Mysteries of the Thyroid
Welcome, everyone. Thank you for joining me! My name is Dr. Trish Murray. I am a physician, author, and Health Catalyst Speaker. I am passionate about educating you on how to take control of your health and transform your life! My first book is entitled Make a D.E.N.T. in Chronic Disease, and I am presently working on a new book that will be discussing the future of medicine.
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The thyroid gland is located in the front of the trachea (or more commonly known as the windpipe) and just below the larynx or your Adam’s apple in the neck. The shape of the thyroid is similar to a butterfly with two halves that are called “lobes.” These two lobes are connected by a band of thyroid tissue called the “isthmus.” The loose connective tissue that surrounds the thyroid gland allows it to move and change its position when we swallow. Interesting, the thyroid initially develops in the back of the tongue and then migrates down to the front of the neck before birth as we are developing. On average, the thyroid weighs between 20 – 50 grams (about 2 ounces). Each lobe contains a high number of small sacks that are called “follicles.” These store thyroid hormone in the form of little droplets.
To understand the function of the thyroid, it’s essential to discuss the endocrine system. The endocrine system is a collection of glands that produce hormones. Hormones regulate metabolism, growth and development, tissue function, sexual function, reproduction, response to stress, sleep, and mood. In addition to the thyroid gland, the pituitary gland, the parathyroid glands, the adrenal glands, the pancreas, the ovaries in females, and the testicles in males all make up the glands of the endocrine system. Each gland of the endocrine system stores hormones to be released into the bloodstream which then are transferred to the body’s cells.
The thyroid gland uses iodine to make two main hormones. One is called “triiodothyronine” or “T3.” (Don’t try to say it three times fast, it’s a difficult one!) The other one is called “thyroxine” and that is “T4.” To a lesser extent, the thyroid also produces calcitonin which helps control blood calcium levels.
The body cannot make the mineral iodine which is why it is required through the diet. Iodine is absorbed into our bloodstream from food in our gut. It is then carried to the thyroid gland where it is eventually used to make thyroid hormones. Thyroid cells are unique in that they are highly specialized to absorb and use iodine. Thyroxine is called T4 because it contains four iodine atoms. T4 is the form of hormone that is released by the thyroid gland, but it is typically not an active hormone. T4 needs to be converted to T3 by the removal of one iodine atom.
Thyroid hormones travel in your bloodstream to reach almost every cell in your body, and they regulate the speed with which the cells and metabolism work. For example, thyroid hormones regulate your heart rate and how fast your intestines absorb and process food. If T3 and T4 levels are low, you may have hypothyroid symptoms which would cause your heart rate to be slower than normal and you may have constipation as well as weight gain. If on the other side T3 or T4 levels are too high and you have hyperthyroid symptoms, you may have a rapid heart rate, diarrhea, or weight loss.
The pituitary gland and hypothalamus both control the thyroid. When the thyroid hormone levels drop too low, the hypothalamus located at the base of the brain secretes a hormone. That hormone then goes off to the pituitary gland which is also in the brain, and that puts out thyroid-stimulating hormone (TSH). The thyroid responds to this chain of events by producing more hormones. The amount of thyroid-stimulating hormone (TSH) that the pituitary sends into the bloodstream depends on the amount of T4 that the pituitary sees in your bloodstream. Once the T4 in the blood goes above a certain level, the production of TSH is shut off.
Basically, you can imagine this cycle like a heater and a thermostat. When the heater is off and the room becomes cold, the thermostat reads the colder temperature and turns on the heater. When the heat rises to an appropriate level, that same thermostat senses this and turns off the heater. The thyroid and the pituitary gland in your brain, like a heater and a thermostat, turn on and off.
People with an overactive thyroid have a condition called hyperthyroidism. Excess amounts of T3 and T4 produced and released cause disruptions throughout the body. The symptoms of hyper- or overactive thyroid including the following:
- Muscle weakness
- Hand tremors
- Mood swings
- Nervousness or anxiety
- Rapid heartbeat
- Heart palpitations or irregular heartbeat
- Skin dryness
- Trouble sleeping
- Weight loss
- Increased frequency of bowel movements
- Women will experience lighter periods or skipped periods
Hypothyroidism is just the opposite, too little T3 and T4. Approximately 10 million Americans are likely to have this extremely common medical condition. In fact, as many as 10% of women may have some degree of thyroid hormone deficiency. Hypothyroidism is much more common in women than it is in men, but this does not mean that men are immune to this condition. Symptoms of hypothyroidism include:
- Weight gain or increased difficulty losing weight
- Course, dry hair
- Hair loss
- Dry, rough, pale skin
- Cold intolerance
- Muscle cramps and aches
- Memory loss
- Abnormal menstrual cycles
- Decreased libido
Obviously from this list, you can see how important the thyroid is and how the thyroid function needs to be normal for us to feel well and to be optimally healthy. There are several conditions that can also result from abnormal function of the thyroid. In addition to hyper- and hypothyroidism, the following conditions can also occur:
- A goiter – a bulge in the neck. A toxic goiter is typically associated with hyperthyroidism. A nontoxic goiter, also known as a simple or endemic goiter, is typically caused by iodine deficiency and is more common in people with hypothyroidism.
