18 Strategies to Beat Hypothyroidism
One of the fastest rising health conditions in the US is hypothyroidism. The most common symptoms experienced are lethargy, depression and weight gain. More than 12% of the US population will develop a thyroid condition during their lifetime with most of these being hypothyroidism (1). In this article, I take a deep dive into thyroid physiology and go over 18 strategies to beat hypothyroidism naturally.
An estimated 27 million Americans have some form of thyroid disease. Up to 60 percent of those with thyroid disease are not aware of their condition. Women are five to eight times more likely than men to develop thyroid problems. 80% of hypothyroid conditions in the US are thought to be auto-immune conditions (2).
The Importance of the Thyroid:
The thyroid gland sits right under the top of the sternum at the base of the neck. From this seat it secretes hormones called T3 (triiodothyronine) and T4 (thyroxine). These hormones circulate in the blood stream and interact with every cell in the body.
Lack of ideal thyroid hormone function leads to a global decline in cellular functionality in all bodily systems. The thyroid is a central player in the complex web of human metabolism and is very sensitive to even minor imbalances in other areas of physiology. The thyroid gland is the most common site for the development of an autoimmune disease.
Hashimoto’s thyroiditis, is an autoimmune condition of the thyroid that is considered the most prevalent auto-immune condition (3). Hashimoto’s is said to account for up to 80% of all cases of hypothyroidism in the US (4).
Often times, this condition is misdiagnosed and improperly treated. This results in a continual worsening of the thyroid gland as it gets destroyed by the immune system. Overtime, these individuals decline in their basal metabolic rate and lose energy, mental function, mood and gastrointestinal motility.
The thyroid responds to messages from the hypothalmus and pituitary gland in order to get out and interact with the cells of the body. The hypothalmus is like the thermometer of the body, it is constantly checking the blood environment for optimal balance of hormones, nutrients and neurotransmitters.
When the hypothalmus decides we need more thyroid hormone in circulation (cold weather or increased activity level for example) it sends a chemical messenger called thyrotropin-releasing hormone (TRH) which goes to the pituitary gland. The pituitary than sends thyroid stimulating hormone (TSH) over to the thyroid. TSH activates the production of a protein called thyroglobulin.
TSH also activates an enzyme called thyroid peroxidase (TPO). This enzyme combines thyroglobulin, iodine and hydrogen peroxide to create both T3 and T4. About 93% of the hormone made in the thyroid gland is T4 with 7% being T3 (5).
T4 circulates through to the liver where 60% of it is converted into T3 through the glucoronination and sulfation pathways. If the liver is sluggish it will cause a problem in T4-T3 conversion (6). Another 20% is converted into reverse T3 which is permanentely inactive. The final 20% is converted into T3 sulfate and T3 acetic acid which can then be further metabolized by healthy gut bacteria to produce more active T3 (6).
Problems with T4-T3 Conversion:
One common problem with hypothyroidism is a poor T4-T3 conversion. As we have discussed, the thyroid produces 93% T4 and then the T4 travels into the liver for conversion to T3 and reverse T3.
The gut converts the other 20% of T4-T3. T4 is inactive and cannot perform the normal thyroid function. It must be converted to T3 to be used by the cells. Here are possible scenarios of why someone would have normal T4 but low T3:
1. Liver Problems: If the liver is sluggish than it will not be able to convert the normal 60% of T4-T3 by the 5’deiodinase enzymes. This will result in lower T3 levels. A sluggish liver could be due to a liver disease, an infection like Hep C, a toxic body, nutrient deficiencies, methylation and glutathione problems, etc (7, 8).
One common problem is estrogen dominance where the individual has taken into too many exogenous estrogen compounds from the environment through food, plastics, cosmetics, etc. This can cause the liver to become sluggish and unable to perform its role effectively (9, 10).
2. High Stress: When someone has high stress or trauma they will often overproduce rT3. rT3 is inactive and it functions to slow the body down (thyroid has a speeding up effect) which is necessary in times of stress or trauma for the body to heal.
Chronic stress can drive rT3 up for a prolonged period of time which results in less T3 activity with the cell and a functional hypothyroidism (11, 12). Low selenium and zinc can also drive up rT3 levels. Other causes of high rT3 may include iron-deficiency anemia and low B12 (13, 14, 15).
