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
Hashimoto’s and pregnancy are linked in many ways. Hashimoto’s is the most common autoimmune disease in the United States and pregnancy is one of the factors that can lead to it. Many people do not know that thyroid hormones can also affect the hormones that are responsible for fertility and successful pregnancies. In this blog post, I will explore how the thyroid and thyroid hormones may affect a woman’s ability to have a baby.
Before we look at how thyroid hormones can affect pregnancy, let’s review some of the basics of the hormones used to make babies and how they work.
Estrogen
Estrogen rises and falls and helps to orchestrate a woman’s cycle. It makes the lining of the uterus thick so that an egg can be implanted and can grow happily there. The body signals the pituitary gland which helps to control the increase and decrease of this hormone. At the end of the cycle a sharp fall in estrogen and progesterone signals the uterus that there is no pregnancy.
Follicle Stimulating Hormone (FSH)
As its name implies, Follicle Stimulating hormone stimulates the follicles in the ovaries to grow. When estrogen levels drop at the end of the cycle, FSH levels go up (this is what is called a negative feedback loop) to start the process all over again. Once the follicles in the ovaries are stimulated, one becomes dominant and it starts secreting estrogen. This is when the effects of estrogen on the lining of the uterus take place and prepare it for nurturing the egg.
Luteinizing Hormone (LH)
At mid cycle (about day 14), the lining of the uterus stimulates a large and sudden release of luteinizing hormone. When this happens, there is a sudden rise in body temperature and this is a sign that ovulation is about to happen. This surge also causes the follicle to break open and release an egg into the fallopian tubes.
Progesterone
When the follicle breaks open, its walls collapse and this cavity is called the corpus luteum. After ovulation, the corpus luteum begins secreting large amounts of progesterone, which helps prepare the lining of the uterus for the fertilized egg.
Human Chorionic Gonadatropin (HCG)
Made popular by the recent diet fad, this hormone is released once the egg is fertilized. It keeps the corpus luteum healthy so that it can continue to pump out more estrogen and progesterone. This keeps the lining of the uterus healthy. After about 6 to 8 weeks of gestation, the newly formed placenta takes over the secretion of progesterone.
As you can see, a lot of things must happen to have a healthy egg implanted in a healthy uterus to make a healthy baby. If there are problems with any of these hormones or their release, then there will be problems with pregnancy and fertilization. As it turns out, thyroid hormone can affect all of these hormones.
When women have hypothyroidism, a common problem is an increase of another hormone called prolactin. This causes less of a release of LH, and a loss of progesterone receptor site sensitivity, and a loss in sensitivity to FSH in the follicle. All of these losses lead to problems with ovulation, and they also mess with the communication to the pituitary gland.
Using birth control pills on top of this can further harm the communication and feedback loops in this system. Using herbs to stimulate the ovaries or the reproductive system will also not work unless the hypothyroid issues are corrected.
Studies have found that even mild hypothyroidism may cause ovarian problems. Testing thyroid function is very important with women who suffer from infertility, especially if they have elevated prolactin or they can’t ovulate.
Hypothyroidism may lead to low FSH levels, which may lead to immature follicles and infertility. Suppressed LH levels will often lead to problems with ovulation in timing or abnormal luteal phase progesterone levels. These changes may cause miscarriage, depression in the second half of your cycle, or migraines in the second half of your cycle.
To summarize, hypothyroidism can cause:
* A decrease in FSH release and FSH receptor sensitivity, this leads to problems with the development of the follicle and infertility
* Suppressed LH which leads to problems with ovulation and abnormal progesterone levels, this leads to abnormal cycles and infertility
* Progesterone receptor insensitivity which also leads to abnormal cycles and infertility
* Increased Prolactin, which leads to problems with ovulation, abnormal menstrual cycles and infertility
First of all, don’t assume your OB/Gyn or endocrinologist have any idea about this. Some do, but many do not, that’s the sad truth.
Secondly, visit this website: www.hypothyroidmom.com, this is a excellent site full of great information from a woman who has been through it.
Let me summarize her suggestions because they are brilliant:
Get a full thyroid panel (TSH, free T4, free T3, and antibodies if you haven’t tested for them before). Some doctors recommend the range for TSH prior to conception of 1.0-2.0 mIU/L. This is in keeping with the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum.
Here is their actual recommendation:
“RECOMMENDATION 15 – Treated hypothyroid patients (receiving thyroid hormone replacement medication) who are planning pregnancy should have their dose adjusted by their provider in order to optimize serum TSH values to <2.5 mIU/L preconception. Lower preconception TSH values (within the non-pregnant reference range) reduce the risk of TSH elevation during the first trimester.”
Your chances of success are better if you know your body and how it is working. Women with Hashimoto’s or hypothyroidism often have lower than normal body temperature. Keep track and find out when your body temperature goes up because, as I stated above, this signals ovulation, the best time to make babies.
