An estimated 27 million Americans are affected by thyroid disease. The thyroid is a relatively small gland that sits at the base of the neck just below the adamʼs apple. For such a small gland, it has a profound effect on how our bodies work and how we feel. More and more people are developing thyroid disorders and 13 million Americans likely have an undiagnosed thyroid disorder at this time. Thyroid disorders are more common in women, but are being seen in increasing numbers in men too. 25 percent of American women will develop thyroid disorders. It is imperative as we age to keep a close eye on the thyroid gland.
The thyroid gland has many roles:
- Regulates metabolic activities in almost all tissues of the body, including energy and heat production.
- Stimulates growth in children.
- Stimulates bone growth and turnover.
- Effects the entire cardiovascular system–including how the heart pumps, blood vessel dilation or relaxation, and effects on cholesterol.
- Reduces total cholesterol and LDL cholesterol.
- Relaxes arterial smooth muscle in vessel walls, lowering blood pressure.
- Stimulates nerve growth and development in the brain and nervous system.
- Effects the way fat is stored and converted to energy.
- Effects the way the liver breaks down toxins, stores energy, fat and cholesterol.
- Interacts directly with the brain/pituitary gland to regulate further production of other hormones.
The thyroid gland produces two hormones, called T3 and T4. The gland secretes mostly T4 (about 80%). T4 is converted into T3 in other areas of the body. T3 is considered the more biologically active form of the two hormones. It responds to a stimulating hormone that comes from the pituitary gland in the brain called TSH. When everything is in harmony, the thyroid gland makes adequate amounts of T3 and T4. T3 and T4 then tell the brain, in a complex negative feedback loop, “everything is balanced” and TSH (from the pituitary) and T3 and T4 from the gland remain normal and balanced in the blood. When there is disease or dysfunction involving the thyroid gland it may be unable to produce adequate amounts of hormone, and T3 and T4 will be low. The brain responds by producing more TSH in an attempt to get the thyroid to produce more hormone. This is the classic case of primary hypothyroidism. T3 and T4 levels are low and TSH is elevated. As mentioned, T4 also needs to be converted to T3. Sometimes there is a problem with T4 converting to T3. Since T3 is the more biologically active form, even though T4 is normal, you may have symptoms of a sluggish thyroid gland with normal T4 levels. Rarely, there can be normal levels of both T4 and T3 but the hormones cannot do their job at receptor sites on cells. This can be a very difﬁcult diagnosis to make since most of the routine labs ordered by your doctor may be normal. It is imperative then, that in order to get a good look at what is happening with the thyroid, that a more comprehensive evaluation includes more than just the TSH.
TSH is considered a screening test for thyroid disease. In the person who feels well without any symptoms, this test may be a reasonable screening tool to evaluate the thyroid. However, it may really only reﬂect what is going on in the brain and not in the rest of the body. I do recommend that for patients with symptoms suggestive of thyroid disease that a more comprehensive evaluation is undertaken.
The thyroid gland may become dysfunctional in either making too much thyroid hormone (referred to as hyperthyroidism) or too little hormone (hypothyroidism). Of these two, we see much more hypothyroidism. Letʼs evaluate this condition ﬁrst.
Symptoms of hypothyroidism:
- Mood disorders: depression, irritability, insomnia, difﬁculty coping, poor memory.
- Neurological: vertigo, hearing loss, poor vision, neuropathy, hoarse voice.
- Gastrointestinal: constipation, gas, bloating, poor digestion.
- Female problems: PMS, irregular periods, infertility.
- Male problems: erectile dysfunction, infertility.
- General metabolism: fatigue, sluggish feeling, weight gain, water retention, feeling cold all the time.
- Cardiovascular: slow weakened heart rate, abnormal rhythms, high cholesterol.
- Immune system dysfunction: frequent infections.
- Skin, hair and nails: coarse and dry, loss of eyebrows, slow growth and healing.
There are many causes of hypothyroidism and your doctor should perform an assessment of these possibilities.
Causes of hypothyroidism:
This is the most common cause of a low functioning thyroid. The body makes antibodies to parts of the gland and the gland is unable to produce enough thyroid hormone. This condition is called Hashimotoʼs thyroiditis. Autoimmune dysfunction of the gland is on the rise, leading to a very high incidence of thyroid disorders in our country. Some causes of this autoimmune process may be related to things in our environment including the foods we eat and environmental toxins. Certain food allergies, like a gluten allergy or celiac disease, are associated with thyroid disease. There is an increased association of type 2 diabetes with autoimmune thyroid disease.
Poor intake or absorption of critical mineral and vitamins involved in thyroid hormone production may be depleted such as iron, zinc, selenium, vitamin A, vitamin D, and iodine.
