The adrenals have a big impact on other systems
Today’s health tip concerns the relationship between your adrenals and thyroid health.
Remember the body is an ecosystem with many systems interacting all the time. One example of this is the adrenal glands and how they impact thyroid hormone absorption.
Chronic immune stimulation, like Hashimoto’s, sets the stage for high cortisol for a prolonged period of time.
This chronic adrenal stress can:
* Increase thyroid binding proteins, so that thyroid hormones can’t get into cells to do their job.
With more thyroid binding proteins, you have less free and available thyroid hormone. It’s like going to a dance, if all the available boys or girls are with dates, your chances of getting some are a lot lower.
* Mess up detoxification pathways, which can lead to thyroid hormone resistance.
If your liver isn’t detoxing properly, thyroid hormone can’t get converted from T4 into it’s active form T3. It’s like driving on the freeway, if there’s lots of traffic, you ain’t goin’ nowhere.
* Slow the conversion of T4 to active forms of T3 that the body can use.
This happens in the liver, it also happens in the digestive tract where the whole process is helped along by good bacteria and in the peripheral tissue. High cortisol leads to problems in the first 2 areas. Eventually, you empty your cortisol tank and then you get problems in the third.
* Weaken the barrier system defenses of the digestive system, the lungs and the brain.
High cortisol leads to imbalances in the gut and intestinal permeability. It’s like your alarm system breaks down and all manner of riff raff just come on in.
This can trigger Hashimoto’s or cause flare ups or both.
Heal your adrenals by:
Balancing your blood sugar: Read all about it in this previous post.
Healing your adrenals: Read all about this in this other previous post.
And relax, people! It’s all going to be fine. Really, it is! 🙂
Hashimoto’s is a web of complexities.
Today’s health tip concerns how to wrap your mind around the complexity of this disease and why half measures usually don’t work.
One of the things I often encounter in working with people with Hashimoto’s is that they have tried this or that and been prescribed this or that and they have arrived right back at zero.
There are many reasons for this, but if you look at the big picture, one of the main ones is that what they have tried has simply not been enough.
It has not been nearly enough.
In order to understand how this all works, you really need to view this globally. There is usually no single drug or single supplement that is going to just make everything perfect again.
This is a multi-system disorder and the only way to properly deal with it is to have a multi-system strategy.
The unfortunate thing is that we are all conditioned by our current medial model which says that this pill or even that natural supplement should be prescribed when you have this group of symptoms.
Well, often with Hashimoto’s you have a web of things overlapping causing a vicious cycle of symptoms that don’t only have one cause. They have multiple causes. And sometimes, things are moving in multiple directions at the same time.
The result is a downward spiral that can seem overwhelming and endless. Blood sugar issues and adrenal problems lead to thyroid problems which lead to intestinal problems which lead to brain problems which lead back to more thyroid and adrenal problems. And on and on…..
Yikes!
Well, the good news is that if you can wrap your mind around this big picture concept and you devote the time ,energy and effort to make enough changes and do enough, then you can turn these downward spirals on their head.
They become positive upward spirals of healing because all these connections can work in a positive direction as well.
Once you start healing these various pieces they start healing each other.
You just can’t do it in a half hearted way.
Half measures don’t give you half results, they often give you no results.
Hashimoto’s is an autoimmune disease.
Did you know that a specific antigen can stimulate the autoimmune attack? For example, a food, mold, bacteria, a chronic virus or a parasite are all examples.
These are Hashimoto’s triggers, they instigate the attack on your tissue by your immune system.
Your immune system attacks proteins and all proteins are made of a sequence of amino acids. There aren’t that many amino acids in nature, so there are certain sequences that are the same.
If antibodies have been created to specific amino acid sequences, then anything that has this same sequence may be attacked. Sometimes, our own tissue has the same amino acid sequences as foods or other things in our environment.
Gluten, is, of course, a perfect example of a trigger. Every time someone who is gluten sensitive eats gluten, it provokes an attack on their thyroid. Gluten has also been found to be very similar in structure to cerebellar tissue. So when you eat gluten, your brain also gets attacked.
Here’s a longer blog post I wrote on this topic.
People can also develop an immune response to environmental toxins and heavy metals. In this case, your body can develop antibodies to a combination of your own tissue and this toxin.
So when you are exposed to these triggers, your immune system responds and your tissue is collateral damage. This can be true of common objects in your house like foam in your pillows or formaldehyde in your furniture.
There is a variety of testing available to find out which of these triggers you may have. With my patients I order tests to test for gluten antibodies (over 24 different proteins), antibodies for environmental toxins and antibodies for other foods that may behave like gluten.
Another thing you can do is to keep a journal. You should note what you eat, what you have been doing, what you were exposed to and how you felt. Over time you may be able to identify some of the common triggers in your diet and your immediate environment.
Some of the most common questions that I get from people who reach out to me are about antibodies.
There seems to be a good deal of confusion about them and also a good deal of emotion and expectation attached to these numbers going up or down.
In this post, we examine thyroid antibodies and, hopefully, dispel some of the myths around them.
First of all, what are antibodies, exactly? I like to use military analogies when describing the immune system. And antibodies are like military intelligence (hold the oxymoron jokes).
They are the part of the immune system that gathers information on the bad guys (bacteria, viruses, fungus, parasites, etc.) and then they label those bad guys. Kind of like putting a red flag on them.
The invader is called an antigen. Antibodies bind to these antigens like a lock and a key. Every cell has antigens and these are what the immune system recognizes. And every cell in our body has a self-antigen which are supposed to let the immune system know that our own tissue isn’t a bad guy.
Once the bad guys have been labeled, other parts of the immune system are signaled and they attack and, in most cases, kill the bad guys. In some cases these antibodies can neutralize the bad guys all by themselves and not have to wait for reinforcements.
With autoimmune disease these antigen signals get confused and the immune system ends up attacking our own tissue.
Over the last 50 years there has been a lot of research in this area.
There is a region on cells located on some of our genes called the HLA (or Human Leucocyte Antigen) System. Many of these are located on chromosome 6 (for those of you keeping count).
Mutations or defects of HLA has been linked to many different autoimmune diseases. Exactly what happens is not known, there are numerous theories, but the end result is that our own tissue gets attacked and destroyed by the immune system.
There is a specific class of HLA (class II) that has been linked to autoimmune thyroid diseases like Hashimoto’s and there are also specific antibodies that are important in the disease.
There are 2 autoantibodies that are important:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production.
TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
In Hashimoto’s, TPOAbs are present in nearly all (>90 %) patients, while TgAbs can be seen in approximately 80%.
Antibodies against TPO (TPOAbs) and Tg (TgAbs) are of immunoglobulin G class, (IgG) and both are really good buddies with their antigens.
For TPO, it is for the enzyme thyroid peroxidase, which frees iodine and helps in the production of T4 and T3.
And for TgAb it is for Thyroglobulin, which is also used by the thyroid to produce T3 and T4.
When these 2 things get destroyed, over time, the body can’t make enough thyroid hormone.
This results in hypothyroidism and all the familiar problems of Hashimoto’s: fatigue, constipation, depression, hair loss, cold hands and feet, brain fog, memory issues and lots more.
Unlike TgAbs, TPOAbs can activate certain parts of the immune system (complement) and are able to cause damage to thyroid cells.
However, there isn’t much evidence that both antibodies have a major role in the formation of Hashimoto’s or in the destruction of thyroid cells.
It seems a lot more likely that other parts of the immune system are signaled and that they bring in the Navy Seals of the immune system which attack and kill thyroid cells.
TPO and TgAb antibodies, however, are considered the definitive test for whether or not you have Hashimoto’s. Basically, if either one or both of these are found to be above the lab range values, then you are positive for the disease.
Most labs have the high end at about 25 to 35. Numbers vary considerably, but it is not unusual for people who have been diagnosed to have antibodies above 1,000.
As I stated above, in most cases these antibodies, themselves, do not attack and kill thyroid cells.
What’s also important to understand is that there are various stages of autoimmune disease and depending on where you are in the progression, you will have different degrees of thyroid tissue destruction and, therefore, different symptoms.
According to Dr. Datis Kharrazian, there are 3 stages of autoimmune disease. While these stages are not recognized by conventional doctors, they are very useful in determining exactly where you are in the progression of the disease.
And realizing that there are stages and that the stages get worse and worse, is also helpful for motivating you to do as much as you can to stop the progression. (Hopefully!)
You can read more about these stages here.
The antibodies are really involved in signaling the immune system and in setting off a series of events that results in the attack and destruction of the thyroid.
I have written extensively about what happens in this previous post.
