THYROID FUNCTION FAILS 101 “The collateral damage that occurs in hypothyroidism”

I often describe the body as one big bio-electrical circuit, made up various components (organs, glands, cells) that are all interconnected either directly, or indirectly. Signals that feed into the circuitry of the body can either enhance or interrupt the normal flow of operation which end up either having a positive or negative effect on the net outcome of bodily function and ultimately dictate or influence the health & wellness of the human host. These signals can come from internal or external sources, or be influenced by lifestyle choices.

The thyroid gland itself is one of number of highly important glandular components that requires specific signalling in order to function optimally and keep us healthy. On the flip side, like with other important components, the wrong kinds of signals can interfere with normal function. Signals can include failed enzymatic reactions, metabolic disturbances, overactive immune system signals, missing nutrient co-factors, stress signals, dysfunctions circadian signals, toxicity signals, poor food choices, food allergies & intolerances, dysfunctional signals coming from other body system components… the list goes on.

Because body-systems are interconnected in terms of their working relationships, and the overall function of the body – when thyroid function is impaired, it has a knock-on effect on many other components that are part of other body-systems, thats if they haven’t been effected already. Systems that are effected such as the digestive system, the hormonal system, the detoxification system can all be feeding the wrong kinds of signals into the overall circuit of dysfunction which reinforce the problem. This can seem like a vicious cycle.

In instances like this, the conventional medical approach has always been to treat the thyroid directly with drugs or synthetic hormone replacement with the hope that the other systems that have been effected will normalise too. That may work if the thyroid hormones are truly needed, but frequently they are inappropriately prescribed, and in a lot of cases that I see in practice, causing more harm than good in the long run. In my experience, most people’s thyroid conditions are a result of other underlying dysfunctions, where physiological damage has occurred that’s weakened body systems and producing symptoms.

In this article I wanted to try a slightly different format to normal that is more like a factual review of the many jobs the thyroid performs, and why undiagnosed hypothyroidism can have many repercussions in other areas of the body. Below I’ve broken down some of the functions that come under the glands influence that I often see in Functional Medicine practice:

BONE METABOLISM

  • Although the parathyroid gland (similar name, but totally different gland) controls calcium levels in the blood, the thyroid can also effect one’s calcium status. This is partly because the thyroid gland manufactures and stores calcitonin, a calcium-regulating hormone. Also, hypothyroidism prevents the ends of the long bones from forming correctly. This won’t show up as a calcium deficiency on blood labs unless you are looking at the ranges from a “functional” perspective, like Functional Medicine (FM) Clinicians like myself use. By that I mean the ranges or levels that indicate good health, as opposed to extreme pathological ranges used in conventional medicine.

GASTROINTESTINAL FUNCTION

  • Chronic constipation is a complaint of individuals who come to work with me who have an under active thyroid gland. Poor thyroid function effects the migrating motor complex (MMC) which slows down the time it takes for food to move through the intestines. This in turn increases the potential of gut infections from harmful yeast & bacteria, leading to inflammation, poor nutrient absorption, and increased risk of developing food intolerances. All stuff I see working with those kind of patients in FM practice.

GALLBLADDER & LIVER

  • The Liver has several channels through which it metabolises hormones, filters toxins, and cleans the blood. Metabolic byproducts from these processes are dumped into the gallbladder for final removal. Low thyroid function slows down the entire process of metabolic detoxification, making the liver and gallbladder sluggish and congested, which often results in the formation of gallstones. I’ve seen X-Rays in hypothyroid individuals showing distended gallbladders that contract weak & sluggishly. Since the liver is the organ-site where thyroid hormones are converted into a useable form, you can see how hypothyroidism created a vicious cycle where it down-regulates liver function so that fewer thyroid hormones get metabolised and converted into active ones.

MALE REPRODUCTION

  • Although Hypothyroidism typically tends to effect women rather than men; any male who suffers with under active thyroid function can have their sex drive, and sperm count negatively effected which can lead to impotence. As hypothyroidism is rare in men, I would always carry out a full assessment of the entire hormonal system to assess everything in context.

