By: Cat Ebeling, RN, MSN-PHN, co-author of the best-sellers: The Fat Burning Kitchen, The Top 101 Foods that Fight Aging & The Diabetes Fix
Your thyroid gland is a small butterfly shaped gland that sits in your neck. It is responsible for important bodily functions such as breathing rate, heart rate, digestion, energy, weight gain or loss, and even your moods.
The thyroid gland produces hormones that regulate your body’s metabolism. These hormones are primarily, thyroxine (T4), and triiodothyroinine (T3). The correct balance of these hormones keeps your body’s functions running smoothly. The thyroid also produces cells called c-cells make calcitonin, which assists in calcium and bone metabolism.
When the body needs more or less of these hormones, the pituitary gland in the brain sends a hormone called “thyroid stimulating hormone” (TSH) that signals the thyroid to change the production level. High levels of TSH mean that the thyroid hormones are too low, and low levels of TSH mean that thyroid levels are too high.
Various conditions can affect the thyroid gland, and thyroid disease can develop when the thyroid makes too much or too little T3 and T4. Women – due to the complex balance between thyroid hormones and female sex hormones–tend to have thyroid problems more often than men or children; however, men, especially older men, can get thyroid problems as well.
Hypothyroidism is one of the most common thyroid disorders. This is “low” thyroid. This occurs when the thyroid does not produce enough T4 and T3. This can also occur when the thyroid cannot convert T4 into the more active thyroid hormone T3 for use in the body.
Symptoms of hypothyroidism include:
- Weight gain
- Fluid retention
- Muscle and joint pain
- Irregular periods
- Hair loss
- Feeling chilly all the time
- Slowed heart rate
- Fertility problems
Hypothyroid treatment usually involves supplementing with thyroid hormones—either just a synthetic T4 medication, like Synthroid, or a natural combination drug that includes T3 and T4, such as Armour thyroid, or Nature-Thyroid.
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the United States. Hashimoto’s is an autoimmune disorder where the body attacks the thyroid gland, and it becomes chronically inflamed. This happens most commonly in middle-aged women, but can affect men and children as well. Over time, this chronic inflammation develops into hypothyroidism, causing:
- Weight gain
- Sensitivity to cold
- Hair loss
- Muscle aches
Those with Hashimoto’s thyroiditis may not show any symptoms early on, but may have the thyroid (TPO) antibodies detected in blood tests. TPO is an enzyme that plays a role in the production of thyroid hormones.
Left untreated, Hashimoto’s can gradually become worse and destroy thyroid function. Treatment for Hashimoto’s is like treatment for hypothyroidism and individual’s take either a synthetic or natural form of thyroid hormones. A blood test for thyroid function needs to be done every 6-8 weeks to determine correct dosages for medication.
Hyperthyroidism is when the thyroid gland produces too much thyroid hormone. While this does occur more often in women, it can also occur in men—especially over the age of 60. The symptoms of hyperthyroidism are just the opposite of hypothyroidism. These include:
- Muscle weakness
- Feeling hot all the time
- Rapid, irregular heartbeat
- Weight loss
- Mood swings
- Bulging eyes
Hyperthyroidism treatment involves taking an anti-thyroid or beta-blockers (medication which slows the heart rate), radioiodine therapy, or surgery to remove the thyroid. If left untreated, hyperthyroidism can cause serious heart, muscle, bone, fertility, and other health problems, because the body goes into overdrive with hyperthyroid conditions.
The most common disease related to hyperthyroidism is a condition called Graves’ disease. This autoimmune disease causes the immune system to attack the thyroid, causing the gland to produce too much thyroid hormone.
Graves’ can create complications in many parts of the body, from the eyes and skin to the heart and bones.
One of the most serious complications of Graves’ disease is something called a “thyroid storm”. A thyroid storm is a life-threatening condition that can happen when Graves’ disease is not treated. It often develops in patients with long-standing hyperthyroidism. It can flare up when there are other stressors in the body, such as heart attacks or even infections. It can also occur following radioactive therapy for hyperthyroidism or from irregular use of anti-thyroid medications. Symptoms include a pounding heart, shaking, sweating, agitation, and confusion. Immediate emergency treatment is critical—a thyroid storm can cause cardiac arrest and death.
Causes of Thyroid Malfunction
1. Gluten – Gluten has been found to be linked to many cases of Hashimoto’s thyroiditis and hypothyroidism. There are several studies show a strong link between autoimmune thyroid disease (AITD), including Hashimoto’s and Graves’ disease, and gluten intolerance. This connection is well-established in the medical community and researchers strongly recommend that all people with AITD be screened for gluten intolerance.