- Thyroiditis – an inflammation of the thyroid. This may be associated with hyperthyroidism or hypothyroidism. When the thyroid gland is inflamed, it can cause the thyroid cells to die, making the thyroid unable to produce enough hormones to maintain the body’s normal metabolism. Hashimoto’s Thyroiditis is the most common cause of hypothyroidism. This is an autoimmune condition caused by the immune system creating antibodies against your own thyroid gland and actually attacking it. This is the most common reason why people eventually develop hypothyroidism.
- Thyroid cancer. Thyroid cancer can develop and has become relatively common today. Long-term survival rates are actually excellent. Thyroid cancer can affect anyone at any age, though women and people over thirty are the most likely to develop this condition.
Before we get into a more functional discussion of the thyroid, I want to make sure I cover the lab tests that are necessary to fully diagnose if the thyroid is functioning optimally or not. In the traditional medical model, I and all other physicians were trained and are still trained that doing a blood test to assess the level of TSH is a very highly sensitive test and all you need to determine if the thyroid gland is functioning normally. But with what I’ve explained so far, TSH does not even come from the thyroid gland! It comes from the pituitary gland in your brain which is the thermostat and not the heater. For example, if there’s something wrong with the heating system in your home, is the technician only going to examine the thermostat? Or are they going to examine your furnace as well as the thermostat?
The bloodwork you want to ask for or have done to fully assess the function of your thyroid gland includes thyroid-stimulating hormone (TSH). This is an excellent test but again this hormone only comes from the pituitary gland in your brain. You also want to test free T3 and free T4, the two hormones that are actually put out by the thyroid. T4 is put out by the thyroid and then needs to be converted to free T3. You want to make sure you know the levels of these. Another lab test is that when T4 gets converted it might get converted to normal free T3, the active hormone, but it also could be converted to something called “reverse T3.” Reverse T3 is actually not an active hormone. It’s created in an abnormal formation and doesn’t function normally when it binds to the cells. The other thing you want to test for is if you have an autoimmune condition against your thyroid gland. There are certain antibodies that your immune system can create against your thyroid. You want to ask to test for the antibodies that can be produced by your immune system against your thyroid gland including antithyroglobulin antibodies or thyroid peroxidase antibodies.
As you now know, the thyroid gland is where the production and secretion of the hormones T3 and T4 take place. But what are the functions of the thyroid? Let’s get into a more functional discussion. The thyroid is responsible for regulating the body’s metabolic rate as well as heart rate and digestion function, muscle control, brain development, mood, and bone maintenance. Its correct function depends on having a good supply of iodine from the diet.
Your metabolic rate is the rate at which your body burns calories. You can separate the types of calories that your body burns into two different categories. One type of category of calories is called “resting calories,” and the other is called “activity calories.” Even when we’re just sitting on the couch watching TV or listening to a webinar like this, our body is burning calories. This is considered our baseline or basal metabolic rate. In fact, it accounts for about 60-75% of the total amount of energy you burn every day! While at rest, your organs and essential biological functions are still working hard for you which is why we need energy in the form of nutrition even when we’re inactive. Our thyroid hormones are involved in how well we burn our calories for fuel. A few examples of specific metabolic effects of thyroid hormones include thyroid hormone levels stimulate fat metabolism. This is the process of either using fat for energy or storing it in the body for later use. Thyroid hormones also stimulate almost all aspects of carbohydrate and sugar metabolism. If your thyroid hormones are off, you will not balance your sugar levels optimally and you will not metabolize your fat storage properly.
You can see that in addition to metabolism, the thyroid plays a significant role in several other body functions. Thyroid hormones are necessary for healthy growth in children. Studies revealed normal levels of thyroid hormone are essential for the development of the fetal and the neonatal brain. Thyroid hormones increase heart rate, cardiac contractility, and cardiac output. They also promote dilation of your blood vessels which leads to enhanced blood flow to many different organs. Both decreased and increased concentrations of thyroid hormones lead to alterations in mental state. Too little hormone will cause you to feel you mentally sluggish and have brain fog, while too much thyroid hormone increases anxiety and nervousness. Normal reproductive behavior and physiology are dependent are having essentially normal levels of thyroid hormone. Hypothyroidism, in particular, is commonly associated with infertility.
