The Thyroid Foundation of American reports that about 13 million Americans have thyroid disorders, of which partly 11 million are women and more than half are undiagnosed 1.
In his book, Thyroid Power, Dr. Richard L. Shamus concurs with the uppermost and writes, “ Although awfully common, low thyroid is an unsuspected sickness. Even when suspected, it is frequently undiagnosed. When it is diagnosed, it oftentimes goes untreated. When it is treated, it is infrequently treated optimally” 2. How true are his words. Like many of you, partly everyone who walks into my office complains of weariness, low energy, depression, weight gain or the inability to lose unwanted weight— all symptoms of suboptimal thyroid function. Many times I have found myself scratching my head and seriously commercial myself “ what is going on here? ” and “ why is it that nearly every forgiving I’ ve pragmatic in seven caducity of practice has something going on with his or her thyroid function? ”
Thyroid Hormones 101
Thyroid Stimulating Hormone ( TSH ) measurement is the blood test most commonly used by conventional doctors to shroud for thyroid dysfunction. The “ normal” range varies from lab to lab; the most common ranges are 0. 3 to 5. 5 with some labs using the newer values of 0. 3 to 3. 0 popular by the American Association of Clinical Endocrinologists ( AACE ) in 2002 3. However, if we bull's eye only on TSH we may be mislaid vital clues in the patient’ s thyroid hormone function. Unfortunately, too oftentimes, if TSH measures within the “ normal” range, the patient’ s complaints are dismissed and isolated untreated. TSH is a very poor thorn of thyroid hormone function and should never be used alone to evaluate or monitor thyroid function. Comprehensive testing that includes free levels of thyroid hormones, free thyroxine ( fT4 ) and free triiodothyronine ( fT3 ) to evaluate out conversion problems ( T4 into T3 ) should be performed. Anti - thyroperoxidase ( TPO ) antibodies should be measured to rule in / out autoimmune thyroid disease ( i. e., Hashimoto’ s ). Many patients come to me saying that their doctor uttered their thyroid tests were all general; however, upon further scrutiny of their labs and with comprehensive testing I have rarely found this to be the circumstances.
The first mistake some physicians make upon finding that their tolerant is hypothyroid is to forthwith put them on thyroid hormone replacement therapy. Thyroid hormone, be it synthetic Synthroid ( T4 ), or natural porcine USP Armour ( T4, T3 ), will increase the patients’ metabolic scale and some will initially report tangibility better with increases in energy and less prostration. However, in many patients this is usually a transient repercussion, and the benefits they initially reported may actualize to decline. This most likely occurs when doctors only treat the symptoms with medication and do not address the underlying cause. I have witnessed time and time again that, when medication for hypothyroidism is the sole therapy, many patients will eventually complain that they no longer feel well. The elderly symptoms of hypothyroidism doctor to creep back in and they feel they are back locale they started, or even worse off than before they were apt the medication.
When adrenal function has been weak by chronic stress, poor diet, and environmental toxins, thyroid medication, by accelerating the metabolic proportion, may further stress the system, causing the kind to feel even more fatigue and weariness. I hold that it is a mistake to prematurely rush in and give thyroid hormone if you find your patients are hypothyroid, as you may cause them to crash and burn. Before treating with thyroid hormone, it is indeed necessary to get a clearer picture of your forgiving and ask yourself how and why your forbearing got here in the first place.
Inscription the Underlying Cause
As with most chronic disease, thyroid dysfunction tends to be multi - factorial; very hardly is there one single initiating cause. Stress 4, aging 5, cigarette smoking 6, 7, insulin resistance 8, genetics 9. 10, nutritional deficiencies / imbalances 11, 12, 13, 14, extreme dieting and / or starvation 15, iodine ( undesirable and / or deficiency ) 16, goitrogens 17, poor digestion / bag and dybiosis 18 are all contributing factors. Toxins from the environment, such as pesticides, herbicides, PCBs, dioxins and heavy metals such as mercury, are known to disrupt the delicate balance of thyroid hormone 19, 20. Perchlorate 31 and thiocyanates 31, 32 have been shown to block the sodium - iodide symporter ( NIS ) and prevent the uptake of iodine into the thyroid gland 21, 22. Exogenous hormones such as xenoestrogens, birth subordination pills, and hormone replacement therapy have also been shown to interfere with thyroid function 23. Halogens such as bromine, chlorine and fluoride may interfere with the NIS and also prevent iodine uptake into the thyroid gland 24, 27 29, 30. More recently plastics ( i. e., phthalates, bisphenol - A ) have also been in the information and are being caught in hormone disruption ( xenoestrogens ) and thyroid dysfunction 33, 34, 35.
