Women's Health Series: Hypothyroidism Part 1
Although hypothyroidism is not strictly a women's health condition, it affects a disproportionately larger number of women than men. 5% of women are actively treated for hypothyroidism, but if you are over 65, that increases to almost a quarter of all women (23.1%). And that's not counting the estimated 60% of people (men and women) who go undiagnosed.
What is hypothyroidism? How do you know if you might be dealing with hypothyroidism? And what can you do about it?
In the first part of this series, we will dive into understanding how the thyroid system works and what hypothyroidism is. By understanding it, we will be better able to figure out how to heal from it.
Part I: What is hypothyroidism?
Hypo = “low”
Like most diagnoses in conventional medicine, the name is descriptive rather than diagnostic. Hypo = "low" thyroid. It is essentially saying: your thyroid is not putting out enough thyroid hormone (thyroxin, or T4 and/or triiodothyronine, or T3). But this doesn't begin to understand why.
Most cases of hypothyroidism are either autoimmune, or Hashimoto's thyroiditis (-itis, meaning ‘inflammation), or non-autoimmune hypothyroidism where the thyroid system simply is putting out less active thyroid hormones. (It can also be secondary to thyroid surgery (removal of the thyroid gland) for thyroid cancer or induced from drugs such as lithium or glucocorticoids (steroids such as prednisone).)
Since there is no difference in treatment protocols for either the autoimmune or non-autoimmune forms of hypothyroidism, most doctors in conventional practice don’t find it necessary to do testing to differentiate between them. Either way, the treatment is hormone replacement therapy.
And since neither the causes nor any other factors that may contribute to hypothyroidism or accompany it are addressed, many people feel only marginally better, or continue to struggle with their energy, health and weight. Some people will need to have their thyroid hormone medication increased or decreased often as the mechanisms that affect hypothyroidism wax and wane.
How do we better manage our thyroid health, or even heal it? To begin to understand this, let’s dive into how thyroid hormone is controlled in the body.
The endocrine system (or, better known as the neuro-endocrine-immune system).
The thyroid is one of the glands that make up the endocrine system. Glands of the endocrine system secrete messenger molecules that we call hormones.
These hormones travel to cells and other glands of the body and tell them how to do their jobs. The goal of all this chemical communication throughout the body is to maintain all the basic functions we can usually take for granted; energy, digestion, breathing, sleep, metabolism, body temperature, blood pressure, water retention or excretion, fertility, menstruation, hair growth, and libido….and so much more.
It is important to remember that though modern science and medicine has classified the endocrine (hormone), nervous (brain and nerves throughout our body), and immune (our body's defense against invaders) systems as separate systems, in reality, this is all one functional system, with different areas of focus. The communication signals between these supposedly separate systems are completely integrated. The cytokines from the immune system, hormones from the endocrine system and neurotransmitters from the nervous system all work together to control our health.
That means that signals about infections and inflammation from the immune system also are being heard and responded to by the nervous and endocrine systems. And vice versa. Stress and disruptions to any part of the system will have ricocheting effects through all the other systems. Everything is interconnected.
The nervous, endocrine (hormone), and immune systems are not at all separate but are entirely integrated and control each other. That means disruptions to any one part of these systems may cause ripple effects throughout all systems.
The Thyroid Hormone Cascade
To understand how we can heal from poor thyroid function, we need to understand how things can go wrong. And to figure that out, we need to know a bit about how thyroid hormone is controlled in the body.
The thyroid is just one endocrine gland in the larger endocrine (hormone) system. The master controller of the endocrine system is the pituitary, a pea-sized gland that sits just back from the center of our eyes. It receives messages both from the brain as well as feedback from hormones and inflammation from the rest of the body.
The pituitary’s job is to listen to all of the messages from brain and body and based on that, tell each gland of the endocrine system how much of its messenger hormones to secrete. What you’ll see as we go through the thyroid hormone cascade is all the brilliant ways the body has of controlling how much thyroid hormone activity is allowed in the body.
