Hypothyroidism also referred to as low thyroid or underactive thyroid, is a very common condition that affects millions of North Americans. It has been commonly treated with the most widely prescribed drug in the United States Synthroid, a synthetic thyroid-hormone replacement used by more than twenty-two million Americans every month. (1)
In this Guide, you will learn:
Let's Review the Anatomy + Function
The thyroid gland is a butterfly-shaped gland that is positioned at the base of the neck, below Adam’s apple (on men). This gland secretes hormones that control metabolic activity in every cell of the body. This means the thyroid has an impact on processes such as temperature control, weight regulation, heart rate, and energy production. It also affects the balance of other hormones in the body, including the neurotransmitters, which influence mood. In hypothyroidism, the thyroid fails to produce sufficient quantities of its hormones.
Common Symptoms
There are many possible symptoms of hypothyroidism, and this is where really narrowing down the root cause with lab work and testing is very helpful. Common ones include fatigue, weight gain, dry skin, hair loss, constipation, intolerance to cold, and poor memory. (See the symptom section below for more.)
Root Cause of Hypothyroidism
The most common root cause of hypothyroidism in the United States is Hashimoto’s thyroiditis, an autoimmune disease in which the immune system attacks and destroys thyroid cells. It makes the affected person less able to produce thyroid hormone. Hashimoto’s is diagnosed by blood tests that detect elevated thyroid antibodies. The exact cause is unknown, although there seems to be a genetic predisposition. However, we will also cover other root causes below as it is commonly affected by a combination of poor digestion, low nutrient status, and a sluggish liver.
How can you tell if Hashimoto's is the cause of your Hypothyroid?
Dr. Kharrazian, paints a vivid picture in his book, “Why do I Still Have Thyroid Symptoms? When my Lab Tests are Normal”.The most common is the person who dutifully takes her thyroid replacement hormones, has her thyroid condition monitored regularly, yet continues to feel worse, needing ever-increasing doses of thyroid hormone to function. In fact, this is the person who may even forget to take her medication, only to realize after the fact that she noticed no difference in her symptoms. What’s going on?
Most cases of Hashimoto’s unfold as a gradual attack of the immune system against the thyroid, with TSH levels and symptoms of hypothyroidism slowly escalating. While the person may have normal TSH levels thanks to thyroid hormone medication, the underlying problem of immune dysregulation goes untreated, as do her symptoms. (4)
Another common scenario is one in which the thyroid condition fluctuates between being underactive and overactive. This is the person whose symptoms are all over the map. One week she fits the classic description of hypothyroidism—she feels tired, complains of headaches and constipation, and has low libido and depression. Then the next week she can’t fall asleep, her heart races, she gets anxious, and she has tremors. If her doctor runs blood tests during these episodes, they will show her TSH peaking and dipping, and even appearing normal in between bouts of symptoms.
These roller coaster fluctuations can happen for seemingly no rhyme or reason, whether it is days, weeks, months or more between swings. Other times they can be linked to a trigger, such as a stressful event, hormonal fluctuations, or eating foods containing gluten.(4) "
One reason hypothyroidism often goes misdiagnosed is because a person with Hashimoto’s can present with normal TSH. As the autoimmune condition fluctuates, TSH levels vary wildly. (4)
So what’s going on? Is the person hypothyroid or hyperthyroid? Indeed, these fluctuations are sometimes misdiagnosed as anxiety disorders. But in reality, this is just the presentation of Hashimoto’s. When an autoimmune flare-up destroys thyroid tissue, hormones stored in the gland flow into the bloodstream. Now flooded with excess thyroid hormone, the body’s metabolism speeds up, resulting in hyperthyroid symptoms. (4)
Other Types & Root Causes of Hypothyroidism
Postpartum Hypothyroidism
There are a ton of postpartum thyroid stories, more than anyone knows, with TSH levels ranging between 1.5 and 1.7. Everyone is focused on the baby’s health and wellbeing, but meanwhile, the mother starts suffering from postpartum depression, weight gain, and hair loss. She is often just prescribed antidepressants, and her problems are blamed on the baby not sleeping through the night. I support the adrenals and use compounds that support the thyroid-pituitary axis.(4) When a new mother’s TSH level increases to 2 and 3, she starts losing weight and her hair begins growing. (4)The stress of pregnancy and birth has just overwhelmed the thyroid, especially since most women are in some state of adrenal stress before getting pregnant.
Subclinical Hypothyroidism & Hypothyroid Syndrome
In subclinical hypothyroidism, TSH is elevated while the other serum thyroid hormone levels are normal.