3. Gut Dysbiosis: 20% of the active T3 is formed in the gut. If the individual struggles with small intestinal bacterial overgrowth (SIBO) or Candida and they have an overpopulation of bad microbes it can result in lowered T3 formation (16).
On a lab test this sort of a problem can show up with TSH being normal or high, T4 is normal but T3 is low and T3 uptake is low. If you are testing for rT3, that can often be elevated in cases of low T3 uptake.
Free & Bound Thyroid Hormone:
Thyroid hormones (T4, T3, and RT3), in the bloodstream, exist either as protein bound or in a free form. The main protein that binds them is called thyroid hormone binding globulin (TBG) which acts as a sponge or reservoir to which hormones bind and then can be freed.
Hormone in free form is then available to interact with a cell’s receptor site to produce its hormonal effect. It is only the free form hormone that is biologically available or active. When the hormone is bound to a protein it is restrained from interacting with a cell’s receptor site.
Most of the hormone is bound to proteins (TBG, albumin and pre-albumin). Albumin has the lowest affinity and the fastest release at tissue sites. TBG has the highest affinity and the slowest release (17). It is important to differentiate and look at both Total T3 & T4 as well as free T4 & T3 to understand how well these hormones are interacting.
Anything that boosts estrogens (artificial sources can come from birth control pills, non-bio-identical hormone replacement, or pregnancy) or estrogen dominance can increase the amount of the protein that binds T4. This will produce misleading elevated Total T4 values which can look like ‘hyperthyroidism’ when it is not (18).
Auto-Immunity and Hypothyroidism
As we described before the thyroid is the most common organ that is effected by autoimmunity. The autoimmunity can be to either be to thyroid peroxidase (TPO antibodies) or to thyroglobulin (TGB antibodies). In some cases of severe autoimmune thyroid disease, antibodies to T4 and T3 can develop (19).
It is absolutely critical for any physician who is treating someone with a thyroid disorder to test for thyroid antibodies. Unfortunately, few mainstream medical doctors test for thyroid anti-bodies and so most do not ever get the proper diagnosis. In the medical system, an auto-immune condition, a sluggish thyroid, a burned out pituitary gland and a T4-T3 conversion problem are all treated the same way, with synthetic T4 such as synthroid or a T3 medication like levothyroxin.
Because the treatment is the same, most doctors do not concern themselves with testing for thyroid anti-bodies. From a natural health perspective it is especially important to understand if it is a sluggish thyroid, a sluggish liver or pituitary gland, elevated sex hormones or if it is an auto-immune condition.
Functional Lab Testing:
TSH: Reflects the blood level of thyroid stimulating hormone. Although clinical ranges are 0.5 – 5.0, the optimal function range is 0.8 – 2.0.
Total T4: Reflects the total amount of T4 present in the blood, i.e., the protein bound (unavailable) T4 and the Free T4. Estrogen dominance can create an effect where you have high total T4 even though you may have low free T4. This could be inaccurately diagnosed as hyperthyroidism.
Total T3: Reflects the total amount of T3 present in the blood, i.e., the protein bound (unavailable) T3 as well as the Free T3. Again, estrogen dominance creates the same effect as mentioned in relationship to T4 above.
Free T4: Reflects the biologically active (free) form of T4. This T4 can be converted to T3 or RT3.
Free T3: Reflects the biologically active (free) form of T3 that can generate production of energy (in the form of ATP). Typical functional lab range is 300-450 pg/ml RT3: Reflects the level of Reverse T3. As discussed above, this is inactive and raises during times of stress, fasting and trauma. This shouldn’t be over 30.
T3 Uptake: This measures the sites for active or unbound T3 to bind with proteins. The more binding sites that are open, the lower the uptake result will be. High testosterone can cause high T3 uptake because it lowers binding sites. Meanwhile, estrogen dominance increases binding sites leading to higher T4 and lower T3 uptake.
Free Thyroxine Index: This test looks at total T4 and T3 uptake to measure the activity of free or unbound T4. If TT4 is low than T3 uptake should be high and if TT4 is high than T3 uptake should be low. Functional range is between 1.2-4.9 mg/dl.
