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
4. Cholesterol and other fats in the blood
6. Cardiovascular system
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.
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.
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
Pustorino S., Foti M., Calipari G., Pusterino E., Ferrero R., Guerrisi O., Germanotta G., Thyroid-intestinal motility interactions summary. Minerva Gastroenterol Dietol. 2004 Dec;50(4):305-15
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
Purandare A, Godil M, Ahnn SH, et al. Effect of hypothyroidism and its treatment on IGF system in infants and children, J Pediatr Endocrinol metal. 2003;16:35-42