The important thing to understand here is that the amount of antibodies don’t necessarily directly correspond to how severe the Hashimoto’s is.
There are many reasons for this, but one simple way to look at it is this: The amount of destruction that is done by the army (the immune system) depends on the strength and number of the soldiers.
As I said earlier, the antibodies are really like the CIA or some intelligence gathering part of the army. The front line soldiers are the killers. If you have lots of soldiers and they are all revved up and ready to dance, then you get more destruction.
If your army is weak and there aren’t that many soldiers, then the CIA tells them to kill, kill, kill, but they can only do so much damage.
On the other hand, even if there are only a few CIA agents and there is a large, aggressive army, you will still have massive destruction (and loss of thyroid function).
Where am I going with all this? The amount of destruction, which really is the cause of how crappy you feel, depends on the strength and number of soldiers, not on the number of CIA agents in the field.
This is why antibodies are not a good measure of progress and often don’t correspond with how well people feel.
Antibody numbers don’t correspond, directly, with tissue destruction. As I mentioned above, in some cases TPO antibodies have been linked to tissue destruction, but more often, this is not the case.
Many patients and doctors or practitioners track these numbers and use them as a measure of whether or not what they are doing is working. And many times, they will find that there is no correspondence.
Obviously, getting antibody numbers to drop is not a bad thing. But it is also not necessarily such a good thing, because it may not be an indication that the destruction or the progression of the disease has slowed.
In conventional lab testing there really aren’t tests that are done to look at this. One theory with Hashimoto’s is that the ratio between the CIA and the soldiers is important.
The soldiers are also known as the TH-1 system, the cytokines or immune proteins associated with this part of the immune system are the killers.
The CIA is known as the TH-2 part of the immune system and you can test for ratios between TH-1 and TH-2 cytokines.
If there is a lot more of the soldiers than CIA agents, then the prognosis is not good and the disease tends to be more severe.
With Hashimoto’s there is a tendency towards more TH-1 than Th-2, but this is not always the case.
On the other hand if the CIA is more numerous or more balanced and the control and command part of the immune system (TH-3 or the regulatory part of the immune system- what we can call the General) is also strong, then, usually the prognosis is better and you can calm the attack and slow or stop the progression of the disease.
In reality, the immune system isn’t linear and this is an oversimplification. Testing is available to look at the cytokines that represent these different parts of the immune system, but there are many other factors that make current tests for this unreliable and not that helpful.
However, you can use these ideas to help figure out what you need to do in order to calm the attack, slow the progression of the disease and, most importantly, feel better.
The major cause of thyroid tissue destruction is something called apoptosis. This is programmed cell death.
Lots of crazy things happen on a molecular level (like cytoskeletal disruption, cell shrinkage, chromatin condensation, nuclear fragmentation, membrane blebbing, and DNA fragmentation – membrane blebbing, people!) to make this happen, but the easiest way to grok the root of it is to understand that it is initiated by inflammation.
The best way to slow the progression and minimize destruction is to do everything you can to stop inflammation and to strengthen the regulatory part of the immune system.
2 important anti-inflammatory agents are: Vitamin D and glutathione. These supplements strengthen the regulatory part of the immune system (TH-3 or the General).
(One important thing to note is that some people with Hashimoto’s have a defect with vitamin D receptors and may need to take more than is usually required by normal individuals.)
These are important anti-inflammatories.
Another player in the complicated drama of Hashimoto’s is TH-17. This is like a rouge agent that when numerous and aggressive can do major damage. TH-17 is highly inflammatory.
Natural supplements that reduce TH-17 include Turmeric and Resveratrol. Some Chinese herbs that have been shown to reduce TH-17 are Chang Shan or dichroa root and Huang Lian and Huang Qin whose active compound is berberine.
Also, it is very important to reduce the causes of inflammation in your diet. The three most inflammatory foods in our diet are gluten, dairy and soy.
Gluten has been extensively hybridized and deamidated and has been linked to the initiation and progression of thyroid autoimmunity.
Dairy products when commercially produced are full of antibiotics, hormones and god knows what else. They have also been linked to the initiation of various autoimmune diseases.
Soy is one of the most heavily genetically modified foods in our diet and is also quite difficult to digest.
Some research has indicated that thyroid replacement hormone can reduce TPO antibodies, though there is also some indication that natural desiccated hormone can raise antibodies in some individuals (it seems to be those who have a particularly severe immune reactivity – i.e., they have lots of inflammation).
Selenium has been found to reduce TPO antibodies in a number of studies.
Thyroid antibodies are important for determining whether or not you have Hashimoto’s but are not always a good indicator of how well what you are doing is working.
Do not get too excited if antibody numbers go up or down. It’s not the antibodies that are the problem as much as the other parts of the immune system that are attacking and destroying the thyroid.
Get excited about reducing inflammation. That should be your daily obsession. Really, its that important.
Thyroid replacement hormone and selenium have been shown to reduce TPO antibodies, but this may not work for everyone.
Hashimoto’s is complicated. It is a multi-system disorder that requires a multi-system approach. That’s why created my program: Healing Hashimoto’s: The 5 Elements of Thyroid Health. Click here to learn more.
References:
http://en.wikipedia.org/wiki/Apoptosis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC555850/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/
http://www.thyroidmanager.org/chapter/hashimotos-thyroiditis/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271310/– Technichal, but great info on what happens in Hashimoto’s
http://www.ncbi.nlm.nih.gov/pubmed/15307940
http://www.ncbi.nlm.nih.gov/pubmed/7878464
http://www.ncbi.nlm.nih.gov/pubmed/20477110
http://www.medicalnewstoday.com/releases/241571.php
http://www.jimmunol.org/content/185/3/1855.full
http://www.cambridgemedicine.org/news/1299069648
http://jcem.endojournals.org/content/87/4/1687.long
Hashimoto’s is the most common cause of hypothyroidism in the United States. An estimated 20 million people suffer from some form of thyroid disease.
Up to 60 per cent have no idea that they have a thyroid problem.Women are five to eight times more likely than men to have thyroid issues.
Fibromyalgia is a multi-symptom disorder that affects an estimated 5 million Americans 18 or older. Between 80 and 90 percent of people diagnosed with fibromyalgia are also women.
This week, I was thinking about the number of patients that I have seen that have been diagnosed with both conditions.
I put the question to my Facebook support group and 74 people with Hashimoto’s responded.
Almost all of them confirmed that they had been diagnosed with both or had all of the symptoms of fibromyalgia.
This is hardly a scientific study, but it does give us some evidence that there is a lot of overlap between the 2 conditions.
As I said, several patients have come to me with a pre-existing diagnosis of fibromyalgia, or FMS, for which they have received little effective treatment or relief.
Many doctors treat these symptoms using drugs rather than uncovering the root cause of the patient’s issues.
Diagnosing fibromyalgia is admittedly difficult. For years it has involved assessing the presence in the patient of multiple symptoms that indicate the syndrome.
Currently, there are three main symptoms which must be present for a fibromyalgia diagnosis. They are:
1. Widespread pain
2. Sleep problems
3. Fatigue
The only existing blood test available is the FM/a, which tests for a lowered cytokine level suggestive of fibromyalgia, but the test is controversial and not yet considered definitive.
I do not mean to diminish or discount a diagnosis of fibromyalgia. What I am curious about is the link between FMS and Hashimoto’s.
Studies have come to indicate there is a component of thyroid dysfunction associated with FMS. A 2007 study by the Division of Rheumatology at the Department of Internal Medicine at the University of Pisa looked into a possible link between fibromyalgia and Hashimoto’s Hypothyroidism. It concluded that the presence of thyroid autoimmunity may predispose one to fibromyalgia.
This opens up the possibility that the opposite may be true: what if in some cases the various symptoms that point to a diagnosis of fibromyalgia are, in fact, just Hashimoto’s (which is often undiagnosed)?
In my own experience, I can tell you that a lot of fibromyalgia symptoms are present in my Hashimoto’s patients.
Is there a connection between the two?
In a review published in Thyroid Science by John C. Lowe and Jackie Yellin at the Fibromylgia Research Foundation, the authors wrote that, based on the available research, “inadequate thyroid hormone regulation is the most likely underlying mechanism of the symptoms and objective abnormalities of patients who meet the criteria for FMS.”
In the authors’ view, only hormone therapy has been seen to result in the mitigation of fibromyalgia symptoms. This, obviously, points to a connection between fibromyalgia and thyroid autoimmunity.
In fact, 2 neuroscientists at Stanford (Dr. Ian Carroll, MD and Dr. Jarred Younger PhD) are currently doing a clinical trial investigating T3 treatment for fibromyalgia.
