When the thyroid gland is not functioning properly you can suffer many debilitating effects, but you don’t need to stay sick, you can get out of the woods and back to healthy living.

What is Hypothyroid?

Hypothyroidism is an endocrine condition where low thyroid hormone levels result in a slowing of the body and metabolism. The thyroid is a small butterfly-shaped gland located in the throat that secretes hormones T3 and T4, which have an influence on basically every cell in the body.

The thyroid controls metabolism, energy use, mood, and facilitates the functioning of the brain, muscles, heart, and other organs. In the case of hypothyroidism, the reduced amount of T3 and T4 results in the decreased functioning of the body. This can be seen in the slowing of the heart rate, the intestinal tract becoming sluggish, brain fog and decreased critical thinking, mood becoming depressed, and less body heat production.

Thyroid hormone impacts

• Metabolism
• Weight
• Mood
• Brain development and function
• Cardiac function
• Respiratory rate
• Temperature control
• Muscle skeletal system
• Reflexes and strength
• Menstrual cycle

Prevalence of Hypothyroidism

Hypothyroidism is a fairly common disorder, approximately 5% of the US population has been diagnosed with it. However, it is likely an even larger number as many people are living undiagnosed or with sub-clinical hypothyroidism.

Hypothyroidism often goes undiagnosed due to the vague and vast symptoms associated with it. It has been estimated that nearly 60% of patients with hypothyroidism don’t realize they have it. In addition, many medical providers don’t test for thyroid hormones T3 and T4 and only test for TSH (thyroid stimulating hormone), which is the hormone released from the pituitary gland. This is a flawed practice because it is not uncommon for people to have a normal TSH level and an abnormal T3 and T4. By just testing for TSH, countless people go undiagnosed.

Another issue is the range in which the thyroid levels are gauged; normal is based on population averages rather than individual function. Normal is determined by taking a bell curve, then chopping off the top 90% and bottom 10% and calling anyone outside that range abnormal. While most people function well in this normal range, it is more nuanced than that. Someone can be testing in the middle range of normal, but their body functions best when they are testing at the upper range of normal. This is because each body is different and while one person may feel best at the low end of the range, another may feel best at the higher end. This is why looking at symptoms, not just numbers are important.

Like most autoimmune diseases, hypothyroidism is more common in women; 12-15% of women have hypothyroidism as opposed to men who have an incidence of 2-5%. It is also more common in older adults. Most patients are over 30 years old at the time of diagnosis, but this is not to say babies and youth don’t also get it.

Types of Hypothyroidism

Hypothyroidism is classified by type: low iodine, medical induced, pituitary, congenital, pregnancy-induced, lifestyle, and Hashimoto’s.

Low Iodine

Hypothyroidism due to a lack of iodine in the diet. The thyroid gland needs sufficient iodine in order to create thyroid hormones, thus a deficiency in iodine will result in a deficiency in T3 and T4.

Several million people all over the world are diagnosed with low iodine hypothyroidism, but it is more common in underdeveloped countries. Developed countries saw a huge drop in iodine deficiency after they started adding iodine to table salt and other foods in the 1950s. However, with the shift to low salt diets and sea salt over iodized table salt, cases are starting to re-appear. Iodine is also found in high amount in seafoods and seaweed. If you are supplementing with iodine be careful not to take too much as too much iodine can also cause hypothyroidism.

Medical associated

Hypothyroidism that is the result of the treatment of hyperthyroidism or another condition that required the removal of the thyroid. In patients with hyperthyroidism, the thyroid gland is often removed with surgery or neutralized using radioactive treatments to prevent chronically high levels of thyroid hormone from wreaking havoc on the body. After the removal or neutralization, the patient is left in a hypothyroid state and will need to be on hormone replacements for life. Medications can also affect the thyroid: lithium and amiodarone for example can induce low thyroid levels.

Hashimoto’s

The most common form of hypothyroidism. It is an autoimmune disease where the body mistakes the thyroid cells as invader cells and destroys them. As tissue is destroyed the thyroid’s ability to produce thyroid hormone decreases. Some patients will present with a goiter (growth on the thyroid) due to the inflammation, while others will present with atrophy (decreased size of the thyroid) due to destruction of tissue. The result is inflammation or atrophy of the gland and an inability of the thyroid to produce normal amounts of thyroid. This leads to a lifelong dependency on thyroid supplements.

While the exact cause is unknown, the autoimmune process is thought to be the result of genetic predisposition and an environmental trigger. Some scientists believe if the cause of the autoimmune attack can be identified and eliminated, then the attack on the thyroid will cease and healing can begin.