Don’t wait to have no period, buy lots of pregnancy tests and test early and often. The developing fetus relies almost entirely on the mother for thyroid hormone. Hypothyroid Mom, Dana Trentini, sums it up beautifully:
“In a person with healthy thyroid function, her body is able to meet the extra demands of pregnancy to provide the fetus with the necessary hormones. In a woman with thyroid dysfunction, her body may not be able to meet the increased demand for thyroid hormone during pregnancy. According to the Endocrine Society’s 2007 Clinical Guidelines for the Management of Thyroid Dysfunction during Pregnancy and Postpartum, thyroid replacement dosage usually needs to be incremented by 4-6 week gestation and may require a 30-50% increase in dosage.”
This is HUGELY IMPORTANT. Because if your TSH levels or T4 levels get too low, it can seriously threaten your baby and you could lose him or her.
According to the Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and Postpartum:
RECOMMENDATION 2 – Trimester-specific reference ranges for TSH are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.
RECOMMENDATION 16 – In pregnant patients with treated hypothyroidism, maternal serum TSH should be monitored approximately every 4 weeks during the first half of pregnancy because further dose adjustments are often required.
RECOMMENDATION 17 – In pregnant patients with treated hypothyroidism, maternal TSH should be checked at least once between 26 and 32 weeks gestation
Like so many things that involve Hashimoto’s, you need to be proactive and armed with knowledge and information to deal with your condition because many doctors and practitioners out there don’t know how to deal with you. This is why I have created Healing Hashimoto’s: The 5 Elements of Thyroid Health, an effective system for understanding and managing your Hashimoto’s. Click on the link to the right to watch my 4 part video series and learn more.
References:
http://hypothyroidmom.com/hypothyroid-moms-story-of-hope-her-miracle-babies/
Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., Nixon, A., Pearce, E.N., Soldin, O.P., Sullivan, S., and Wiersinga, W. Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum
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
In today’s health care system there are many specialists. It is easy to lose track of the fact that the body is a group of ecosystems, all interconnected and interacting. The thyroid is a perfect example of all these complex interactions and connections.
I have been a long time student of Dr. Datis Kharrazian, one of the leading experts of the treatment of the thyroid with functional medicine and author of the book, Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?. (This book should be required reading for anyone diagnosed with Hashimoto’s). The material in this post comes from some of my studies with him and from a book called The Thyroid, A Fundamental and Clinical Text, by Braverman and Utiger.
The body is not just a bunch of unrelated machine parts. Everything is connected in some way.
When you have Hashimoto’s, chances are good that you have symptoms in some other areas of your body. Read on and you will understand why.
That’s right, 11. In this 2 part blog post we will introduce each one of them briefly and also discuss how these connections affect Hashimoto’s patients. I will also be exploring all of these in more depth in future posts. Please let me know what interests you.
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 Proper Weight
10. Protein metabolism
11. Red blood cell metabolism
Low TSH or a hyperthyroid state can lead to an increased lifetime risk for fractures, even after TSH has become normal again.
In children, a lack of thyroid hormones will affect normal growth.
Adult hypothyroid and some Hashimoto’s patients tend to have higher than normal bone density. But, this higher density does not necessarily mean good bone quality: there may be issues with collagen, bone turnover, the size of mineral crystals and bone structure. So, even though the bones are more dense, these people may still be at risk for fractures because the bone quality is really poor.
IL-6, an inflammatory cell commonly seen elevated in Hashimoto’s patients can also lead to bone loss.
Blood sugar is controlled by the pancreas. The pancreas and thyroid are both part of the endocrine system. The endocrine system is made of many feedback loops and their various hormones all “talk” to one another and make changes to the body to try and keep things in balance.
These systems also work in both directions. They influence each other. In the case of sugar, insulin is released by the pancreas to help the cells of the body absorb sugar so that it can be used. And the adrenals release cortisol to help sugar get absorbed by the cells of the body.
A hypothyroid state leads to a slow absorption of glucose, a slower breakdown of insulin, a decrease of the speed at which glucose is absorbed in the gut, a lower glucose to insulin response and, finally, less glucose in the cells for the body to use. All of this means less energy to power your cells and brain and more fatigue.
To make matters worse, all of this affects the adrenal glands and the hypothalamus-pituitary-adrenal axis (HPA axis). In order to try and fix the problem of not having enough sugar, the adrenal glands release the stress hormone cortisol to increase glucose in the cells.
Every Hashimoto’s patient has some degree of the sugar imbalance described above. If you are skinny, its probably hypoglycemia. If you are overweight it may be insulin resistance or metabolic syndrome. If you feel better after you eat, you are hypoglycemic. If you are tired after you eat, you have insulin resistance.