So, at the very least, FMS and Hashimoto’s share a great number of symptoms. If you are diagnosed with FMS, it is highly advisable that you be tested for Hashimoto’s.
If you aren’t familiar with which tests to order for Hashimoto’s, check out my previous blog post for an in depth discussion on this.
Since there is so much overlap, I have decided to illustrate how virtually all the common symptoms of fibromyalgia can be caused by hypothyroidism (and, often, Hashimoto’s).
According to WebMD the most common symptoms of fibromyalgia are those in italics below. We will examine how hypothyroidism leads to each group of symptoms and why.
• Chronic muscle pain, muscle spasms, or tightness: Muscle-related symptoms are common with patients with hypothyroidism. The symptoms vary, but in a recent series of studies 79% of patients reported some kind of myopathy (muscle pain).
The exact reasons why are not known, theories include impaired glycogenolysis (the breakdown of glycogen to glucose – a reminder of why blood sugar balance is so important), reduced mitochondrial activity (mitochondria are the cell’s energy producers) and a decrease in production of ATP (Adeosine triphosphate), the actual fuel in the cell.
A recent study also showed increased lactate production during exercise with hypothyroid patients – this is also consistent with mitochondria problems.
• Tension or migraine headaches: Any of the causes above or below can lead to tension and headaches.
• Jaw and facial tenderness: Jaw and facial tenderness can also be caused by the same factors that lead to other muscle pain.
• Moderate or severe fatigue and decreased energy: Fatigue and decreased energy are some of the most common symptoms of hypothyroidism and Hashimoto’s.
There are many factors that lead to this including too little thyroid hormone production, the affect of too little thyroid hormone on the adrenals and blood sugar metabolism and the problems with ATP and mitochondria mentioned above.
• Insomnia or waking up feeling just as tired as when you went to sleep: Sleep issues are also incredibly common with hypothyroidism. Instability of thyroid hormone levels due to poorly managed autoimmunity, T3 building up and being released into the bloodstream, and the thyroid’s affect on the adrenals can all lead to insomnia.
With hypothyroidism, too little T4 can lead to a slower breakdown of cortisol. It then builds up in the body and this impacts the HPA axis (hypothalmus-pituitary-adrenal axis). See my past blog post for an in depth look at this.
• Stiffness upon waking or after staying in one position for too long: Hypothyroidism tends to cause a slower relaxation of tendons and some studies have shown high serum creatinine kinase levels. The levels are almost invariably in the MM isoenzyme that is the type of creatinine kinase found in skeletal muscles.
High levels of this enzyme are normally found in people who have been under extreme stress or who have just completed heavy exercise.
• Reduced tolerance for exercise and muscle pain after exercise: This certainly could be caused by what we just discussed. In addition, there are a host of issues that hypothyroidism can cause that relate to reduced tolerance for exercise. Check out my previous post on this.
• Difficulty remembering, concentrating, and performing simple mental tasks (“fibro fog”): According to Dr. Datis Kharrazian, the role of the thyroid on the brain is profound. Thyroid function impacts brain inflammation, plasticity, neurotransmitter activity and general brain function.
Thyroid hormone impacts all neurotransmitter receptors in men and women.
All of them.
So hypothyroidism can impact serotonin, dopamine, acetylcholine and gaba levels.
These neurotransmitters have a huge influence on memory, concentration and mood. Especially acetylcholine. Hypothyroidism can lead to acetylcholine deficiency and inefficient nerve firing.
This can cause memory loss and poor concentration.
Brain fog is brain inflammation, plain and simple. It is really important not to ignore it, like many doctors do. The consequences can be really bad.
• Feeling anxious or depressed: As we just discussed, thyroid hormone impacts all neurotransmitter receptors. Gaba is an inhibitory neurotransmitter, it keeps you calm.
Hypothyroidism can impact gaba synthesis, release and reuptake. All of this can lead to increased anxiety.
Dopamine and serotonin are responsible for enabling us to experience joy and enjoy activities in our life and to get pleasure out of what we do. Hypothyroidism can also impact these neurotransmitters and can lead to deficiencies in both serotonin and dopamine.
• Increase in urinary urgency or frequency (irritable bladder): Acetylcholine deficiency can impact urinary urgency and frequency.
• Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome): Studies in human and dogs of hypothyroid patients have demonstrated a decrease in the electric and motor activity of the esophagus, stomach, small intestine and colon.
Digestive dysfunction is also incredibly common with hypothyroid patients. Leaky gut has been implicated in the formation and progression of various autoimmune diseases including Hashimoto’s.
Neuropathic symptoms including parasthesias (tingling or prickling sensation caused by issues with peripheral nerves) and painful dysthesias (an abnormal, uncomfortable sense of touch) are also common with hypothyroidism.
The most common type of neurological symptom in hypothyroid patients is carpal tunnel syndrome.
• Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold: Neuropathies involving the cranial nerves (those that control smell, hearing, vision) have all been reported. Hearing loss due to hypothyroidism is the most common and has been reported in 31%-85% of patients.
There are many theories on how hypothyroidism impacts nerves, but some studies have shown demyelination (the loss of the coating around nerve fibers), and axonal degeneration (degeneration of the nerve branches).
• Numbness or tingling in the face, arms, hands, legs, or feet: Certainly, this can be caused by what we just discussed.
• A feeling of swelling (without actual swelling) in the hands and feet: This could be neurological or it could simply be caused by the destructive inflammatory process that is at the root of Hashimoto’s.
As you can see, there is a plausible argument to be made that almost all of the symptoms of fibromyalgia could be rooted in hypothyroidism and Hashimoto’s.
Of course, this begs the question of what to do.
As with all things related to this disease, we are once again reminded that this is a multi-system disorder.
It’s much more than just a thyroid problem and it requires a multi-system approach if you want to manage it successfully.
This is exactly why I created my program: Healing Hashimoto’s: The 5 Elelments of Thyroid Health.
In it, I teach a step by step strategy for finding and healing your issues in all of these systems.
For more information, check out my program here.
References:
http://www.thyroid.org/media-main/about-hypothyroidism/ : Statistics on thyroid disease
https://med.stanford.edu/clinicaltrials/trials/NCT00903877 : Clinical study using T3 to treat fibromyalgia
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856434/?tool=pubmed : Paper on leaky gut
http://69.89.19.190/thyroidscience/reviews/lowe.yellin.6.17.08/ithr.review.6.17.08.pdf
: A review of the evidence on the link between fibromyalgia and hypothyroidism
http://www.ncbi.nlm.nih.gov/pubmed/21085966 : Study linking fibromyalgia and autoimmune thyroid disease
Rodcolico C, Toscano A, Benvenga S, et al. Myopathy as the persistently isolated symptomaology of primary autoimmune thyroidism. Thyroid 1998;8:1033
Monzani F, Caraccio N, Siciliano G, et al. Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J. Clinical Endocrinol Metab 1997;82:3315
Goti I. Serum creatinine phosphokinase isoenzymes in hypothyroidism, comvulsions, myocardial infarction and other diseases. Clin Chim Acta 1974;52:325
Kowalewski K, Kolodej A. Myoelectrical and mechanical activity of the stomach and intestine in hypothyroid dogs. Am J Dig Dis 1977;22;235
Bhatia PL, Gupta DP, Agrawal MK, et al. Audiological and vestibular function tests in hypothyroidism. Laryngoscope 1977;87:2082
Dyck PJ, Lambert ED. Polyneuropathy associated with hypothyroidism. J Neuropathl Exp Neurol 1970;29:631
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Why Isn’t My Brain Working? Dr. Datis Kharrazian, Elephant Press, 2013
The human body, like the planet earth, is made of many ecosystems all interacting and influencing each other. With Hashimoto’s many of these ecosystems are altered and dysfunctional.
And one example of this is the interaction between the adrenal glands and the thyroid.
The adrenals are two little glands, about almond size that sit on top of the kidneys.
The one on the right kidney has a triangular shape and the one on the left kidney has a sort of half moon shape.
Each of the adrenals has different inner and outer parts or zones. The inner zone or the medulla is what secretes adrenalin and norepinephrine and just the right amount of dopamine.
These are the stress hormones.
The outer zone……(cue Rod Serling)
You’re traveling through another dimension — a dimension not only of sight and sound but of mind. A journey into a wondrous land whose boundaries are that of the imagination. That’s a signpost up ahead: your next stop……
The outer zone of the adrenal cortex,
this is where 3 different types of hormones are secreted: glucocorticoids, mineralcorticoids and androgens.
These hormones are all made from cholesterol (See? It does do good things.) and are critical to every day function.
Of the glucocorticoids, cortisol is the star.
It is stimulated by ACTH from the pituitary. This is very much like the relationship between TSH (also secreted by the pituitary) and T4.