(We’re going to ignore the rest of the endocrine system today, but know that in real life and hence clinical practice, it is unlikely that any one part of the endocrine system gets out of very out of wack with out other parts also being dysregulated. Take home message: to heal from hypothyroidism, we need to consider the other hormones of the endocrine system as well.)
On to the thyroid hormone cascade:
The pituitary secretes thyroid-stimulating hormone (TSH) to tell the thyroid, "Hey! Secrete thyroxine!” You’ll see thyroxine listed on your labs as T4.
Thyroxine, or T4, is only a very weakly active hormone. It has to be converted in the body to its more active form, triiodothyronine (T3). Both T4 and T3 have free and available forms (Free T4 and Free T3) and not available forms (total T4 and total T3). The body only keeps a small amount of total hormone available and active.
The body has many checkpoints to control just how much thyroid hormone is active in the body. The body wants to be able to control our metabolism in response to stressors, nutrient availability and inflammation. Realize that biology’s “goal” is not to make us tan, thin and happy, but to keep us alive so we can reproduce. To that end, conserving energy (which may mean tired and overweight ) has been the go-to survival strategies for humans for millions of years.
One step to decrease thyroid activity in the body is to increase or decrease the amount of TSH secreted from the pituitary. The pituitary can reduce the amount of TSH it sends to the thyroid that tells it to secrete T4.
Next in the thyroid hormone cascade chain, the body can control how much thyroid hormone is active is by controlling how much total T4 is or isn't converted to the more active total T3.
It can also increase or decrease the amount of total T4 and T3 that is converted to its free and most active form, free T4 and free T3.
The body also has a sort of “stop-gap” measure to limit thyroid action in the body. It can convert the free and active T3 into Reverse T3, which is inactive.
Finally, our cells can become resistant to the thyroid hormone signal. This phenomenon is less well understood and studied, but basically, this is like a kid (the cell) who puts his hands over his ears, closes his eyes, and sings loudly when mom (thyroid hormone) is telling him what to do.
The message may be out there loud and clear, but when your cells become resistant to thyroid hormone signaling, they are not getting the message. Thyroid hormone resistance is associated with inflammation, long-term stress, and insulin resistance.
Why would my body want to be hypothyroid?
Why does the body have so many ways and checkpoints to turn thyroid hormone activity up or down in our body? For our own good, of course. In interpreting our body's actions, it's important to remember we are still simply biological organisms. Beyond our comfort, aesthetic goals, or happiness, our body just wants to keep us alive in the hopes we may eventually reproduce.
So while it may not feel great, the body is turning up or down our thyroid hormone signaling and sensitivity to preserve our survival in the face of real or perceived threat or stress, too high or low other hormones, nutrient insufficiency, and inflammation.
In modern life, perceived threat, perceived stress along with inflammation are likely playing the greatest roles in the high incidence of hypothyroidism.
Autoimmune Hashimoto's Thyroiditis.
If you are expressing hypothyroidism symptoms or have low T4 or T3 levels, your doctor may then check you for antibodies against your own thyroid gland or other parts of the thyroid system. These include
Anti-thyroid peroxidase (anti-TPO)
Anti-thyroglobulin (anti-Tg)
Less commonly: TSH-receptor antibody (TRAb), Thyroid stimulating antiglobulin (TSI)
Autoimmune disease is caused by a complex mix of genetics, epigenetics, and environmental triggers that can vary from person to person.
While you can never get rid of antibodies once you have created them, you can heal from or at least better manage autoimmune hypothyroidism by addressing many of the same mechanisms that lead to the non-autoimmune form of hypothyroidism: by identifying and treating inflammation, nutrient insufficiencies, stress, and hormone imbalances.
How do you know if hypothyroidism is playing a role in your health issues? Head on over to part II in our hypothyroidism series to learn more about diagnosis.
Stay tuned for part III: Healing and improved management of hypothyroidism.
Want to get started addressing the underlying causes of your health conditions and feeling your best? Call us at 804-288-1111 or contact us here.