Symptoms of Hypothyroidism in the absence of laboratory findings are more accurately called hypothyroid syndrome (2) and this condition is associated with the following:
The presence of hypothyroid symptoms
The absence of other explanatory diseases
Possible functional thyroid abnormalities such as low basal body temperature or slow Achilles reflex
For clinical hypothyroidism to be diagnosed, patients with hypothyroid syndrome must also have one or more of the objective findings: (5)
Suboptimal blood levels of thyroid hormones
Abnormal thyroid antibodies
Abnormal findings on ultrasound
Abnormal findings on biopsy (fine needle aspiration)
Risk Factors
Risk Factors + Vitamin D Deficiency
Commonly, when lab results return a correlating Vitamin D deficiency and gluten sensitivity/allergy are found as well. And from experience, we could all benefit from less or no gluten. Gluten is a large trigger for brain autoimmunity and can cause depression, brain fog, irritability, trouble focusing, dementia, chronic fatigue, and more. Even more so, the body produces antibodies against gluten and sees it as the enemy. Other possible risk factors include increased intestinal permeability, other hormone imbalances, environmental toxins, other infections, and the effects of stress.
Hormonal Changes
Hypothyroidism can also be caused by hormonal changes accompanying pregnancy, certain medications, infectious/inflammatory reactions, and problems with the hypothalamic and pituitary areas of the brain.
Hypothyroidism is more common in women. The balance of estrogen and progesterone can have an indirect influence on the thyroid glands. The most common is estrogen dominance, wherein relatively higher estrogen levels suppress thyroid function. Estrogen dominance can also be seen in issues like endometriosis and heavy, painful cycles. This predisposition can occur throughout a woman’s life. Women on synthetic estrogen therapy are particularly susceptible to decreased thyroid function so it is important that we supply the body with the proper nutrients. (1)
The Effect of Stress
The effects of stress and the balance of stress hormones are also important in thyroid function. Chronic elevation of the stress hormone cortisol suppresses thyroid function, while low levels of DHEA appear to make one more susceptible to hypothyroidism.
Toxic metals, such as mercury, lead, arsenic, and others, can also interfere with thyroid activity. Although hypothyroidism can wreak havoc upon a patient’s entire body, it is easy to treat, especially if caught in its early stages.
How to Check at Home
If you suspect that you have an underactive thyroid, measure your basal body temperature by taking your temperature at the same time every morning, before you get out of bed, for several days in a row. If your body temperature is consistently low, you should see a doctor for an evaluation. For mild cases, nutritional supplements can set you back on track quickly. For people with more severe cases, the use of thyroid hormone replacement may be required. Bioidentical is the best form if this route is necessary, as other common brands contain gluten.
Even if you require a thyroid-hormone supplement, you should complement this regime of supplementation with dietary changes, stress-reducing activities, exercise, and general hormone balancing.
SYMPTOMS
Since thyroid hormones affect every cell of the body, a deficiency will usually result in a large number of signs and symptoms.
Fatigue
Anxiety and panic attacks
Apathy
Poor memory and concentration
Depression and irritability
Low libido
Weight gain
Headaches
Aches and pains
Premenstrual syndrome
Sensitivity to cold and heat
Lowered immunity
Constipation
Carpal tunnel syndrome
Menstrual problems (irregular periods and heavy periods)
Raynaud’s phenomenon
Water retention
Recurring infections
Dry eyes/blurred vision
High cholesterol
Eyebrow loss (outer one-third)
Hair loss
Anemia and easy bruising
Dry skin and hair
Slow healing
Brittle, peeling nails
Hoarse voice
Infertility
Tingling hands and feet
Insomnia
Decreased perspiration
Decreased hearing
Full sensation in throat, hoarseness
Swelling of the face
Slow pulse
Swelling of the ankles
Slow reflexes
Chilliness
Low body temperature
Muscle aches
Muscle weakness
Hyperthyroid symptoms to be aware of
Heart palpitations
Inward trembling
Increased pulse rate, even at rest
Feeling nervous and emotional
Insomnia
Night sweats
Difficulty gaining weight
ROOT CAUSES
•Hashimoto’s disease and other inflammatory disorders of the thyroid
•Hormone imbalance (especially estrogen/progesterone, cortisol/DHEA)
•Iodine and other nutrient deficiencies
•Stress
•Surgery on or radiation of the thyroid
•Poor diet
•Inactivity
•Certain medications, most notably lithium, arrhythmia medications, and synthetic estrogen
•Pregnancy
•Failure of the pituitary gland
•Pituitary gland imbalance
•Genetics
•Head or thyroid injury
Tests You Will Need for a True Picture
The following tests help assess possible reasons for hypothyroidism:
Thyroid-hormone testing (blood-serum)
TSH - this is standard and typically run, but it is not enough to diagnose. This is a stimulating hormone from the pituitary gland that tells your thyroid what to do and what the body needs. The optimal range is 1.8 to 3.
