Is not necessarily true if you make the right nutritional adjustments

 This 75-year-old lady was recently admitted to hospital with acute delirium and chronic fatigue, with a background of depression, hypertension, IBS and osteoarthritis.  She also had the severe menopausal symptoms of hot flushes and insomnia.

Examination revealed severe proximal (quadricep) muscle weakness.  She weighed 52 kg and her BMI was normal at 22.8.  A thyroid test revealed a high level of the thyroid stimulating hormone TSH at 9.66, and borderline thyroxine T4 at 9.5.  A genetic test revealed lactose and gluten intolerance.

She was advised to eliminate gluten, milk and dairy products from her diet.  A repeat test was normal with TSH down to 3.5 and T4 up to 16.3.  This was achieved without the need for any thyroid hormone replacement.

Thyroid function normalised without thyroxine therapy

A 49-year-old lady presented with lethargy, excessive weight gain and increasing depression.  She had gone through a brutal divorce and had severe business-related stress. Her bodyweight was 97 kg, her BMI was high at 37, and routine blood tests revealed a hypothyroid state with high TSH at 14.9 and low T4 at 6.9.  her lipid profile showed high cholesterol at 7.4 and triglyceride at 3.2.

She started on low dose thyroxine, was referred for divorce counselling and received hypnotherapy to resolve severe emotional trauma.

Further investigations showed very high levels of mercury: she had 10 silver dental fillings, had undergone 4 root canal treatments and ate tuna on a regular basis.

The patient was advised to come off gluten and dairy products, to stop eating tuna sandwiches and was referred to a biological dentist to remove the mercury fillings.

She lost 12 kg in weight and her mood improved.  She started chelation therapy to rid her body of mercury.  This resulted in further clinical improvement, and her thyroid function normalised without the need to stay on thyroxine.

What is the thyroid?

Thyroid is a small gland situated in front of the windpipe.  It produces thyroxine, which has a receptor in every cell in your body.  Thyroxine is like the petrol in your car, accelerating your body’s metabolism.

But the thyroid can malfunction, with thyroid disease is 10 times more common in women than in men in the UK. 15% of the UK population have detectable goitre.

An under-active thyroid causes your metabolism to slow down resulting in fatigue, weight gain, a puffy face, cold intolerance, slow heartbeat, brain fog, dry skin, hair loss, constipation and depression.

On the other hand, with an overactive thyroid, everything accelerates.  You feel hot and sweaty, have tremors or palpitations, fast heartbeat (which can progress to atrial fibrillations), anxiety, weight loss despite a good appetite, diarrhoea and weak muscles.

Very limited traditional medical tools

The thyroid is governed by the master (the brain.)  The hypothalamus releases the thyroid hormone releasing hormone (THRH) to stimulate the pituitary gland to produce the thyroid stimulating hormone (TSH), which governs the thyroid gland.

When the thyroid gland becomes under-active, the pituitary gland produces more TSH, stimulating the thyroid gland to produce more thyroxine.  TSH is correspondingly low when the thyroid gland becomes overactive.

When I started in practice, I had limited tools at my disposal: I could measure TSH to find out whether my patient had a normal, over- or under-active thyroid.  I was very rarely able to measure thyroxine (T4) itself.  And, on this basis, I had to make serious decisions about putting patients on a lifetime of medication.

I could offer thyroxine for patients presenting with an under-active thyroid when TSH was high or prescribe Carbimazole to slow overactivity when TSH came back very low.

If overactive thyroid patients failed to respond to this, I could refer them for surgery to remove their thyroid gland, or send them for a dose of radioactive iodine, strong enough to render the thyroid inactive.  Patients who lost their thyroid had to go on thyroxine replacement.

I followed these procedures for over 40 years of medical practice until I stumbled on Functional Medicine.

Let’s look a little more deeply into what the thyroid does.

The thyroid gland produces thyroxine (T4), the least active thyroid hormone, together with a small amount of T3 (more active), which is eventually converted to free T3 (the most active thyroid hormone.)

Your body requires 10 essential nutrients to make thyroxine (T4), activate it (T3) and act on the thyroxine receptor to accelerate or decelerate cellular activities.  These key nutrients include iodine, tyrosine, vitamin A, B, C, D, E, Zinc and iron.  Selenium is needed to activate T4 to T3.  40% of T4 to T3 activation occurs in the liver, 40% in the gut, and 20% in the periphery.

Hormone receptors are usually located on the outer surface of the cell wall, but thyroid receptors are located not only inside the cell but right inside the nucleus, reflecting their vital importance.  You need 3 nutrients – vitamins D, A and C for thyroxine to switch on cell metabolic activity.

You cannot enjoy a normal thyroid state without having a healthy gut and liver.  I have met many patients suffering with IBS, ulcerative colitis, Crohn’s disease, alcoholic and non-alcoholic liver disease who have classic under-active thyroid symptoms such as lethargy and cold intolerance, but a normal thyroid function.

The Functional Medicine approach to thyroid disease

First, we ask, what is the thyroid state – hypo, normal or hyper thyroid?  Secondly, is it autoimmune, as 90% of hypothyroidism is autoimmune thyroiditis (Hashimoto’s disease.)  The initial tests include thyroid antibodies TPO/TG.  Then we explore the underlying cause of a leaky gut – this covers the common culprit – gluten – plus other allergens such as dairy, eggs, soya, peanuts and lectins.  The second common cause is heavy metals such as mercury.  Gut infection (dysbiosis) particularly with LPS producing gram negative bacteria. A GI-MAP stool test is good for diagnosing this.  Chronic stress is rampant, and it is also relevant to explore nutrient deficiencies.