How does this work? It’s a case of the body mistakenly identifying components of gluten in wheat, rye, barley, and other grains, for the thyroid gland. Gliadin, which is one of the protein components that make up gluten, resembles thyroid tissue. Repeated ingestion of wheat creates inflammation in the gut (whether you react to it or not). Chronic gut inflammation can cause tiny holes in the gut, where tiny particles of food can leak outside of the gut. When gluten is eaten, the gliadin from the gluten escapes the gut barrier and gets into the bloodstream, and the immune system attacks it. These same antibodies become activated to attack the thyroid tissue.
The immune response to gluten can last for 6 months each time you eat it. So, if you have any type of thyroid problems, it is critical for you to eliminate ALL gluten from your diet. Being mostly gluten—free will not help your gut or your thyroid function.
Standard lab tests for gluten are not very accurate. They only test for antibodies to gluten in the bloodstream. Antibodies for gluten in the blood are only found when the gut has been damaged to the point where the gluten is escaping the gut, which is a relatively advanced stage of this sneaky disease. Blood tests will miss the milder or early cases.
Additionally, when you are tested for celiac disease, you are tested for only ONE specific gliadin, alpha gliadin and tissue transglutaminase, tTG-2.
- People can react negatively to other components in gluten that are not included in the standard celiac/gluten intolerance test. And this includes your thyroid function.
- Even if you test negative for celiac disease you can have serious negative reactions to other wheat proteins or transglutaminases—which all can cause inflammation and problems with the thyroid gland.
- For every positive gluten test, there are many more that go undiagnosed—many with NO gastrointestinal symptoms at all.
If you have any symptoms of the above hyper- or hypo-thyroid conditions, it is best to avoid gluten totally. Partially avoiding it will not help your condition.
2. Hormone Imbalance
We often think of our sex hormones as functioning totally separately from the thyroid hormone. However, thyroid hormones are affected by estrogen, progesterone, and cortisol levels.
Women’s sex hormones — especially progesterone —can have a strong influence on the conversion and effectiveness of thyroid hormones. When sex hormones are out of balance, it will generally lead to hypothyroid symptoms, including weight gain, fatigue, and hair loss—even when your lab work tests in the normal ranges.
For women, the healthy hormonal balance between estrogen, testosterone and progesterone can become unbalanced after childbirth, from using oral contraceptives, or during perimenopause.
During perimenopause (the 10 or so years prior to menopause), women’s hormones begin to shift in as progesterone levels can drop quickly to about 75% of the previous levels. Estrogen decreases more gradually and can remain high, throwing off the delicate balance that exists. This causes a condition called “estrogen dominance”. The result is higher estrogen levels in relation to progesterone. Many of the typical perimenopause and menopause symptoms are often because of estrogen dominance.
When estrogen levels are high and progesterone levels too low, the liver increases production of a protein called thyroid binding globulin or TBG. TBG binds up the free thyroid hormones in your blood. TBG basically holds thyroid hormones hostage, and they don’t get to your cells where they need to. Instead, you get symptoms of low thyroid. The frustrating thing is that your thyroid lab work can look perfectly normal unless testing is done to look at the levels of TBG.
People who are hypothyroid also tend to overproduce estrogen and their body cannot detoxify as well, causing higher than normal levels of estrogen to accumulate in their body. So, this creates an ever-worsening problem. Regardless of the mechanism, you end up with long-term exposure to high levels of estrogen. Long term exposure to high levels of estrogen without enough progesterone to balance it out, can create serious health problems including diabetes, uterine fibroids, ovarian and breast cancer. In addition, prolonged exposure to an overabundance of estrogen (in relation to progesterone) is shown to significantly increase the production of Hashimoto’s thyroiditis antibodies, leading to Hashimoto’s thyroiditis.
Progesterone also helps to facilitate the action of the thyroid hormones, while estrogen is antagonistic to thyroid hormone. So, women with low progesterone and high estrogen have a more difficult time getting the thyroid hormone to do its job.
Solution: Depending on hormone levels and a woman’s age, natural over-the-counter progesterone cream can be applied to the skin to help bring estrogen and progesterone levels back into balance. In turn this can help thyroid function return to normal.
3. Cortisol, Stress and Thyroid Hormones
By now we should all know that high levels of stress can cause increased cortisol. High cortisol can have wide-ranging effects including thinning of the bones, muscle wasting, weight gain, metabolic syndrome, high blood sugar, compromised immune function, memory loss and more.
