Considerations for Diagnosis and Treatment of Thyroid Function
Improving Conditions of the Thyroid
The thyroid, situated at the front of the neck, plays a central role in metabolism regulation – the processing, storage, and use of energy. When the thyroid functions as it is designed to, we never notice. When health conditions trigger a dysfunctional thyroid, though, it can wreak havoc on overall health and severely impact quality of life in affected patients.
The thyroid is a component of the endocrine system, the network of organs and glands and their related hormones that send signaling molecules throughout the body to catalyze various biological processes. As we will explore later on, a dysfunctional thyroid may be a sign of a deeper underlying issue with the endocrine system, particularly as it relates to human growth hormone (HGH) and the pituitary gland.
Here is an overview of the thyroid gland, its related hormones, how it supports health, what can go wrong with thyroid function, and how to treat a dysfunctional thyroid.
The Thyroid, Its Hormones and Metabolism
As mentioned at the outset, the thyroid’s main function in the body is to regulate metabolism, the process by which nutrients taken in through diet is converted into energy for distribution throughout the body.
The Thyroid Hormones: Triiodothyronine (T3) and Thyroxine T4)
Triiodothyronine, frequently referred to in common parlance as T3, and thyroxine, known as T4, are the two most important hormones in terms of their biological activities and maintenance of overall health.
T3, which accounts for about 20% of total thyroid hormone in circulation, is the more physiologically potent of the two – it is four times more effective on target tissues than T4, its prohormone counterpart.
T3 performs, or assists in, an array of biological functions from birth throughout the lifespan, including:
- Heart rate stabilization.
- Body temperature regulation.
- Energy metabolism.
- Normal growth of tissues.
The first three functions listed above serve to maintain homeostasis, the continuous stability of conditions in the body against the backdrop of changing environments.
T4 is a prohormone of T3, meaning that it is a precursor molecule to the stronger T3 hormone. Rather than an active hormone itself, T4 acts as a reservoir from which to synthesize T3. While less effective than T3 in stimulating relevant tissues, T4 accounts for about 80% of circulating thyroid hormone, so it’s four times as prevalent in the blood at any given time.
A Pitfall in Thyroid Testing: Is Measuring T4 Alone Enough?
The most common medical tests to analyze the performance of a thyroid measure T4 levels, the “precursor” to T3. If tests indicate an adequate supply of T4, then thyroid function is assumed to be normal and the doctor may then move on to other diagnostic tests.
For patients who can readily convert T4 into T3, this type of testing is typically adequate to rule out thyroid dysfunction. However, an under-considered issue for many doctors is that some patients do not easily synthesize T3 out of T4 – rendering the common tests useless in these situations. All the T4 in the world does not matter if it cannot be converted efficiently into the biologically active T3 form.
In cases where the thyroid produces adequate quantities of T4 but does not convert it into T3, the patient will continue to suffer from hypothyroidism despite normal readings from blood tests.
Thyroid Medications May Ironically Worsen Thyroid Health in Some Patients
In cases of diagnosed deficiencies due to lower-than-normal T4 levels, doctors may prescribe a synthetic version of thyroxine known as levothyroxine, sold under the brand name Synthroid, among others.
For some patients, this synthetic hormone may correct hypothyroidism. For those who cannot efficiently convert T4 into T3, though, as we discussed earlier, the elevatedT4 levels seen during treatment may “mask” the underlying issue. So, while blood readings indicate normal thyroid function, the symptoms of hypothyroidism persist because the wrong measurement (T4 levels rather than T3) is utilized.
In addition, several medications are shown through clinical study to interfere with T3 conversion, yet these interactions with the thyroid are unfortunately often under-appreciated by prescribing physicians. The most common medications that impair thyroid function are explored below.
Statins and Their Effect on Thyroid Health
The essential issue with devising an optimal treatment strategy in a clinical setting comes down to the age-old question of cause-and-effect. In this case: Which came first, hypothyroidism or high cholesterol?