When tested, TSH has a wide range from 0.4 to 4.5.  After long medical practice, I conclude that the optimal range may fall between 1.5 to 2.5, i.e. around 2.

A thorough clinical history and a full physical examination will usually validate the diagnosis, with findings such as a low body core temperature, below 36C, and high cholesterol.  Simple tools, such as an ECG, would confirm a slow heartbeat, under 50, or arterial fibrillation, particularly in an overactive thyroid state.

Wheat is a common cause of autoimmune thyroid disease, because it contains gluten, a protein many people find hard to digest.  This is compounded by the fact that wheat nowadays is hyper-densified by modern agricultural techniques, increasing the amount of gluten.  Gluten disrupts the tight junctions on the gut lining resulting in leaky gut syndrome.

Gluten looks like thyroid cells (molecular mimicry): when undigested particles enter the bloodstream, they will irritate the immune system, which will attack the gluten as well as the thyroid cells.  This results in the inflammation and eventual destruction of the thyroid gland, resulting in Hashimoto’s disease.  Heavy metals like mercury can also destroy the gland.

Nutritional deficiencies common in thyroid disease

Selenium is important in supporting the conversion of T4 into T3.  The daily dose is 200 µg, but you can gain the same benefit by eating 2-3 Brazil nuts. Inflammation is common in thyroid disease and patients will benefit from omega-3 (fish oil), as well as vitamin D, probiotics and a high-quality multivitamin.

You need iodine to make the thyroid hormone.  Lack of iodine not only results in an underactive thyroid, but also causes the abnormal enlargement of the gland, known as goitre.

Iodine is also important to the breast, reproductive system and prostate.  Studies have shown that taking 14 mg of iodine a day has given Japanese women the lowest incidence of breast and reproductive system cancer in the world.

A simple method to test for iodine deficiency is to put an iodine patch on the patient’s skin.  If the patch has largely disappeared in 24 hours, this indicates iodine deficiency, since the body has absorbed most of the iodine in the batch.

Another method is to administer a loading dose of 20 mg of iodine, and measure how much iodine is excreted in a 24-hour period.  Low iodine in the urine indicates the body is deficient and would benefit from further iodine supplementation.

Foods rich in iodine include fish, seaweed, eggs, dairy and nuts.

Goitrogens are substances that disrupt the production of thyroid hormones due to interference with the iodine uptake by the thyroid gland.  Cruciferous vegetables come on top of the list but must be consumed in excess before It is a real concern.  I had been taking them for many years and was not affected.  I think the benefit of this type of vegetable in enhancing the second phase of detoxification outweighs any possible risk of depleting the thyroid of iodine.

Prescription drugs such as amiodarone and lithium, and anticonvulsant drugs such as phenytoin, are known goitrogens.

Fluorine (in drinking water and toothpaste), chlorine (in drinking water and swimming pools) and bromine in bread are all halides, i.e. they share similar chemical structure with, and can displace, iodine in the thyroid gland, resulting in hypothyroidism.  Avoid halides and use high-quality water filters.

The thyroid gland can also get bigger without iodine deficiency: I had a thyroglossal cyst that transported me, in a few minutes, from being the doctor in charge of the hospital to being its most serious patient 100 marathon club.

Thyroid tumours are rare but can also present with enlarged thyroid gland.

Adrenal and thyroid are non-identical twins!

Adrenal gland sits on top of each kidney, producing stress hormones to support various bodily activities.  Adrenal fatigue and hypothyroidism are separate entities that may originate from the same source.  A patient with chronic stress produces high quantities of cortisol, the main stress hormone.  This suppresses the hypothalamus and the pituitary gland, which also controls the thyroid gland, resulting in an underactive thyroid.  Therefore, when adrenal fatigue and an under-active thyroid co-exist, it would be sensible to treat the adrenal gland first, as this may short-circuit the negative feedback loop on the hypothalamus and pituitary gland to reinstate normal thyroid function.

An under-active thyroid is characterised by cold intolerance, low body core temperature and slow heart rate, whereas adrenal fatigue usually produces cold hands and feet, and low blood pressure.

Chronic adrenal stress usually produces high cortisol levels in saliva samples.  However, when both conditions exist, the thyroid test shows low TSH, but also low T4 and T3, a clinical picture suggestive of secondary hypothyroidism.

Primary and secondary hypothyroidism?

Primary hypothyroidism is when the thyroid becomes under-active due to a problem within the gland, whilst secondary hypothyroidism is related to a problem occurring away from the thyroid, most commonly in the pituitary or hypothalamus.

TSH is high in a primary under-active thyroid but low in a secondary.

Thyroid disease is more prevalent in patients diagnosed with coeliac disease and non-coeliac gluten sensitivity, in patients with heavy metal toxicity such as through mercury, in those who suffer with leaky gut syndrome and autoimmunity.  Unfortunately, suffering from one autoimmune condition increases by a factor of ten your likelihood of having another.

And now, my friends, I would love to hear your stories – your experiences of success and failure – in relation to thyroid disease.  Your journey may well help or encourage someone else suffering along the same lines.