ACTH and cortisol are the analogous hormones of the adrenals.
What does cortisol do?
It regulates blood sugar levels, increases body fat, defends the body against infections and helps the body adapt to stress. It also helps to convert food into energy and is anti-inflammatory.
What doesn’t it do might be a better question.
There are other hormones produced by the adrenals, but let’s not go there right now. Keep your focus here on the cortisol’s reason for being (or raison d’être, as the French would say).
Ok, so let’s take a look at few different ways that stress, the femme fatale of the body, causes hypothyroid symptoms.
Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, divorce, losing a job, moving, losing a loved one and the many other emotional and psychological challenges of modern life.
But other things you don’t normally think of, also place just as much of a burden on the adrenal glands.
These include blood sugar swings, gut dysfunction, leaky gut, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems and inflammation.
All of these conditions sound the alarm and cause the adrenals to pump out more stress hormones.
So really, stress can be thought of as anything that disturbs the body’s natural balance (or if you like, homeostasis).
Adrenal stress is one of the most common problems encountered in modern clinical practice, because nearly everyone is dealing with at least one of the things I just discussed.
Symptoms of adrenal stress are many, because the adrenals (like its buddy, the thyroid) can affect every system in the body.
Symptoms of Adrenal Stress
Some of the more common symptoms are:
* Fatigue, also a thyroid symptom
* Headaches, splitting headaches especially
* Decreased immunity
* Sleep issues. Difficulty falling asleep, staying asleep and waking up feeling exhausted even after you had enough sleep.
* Mood swings
* Sugar and caffeine cravings, (have a hankering for a Red Bull? It could be your adrenals)
* Irritability or lightheadedness between meals, a blood sugar and adrenal problem
* Eating to relieve fatigue, another blood sugar problem
* Dizziness when moving from sitting or lying to standing, it affects your blood pressure
* Gastric ulcers, ulcers in the stomach can be caused by the adrenals
Weak adrenals can cause hypothyroid symptoms alone without any problem in the thyroid gland itself.
In such cases, working on the adrenals themselves may be the key to improving thyroid function.
The most significant indirect effect the adrenals have on thyroid function is through their affect on blood sugar.
Low or high cortisol – caused by any of the chronic stressors listed above – can cause hypoglycemica, insulin resistance or both.
Blood sugar imbalances cause hypothyroid symptoms in a variety of ways. (More on this in an upcoming post).
But adrenal stress also has more direct impacts on thyroid function. And, (darn the luck!) hypothyroidism has a direct impact on adrenal function. (I feel a vicious cycle coming on!)
Let’s reflect on non-linearity for a moment, none of this happens in one direction. Hypothyroidism impacts adrenal function and adrenal function, in turn, impacts the thyroid.
First, what happens with the adrenals when the body is in a hypothyroid or functionally hypothyroid state?
There is a very clear link between hypothyroidism and hypoadrenalism. When there is trouble from this, it is often linked to problems in a part of the brain called the hypothalmus.
The hypothalamus is really like the boss of the boss. (The pituitary is the master or boss endocrine gland and the hypothalamus is the pituitary’s boss.)
You know, like when the boss is real arrogant and always doing bossy things and then, all of a sudden, the boss’s boss shows up and he gets put in his place?
Well, the pituitary and the hypothalamus’ relationship is nothing like that. (Just wanted to see if you were paying attention.) 😉
Their relationship is more like, “Hey, we have this amazingly complex, super complicated body to run, do you want to help each other? Cool. Oh and by the way, this is not linear.”
With the adrenals, this little benevolent, enlightened dictatorship is called the hypothalmic-pituitary-adrenal axis or the HPA axis. These 3 run the whole show.
The HPA axis plays a major role in regulating immune function, digestion, energy use, mood and thrill of thrills, sexuality.
This HPA axis is controlled by hormones (in a non-linear fashion) and it is totally manipulated by stress.
Stress is like the femme fatale of the HPA axis. It’s the mean wife of the boss’ boss.
Where am I going with all of this?
Well, a dysfunctional HPA axis, like the troubled empire ruled by the mean boss’ wife, can cause all kinds of problems.
With Hashimoto’s, one of the reasons why people continue to feel exhausted even though they are taking thyroid hormones is because of a messed up HPA axis.
And adrenal stress can lead directly to a messed up HPA axis.
Hypothryoidism also impacts the HPA axis. When you are hypothyroid it leads to elevated cortisol due to decreased clearance and a negative feedback loop (The HPA axis doesn’t work properly.)
This, in turn, inhibits thyroid function because cortisol inhibits the enzyme (5’ deodinase) that is responsible for converting T4 to the form the body uses, T3.
It can also inhibit TSH. Hmmmm…..
Something else no one ever tells you is that treatment with T4, like Synthroid or Levothyroxine, can cause adrenal problems.
If someone has adrenal insufficiency, then they are at risk for thyroxine making the problem worse!
Even if the adrenal insufficiency is not that bad, it may have an effect on thyroid conversion, tissue uptake, and thyroid response. And not in a good way.
If the T4 to T3 conversion doesn’t happen as it should, the body can become overloaded with unused T4.
If it is converted, but the T3 cannot enter the cell walls due to adrenal insufficiency or iron deficiency, the T3 cannot be used, and may pool or build up in the blood.
Studies have shown that very high levels of T3 can be toxic to the liver.
Sometimes this T3 pools and then releases or dumps into the blood stream. When this happens, you may suddenly feel all the hyper symptoms like heart palpitations, insomnia, nervousness, etc. This is one of the reasons why some Hashimoto’s people experience hyper to hypo cycles.
In many cases, T4 and TSH blood tests will appear normal, but the patient will feel really lousy.
If a doctor raises the thyroxine dose in this situation, things may become worse. How bad depends on the degree of adrenal insufficiency.
Symptoms may include all the symptoms mentioned above.
And check this out! (This comes from the warning label for Synthroid, but is true of all synthetic T4 drugs.)
“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.
Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”
What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone.
How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency?
I put this question to my Facebook support group and 100% of the 85 respondents with Hashimoto’s said they had most of the symptoms of adrenal insufficiency mentioned in the list I posted above. Granted, that’s not a scientific study, but it certainly is emblematic of this problem.
Have you ever heard of a doctor checking for this prior to beginning treatment?
It’s not very common, believe you me. Many doctors dismiss adrenal insufficiency as one of those make believe disorders.
The other side of this is the many ways that adrenal stress can cause hypothyroidism.
As we discussed above, it messes with the HPA axis and this, in turn, messes with the HPT (hypothamus-pituitary-thyroid) axis. Communication gets all garbled all around.
And we all know how important good communication is. Especially when you have a super complicated body to run.
Adrenal Stress Can Lead to Autoimmunity
The GI tract, lungs and the blood-brain barrier are the main immune barriers in the body.
They prevent the bad guys from entering the bloodstream and the brain.
Adrenal stress weakens these barriers, weakens the immune system in general, and promotes poor immune system regulation.
Cortisol can impact this in both directions. Too little cortisol causes the immune system to rev up and can lead to an over aggressive immune response.
Too much cortisol can weaken the immune system and make you more vulnerable to attacks or unable to defend yourself.
When these immune barriers are breached large proteins and other antigens are able to pass into the bloodstream or brain where they don’t belong.
If this happens over and over again, the immune system gets thrown out of whack and we become more prone to autoimmune diseases – such as Hashimoto’s.
Adrenal Stress Leads to Thyroid Hormone Resistance
In order for thyroid hormone circulating in blood to work, it must first activate receptors on cells.
Inflammatory immune cells called cytokines have been shown to make thyroid receptor sites less sensitive.
With insulin resistance, where the cells gradually lose their sensitivity to insulin, we see a similar pattern. There it is insulin, here it is thyroid hormone.
It’s like thyroid hormone is knocking on the cell’s door, but the cells don’t answer.
“I hear you knockin’ but you cain’t come in.”
A perfect example of this in practice is the Hashimoto’s patient who is taking replacement hormones but still suffers from hypothyroid symptoms – often in spite of repeated changes in the dose and type of medication.
In these patients, inflammation is depressing thyroid receptor site sensitivity and producing hypothyroid symptoms, even though lab markers like TSH, T4 and T3 may be normal.
Adrenal stress reduces conversion of T4 to T3
93% of the hormone produced by the thyroid gland is T4, it is inactive in that form and must be converted into T3 before it can be used by the cells.
The inflammatory cytokines I just mentioned not only disrupt the HPA axis, they also interfere with the conversion of T4 to T3.
The enzyme 5″-deiodinase is responsible for the conversion of T4 into T3 in peripheral tissues such as the liver and the gut.
