“Unfortunately, the thyroid has been misdiagnosed, mismanaged and misunderstood since the 1970s when the TSH test was brought in as the gold standard in thyroid testing,” explains leading Sydney Naturopath Victoria O’Sullivan.
She suggests that the poor diagnosis of thyroid disorders comes down to the fact that here in Australia (and many other countries) the first point of screening is limited to TSH or thyroid stimulating hormone thyrotropin.
“The vast majority of pathology labs consider a thyroid stimulating hormone (TSH) test of .5 to 4.2 as normal, whereas if the normal range of the TSH test were reduced from 4.2 to 3.0 mIU/L as recommended by some professional societies, a much larger pool of people would be diagnosed and treated for hypothyroidism,” says O’Sullivan.
“The problem with this is that many cases of hypothyroidism are actually due to an autoimmune disorder called Hashimoto’s thyroiditis. In the early stages of Hashimoto’s disease, thyroid function can switch from ‘hypo’ to normal and even ‘hyper’. Unfortunately, TSH levels will sit within reference ranging for many years before the damage to the thyroid gland has gone far enough to cause permanent dysfunction and altered TSH levels.”
How is low thyroid function diagnosed?
“Functional ranges assess risk for disease before it develops looks at all of the driving factors for a patient’s potential thyroid issue,” says O’Sullivan, who herself uses scientific based methodologies to identify and naturally remove underlying causes and restore normal thyroid function.
“One of the most definitive ways to diagnose a thyroid problem is through full thyroid panel (serum TSH, T4, T3 and thyroid antibodies) blood testing. A thyroid ultrasound is also an essential tool to determine the structure of the gland and define any physical abnormalities within the gland.”
O’Sullivan also takes the step, prior to serum thyroid testing, of doing basal temperature testing, which while not definitive can be helpful, along with symptoms, in putting the story together.
“Basal body temperature is a good overall indicator of thyroid status and may also give us some information as to the patient’s response to treatment. If the thyroid is functioning optimally, basal body temperature should ideally fall between 36.5 – 36.9 degrees Celsius,” says O’Sullivan.
What are some of the symptoms of low thyroid function?
The most common signs and symptoms of hypothyroidism are fatigue, increased sensitivity to cold, constipation, dry skin and weight gain.
Other symptoms include muscle aches and weakness, infertility, hoarseness, brittle hair and nails, irregular or heavy menstrual periods, cognitive impairment, memory loss, depression, increased blood cholesterol (LDL) results and the development of a goitre, which can lead to difficulties swallowing or breathing.
Underlying causes of thyroid problems in women
The naturopathic approach is to fix the root cause of the thyroid problem and O’Sullivan says there are several common causes behind different thyroid conditions.
Autoimmune thyroid disease – The most common cause of hypothyroidism is an autoimmune disease known as Hashimoto’s thyroiditis. However, other autoimmune diseases such as Type 1 Diabetes, coeliac disease and rheumatoid arthritis can increase the risk of autoimmune thyroid disease.
Central or pituitary hypothyroidism – A condition where the thyroid just isn’t making enough hormone, O’Sullivan says this is often influenced by environmental and nutritional factors such as gastrointestinal system inflammation, vitamin and mineral deficiencies or imbalances, high levels of cortisol and elevated oestrogen.
Euthyroid sick syndrome – This condition occurs during episodes of illness including systemic illness, fasting/starvation, major operation, and numerous additional health conditions. The main feature of this syndrome is a fall in fT3 levels with normal TSH.
Post-therapeutic hypothyroidism – A condition resulting from the treatment of hyperthyroidism with radioactive iodine or surgical removal of part or all of the thyroid gland. This type of treatment can leave the patients’ thyroid unable to produce enough thyroid hormone.
The key drivers of low thyroid function
Nutritional deficiencies – Iodine, selenium, and vitamins A and E are required for optimal thyroid function. Low levels of vitamin D are associated with increased thyroid autoimmunity.
Inflammation – Elevated tumour necrosis factor alpha (TNF-alpha) has been found to decrease serum triiodothyronine (T3) – one of two major hormones made by your thyroid – in your blood. It also increases (rT3) – a metabolically inactive form of T3, while elevated IL-6 9 (a protein that helps regulate immune responses) suppresses T3 generation by deiodinases, D1 and D2 (selenium-containing enzymes used for the synthesis of T3).
Oxidative stress – This inhibits thyroid function and peripheral conversion of thyroid hormones.
Stress – Generalised stress suppresses TSH and decreases peripheral conversion of Thyroxine (T4) – a hormone responsible for your metabolism, mood, and body temperature – to T3. The increase in cortisol encourages conversion of T4 to rT3, decreasing free triiodothyronine (FT3) in your blood.
Gastrointestinal function – Gut dysbiosis, a reduction in microbial diversity, is associated with loss of immune tolerance and the generation of self-antigens by post-translational modification of proteins. It is also associated with lipopolysaccharide (LPS) induced Toll-like receptor 4 activation – a recognition receptors that represents the first line of defence aainst infections). A poor performing gut also results in induction of Th1 to Th2 – helper cells that play an important role in immunity, shift and activation of immune responses in the gut.
Oestrogen excess – The long-term elevation of oestrogen can contribute to a raft of conditions including low thyroid function.
Environmental toxicants – Exposure to toxins such as dioxin, organochlorine, bisphenyls, heavy metals, insecticides, amongst others, may directly disrupt thyroid function.
Stealth infections – Viral and bacterial infections are associated with triggering of autoimmune thyroiditis.
Can low thyroid function be reversed?
In the case of post-therapeutic hypothyroidism, it is unlikely thyroid function can be reversed says O’Sullivan. But, she adds, “In other instances, yes, it is possible to reverse some cases of hypothyroidism, especially if the above-mentioned drivers are addressed.”
What’s the best way to naturally address impaired thyroid function?
O’Sullivan says there are several ways to naturally address low thyroid function, these include:
- Ensuring precursor nutrients (tyrosine, iodine) and cofactors (selenium, zinc) for thyroid hormone production and conversion are nutrient replete.
- Minimising exposure to drivers of thyroid disease, including chronic stress, gastrointestinal dysbiosis or exposure to environmental toxins.
- Supporting antioxidant and anti-inflammatory pathways to protect the thyroid land from damage caused by oxidative stress and inflammation.
- O’Sullivan also recommends dietary changes for people with low thyroid function. These include increasing iodine rich foods such as seaweed, eggs, nuts, fish and seafood and adherence to a gluten free diet, which has been shown to reduce anti-thyroid peroxidase antibodies (TPO-Ab). People with impaired thyroid function should also avoid consumption of large amounts of brassica vegetables (including cabbage, broccoli, and Brussels sprouts) as goitrogens may impair the binding of iodine to thyroglobulin and prevent oxidation of iodide by thyroid iodide peroxidase.