HUMAN GROWTH HORMONES

  • Even as a fully grown adult, we still need (GH) for regenerating cells & tissues. The pituitary gland releases these “anti-ageing” hormones to be despatched where cell creation & growth are needed. GH then stimulates the synthesis of insulin-like growth factor (IGF-1) in the liver in order to complete the job. During this conversion process, an I inadequate amount of thyroid hormones can interfere with the process required to make IGF-1.

FAT BURNING & FAT METABOLISM

  • One of the most frustrating symptoms of hypothyroidism that I hear from patients is the inability to lose weight, or weight gain, even when calories are low, and exercise output is high. Hypothyroidism simply slows down the body’s metabolic rate which in turn reduces the amount of calories & stored body-fat it burns on a daily basis. For instance, the adrenal hormones epinephrine & norepinephrine that enhance fat burning lose power when the thyroid gland is under active. What’s more is that low thyroid function makes it harder for the body use stored body fat as a go-to fuel source by shutting down the sites on the cells that respond to lipase, an enzyme that mobilises fat from storage, so not only does fat refuse to budge, but the inability to burn fat for energy also contributes to fatigue and chronic craving for sweet & starchy foods. Lastly, since hypothyroidism hinders HGH, building muscle through exercise is difficult, it not impossible and muscle catabolism (breakdown) occurs.

INSULIN & GLUCOSE METABOLISM

  • Glucose (sugar) metabolism is the rate in which the body uses glucose to make energy, and glycolysis is the metabolic step involved in the process. That fuzzy, foggy brain, coupled with poor memory are very common in hypothyroid patients. The brain is the most voracious consumer of glucose, so when glucose metabolism is poor, so is brain function. People with low thyroid function absorb glucose more slowly than normal & the cells don’t use its energy so readily. Furthermore, once glucose is absorbed, the body falls behind eliminating it which put together creates hypoglycaemia, or too little sugar available for energy, with symptoms of fatigue, irritability, and light-headedness. The issue is rarely too little glucose, it’s that due to some faulty or impaired metabolic steps, glucose cannot get into the cell where it can be burned. I’ve seen many glucose blood tests come back as ‘normal’ yet symptoms or hypoglycaemia rage on. To compensate for low energy, the adrenal glands are called upon to pump out stress hormones, and the liver has to release & flood the bloodstream with stored glucose for energy. Eventually this repeating scenario exhausts the adrenal glands, as well as the brains hypothalamus & pituitary glands which are responsible for orchestrating so many bodily functions. This is where an a highly skilled Functional Medicine Practitioner has to read between the lines of what the labs are saying collectively, connecting all the dots, and fill in the less obvious blanks in order to design the correct interventions that are conducive to the patient’s health situation.

THYROID HORMONES & CHOLESTEROL

  • Any time I see high triglycerides, high cholesterol, and high LDL (“bad”) cholesterol on a blood panel, I always want to rule out primary, functional or sub-clinical thyroid dysfunction first. Generally speaking, when an individual’s thyroid is under-functioning, the individual stores fat much more quickly than it’s burned, which drives up triglycerides, cholesterol, and LDL cholesterol. As mentioned earlier, hypothyroidism makes the liver & gallbladder sluggish, so that fat is not easily metabolised and cleared from the body. Cells become less receptive to taking up LDL, so that too much accumulates. When an individual with a healthy functioning thyroid becomes hungry and needs energy, the body is able to readily access & burn fat for fuel, however, that’s not so with low thyroid function. What tends to happen is the body will catabolise lean tissue which further lowers the metabolic rate, and store calories coming in as fat. When one of my patients has abnormal lipid panels (cholesterol & triglycerides) and has hypothyroidism, I address the thyroid disorder & dysfunctions surrounding the disorder first, after which the lipids in circulation often reach normal levels.

BRAIN CHEMISTRY

  • The adrenal glands, located on the top of each kidney, are our stress-management glands. In hypothyroidism, they do not function optimally or have the same energising effect on the brain as they normally would. This often leads to mood disorders, depression and weight gain.