Both Th1 and Th2 inflammatory cytokines – IL-6, TNF-alpha, IFN-gamma and IL-1 beta – have been shown to suppress the conversion of T4 to T3.
In patients without thyroid illness, as levels of IL-6 (a marker for inflammation) rise, levels of serum T3 fall.
These inflammatory immune cells make T3 and TSH levels go down and reverse T3 levels go up.
So, adrenal insufficiency leads to poor conversion and adrenal stress due to inflammation can lead to this, as well. Giving us a lovely double whammy.
Adrenal stress causes hormonal imbalances
Cortisol also acts on the liver. When it is high, caused by chronic stress, this decreases the liver’s ability to clear certain hormones, like excess estrogens from the blood.
Excess estrogen increases levels of thyroid binding globulin (TBG), the proteins that thyroid hormone is attached to as it’s transported through the body.
When thyroid hormone is bound to TBG, it is inactive. Meaning it doesn’t work.
It must be taken from TBG to become “free” before it can activate the receptors on cells. (These are the free-fraction thyroid hormones that you see on lab tests as “free T4 [FT4]” and “free T3 [FT3]“.)
When TBG levels are high, the percentage of free thyroid hormones drops. This shows up on labs as low T3 uptake and low free T4/T3.
When stress is not the cause, the most common reason for elevated TBG are birth control pills and estrogen replacement (i.e. Premarin).
Here’s the tricky thing about adrenal stress: it’s almost always caused – at least in part – by something else.
These causes include anemia, blood sugar swings, gut inflammation, food intolerances (especially gluten), essential fatty acid deficiencies, environmental toxins, and of course, chronic emotional and psychological stress.
Sound familiar?
These are also all the things that make Hashimoto’s worse.
You can’t ignore them or pretend like they aren’t there like so many doctors do. We have to deal with all of them.
All of them. Half measures don’t lead to half results, they often lead to no results.
When they exist, these conditions must be addressed or any attempt to support the adrenals directly will either fail or be only partially successful.
So much more than a thyroid problem. Hashimoto’s is a multi-system problem.
Need help? I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.
Book your session now: https://hashimotoshealing.as.me/strategy
This has been a long, exhausting blog post. It’s time to rest (for the sake of our adrenals). In an upcoming post I’ll look at all the things we can do to love our adrenals back to health. 🙂 Stay tuned!
References:
http://www.rxlist.com/synthroid-drug/warnings-precautions.htm
https://cfids-cab.org/cfs-inform/Neuroendocrin/tsigos.chrousos02.pdf – Adrenal stress leads to Hashimoto’s
http://www.karger.com/Article/Abstract/87001 -HPT and HPA responses during repeated stress
The Thyroid: A Fundamental and Clinical Text, Lewis E. Braverman & Robert D. Utiger, Ninth Edition, Lippincott, Williams & Wilkins, 2005
Hashimoto’s Thryoiditis, Izabella Wentz, Wentz LLC publishing, 2013
http://www.holtorfmed.com/blog/adrenal-health-understanding-the-adrenal-and-thyroid-connection/
http://articles.mercola.com/sites/articles/archive/2000/08/27/adrenals.aspx
http://www.ncbi.nlm.nih.gov/pubmed/3527687
http://www.ncbi.nlm.nih.gov/pubmed/3500324
There is no question that exercise is a very important part of any healthy lifestyle. This is especially true if you have an autoimmune disease. However, when you exercise with Hashimoto’s you must be careful to do it properly or you can wind up doing more harm than good.
In this post we examine new research on exercise and look at the best type of exercise program for people with Hashimoto’s.
Exercise has many health benefits and many of these are hugely important if you suffer from Hashimoto’s. In my last post, I mentioned a lecture I attended that was taught by Dr. Datis Kharrazian, here is some additional information I learned and how I think it applies to Hashimoto’s people. According to Dr. Kharrazian, the benefits of exercise include:
* Growth Hormone Release
* Opioid Response
* Nitric Oxide Synthase (eNOS) Responses
* Brain-Derived Neurotrophic Factor Release
* Insuline Receptor Sensitivity
* Immune Enhancement
Growth hormone stimulates cell reproduction and regeneration, and growth in our bodies. It also has a number of positive effects on our nervous, endocrine, and immune systems
A lot of growth hormone’s effects are felt in the liver where it can improve the burning of body fat, improve blood glucose levels and increase protein synthesis.
It also has important effects on the nervous system where it can improve synapses in the brain. It also improves heart function, immune function and decreases recovery time.
In addition, it has been found to increase calcium absorption and improve bone density.
Studies have shown that growth hormone release is increased with increased exercise intensity. (So walking on a treadmill and watching t.v. probably won’t result in much being released.)
Hypothyroidism can cause increases in body fat and alter lipid metabolism, and can lead to poorer absorption of calcium and protein. So these effects can be very beneficial for Hashimoto’s patients.
Exercise has been found to release the body’s natural opioids called endorphins and enkephalins. This is commonly known as the “runner’s high” or that blissful feeling that you get after certain kinds of exercise and sports.
Endorphins have many positive effects including pain relief, stress reduction, and improving our moods. Exercise can also result in the release of more dopamine and serotonin both of which are responsible for happiness and satisfaction with life and relationships.
Studies have shown that moderately high to high intensity exercise stimulates the release of these natural proteins. It also seems to depend on the individual with some people needing to do more than others.
Hypothyroidism can lead to declines in dopamine and serotonin and to feelings of depression and overwhelm. Some of the most widely prescribed drugs for Hashimoto’s people are anti-depressants, so exercise can have huge benefits for these people, as well.
Nitric Oxide Synthases (NOS) are enzymes that can do both good and bad things in the body. Increased eNOS (endothethelial NOS) increases blood flow which can get more blood to the brain, can improve heart health and can get more nutrients and oxygen to our bodies’ cells. This results in tissue repair and more energy.
Increased nNOS (neuronal NOS) causes more muscle contraction and brain focus which results in improved performance in various activities.
On the other hand, increased iNOS (inducible NOS) can result in a host of bad things like: surges in destructive immune cells called cytokines, damage to mitochondria and inflammation. Too much of this can lead to injury, muscle wasting and breakdown and pain.
(Arginine is an important nutrient for iNOS and should be avoided before exercise.)
NOS plays a key role in cardiovascular, immune and brain function. All things that can be compromised in Hashimoto’s people.
It seems that the right amount of exercise is key for getting the right amounts of the right kinds of NOS. Too little and you won’t get the benefits, too much and you get the damaging consequences mentioned above. One again, the key is high intensity, but not for too long.
BDNF helps with nerve growth and differentiation in the brian. It is very important in building new nerve pathways and preserving and keeping healthy old ones. So it is critically important in maintaining a healthy brain and in slowing the destruction of nerves in the brain that can lead to dementia and Alzheimer’s.
Exercise increases levels of BDNF and also improves brain function. Once again (are you seeing a trend emerging?), the amount released is dependent on the intensity of the exercise.
Brain fog and neuro-degeneration are very common complaints from people with Hashimoto’s. This is caused by numerous things, but the underlying mechanism is inflammation caused by immune cells and the destruction of brain cells.
Problems with insulin resistance are very common in today’s society and are a driving force in the initiation of Hashimoto’s. It can also prevent people from getting any better once they have developed the disease.
Insulin normally helps sugar get into cells, when people become insulin resistant because they are exposed to too much sugar, the cells of the body start blocking insulin because they can’t deal with so much sugar.
This person feels like she needs to nap after every meal, and may actually fall asleep after eating a carbohydrate rich meal. This person will also have belly fat and will complain of insomnia.
Insulin resistance can drag down thyroid function and contributes to diabetes, heart disease, sleep apnea, hormone problems, obesity and certain types of cancer.
Aerobic and strength-training exercises improve insulin sensitivity by increasing the number of protein molecules called glucose transporters (GLUT), which allow your cells to better respond to insulin.
Hashimoto’s is an autoimmune disease. The immune system has short circuited and attacks the thyroid as if it were a foreign invader.
Exercise can be very beneficial for improving immune function. The right kind of exercise can be helpful in healing the gut and in improving gastrointestinal immunity. Since 70% of the immune system lives in the gut, this can be very beneficial.
But, excessive exercise can actually cause major problems with immune function. And if you have Hashimoto’s it is very important not to overtrain or you can wipe out all of the benefits and actually make many things worse.
It is clear that exercise can be very beneficial for Hashimoto’s patients, but what is the right kind and the right amount?
According to research, the optimal exercise level to achieve all the health benefits described above is high intensity: when doing this you will:
* Break a sweat after 3-5 minutes
* Breathe deeply and rapidly
* Only talk in short phrases while you are doing this.