Environmental Effects on the Thyroid Function
Variegated environmental chemicals easily disrupt the delicate balance of the thyroid gland and its function 25. It is the additive effects, or bioaccumulation, of these chemicals over the agedness in our tissues that create hormone disruption and imbalance.
The European Chronicle of Endocrinology reported in 2006:
“ Several groups of chemicals have potential for thyroid disruption. There is substantial evidence that polychlorinated biphenyls, dioxins and furans cause hypothyroidism in exposed animals and that environmentally occurring doses affect human thyroid homeostasis. Similarly, flame - retardants reduce outer thyroid hormone ( TH ) levels in rodents, but human studies are appreciated. Studies also indicate thyroid - disruptive properties of phthalates, but the ramification of certain phthalates seems to be stimulative on TH production, contrary to most other groups of chemicals. Thyroid disruption may be caused by a modification of mechanisms, as different chemicals interfere with the hypothalamic - pituitary - thyroid pivot at different levels. Mechanisms of working may impinge the sodium - iodide symporter, thyroid peroxidase enzyme, receptors for THs or TSH, transport proteins or cellular uptake mechanisms. The apparent metabolism of the THs can be affected through effects on iodothyronine deiodinases or hepatic enzymes. Even small changes in thyroid homeostasis may adversely affect human health, and especially fetal neurological development may be vulnerable” 26.
Every man, woman, and child on planet earth has been found to harbor these toxins in their tissues. Even more disturbing is the detail that leash blood of newborn babies was found to contain these harmful compounds exposing neonates to their unsuitable effects even before they are born 27, 28. 29, 30.
Environmental Toxins: Disruption of Thyroid Hormone Individuality
Chemical: Perchlorate ( ClO4 )
Pursuance: Blocks iodine uptake by the NIS; displaces T4 from thyroid - hormone binding
Sources: Contaminated drinking water ( propellant found in rush fuel ), found in milk, human breast milk, vegetables ( contaminated irrigation water )
Chemical: Thiocyanate
Development: Blocks iodine uptake by the NIS; displaces T4 from thyroid - hormone binding, fluid proteins ( causes transient elevation in free T4 )
Sources: Cigarettes, brassica vegetables ( i., e., broccoli, cauliflower, etc ).
Chemical: Phthalates
Sequence: Thyroid disruptor ( exact mechanism unknown )
Sources: Plastics ( polyvinyl chloride ), children ' s toys, IV tubing, cosmetics, nail polish, perfumes, detergents, solvents.
Chemical: Bisphenol A ( BPA )
Follow through: Binds thyroxine receptor ( foe ); increases secretion thyroxine ( T4 )
Sources: Polycarbonates ( plastics ) #7, water bottles, liners in cans, baby bottles, dental fillings, sealants, electronics, paints, adhesives, varnishes.
Chemical: Mercury
Sequence: Blocks conversion of T4 into T3 ( 5’ deiodinase ) inhibits TPO enzyme.
Sources: Thimerosol ( i. e. flu vaccines ), dental amalgams, mercury thermometers, agriculture, medications ( i. e., nasal spray, opthalamic solutions, antibiotics, and the new Compact Bright energy - saving light bulbs )
Chemical: Perfluoro - octanoic acid ( PFOA )
Conclusion: Possible thyroid disruptor
Sources: Teflon coatings, coating for food packaging, stain - resistant coatings for carpets, fabrics, and dress. Scotchguard, Pierce - Tex, coatings on microwave popcorn bags, fast food containers.
Chemical: Bromide
Development: Displaces iodine; increases plasma TSH. Inhibitory outcome on thyroid labor
Sources: Flame retardants found in plastics, paints, electronic parts and fabrics. Bromated flour, bromated vegetable oils ( i. e., Gatorade®, Powerade®, Squirt®, Fresca®, and MountainDew® ), contaminated drinking water.
Chemical: Fluoride
Follow up: Suppresses thyroid hormone ( mechanism unknown ); increases plasma TSH
Sources: Sodium fluoride in treated drinking water, fluoride toothpaste, fluoride dental treatments, beverages made with fluoridated water ( i. e., soda, juice, tea )
Chemical: Chlorine
Backwash: Inhibits iodide trapping; Decreases liquid thyroxine ( T4 )
Sources: Chlorinated tap water, swimming pools, bleach, home chemicals
Chemical: Polychlorinated Biphenyls ( PCBs )
Eventuality: May reduce thyroid hormone levels by decreasing consensus; displacing T4 from binding proteins; may mimic thyroid hormones’ reaction on expression of genes.
Sources: Persistent, everywhere environmental contaminants. Banned in 1977; found in ancient unclouded lighting fixtures, electrical devices; enter the environment through open burning of plastics, paints, etc.
Dietary Compounds: Disruption of Thyroid Hormone Federation
Compound: Isothiocyanates
Flak: Goitrogenic; interferes with iodine uptake in the thyroid gland; inhibition of thyroid peroxidase ( TPO ) action Produces goiter & hypothyroidism in lab animals.
