Thyroid imbalance is one of the most common chronic conditions in the United States, and the prevalence is on the rise. Estimates of adults with thyroid dysfunction range from 4-10 %, with women more commonly effected than men (though incidence in men is on the rise as well). Prevalence increases quite a bit with advancing age and menopause as well. This article looks at the main subset of thyroid disease: hypothyroidism. Beyond people with overt disease, a large portion of the population has “subclinical” hypothyoridism, meaning they display the symptoms without clear diagnosis on lab testing. Causes are varied, and related to genetics, nutrient deficiency, and lifestyle factors — like sleep, diet, and environmental exposures. Effective treatment takes these different factors into account.
Thyroid anatomy & role. The thyroid gland is shaped like a butterfly, and rests around the windpipe at the front of the neck. When functioning optimally, the thyroid maintains healthy levels of hormones — called thyroxine (T4) and triiodothyronine (T3) — that support energy, mood, growth, and skin/hair health. Symptoms of low thyroid function include tiredness, dry skin, coarse/brittle hair, feeling cold, and having sleep issues.
What’s TSH? If you’ve had a routine physical, you may have seen a TSH test on your lab panel. TSH stands for thyroid stimulating hormone, and is released by the pituitary gland in the brain in response to low thyroid hormones in circulation. In a healthy state, the thyroid starts pumping out T4 & T3 in response to TSH. With hypothyroid disease, the thyroid is unable to keep up. The brain sends more and more TSH to try and get things moving, and levels rise in the blood — so a high TSH equals a sluggish thyroid gland. In treatment, we want to find out why the thyroid is slowing down. Below are some of the main causes, with holistic treatment ideas.
Deficient precursors for thyroxine (T4) synthesis. Adequate iodine supports the synthesis of thyroid hormones and is high in foods like iodized salt, sea veggies, and seafood. In particular, bladderwrack and kelp are local seaweeds rich in a variety of minerals and nutrients that support a healthy thyroid. These can be added to soups to increase flavor, or taken as a supplement. Use caution with thyroid supplementation, as too iodine much can suppress the thyroid in some people.
Impaired conversion of T4 to T3. Selenium, zinc and copper are cofactors for the deiodinase enzymes that convert T4 to metabolically active T3. Adding a supplement with 200 mcg will help, as well as increasing high selenium foods like brazil nuts, shellfish, and spinach.
The Adrenal-Thyroid Axis. The adrenal stress hormone cortisol interferes with T3 conversion, causing formation of inactive reverse T3. Cortisol and other stress hormones go out of whack with adrenal fatigue states. Herbal adaptogens, like ashwaghanda, help balance chronic stress. Lifestyle medicine for stress support is always a good idea. Spend time in nature daily, and try a guided meditation (UCLA has free meditations available online). Take regular breaks from work and practice deep breathing to reset the nervous system. Place one hand on the abdomen just below the lower ribs, and take five deep breaths, feeling the abdomen rise and fall.
High antithyroid antibodies. One main cause of hypothyroidism are immune antibodies that target the thyroid. The most common antibodies are related to Hashimoto’s disease, which is a genetic autoimmune condition. Identifying and eliminating food sensitivities decreases the chance for cross reactions with the thyroid gland. Creating a four day food journal, where you track meals and symptoms, can help clarify sensitivities. Additionally, vitamin D helps regulate immunity and may help protect against the development of autoantibodies. Get vitamin D3 in salmon, mushrooms, fortified grains and beverages, and as a supplement. Wide-spectrum light at 10,000 lux used for 20 minutes per day also builds up vitamin D levels in the winter.
Avoid excessive intake of goitrogens. Goitrogens are foods that can cause iodine deficiency by decreasing bioavailability. Foods such as broccoli, cabbage, cauliflower, Brussels sprouts, turnips, walnuts, almonds and soy are considered goitrogenic. Steaming and baking usually neutralizes the goitrogens in these foods. Of course, many of these foods are packed with beneficial nutrients and minerals, so eliminating them from the diet is less than ideal. Go for lightly cooked foods in these categories in moderation, depending on your individual food sensitivities.
One last note, keeping up with moderate intensity exercise stimulates thyroid hormone synthesis, tissue sensitivity and decreases stress. With exercise, moderation is key. Too much can deplete hormones when we're already deficient, and too little leads to stagnation. Aim for around 30-40 minutes minutes of mixed resistance aerobic exercise 5 days per week. At MNHC, we have a simple 30 minute home routine, just ask your doc!