Thyroid & Hashimoto’s Root Cause Solutions
The thyroid hormone is vitally important: every cell in the body - be that a gastrointestinal cell, brain cell or muscle cell - has receptors for it. Thus it quite literally drives the rate at which our cells burn energy: our metabolic rate. Like an accelerator pedal, turn it up and your metabolism will speed up; slow it down and you quite literally start to slow down - displayed as fatigue, drying skin, slower bowel movements, thinning hair and impaired digestion.
Production of thyroid hormones
Under the control of a clever feedback loop, the thyroid axis begins within the hypothalamus. This is portion of the brain that contains a number of small nuclei called the paraventricular nucleus (PNV), and regulates hormone output. Once the PNV has been stimulated by neurotransmitters (predominantly serotonin and dopamine), the hypothalamus releases Thyroid Releasing Hormone (TRH).
This affects a second gland, the pituitary, causing it to release Thyroid Stimulating Hormone (TSH), which in turn triggers the thyroid gland to produce thyroxine (T4) 94% and triiodothyronine (T3) 7%.
However, the T4 is inactive at this time and the hormones produced by the thyroid are bound (to another protein: thyroid binding globulin). Therefore it is not until they reach the peripheral tissues (including the liver and gastrointestinal tract) and become both unbound and converted to the active form of T3 that the thyroid hormone can do its job, binding to a receptor site of a cell and activate a response.
Hypothyroidism, by its very definition, is a condition where the body has inadequate levels of thyroid hormone. Hyperthyroidism is a less common condition that exists when excess thyroid hormones are present. As every cell of the body is affected by thyroid hormones, symptoms of imbalances are often varied and can impact multiple body systems.
Symptoms of low thyroid function
- Brittle hair and nails
- Cold temperature intolerance
- Cold hands and feet
- Decreased sweating
- Dry skin
- Inability to lose weight
- Low libido
- Menstrual irregularities
- Shortness of breath
- Weight gain
Symptoms of high thyroid function
- Eye/vision changes
- Hair loss
- Rapid heart beat
- Weight loss
Estimates show that a massive 95% of those that consider themselves hypothyroid may actually have Hashimoto's Autoimmune Hypothyroidism, and that if antibodies are not run on a blood test many clients are sent away with a “clean bill of health”, told that there is nothing wrong with their thyroid at all. In fact, a TSH can remain “normal” for years while the autoimmune attack is insidiously at play.
Testing for Thyroid Function
Laboratory tests are available to check thyroid function and autoimmune thyroid markers. Often, people with thyroid symptoms will ask their doctors to be tested, but will be told that their thyroid function is normal. Unfortunately, this is because GPs typically only run TSH and T4 rather than a broader panel (as shown below). Because TSH does not become permanently elevated until Hashimoto’s is advanced, it is not uncommon for people to have many unpleasant thyroid symptoms such as brain fog, weight gain, bloating, sluggish bowel movements and fatigue, then to be tested for thyroid function by only a TSH measurement and be told they are “fine”, and that their thyroid is completely “normal”.
Furthermore, under certain conditions, the conversion of T4 to T3 - the most active thyroid hormone - can be impaired. This results in high levels of a hormone called reverse T3 (rT3). Although chemically similar to T3, reverse T3 is completely inactive and lowers the amount of active T3 available to the cells. The way I describe it to clients is as though you are driving a car with the handbrake on. This can all occur in the face of “normal” TSH FT4 and even FT3 readings.
Here is a comprehensive list of the 7 thyroid tests I run (often in conjunction with a comprehensive metabolic blood panel):
- TSH (Thyroid Stimulating Hormone)
This is a pituitary hormone that responds to low/high amounts of circulating T4. In advanced cases of Hashimoto’s and primary hypothyroidism, this lab test will be elevated. In the case of Graves’ disease the TSH will be low. People with Hashimoto’s and clinical hypothyroidism may have a normal reading on this test.
