Thyroid Regulation

The thyroid gland is a butterfly-shaped organ located in the neck. Its main function is to produce thyroid hormones, which control the body’s metabolic rate. The thyroid gland uses iodine (mostly available from the diet in foods such as seafood, bread, and salt) to produce thyroid hormones. The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3). While a small amount of T3 is actually made in the thyroid gland, most of it is converted in the tissues from the T4 released from the thyroid gland into the blood. T3 is the active hormone that affects the metabolism of cells.

An excess of thyroid hormones (hyperthyroidism) overstimulates the body, resulting in increased heart rate, anxiety, and weight loss, while a lack of thyroid hormones (hypothryoidism) can cause depression, sluggishness, weight gain, and heart failure. Hyperthyroidism is rare (affecting about 1 percent of the population), while mild, subclinical hypothyroidism may be much more common than most people think.

Subclinical hypothyroidism is estimated to occur in a significant percentage of the adult American population (Hollowell JG et al 2002). One side effect of thyroid deficiency is high cholesterol. It is very possible that many people are being prescribed cholesterol-lowering statin drugs while their underlying problem—low thyroid function—goes unaddressed.

The most common cause of overt hypothyroidism in the United States is an autoimmune disorder known as Hashimoto’s thyroiditis (Lorini R et al 2003). This condition is characterized by an overactive immune system response that floods the thyroid gland with white blood cells that attack the gland. Hashimoto’s thyroiditis is more common in women than in men, and there is a genetic component to the disease.  Worldwide, a lack of dietary iodine is the leading cause of hypothyroidism (Delange F 1998). Iodine is necessary for the synthesis of thyroid hormones. Since table salt was iodized in the United States, lack of dietary iodine has not been a major problem, though cases of iodine deficiency are still reported. In recent years, the concern about too much sodium has led many to restrict salt resulting in lower iodine intake.  Besides iodine, thyroid function can be affected by a number of nutrients, including zinc and selenium. Deficiencies in either of these have been shown to increase the risk of hypothyroidism.

Standard blood tests are inadequate and may miss many cases of subclinical hypothyroidism.  Additional tests to r/o Hashimoto’s and defects in the conversion of T4 to T3 are required.  An iodine stimulation test may be needed to diagnose iodine deficiencies.

Low levels of thyroid hormone may result in a host of medical problems ranging from weight gain, poor energy, cardiac insufficiency, high blood pressure, high cholesterol, impaired glucose metabolism, depression and psychiatric disorders, musculoskeletal pain, infertility and reproductive disorders, pregnancy complications and, in severe cases, death.

The most common treatment for low thyroid hormone levels consists of thyroid hormone drug replacement therapy. The goals of thyroid hormone replacement are to relieve symptoms and to provide sufficient thyroid hormone to decrease elevated TSH levels to within the normal range (Hennessey JV et al 1986).  Most commonly, clinicians give a drug which only contains T4 expecting the body to convert the T4 to the active hormone T3.  This conversion requires many nutrients and is inhibited by stress. Clinical trials report patients feel better when a combination of T4 and T3 are given. Additionally, iodine, zinc, selenium, Vitamin C, copper and Vitamin E may be deficient and could result in incomplete relief of symptoms and may need to be replaced as well.  Proper doses of nutrients are critical to avoid the side effects of incorrect replacement and proper training is crucial for a successful outcome.

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