Functional Medicine: Your Wacky Hormones and Thyroid Gland

Let me start by saying that the majority of board-certified endocrinologists give me a pain. They’re internists, like me and our newest WholeHealth Chicago physician Neeti Sharma, MD, but they have additional training via endocrinology fellowships.

Somewhere along the way, many of them become almost too academic, no longer actually listening to patients but rather focused totally on lab test results.

This can be a real disservice to their female patients especially. Women, far more than men, can sense when their hormones are out of whack, whether they’re feeling the effects of an underactive or overactive thyroid, adrenal fatigue, or some imbalance in the monthly hormonal roller-coaster ride of their menstrual cycles (or the relentless downhill course of hormone depletion in menopause).

Moreover, women are eight times more likely than men to have thyroid problems.

I’m not suggesting that women are 100% accurate in their ability to self-diagnose conditions such as subclinical hypothyroidism, estrogen-dominant premenstrual syndrome, or adrenal fatigue, but rather that they deserve more than being dismissed with a brusque “Your TSH is normal” or “There’s no such thing as adrenal fatigue.”

Powerful, powerful hormones
Hormones, which are molecules produced by your endocrine glands, are astonishingly formidable little units. They’re made even more powerful because certain cells (called target cells) have actual hormone landing sites (called receptor sites).

How mighty are hormones? Well, for example, the amount of estrogen in a typical birth control pill is measured in micrograms, or one millionth of a gram. If you removed all the binding material from a birth control pill, the amount of hormone it contains would be virtually invisible. You cannot actually see something that’s one millionth of a gram.

But ponder the power of a birth control pill when you take it. Not only is it capable of shutting down ovulation (release of eggs), but glance at the package insert and brace yourself for the hundreds of side effects these micrograms can trigger.

Thyroid hormones, underactive and overactive
Today let’s discuss your thyroid gland and the hormones it releases. Future Health Tips will address functional medicine’s approach to your adrenal glands and your sex glands.

Here’s a list of symptoms associated with hypothyroidism (low thyroid). Brace yourself.
–Brain fog
–Brittle nails
–Constipation
–Depression
–Difficulty concentrating
–Dry, coarse and/or itchy skin
–Dry, coarse and/or thinning hair
–Fatigue, exhaustion
–Feeling cold (wearing a sweater in summer!)
–Feeling rundown and sluggish
–Infertility and miscarriage
–Irregular menstrual flow
–Low sex drive
–Muscle cramps
–Muscle loss
–Unexplained or excessive weight gain

Other signs that are potential symptoms of hypothyroidism and Hashimoto’s thyroiditis (the most common cause of hypothyroidism) include:
–Acid reflux
–Acne
–Anxiety
–Candida (yeast overgrowth)
–Constipation
–Depression
–Difficulty expressing yourself
–Digestive discomfort or diarrhea
–Eczema
–Eyebrow loss
–Feeling socially distant
–Forgetfulness
–Frequent colds
–Gluten intolerance
–High LDL cholesterol
–Hypoglycemia (low blood sugar)
–Intestinal bloating
–Intestinal gas
–Irregular menstrual flow
–Itchy skin
–Lack of motivation
–Low level of vitamin B12
–Low level of ferritin (iron) or anemia
–Low level of vitamin D
–Low sex drive
–Muscle aches
–Muscle cramps and muscle loss
–Puffy eyes
–Swollen tongue
–Throat discomfort and/or tightness
–Water retention

Now, honestly, if I showed this list to any second-year medical student (or really anyone who uses Dr. Google regularly), he or she would diagnose hypothyroidism. But to this day, physicians are encouraged to limit their thyroid testing to one test only: the TSH (thyroid-stimulating hormone).

TSH is a hormone that isn’t even produced by your thyroid gland, but rather by your pituitary gland, the so-called master gland that stimulates the thyroid when it senses thyroid underactivity.

Thus the TSH test measures your thyroid levels only indirectly. If your pituitary is producing too much TSH, it’s inferred that your thyroid must be underfunctioning.

Endocrinologists have decided that if your TSH level is 4 or higher you probably have an underactive thyroid. It is truly ironic that this number was only established relatively recently. For decades the standard was 5 or higher and it’s estimated the number of missed hypothyroid diagnoses was in the millions.

But hypothyroidism isn’t the only thing affecting your TSH. Your test result can be influenced by what you eat, your stress levels, the time of day your blood is drawn, and even the lab chosen by your physician.

Am I making it clear that relying solely on a TSH test result to diagnose thyroid problems is not a good idea? Instead, docs need to test thyroid function.

Functional medicine and your thyroid
A functional medicine approach to your thyroid begins with the doctor herself having in mind that hypothyroidism is more common than most doctors realize and is likely the single most overlooked diagnosis.

