This is a guest post from Dr. Justin Marchegiani who is a cutting edge functional medicine practitioner in the Bay Area. He deals with many issues relating to thyroid dysfunction on daily basis. He specializes in looking for the root cause of health problems not just treating symptoms.
Q: What do you think is causing an explosion of low thyroid cases?
A: A combination of gut infections, auto-immunity, dysbiosis (an imbalance of healthy gut flora), food allergens, nutritional deficiencies, adrenal dysfunction, and toxicity from chemicals and heavy metals.
When dealing with the thyroid it is not a simple solution. In medicine it’s very common to specialize and only focus on one area of the body. So you have a gastroenterologist that only looks a gastrointestinal problems, you have a hepatologists that only looks at liver problems, you have an endocrinologist that only looks at hormonal issues and the list goes on….
The problem with this paradigm is that all systems in the body are connected, sort of like a spider web, requiring a background in all of the above areas. If you have instability on one side of the web, it inevitably affects the entire web. So the goal is to look at the body holistically and support systems that are not functioning optimally.
We know that having a healthy balance of beneficial bacteria in the gastrointestinal tract is important in activating thyroid hormone. Almost 20% of thyroid hormone is converted from T4 to T3 via the sulfatase enzyme which is present in healthy guts. Eating healthy fermented foods along with addressing gut infections, food allergens and an overabundance of sugar and carbohydrate in the diet can help resolve this issue.
The liver is responsible for almost 60% of thyroid hormone conversion from T4 (inactive) to T3 (active hormone). Addressing toxicities that overburden the liver is essential for allowing the liver to maximize thyroid hormone conversion. Various chemicals from pesticides, hormones in food, birth control pills and toxic skin care or hygienic products provide a significant burden on our liver and detoxification pathways.
Below is a picture that provides a summary of the above information:
Q: Which tests should people ask for at the doctor?
- T4: total and free
- T3: total and free
- Reverse T3
- T3 uptake
- TPO and TG antibodies
A: Conventional medical doctors typically only look at TSH and T4 (if you are lucky), all other tests are usually irrelevant because they do not change the treatment protocol in the conventional paradigm they work under. Your typically medical doctor is looking to see if the TSH is in an abnormal range usually ranging from 0.45 to 4.5 (some labs ranges are even wider). When the TSH is elevated it signifies hypo-thyroidsm (low thyroid) while a low TSH signifies hyper-thyroidism. The range I believe to be the most sensitive is the one supported by the National Endocrine Society which is a TSH level between 1.8-3.0.
The majority of patients treated are found to be hypo-thyroid and are prescribed only synthroid or levothyroxine (synthetic T4). Labs are usually run 1 to 2 per year to tweak medication without delving any deeper in to the problem. After hearing about all of the underlying drivers of thyroid dysfunction it’s easy to see why the conventional medical paradigm doesn’t even come close to addressing the underlying cause of the thyroid dysfunction in the first place.
Did you know that 90% of all thyroid conditions stem from an underlying cause of auto-immunity? Essentially the immune system is producing various antibodies that attack the thyroid tissue. Thyroid Peroxidase Ab (TPO), and Thyroglobulin Ab (TG) are produced in Hashimotos Thyroiditis which is an auto-immune condition that causes hypothyroid function over time. Thyroid Stimulating Immunglobin Ab (TSI) is produced in Graves Disease, an auto-immune condition that causes hyperthyroid function.
At a minimum it is important to at least ask your doctor to run TPO and TG antibodies to see if your thyroid condition is auto-immune in nature. Most medical doctors resist running these antibodies because it doesn’t change conventional protocol. From a functional medicine paradigm it’s important to know if you are auto-immune because it changes the overall approach to how the thyroid is treated. Any time any auto-immune condition is present the focus needs to more on the immune system and the gut and less on the thyroid or injured gland.
I also recommend running T4: total and free T3: total and free, thyroglobulin, reverse T3, and T3 uptake. It’s important to assess the body’s ability to convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone). Any time we see a normal level of T4 followed by a low level of T3 we know there is a conversion issue. On a conventional thyroid test T3 would never be assessed and you would probably slip through the cracks of the medical system with an undiagnosed hypothyroid condition.
There are many factors that can cause decreased conversion of T4 to T3 such as nutrient deficiencies (zinc, magnesium, b12, selenium and calcium), low stomach acid, infections (H-pylori), low or high adrenal function (test with a salivary panel), and various anemia’s.
