In this weeks article, I wanted to cover a topic that I’m confronted with most days in Functional Medicine practice, involving the little butterfly-shaped gland that resides at the base of the neck known as the thyroid gland.
Based on my own clinical observations & empirical experience – the amount of individuals that suffer with any symptoms of thyroid dysfunction that are rapidly put on synthetic thyroid medication by their GP or M.D as a way of correcting this problem is alarming.
I’ve had the privilege of helping a number of young children with various kinds health challenges, working in collaboration with their parents, with some kids as young as 11 that have been put on thyroxine by their primary healthcare physician. Essentially, all this kind intervention is doing is temporarily ‘patching up’ a problem, very much like painting over a crack in the wall of your home, or putting a huge band-aid on it, much like the featured image used in the article, without even considering what the underlying causes are, or without any in-depth assessment. In most cases, all that tends to happen over time is the doses of meds keep getting increased as the underlying problems persists & more physiological damage occurs which further weakens the body-systems, and the patient generally feels worse while their health continues to deteriorate. A very slippery slope, health-wise.
Fortunately, in the case of the 11 year old example, it wasn’t the thyroid itself that was the primary issue; we took care of a number of sub-clinical situations, and lifestyle factors, and then went on restore the body back to its normal function, which eventually resulted in her slowly tapering off synthetic thyroid medication which was done under the supervision of her prescribing GP, but I’ll cover more on this later on in article, but let’s set the scene first.
The thyroid gland itself secretes a variety of different hormones which effect virtually every one of the trillion cells in the body, including every single body-function. Without these hormones, you cannot survive in the long term. This statement kind of sets the tone as to why people who suffer with thyroid issue’s health & wellness isn’t optimal, as the often have a number or other sub-clinal health factors reinforcing the dysfunction.
I recall back in my study days reading about a very eye-opening scientific experiment at medical school involving one of the late pioneers of thyroid research & treatment, a number of years ago. The experiment involved surgically removing the thyroid gland of a rabbit, to monitor the changes that occur as a result over time, in an attempt to gain a greater scientific understanding of the importance of the gland & it’s function. This study would mimic the outcome of either someone who has had their thyroid gland surgically removed, or someone with thyroid dysfunction.
Prior to the removal of the thyroid, the rabbit was active, alert, content, and warm at room temperature. Following the removal of the gland after, a completely different story unfolded. The animal now shivered with cold, moved in slow motion, and was drugged with fatigue – as if old a feeble. It’s skin was scaly, it’s mucous membranes were infected – particularly in the respiratory system, and its heartbeat & muscles were weak.
This may sound familiar to some of you reading this who have either been diagnosed with a thyroid condition, or are experiencing one or more of the symptoms listed above, alongside suffering with other health issues.
I describe the thyroid as the gas pedal or accelerator, producing hormones that fuel the entire body. To stretch out the metaphor to the breaking point, when you have a lead foot & push the pedal to the metal too hard for too long, the engine over-revs, your car then runs out of fuel, and eventually breaks down, often at the most inconvenient time. This is what happens when the thyroid glands hormone production begins to deteriorate, as the gland has been on overdrive for too long, that before long it breaks down.
When their is a fault with your vehicle, it can often go into what’s known as ‘limp-mode’ where it down-regulates the overall function of the vehicle as a protective mechanism. This not only restricts performance but also means the car doesn’t function the way that it should. The vehicle will be restricted to a low speed where it feels like you are just crawling along. Remember, the net result of this due to one or more faults or dysfunctions in other completely different parts of the engine. Think of hypothyroidism as the ‘limp mode’ of your biological vehicle, or physical being known as the human body. Equally, the polar opposite which would be hyperthyroidism, is like the gas pedal or accelerator being stuck down where the engine is on overdrive, and burning through fuel at a rate of knots.
Now these are both extreme ends or the scale which conventional medicine tends to focus on. You’re either high or low, hypo or hyper, sick or well with no consideration of the broad functional range that exists in between these extreme ranges. In other words, people don’t have to be clinically diagnosed with Hashimoto’s or Graves to be suffering with a sub-clinical thyroid condition, yet this gets missed in the allopathic model of treatment. I’ve seen many thyroid labs that on the surface don’t look too bad, yet these people are reporting all the same symptoms as someone suffering with a thyroid condition indicating a sub-clinal thyroid issue. This is where an in-depth evidence-based comprehensively assessment is key in understanding underlying causes & all the mechanisms that are feeding in the wrong kind of signals to the equation.