Pituitary

Occurs when the problem does not stem from the thyroid, but rather the pituitary gland, which is responsible for signaling the thyroid to produce more thyroid hormone when hormone levels are low. When the pituitary gland fails to detect low amounts of thyroid in the blood and does not release enough TSH, the hormone that signals the thyroid to secrete T3 and T4, the result will be low thyroid hormone.

Lifestyle

Stress on the body from extreme lifestyles is also postulated to cause hypothyroidism. Conditions such as anorexia, extreme exercise, smoking, and high toxin exposures are examples.

Congenital

Babies can be born with hypothyroidism due to developmental dysfunction in utero. The congenital form will lead to mental retardation if not treated early in life, which is why screenings are completed on all babies at birth. Immediate thyroid replacement treatment is needed to prevent mental and physical growth defects.

Pregnancy

Pregnancy causes many hormone fluctuations and the thyroid is not an exception. The extra demands on the body that comes with being pregnant stresses the thyroid and women can experience temporary or sustained hypothyroidism as a result.

Typical hypothyroid symptoms include the following:

• Fatigue
• Weight gain or difficulty losing weight
• Brain fog
• Difficulty concentrating
• Depression
• Sleep disorder (too much or too little sleep)
• Constipation
• Cold intolerance
• Fatigue
• Dry skin
• Brittle nails
• Hair loss or coarse hair
• Muscle aches
• Heavy periods
• Slowed heart rate
• Slowed reflexes

Hypothyroidism crisis

Thyroid crisis, which is also referred to as hypothyroid coma, can develop in poorly controlled hypothyroid patients. Hypothyroidism crisis is very dangerous and needs immediate medical attention as it can result in coma.

Hypothyroidism crisis is characterized by:

• Extreme intolerance to cold and shivering
• Slow labored breathing
• Slow heart rate
• Extreme lethargy
• Loss of consciousness

Normal thyroid function

In a healthy endocrine system, the brain and body communicate with each other to maintain homeostasis. When thyroid hormone levels (T3 and T4) dip below normal levels the parathyroid will send out TSH (thyroid stimulating hormone) to the thyroid telling the thyroid to make more thyroid hormone. Then if thyroid level are too high, the pituitary will tell the thyroid to make less.

Pituitary-thyroid axis feedback loop

Step 1: Pituitary gland located in the brain detects a dip in thyroid hormone circulating in the body and releases TSH (thyroid stimulating hormone) into the bloodstream

Step 2: TSH travels to the thyroid where it signals the thyroid to release more T4

Step 3: T4 is released from the thyroid gland and either enters the tissues (free T4) or becomes inactive by attaching to proteins (bound T4). This is determined by how much thyroid is needed.

Step 4: Some of the free T4 is converted into T3 in the liver and enters the bloodstream to reach tissue cells. T3 has a much more substantial impact on the tissues than T4. For this reason, even if your T4 and TSH are normal, but your T3 conversion is low, you may still have symptoms.

Step 5: The body sends signals back to the pituitary gland. If the amount of T3 and T4 are high the pituitary will stop sending TSH signals to the thyroid, if the T3 and T4 are low, the pituitary will send more TSH to the thyroid.

In hypothyroidism, the thyroid is injured and unable to produce more thyroid despite the stimulation from the pituitary gland hormone TSH. Thus, most often on the lab, you will see high TSH levels and low T3, T4.

Subclinical Hypothyroid:

Early immune response causes inflammation of the thyroid tissue and a slight decrease in thyroid hormone production due to tissue damage. Not all people with Hashimoto’s will go on to develop hypothyroidism. Many stay in a subacute state with slightly lower thyroid hormone being produced.

Most western doctors say this is not low enough to warrant treatment, but functional doctors will disagree and state treatment may be needed if symptoms are present.

Labs will show: elevated TSH, borderline T3, T4

Overt Hypothyroidism

Chronic inflammation and destruction of thyroid tissues results in a substantial deficiency in thyroid hormone. In most cases the progression from the sub-acute state to full-blown hypothyroid is gradual. Therefore the symptoms are often slow developing and in many cases, the patient doesn’t realize they are experiencing them until they are extreme.

Labs will show: elevated TSH, low T3, T4

Causes

For many of the hypothyroid types, such an iodine deficiency hypothyroidism, the cause can be discovered and treated. For the autoimmune Hashimoto’s form, however, the cause is unknown. Proposed causes are genetics, aging, environmental, viral, dietary, and other autoimmune disorders.

