependent on the health of other glands.
The hypothalamus is the master control centre in the brain. It is on a constant 24-hour surveillance of what's going on in the body. It monitors and creates changes in the body based on our body temperature, hormone or mineral levels in the blood stream, and our emotions.
As it relates directly to the thyroid, it regulates the pituitary gland's production of the TSH hormones that we discussed in Step 1. Simply put, TSH stimulates the thyroid to make T3 and T4.
For those with low optimal adrenal gland function for example, have declined levels of cortisol. Both thyroid hormones (T4 and T3) and cortisol control the metabolism of all our cells in the body. We can see how the health of either the thyroid gland or adrenal gland will place a greater reliance on the other gland for metabolic processes.
Because T3 is a stronger hormone compared to T4, poor gut health and decreased liver function can cause a significant decline in our body’s ability to metabolize and stay fit. Dr. Datis Kharrazian, a leading educator in this field, discusses in his book titled “Why Do I Still Have Thyroid Symptoms? When My Lab Tests are Normal” that 60% of the T4 is converted to T3 in the liver (only 6-7% of T3 production occurs in the thyroid). Another 20% of T4 becomes active in the intestines in the presence of a sufficient amount of healthy gut flora (i.e. presence of ‘good’ bacteria species). Poor dietary habits and antibiotic use can significant deplete these gut bacteria, thereby contributing to even lower thyroid hormone activity.
Step 4 – Use naturopathic treatment options to provide relief while addressing causes
Because of the unpleasant nature of thyroid imbalances symptoms (e.g. fatigue, constipation, etc…), providing relief is also important. Naturopathic medicine has options to help minimize and manage the symptoms giving you time to address the underlying cause(s) of your condition.
Step 5 – Support thyroid function and establish an individualized treatment plan
To explain the concepts behind my treatment approach, let’s look at low thyroid function (called hypothyroidism) as an example. The standard treatment is simply replacing thyroid hormone to make up for the lack of production. In this case, Synthroid medication is commonly prescribed as discussed earlier.
A new model for medical practitioners is to adopt a multifaceted approach to treating thyroid imbalances. Treatment options should aim to: a) address underlying causes (examples are described in Step 2); b) support other organs that that are interconnected to the issue in question (e.g. liver or adrenals); c) support the organ in question such as replenishing nutrients that the gland requires to make hormones (e.g. L-tyrosine for the thyroid); and d) use hormone replacement therapy (e.g. Synthroid) only if necessary for severe cases (i.e. the gland is beyond repair) or when symptoms are severe thereby providing relief and buying time while the causes and organ dysfunction are addressed.
Always ask “Why” when faced with any health concern. Fatigue is not caused by aging; rather, it culminates from multiple factors that are unique for each individual. Seek the answer, by asking yourself “is my thyroid the cause?”, “why is my thyroid not working optimally?” and, lastly “how can I use naturopathic treatment options to solve fatigue or exhaustion?”.
Published by Dr. Gleixner on Friday, June 28th, 2013 in Times & Transcript.
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