A common issue I see across my client base, especially for women, is a thyroid complication. Some cases have already been diagnosed and sometimes we identify them through a combination of blood testing and symptom analysis. However, there’s another pattern I’ve observed and that is people looking for a thyroid issue as an explanation for their sluggish metabolism or lack of results when it comes to weight loss.
When it comes to body composition thyroid problems can certainly be contributing, however, I feel it’s important not to jump to conclusions or look for a scapegoat here because health issues, including suboptimal thyroid function, can also be caused by weight gain or the factors associated with it including a diet of processed, low nutrient foods, calorie excess, excessive alcohol intake, sedentary lifestyle medications, and sleep deprivation.
All of the above have the potential to trigger a state of chronic inflammation, cellular dysfunction and lead to metabolic complications, so the situation can be a little chicken and egg.
Weight gain is not the only factor that may contribute there are many others including chronic stress, trauma, infection, nutrient insufficiencies, and genetics.
To obtain a true picture of thyroid health and identify if and where the problem lies it helps to understand the role and nature of thyroid hormone production first of all.
The Role Of Thyroid Hormones
The thyroid gland is located in the base of the neck and shaped like a butterfly with two lobes either side of the wide pipe.
Thyroid hormones are well known for their role in regulating cellular energy metabolism and therefore have a strong association for many people with body composition, however, they also control breathing, heart rate, nervous system activity (and therefore cognitive function), body temperature, menstrual cycles, muscle strength, and blood cholesterol levels.
Thyroid Hormone Production
The thyroid gland and hormones are part of the bigger endocrine (hormone) system in the body. Hormones are a type of email system within the body, they deliver instructions between the different systems to make things happen. The hypothalamus gland in the brain monitors the internal and external environment and makes decisions that govern the priority and nature of the hormonal activity.
In terms of the thyroid hormone hierarchy, the hypothalamus releases Thyroid Releasing Hormone (TRH) which triggers the pituitary gland to release Thyroid Stimulating Hormone (TSH). It’s important to understand that TSH is the hormone most commonly used by GP’s to assess thyroid function because hormones work on a feedback loop.
Every cell in the body has a receptor on its nucleus for thyroid hormones.
If there’s feedback to the brain that the cells are NOT receiving adequate thyroid hormone, the brain will seek to compensate and release more TSH and therefore a rise in TSH levels suggests an issue with thyroid activity further downstream.
Types Of Thyroid Hormones
Responding to the pituitary the thyroid gland then produces three hormones:
T4 – Tetraiodothyronine and also called thyroxine
T3 – Triiodothyronine
Calcitonin – involved in controlling blood levels of calcium and phosphorous.
Thyroid hormones are bound to protein and carried around the body (known as thyroid binding globulin) this is so they don’t start to act on the cells around the thyroid. T4 is inactive and must be converted to T3 to finally pop into the ‘inbox’ (or nucleus) of the cell and exert an effect.
REMEMBER – If levels of T4 and T3 are too low the brain raises TSH and if the feedback that T4/T3 are too high the pituitary gland will lower TSH secretions.
This hormone is worthy of discussion yet rarely measured in conventional thyroid tests.
Reverse T3 (rT3). This is simply another form of T3 with a slightly different chemical structure that renders it inactive. It can bind to the same receptors as active thyroid hormone, however, it’s purpose is to block the action of thyroid hormones and in doing so conserve energy, effectively slowing down the metabolic rate of the body.
This is common in something called Euthyroid Sick Syndrome where the thyroid feedback loop has been interrupted. It is commonly observed during starvation, critical illness and surgery.
There is also increasing discussion that stress, fasting, trauma, intense exercise, medications, and inflammation may also influence levels of rT3 in the body.
Signs and Symptoms of Thyroid Dysfunction
In terms of indicators of thyroid issues, they are generally separated into over and under active symptoms outlined below. An overactive thyroid condition is referred to as Hyperthyroidism (think hyper like high), whilst an underactive thyroid condition is referred to as Hypothyroidism (think hypo rhymes with low).
It’s important to note that due to the ubiquitous nature of thyroid function all systems in the body have the potential to be affected including cholesterol metabolism, fertility, and cognitive function.
The most common cause of hyperthyroidism is an autoimmune disorder known as Graves Disease. It tends to effect women more than men, especially in the reproductive years.
Treatment usually involves anti-thyroid medications that inhibit the synthesis of T4/T3. In certain cases, a surgical resection of the thyroid gland is necessary to remove tissues. Radioactive iodine therapy may also be required to normalise thyroid hormone levels. TSH receptor autoantibodies (TRAb) can be measured to establish autoimmunity.
With hypothyroidism, it helps to establish WHERE the issue is arising and then investigate potential causes and drivers that impact the functionality of those tissues.
This is established by measuring multiple thyroid hormones and other markers associated with thyroid function.
Hypothyroid conditions can be divided into the following:
- Primary – Defect of the thyroid gland
- Secondary – Defect of the pituitary gland
- Tertiary – Defect of the hypothalamus gland
Autoimmune Thyroiditis Hashimoto’s
This occurs when the immune system begins to attack the tissues of the thyroid gland, causing hypothyroidism and sometimes a painless goiter.
This is usually identified by measuring thyroid autoantibodies:
- Thyroperoxidase (TPO)
- Thyroglobulin (TgAb)
- TSH receptor autoantibodies (TRAb) * these can be associated with both hyperthyroidism and cause hypothyroidism
Often there maybe other autoimmune disorders present and/or a history of autoimmunity in the family. The treatment is generally levothyroxine (synthetic T4) which is then converted to T3 in the tissues.