Increased stress whether due to social, emotional, or environmental factors may inhibit adequate conversion of T4 to T3. Adrenal dysfunction may also inhibit adequate stimulation of the gland to produce enough hormone from the brain.
Tests we will perform may include:
TSH, T4, T3, thyroid antibody levels, rT3, occasionally T3/rT3 ratios, and select mineral and vitamin analysis including iron, selenium, zinc, vitamin D and vitamin A levels.
An evaluation of the adrenal glands will also be performed. Adequate and balanced function of the adrenal gland is critical to thyroid function. An adrenal that is overactive will suppress the thyroid gland. An adrenal gland that is underactive may cause the gland to shut down as a compensatory reaction to conserve energy. Treating the adrenal glands and balancing the thyroid is critical.
Treatment of thyroid deﬁciency will begin after thorough evaluation to maximize the gland’s own production. We may choose a variety of mineral and vitamin supports unique to each individual’s results.
There are multiple oral replacement hormones available to choose from if replacement is indicated. These include desiccated thyroid hormone such as Armour or synthetic hormones including Levothyroxine and Synthroid.
Diet is always important in treating the adrenal and thyroid glands, and an anti-inﬂammatory and balanced diet is recommended along with avoidance of potential toxins that might further damage the gland. Certain foods may need to be avoided if causing increased autoimmune problems as in celiac disease and other food sensitivities. Your doctor may want to screen you for food allergies.
Hyperthyroidism is much less common than hypothyroidism. It is more common in women. When the thyroid gland becomes overactive and produces too much hormone we call this hyperthyroidism. The most common cause of hyperthyroidism is also autoimmune disease, just like in hypothyroidism. The body is producing antibodies to the gland, stimulating it to produce too much hormone. Thyroid hormones, T3 and T4 will be elevated and TSH will be low. The hormones produced by the gland T3 and T4 will suppress TSH being made from the pituitary gland in the brain. The body will attempt to regulate itself by turning off further stimulation of the gland. Anti-thyroid antibodies will also be present in the serum.
Symptoms of Hyperthyroidism
- Weight loss.
- Feeling warm.
- Increased heart rate, palpitations, abnormal heart rhythms.
- Bowel and digestive problems, diarrhea.
- Skin changes on shins and legs.
- Hair loss.
- Eye problems, eye bulging, dryness.
- Irritability, nervousness.
- Panic attacks, anxiety.
- Sleep disturbances, insomnia.
Causes of Hyperthyroidism
Autoimmune disease is the most common cause of hyperthyroidism. This form of hyperthyroidism is called Gravesʼ disease.
Growths or nodules on the thyroid gland that produce too much hormone may cause hyperthyroidism. Infection, usually involving a virus, can also cause the thyroid gland to temporarily make too much hormone.
Too much iodine in the diet and pregnancy are also associated with overproduction of thyroid hormones.
Tests We Will Perform:
- T3 and T4 levels, TSH, thyroid antibodies, rT3.
- Imaging of the gland may be ordered to rule out the presence of thyroid nodules, such as an ultrasound of the gland.
- Occasionally studies of the gland in which radiolabeled iodine is given to observe thyroid function may be performed.
- Just as in hypothyroidism, the thyroid gland functions in harmony with adrenal glands and function of the adrenal glands may be performed simultaneously.
- An assessment of mineral and vitamin status may be performed if indicated, speciﬁcally looking for things such as iodine status in the body and mineral deﬁciencies or excesses.
Treatment for Hyperthyroidism
Treatment for hyperthyroidism is usually with “antithyroid medication”. Drugs called Methimazole , Tapazole or Propothiouracil may be prescribed to decrease production of thyroid hormone. PTU also inhibits the conversion of T4 to T3.
Sometimes additional medications are prescribed to control certain symptoms including drugs like beta blockers to control rapid heart beat and steroids to reduce inﬂammation.
Antithyroid drugs are usually given for at least 6 months to a year. Sometimes after this time the gland will go into remission and the patient can go off medications.
If the gland continues to produce excess hormone, treatment with radioactive iodine, to permanently destroy the gland is required. Once the gland is destroyed, replacement of thyroid hormone is needed for life as in hypothyroidism.
Rarely, surgery is performed to remove the gland, if antithyroid medications cannot be tolerated or given safely. Sometimes the thyroid gland can become so large that it causes difﬁculty in swallowing and may even cut off the airway in the neck. When this occurs, removal of the thyroid gland may be life saving.
At Balanced Well Being Healthcare we seek to get to the root of your health issues, and can help you decide on a thyroid treatment. Call our Fort Collins office to learn more.