Due to its role in cholesterol metabolism, an under-performing thyroid can trigger elevated low-density lipoprotein, or LDL, cholesterol levels (the harmful variety of cholesterol). Even sub-clinical thyroid deficiencies (meaning conditions deemed mild enough to not warrant intervention or that are so mild as to evade detection by blood tests) can result in LDL spikes.
Statins work by inhibiting cholesterol synthesis. When a thyroid-induced cholesterol increase occurs, a doctor may prescribe a statin drug to lower LDL levels when, in fact, treatment of the thyroid deficiency directly could restore cholesterol levels to normal.
Unfortunately, statins in combination with Synthroid may exacerbate the cholesterol-raising effects of hypothyroidism and ironically drive cholesterol levels further upwards by lowering the availability of T3.
The essential takeaway is that physicians, upon discovering elevated cholesterol levels in a patient, should first consider the thyroid. Is it functioning properly? Is it producing adequate supplies of T4 and, equally importantly, is T4 effectively converted into T3?
Beta-Blockers and Their Impacts on Thyroid Function
Beta-blockers, as the go-to medication for high blood pressure for many prescribers, are extremely common in American heart patients’ medicine cabinets. They work by blocking the Beta-1 receptors sites on heart cells that receive adrenaline, the excitatory hormone that ups blood pressure during times of stress. The result is a relaxed heart that works less strenuously than it otherwise would without medication – critical for patients with heart disease.
Although the mechanism through which beta-blockers inhibit T4 conversion into T3 remains unclear, the clinical evidence is clear that these medications can exert a deleterious influence on thyroid function.
This potential effect of beta-blockers on T3 conversion does not contraindicate their therapeutic use; rather, prescribers should be aware of this potential link and test T3 regularly after beginning treatment.
The Pituitary-Thyroid Connection (HGH Deficiency and Hypothyroidism)
The pituitary and thyroid glands, both components of the endocrine system, make up 2/3 of the hypothalamic–pituitary–thyroid (HPA) axis.
The HPA axis serves as a balancing force to regulate the release of hormones like T4, human growth hormone (HGH), and others. Thyroid-stimulating hormone (TSH) is produced and released by the pituitary gland. From there, it travels to the thyroid to stimulate the production of T4 and, ultimately, of the bioactive T3.
When the pituitary gland fails to release optimal amounts of TSH, this can negatively impact the production of the thyroid hormones, a condition called secondary hypothyroidism.
Growth hormone deficiency (GHD) occurs when the circulating levels of another critical hormone produced by the pituitary, human growth hormone (HGH), are lower than normal. In some cases, GHD may mask hypothyroidism in a “significant portion” of adults diagnosed with growth hormone deficiencies.
Given the under-appreciated connection between GHD and hypothyroidism, proper testing of thyroid function should be performed following the diagnosis of a growth hormone deficiency to chart the proper course of corrective action.
The Dangers of Iodine Deficiency for Thyroid Health
The thyroid hormones are synthesized using iodine, a trace element that is indispensable due to its role in thyroid function. In previous eras, iodine deficiency was a serious health risk that led to hypothyroidism (under-performing thyroid) and other conditions such as goiter, characterized by a swollen thyroid.
With the introduction of iodized table salt and a greater emphasis on adequate iodine consumption, deficiencies in the West and other developed areas has declined in the last hundred years.
Nonetheless, estimates by health advocacy groups indicate that 30% of the world’s population is at-risk for iodine deficiency. A simple iodine blood test can determine a clinical iodine deficiency.
Blueprint for a New Way Forward: Suggested Alternative Diagnostic and Treatment Modalities for Hypothyroidism
Drawing on the newfound wealth of clinical data regarding the thyroid and how it interfaces with the endocrine system at large, there are several considerations that doctors should take into account to develop new and improved diagnostic procedures. Here are a few tests that should be performed if thyroid dysfunction is suspected:
- Free T4 Levels
- Free T3 Levels
- TSH Levels
- HGH Levels
- Iodine Levels
- Gluten Sensitivity Test (more on the relationship between gluten and the thyroid later)
Direct Laboratory Services via Anti-Aging and Wellness Clinic offers comprehensive blood screenings to accurately diagnosis thyroid dysfunction. The firm performs all the relevant tests listed above.