Antibodies: Autoimmune thyroid disease falls into two main categories: Hashimoto’s Thyroiditis and Grave’s Disease. Hashimoto’s Thyroiditis is typically identified by checking antibodies that attach the thyroid tissue.
We find Antithyroglobulin Antibody (TG Antibodies) in 70% of the cases and Thyroid Peroxidase (TPO) antibodies are found in 95% of the cases. Grave’s Disease is typically diagnosed using Thyroid-Stimulating Immunoglobulin (TSI) and TSH-Binding Inhibiting Immunoglobulin (TBII). These are different names for the same test.
Most cases of hypothyroidism are characterized by a hyper responsive immune system and autoimmunity. There are several key factors that must be addressed to regulate and better coordinate the immune system.
1. Poor Blood Sugar Stability: Blood sugar imbalances cause immune dysfunction and malcoordination. Stable blood sugar is critical for a healthy immune response.
4. Mitochondrial Dysfunction: The mitochondria are the energy producing organelles in each cell of the body. They are extremely key in the bodies ability to handle oxidative stress. Dysfunction in the mitochondria leads to increased free radical and oxidative stress which creates immune alterations. This is a classic sign in Hashimoto’s autoimmune pathophysiology (22).
5. Low Glutathione Levels: Glutathione is the major anti-oxidant within every cell of the body. It is critical for white blood cell (WBC) function as the WBC’s encounter tremendous amounts of free radical and oxidative stress every second of the day. Low glutathione leads to chronic inflammation and often to auto-immunity (23).
6. Poor Omega 6:3 ratio: The average person has significantly more omega 6 fats than omega 3 fats. The increased omega 6 stimulate the release of pro-inflammatory mediating prostaglandin molecules. This is a key factor in the development of chronic inflammation and auto-immunity (24).
7. Upper Cervical Subluxation: The bottom of the skull (occiput) and the first bone (atlas) play a significant role in the coordination patterns of the brain and immune system. Dysfunction at this joint torques and compresses the top of the spinal cord and increases inflammatory activity in the body (25).
8. Environmental Toxins: Exposure to high levels of infectious microbes, environmental chemicals such as plasticizers, pesticides, herbicides, personal care products, heavy metals and biotoxins such as mold wear down the bodies glutathione levels, alter the gut microflora and increase inflammatory activity in the body (26, 27, 28).
9. High Stress and Poor Breathing Habits: High mental and emotional stress increases stress hormone production which induces inflammatory activity within the body. Short and shallow breathing habits can simulate chronic mental and emotional stressors on the physiological level (29).
10. Lack of Sleep: Poor sleep promotes immune dysfunction and increased inflammation. Good sleeping habits and optimal melatonin secretion reduce inflammation and promote improved tissue healing (30).
11. Methylation: Methylation is a key process that protects DNA, turns on and off genetic traits and helps to detoxify environmental chemicals. Many individuals have certain genetic polymorphisms that limit their ability to appropriately methylate. Methylation plays a very important role in T cell function and poor methylation status is associated with the development of auto-immunity (31).
12. EMF Exposure: Electromagnetic frequency exposure has been shown to alter the function of the immune system and increase one’s susceptability to developing an auto-immune condition (32) I will touch on a few of these key areas and how they relate to hypothyroidism in this article.
Environmental Toxins and Thyroid:
The thyroid gland is one of the most sensitive regions of the body to environmental toxins. The most common environmental toxins affecting thyroid function include:
1) Industrial Pollutants: This includes the various pollutants we find in our air, food and water that negatively effect the immune system and thyroid function. These come from our vehicle emissions, industrial chemical waste and chlorine in our water supply. Pesticides, herbicides and artificial chemicals in our food supply (33, 34, 35).
2) Ionizing Radiation: We are exposed to these through medical devices such as CT scans and mammograms, microwaves and cell phones. We also are exposed to ionizing radiation when we fly in an airplane.
There is also thought to be nuclear radiation from powerplant explosions that is around us in varying amounts depending upon our geography. All ionizing radiation has a negative effect on thyroid function (36).