Most common causes of all types of thyroid disorder

• Aging (hypothyroidism increases with age)
• Sex (being female)
• Family History (no genes have been identified at this time)
• Viral or bacterial infection triggered an autoimmune response
• Environmental triggers (pesticides, too much iodine, not enough iodine, toxic chemicals)
• Autoimmune disease and conditions (diabetes, lupus, celiac disease, dietary )
• Food allergies (Gluten: the molecules of gluten are thought to mimic the molecules of the antigens that attack the thyroid. Thyroid blocker foods: soy and goitrous foods block thyroid production and increase risk for goiters)
• Anorexia

Diagnosis of Hypothyroid

Diagnosis is based on symptoms and lab results. Most often lab results will display high TSH, low T3, T4. Symptoms include weight gain, fatigue, hair loss, brittle nails, muscle aches, slow heart rate, cold intolerance, constipation, brain fog, difficulty concentrating, depression, dry skin.

Normal Thyroid Blood Levels

· TSH (normal 0.5-5 mIU/L)

· T3 (normal 100-200 mIU/L)

· Free T4 (normal 0.8-2.4 ng/dl)

· TPO Antibodies (0-34)

Lab Result for Thyroid Disorder

· High TSH with low T3, T4

Lab Result for Pituitary Disorder

· Normal TSH with low thyroid hormones (T3, T4)

Lab Results for Hashimoto’s

· High or normal TSH, low T3 and T4, elevated TPO antibodies, and the presence of anti-Tg

· The circulation of antibodies to thyroperoxidase are the most accurate markers. The antibodies to thyroglobulin are less sensitive and less specific.

Side NoteOther causes of low T4 can include low albumin (low protein in the bloodstream), pituitary gland disorder, or hypothalamic failure

The frequency of ‘Thyroid Panel’ blood work:

How often you should have your thyroid levels tested will be based on symptoms, medications, and maintenance schedule.

New diagnosis: Most will have thyroid hormones tested every 3 months when first starting treatment and while hormone levels are reaching target level.

Change in medication dose: Once the dose is changed, levels should be checked in 3 months. If the tests are within a normal range, the tests can be then performed biannually.

Reaching target: Once reached target level blood levels will be checked once per year or every 6 months

Other Tests for patients with hypothyroid:

• Vitamin D (tends to be low)
• Cholesterol (tends to be high)
• Magnesium (tends to be low)
• Complete Blood Count
• Iodine (too low is bad, too high is bad)
• Other hormonal tests, such as estrogen, as they are closely related to normal thyroid functioning
• Imaging with thyroid ultrasonography is most useful for monitoring thyroid size and appearance of thyroid nodules.

If lab tests are normal, but symptoms persist

If your doctor tells you your lab results are “normal,” but you are experiencing symptoms of fatigue, weight gain, etc there are several steps that you can take.

Step 1) Make sure tests are complete.

· A comprehensive thyroid panel will include T3, T4, TSH, T3 conversion rate, and thyroid antibodies. Many providers just look at the TSH. Just TSH is not enough information. Many people have normal TSH, but their T3 or T4 is off.

Step 2) Rule out other conditions that may present with similar symptoms

• Adrenal fatigue
• Anemia
• Depression
• Hormonal imbalances
• Electrolyte imbalances
• Irritable Bowel Syndrome
• Food allergies
• Autoimmune disorders

Treatment for Hypothyroid

Treatment will depend on the type of hypothyroidism you are diagnosed with and will include medications, diet, and exercise plans. Most people with hypothyroidism (excluding iodine deficiency) will need lifelong thyroid hormone medication and lifestyle choices are just as important. The foods we eat and the exercises we perform will have a substantial impact on people with hypothyroidism.

Pharmacological options for treating hypothyroidism include

Levothyroxine: It is a synthetic form of thyroid hormone. It provides T4 that will then need to be converted into T3. Typically given at doses of 1.6–1.8 μg per kg of body weight. The administration of levothyroxine must be controlled and regularly evaluated since excessive levels may have adverse effects.

Synthroid: Is in synthetic form, provides T4 that will need to be converted into T3.

Armour: Natural option made from bovine cells.

Shield: Is a combination of T4 and T3. This medication is often considered the best option for those who have either the inability to convert T4 into T3 or who have a lower conversion range.

Many people will start on one medication, feel better for a while and then start to feel worse again. Others may not feel better at all. Reasons, why this occurs are very individual, but nutrition deficiencies, protein imbalance, insufficient iodine, low T4 to T3 conversion rates, or food sensitivities all play a role. Speak with your medical provider if you are not reaching your maintenance and well-being goals on current treatment. Often it can be as simple as switching brands or going from generic to brand. 

Once a medication is started, the patient will have to follow up lab work every 3 months to check thyroid levels. Medication will be adjusted based on findings. Once the thyroid hormone levels have reached a healthy range, lab work can be done every 6 months.

Surgical options for treating hypothyroidism

Thyroidectomy: Removal of the thyroid gland by surgery is available as an option in cases where there is severe cervical compression or if there is a suspicion of malignancy.