Sources: Brassica ( cruciferae ): filthy lucre, broccoli, kale, cauliflower, kohlrabi, turnip, rutabaga, mustard, horseradish and rapeseed. Cassava, sorghum, maize, millet
Compound: Isoflavones
Outgrowth: Inhibits thyroid peroxidase ( TPO ); goitrogenicInhibits thyroid peroxidase ( TPO ); Inhibits type I deiodinase animation.
Sources: Soy protein ( i. e., genestin, daidzen ), peas, wealth Flavonoids: Fruits and vegetables ( i. e., quercetin, catechin, rutin ).
Compound: Gluten ( Gliadins )
Backwash: Associated with autoimmune thyroid disease ( i. e., Hashimoto’ s ); may increase anti - thyroperoxidase antibody levels ( anti - TPO ) in gluten - sensitive mortals.
Sources: Wheat, rye, barley, spelt, and non - gluten - free oats,
may be buried in filtered foods as natural flavorings
Compound: Epigenin and luteolin
Consequence: Thyroid disruptors
Sources: Millet
Medications that Disrupt Thyroid Combination
Drug: Sulfonamides
Aftermath: Antithyroid motion, prevents intrathyroidal iodide binding
Sources: Acetazoleamide ( Diamox )
Drug: Sulfonylureas
Follow up: Inhibits the undividedness of thyroid hormone; goiter ( rats ); inhibit iodide binding, block binding of T4 to the carrier proteins in juice
Sources: Carbutamide, tolbutamide, methahexamide, and maybe
chlorpropamide
Drug: Lithium
Flak: Inhibits thyroid hormone release; and coupling reactions; associated with the development of goiterinhibits thyroglobulin iodination
Sources: Bipolar medication
Drug: Estrogen ( ERT )
End product: Increases thyroid binding globulin, possible elevation of TSH
Sources: Hormone replacement, PCBs, ( TBG ), xenoestrogens
Drug: Androgens
Backlash: Decrease thyroid binding globulin
Sources: Testosterone replacement, anabolic steroids, Danazol
I have much pondered that what we may regard dysfunction may not be dysfunction at all, and that the slowing down of the metabolic proportion in hypothyroidism may without reservation be an important mechanism that protects the body from undue harm mannered by chronic exposure to harmful substances in our environment. Down - regulation of the hypothalamus - pituitary - thyroid ( HPT ) swivel may be a apprehensive mechanism to conserve energy in times of stress. Chronic, low - dose exposure to environmental chemicals most certainly must be considered a stressor to all life upon this planet. One just has to glance at the inventory provided hefty to get an notion of the magnitude of the problem. Based upon this evidence, metabolism most likely slows down to protect the assembly from the toxic effects of its internal and apparent environment. It is striking to note, that hyperthyroidism ofttimes precedes the hypothyroid state. A common trigger of hyperthyroidism is excessive stress. When you ask a hyperthyroid empathetic what was occurring in his or her life before they were diagnosed with hyperthyroidism, many of them will tell you a lamentable event or that a term of severe stress precipitated their diagnosis. In hyperthyroidism the metabolic rate accelerates and metabolism is upregulated. At this standard the cells are rapidly metabolizing toxins. I propose it is equitable to reckon with that if the liver ( thing II ) is unable to keep up with detoxifying this large metabolic load, toxic metabolites will build up in the bloodstream and impel to interfere with metabolic functions. Therefore, the metabolic proportion slows down in an one's darnedest to reduce the ratio of toxic metabolites that are building up, thence leading to a hypothyroid ( low metabolic ) state in distribution to protect itself. Obviously, this synopsis is conceptual; nevertheless, the body in its own inscrutable wisdom ALWAYS strives to do the right thing. Could this so - called disease just be the body’ s way of attempting to correct the problem? It is our job, as naturopathic physicians, to distinguish and remove the barriers to healing.
Uncovering the Underlying Cause
It is most important to not just treat symptoms with thyroid hormone medication and / or supplements without addressing the underlying cause ( s ). It is our job as doctors to recognize and remove the barriers to healing. Ask yourself, why does your considerate have thyroid dysfunction in the first place? Evaluate his / her lifestyle; help your empathetic build a solid foundation on which they can inaugurate to heal. Look at their diet and nutritional class and work with them to optimize it; find out if they are getting enough high quality sleep, and if they are not, help them to achieve it. Ask questions to find out how they are coping with the stressors in their lives.
What is upsetting the balance, what are the barriers to healing? Ask yourself not “ are they toxic? ” but “ how toxic are they? ” and develop a comprehensive detoxification plan based on their biochemical individuality.