4) Perfluorooctanoate (PFOA) These are dangerous chemicals found in non-stick style pans. Be sure to avoid all non-stick pans and especially those that are not labeled as PFOA free (40).
5) Fluoride: Fluoride is a halogen that competes with iodine uptake in the thyroid gland. Iodine is needed for the production of thyroid hormones. Fluoride is found in tap water, toothpaste, & many processed foods (41).
6) Bromide: Like fluoride, bromide is a halogen that competes for iodine uptake in the thyroid gland. Bromide is found in soft drinks and baked goods (42).
7) Inflammatory Foods: This includes industrial vegetable oils, high omega-6 fatty acids, GMO’s, added sugar and artificial sweeteners, preservatives, gluten and soy containing foods.
Key Nutrients Needed:
Iodine: Iodine is critical for thyroid hormone production in the body. A true iodine deficiency will cause hypothyroidism (43). In western culture we often see subclinical iodine deficiencies which contribute to hypothyroidism (44). I typically don’t recommend high doses of iodine as it could be problematic with individuals with Hashimoto’s – especially with TPO anti-bodies.
I almost always have my clients take high doses (200-400 mg) of selenomethione each day and this reduces antibody formation and allows for better iodine utilization in the thyroid (45).
I have my clients get their iodine from a tsp of high quality sea vegetable each day in the form of kelp, dulse, nori and dulse. Kelp is the richest source of iodine, so if the client is very iodine deficient, kelp usage gets the levels up the quickest.
Tyrosine: L-Tyrosine is the key amino acid for the production of thyroid hormones. This provides the necessary raw material for the formation of the backbone of thyroid hormone.
Vitamin A: The thyroid hormone binds to thyroid receptors and undergoes a process called intercellular transduction (46). This carries the message of binding to the nuclear receptors. Thyroid hormone nuclear transcription is dependent upon vitamin A in order to be activated (47).
Selenium: Selenium is one the MOST IMPORTANT when it comes to healthy thyroid function! It is incorporated into key enzymes involved in several metabolic pathways implicated in thyroid hormone metabolism; additionally, it plays an antioxidant role in the regulation of the immune system. There are strong links between selenium deficiencies and auto-immune thyroid problems (48, 49).
It has been hypothesized that these compounds activate a complex defense system that maintains normal thyroid function by protecting the gland from both hydrogen peroxide (H2O2), produced by thyrocytes and oxidative stress. This is the major cofactor for the key thyroid enzyme 5’deiodinase which is what converts T4 into T3. 5’deoidinase also degrades the inactive rT3.
Studies have indicated that individuals with lower selenium levels are at higher risk for low T3 (50). Selenium has been shown to reduce rT3 levels and improve active T3 status (51). It also reduces anti-thyroid anti-body formation (52). Be sure to get selenomethionine which is the most effective form of selenium for reducing anti-body formation and improving thyroid function.
Zinc: Low zinc status has been shown to compromise T3 production. Zinc plays an important role in immune modulation which may reduce thyroid anti-bodies (53). Additionally, it is a key player in 5’deiodinase activity.
Riboflavin – B2: Hypothyroidism induces the symptoms of riboflavin deficiency. This is because thyroid hormone is needed for production of the enzyme flavin kinase, which is in turn needed to generate flavin adenine dinucleotide (FAD). Riboflavin deficiency and thyroid hormone deficiency lead to the same low FAD levels in both rats and humans.
Vitamin B6: Pyrodixal 5’phosphate is a co-enzyme participating in more than 100 enzymatic reactions in the human body. The activity of the hypothalamic-pituitary-thyroid axis in the setting of vitamin B6 deficiency has been studied in rats (54).
Well-conducted experiments have shown that vitamin B6 deficiency leads to hypothyroidism. B6 supplementation also helps quite an overactive immune system which is helpful in cases of auto-immune thyroid disorders (55).
Blood Sugar Balance:
Blood sugar imbalances are major contributers to the development of hypothyroidism. When our blood sugar gets too high (hyperglycemia) the sugar molecules bind to proteins in the body and create Advanced Glycolytic Enzymes (AGEs) (56). The AGEs destroy cell membrane function and damage insulin receptor activity creating a vicious cycle of elevated blood sugar and inflammatory stress.