Hypothyroid and diet

Diet plays an important role in the maintenance of thyroid function. Hypothyroid patients need to pay attention to what they consume because there are foods that have been proven to hinder thyroid function such as estrogenic and goitrous, as well as foods that improve function such as selenium-rich. In addition, patients with hypothyroidism are at risk for weight gain so making proper food choices is essential for maintaining a healthy BMI. Nutritive deficiencies such as low B-12 are common among patients in this group and can lead to co-morbid conditions such as anemia. Foods high in nutrients should be chosen over empty calorie foods.

Foods to enjoy 

Proteins: It is recommended that hypothyroid patients have one serving of protein at every meal. Lean meats such as chicken, turkey, lamb, pork, fish, as well as beans, nuts, and cheese are all good sources of protein.

Vegetables: 5-6 serving per day. Using the plate method, vegetables should make up half your plate. Make sure if you are eating goitrogenic vegetables like kale and broccoli that you are cooking them.

High fiber foods: Hypothyroid patients often suffer from constipation. High-fiber foods not only keep patients regular but also keep them full which promotes weight loss.

Iodine rich foods: Studies are contradictory when it comes to iodine. Too little and you can get hypothyroidism, too much and you can inhibit thyroid hormone production. Source of iodine include table salt, seaweed, medications, nutritional supplements, and drinking water.

Daily allowance iodide is 150 mcg per day. Toxicity may develop when intake is over 900 mcg per day. Iodine deficiency leads to developmental delays, mental retardation, goiter, and other health problems. Iodine supplementation, such as universal salt iodization (USI) has been successful in controlling iodine deficiency disorders (IDD).

Excess consumption of iodine can also lead to hypothyroid. A number of epidemiological studies have acknowledged the association of excess iodine with the development of thyroid autoantibodies, hypothyroidism, hyperthyroidism, cancers, and autoimmune thyroid disease.

Foods that have Selenium: Selenium is an essential element required for the normal functioning of the thyroid gland and thus its beneficial effects in hypothyroidism have been suggested. However, more studies are needed to further evaluate these findings.

Sources of selenium; Brazil nuts, sunflower seeds, fish, shellfish, beef, pork, chicken, eggs, grains. Daily allowance 50-55mcg per day. Toxicity may develop when intake is over 350-400 mcg per day.

Highly desirable micro-nutrients and their sources:

• Organ meats such as liver and kidney
• Egg yolks due to the amount of selenium
• Seaweeds because they contain iodine
• Shellfish because they contain iodine
• Fermented vegetables because they contain natural properties and probiotics that aid with digestion
• Bone broths for their gut healing properties and high nutrition values 

Foods to avoid or limit

Goitrogens: foods that block iodine uptake into the thyroid, which is needed to create thyroid hormone. In addition to blocking iodine, goitrogens can block the absorption of thyroid medications. Goitrogens also have the potential to enlarge the thyroid tissue and create a goiter.

• Raw kale, spinach, cabbage
• Raw cruciferous vegetables such as broccoli, brussel sprouts, bcauliflower, turnips, radish, etc
• Raw strawberries and peaches
• Soy and its derivatives

***Many of the foods on this list are rich in nutrients so avoiding them completely may not be beneficial. The vegetables and fruits in these groups when cooked are much less likely to cause harm because heat inactivates goitrogenic compounds.

Gluten: many patients with hypothyroidism have a gluten sensitivity or celiac disease. Gluten molecules mimic the antithyroid molecules and thus eating gluten can act as a trigger the attack of the thyroid by the immune system. Gluten can also irritate the lining of the intestines and lead to decreased absorption of thyroid medication and nutrients.

• Wheat, barley, oats, rye, farro, etc

Dairy products: like gluten, dairy molecules can trigger an attack on the thyroid leading to further damage to the tissue.

• Milk
• Cheese
• Yogurt

Artificial sweeteners: these sugar substitutes are linked to insulin resistance, weight gain, and even cancer.

• Splenda, aspartame, sweet and low, etc. Stevia is a somewhat healthier option as it is more natural, but still linked to weight gain and insulin resistance.

High-fat foods: patients with hypothyroid are at risk for high cholesterol and should limit foods with high fat and saturated fat content. Ideal is to stay under 12g of saturated fat per day.

• Red meat, processed foods, fried food, butter

High sugar foods:

• Pastries, candies, desserts, ice cream

Interactions of medication and food:

• Its best to take when your medication when you first wake up with a large glass of water. Take thyroid medication 1 hour before meals and drinks or 2 hours after the last meal or beverage.
• The milk in coffee will inhibit the absorption of thyroid medication if consumed together 
• Eggs contain high amounts of iron while will also block absorption if consumed together 
• Citrus fruits and juices decrease absorption if consumed together