As you can gaze, cleaning up the thyroid patient’ s internal and superficial environment becomes a very important matter in piece them to improve thyroid function and plunge into to heal. There are simple things you can teach your forbearing to do, such as avoiding polycarbonate plastics ( i. e., phthalates, Bisphenol - A ), and drinking reverse osmosis pure water instead of tap water to avoid contaminants such as perchlorates, fluoride, bromide, chlorides and mercury.
Other important steps should enter classifying the patient’ s total body onus. Look for sources of exposure to heavy metals such as mercury ( i. e., silver amalgams, fish, vaccines ) and exogenous estrogen ( xenoestrogens ) exposure such as hormone replacement therapy, birth regulation pills, excessive exposure to estrogen mimics ( pesticides, plastics, cosmetics, hormones in dog products, etc ).
Detoxification
This makes detoxification a very important mainspring. However, placing someone on a “ cleanse” or “ water fast” is not necessarily the best step to take. There is testify to that when someone loses weight, the toxins that are stored in the body fat ( adipose tissue ) will be released into the bloodstream. The circulating toxins jeer endocrine function and interfere with thyroid function. Proper and safe methods of detoxification are essential for the sympathetic and should carry nutrients ( i. e., glutathione, sulfur amino acids, etc. ) that have been shown to foothold circumstance I and exploit II liver detoxification of toxins. Detoxification powders, such as UltraClear or MediClear, may be used and are adapted for detoxifying most patients. Use of saunas and hydrotherapy may also be tailor-made for the discerning to enhance the detoxification process. It is important to evaluate your patients’ needs and create a program just for them.
Diet & Nutrition
Encourage an organic, whole foods diet, rich in ensconce foods ( i. e., phytochemicals and minerals ). Optimizing nutrition through diet and nutritional supplements is necessary to locus down the foundation for healing. It has been found that deliberate foods may interfere with thyroid function - - especially gluten found in wheat, rye and barley.
Goitrogenic properties found in the brassica ( cruciferae ) family of vegetables ( i. e., broccoli, collard greens, mustard greens, arugula, Brussels sprouts and kale ) have been shown to impede thyroid function. Nevertheless, it is not advised to avoid these foods, seeing they are shown to help the body to detoxify; tidily do not eat too many in their raw state. Moveable feast has been shown to deactivate the goitrogenic properties associated with this family of vegetables. Isoflavones, found in almighty dollar, especially soy, have been shown to impede thyroid function. However, studies have found that soy did not cause problems in nation with sufficient iodine intake 37, 38.
Vitamin D position should be evaluated in humans with thyroid dysfunction as it is multiple in constituent T3 puzzle to nuclear receptors 39. It has been suggested that optimal 25 - hydroxy vitamin D3 levels should be between 50 and 75 ng / ml in the blood 40. Food sources of vitamin D are barbaric - into, cold - water fish such as carmine, mackerel, sardines and herring.
Other important nutrients such as selenium 12, zinc 12, 13 and vitamin A 11 are also important for thyroid health.
Sleep, Exercise, and Stress Management
Address sleep weight and quality, amount of exercise ( too little, too much ), and stress levels and coping skills in all thyroid patients. It is engrossing to note that the thyroid and adrenal glands cannot function without each other, and to directions only the thyroid without addressing adrenal health is not good medicine.
Steps to Activate Optimizing Thyroid Function
• Drink and wet in processed water only ( reverse osmosis )
• Avoid swimming in chlorinated pools, chlorine bleach
• Avoid fluoride toothpaste
• Avoid bromated flours, flame - retardants ( i. e., clothes, furniture, electronics, etc )
• Purchase and use environmentally - chummy cleaning products
• Optimize nutrition
• Avoid pesticides
• Avoid plastics that contain phthalates, and bisphenol - A ( BPA )
• Purchase and eat organic foods whenever possible
• Cook cruciferous vegetables and don’ t eat too many in their raw state
• Avoid gluten ( especially with Hashimoto’ s autoimmune thyroiditis ) and / or gluten sensitivity or Celiac Disease
• Evaluate vitamin D station by 25 - OH vitamin D3 testing
• Evaluate halogens ( iodine, bromide, fluoride ) class – Doctor’ s Data
• Scrutinize and inscription adrenal function
• Envisage and inscription sex hormone class
• Identify and avoid food sensitivities
• Ponder and label inflammation
• Directions blood sugar and insulin levels
• Individualized detoxification program
• Comprehensive thyroid panel: TSH, Free T3, Free T4, anti - TPO antibodies
• If indicated, use thyroid medication wisely along with addressing the cause
As you can stare, there is not one simple answer that fully corrects the thyroid epidemic we are seeing in this country. Nevertheless, addressing the underlying causes and removing the barriers to healing provides the best good fortune for healing patients with thyroid disorders.
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