Tired, Overweight and Feeling Sluggish? Why your undiagnosed thyroid condition could be to blame
Fatigue, weight gain, constipation, depression, menstrual irregularities, dry skin. Do these symptoms feel familiar to you? They are all signs of hypothyroidism, or a low functioning thyroid gland. An estimated 1 in 10 Canadians are expected to have a thyroid condition, but the diagnosis is often missed - as many as 50% of those people remain undiagnosed! Fortunately, Naturopathic Doctors are really knowledgeable about how to diagnose and treat thyroid conditions to get you feeling better.
WHAT IS THE THYROID?
The thyroid is a butterfly-shaped gland located at the base of your neck, and is responsible for the output of thyroid hormones. Thyroid hormones play an important role in your metabolism, temperature regulation, digestion, energy levels, hormones, menstrual cycles, body weight and more. There is a feedback mechanism between your brain, and your thyroid gland to regulate the release of thyroid hormones, and subsequently your metabolism. It is important to note that 90% of the thyroid hormones released are in the form of T4, and then the body converts it to the more biologically active form, T3. We will discuss this more later.
WHAT IS HYPOTHYROIDISM?
Hypothyroidism occurs when there is not enough of the active forms of thryoid hormones circulating in your body. The most common cause of this in North America is an auto-immune condition called Hashimoto’s Thyroiditis, in which antibodies attack the thyroid gland. In other regions of the world, iodine deficiency is a leading cause of hypothyroidism.
The condition is much more prevalent in women, and also common up to a year after giving birth. Hypothyroidism can also interfere with fertility, so it is an important work-up for any woman coming to my clinic with fertility issues. Pregnant women with hypothyroidism also have to be monitored closely, and will have to increase their thyroid medication by 50% in the first trimester.
WHY ARE WE MISSING THE DIAGNOSIS?
Typically, you will get your TSH measured periodically with your doctor. TSH is what tells your thyroid gland to produce thyroid hormones. If your thyroid is sluggish, TSH has to yell louder to get the thyroid to respond, so primary hypothyroidism is typically accompanied by a high TSH. Depending on the lab, the TSH reference range spans from 0.5 to 5umol/L. If your TSH level falls within this window, you have likely been told that your thyroid is fine.
As a Naturopathic Doctor, I like to look at “ideal” reference ranges. For NDs, an ideal TSH level is below 2mU/L, some will even say 1.5mU/L. Also, if a patient has moderately high TSH combined with a lot of the symptoms mentioned above and a physical exam that points to decreased thyroid function, I will run a full thyroid panel. This involves looking at the individual thyroid hormones (T4 and T3) as well as any thyroid antibodies (which would indicate Hashimoto's).
TREATMENT OPTIONS
1. THYROID REPLACEMENT HORMONES
The most common treatment for hypothyroidism in North America is hormone replacement therapy. Either T4 on it’s own, or NDs will typically choose a combination of T3 and T4. Thyroid hormone is generally well tolerated, but your hormone levels and symptoms have to be monitored to make sure that the medications are not over-doing it. If there is a conversion issue (T4 is normal but T3 is very low), supplements such as iodine, selenium and L-tyrosine can help, although those doses have to be closely monitored as well.
2. STRESS MANAGEMENT
When you are under chronic stress, your adrenal glands are kicking out a constant release of cortisol – which tells your body to conserve energy. This tells your thyroid to slow down, too. The release of cortisol also stimulates the body to release a lot of other inflammatory chemicals which decrease the production, and activity, of key thyroid hormones. This constant inflammation also puts you at increased risk for a lot of other health conditions, including cardiovacular disease and digestive problems. So stress management is key! My next blog post will give you tips for evaluating, and managing your stress.
3. DIET
Certain foods are called goitrogens and block iodine utilization so should also be avoided in hypothyroidism – this includes brassica vegetables (broccoli, turnips, cabbage etc), mustard, soy, peanuts, pine nuts and millet. The good news is that cooking usually inactivates goitrogens.
Also ensuring you have an adequate intake of all the cofactors involved in thyroid hormone synthesis and activation is important. These include zinc, selenium, iodine, tyrosine, vitamins A, D, E and C.
If you have had your thyroid antibodies measured, and your levels are high, your treatment will also include immune regulating protocols to treat Hashimoto’s. The biggest thing you can do in terms of dietary modification if you have Hashimoto’s is to avoid gluten. I know this advice gets thrown around a lot but it is really important for auto-immune conditions. Gluten mimics thyroid antibodies – for an amazing summary watch this video.
4. HERBS
Certain herbs can be very effective at boosting a sluggish thyroid gland, but these should never be given without supervision from your Naturopathic Doctor, and should not be combined with conventional hormone therapy. This include Coleus forskoli, Commiphora mukul, Fucus vesiculosus and Withania somnifera.
Talk to your ND if you suspect your thyroid may be out of balance, but haven't been able to get a diagnosis yet.