You want to go hard enough to achieve 70% or greater of your maximum heart rate. This can be calculated by this simple equation: 220 – your age in years = your maximum heart rate.
There is a fine line between the right amount of exercise which can really improve health and too much which can actually cause more health problems.
The key point is this: The more intense the exercise, the greater the potential for health benefits that include everything mentioned above, but also the greater risk of doing too much and this results in the loss of all those benefits.
This is especially true if you suffer from an autoimmune disease like Hashimoto’s because you may not be able to exercise like a normal person and you may reach the threshold of maximum benefit sooner than people who do not have this condition.
Dr. Kharrazian also noted that there are a number of things that can make exercise not work for you. If you have any of these conditions, you must be very careful not to overdo it when working out.
These conditions include:
* Pre-existing high or low cortisol levels
* Pre-existing systemic inflammation
* Pre-existing immune weakness
* Pre-existing intestinal permeability
* Pre-existing hormone imbalance
* Pre-existing nutrient deficiencies
* Pre-existing obesity
People who suffer from Hashimoto’s often have a majority of conditions from that list, which means they are very vulnerable to getting worse as the result of exercise.
There are a number of signs and symptoms that can help you identify if you are working out too much.
Performance Signs and Symptoms
If you have a hard time recovering from workouts, can’t complete your workouts, notice your performance is declining or that you have more injuries then you may be doing too much.
Psychological Signs and Symptoms
If you are exercising frequently and you notice a loss of motivation and enthusiasm, a loss of competitive drive, depression, irritability or aggression for minor reasons then you may be doing too much.
Physical Signs and Symptoms
If you are exercising regularly and you notice that you have a weakened immune system, a loss of libido, loss of menstrual cycle, decreased muscle strength or unexplained increases or decreases in weight then you may be over doing it.
The Best Workout: Maximum Results With Minimal Energy Expenditure
An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal offers an example of an optimal 7 minute workout that can be used as a starting point for Hashimoto’s patients and can be utilized to achieve all the health benefits without causing any of the negative effects of overtraining.
I really like this workout because it can help you achieve all the health benefits we have discussed in a very short time, it works on your entire body and it can be modified so that you can do more or less.
This entire workout can be done at home, in a hotel room or anywhere that has an open room and a chair. You don’t need to purchase any equipment and you can do it by yourself without having to hire a personal trainer or therapist.
The entire workout is 7 minutes and you can repeat the circuit up to 3 times. It consists of 12 different exercises each done at high intensity for 30 seconds.
For people with Hashimoto’s, I recommend starting with one cycle and seeing how you feel. For some, even a 7 minute workout will prove to be too much. If that is the case, cut the 30 second intervals in half.
If you are able to do all 12 exercises as suggested for 30 seconds then do one interval for one to 2 weeks (a minimum of 4 times per week). Repeat the entire sequence after 2 weeks and then add a third repetition after an additional 2 weeks. If pressed for time, you can simply do 1 round of 7 minutes.
The optimal time to get most benefit is within 10 minutes after you wake up, before you have had breakfast. This is the perfect time to exercise because you can take advantage of your body’s natural cortisol surge and exercising before breakfast will also help you burn fat more efficiently and help reduce insulin resistance.
For my patients and myself, I recommend taking a drink that provides electrolytes (not Gatorade – which is loaded with sugar). Here’s a recipe for a simple Electrolyte Lemonade:
Electrolyte Lemonade:
3 organic lemons, peeled, but leave white pith intact
3 tablespoons coconut oil, olive oil or flax oil
1 organic pear, cored
1 tablespoon Celtic sea salt or Himalayan Salt
6 cups filtered water
Blend everything well in a Vitamixer, makes 1 pitcher
Drink 1 glass before your workout.
It is also recommended to support nitric oxide synthase production. The following nutrients and co-factors can do this: ATP, N-Acetyl L-Carnitine, Huperzine A, Alpha-GPC, Vinpocetine and Xanithol Nicotinate. This will help boost eNOS and nNos.
After the workout take something that will reduce inflammation and support the immune system like turmeric and/or resveratrol and another glass of electrolyte lemonade.
Hashimoto’s is a complicated condition that can impact all the major systems of the body. In order to treat it effectively, you really need to adopt a lifestyle that supports you with the right kind of diet, exercise and supplement regimen to get you feeling your best and to slow or stop the destructive progress of the autoimmune disease.
Would like help in designing the right kind of diet, exercise and supplement regimen from someone who has worked with over 2,000 people with Hashimoto’s?
I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.
Book your session now: https://hashimotoshealing.as.me/strategy
The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013
Opioids and Exercise. An Update. Sports Med. 1989 Feb;7(2):109-124
Life Food Recipe Book, Annie Padden Jubb and David Jubb, North Atlantic Books, 2003, page 186, Electrolyte Lemonade
Hashimoto’s is one of the most common autoimmune disease in the United States, yet is is also one of the most poorly managed. One of the most common questions I get is, what tests should I ask my doctor to order?
Because Hashimoto’s is a thyroid disorder and an autoimmune disease there are a number of additional lab tests that are important but are not, specifically, tests for the thyroid. In this post I will discuss them all and explain why it is important to order them, as well.
There are some people out there on the internet, who, out of frustration, believe that you should forget about asking a doctor to order tests for you and just order them for yourself.
In their defense, many doctors do not order the appropriate tests to do proper management of thyroid patients. There is too much emphasis put on some tests, and not enough on others that can give a great deal of information about how you are doing and how your medication is working.
However, here’s my take on that:
If you bought a luxury car, say a Tesla or a Lamborghini, you’d want to make sure it was kept in tip top shape. Would you do the diagnostics yourself? Think about how long it would take you to master the proper care of those vehicles.
It’s kind of the same thing with your body and lab testing. Hashimoto’s has so many moving parts. You are better off finding a doctor who you can have a partnership with who can give you his years of clinical expertise and help you to make sense of it all.
And if your doctor can’t or won’t do that? Well, find a doctor who will and work together to do a proper history, evaluation and diagnostic testing so that you can optimize your body and your health.
For myself, my health and my body are worth way more than a luxury car. I want to do everything I can to make sure it is kept in the best possible running order. And ordering your own lab tests can be very expensive, especially if you don’t have insurance. I give my patients lab tests at my cost. We can get them at a substantial discount and we are able to pass the savings onto them.
When interpreting Hashimoto’s lab tests you are always given 2 sets of numbers. Your test results and the laboratory range. The laboratory range is an average that is calculated based on the number of people who go to the lab in a given geographic area for a fixed amount of time.
These averages are influenced by many things: the health of that general population, the medication that is popular and prescribed during that period of time and by what general diseases those people have.
All of these factors skew the numbers. Have you been to a lab lately in your area? Spend a day there and ask yourself if those people represent the quality of life and general state of health that you want.
In many areas, in the US in particular, the general population has not gotten any healthier over the last 20 years. Look at the statistics. You probably don’t want to be among that average group. What I am getting at is, the laboratory range is not really a measure of good health. This is particularly true when it comes to the thyroid.
Millions and millions of Americans have thyroid disease and are on thyroid medication. This skews the numbers. Practitioners of functional medicine, like myself, use an additional set of numbers when we evaluate people’s health.
This is called the functional range and different specialists in various fields have identified these ranges as being where optimal health is.
So, when you are looking at laboratory results make sure you ask about functional ranges as well as laboratory ranges. Many doctors do not look at functional ranges, so be aware that asking about this may elicit a confused or dismissive response. (In this post we are focusing on lab tests alone, in a future post I will discuss how to interpret these tests.)
Hashimoto’s is an autoimmune disease and a thyroid disorder, so we must evaluate many things not just the thyroid. Here’s a list of what any good workup should include:
* Thyroid tests: TSH, free T3 (fT3), free T4 (fT4), Reverse T3, (rT3)
* Blood Sugar Analysis: Fasting glucose, HgA1C, Triglycerides, Cholesterol, LDL, and HDL
* Iron: Serum iron, TIBC, Transferrin and Ferritin
* Vitamin D3
* Vitamin B12 and B6
* Red and White Blood Cell Count: Complete CBC
* Tests to determine Adrenal Gland Health: BUN, Creatinine, Sodium and Potassium, Special test(s)
* Electrolytes: Sodium, Potassium, Magnesium, CO2, Chloride, and Phosphorous
* Markers that Evaluate the Health of the Intestines: Protein and Globulin, Special tests
* Hormone Testing: Saliva tests
* Immune Cell Testing: Special tests
…and maybe more, depending on what is found in a good thorough history. Let’s take a look at each of these briefly to give you a good sense of what we are looking for.