An underfunctioning thyroid (hypothyroidism) or overfunctioning thyroid (hyperthyroidism) likely affect one quarter of women over 30. And up to 60% of this group are unaware that thyroid function is an issue. If a doctor is always suspecting hypothyroidism, she’ll rarely miss the diagnosis. This requires that she listen, listen, and listen some more to her patient.

(A nice pair of rules I learned in medical school: If you listen long enough and carefully enough to your patient, she’ll tell you her diagnosis. Use tests to confirm what she’s told you.)

Now go back and glance at that list of possible symptoms. Obviously, for virtually all of them, there are other possible causes, but a relatively small number of lab tests can eliminate any that aren’t being caused by hypothyroidism.

Functional medicine tests for thyroid issues
So what tests are needed to diagnose an underactive thyroid? Here’s the list from Janie A. Bowthorpe’s excellent Stop The Thyroid Madness website. A list like this lies at the heart of functional medicine because each item revolves around how your body is functioning with its current supply of thyroid hormone. (Bowthorpe’s book is really good too.)

TSH (thyroid-stimulating hormone). Since this hormone comes from the pituitary gland, at best it tests pituitary function. High TSH usually means underactive thyroid, but low TSH in the presence of hypothyroidism means pituitary insufficiency.
Free T3 and Free T4. These are measurements of the actual thyroid hormones themselves.
Reverse T3 (rT3). This is an “inactive” hormone that can appear in some cases of hypothyroidism. Your body should convert inactive T4 to the active hormone T3, but under certain stresses it makes rT3 instead. By itself, reverse T3 is not a helpful test, but it should be viewed in context of thyroid function.
Thyroid antibodies. The most common autoimmune disease and cause of hypothyroidism is Hashimoto’s thyroiditis. The presence of thyroid antibodies clinches a Hashi diagnosis. Some physicians, especially in Europe and the UK, start thyroid hormone replacement when antibodies are present.
Iron profile (ferritin, percentage iron saturation, iron binding capacity). Symptoms of low iron are often indistinguishable from hypothyroidism.
Saliva adrenal cortisol. The same goes for adrenal fatigue, but more about this next week.
Vitamins D, B-12 and folate. More on this next week too.
Sex hormones (estrogen, progesterone, testosterone) measured throughout a one-month cycle. Single-day test is fine for postmenopausal women.
MTHFR gene mutation tests susceptibility to heavy metals damaging thyroid. If MTHFR inherited from both parents, test for metals.
Complete blood count and comprehensive metabolic profile. This is the standard wellness profile your doctor orders when you get a general check-up. It can yield a lot of useful information.
–Basal body temperature measurement for five days in a row. This is your oral temperature just as you emerge from sleep (click here for full instructions)  If you’re a menstruating women, take your temp for five straight days beginning with the second day of your period (to avoid the normal temperature rise that occurs with ovulation). An average temperature of 97.6 or lower make a diagnosis of mild hypothyroidism a strong possibility. The test is less useful for adjusting your dose once you’ve started thyroid replacement.

Endocrinologists rarely order anything like these tests when approaching a patient with low thyroid. This is a problem that reflects being over-trained in a single specialty instead of taking a more holistic view and treating the whole patient.

When it comes to treatment, endocrinologists like the synthetic Synthroid (Levoxyl) and disparage any use of natural (desiccated) thyroid as old fashioned. They may be unaware that when Synthroid was first released the advertising campaign was based on denigrating natural thyroid (then called Armour thyroid, though today there are several brands).

In other words, endocrinologists dislike desiccated thyroid because they fell for an advertising campaign. A campaign, in fact, that years later was proven false and misleading and which subjected its Big Pharma company to a hefty financial penalty.

Oh well. Nobody ever said that having an MD after your name immunizes you from gullibility.

Be well,
David Edelberg, MD

 

 

14 comments on “Functional Medicine: Your Wacky Hormones and Thyroid Gland
  1. Jules Arbor says:

    I have thought that I was hypothyroid for a very long time and have a majority of the symptoms listed. And yet, each time my thyroid tests are run, they alway come back within the normal range. I was once placed on Cytomel for a brief period of time, and it was like someone turned the light switch on…I felt great! After an incidental finding of thyroid heterogeneity on an MRI, I had thyroid antibodies checked and again, no sign of a problem. I requested that they also check my rT3, but I was told that wouldn’t give them any additional information. Unfortunately, doctors don’t like getting their continuing education credits from their patients! 😂 However, last week I had an ultrasound of my thyroid and I have three small nodules. Would that impact my thyroid functioning even though my labs are in the normal range? I certainly know that rT3 and adrenal fatigue do! If the HPA Axis is messed up, chances are good that the HPT Axis is not doing very well either! But I’m just a patient!