There are numerous natural techniques you can utilize to boost the health and function of your thyroid gland. Stress is a natural part of our lives, however, today more people are experiencing higher levels of stress which can wreak havoc on our health. Living in a constant state of fight or flight can tax the adrenal glands which can suppress the hypothalamus and the pituitary glands, both of which directly influence the thyroid function.”] We all must find ways to minimize stress. I recommend my clients and patients to have a daily practice (at least five to ten minutes a day) of calming the mind such as doing meditation, deep breathing, stopping your day and going for a walk, or doing some journal writing. All of this is important.
Let’s take a look at the thyroid adrenal connection. When our stress is up, we need to produce more cortisol. Cortisol is your stress hormone that helps you handle all the stress of our lives and gets you up in the morning. In order to get out of bed in the morning, you must have an increase in your cortisol. The thyroid comes from a connection of hormones that first starts coming from the brain. The hypothalamus in the brain to the pituitary in the brain and then TSH tells the thyroid to put out T4. Then T4 has to get converted to T3. On the stress side of things, you notice in the image shown above that the hypothalamus puts out a hormone that then goes to the pituitary gland that turns on your adrenal glands to put out cortisol which is your stress hormone. If you are over stressed and your brain is constantly focused on putting out the correct hormones to give you enough cortisol to deal with your stress levels, you will notice that too much cortisol, or any of the hormones that are precursors to cortisol, inhibit the production of thyroid-stimulating hormone and inhibit the production of T4 and inhibit the production or the conversion of T4 to T3. It might be your stress that causes thyroid symptoms to occur when excess cortisol blocks the production of TSH or prevents the conversion of T4 to T3. You experience thyroid symptoms such as fatigue, cold intolerance, weight gain, memory problems, poor concentration, depression, hair loss, dry skin, and infertility. It’s extremely important to realize the crazily increasing levels of stress in our lives affect not only our adrenal glands but also affect our thyroid function and can lead to the main reason why we are having a hypo- or even hyperthyroid.
The body requires sleep for overall health and healing, however, thyroid conditions can impact sleep patterns. For adults, essentially the optimal amount is between seven and nine hours of sleep a night. Keep in mind if you miss a few hours you also cannot catch up later on. Missed sleep is typically felt to be scientifically lost. If you have trouble sleeping this is typically related to stress and lifestyle habits. Try eating dinner at least two hours before bed. Have a cup of calming, herbal tea. Do some deep breathing or stretching prior to going to sleep, or learn about essential oils and which ones can help promote sleep. There are many avenues that can help reduce stress and improve sleep.
Physical activity is excellent for assisting in hormone production. If you’re experiencing a sluggish metabolism, aim for 20 to 30 minutes of low-intensity exercise three times per week, and do some gentle basic stretching every day. That is not a lot of exercise! Some of you are out there thinking you need to go run a marathon to be healthy – you do not! Again, aim for 20 minutes of low intensity exercise three times per week and do some gentle basic stretching every day. If you know you are not moving enough and are not sure how to get started then another option is go to the Health Library on my website and click on the link to Exercise Videos. There you will find Level 1 demonstration videos by me on stretching, core strength, and weight resistance exercises. Just follow along with them and you’re going to start creating your exercise practice. We also offer gentle yoga classes on Friday mornings as well as balance and strength Movement for Longevity classes. To learn more about any of our classes, go to our Discover Health Calendar.
Refined sugars and carbohydrates as well as alcohol can wreak havoc on your body and your thyroid. These foods cause inflammation, weight gain, and blood sugar issues. If you have a sweet tooth, turn to fresh fruit. You’ll be surprised how quickly your taste buds will adapt to the natural sweetness. Also, beware of hidden sugar in packaged foods, condiments, and sauces. Make sure to check ingredients to avoid products with added sugar. A diet rich in essential vitamins and minerals such as selenium, iodine, zinc, thiamine, B12, and vitamin D can help heal your thyroid and reduce inflammation. Fill you plate with dark leafy greens, quality fats, and plant-based protein sources. You can also test out incorporating more sea vegetables like seaweed into your diet. In fact, just one dried sheet of seaweed contains well above the daily recommended value of iodine. You can buy in little packets these little squares the size of your palm or smaller of dried seaweed sheets that you just put in your mouth and chew. They are a little bit of an acquired taste. Some people love them, and some people think it’s an acquired taste. Again, one of these sheets gives you well above the daily required amount of iodine. Another tip is a handful of Brazil nuts can contain more than your daily recommended value of selenium which kickstarts the production of active thyroid hormones. Actually, eating only two Brazil nuts per day can typically give you the daily required amount of selenium you need to optimize your thyroid function. More is not always better, and the saying “less is more” applies in this case of Brazil nuts. You don’t want to eat a handful every day. Only two a day is about all you’re going to need. One egg contains about 20% of your daily recommended value of selenium and 15% of your daily recommended value of iodine. Lentils are an excellent of plant-based protein, but they also provide iron to the body. Low iron levels have been linked to poor thyroid function. You can learn how to optimize your diet which we help people do every day at Discover Health Functional Medicine Center with group classes and through one-on-one appointments with myself or our health coach in-person or online! We work with people from all over the country. This may be what you need to correct your thyroid problems, especially if you have subclinical issues, without even ever needing to go on prescription medicines.