I’ve also witnessed individuals be mis-treated with substances like radioactive iodine for hyperthyroidism & feel terrible as a result, because in certain cases before an individual is about to move towards clinical hypothyroidism, the body can go into a temporary state of hyperthyroidism which is like the body trying to pull in all its resources to fight this pathological change occurring. Treating these situations can exacerbate the problem, and made a person’s condition worse. Without having comprehensive evidence-based data as a guide to add context, and the right knowledge & experience to analyse the situation, you’d never know that to be a potential factor.
I want to give you some of the basic science behind the functions of the thyroid to add a little more context to the article. The thyroid gland itself produces several types of hormones, with the two most important being triiodothyronine (T3) and thyroxine (T4). T3 is the stronger and the more biologically active of the two, that comprises of 20% of thyroid hormone produced by the body. T4 is the weaker hormone, but more plentiful, and constitutes for approximately 80% of thyroid hormone production which goes on to be converted by the liver & hypothalamus to join the T3 army.
These two hormones help get oxygen into the cells of the mitochondria, and the oxygen is a critical factor in combustion & in the burning of calories. In other words they control the rate of metabolism. When their is little to no oxygen reaching the cells you start to become like the poor rabbit, or in a state of hypothyroidism. A thyroid gland that is suppressed or dysfunctional, is no different to not having one. The net result is the same. To start a fire you need 3 things… fuel… a spark… and oxygen…. Without oxygen there is no fire.
The cells of the thyroid gland are the main ones that use iodine, which when combined with molecules of the amino acid tyrosine, helps the body to form T3 & T4. T stands for tyrosine, and the number pertains to the number of iodine molecules in each thyroid hormone.
A healthy thyroid produces about 80% T4, and 20% T3, even though T3 has four times the hormone strength of T4. The additional T3 your body needs is converted from T4 in other organs including the liver & the hypothalamus (HPT), a part of the brain. The HPT plays an important role within the endocrine system as the conductor of the endocrinological orchestra. Signalling each instrument to play louder or quieter within the mix of other instruments or in this case – glands & organs. The HPT regulates the thyroids production of T3 and T4 by telling the pituitary gland (PT) to release more thyroid-stimulating hormone (TSH).
As the thyroid is part of the endocrine system, which is a complex network of glands & organs that carry out important metabolic functions; this means that these glands don’t tend to malfunction in isolation, just like they don’t operate in isolation without one or more of the other biological components being involved in the chain of function – in one way or another. If one is is effected, you can almost always see others effected or involved as a result, or as a causal factor. To take that a stage further, a individual may have liver issues, or problems with in the digestive tract that are directly or indirectly feeding signals into the problem, even if acutely asymptomatic in that particular area of the body. It may be a collection of signals that are reinforcing each other in a state of dysfunction. Remember… any can cause anything in Functional Medicine.
The thyroid gland is like a small, but powerful throttle mechanism, because the energy hormone T3 that it produces acts like a gas pedal for the rest of the body. But when the production or circulation of T3 & T4 are out of whack, the HPT & PT try to correct the shortfall by sending out more TSH, asking for more production of essential thyroid hormones.
Malfunction of the thyroid can be caused by many different factors. Some may be directly involved, and some indirectly. Some obvious, some not so obvious.
Some of the factors I commonly see in practice that effect thyroid function are:
- Various forms of chronic stress
- Inability to make enough T4
- Problems with conversion from T4 to T3
- Pathological conversion of T3 to RT3 which is like a blank round of ammunition in a gun. You get the bang sound, but no bullet trajectory actually leaves the weapon making it ineffective at doing its job
- The HPA axis has suppressed or limited the adrenal gland output as a protective mechanism, due to the system becoming too weak to maintain the body’s normal rate of metabolism, thus going on strike & force a slowdown in energy production
- The cellular machinery such as the enzymes that make ATP – the cells major energy carrier – may be held back due to chemical interference from various toxins, lack of nutrient co-factors, pathogenic activity or viral damage, or breakdown from autoimmune disease dysfunction
- Other hormonal imbalances with oestrogen, progesterone, and/or testosterone which play into energy production, and the bigger picture
- Starvation, malnutrition or malabsorption which results in deficiencies & a lowered basal metabolic rate (BMR) which registers in the body as another stress signal
Hopefully by now it is clear that every cell of the body requires thyroid hormone to function properly, therefore it stands to reason that when thyroid function is impaired, nothing in the body is functioning at an optimal level.
