Welp – it’s been a minute! But about time we returned to The ABCs of Healthy Hormones series.
If you missed it – we started here at A is for Adrenals and carried on through to a two-parter on Sleep (check out Part 1 here and Part 2 here). And we covered a lot of other important topics in between.
But while I’ve talked about this topic – thyroid – in relation to a number of others, we’ve not devoted a full post to it until now.
Actually, I could probably devote multiple posts, as there are lots of complexities and conditions that can affect our thyroid including autoimmune conditions like Hashimoto’s or Grave’s disease, thyroiditis, cancer or simply an imbalance of thyroid hormones that can impact our overall metabolic wellbeing.
We can dive into specifics related to autoimmune issues and the protocols to help those challenging conditions at a future time.
What I will say is that thyroid health is multifaceted and can have overarching tentacles in terms of how it impacts and influences the way other hormones also carry out their work in the body. It plays a critical role in keeping women vital, including helping us keep our weight in check especially as we slide through perimenopause and land in post-menopause.
So when considering the health of your thyroid, don’t look at it in isolation. It’s just one part of your ‘holy trinity’ of hormone health as coined by functional medicine Dr. Sara Gottfried who calls estrogen, cortisol and thyroid the Charlie’s Angels of hormones.
Before we start on the basics, let me just be clear: men have thyroids too. And can be affected by pretty much the same issues as women, although the prevalence of thyroid imbalances and auto-immune diseases and even cancer, is much, much lower.
So here we are – T is for thyroid.
Your thyroid gland is located at the base of your throat. It’s a tiny butterfly-shaped gland that produces several hormones that are responsible for regulating body temperature and metabolism. It is integral to a healthy cardiovascular system, your vision, your brain health – including memory and depression, and reducing the risk of osteopenia.
Disorders of the thyroid are pretty common due to a number of issues (like nutrient imbalances, environmental stressors, inflammatory responses, antibody production, etc), especially for women.
It’s estimated that 1 in 8 women will be affected by a thyroid disorder at some point in their lives. To put that in perspective, that’s the same statistic as breast cancer prevalence. Men experience about 20% of the number of cases that women get.
Thyroid disease is also one of the most underdiagnosed issues in the world with estimates ranging from 50-60% of people affected who remain unaware of their condition. That’s a lot!
And given how important thyroid hormones are for overall health, you’d think that we’d all pay more attention and screen for the right things to ensure we remain balanced.
You’d think…… but that isn’t always the case.
What hormones do we need to look at?
As a recap – a hormone is a chemical messenger that signals your body what to do and when to do it.
The two main hormones that your thyroid releases are thyroxine (T4) and triiodothyronine (T3). T4 is largely an inactive hormone, meaning it needs certain functions in your body to transform it to T3, so that it can be active and do its job – ie: bossing around your cells and your metabolism.
How does the thyroid gland know when – and how much – hormone to produce for you to stay balanced and well? Like many chemical actions and reactions in the body, there’s a feedback loop involving your hypothalamus gland, pituitary gland, thyroid gland and a whole suite of hormones. It’s referred to as the HPT axis (for hypothalamus, pituitary, thyroid).
You might remember, we previously talked about the HPA axis which is also a critical feedback loop that is fundamental to good hormone health. Same concept – slightly different glands and hormones involved.
We live in a visual world – so instead of me writing multiple paragraphs about how the HPT loop works, I invite you to check out this easy to consume 8 minute video from Justin Siebert, an amazing Memphis-based collegiate science teacher. He is one of my go-to resources when I want to better understand the inner workings of the body or get new ideas about how to simplify explanations of mechanisms, so we can all know better.
I’ll wait. 😉
How do we identify thyroid issues?
Experiencing subtle symptoms where you – or your physician – may not connect the dots is common. Sometimes these symptoms are annoying or confusing, but not recognized as an indication to look closer. Unfortunately, sometimes they are brushed off as, “well, you’re getting older” or treated with an anti-depressant to alleviate symptoms instead of identifying the root cause.