OESTROGEN METABOLISM & CANCER

  • For the female hormone oestrogen to be safety removed by the body it first must be made water soluble in the liver in order to be eliminated. During this metabolic process some of the original hormone forms a secondary type of oestrogen such as estradiol. Hypothyroidism can hinder the pathways in the liver that make this possible. The result is the production of too much so-called ‘proliferative’ oestrogen, which can lead to breast cancer, fibroids, and ovarian cysts.

LIVER DETOXIFICATION

  • Thyroid hormones effect the liver cells responsible for detoxification most of all. To keep things simple – the liver has two phases of detoxification. In phase 1, fat soluble hormones are made water soluble so the body can move one step closer to eliminating them. This process is finalised in phase 2, where the metabolic end-products are excreted via faeces, sweat & urine. It is in phase 2 where good thyroid health is important. When thyroid function is low, the enzymes which are the metabolic spark plugs that carry out the detoxifying tasks, simply don’t mature, hindering important steps in the elimination process. Many people that come to work with me who suffer with hypothyroidism, do poorly at any attempts or detoxification, as the metabolic functions involved are hindered. These peoples detox pathways don’t start functioning normally until thyroid function is restored either directly, or indirectly. This is one of those vicious cycles where healthy liver function is integral to converting thyroid hormones into a useable form, and healthy thyroid function is equally important for the liver to carry out its functions.

STOMACH ACID PRODUCTION

  • Most individuals who suffer with hypothyroidism or autoimmune thyroid either have hypochlorhidria or low gastric acid production, meaning the breakdown of animal proteins is hampered, and the stomach is at a pH where unfavourable bacteria can begin to take advantage of the tightly regulated gastrointestinal environment.

PROTEIN METABOLISM

  • Another crucial job stomach acid performs is breaking down and digesting animal proteins, making them available for use. Due to an impaired ability to break down proteins into usable amino acids, the body becomes deficient in some of the important essential & non-essential building blocks the body requires to manufacture certain chemicals, and to repair and regenerate damaged tissues with new ones.

BODY TEMPERATURE & HOT FLASHES

  • Since the thyroid is like the thermostat that maintains body temperature, a person with hypothyroidism other than suffering with cold hands and feet, may develop other abnormalities relating to body temperature, such as hot flashes and night sweats. These symptoms tend to confuse a lot of people because they are usually associated with peri-menopause. This is where I would comprehensively assess the female hormones to ensure the right disorders & dysfunctions are addressed correctly. Although the thyroid gland is most commonly associated with regulating body temperature, the ovaries & adrenals can cause fluctuations in body temperature too. Assessing the hormones, and cycle-mapping if required can help the clinician determine whether night sweats are caused by oestrogen fluctuations or not. If the symptoms turn out to be a thyroid disorder, it’s likely other signs of thyroid malfunction are present as well. When there is a adrenal issue, hot flashes don’t generally tend to occur, however, shifts in the adrenal hormone cascade can bring on a sweating attack.