AGEs cause massive destruction throughout the body and have an affinity for thyroid tissue. Elevated HgA1C (a measure of glycation) is correlated with increased TSH and decreased free T3 & T4 (57). When the blood sugar drops too low (hypoglycemia), it increases stress hormone (cortisol and adrenaline) to boost up blood sugar. Cortisol directly inhibits the enzyme (5’-deiodinase) which converts inactive T4 into active T3.
This can lead to low T3 levels (58). In addition, elevated cortisol will cause thyroid hormone receptor insensitivity meaning that even if T3 levels are high enough, they may not be able to bind normally to receptor sites. And when this happens it doesn’t get into the cells. Cortisol will also increase the production of reverse T3 (rT3), which is inactive (11).
The MicroBiome and Thyroid Disease:
The gut microbiome is made up of over 1000 different species of microbes and it plays a huge role in nutrient absorption, detoxification and the development and maturation of the immune system (21). Certain bacteria of the gram negative classification are known to release a potent inflammatory mediator called lipopolysaccharide (LPS).
Individuals with hypothyroidism and Hashimoto’s are known to have dysfunctional characteristics involved in their microbiome (59, 60). Elevated levels of LPS have been shown to affect pituitary TSH stimulation, T4 production and TBG production.
Gluten and Thyroid Disorders:
Gluten is the common protein found in wheat, barley, & rye. Gluten is a sticky, storage protein that is challenging for the digestive tract because it binds to the small intestinal wall where it can cause digestive and immune system disorders. Gluten sensitivity is an epidemic that is a major contributing factor with inflammatory and autoimmune diseases (61, 62).
Gluten intolerance is highly associated with inflammatory disorders of all kinds (63). It is also a contributing factor in many autoimmune diseases such as celiac disease, rheumatoid arthritis, type I diabetes, Hashimoto’s thyroiditis, autoimmune cardiomyopathy, lymphoma and dermatitis herpetiformis (skin disease) among others (64, 65). If you have a thyroid problem or just want to avoid having a future thyroid problem, the first place to start is on a gluten-free nutrition program!
An anti-inflammatory lifestyle is critical for full recovery from hypothyroidism. Anti-inflammatory foods help to modulate the immune system and give it a more accurate pair of eyes so as to not over-inflame when stimulated. To effectively de-inflame one must completely avoid man-made foods, sugars, and food sensitivities as listed above.
This nutrition plan is rich in phytonutrient dense vegetables, healthy fat and clean protein sources. Non-starchy vegetables, herbs, & teas are great sources of anti-oxidants. Healthy fat sources include coconut products, grass-fed ghee, avocados, olive oil, nuts, seeds, & purified omega-3 fish oil supplements.
Healthy protein includes wild-caught fish, grass-fed red meat and free range chicken, turkey and eggs (although these are usually eliminated for the first 30 days and then added slowly to see if the individual is able to tolerate them). Be careful to watch for any hidden food sensitivities.
Tips For Improving Hypothyroidism:
Here are the best action steps to get started with on your journey to prevent and/or beat Hypothyroidism. You should always consult with your physician before stopping or changing medications or taking on new health strategies. Additionally, you should be working with a functional health practitioner to help guide you through these strategies.
This is not an exhaustive list and there are other natural therapeutic strategies that I and functional health practitioners will utilize to help individuals with Hypothyroidism.
1) Change Your Diet: Most thyroid problems are related to auto-immunity and leaky gut with multiple food sensitivities. It is key to follow an Anti-Inflammatory nutrition plan here for 90 days and try to choosing fresh or frozen organic food as much as possible.
2) Improve Your Sleep: Sleeping a high quality 8-9 hours each night is key to healing and improving thyroid function and reducing any form of auto-immunity. Follow the steps in this article to improve your sleep.
3) Include Magnesium & B Vitamin Rich Foods: Magnesium helps to improve blood sugar signaling patterns and protects the blood-brain barrier. The best magnesium and B vitamin rich foods include dark green leafy veggies, grass-fed dairy, raw cacao and pumpkin seeds. If you can tolerate these foods (don’t have food sensitivities to them or problems with oxalates or high histamines) than consume as staple parts of your diet. You can also do Epsom salt baths to boost your magnesium levels.