So, earlier I touched upon how thyroid hormone is formed & the 2 constituents that make up the hormone itself, namely the amino acid ‘tyrosine’ & non-metallic chemical element ‘iodine’. So in the case of the more biologically active form of the hormone T3; this is made up of 1 molecule of tyrosine, and 3 molecules of iodine, whereas T4 is made up of 4 molecules of iodine.
Now when it comes to actual deficiencies of iodine, & it’s use supplementally, or as a form of therapy there are many schools of thought from many professionals in the field of Allopathic & Naturopathic medicine. You have the minimalist camp, the middle road, and the megadose camp. But the big question is who’s right & who’s wrong?Well, based my own professional opinion & experience, the answer is ‘all of them, and none of them’. But let me elaborate to add context to that statement, otherwise like anything it’s meaningless.
In my view, and one shared a number of the worlds elite experts in the field of Functional, Naturopathic & Integrative Medicine; some whom i’ve had the pleasure of working with & learning from myself over the years is that hypothyroidism (not to be confused with sub-clinical or functional hypothyroidism which is another facet of impaired metabolic function of the thyroid where it is ‘caught in the crossfire’ of another battle so to speak) is as an autoimmune condition, just at different degrees on the dysfunctional scale, not a faulty thyroid gland as such, more an overzealous immune system.
Thyroid conditions rarely even begin at the thyroid, yet so many medical professionals focus their attention here as the starting & end point when it comes to treatment interventions. I’ve mentioned this before but supplementally dosing someone up on iodine who has an autoimmune thyroid condition is like like throwing fuel on the fire in that it increases TPO antibodies which can exasperate the problem. Is iodine an important element for the body… yes, absolutely. Is it conducive to every persons health situation who’s suffering with an under-active autoimmune thyroid condition… definitely not! Does a thyroid need to be supported while addressing the sub-clinical factors… in some cases, yes absolutely.
Just because something makes you feel good temporarily, doesn’t always mean it’s helping long-term. Recreational drugs may make you feel amazing while you are on them, but they are physiologically damaging the machine and you generally feel terrible after.
It’s the same deal with the adrenal glands. When people use the term ‘adrenal fatigue’ or ‘adrenal burnout’ it’s not actually the gland itself that’s tired & on its last legs, or on the verge of submitting. It’s the system that’s suppressed it’s function for the survival of the organism to hang onto what little glimpse of homeostasis it has. Common low thyroid function starts as a mild immune system dysfunction. The term ‘Hashimoto’s’ – an insidious form of hypothyroidism was named so in honour of the Japanese doctor who first identified it, because it’s symptoms have a slow onset, and can go undressed for years.
In the toxic modern world we live in today that’s replete with environmental toxins, chemical additives & harmful pesticides in food, pseudo-hormones, physical, mental & emotional stress, our immune systems desperately seek to fight off the toxic effects by churning out antibodies that attack our own glands resulting in more physiological damage which further weakens body-systems, effecting hormones, resulting in unpleasant symptoms.
When it comes to symptoms of hypothyroidism, there’s a laundry list of them, and each person has their own version, whether it be one or two, or a cluster of unpleasant manifested experiences. The most common is see in practice are intractable weight gain, fatigue, low basal temperature with susceptibility to having cold hands & feet. That being said, in Functional Medicine, these symptoms cross-over to many other things, so the presence or absence of these common symptoms is not a means to rule in or rule out.
When it comes to symptoms, they are often highly individual. 2 people may have the very similar functional thyroid numbers, yet for one of them their hypothyroidism may be extreme, while the other person’s are extremely mild – however, in my clinical experience, this does not appear to be an indicator of the severity of seriousness of the person’s problems.
During a comprehensive functional assessment analysing full thyroid panels, alongside other highly specialised evidence-based lab data, a general picture can be seen of the different signals that are feeding into the problem. Some may appear obvious, and many not so obvious to the untrained eye. Lab data is just a series of highly advanced bio markers to help the clinician understand what’s going on sub-clinically. Where the real skill lies when interpreting lab data is understanding what all these markers actually mean in relation to each other, as well as having a in-depth scientific understanding of the body on a biochemical & physiological level, and how each body system function, interacts & effects another. Then the dots can be connected, and the blanks be filled in, and you have a decent chance of getting the result you are looking for… restoring functional wellness.
Thanks for your attention.
*By Steve Hawes
If you have been a victim of sub-optimal health, and are looking for someone to guide you towards functional wellness, then feel free to book a free 30 minute consultation to informally discuss whether we can help.