I never thought when I started practicing that I would one day write a thyroid book and teach thyroid classes, as I am not inherently passionate about the thyroid.
But I have invested so much time into the thyroid because the majority of my patients have some degree of thyroid dysfunction. I quickly learned you can’t help a chronically sick person if you ignore the thyroid, as every cell in the body has receptors for thyroid hormones. Poor thyroid function affects bone health, neurological function, hormone balancing, immune function, and so on. As a practitioner, you have to be an expert in the thyroid if you want to get anywhere with your patients.
Thyroid Hormones Don’t Complete the Care
This was once a problem for me because, like a lot of doctors, I did not know how to truly influence thyroid function beyond thyroid hormones. No other disorder has frustrated me more — I used to dread it when a thyroid case walked in because it pushed me to the edge and made me feel like a poor practitioner. Add to this that I was up against the Thyroid Dream: The idea that patients will take the right thyroid hormone, get skinny, and have no more symptoms. They also frequently come in with bagfuls of supplements, a testament to their endless search for that magic bullet.
The truth is, although thyroid hormones are necessary in many cases, there is rarely one magic medication or supplement to cure thyroid disease. Instead it’s a whole web of dysfunction that needs to be unraveled, and the trick is knowing which thread to pull first.
The Immune Connection
So I started running antibody tests, looking for Hashimoto’s, because I noticed my failure rate was the highest when an immune component was active. To add to the frustration, some tests came back negative when Hashimoto’s seemed so evident. Turns out some Hashimoto’s patients will always test negative for the disease. Biopsies, however, show Hashimoto’s is nevertheless active and present in these individuals.
I learned that not only do the immune surges of Hashimoto’s directly affect the thyroid gland, but they also affect the various thyroid pathways: conversion of T4 to T3, the brain’s communication with the thyroid, the number of thyroid-binding proteins that transport thyroid hormones, and how well cellular receptor sites accept thyroid hormones. This was not exactly an overnight discovery.
To compound the confusion, thyroid hormones themselves modulate immune activity. In other words, having sufficient thyroid hormones in your body helps keep your immune system under control so that it doesn’t go haywire and attack your own body tissue. You can see how Hashimoto’s, which often leads to a thyroid hormone deficiency, fires up the immune system in a vicious, compounding cycle. This is one reason it is so important to quench the immune attacks.
The Brain Connection
And if that all wasn’t enough, the brain plays a significant role in matters. As a practitioner trained in neurology, I constantly deal with the neurological fall-out of hypothyroidism: depression, brain fog, balance issues, and autoimmune attacks in the brain. The immune surges of Hashimoto’s and the resultant hypothyroidism depress neurotransmitter levels and activity, which are needed for healthy thyroid function (and vice versa). If Hashimoto’s goes unchecked, it can eventually lead to autoimmune attacks in the brain with devastating consequences.
I have also come to learn that hypothyroidism suppresses autonomic function, with symptoms such as chronic gastric distress and leaky gut, poor gallbladder function, dry eyes, incontinence and more. What’s more, taking thyroid hormone medications, even though they may be necessary for optimal function, also have a suppressive effect on autonomic function, and these patients will need to incorporate lifelong modifications to their diet and lifestyle as a result.
Goiters, Nodules and Masses
Goiters, nodules and masses are other facets of poor thyroid function that don’t always have clear-cut answers. For instance, goiter is not always related to iodine deficiency, and there are a variety of questions that have to be asked and tests run to determine the relevant mechanism when a patient presents with any of these.
Unraveling the Web
These are just some of the ways hypothyroidism and Hashimoto’s can weave a tangled web. I haven’t even addressed diet, iodine or the fact that some people develop sensitivities to the fillers in their thyroid hormones!
Too many practitioners have been lulled into looking for hypothyroidism in their 40-something, overweight female patients with cold hands and feet, when the reality is that hypothyroidism and Hashimoto’s affects both men and women of all body types and ages, presenting with a variety of symptoms. And Hashimoto’s is all too often dismissed, because for most doctors, diagnosing it doesn’t change how they will treat their patients.
These topics are a sampling of what I will discuss more deeply in bi-weekly newsletters. I hope you will subscribe to receive articles on thyroid function and other facets of functional medicine, and that they will benefit you on your journey toward better thyroid health. Please also stay tuned for an upcoming forum where readers can share experiences, successes and challenges, hopefully creating a space for further education.