by Chris D. Meletis, ND
One of the most common reasons patients visit my office is because they are chronically tired and fatigued. Although there are many causes of fatigue, a poorly functioning thyroid gland is often the culprit behind their low energy levels.If you’re fatigued, this may be your problem as well. Low thyroid function or hypothyroidism not only can zap your energy levels—it can also be to blame for other symptoms such as:
- Increased sensitivity to cold
- Constipation
- Pale, dry skin
- Sluggishness
- A puffy face
- Hoarse voice
- Elevated blood cholesterol and liver enzyme levels
- Unexplained weight gain
- Muscle aches, tenderness and stiffness
- Pain, stiffness or swelling in your joints
- Muscle weakness
- Heavier than normal menstrual periods
- Brittle fingernails and hair
- Depression
Hypothyroidism also is associated with an increased risk of heart disease—and new research indicates that the reason why may be because hypothyroid patients have a higher level of the inflammatory marker C-reactive protein and a higher level of homocysteine, an amino acid linked to heart disease.1
Conversely, hyperthyroidism—when your thyroid goes into overdrive—can also cause fatigue as well as the following symptoms:
- Palpitations
- Heat intolerance
- Nervousness
- Insomnia
- Breathlessness
- Increased bowel movements
- Light or absent menstrual periods
- Fast heart rate
- Trembling hands
- Weight loss
- Muscle weakness
- Warm, moist skin
- Hair loss
- Staring gaze
If you have any of the symptoms above, it’s time to talk to your doctor about getting your thyroid tested. But first, it’s critical to make certain that you’re getting the right thyroid tests.
Do You Have a Healthy Thyroid?
I have found that testing for free T3, free T4, thyroid stimulating hormone (TSH) and reverse T3 (rT3) provides the most accurate initial picture of how the thyroid is functioning.
T4 (thyroxine) and T3 (triiodothyronine) are important thyroid hormones. Yet, even with normal levels of T3 and T4, it’s possible to still have the symptoms of hypothyroidism, which may be due to excessive production of rT3 in the body. Reverse T3 competes with T3 at important binding sites, which is a problem because rT3 is inactive and therefore not as beneficial as T3.
It’s normal for your body to produce some rT3. In fact, the liver constantly converts T4 to rT3 to get rid of excessive amounts of T4. Normally, about 40 percent of T4 is converted to T3 and 60 percent is converted to rT3.2
However, the production of rT3 can rise after emotional or physical stress, after you get the flu, after surgery, car accidents or any acute injury, diabetes, aging or even being on drugs like beta blockers and amiodarone. If you’re under chronic stress and your adrenal glands are producing too much cortisol, your production of rT3 may skyrocket.
When looking at thyroid test results, it’s not necessarily the levels of reverse T3 alone that are important—although if rT3 is high that’s a signal something is wrong. But it’s really the ratio between rT3 and free T3 that tells the full story. To calculate the ratio, divide the free T3 by the reverse T3 (free T3 ÷ rT3). Holistic providers often suggest that the ratio should be 20 or larger. Anything lower indicates potential cause for concern.
It’s also important to test for free T3 and free T4 rather than total T3 and total T4. This is because total T3 and total T4 doesn’t tell you how much of the T3 and T4 are doing their proper jobs in the body. In other words, total T3 and total T4 can’t show you whether your body is using these two thyroid hormones effectively.
Lastly, your doctor may also want to do an ultrasound on your thyroid, especially if it’s enlarged. In addition, if there is concern of autoimmune thyroid disease, ordering a thyroid peroxidase antibody and anti-thyroglobulin antibody level is a common next step.
Pinpointing the Cause
If your test results indicate you’re hypothyroid (we’ll talk more about hyperthyroidism later), it’s important to ask: What is causing the sluggish thyroid? Because, without addressing the cause of the problem, we can’t find a true solution.
A one-size fits all approach doesn’t work. In fact, in the Colorado Thyroid Disease Prevalence Study, 60 percent of the subjects taking thyroid medication still didn’t have normal TSH levels.3
First, we need to look at the factors that inhibit proper production of thyroid hormones. One of those factors is stress, which increases the conversion of T4 to rT3 and suppresses the production of T3 and TSH. Extreme exercise can have the same effect.
Environmental toxins also inhibit proper production of thyroid hormones. Perchlorate, a toxin found in rocket fuel, pesticides, herbicides and household bleach, is commonly found in the water supply and in food. Researchers have linked increased urinary perchlorate to higher levels of TSH in women with normal serum T4.4-5
Bisphenol A, found in canned foods and even cash register receipts, as well as phthalates, which are found in cosmetics, shampoos and other common products, both disrupt thyroid gland function.