4) Reduce Stress: Find ways to reduce stressful activities and enjoy more peace and calm. Learn to thrive under stress by reading this article here
5) Focus on Deep Breathing: Improving your posture, seeing a high quality chiropractor and optimizing your breathing patterns is highly recommended. Follow these tips here to improve your breathing patterns.
6) Use Anti-Oxidant Rich Herbs: Add turmeric, ginger, oregano, garlic, basil, thyme, kelp and rosemary to as many dishes as possible and drink organic herbal teas on a regular basis.
7) Test For Food Sensitivities: You can do a biofeedback test to determine what foods are causing stress in your system and an elimination diet to test how you are responding to eliminating certain foods for periods of time.
8) Supplement With Omega 3’s: Omega 3 fatty acids and in particular the long chain variety EPA and DHA are critical for stabilizing blood sugar, reducing inflammation and taming the immune system. Consume grass-fed meat, grass-fed butter, wild-caught fish and spirulina to get it in your diet. It is also advisable to supplement with 2-5 grams daily of EPA/DHA along with 200 mg of GLA. Clinically, I use ProEFA to boost up omega 3’s.
9) Improve Your Mitochondria: The mitochondria are the energy powerhouses of every cell. When someone has a thyroid disorder and especially Hashimoto’s it is a clinical sign that they have dysfunctional activity going on in the mitochondria. Support your mitochondria with clinical doses of CoQ10, L-carnitine, N-acetyl cysteine and Lipoic acid. The supplement I use with my autoimmune clients is Brain Supercharge which has the clinically effective dosages of each of these key nutrients and more.
10) Optimize Your Vitamin D: Be sure to increase your vitamin D through good amounts of regular sun exposure and/or taking a high quality vitamin D3/K2 supplement.
11) Practice Oil Pulling: Oil pulling helps to reduce the microbial load in your mouth. This takes stress off of the immune system and reduces inflammation levels throughout the body. Read more about oil pulling here and practice this 2x daily.
12) Get a Home Water Filtration System: Very important to avoid the chloride, fluoride, pesticides, heavy metals, etc. that are found in tap water. Use a good whole home water filtration system as discussed in this article here
13) Low Intensity Movement: A sedentary lifestyle reduces cerebrospinal fluid flow and can lead to increased oxidative stress in the brain. Throughout the day, get a lot of low-intensity movement such as walking, light cycling, playing, etc. Regular movement will help reduce inflammation and boost the development of new neurons in the brain.
14) Improve Your Gut Motility: Improving bowel movement frequency and consistency is a key detoxification concept. Consuming an anti-inflammatory diet with good fiber sources such as chia seed and flax seed, using bone broths, fermented foods and probiotics will improve bowel motility.
15) See a Chiropractor: Have a full neurological exam and see a high quality chiropractor to help reduce stress on the nervous system and enhance overall well-being.
16) Juice Your Veggies: Juicing is one of the best ways to get high quality anti-oxidants and powerful phytonutrients into your system. Here is my article on Best Juicing strategies.
17) Liver Detoxification Support: Individuals with thyroid problems most often have a sluggish liver. Supplementing with nutrients to boost glutathione such as N-Acetyl Cysteine, Alpha Lipoic acid and milk thistle can be of great support. I use Thyro-Liver protect with my thyroid clients.
18) Use Essential Oils: The anti-oxidant content and aromatherapy benefits of essential oils help to improve oxygenation and reduce the harmful effects of oxidative stress throughout the body. Some of my favorites for thyroid function include lavendar, frankincense and peppermint among others. Put a drop on your hands and mix together and then cover your nose and inhale the healing vapors. This will stimulate your brain and increase blood flow to your cranium. You can also rub them on the skin around your neck and thyroid region to reduce inflammation.
Healthy Thyroid Pack:
Most thyroid issues are related too leaky gut, chronic inflammation, toxicity and micronutrient deficiencies. The supplements included in this pack help to improve gut function, reduce inflammation, gently eliminate toxins and provide highly bioavailable nutrients to support thyroid function.