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Thyroid, A Small but Powerful Gland

By Timothy Schwaiger, ND

Introduction

Thyroid disease effects more than 20 million people in the United States and it is estimated that over 10 million people are unaware that they have a problem. Thyroid conditions are more common in women and as we age. The thyroid gland is in the throat area behind the “Adam’s Apple” and is a part of the endocrine system because it releases thyroid hormones. 

The hypothalamus, located in the brain release thyrotropin-releasing hormone which in turn stimulates thyroid-stimulating hormone (TSH) from the pituitary gland. The thyroid gland produces tetraiodothyronine or thyroxine (T4) and triiodothyronine (T3), both active thyroid hormones. 

Thyroid hormones help regulate body temperature, heart rate, brain and body growth in children, mood, and nervous system activity that are responsible for attention and reflexes.

Another thyroid hormone, reverse-triiodothyronine (rT3) is also produced which counteracts the actions of T3 during periods of stress or when too much T3 is produced, such as in hyperthyroidism. TSH is the most common lab test to evaluate the status of thyroid function, however, whenever someone is taking hormones or I highly suspect a thyroid condition, I always check free T4, free T3, TSH and when appropriate rT3.

Thyroid Conditions

In general, most thyroid diseases are autoimmune in nature. When hypothyroidism (low thyroid hormones) is related to an autoimmune cause it is called “Hashimoto’s Thyroiditis”, but most physician just call it “Hypothyroidism”. When hyperthyroidism (high thyroid hormones) is caused by autoimmunity it is called “Grave’s Disease”.

Thyroid Tests

The type of thyroid tests varies depending on what the physician is looking to diagnose. Not all physicians agree on which tests are ordered. Some physicians will not run antibody tests because the treatment may be the same if the patient has or does not have an autoimmune condition. I disagree with this approach because have one autoimmune condition may increase the likelihood of another condition. Thyroid hormones are either bound to proteins to carry them through the bloodstream or free so they can act directly on cell receptors.

Total Thyroxine (TT4): total bound and non-bound T4 in the blood

Free Thyroxine (FT4): total non-bound T4 in the blood

Free Triiodothyronine (FT3): total non-bound T3 in the blood

Reverse-Triiodothyronine (rT3): The rT3 level tends to follow the T4 level: low in hypothyroidism and high in hyperthyroidism. However, increased levels of rT3 have been seen in stress, starvation, anorexia nervosa, severe trauma, liver dysfunction, following surgery, severe infection, and in burn patients. If patients are not responding to typical doses of thyroid hormones, especially when using non-synthetic hormones, I will order this test. It is very important to run this test along with TSH, FT4 and FT3, otherwise the test results will not make sense.

Thyroid-Stimulating Hormone (TSH): individuals with hypothyroidism will have elevated levels; those with hyperthyroidism will have low levels of TSH; and some people will have elevated levels of TSH but normal amounts of thyroid hormones (called subclinical hypothyroidism).

Thyroid peroxidase (TPO) Antibodies: These antibodies attack the thyroid gland and cause inflammation and impaired function of the thyroid. These can be found in both Hashimoto’s and Grave’s disease.

Thyroglobulin antibody (TgAb): These antibodies are present with an autoimmune cause of the thyroid disease, but are not positive as often as the TPO antibodies are in Hashimoto’s disease.

Thyroid-stimulating immunoglobulins (TSI): this test is usually run to help diagnose and follow patients with Grave’s disease which will elevate levels of this lab test.

Hypothyroidism is when your thyroid hormones are low and usually need supplemented with hormone therapy. Because the thyroid hormones are low your brain will try and stimulate more hormones to be produced, thus the TSH will be elevated to create more hormones. When the condition is caused by the autoimmune condition Hashimoto’s thyroiditis, the thyroid gland becomes inflamed and thus called “thyroiditis” or inflammation of the thyroid gland. This is the most common cause of hypothyroidism in humans. Symptoms of hypothyroidism include the following but vary person to person.

·  Fatigue

·  Feeling cold

·  Constipation

·  Dry skin

·  Weight gain

·  Puffy face

·  Hoarseness

·  Muscle weakness

·  Elevated blood cholesterol level

·  Muscle aches, tenderness and stiffness

·  Pain, stiffness or swelling in your joints

·  Irregular menstrual periods

·  Thinning hair

·  Slowed heart rate

·  Depression

·  Impaired memory

·  Insomnia

Treatment Options:

Synthetic:

1.  Levothyroxine (Levothroid, Levoxyl, Synthroid, Tirosint, Unithroid) is a synthetic form of thyroxine (T4), which is converted to its active metabolite, L-triiodothyronine (T3).

2.  Liothyronine (Cytomel) is a synthetic T3 medication usually used with levothyroxine. I start very low (5 mcg) and increase slowly.

Desiccated Thyroid Extract:

These are hormones derived from porcine source (pigs) and are considered “natural”. They contain 38 mcg of T4 and 9 mcg of T3 for each 65 mg (1 grain) tablet. As you can see form the table below Nature-throid and Westhroid have the most choices in dosing, which is why I prefer those over the Armour thyroid. Also, when converting from synthetic hormones to desiccated thyroid it is extremely important to do under physician care and not to attempt using medication used by a friend or family member. 

1.  Nature-throid

2.  Westhroid

3.  Armour

Hypothyroidism is when your thyroid hormones are high and need to be lowered. Because the thyroid hormones are high your brain will try and suppress or stop the production of thyroid hormones, thus the TSH will be very low. When the condition is caused by the autoimmune condition called Grave’s disease, the thyroid gland becomes inflamed and thus called “thyroiditis” or inflammation of the thyroid gland. This is the most common cause of hyperthyroidism in humans. Symptoms of hyperthyroidism include the following but vary person to person. Inflammation behind the eyes can also cause the eyes to bulge out.

• Sudden weight loss, despite increased appetite that comes with hyperthyroidism
• Rapid heartbeat or feeling your heart beat (palpitations)
• Nervousness, anxiety and irritability
• Tremor, usually shakiness in hands
• Sweating
• Changes in menstrual patterns
• Feeling hot
• More frequent bowel movements
• An enlarged thyroid gland (goiter)
• Fatigue, muscle weakness
• Difficulty sleeping
• Skin thinning
• Fine, brittle hair

Botanicals used for Hypothyroidism:

Ashwagandha is known as an “adaptogen” and some studies show that this herb can increase production of thyroid hormones, so it makes sense to include the herb in the treatment of hypothyroidism, however, not in hyperthyroidism.

Guggul (Commiphora mukul) may increase conversion of T4 into T3 and help reduce symptoms of hypothyroidism. 

Botanicals used for Hyperthyroidism (these herbs should only be used under physician supervision and never during pregnancy):

Bugleweed (Lycopus virginicus) suppresses thyroid function and is used to reduce symptoms of hyperthyroidism. This herb should not be used during pregnancy or for hypothyroidism. 

Lemonbalm (Melissa officinalis) is historically used to “calm the heart” and used for restlessness, irritability, digestive disorders, and cold sores, this herb can be used in combination with other herbs used to treat hyperthyroidism. It is also used as an antiviral herb. It should not be taken during pregnancy.

Gromwell (Lithospermum ruderale from North America), and European gromwell (Lithospermum officinale) which like bugleweed suppresses thyroid function. This herb and Lycopus need to be prescribed by a physician and should not be used during pregnancy.

·  LDN has anti-inflammatory properties

·  LDN increases endorphins and may help in modulating the immune system

·  LDN decreases inflammatory cytokine concentration, lowering IFN-a and TGF-a (inflammatory markers)

·  LDN may improve sleep