Using data from the National Health and Nutrition Examination Survey, researchers examined whether there was a connection between phthalate and BPA levels and thyroid function in 1,346 adults and 329 adolescents. Among adults, researchers observed that the higher the metabolites of a particular type of phthalate, the lower the levels of total T4, free T4 and total T3. High phthalate metabolites also were associated with higher thyroid-stimulating hormone.
High urinary BPA levels were linked to low total T4 and TSH. In adolescents, high phthalate metabolites were associated with high total T3.6 The results further confirmed that there is indeed a link between the toxins we’re exposed to every day and altered thyroid.
Another substance we’re exposed to frequently is fluoride, which inhibits proper production of thyroid hormones. Currently, an estimated 300 million people are exposed to fluoridated water, including 5.5 million in the United Kingdom and 144 million in the U.S.7-8
This means that a massive number of people are exposed to fluoride, which spells trouble for the thyroid gland. In one study, researchers evaluated thyroid function in rats consuming a diet with added fluoride. The rats were evaluated for serum levels of the thyroid hormones T3, free T3, T4 and free T4. The results of the study showed that the rats fed the diet with added fluoride had significantly decreased levels of all four thyroid hormone measurements.9
But what about in humans? Turns out similar effects occurred in a study of 123 subjects evaluated for thyroid hormone levels. Prolonged consumption of drinking water with elevated levels of fluoride caused an increase in thyroid stimulating hormone (TSH) released from the pituitary, decreased levels of T3 and a more intense absorption of radioactive iodine by the thyroid as compared to healthy individuals who consumed drinking water with the normal fluorine concentration.10
Another study evaluated thyroid and immune function in individuals exposed to fluoride at work. The researchers showed that in the workers with subclinical hypothyroidism (low thyroid), T3 was reduced in 51 percent of subjects exposed to the fluoride. Furthermore, alterations in immune system function were more pronounced in these workers, causing increased numbers of T-lymphocytes (white blood cells), but decreased functional activity of these cells.11
Other Thyroid-Blockers
People who have celiac disease are often plagued by thyroid problems, possibly due to the fact they have a hard time absorbing selenium, a nutrient essential for proper thyroid function. Celiac disease also occurs more often in people with autoimmune thyroid diseases.12
Chronic infections are also known to decrease blood levels of T4, T3, TSH and selenium.13
Additionally, certain foods (called goitrogens) may inhibit thyroid function. Soy is possibly the worst offender. It can interfere with thyroid hormone absorption to the point where people taking thyroid hormone replacement for underactive thyroid continue to be hypothyroid until they either stop consuming soy or significantly increase their doses of thyroid hormone.14
In humans, infants fed soy formula developed goiter. However, in post-menopausal women and healthy young men, soy intake did not affect thyroid function.15-16
In another study, there was a three-fold increased risk of developing full-blown hypothyroidism in female patients with subclinical hypothyroidism who consumed 16 mg of soy phytoestrogens per day. Ironically though, insulin resistance, CRP and blood pressure declined in the patients on soy.17
Other foods thought to inhibit thyroid function include peaches and cruciferous vegetables (broccoli, cauliflower, cabbage, etc.).
Mammograms and Dental X-Rays
Although conventional medicine disputes the claim that mammograms or dental x-rays can increase the risk of thyroid cancer, the reality is that no one can say for sure how much radiation exposure it will take to cause one person to develop cancer. Radiation exposure is, after all, cumulative.
In fact, in an article published in March 2012, one group of researchers asked whether diagnostic radiation causes cancer and concluded, “We don’t know, but we should act as if it does.”18
Therefore, it’s extremely important to ask for a proper shield around your thyroid when undergoing these tests.
Helping the Thyroid Thrive
Now that we’ve discussed the factors that inhibit thyroid function, let’s look at what the thyroid needs to stay healthy.
Most importantly, the thyroid craves balanced levels of iodine. Even mild iodine deficiency is associated with multinodular goiter (enlarged thyroid).19
Iodine deficiency is more common than you would think. This is because the amount that’s added in salt isn’t enough to compensate for the fact you’re exposed regularly to substances that compete with iodine. Bromide is one of those substances.
Bromide is found in sodas like Mountain Dew in the form of brominated vegetable oil. It also lurks in pesticides (methyl bromide), some breads (as potassium bromate), hot tub cleansers, some asthma inhalers and prescription drugs, plastic products, personal care products, fire retardants and some fabric dyes.
Diets both low and high in iodine are associated with hypothyroidism. This is supported by studies that have shown that both low and high urinary iodine excretion are associated with hypothyroidism. High intake of iodine also increases the risk of Hashimoto’s thyroiditis.20-21 So achieving balanced iodine levels is key.
Taking an iodine sufficiency test is the best way to determine if you’re deficient in this important nutrient. You can take this test at home and the results will help determine how much you should supplement with.
Depending on the results, a supplement regime can be determined. For healthy individuals under the care of a physician, a starting dose is often 6.25 to 12.5 mg per day of the most beneficial form of iodine, which is a combination of iodine and iodide. This blend of iodide and iodine has been clinically shown to be better tolerated and provide the maximum benefit.