Free T4 - measures the main form of thyroid hormone. We can use this but it is not as abundant as Free T3. It gets converted into Free T3.
Free T3 - if we are converting to this, which happens in the liver, and utilizing this hormone, it will help resolve common thyroid symptoms.
Reverse T3 - an inactive form that we will convert to in times of high stress or nutrient deficiency. We can't use this form, but it can block the receptor sites for Free T3.
Anti-thyroglobulin antibodies & Anti-thyroid peroxidase- A test for thyroid peroxidase antibodies (TPO Ab) is most important, as Hashimoto’s most commonly occurs when the immune system attacks TPO, an enzyme in the thyroid responsible for of thyroid hormone production.
General hormone testing
DHEA
Cortisol
Testosterone
Estrogen
Progesterone
Insulin
Vitamin and mineral analysis (especially vitamin A, selenium, zinc, iodine, copper, magnesium, vitamin D)—blood, urine
Digestive function and microbe/parasite/fungal testing—stool analysis
Food and environmental allergies/sensitivities—blood
Medications that can be a factor in hypothyroidism: Amiodarone Interferon alfa
Thalidomide
Lithium
Stavudine
Oral tyrosine kinase inhibitors – Sunitinib, imatinib
Bexarotene
Perchlorate
Interleukin (IL)-2 Ethionamide
Rifampin Phenytoin
Carbamazepine
Phenobarbital
Aminoglutethimide
Sulfisoxazole
p -Aminosalicylic acid Ipilimumab (1)
Holistically Approaching Hypothyroidism
Nourishing Thyroid Foods
Fish and sea salt are also good sources of iodine.
Hypothyroidism can be worsened by deficiencies in several other minerals, including zinc, selenium, and copper.
A deficiency of the amino acid tyrosine is often present in those with hypothyroidism. To make sure you’re getting enough of these nutrients, incorporate pumpkin seeds, beans, almonds, and fish into your diet.
Important Nutrients to Help You Thrive
Essential fatty acids found in flaxseeds, walnuts, and fish are important for thyroid function.
Essential fatty acids establish and maintain cell membrane integrity and fluidity in the thyroid gland. Additionally, inflammation can decrease thyroid receptor function and decrease the conversion of T4 to T3. EFAs play an important role in preventing and reducing inflammation.
Sufficient amounts of EFAs promote proper hormonal balance, mental clarity, and steady energy levels throughout the day.
The thyroid is sensitive to selenium deficiency. Selenium is a crucial component of the enzyme that converts T4 (inactive hormone) to T3 (active hormone) in the body.
A deficiency in selenium can result in less active thyroid hormone available which will result in symptoms of hypothyroidism.
Brazil nuts are a rich source of selenium, a mineral required for thyroid hormone production.
A deficiency in vitamin D is associated with several autoimmune diseases and specifically thyroid disease. Sufficient amounts of vitamin D support immune cells in making sure they are attacking outside invaders and not ourselves. In the case of autoimmunity, the receptor sites for vitamin D are diminished due to polymorphisms, and thus its biological effects on immunity are reduced.
The skin is able to synthesize vitamin D so one of the easiest ways to get this vitamin is through exposure to natural sunlight.
Vitamins D is found in a few foods, including mackerel, salmon, sardines, or fish liver oils. For this reason, many foods are fortified with vitamin D. However, I always encourage getting nutrients in naturally occurring, whole food forms to ensure quality and bioavailability.
A three-ounce serving of sardines offers 4.1 micrograms of vitamin D, and three ounces of canned salmon has 11.6 micrograms.
Magnesium.
Magnesium participates in at least three hundred enzymatic reactions in the body. In cases of severe thyroid hormone deficiency, blood pressure rises as a result of a loss of plasticity of blood vessels. It plays a role in regulating blood pressure by preventing excessive contraction of the vessels.
Zinc.
Zinc works together with vitamins A and E to manufacture thyroid hormone, and is also a necessary cofactor along with copper and selenium in converting T4 to T3. Further, zinc also assists in many other hormone activities, including growth hormones and insulin, and is critical for immune function
Iron.
Iron contributes to the proper production of thyroid hormones, and studies have shown that a deficiency in iron can have a negative impact on thyroid function. Without iron, individuals especially with an underactive thyroid can struggle with the ability to heal the thyroid and raise T3 without having hyperthyroid-like symptoms.