Reverse T3 is an important marker because it assesses overall stress in the body. When the body is over stressed T3 is converted to RT3 to essentially act as the brakes on the overall metabolism. A few factors that tend to drive conversion are adrenal stress, food allergens, lack of sleep, gut health, emotional stress and low calorie diets. Everything the body does is for a reason and the more you listen to your body’s whispers the less you will have to endure its cries.
Birth control pills can increase thyro-binding globulin which can affect thyroid hormone’s ability to bind to its receptor site. That is why one of the common side effects of birth control pills is weight gain. Assessing thyro-binding globulin as well as Free T3 can be a good marker to assess this problem.
Q: What are some of the overlooked thyroid symptoms ?
A: There are many thyroid symptoms that go overlooked. You have the typical thyroid symptoms that include weight gain, cold extremities and fatigue which are usually the first symptoms noticed by someone with a thyroid issue. Thinning of the outside of the eye brow as well as hair loss are common symptoms also seen with thyroid dysfunction too.
Constipation is a common symptom never associated with a thyroid problem. Many people are unable to have at least a one a day bowel movement, which can be caused by a low thyroid. When your transit time is abnormal it can cause auto-intoxication, this is when your body starts to reabsorb toxins from the stool. This then causes more stress on the liver which can then causes a vicious cycle of even more thyroid dysfunction over time.
High cholesterol can also be caused by low thyroid function. Before anyone goes on a statin, the first thing that should be done is a full thyroid work up. Cholesterol is the raw material for all of our hormones in our body. If our ability to metabolize and use cholesterol effectively is impaired because of low thyroid function, an elevation in cholesterol can occur.
Q: What is the biggest mistake most people make when trying to normalize thyroid function?
A: One of the biggest mistakes people make when trying to treat a thyroid issue is not ordering a complete thyroid test. It’s really easy for anyone who feels tired or sees their hair fall out to start purchasing every thyroid supplement known to man.
If you have an auto-immune condition using supplemental iodine can actually make the problem worse. This is a very controversial topic in natural medicine but there is a great body of evidence showing if you have an active auto-immune condition you should avoid iodine at least initially. Iodine can be a powerful supplement when used properly, but you need to be evaluated first to see if you are a good candidate to begin with.
Supplements can be an important part to help accelerate healing but you need to evaluate what the underlying cause of your thyroid dysfunction is in the first place. Once you figure out what thyroid pattern you have, supplements can used more appropriately along with diet and lifestyle changes to help accelerate healing.
A small amount of people may need thyroid hormone due to long term destruction of their thyroid gland. These patients tend to do better on a natural thyroid hormone product like “Nature Throid.” This product has a natural spectrum of T4, T3, T2, T1 and calcitonin. Other natural thyroid support like Armour is similar, but contain gluten fillers and dyes that could irritate someone with an auto-immune thyroid.
It’s my belief; if you address the above issues first, you can avoid having to use thyroid hormone most of the time.
Q: What are the top 3 things people can do to improve their thyroid health?
The first thing people can do to help improve their thyroid function is improve their diet and the quality of food they consume. I am a huge fan of a paleolithic style of eating that involves consuming organic nutrients dense whole foods, avoiding foods high in toxins and gut irritating compounds. This style of eating is based off of strong anthropological evidence and is essentially the way are genetics are hardwired. Eating the Standard American Diet (SAD) consisting of toxic, nutrient poor foods will increase your levels of systemic inflammation and also make it virtually impossible to improve your thyroid function.
Eating high quality whole foods primarily consisting of organic free range meat and carbohydrate (from non-starchy and or starchy sources) every 3-5 hours is important for stabilizing blood sugar. Blood sugar imbalances can be a major stress on the adrenal glands and skipping meals and eating poorly at meals can lead to adrenal fatigue and thyroid dysfunction over time. It’s important to watch how much carbohydrate you are consuming, if you are overweight I recommend getting at least 3 times more of your carbohydrate from non-starchy vegetable sources over fruit and starchy carbohydrates.
Finding a functional medicine doctor or holistic nutritionist you can work with that has experience running lab tests, assisting with diet/lifestyle changes and can put together a supplement program to help improve your thyroid function is very important. It is difficult for even the most healthy savvy individuals to deal with these issues by themselves. It’s always good to at least consult with an expert in this area to make sure there’s nothing your missing that could be preventing you from experiencing optimal health.
Want some help with your thyroid ?
Any questions please email Office@JustInHealth.com or call my office at (408) 217-2391.
You can learn more about Dr. Justin here.
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