Selenium is another nutrient crucial to a healthy thyroid. The human thyroid gland contains one of the highest selenium contents of any tissue in the body. Selenium is present in thyrocytes (cells in the thyroid gland) and thyroid tissue and helps provide antioxidant defense against significant amounts of hydrogen peroxide resulting from thyroid hormone production.22-23
Because of the interaction of iodine and selenium in thyroid metabolism—and the fact that iodine replacement increases oxidative metabolism in thyroid tissue—if you’re deficient in both selenium and iodine, replacement of both minerals is necessary to support thyroid function.24
Studies using 50 mcg selenium daily in goiter endemic areas in Zaire have resulted in significant improvement of symptoms, while serum levels of T4 and reverse T3 dropped to normal range, serum total T3 improved and serum TSH levels stayed within normal ranges.25
I suggest supplementing up to 200 mcg per day—anything beyond that is excessive and can be toxic.
Vitamin D deficiency also spells trouble for the thyroid. The prevalence of vitamin D deficiency was significantly higher in patients with autoimmune thyroid disorders compared with healthy individuals (72 percent versus 30.6 percent), as well as in patients with Hashimoto’s thyroiditis compared to patients with non-autoimmune thyroid disorders (79 percent versus 52 percent).
Additionally, significantly low levels of vitamin D were documented in patients with autoimmune thyroid disorders that were related to the presence of antithyroid antibodies and abnormal thyroid function tests, suggesting vitamin D is involved in the development of autoimmune thyroid disorders.26
Given this, testing for vitamin D levels, either through your doctor or an at-home test, is a good idea. Depending on what the test reveals, supplementing with 2,000 to 5,000 IU per day may be warranted.
Other nutrients important for thyroid function include iron, tyrosine, zinc and vitamin C. Consuming a good detoxification supplement also can help rid the body of thyroid-disrupting toxins.
Treating Hyperthyroidism
For some people, the problem isn’t a sluggish thyroid, but rather a thyroid that has gone into overdrive, causing hyperthyroidism. Hyperthyroidism is a serious condition, and left untreated, it can be life threatening.
Here are a couple of items that I have used in my practice. However, I would like to emphasize that it is essential that you work with a skilled provider when dealing with hyperthyroidism, as the condition requires close monitoring of many organ systems in the body beyond just the thyroid gland.
In my practice, I have found Lycopus europaeus (also known as gypsywort) to be very helpful in hyperthyroid patients. It has a long history of traditional use in treating hyperthyroidism.
Additionally, in an animal study, Lycopus europaeus caused a long lasting decrease of T3 levels. Researchers also observed a pronounced reduction of T4 and thyroid stimulating hormone (TSH) concentrations 24 hours after application of the test solution by gavage.27
Another useful nutrient in hyperthyroidism is L-carnitine. Increased thyroid activity increases loss of L-carnitine through the urine. Individuals suffering from hyperthyroidism may, therefore, require supplemental L-carnitine. Clinical trials have shown that doses of 2,000 to 4,000 mg per day of L-carnitine are helpful.28-29
Risk Factors for Thyroid Cancer
Several factors may play a role in the development of thyroid cancer. The first is iodine deficiency. Iodine is crucial to the thyroid, as mentioned above.
In addition, some studies have proposed that sex hormones may play a role in the development of thyroid cancer. One study published in February 2012 found a similar link between sex hormones and thyroid cancer. Researchers compared 99 female subjects (average age 40) who had thyroid cancer to 51 healthy women (mean age 36).
Patients with thyroid cancer had more frequent menstrual cycle disturbances, used hormone-containing medicines more frequently, had spontaneous miscarriages more frequently and their duration of lactation was significantly shorter than in controls. The mean serum estradiol (estrogen) level in women with thyroid cancer was significantly higher than in the controls. The mean serum progesterone level was higher in the controls than in patients with thyroid cancer.30
According to the researchers, “The results of these studies imply that estrogens may at least modify the proliferation of thyroid cancer cells. The sex hormones probably intensify the actions of other carcinogens as well.”
A study published in June 2012 explored another risk factor for thyroid cancer—vitamin D deficiency. In the study, 212 patients undergoing thyroidectomy (removal of the thyroid) had their preoperative 25-hydroxyvitamin D3 levels recorded. There was a strong link between thyroid cancer and vitamin D deficiency in these subjects.31
Protect Your Thyroid, Protect Your Health
Having your doctor perform thyroid testing can help pinpoint the true cause of your fatigue. If your thyroid is the cause of your plummeting energy levels, weight gain, depression and other problems, giving this gland what it needs to stay healthy will make a huge difference in how you feel.
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Source: Understanding and Overcoming Thyroid Dysfunction
