Hypothyroidism is one of the most prevalent disorders of the endocrine system worldwide, although its causes can differ significantly according to region. It can affect women at twenty times the rate of men, and may become particularly prevalent in the elderly. Although medical statistics place the rate of this condition at roughly 2.5% of the population, it may be argued that this grossly under represents the true prevalence. This is due to the fact that hormonal markers used to determine hypothyroid status are generally placed at the extreme end of triggering potential, thus missing a broad swathe of individuals experiencing sub-clinical manifestations of the disease. It is a truly multi-faceted and complex disease process, with many varied factors that can initiate and sustain it. As always, the treatment options listed here are only intended as a starting point to explore your own individual journey to recovery while working with an appropriate health professional.
Hypothyroidism – not simply a condition of insufficient thyroid hormone
The first important point to make is that Hypothyroidism is rarely simply a case of the thyroid gland not producing enough thyroid hormones (T4 & T3). This process is only a minor part of a much more complex interplay of hormones and neurotransmitters that eventuate in the cellular triggering that is the end game of thyroid activity. Initially, the hypothalamus (a region of the brain) must produce Thyrotropin Releasing Hormone (TRH). This then triggers the pituitary gland to produce Thyroid Stimulating Hormone (TSH), which in turn stimulates the thyroid gland to produce the thyroid hormones T4 and T3 (although the latter is produced in much smaller amounts). T4 is a relatively low activity thyroid hormone which must be converted to T3 in the liver, kidneys, gut, and other tissues for sufficient stimulating capacity in the body, and must be transported from the thyroid gland by Thyroid Binding Globulins (TBG) to reach these tissues. Each of these steps can be confounded by a number of factors, thus creating a hypothyroid presentation that will differ with every individual.
Autoimmunity the number one ’cause’ of hypothyroidism in the West
Although globally the number one cause of hypothyroidism is insufficient dietary intake of iodine (a crucial mineral in thyroid hormone production), in Western countries where this dietary deficiency has been largely eradicated the primary cause is an autoimmune reaction to the tissues of the thyroid gland, commonly presenting as Hashimoto’s Thyroiditis. I use inverted commas around the word ’cause’ in the subtitle as there are clearly underlying factors causing the autoimmunity itself. These factors are varied, however there are some common drivers that should be considered in most cases.
Firstly, reactivity to food allergens should be investigated, especially gluten. Gliadin (a protein found in gluten containing foods) has a striking molecular similarity to thyroid tissue, and as such a coeliac presentation or even gluten sensitivity may trigger a subsequent attack on the thyroid gland. Other dietary triggers such as dairy, egg, nuts, fish and artificial colours and flavours should also be investigated through IgE and IgG sensitivity panels as well as monitored elimination diets. Gut permeability should also be considered as a predisposing factor in the development of a food sensitivity or allergy, and appropriate healing protocols and dietary applications such as the GAPS diet should be utilised where appropriate.
Exposure to toxins such as lithium, mercury, fluoride, BPA, teflon and perchlorate (used in rocket fuels and explosives) can also trigger a thyroid autoimmune presentation. Detailed health and exposure history should be taken to determine whether appropriate detoxification measures may be called for.
Although insufficient dietary iodine can be a cause of hypothyroidism, an overload of iodine can in fact precipitate a Hashimoto’s presentation (especially when present alongside a deficiency of selenium, another crucial mineral in thyroid hormone production and transportation).
The complex interplay of hormones
Another possible cause of hypothyroidism may be fluctuations in other hormones, specifically oestrogen and testosterone. Elevations in oestrogen can increase Thyroid Binding Globulin, which in turn can decrease the availability of circulating T4 and T3. The use of the oral contraceptive pill, pregnancy, hormone replacement therapy, and the drug tamoxifen can all cause this increase in TBG. Assisting liver clearance of excess oestrogen may be a helpful therapeutic strategy in this case. Testosterone on the other hand can decrease TBG, which on the face of it should increase free circulating thyroid hormones and possibly cause a hyperthyroid symptom picture. In reality, however, a cellular resistance to thyroid hormones tends to develop and thus precipitate hypothyroidism. Polycystic ovarian syndrome and insulin resistance can be primary causes of increased levels of testosterone.