Iron also aids in maintaining proper immune function, which is important in the case of underlying autoimmunity. (3)
Iron deficiency is common in those with hypothyroidism. Too little thyroid hormone makes it near impossible to liberate and absorb your nutrients.
The most absorbable form of iron is found in animal sources and is called heme iron. One ounce of chicken liver delivers 3.6 mg, and three ounces of beef has 1.3 mg of iron. Non-heme iron is found in plants, and its absorption is influenced by other dietary factors. (3)
Vitamin C, for instance, can enhance the absorption of nonheme iron, while phytic acid can inhibit it. (3)
Vitamin A.
This vitamin is often deficient in people with any type of autoimmune disease, with Hashimoto’s being no exception. Vitamin A is an antioxidant and important for immune function.
Dendritic cells that communicate to the immune system need vitamin A to prevent excessive immune reactions. For the thyroid, vitamin A works together with zinc and vitamin E to convert T4 to T3 in appropriate amounts. (3)
Vitamin A that is preformed and ready to use by the body is called retinol and can be found in animal products such as liver, egg yolks, and grass-fed butter.
One teaspoon of cod liver oil has 1,350 micrograms of retinol. One egg contains 80 micrograms of retinol.
Other forms of vitamin A are carotenoids, and these are precursors to vitamin A. Carotenoids can be found in yellow and orange-colored vegetables such as sweet potatoes and carrots, as well as other green vegetables. The conversion rate from carotenoids to retinol varies.
Cruciferous Vegetables
The most common types of goitrogenic foods are cruciferous vegetables, such as cabbage, kale, broccoli, and Brussels sprouts.
These foods are nutrient powerhouses serving as excellent sources of vitamin C, potassium, folate, vitamin B6, calcium, and magnesium.
Several studies have been conducted on cruciferous vegetables and their anti-cancer compounds. Due to their high nutrient density, completely eliminating foods in this family would not be a good idea.
Consume organic, hormone-free meats and poultry since environmental hormones disrupt thyroid function.
A slow metabolism often means a slow digestive process. Encourage faster elimination by eating more fiber in the form of whole grains, beans, fruits, and vegetables.
You must stay adequately hydrated. Drink a glass of clean, quality water every two waking hours.
Food to Avoid
Excess soy consumption, especially of non-fermented soy, may be problematic.
Inflammatory Seed Oils
Processed foods
Tap Water
Drink your coffee with or after food, and never on an empty stomach
Use my Rooted in Foundations Guide to narrow down inflammatory foods. If you are in need of thorough bloodwork, contact me!
It’s never advisable to drink tap water, but people with hypothyroidism must be especially wary of it. Most tap water is full of fluorine and chlorine, two chemicals that inhibit your ability to absorb iodine.
My Favorite Supplements
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Digestive Enzymes
Bodywork Massage A full-body massage will reduce stress, improve circulation, and lift your energy level. If you like, you can add any of the essential oils listed in the Aromatherapy section to further enhance the treatment.
Aromatherapy
Geranium oil will regulate the thyroid hormone. Use it in a bath, or better yet, add to a carrier oil and incorporate into a massage. Geranium can also help lift fatigue and depression. So can jasmine, neroli, bergamot, and rose. If your skin is dry, add chamomile (Matricaria chamomilla) to a lotion, a cream, or a carrier oil and apply the mixture to the affected area.
Oil of black pepper or marjoram will stimulate a sluggish digestive system and improve overall circulation.
Stress Reduction
General Stress-Reduction Therapies
High levels of stress inhibit the thyroid’s ability to properly manufacture its hormone. Exercise has been shown to improve thyroid function and should be done on a daily basis.
REFERENCES
Stengler, M., Balch, J., Young, R. Hypothyroidism Prescription for Natural Cures. 3rd Ed.
Murray, Michael, Pizzorno, Joseph. Hypothyroidism. Encyclopedia of Natural Medicine. 3rd Ed. (716-723)
Kharrazian, D. Why Do I Still Have Thyroid Symptoms? When my Lab Tests are Normal (1596-1772)
Brighten, J. What to Eat for Thyroid Health + One Day Thyroid Meal Plan https://drbrighten.com/thyroid-foods-and-one-day-thyroid-meal-plan/
Weetman AP. Hypothyroidism:screening and subclinical disease. BMJ 1997; 314:1175-1178
Gartner, R. 2003. Selenium in the treatment of autoimmune thyroiditis. Biofactors 19(3–4):165–70. Medscape. Accessed June 26, 2015, at http://emedicine.medscape.com/article/122393-overview#a4.
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