Thyroid Testing
TSH – Thyroid stimulating hormone (TSH), also called thyrotropin is released by the pituitary gland after the hypothalamus releases TRH (thyrotropin releasing hormone). TSH is the most common and most sensitive marker used to assess thyroid function. But it is not the be all and end all in thyroid testing, the way that so many doctors and practitioners make it.
In addition, many laboratories have do what is called a “thyroid cascade” in order to save themselves and insurance companies money. Basically, if the TSH is deemed to be in the normal range they will not analyze for T3 or T4 or anything else. That doesn’t help you and there not much agreement on what the normal range should be.
TSH levels increase as T4 levels drop and TSH levels decrease as T4 levels rise. The reason this is the most popular test in today’s medical model is because the only treatment offered for thyroid dysfunction is thyroid hormone replacement and that’s what doctors are checking when they test your TSH.
A TSH test alone doesn’t give you information about thyroid-pituitary communication, about T3 to T4 conversion in other parts of the body or about whether or not your immune system is attacking your thyroid.
One important thing for Hashimoto’s people to understand is that some antibodies can inhibit thyroid function by turning off instead of stimulating TSH receptors on cells. In this case, you will see high TSH and high antibodies.
Free T3 – measures the free T3 hormone levels. This test is rarely ordered by traditional endocrinologists and is usually only used when a patient has hyperthyroid symptoms and the fT4 levels are normal.
Even so, this test can be really useful for finding out what amount of active thyroid hormones are available for the thyroid receptor sites. Free T3 is high in hyperthyroid conditions and low in hypothyroid conditions. May also be high in thyroid toxicosis.
Free T4 – used to measure the amount of free or active T4 in the blood. High with hyperthyroidism, low with hypothyroidism. The drug Heparin can also cause elevated free T4 as can some acute illness. Its also high in an overdose of thyroid hormone.
Reverse T3 – Reverse T3 is usually produced when there is an extreme amount of stress. For example, a serious car accident, or surgery or really bad chronic stress.
Its no surprise that this is elevated after a stress response or when the body produces high amounts of the stress hormone cortisol. Reverse T3 is low when you have severe tissue damage like a bad burn or laceration or when you have liver disease like cirrhosis.
This may also be high if your iron is low.
Thyroid Antibodies
When these antibodies are present, it means that your immune system is attacking your own tissue. When your body produces thyroid autoantibodies it could create a hypo- or hyper- thyroid state.
They may also be elevated if there is thyroid cancer. Some antibodies can attach to TSH receptors, but they don’t cause a response in the thyroid.
These people will complain of low thyroid symptoms, but the TSH might not change at all. In other cases, the antibodies bind to receptor sites and cause the thyroid to be over active. Here you will see high T4, low TSH and high antibodies.
There are 3 autoantibodies that are tested. The first 2 are the most common:
Thyroid Peroxidase Antibody (TPO Ab): This antibody is the one that is usually high in autoimmune thyroid conditions like Hashimoto’s. It is also known as microsomal antibody.
Thyroglobulin Antibodies (TgAb): These aren’t seen high as often as TPO Ab. They are usually ordered when thyroid lab results seem strange because these antibodies can interfere with thyroid hormone production.
TgAb is also used to monitor progress after surgery for removing the thyroid in thyroid cancer.
Thyroid-Stimulating Hormone Receptor Antibody (TRAb): This antibody is only ordered when a patient is hyperthyroid. Positive results usually mean Grave’s disease.
For a complete overview of all thyroid tests to order, you can read my previous post here.
Blood Sugar
Measuring blood sugar is critically important for Hashimoto’s patients because if you have issues with your blood sugar (too high or too low) it can undermine everything else you are trying to do.
Fasting Glucose: A snapshot of how your blood sugar is at the time of the test.
HbA1C (Hemaglobin A1C): This test is a long term sugar marker and commonly used to assess type II diabetes and metabolic syndrome. (It’s optional, but should be ordered if you are overweight and have a history of high triglycerides and fat around your waist.)
Triglycerides: These are sugars stored in the fat in the liver.
Cholesterol, LDL, HDL: Most people have been brainwashed into thinking cholesterol is about fat. Don’t be misled. Its about sugar and sugar consumption and statin drugs do nothing to fix this.
Iron:
Iron is another “deal breaker”. If you have low iron it will undermine everything you are trying to do and make it unsuccessful. Hashimoto’s folks, especially women, often have issues with their iron levels. Most iron panels contain all of the following tests:
Serum Iron – Iron is necessary for making hemoglobin which carries oxygen on red blood cells. Decreased iron levels must be correlated with RBC, HGB, and HCT to rule out anemia (more on what those mean in a moment).
TIBC – Total iron binding capacity. this will be elevated in iron deficiency because this increases the cells’ potential to bind to iron. TIBC is high before anemia develops and, therefore, can be a good way to find iron deficiency early.
Transferrin – Regulates iron absorption. Increased with iron anemia.
Ferritin – A good marker for total body iron levels and reflects how much iron the body has stored. It also called an “acute phase reactant” and can be a good marker of inflammation.
Vitamin D:
Test for Vitamin D3 (25-hydroxyvitamin D). Vitamin D is hugely important for people with Hashimoto’s because it strengthens the regulatory part of the immune system and we often have difficulty absorbing it.
Vitamin B12, B6 and Folate
These tests can be expensive and B12 and B6 can be tested by reading a CBC (Complete Blood Count) properly, a test that is available for under $20. (I’ll explain how to do this in a future post.)
CBC
A complete blood count that includes: Red Blood Cell counts: Red Blood Cells (RBC), Hemoglobin (HGb), Hematcrit (HCT), MCV, MCH, MCHC
and White Blood cell counts: White Blood Cell Count (WBC), Lymphocytes, Neutrophils, Basophils, Monocytes, Eosinophils.
There is a ton of information that you can gather from this very inexpensive test, including information about various anemias, autoimmunity, and possible infections that may be affecting your progress. (More on how to interpret this in a future post).
Electrolytes: These tests are usually part of what is called a “metabolic panel” and can be helpful in finding mineral deficiencies and electrolyte imbalances. These include: Sodium, Potassium, Magnesium, CO2, Chloride, and Phosphorous. The metabolic panel will also include Serum Protein, Albumin and Globulin.
Adrenal Health:
On a simple blood test, you can test the adrenals by ordering a Renal panel (BUN, Uric Acid, Creatinine) and by evaluating electrolytes, Potassium and Sodium.
The gold standard for measuring adrenal health is a saliva test that tests cortisol levels throughout the day. This can tell you a lot about how adversely stress may be affecting your health and your thyroid.
Special Tests:
These are all tests that can be very important for Hashimoto’s patients, but they are complicated and should be ordered by someone who knows what to do with the information that they provide.
Intestinal Health:
Healing the intestines is job #1 for many Hashimoto’s patients because the gut is where the immune system lives and if you want to modulate and calm your immune system, you must go there it lives. In a common blood test, Serum protein, and globulin levels can give clues to intestinal issues.
There are test on the market for intestinal permeability (leaky gut), gluten sensitivity and intolerance, and cross reactive foods that may be causing immune flare ups. The best Lab for this is Cyrex labs.
Hormone Testing:
There are various hormones that can be tested including, estrogen, progesterone and testosterone. This is involved and deserves a blog post of its own (which I will, humbly provide, in due time).
Depending on what you want to accomplish, the best of these to determine fertility and possible defects throughout a woman’s cycle are saliva tests gathered at intervals throughout the entire month.
Immune System Testing:
There are various ways to test the different aspects of the immune system from Cytokine testing, to TH-1 and TH-2 challenges. This is also quite complicated and involved and must be done with someone who understands what to do with this data.
Bottom Line:
As you can see, this can get pretty complicated, pretty quick. The best thing to do is inform yourself and then work with someone who is experienced in reading and evaluating these kinds of tests and who knows what to do with the data that is gathered.
That is what I offer here at Hashimotoshealing.com and why I created my program, Healing Hashimoto’s: the 5 Elements of Thyroid Health. In this 6 week intensive you will learn how to interpret your blood tests and, more importantly, learn what to do with that information in order to create an effective strategy for Healing your Hashimoto’s.
In my last post I looked at 6 different systems and how they were affected by the thyroid and, how that affected Hashimoto’s patients. This is part 2 of that post. And, as I stated in that post, some of this material comes from Dr. Datis Kharrazian, one of the world’s leading experts in the treatment of thyroid issues using functional medicine and from another book called The Thyroid, A Fundamental and Clinical Text, by Braverman and Utiger.