Excessive stress or an active infection may cause an overproduction of cortisol, in turn suppressing pituitary gland activity and therefore decreasing thyroid hormone production. Hypoglycaemia and insulin resistance can also trigger excessive cortisol production. Hyperglycaemia however will drive up the production of the hormone insulin which can in turn damage thyroid tissue.
Inflammation as an inhibitor of cellular response to thyroid hormone
Inflammation can interfere with the function of all body systems, and specifically the highly sensitive cell membranes, and this may affect thyroid hormone status in three ways. Firstly, inflammation can suppress the entire hypothalamus-pituitary-thyroid axis, thus interfering with all steps of thyroid hormone production. Secondly, the conversion of T4 to T3 takes place in the cellular membranes and can thus be diminished. This means less highly active thyroid hormone in circulation and interacting with the cell receptors. Thirdlly, cellular inflammation can affect the thyroid hormone receptor activity in the membrane and thus diminish cellular response. Inflammation is such a common presentation in modern society that it is surprising (and testament to the robustness of our physiology) that more people do not present with full blown hypothyroidism. An individualised approach to reduce drivers of inflammation should be a part of any hypothyroid treatment strategy.
As you can plainly see, a presentation of hypothyroidism can be much more complex than at first assumed. Treatment with just a synthetic hormone replacement is unlikely to offer complete recovery (although it can be an important part of the treatment strategy). I’ll discuss some general treatment options from a naturopathic perspective, however as always it is important to work with a practitioner to determine your particular presentation and treat accordingly.
Diet and nutrition
Avoiding the consumption of foods that contain goitrogens is an important consideration in any hypothyroid presentation. These substances are found mainly in uncooked brassica vegetables (turnips, brocolli, kale, cauliflower, brussel sprouts etc.), soy milk, cassava, millet, pine nuts and peanuts, and can interfere with thyroid hormone production. The good news with the brassicas is that if you cook them the goitrogenic compounds are largely denatured and are rendered safe to eat.
As discussed above, removing gluten from your diet is highly recommended due to a high prevalence of cross reactivity with thyroid tissue (especially in Hashimoto’s presentations). Some other proteins can also trigger this effect due to structural similarity with gluten. Other foods with which to exercise caution are corn, oats and rice. Dairy can also be a problem, especially milk with a high casein (a type of milk protein) content.
Sugar can be inflammatory and its consumption a major predisposing factor in the development of metabolic disorders. These are two strong reasons why the consumption of refined carbohydrates should be strictly limited in hypothyroid individuals. Swapping out processed foods with a high sugar content and artificial additives for fresh fruits and vegetables is a sure way to reduce exposure to refined sugar and increase your intake of anti inflammatory compounds.
Increasing consumption of foods naturally high in iodine, selenium and zinc such as seafoods, seaweed and organ meat is a great way to get the nutrients your body needs for thyroid hormone production.
Supplemental nutrients that can assist may include vitamins A, C, E and D, as well as zinc, selenium, iodine, iron and tyrosine.
Herbal medicine
The herbs used in treatment will vary depending on an individuals presentation, however I will list the main classes of herbs used in various aspects of intervention.
Bladderwrack is useful for its ability to raise serum iodine. Coleus is effective as a metabolic stimulant and can stimulate the thyroid gland.
Anti-inflammatory herbs such as curcumin and ginger can effectively reduce the body’s inflammatory load and enhance HPT axis function and cellular signalling.
Herbs to help promote liver clearance of oestrogens include milk thistle, globe artichoke, dandelion root and curcumin.
Herbs to support insulin production and those with metabolic syndrome include gymnema, coleus and fenugreek.
Anti-oxidant herbs such as pine bark extract and grape seed can protect thyroid tissue from damage and improve cellular membrane function.
Adaptogen and nervine herbs can help reduce the damaging effects of stress and include withania, rhodiola, passionflower and zizyphus.
Immune balancing herbs such as echinacea and hemidesmus can reduce autoimmune tendency. Immune enhancing herbs such as cats claw and pau d’arco may be indicated where a predisposing factor for Hashimoto’s is suspected to be an underlying infection.
Again, treatment options are as varied as an individual’s presentation and must be approached and administered under the care of a qualified practitioner.
I hope this helps you to see a hypothyroid presentation as more than just a lack of thyroid hormone production, and to begin the process of digging deeper to determine the true underlying cause of your own individual disease process.
In wellness,
James