Stress and cortisol also slow down immune function. High cortisol can inhibit secretion of TSH (thyroid stimulating hormone) from the pituitary gland, leading to suppression of thyroxine, which is the main hormone produced by the thyroid gland. Increased cortisol can shift the thyroid into an inactive state, elevating reverse T3, instead of the proper conversion of T4 into T3.
Chronic stress also has a big effect on progesterone levels. When your body is stressed, it works to produce higher levels of the hormone cortisol which helps to handle stress in your body. Progesterone is a master hormone and a precursor to cortisol. So, when cortisol levels increase, progesterone levels decrease, and this also causes problems with hypothyroid and puts you more at risk for Hashimoto’s thyroiditis.
Receptors for all progesterone, thyroid and cortisol are in nearly every cell of the body, so the relationship between them and the adrenal gland, thyroid, and pancreas is critical for energy production and balanced physiology.
Solution: Vitamin C helps cortisol, as does meditation and exercise to relieve stress. Women may benefit from a natural progesterone cream as well.
4. Birth Control Pills and Hormone Replacement Therapy
Hormone replacement therapy at any point in a woman’s life, can create thyroid problems by creating an overabundance of estrogen in the body. This also slows production of the body’s natural progesterone, creating chaos in the endocrine system.
This creates a similar situation to the above, with low progesterone, high estrogen, and lowered levels of thyroid. High levels of estrogen also contribute to a rise in Hashimoto’s thyroiditis. Generally, this happens far more often with oral contraception, as opposed to dermal patches or sublingual treatments.
For women on long term birth control, estrogen in birth control pills increases the amount of thyroid binding proteins available to bind to thyroid hormone. What does this mean? If you have a lot of thyroid hormones bound to TBG, you’ll have less free T4 in your body that’s able to do its job.
And be aware, that if you are on birth control and you need medication for hypothyroidism, you might need a higher dose of thyroid medication to get to your normal thyroid levels. TBG starts to increase around two weeks after starting oral contraceptives.
Anyone who is taking thyroid medication, whether it’s synthetic T4 or T3, should be monitored for six to eight weeks after the oral contraceptives are started, to check thyroid hormones. If symptoms of hypothyroidism appear in a woman taking HRT or birth control pills, the best treatment, if possible, is to stop the treatment or birth control pill and see if symptoms disappear.
Women who have Hashimoto’s thyroiditis and start on birth control pill, will most likely need more thyroid hormone as estrogen contained in the pill works against it. Women who are on any type of birth control pill may need to have a full thyroid panel done to check thyroid function frequently.
5. Nutritional Deficiencies
Believe it or not, nutritional deficiencies, even slight ones, can have a drastic effect on thyroid hormones. Inadequate intake of iodine impairs thyroid function and results in a spectrum of disorders. Other common deficiencies of micronutrients such as iron, selenium, vitamin A, and possibly zinc may interact with iodine nutrition and thyroid function.
Iodine is the main component in T3 and T4 hormones. But our bodies cannot produce iodine on their own, so it is essential to get enough iodine through the diet. In the United States and other countries, iodized salt was introduced many years ago, helping to eliminate problems with too little iodine in the diet. Other common deficiencies of micronutrients that affect thyroid function include iron, selenium, vitamin A, and zinc which all interact with iodine uptake and thyroid function.
Goitrogens are naturally occurring chemicals found in many plant-based foods. Goitrogens interfere with thyroid hormones and can cause thyroid malfunction. Consuming large amounts of these substances on a regular basis can affect thyroid health. The key goitrogen-rich foods include cruciferous vegetables, some types of fruit, nuts, and soy.
There are three types of goitrogens: goitrins, thiocyanates, and flavonoids. Some of the more common foods that contain goitrogens include:
- Cruciferous vegetables such as broccoli, brussels sprouts, cabbage, bok choy, cauliflower, collard greens, radishes, kohlrabi, turnups and arugula.
- Cassava (this is an ingredient very common in gluten free/no grain products)
- Pine nuts, peanuts
- Soy products such as tofu, tempeh, edamame, and soy milk
Foods that contain goitrogens disrupt thyroid hormones by slowing down the body’s ability to iodine. Goitrogens can block the process by which iodine is incorporated into the key thyroid hormones T3 and T4.