You should not settle for vagaries when it comes to any symptoms that limit your well-being. Seeking a second opinion or looking at alternate or complimentary support is both your prerogative and simply a smart way to take back control of your health.
So start with an assessment of how you are feeling and what you are experiencing in your body. You may have many of these symptoms and signs, or you may only have a couple. They may be nagging but not alarming – or vice versa.
Make notes, be specific so that you can have an informed conversation with your health practitioner – whoever that may be – who serves you best.
Here are some of the things to look for:
- Hair loss – anywhere – but very commonly eyebrows, especially the outer 1/3, and eyelashes, get very thin
- Lethargy, fatigue that is unexplained
- Choking feelings without anxiety, or difficulty swallowing
- Hoarse voice for no reason
- Dry skin
- Thin brittle nails that break easily
- Dry straw-like hair that tangles easily
- Weight gain – or you are stuck at a particular weight and just can’t move the extra pounds no matter what you try
- Constipation – meaning you poop less than once a day and it generally looks like types 1-3 on the Bristol Stool chart. It might also mean that you have to strain or that it feels like you haven’t fully emptied out.
- Recurrent headaches (not necessarily migraines, but that is possible)
- Decreased sweating (except when you might be having a hot flash)
- Sensitivity to cold – always freezing and wearing layers (except when you are having a hot flash)
- Joint or muscle aches or poor muscle tone (like you feel, look and are weaker than others you know who are a similar age, body type)
- Edema – fluid retention in ankles and other places
- Tingling in your hands and feet
- Slow heart beat (fewer than 68 beats per minute)
- Sluggish reflexes and diminished reaction time
- Low libido
- Heavy periods if still menstruating
- An enlarged thyroid gland
- Family history – thyroid issues are not always genetic but they may be
So you’ve got a number of these symptoms – now what?
If you have a concern about your thyroid, the next step is to get some functional testing done. That means blood tests.
Pro tip: conventional medical doctors and healthcare systems test only a few of the potential thyroid issues that might be in play. If you have a progressive and open-minded family doc, they might go deeper if you ask (although often times the provincial government health system restricts you from having these additional tests covered even if your doc calls for them).
You might have to seek additional support from a functional medicine practitioner or integrative practitioner. This might cost you a few quid but really, an investment in your health, so you can get to the root of an issue and solve it efficiently is a worthwhile spend. Right?
Below are the key thyroid hormones and what measuring their levels might show. Note – not all of these tests are included in a conventional thyroid panel, so be sure to chat with your healthcare team to ensure you are getting what you need before you visit the lab so you get the most appropriate profile.
I won’t go into what is considered to be optimal or suboptimal in terms of ranges for each hormone level and how the levels differ between allopathic and functional or naturopathic medicine. This information is nuanced and is best reviewed and discussed as part of an overall protocol and plan for improvement.
But here’s an overview of what tests to consider:
- T3 (triiodothyronine) and T4 (thyroxine): these are main hormones that work together to regulate body metabolism. The body can only use T3. T4 is inactive because it is bound to proteins. Its role is to help move T3 around the body. T4 can also be activated and become Free T4. But to do this, your body needs to be able to convert it via enzymes known as deiodinases.
These two hormones are the foundation of understanding your hormone health but far from a comprehensive picture.
- Free T4 (active form of T4): testing for this measures the amount of active T4 that is circulating freely through the blood stream, unbound to proteins, and therefore available to enter tissues and act upon them.
- Reverse T3 (inactive form of T3): mimics the active form of T3 but when it binds to a cell the same way the T3 does, there is no reaction, meaning your body will not be getting the benefits of whatever T3 it is making.
- TSH (thyrotropin or thyroid stimulating hormone): made in the pituitary but tells the thyroid when and how much T3 and T4 to make. Results from this test show how well a person’s thyroid is working by measuring the amount of TSH in the blood.