If you are on a prescription medicine for your thyroid, I never recommend anyone stopping any medication until you’ve working with someone. If you’ve had hyperthyroidism and then they needed to irradiate your thyroid, then you don’t have a thyroid anymore and you must take your thyroid medicine. I never recommend stopping any prescription medications without absolutely working with a functional medicine provider and making sure your individual situation is completely understood to determine whether you’re going to need to stay on your thyroid medicine. Maybe you’re going to improve your overall health so you’re not going to need to keep increasing your thyroid medicine. Maybe you’d even be able to reduce it. Everyone is different, and that’s what you need to understand.
Another food example is garlic. Garlic is thyroid-friendly because it supports blood sugar metabolism and can fight against inflammation. Over the last twelve weeks we have been running a study on the effects of eating fermented black garlic on inflammation, blood sugar, and cholesterol. This study is essentially coming to an end right about now and people are getting their repeat or end of the study bloodwork done. Over the next couple of months we’ll be seeing what effect it has had for people. Stay tuned for that information!
The best thing you can do when planning a meal is to limit dietary stress which is caused by eating foods that create inflammation, sensitivity, allergic response, a spike or rapid fluctuations in your blood sugar, or contain toxins or chemicals that can trigger immune responses.High amounts of unhealthy fats like trans fats or hydrogenated fats that are found in all packaged and processed foods should be avoided. With a few strategic changes, you can help eliminate your dietary stress. Some recommendations for you to focus on are these:
- Eliminate heavily processed foods (foods that come in boxes or bags that can live on a shelf for years at a time).
- Skip table salt and instead opt for a natural form like unrefined sea salt or Himalayan pink salt.
- Incorporate more good fats in your diet such as olive oil, avocados, healthy nuts and seeds, coconut, coconut milk, and coconut oil.
- Avoid eating too much in one sitting.
- Give your body a ten to twelve-hour break from eating every day (overnight for example).
According to the National Institute for Environmental Health Sciences, endocrine disruptors are chemicals that may interfere with the body’s endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in both humans as well as animals. Endocrine disruptors are chemicals that mimic our hormones. When this occurs, the chemical disruptor interferes with the messages our hormones are trying to send to our cells. A wide range of substances, both natural and human-made, are thought to cause endocrine disruption. These include chemicals like dioxin, dioxin-like compounds, polychlorinated biphenyls, DDT and other pesticides, and plastics and plasticizers like bisphenol A (BPA). When you go to the grocery store and they hand you a receipt and you touch the ink on the receipt, for example, that ink has bisphenol A in it which is an endocrine disruptor. Certain cosmetics that we use…if you read the ingredients on any of your creams or any of your makeup or any of your cosmetics out there that men or women use and you read the list, if you see the word “parabens” or you see the word “phthalates” these are typically very commonly used chemicals in many common cosmetics and cleansers and things we use on our bodies every day. These are endocrine disruptors. They are blocking your normal and optimal hormone function.
For more information on this topic because this is a huge topic of its own, to avoid endocrine disruptors, there is a wonderful organization called the Environmental Working Group. This is a non-profit organization, and if you go to their website you’re going to learn a ton about how to clean up your world when it comes to cleaners, cosmetics, and things like that. Endocrine disruptors may be found in everyday products including plastic bottles, metal food cans, detergents, flame retardants, food, toys, cosmetics, and pesticides. To reduce expose to endocrine disruptors, choose glass containers over plastic containers, drink filtered water, and buy organic produce. Additionally, opt for nontoxic, natural bath and beauty products, household cleaners, and laundry detergents. For more information on what products are safe and which are not, visit Environmental Working Group’s website. There are different things you can click on there where I’ve stood, for example, in a health store pharmacy looking at the different cosmetic and makeup aisle and I’ve been able to put in any product I’m looking at on the website and they will rate that specific product I have in my hand or am looking at. They will rate it green (go ahead and use it), yellow (think about it), or red (please do not buy it because it is full of toxins and endocrine disruptors).
Thank you everyone for being a part of this!
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- For more information about endocrine disruptors: Environmental Working Group
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