Goitrogens can also inhibit the release of thyroid hormone by the thyroid gland and block the conversion of T4 into active thyroid hormone T3. In very large quantities, goitrogens can cause a goiter on the thyroid gland and act like anti-thyroid drugs, slowing down an underactive thyroid causing hypothyroidism.
Soy foods generally do not affect the thyroid function in people who have normal thyroid function and healthy iodine levels, but soy does interfere with absorption of thyroid hormone replacement medication. It is recommended that patients on medication for hypothyroidism take their thyroid medication on an empty stomach an hour so before eating.
Eating a diet low in nutrient dense foods or following a restrictive diet may lead to other nutritional deficiencies that affect thyroid function. The following supplements may help to support thyroid health:
Iodine provides the building blocks of thyroid hormones, and is essential to healthy thyroid function. Beware of too much iodine, however, especially if you Hashimoto’s, because this can stimulate the autoimmune antibodies.
Selenium is a critical element of thyroid hormone production. Selenium helps the thyroid convert T4 into T3. Selenium also helps to reduce thyroid antibodies that attack the thyroid.
Vitamin D deficiency has been linked to Hashimoto’s disease and helps to manage and balance hormones.
Zinc is necessary for DNA synthesis and immune function. This vital mineral is also needed for the conversion of T4 into active T3, as well as the production of TSH. Zinc is also required for the T3 receptor to adopt its biologically active status.
Iron is important to prevent iron-deficiency anemia, and helps to move iodine to the thyroid gland to create more thyroid hormone. Iron deficiency is associated with thyroid dysfunction.
Vitamin B12 is common in people with hypothyroid and Hashimoto’s disease. Taking a B12 or B complex supplement can help prevent and treat deficiency, as well as maintain optimal B12 levels. Be sure to take a supplement that contains methylcobalamin, the most absorbable type of B12. It is thought that B12 absorption may be affected by the presence of gluten sensitivity.
Magnesium is an often-overlooked critical mineral. Magnesium is responsible for more than 300 biochemical reactions in the body. Magnesium supports the immune system, helps maintain normal nerve and muscle function, regulates the heartbeat, strengthens bones, keeps blood glucose levels steady and plays a role in the production of energy. Magnesium is necessary for iodine utilization by the thyroid gland.
Dietary changes can have a positive effect on thyroid conditions. Some of the most important ones include:
- Adopt a gluten free diet—If you have ANY type of thyroid issues, whether it may be hyper- or hypothyroid; Hashimoto’s or Graves, it’s important to avoid ALL gluten in the diet. Gluten has been found as a contributing factor in a large percentage of thyroid conditions. Avoiding gluten 100% is the only way to avoid the inflammation that gluten can cause.
- Anti-inflammatory diet—Following an anti-inflammatory diet can be highly beneficial for anyone with Hashimoto’s disease and improving gut health. Avoid omega 6 vegetable oils, all forms of sugar, and other foods that trigger an immune response such as nightshades, dairy, grains, and even legumes, especially soy products.
- Organic foods—Eating organic foods will help you avoid environmental triggers that can harm the thyroid gland and contribute to thyroid problems.
- Reduce your intake of goitrogens—While cruciferous vegetables can be highly nutritious, reduce your intake of them and be sure to lightly cook them before eating. Avoid eating soy products as these foods are often from genetically modified soy, sprayed with pesticides—in addition to causing problems with thyroid hormones.
- Beware of ketogenic diets—Very low carb diets can negatively affect thyroid function. While this is not always the case for everyone, be aware that this type of diet may affect your thyroid function.
Proper Testing is Vital
There are many things that can negatively affect thyroid function. If you have any of the above thyroid symptoms: fatigue, weight gain, hair loss, depression, loss of appetite; or insomnia, racing heart, weight loss, nervous energy, and anxiety, be sure to get a full thyroid panel from your doctor. Just checking your TSH status will not always expose thyroid problems.
If you are on birth control pills, hormone therapy or are a woman experiencing perimenopause or menopause symptoms, it is wise to get your thyroid function tested completely. Often the same symptoms of menopause can be thyroid issues.
Interesting articles. I had Thyroid cancer 26 years ago and had a total thyroidectomy. I am 63 now. 5’6, 155 lbs. I have also had regular testing for my levels, and only really had a change of the meds twice.
Any comments on that? I am usually feeling well, once I got rid of the lectins in my diet, and the alcohol consumption article is making me reflect on how I drink. 2-3 glasses of wine a day..(I add ice too.). However when it is hot out, I cannot handle it.
I like this newsletter.. Thank you.