How Can YOU Support Thyroid Function?
1) Be Aware of Risk Factors
As well as the signs and symptoms it helps to be aware of risk factors which include being female, radiation exposure (especially chest and neck), medications, pregnancy, nutrition deficiencies, and menopause can trigger thyroid complications and a family history of autoimmunity.
2) Optimise Lifestyle and Nutrition
Undoubtedly the quickest win in supporting thyroid health is to start eating nutritiously, minimise the impact of stress and ensure you get adequate sleep and exercise.
We’ve had several cases of hypothyroidism and Hashimoto’s join our Fitter 16 programme and obtain great results without altering medication or needing further testing.
The elimination of gluten, dairy, grains, and processed foods in Phase 1 is supportive of addressing a number of health issues, especially those which are autoimmune in nature.
It’s important to note iodine and tyrosine (an amino acid) are the building blocks of thyroid hormones. Iodine is sourced from your food and transported from the gut to thyroid gland and used to make the hormones.
You can eat tyrosine-rich foods but this is not an essential amino acid which means the body can synthesise tyrosine as long as you have sufficient protein intake and adequate B6 status.
Thyroid hormone production is an enzyme dependent process and enzymes have nutrients they need to work (referred to as co-factors and co-enzymes). Selenium is fundamental to thyroid hormone production along with zinc, magnesium, vitamin C, iron, B vitamins, and zinc.
Thyroid hormones require vitamin A to act upon the receptors on the nucleus, not all individuals are efficient in converting beta-carotene from carrots, squash, and sweet potatoes to vitamin A (retinol) and therefore require a higher intake of pre-formed vitamin A within their diet or in supplemental form.
3) Obtain and SUSTAIN a Healthy Body Composition
As mentioned earlier this could be a chicken and egg situation.
BUT if you begin implementing steps and habits that improve nutrient status, expend more energy with exercise (even just daily walking and standing) reduce energy intake if needed, get sufficient sleep and work on your mindset health it will begin to reverse the complications that co-exist with thyroid hormone issues like chronic inflammation, digestive issues, and systemic cellular dysfunction.
So if you are overweight make a start on these and if you need support this is our speciality so fire us an email and we can help you out.
4) Optimise Gut Function
The paleo template we use in Fitter 16 is an excellent starting point in supporting thyroid function for a number of reasons; it encourages the consumption of nutrient dense foods ( those that provide plenty of micronutrients as well as macronutrients) and the removal of grains, dairy ad other refined food make it digestive friendly.
You can build up to it by trialling some basic eliminations like gluten and dairy that are commonly associated with digestive issues. Autoimmune Paleo (which also excludes eggs, nuts, nightshades as well as grains, legumes and dairy) might be helpful to trial also
The health of the small intestine is particularly important to consider with thyroid hormones because this is where nutrient absorption takes place and the body obtains the iodine, selenium, zinc, etc that is needed to produce thyroid hormones.
Furthermore, it’s where the greatest concentration of immune cells are based and therefore will influence inflammatory processed and immune cell activity often associated with thyroid problems.
Low FODMAP or low carb diets maybe helpful certain thyroid conditions by addressing bacterial and fungal overgrowth in the small intestine. Antimicrobials like oregano, berberine and garlic can also help restore thyroid function by improving the health of the small intestine, nutrient absorption and immune regulation.
You can read more on digestion HERE.
5) Obtain Comprehensive Test Results
To investigate the causes of the thyroid issues it helps to obtain more comprehensive test results.
Blue Horizons, Biolabs, Genova and The Doctors Laboratory all provide full thyroid panels, the following are also helpful to obtain due to their role in thyroid hormone production:
- A full blood count
- Liver/kidney function
- Active B12
- Vitamin D
Blue Horizons, Biolabs, Genova and The Doctors Laboratory all provide full thyroid panels. Always ensure the test is venous blood draw.
6) Review Thyroid Medication Options
I tend to see more cases of hypothyroidism and a common pattern I’ve come across is clients in need of a review of their hormone replacement medication.
Often the doses are increased with little assessment of efficacy or assessment of the root causes and drivers. If the steps above are not in place it may compromise the impact of the medication.
Levothyroxine is prescribed which is synthetic T4 to help support the thyroid gland when it cannot produce enough.
Ideally, it is dosed appropriately and reviewed on a regular basis. It’s important to keep in mind T4 must undergo further conversion to T3 to become active and fulfil the metabolic roles of thyroid hormones. T
This conversion can be inefficient if certain nutrients are low including zinc and selenium. Also, the conversions require good liver and kidney function. As highlighted above stress, digestive issues, inflammation, environmental toxins, vitamin A insufficiency may all hinder the efficacy of thyroxine as an intervention.
Some medications also contain ingredients that might not be helpful if autoimmune and digestive issues are present including lactose and grain based fillers.
If you’re already using a medical intervention and it doesn’t seem to be working as your symptoms are persisting it can be helpful to explore your options including T4/T3 combined replacement therapy (not prescribed on NHS but offered on private prescription) or another T4/T3 option is Natural Desiccated Thyroid (NDT) obtained from the thyroid gland of pigs and therefore deemed bio-identical. You can read more at Thyroid UK
REMEMBER – you MUST still address the cause and support your nutrient status, digestive health, emotional health and assess your environment to improve thyroid hormone health even with medication.
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