- Thyroid peroxidase antibodies (TPO Antibodies)
- Thyroglobulin Antibodies (TG Antibodies)
Most people with Hashimoto’s will have an elevation of one or both of these antibodies. These antibodies are can be elevated for years before a change in TSH is seen. People with Graves’ disease may also have an elevation in thyroid antibodies including TPO & TG, as well as TSH receptor antibodies.
- Total T3
- Total t4
- Free T4 and Free T3
These tests measure the levels of active thyroid hormone circulating in the body, but contrary to what many practitioners say they don’t impact on the TSH feedback loop.
Hashimoto’s Autoimmune Hypothyroidism causes
Over the years, I have integrated the post graduate work I have completed under the wonderful Dr. Izabella Wentz at the Hashimoto’s Institute and the advanced thyroid education I’ve taken through Dr Datis Kharrizian into how I work specifically with Hashimoto’s autoimmune hypothyroidism.
A general outline of how Hashimoto’s autoimmune hypothyroidism (HAH) develops is best explained by an analogy that has been adopted in functional medicine as the "The three legged stool of autoimmune disease".
Dr. Alessio Fasano, a world-renowned gastroenterologist and expert in autoimmune disease and coeliac disease, coined this term. Put simply, it means that three essential components must be present in order for someone to develop an autoimmune disease:
- Specific genes that make a person susceptible to developing autoimmune disease
- Specific triggers that turn on the genetic expression. In the case of coeliac disease, the trigger is gluten. However, in the vast majority of autoimmune diseases the trigger remains unknown. In HAH we have some intersting published research on some viral and bacterial triggers such as the Epstein Barr Virus and Yersinia Enterocolitica.
- Intestinal permeability (also referred to as “leaky gut”). This increased permeability means that the normally tightly knit cells of the intestines are weakened and therefore “leaky”. This allows large compounds, such as proteins from food or bacteria, entry into our bloodstream. The immune system is highly dependent on the health of the intestines.
If all of these three components line up, then the scene is set for a perfect storm of an autoimmune fire. A feed forward cycle of a chronic state of intestinal permeability and therefore immune system overload starts. You become vulnerable to more infections which depletes immunity further, worsening intestinal permeability and leading to nutrient depletions, together with poor digestion, increased inflammation and demands upon the endocrine system. Overall hormone anarchy is the result.
To start with the main symptom will be fatigue as the body stops absorbing nutrients properly due to the intestinal permeability. A TSH test will invariably be normal, and thyroid antibodies may or may not be present.
As the immune system starts to attack the thyroid more aggressively, symptoms start to occur and can even be mistaken for hyper symptoms such as anxiety and palpitations as the damaged thyroid releases hormone into the bloodstream. At this point, thyroid antibodies will likely be detectable, and a slight change in TSH may be seen.
Then, as the thyroid becomes severely damaged, more classically hypothyroid symptoms occur: hair loss, fatigue, cold intolerance, depression, brain fog, inability to lose weight. Now, a change in TSH is more likely going to be seen, but we are quite a long way down the road.
My Approach to hypothyroidism and Hashimoto’s Thyroiditis
As Dr. Izabella Wentz states, most people with hypothyroidism and Hashimoto’s Thyroiditis need to take thyroid hormone medication, as having low or depressed thyroid hormone levels can lead to moderate to severe symptoms.
But then we must get to work on addressing the root causes.
- Why is there intestinal permeability?
- What are the triggers at play in your particular case? For example: are there gut infections, is there a heavy viral load, is there unrelenting stress and cortisol present, are there environmental toxins at play or food antigens like gluten that are feeding an attack through molecular mimicry?
If the underlying cause(s) are not addressed, the thyroid gland will continue to get damaged by the immune system.
The whole picture
Identifying root causes to achieve your optimal health and wellbeing
I use the functional medicine model to assess your health. This means seeking to identify interactions between different systems in the body through comprehensive case history taking, your presenting signs and symptoms and on occasion functional laboratory testing. The goal is to identify and address the triggers and underlying causes of your health problems rather than simply focusing on symptoms.
To book an appointment or speak with a member of my team, get in touch.