  2. Jill says:

    I love this article! Thank you for sharing this important information. I am an RN & functional women’s health coach here in Chicago, and the bulk of my clients describe symptoms that align with clinical or sub clinical hypothyroidism. We always do testing to confirm. I have had multiple clients then go to their physician (usually endocrinologists) seeking a prescription for dessicated thyroid hormone (while we work on the root cause), and they’ve been shut down. They are told that their results are not “that bad”. It’s been a real struggle. Most have described symptoms for years, and seen multiple doctors and often prescribed an antidepressant because it must be in their head. It’s really unfortunate that these women are dismissed.

  3. Sarah says:

    Thank you for this excellent piece! I went through many doctors complaining of several of these symptoms until i found an osteopath who heard me, diagnosed low thyroid, and had me on Naturethroid for about two years. I felt normal for the first time in over ten years. I believe it started when I used birth control pills.

  4. Anne says:

    My pharmacist in CA is unable to get NatureThroid for several months now. it is currently unavailable, no longer made?! What is your recommended replacement? Thanks!

  5. Jules says:

    @Jill…that’s exactly how I ended up on a brief course of Cytomel. The assumption was that I was depressed and not responding the greatest to the antidepressant that I was prescribed. The psychiatrist gave me a script for a small dose of Cytomel and all my symptoms vanished! Why is it that so many doctors believe that it’s all in women’s heads? I was also diagnosed with a Conversion Disorder that turned out to be Syringomyelia…a cyst in the center of my spinal cord! 🙄

  6. Dr E says:

    Hi Jules
    The small nodules would NOT affect your thyroid function and are most likely harmless

  7. Laura Gracia says:

    I had several test done for my thyroid that you mentioned and all came back within normal range . My Dr. decided to put me on thyroid medicine, anyway because of my symptoms of fatigue , etc.. Unfortunately the only thing that happened was rapid weight gain of twenty five pounds . Still felt miserable . After stopping the medicine I continued to gain weight, which was really upsetting because it had taken me two and a half years to lose 50 pounds and I was finally at my goal weight . So now I’m working all over again to lose the excess weight . This is very depressing for me . I feel that I never should have been put on the medicine in the first place and should have looked for other possible reasons for my symptoms .
    After reading an article of Dr. Casey Kelley about Lyme disease and it’s list of 40 or so symptoms . Of which I had them all. I was tested for Lyme and BINGO !
    Turns out I was loaded with three of the five strains . It was a simple blood test . So if you still feel lousy after being treated for thyroid based on normal test that run low , I suggest you investigate Lyme disease . Turns out many more people have it than you would think.

  8. Angela says:

    Could you please address hyperthyroidism, the tests and treatments?

  9. jan says:

    i feel i was put on thyroid med too fast too…i was estrogen dominant, had been on a crash diet, had low b12, low iron, low vit d3, etc and my hormones was out of balance, instead of addressing that first and retesting,,they just put me on thyroid meds and then i started gaining weight , hair issues etc..but i was fine before thyroid med but i think the meds have slowing slowed down my thyroid to be dependent on them now……if i had known more then..i would have never started the thyroid hormone and got by body in balance first….my ft3 ft3 were perfect– more so than even now on meds , my tsh was only 8 and i never had antibodies…..

  10. Dr E says:

    Hi Anne
    Ask your pharmacist to order NPThyroid. It is the same as NatureThroid
    https://npthyroid.com/

    The connection between Lyme and weight gain is complicated. Lyme disease causes chronic fatigue which encourages patients to stress-eat. Often Lyme disease affects the thyroid hormone, and this results in hypothyroidism and weight gain

  11. Brenda Burg says:

    Thank you for this article! I am on the hunt, again, for a new doctor. I live in Newberg, Oregon.
    Can you recommend one please.

  12. Dr. R says:

    Hi Brenda. Check out the “find a physician” link on the Institute for Functional Medicine’s website. Good luck.

  13. Karen Joyce leaf says:

    Thank you so much For this article I had thyroid cancer and also and I thyroid ectomy and my parathyroid removed as well I am on Synthroid 150 mg I have been hypothyroid and hyper thyroid I have lost weight gained weight I am exhausted all the time please help my endocrinologist says my levels are normal as of right now please help me I wanna show her this article I don’t know if it’ll help I have almost everyone of these on your list !!!!

  14. Dr E says:

    Hi Karen
    As I mention in the article, endocrinologists, bless their little hearts, live and die by lab tests. Ask to be switched to the natural NP Thyroid or if he simply won’t do that, ask about adding some pure T3 (liothyronine) to your Synthroid.
    Good luck

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