The reason this is important is because the things that you are feeling are not a coincidence or some random group of symptoms. They are caused by your thyroid not functioning properly.
And often, there is a back and forth relationship where a problem or weakness in one of these systems can actually make the problem in your thyroid worse. This is why a holistic approach that treats these various systems is so important.
In our last post, we looked at these systems:
1. Bones and bone growth
2. Blood sugar metabolism
3. Brain
4. Cholesterol and other fats in the blood
5. Gallbladder
6. Cardiovascular system
7. Intestines
8. Liver
9. Maintaining Weight
10. Protein metabolism
11. Red blood cell metabolism
Thyroid hormone has a direct affect on movement through the entire gastrointestinal tract. Thyroid hormones increase intestinal neurotransmitters, increase blood flow to the intestines and support the repair and regeneration of the intestines.
Hypothyroidism can slow movement through the esophagus, can affect muscle function in this area and can affect the nerves that cause movement. Hypothyroidism also has an affect on the vagus nerve and this can lead both directly and indirectly to slowing movement through the intestines.
This can lead to 3 common problems:
1. Constipation: One of the most common complaints of Hashimoto’s and hypothyroid patients is constipation. When the bowels slow and it takes more time to empty.
2. Malabsorption: People with hypothyroid problems and Hashimoto’s can have difficulty absorbing important vitamins, minerals and nutrients from their foods. This can lead to a host of health problems including, low protein, anemias, and vitamin deficiencies. Hyperthyroid patients can experience diarrhea that can also lead to poor absorption.
3. Dysbiosis: Hashimoto’s and hypothyroid people often have issues involving problems in the intestinal tract with overgrowth of yeast, harmful species of bacteria and fungus.
When you add the problems caused by gluten and cross reactivity to the slowing of movement and repair in the intestines you have a recipe for a really vicious cycle. Gluten causes breakdown of the lining, slow transit and slower repair and this means that the damage done is compounded and each makes the other worse.
T4 that is secreted by the thyroid gland is converted by the liver into T3 which then has effects on the body. Patients with liver diseases, like cirrhosis have problems converting T4 into T3. High TSH has also been found to cause an abnormal response in the pituitary gland, which signals the thyroid to release more hormones.
Hypothyroid and Hashimoto’s patients also experience issues involving the liver. A hypothyroid state can lead to problems with detoxification pathways, especially phase II detoxification. This can lead to a clogged liver and more problems with converting T4 to T3. This is the reason why liver detoxification is so important for Hashimoto’s patients whether or not they are taking thyroid hormones.
Many Hashimoto’s patients have issues maintaing a proper weight. For some it is due to a low thyroid state, for others it is due to a hyperthyroid status.
For those who are unable to lose weight, there are several different reasons for this. Thyroid hormones are responsible for metabolic activity, a slower metabolism means an inability to lose weight or, in some cases, weight gain. A hypothyroid state can also slow the the body’s ability to use free fatty acids, when this happens fat can not be broken down.
A slower metabolism and fat not breaking down can both lead to fatigue. Hypothyroidism can also cause less growth hormone to be produced, this can lead to loss of muscle mass and the inability to build muscles.
For Hashimoto’s people who have difficulty gaining weight, their problem is that their thyroid is undergoing an immune attack and is in hyperthyroid state. This can last for an extended period of time. Eventually, in Hashimoto’s patients, they get to a hypothyroid state due to thyroid tissue destruction.
If a patient stays in a hyperthyroid state, then Grave’s disease should be considered and a tissue biopsy should be ordered. Also, in Graves disease TSH autoantibodies will be very high. In Hashimoto’s TPO (thyroid peroxidase) antibodies will be highest, with or without TSH antibodies.
When someone is hypothyroid, serum protein levels may be increased because capillaries dilate and allow larger proteins into the bloodstream. Albumin also breaks down more slowly. This can be seen in elevated protein in both the blood and the urine.
A hypothyroid state can lead to several different types of anemia.
Normocytic normochromic anemia: Hypothyroidism can cause a decrease in the production of the hormone erythropoeitin and this may cause this type of anemia. There are about 14 different kinds. For this treatment should be focused on the thyroid.
Macrocytic anemia: Low thyroid activity can lead to this because of a decrease in absorption of vitamin B12 and folic acid caused by a decrease in hydrochloric acid. For this, one must rule out the autoimmune condition below and if it is not autoimmune supplement with B12, folic acid and, possibly hydrochloric acid.
Pernicious anemia: This is an autoimmune disease caused by an autoimmune attack on intrinsic factor which is responsible for helping the body break down and absorb vitamin B12. One of the realities of autoimmune disease is that there are sometimes multiple tissues being attacked.
In about 12% of Hashimoto’s patients, there is also an autoimmune attack on intrinsic factor. If you suspect this type of anemia, an Intrinsic Factor Autoantibody test can be ordered. (IF ab). If this is positive, then they have pernicious anemia. These people respond better to B12 injections.
Iron deficiency anemia: Hypothyroidism can also affect iron absorption because of decreases in stomach acid and excessive blood loss from progesterone receptor site resistance. If iron is deficient, TIBC (total iron binding capacity) should be checked. This will be elevated in iron deficiency and is a good marker to see early iron deficiency. For this, supplement with iron, hydrochloric acid and, possibly, vitamin C to enhance absorption.
Whenever you see an abnormal pattern in a CBC (complete red and white blood cell count) then the thyroid should be evaluated. And when someone sees a thyroid issue, a CBC should always be evaluated.
And here is why this matters: if a patient is anemic, they are not getting enough oxygen to their cells and nothing you do is going to be effective. If you don’t fix this, all the treatments that you attempt will be exercises in futility because the cells of the body are not being powered properly.
Bottom Line:
The body is not a machine with a series of unrelated parts. It is a group of inter-related ecosystems that all affect one another. When treating Hashimoto’s, it is important to understand these relationships and to work on healing and balancing the body. This will lead to faster, better and more long lasting results. This is why I created Hashimoto’s Healing: The 5 Elements of Thyroid Health. This system gives you the tools to do this and to radically improve your results in managing and healing your Hashimoto’s.
References:
Kharrazian, Datis, DC Mastering the Thyroid, 2011
The Thyroid, A Fundamental and Clinical Text, Ninth Edition, Lewis E. Braverman & Robert D. Utiger, 2005, Lippincott Williams & Wilkins
Green JR, Diminished TSH repines to TRH stimulation in patients with hepatic cirrhosis dispute subnormal T3 levels. Z. Gastroenterol. 1979:17(7):447-51
Saha B, Maity C. Alteration of serum enzymes in primary hypothyroidism. Clin Chem Lab Med. 2002;40:609-611
Green Health Acupuncture and Marc Ryan, L.Ac. are proud to announce the launch of their new website www.hashimotoshealing.com, devoted to offering community, tools and resources for better management and treatment of Hashimoto’s, hypothyroidism and related issues.
I have been treating patients with Hashimoto’s for over 10 years and I have developed a system that combines the wisdom of Eastern medicine and ideas with Western diagnostics techniques and understanding of how the body works. This system is called Healing Hashimoto’s: The 5 Elements of Thyroid Health.
The 5 Element system is a way of looking at interactions in the natural world and was discovered while observing nature. The ancient Chinese noticed that things affected one another and they looked for way to explain it. They came up with the 5 elements as a way of describing these interactions within living systems.
The 5 element system can be applied to almost anything. It is used to describe the human body and human personalities. It has also been applied to business, management and marketing. Basically, it says that there are distinct groups within any living system and they influence each other. If one of these groups is unhealthy or neglected then the others will eventually suffer. If you want to be healthy or successful, you must make sure that all of the systems are healthy and in balance.
For example, if bees die out, we will have no pollination and no fruits or vegetables. If a predator dies out, then some species of animals grow out of control and they eat all the plants and push out other species. If we continue to emit excessive amounts of CO2, the earth will get warmer and we will create more extreme weather and dangerous storms. We see this idea playing out, all around us, every day.
The 5 Elements of Thyroid Health system applies this idea to the thyroid and looks at 5 areas that can (and often do) prevent people from effectively managing their Hashimoto’s or hypothyroid conditions. These 5 areas are the digestive system (earth), the immune system (metal), the kidneys and adrenals (water), the liver and gall bladder (wood) and the heart and blood (fire).
In the weeks and months to come we will explore these interactions in this blog and look at how each of these systems affect each other and how they affect thyroid health.
If you want to get started right away, please check out my free 4 video series that explores this system and how it help you.
We look forward to exploring this with you and we want to learn about your challenges and solutions for managing Hashimoto’s. So please leave your thoughts and comments.
I wish you good health and happiness,
Marc