There are several other thyroid tests that measure anti-body levels. These are important if there is a suspicion of an autoimmune condition such as Hashimoto’s or Grave’s disease. Like I mentioned, the area of thyroid-related autoimmune conditions is vast and will require its own post. But just as an FYI, these tests include:
- Anti-TPO (thyroid peroxidase antibodies): measures the level of antibodies in the blood which might suggest an auto-immune issue like Hashimoto’s or Grave’s disease.
- Anti-TG (thyroglobulin antibodies): these antibodies can also indicate the presence of Hashimoto’s
- TSH receptors: presence of these antibodies may suggest the presence of Grave’s disease
As you can see – there are a lot of variables to consider when you are looking at thyroid health. But it’s worth having a baseline and understanding what is going on when you are feeling or experiencing some symptoms as described above.
Nutrition and your Thyroid
Depending on what’s going on with your thyroid, you may need a combination of diet changes, supplements and/or medications.
But it is important to note that hormones are definitely affected by what you eat, by your stress levels, by your sleeping habits and a raft of other issues. So keep that in mind as you are working with your medical practitioner.
You might also benefit from working with a nutritionist, who is skilled in hormonal balance and/or a lifestyle coach, who can educate you on some habit changes that will give your thyroid some support. If you want to talk about what might work for you, you can set up a no-obligation, no-cost clarity call here.
There are several nutrients that are associated with good thyroid health:
- Iodine: which is essential to help make thyroid hormones. It comes from iodine-rich foods like seaweed, fish and shellfish, and table salt that is labeled ‘iodized’.
- Selenium: which helps to activate thyroid hormones, so that they can be used by our bodies. One of the best sources is Brazil nuts, as well as tuna, sardines, eggs and legumes.
- Zinc: like selenium, this helps to activate thyroid hormones and it’s also thought to be important in regulating TSH. Oysters, shellfish, beef and pumpkin seeds are all good sources of zinc.
On the flip side, there are some nutrients to watch that may inhibit or unbalance the workings of your thyroid:
- Goitrogens: these compounds may interfere with the normal function of your thyroid and may block iodine. Some common sources include:
- Cruciferous vegetables like broccoli, kale, cabbage, spinach
- Soy foods like tofu, tempeh, edamame
- Starchy plants like millet, pine nuts, peanuts, cassava, strawberry, corn
- Gluten can also have an impact on thyroid. It’s found in wheat, barley, rye, spelt, kamut, farro and all foods that contain these grains in any form.
- And of course, ultra-processed foods and alcohol may also be of concern.
Just a caution, before you go cutting foods out of your diet, remember that the first course of action is to understand what is going on based on symptoms and on the results of appropriate testing.
Environmental toxins and their impact
The whole area of exposure to environmental toxins that are known endocrine disruptors needs its own separate deep dive. But as a start, here are the biggest concerns for you to keep an eye out for and choose alternate products whenever possible:
- Phthalates – in plastics of many kinds and synthetic fragrances
- Benzophenones – in many commercial sunscreens
- Triclosan – antibacterial soaps and other products
- PCB (Polychlorinated biphenyls) – coolants in various transformers and capacitors
- Perchlorates – nitrogen-based fertilizers
- Pesticides, herbicides, fungicides of all kinds
While it may be difficult to avoid all environmental toxins that could have an impact on thyroid health, getting familiar with what’s out there and how to make safer choices with the products you buy and use is a good first step. The EWG has a lot of good resources to help make you a more informed consumer and thyroid supporter.
The Holy Trinity – Or Charlie’s Angels – of Vitality: Estrogen, Cortisol + Thyroid (and why they’ve got your back + your rack, baby) – Dr Sara Gottfried
Disparities in Thyroid Screening and Medication Use in Quebec, Canada – Healthy Equity
9 Foods to Avoid with Hypothyroidism – Everyday Health
4 Things You Should Do to Keep Your Thyroid Healthy – Health.com
Thyroid disruptors and their possible clinical implications – Indian Journal of Pharmacology
Thyroid Cancer Canada