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Alternative Treatment Modalities for Hypothyroidism
Medical providers are arguably all too trigger-happy to prescribe drugs as the frontline treatment for thyroid disorders when natural remedies may effectively boost thyroid function.
While conventional treatments using standard pharmaceuticals may be indicated to treat thyroid deficiencies, in some cases — such as instances of subclinical hypothyroidism where the deficiency is mild — natural interventions may be sufficient to correct the condition without the negative side effects of pricey pharmaceuticals.
Alternative treatments for hypothyroidism may include:
- Increased vitamin A intake via diet or supplementation. Vitamin A-rich foods include fish, liver, eggs, carrots, broccoli, and cantaloupe.
- Increased iodine intake via diet or supplementation. Seafood is the optimal natural source of iodine. In addition, most table salts sold in the US are fortified with the trace mineral.
- Increased selenium intake via diet or supplementation. The thyroid contains the highest concentration of selenium, a critical micronutrient, of any tissue in the body. Optimal selenium levels are a prerequisite for T4 production. Many US adults, however, fail to obtain the necessary 55 micrograms of selenium through dietary intake per day. Natural sources of selenium include fish, most other meats, brazil nuts, eggs, beans, and brown rice.
- Aloe barbardensis Miller juice (ABMJ). Preliminary evidence indicates that AMBJ increases blood concentrations of T4.
- Elimination/reduction of refined carbohydrates via processed foods.
- Tumeric may also improve thyroid function.
- For patients predisposed to a gluten intolerance (a protein found in wheat, barley, rye, and other grains), gluten intake may cause an autoimmune attack on the thyroid. A gluten sensitivity test can determine whether an individual is susceptible to thyroid dysfunctions caused by this protein.
- (Possibly) intermittent fasting. Intermittent fasting, or IF, is the practice of restricting caloric intake to zero or near-zero for set periods of time (called the “fasting window”) followed by a set period of free eating (called the “feeding window”).
The proven health benefits of IF are legion, including general improvements to endocrine function. While circulating T3 levels are known to temporarily decrease during short fasts, several studies show that fasting has no appreciable effect on T4 or TSH levels in most people and may in fact boost TSH over time. Furthermore, T3 levels are seen to return to normal upon eating. Although the research on thyroid health and fasting is insufficient to draw definitive conclusions, IF has been shown to have a normalizing effect on other hormonal feedback loops. More research is needed, but with proper monitoring, patients with thyroid dysfunction may benefit from regular IF.
- (Possibly) ketogenic diet. The ketogenic diet, or “keto” for short, involves cutting carbohydrate intake to zero or near-zero and is often practiced in combination with IF. As with IF, the research on keto and thyroid function is unfortunately sparse, but the web is replete with anecdotal accounts of near-miraculous turnarounds in thyroid health after years of failure attempting conventional treatment. Again, more research on keto and thyroid function is needed, but the elimination of carbohydrates and grains containing gluten may explain, in part, the reported thyroid-related benefits of keto for some.
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The Bottom Line: How Patients Can Take Charge of Their Thyroid Health
In the sea of (sometimes contradictory) clinical literature on the causes and solutions to thyroid dysfunction, patients may become overwhelmed. However, there are straightforward steps that individuals experiencing thyroid issues can follow to take charge of their hormone health. They include:
- Comprehensive, full-panel blood screenings. The more information available, the more effective the treatment plan.
- Safe experimentation with diet modification vis-à-vis the changes outlined above under the observation of a certified healthcare provider.
- Testing for underlying conditions that may affect thyroid function.
- Consultation with numerous healthcare providers to reach a consensus opinion.
- Adjustment of non-thyroid-related medications such as beta-blockers and/or statins to screen for adverse effects on thyroid health under the guidance of a certified provider.
- When necessary, conventional pharmaceutical interventions may be utilized with the end-goal being the restoration of thyroid function and an end to reliance on medication.
Recovering from thyroid health, with persistence and a willingness to explore new science-backed solutions, is possible.
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