PROGESTERONE PRODUCTION

  • When it comes to the hormone progesterone & it’s relationship with thyroid hormones, the two are intimately connected. Remember earlier I said that when the pituitary sends TSH to the thyroid, the gland makes T4 & T3 out of thyroglobulin and Iodine? Well, the catalyst for this is the enzyme thyroid peroxidase (TPO), which resides in the follicles of the thyroid gland itself. Follicles are small spheres of hormone producing cells within the gland, and progesterone appears to both improve the signalling mechanisms of thyroid receptors as well as stimulate TPO production. One reason why a woman’s body temperature rises when she ovulates is that the normal progesterone surge that occurs in her cycle ramps up TPO activity, which in-turn stimulates overall thyroid activity and metabolism. Progesterones effect on TPO – i.e – too little progesterone depresses TPO activity, thus lowering T4 production – also explains why a woman with progesterone deficiency can show up as having mostly normal thyroid levels apart from a low T4 level. Common symptoms I see with progesterone deficiency is heavy mensural bleeding, an inability to lose weight, depression, headaches, and other symptoms that tend to occur mid-cycle. Unlike Functional Medicine that is all about using cutting edge, evidence-based science to identify, expose and uncover the dysfunctional signals that collectively define the underlying causes behind a patient’s health issues – The best & only so-called solution that conventional medicine offers in any situation like this is topical progesterone creams in isolation. Firstly, anything given in isolation tends to cause further imbalances, and secondly, this approach does not take into account the reason for the deficiency, which can stem from the HPA axis – specifically the pituitary gland – earlier referred to as the ‘air traffic controller’ that orchestrates hormonal activity. Many factors can be behind poor pituitary function, such as adrenal hormone disorders which can be caused by a number of different signals, oral contraceptives, post-partum hormonal changes to name just a few examples. For menopausal women who’s pituitary function doesn’t seem to rebound, we may use sublingual bio-identical plant based progesterone that is carefully dosed, along with other bio-identical hormones if needed, based on the lab data analysis. In my experience, this is often the only way to get the patient feeling human again, and to restore some kind of functional order of the hormonal situation, to ultimately get the body back on track. Progesterone creams almost always guarantee a build-up of progesterone in the fat tissue which is really not what you want to happen. This in itself can lead to problems further down the road. For both menstruating and menopausal women, addressing the adrenal hormones is an integral step of restoring functional wellness. Severe hypothyroidism can lead to loss of ovulation and insufficient progesterone, the build up of too much tissue lining of the uterus, and excessive irregular bleeding. Ultimately, hypothyroidism raises the risk of infertility and miscarriage. Lastly, thyroid hormones sensitise the body’s cells to progesterone, so that are readily able to take it up when they needed. When the cells progesterone receptor sites are not exposed to enough thyroid hormones, they lose the ability to allow progesterone into the cells. So even though plenty of progesterone is circulating through the bloodstream, a  woman can have symptoms of progesterone deficiency. I’ve also written about this before that in hormones, a deficiency can mimic symptoms of excess, and vice-versa.

THYROID HORMONES & ANAEMIA

  • Hypothyroidism can lead to anaemia in 3 different ways. The first possible consequence is B12 and folate deficiency, which usually stems from have insufficient stomach acid which is required for the absorption of these nutrients. Secondly, around 15 percent of people with hypothyroidism suffer with pernicious anaemia, an autoimmune disorder where the body’s immune system destroys a compound in the stomach lining necessary for the absorption of B12. Given that the vast majority of thyroid cases I deal with in practice are also an autoimmune disorder in which the body wrongfully attacks and destroys its own thyroid gland tissue, it’s not surprising that a hyperactive and malfunctioning immune system can lead to both pernicious anaemia and hypothyroidism. Lastly, since hypothyroidism leads to a deficiency in gastric acid production, iron absorption (among other things) is poor. And remember how hypothyroidism makes it hard for progesterone to get into the cells? Well, that effect cause me excessive bleeding during menstruation, and poor iron absorption from the low stomach acid coupled with excessive blood loss brings on an iron-deficiency anaemia.

PROTEIN BINDING

  • Earlier I mentioned that when the thyroid hormone is traveling to the liver or to various cells, it catches a ride with binding proteins that serve as taxi cabs. The same is true for reproductive hormones who’s taxis are called sex hormone-binding globulins (SHBG). When these ‘bound’ hormones arrive at their destination, they become ‘free’. Under active thyroid tends to refund SHBG levels which in addition to contributing to hormonal imbalances, low SHBG can skew test results which can deceive an inexperienced set of eyes that are analysing and assessing the data.

HEART & CARDIAC HEALTH

  • An excess of homocysteine, which is an amino acid made in the body, can seriously increase the risk of heart disease, as well as dementia and other neurodegerative diseases. Hypothyroidism often contributes to high homocysteine levels by compromising the livers ability to manage & metabolise the amino acid. I see this a fair bit in practice in individuals suffering with hypothyroidism.

This list is by no means exhaustive, but I had to draw the line somewhere so as to not go on all day. Hopefully it’s given you some food for thought if you are suffering with these kind of symptoms, or have already been diagnosed.

For those that are looking to work with an experienced Functional Medicine Practitioner to help them intelligently assess, address and restore functional wellness then feel free to book a free 30 minute consult with me in order to see if we are the right fit to work together.

Thanks for your attention

*By Steve Hawes