All of this creates a vicious cycle that can really stop you from getting better. All Hashimoto’s patients must take blood sugar problems seriously. You won’t get better unless you do. In my six week program you will discover how to do this. Click on the link to the right get my 4 video series and learn more.
Thyroid and the Brain
Thyroid hormones are very important for healthy brains. In the adult brain, thyroid hormones have shown the ability to help the brain grow and change and to help the brain age in a healthy way.
Hashimoto’s patients know about “brain fog”. There are many reasons for this, the principle ones being inflammation of the brain and a breakdown of the blood brain barrier. The proteins that protect the brain (called zonulin) are the very same proteins that protect the gut. So if you have leaky gut, there is a good chance that you also have leaky brain.
When your brain is inflamed you get brain fog and it degenerates. There are 2 primary symptoms:
1. Depression
2. Fatigue
It is no surprise that the most common drugs prescribed with Hashimoto’s are anti-depressants. You absolutely must support your brain if you have these symptoms.
Brain fog is a brain cell activated immune response. The immune system in the brain is not specialized and sophisticated like the immune system in the rest of the body. Brain immune cells (called microglia) are kind of like paranoid chihuahuas with automatic rifles. They tend to over react quickly and when they do you get lots of inflammation (brain fog).
In some patients, thyroid hormone may improve brain fog. In others it won’t. You have to reduce inflammation in the brain in a different way. In my 6 week course you learn how to do this and what herbs and supplements can really help with this. One important herb that is used is turmeric. Click on the link to the right to get my 4 video series and learn more.
Thyroid and Cholesterol
In hypothyroid conditions, both the breakdown and the use of cholesterol by the body are depressed. But the breakdown is much slower, so the net result is higher cholesterol, triglycerides and LDL. This may be slower because of a decrease in the breakdown of fats once they leave the liver or in a decline of LDL receptors.
This is why some Hashimoto’s patients also have high cholesterol, triglycerides and LDL (and sometimes low HDL). Once they get their thyroid under control, it is not unusual to see their cholesterol, LDL and triglycerides return to normal as well.
Thyroid and Gall Bladder
Gall bladder function is also adversely affected in hypothyroid conditions. Studies have shown that the gall bladder gets larger and doesn’t contract normally.
Studies also report an increase in the number of gallstones and stones in the common bile duct. One reason they think this might be happening is because the thyroid hormone thyroxine relaxes the gall badder’s opening (called the sphincter of Oddi). This makes bile not flow normally, and makes the possibility of stones forming in the bile duct more likely.
Bile also helps to break down cholesterol so when there is less bile, less bile flow and gall bladder is slow and sluggish you have the perfect situation for stone formation.
Thyroid and Cardiovascular System
Thyroid hormones have a big impact on many functions of the arteries and veins in the body. Low T3 levels have been linked to diseases of the blood vessels. One of the most common problems that Hashimoto’s patients have is cold hands and feet. Hair loss and fungal nail growth can also be signs of poor blood flow.
Low thyroid function means less nitric oxide is available in the blood vessels, this can lead to a break down of the vessels themselves. When you add in the problems with cholesterol and you have a recipe for plaque clogging the arteries.
For those patients taking levothyroxine, some of these problems have been shown to be reversed by the medication.
Bottom Line
All those symptoms that you experience are not by accident or some coincidence. There are very clear reasons why your body is experiencing what it is going through. The goal of this blog, my website and my program are to help you to understand how all this works in simple terms, so that you can discover how to get control of your health.
That’s why I created my program Healing Hashimoto’s: The 5 Elements of Thyroid Health. To give you all the information and solutions in 1 place, to teach you how to better manage your Hashimoto’s and to make the goal of having more goods days than bad ones easy to reach.
References:
Muller MJ, Burger AC, Ferrannini E, et al. Glucoregulatory function of thyroid hormones; role of pancreatic hormones. Am J Physio. 1989;256:E101-E110
Flavin RSL, et al. Regulation of microglial development: a novel role for thyroid hormones. The Journal of Neuroscience. 2001;21(6):2028-2038
Oge A, Sozmen E, Karaoglue AO. (2004) Effect of thyroid function on LDL oxidation in hypothyroidsim and hyperthyroidism. Endocr Res 2004; 30:481-489
Napoli R, Guarasole V, Angelini V, et al. Acute effects of triiodothyronine on endothethial function in human subjects. J Clin Endocrinol Metabl. 2007;92(1):250-4
Taddei S, Caraccio N, Virdis A, et al. Impaired endothelium-dependent vasodilation in subclinical hypothyroidism: beneficial effect of levothyroxine therapy. J Clin Endocrinal Metab. 2003:88(8):2731-7
Mastering the Thyroid, Datis Kharrazian, 2011
The Thyroid, A Fundamental and Clinical Text, Ninth Edition, Lewis E. Braverman and Robert D. Utiger, 2005 Lippincott Williams and Wilkins