“Every cell in the body has receptor sites for thyroid hormones. Thyroid hormones are responsible for the most basic and fundamental aspect of physiology, the basal metabolic rate. Lack of ideal thyroid hormone leads to global decline in cellular function of all bodily systems. The thyroid is the central gear in the complex web of metabolism and extremely sensitive to minor imbalances in other areas of physiology.” Datis Kharrazian, D.C.
Thyroid disorders are very common in the U.S and continue to increase each year. Thyroid hormones are some of the most commonly prescribed medications and remain on the top 10 list of most commonly prescribed medications for decades. Most thyroid conditions are not diagnosed in the early stages but can impact quality of life significantly prior to diagnosis. Hypothyroidism (lack of thyroid hormone to meet the body’s needs) is the most common thyroid problem, by far.
Thyroid hormone is extremely important for every cell and every tissue type of the body. Every single cell of the body has receptor sites for thyroid hormone. We know that thyroid hormone controls the metabolic rate of these cells to some degree. But the thyroid itself is one of the most vulnerable tissues of the body. It is very vulnerable to autoimmune issues, environmental issues, hormonal shifts, etc. When a person has a thyroid disorder, they may have dysfunction in other areas. When we see thyroid issues, functional medicine practitioners always ask: “What’s causing it?”
Most Hypothyroid Patients Have Hashimoto’s Autoimmune Thyroid
Most people in the U.S. are hypothyroid because of autoimmunity against the thyroid. Most people in the U.S. are also iodine deficient but that is not the cause for their hypothyroidism. The research shows that 90% of people that become hypothyroid have an autoimmune attack against the thyroid gland. This leads to destruction of the thyroid tissue and decreased ability to produce thyroid hormone. The thyroid gland is the most common site for autoimmune attack and often times the first sign of the development of an autoimmune disease. The two types of autoimmune thyroid disorders are Hashimoto’s disease and Graves disease. By far, the most common of the two is Hashimoto’s disease which eventually manifests as hypothyroidism. This can only be diagnosed by checking for antibodies against the thyroid. Depending on the thyroid antibodies that come up positive in your lab tests, this determines the type of autoimmune thyroid disorder.
Doctors often do not check for these antibodies even after the patient has been diagnosed with hypothyroidism because the cause is the same: thyroid hormone. But this is very important to do because it is critical to know if you have autoimmunity against the thyroid. If so, you have an autoimmune disease and the thyroid is merely the victim of your immune system. In functional medicine, this makes an enormous difference in the therapeutic approach. The focus then becomes to manage the autoimmunity and decrease the attacks against the thyroid, whether or not the person is taking thyroid hormone.
Most Autoimmune Thyroid Patients Have Autoantibodies Against Other Tissue
The research says 50% of people that have autoimmune thyroid have antibodies against other tissues. So they actually have global autoimmunity against multiple tissue types. This is very important to understand because this means if the autoimmunity is not managed then this leaves multiple organs vulnerable to autoimmune attack. When the person is exposed to triggers of the autoimmunity, this leads to “flareups” and further destruction of tissue. Which organs or tissue get destroyed? All the tissues that are being targeted by the immune system. How do we know which tissues are being targeted? By checking for antibodies against them! This is something most doctors do not give sufficient attention to. When a person has been diagnosed with autoimmune disease, it is critical to test for antibodies against other organs as well in order to determine which tissues are potentially targeted for destruction during flareups.
When we see a person with a thyroid starting to fail, we often see many different problems in other tissue and organs, because of the importance of thyroid hormone on these organs, including:
- Brain (accelerated neurodegeneration, neurotransmitter imbalances, anxiety and depression, etc.)
- Gastrointestinal tract (intestinal permeability issues, ulcers, pernicious anemia, GI autoimmunity)
- Gallbladder (gallstone formation)
- Liver (detoxification issues)
- Lipid and Cholesterol Metabolism (elevated lipids)
- Protein Metabolism (decreased protein metabolism)
- Red Blood Cell Metabolism (anemias)
- Glucose Metabolism
- Hormone Steroidogenesis
- Bone Metabolism (decreased bone density)
Autoimmune Thyroid Patients Get Little Help From the Current Healthcare Model
Most hypothyroid patients are not checked for autoimmune thyroid. Thyroid antibodies are never checked because the issue is the same (thyroid hormone) and running these markers is not the standard of care. These patients are told they are hypothyroid and put on levothyroxine (synthetic T4) for the rest of their life and the mechanism involved is usually not investigated. What does thyroid hormone replacement do for the autoimmune disease? Nothing. It virtually has no effect on their autoimmunity. They just put them on thyroid hormone and they need to be checked every 6-12 months. Why do they do this? Because they assume the autoimmune disease will continue to destroy their thyroid and they will require greater and greater amounts of thyroid hormone as time goes on.
A lot of these people still have issues with their doses and fluctuations in TSH but there is no real approach for them other than to increase or decrease the dose or type of thyroid hormone. The type of hormone they are put on is what their insurance plan covers and there is no real type of specificity for them. They are usually not evaluated for autoimmunity. Even if they are, there is no conventional management available. Once the TSH is normalized in conventional medicine, they stop there and there is no further care for the hypothyroid patient. If they have Hashimoto’s autoimmune thyroid, their health continues to decline because their autoimmunity is not managed. They are often told by their doctors that “they are fine” because their TSH is in a “normal range” on their lab test but they often continue to have a wide range of symptoms.
There is Hope for Thyroid Patients if They Have the Right Attitude
There are several possible mechanisms that can impact thyroid function particularly in autoimmune thyroid conditions such as Hashimoto’s hypothyroidism. Each of these must be considered in the thyroid patient. Fortunately, for patients with thyroid problems, all of these mechanisms can be modulated and improved with diet and lifestyle modification and the use of key nutritional supplements that impact these known mechanisms. These modifications can have a significant impact on thyroid function and quality of life. There is an excellent book written on this very topic, which we often recommend to our patients, entitled, “Why do I still have thyroid symptoms? When my lab tests are normal”. This is an excellent resource for those suffering from autoimmune thyroid conditions.
When we see autoimmune thyroid conditions in the functional medicine model, we focus on:
- Identifying triggers of flare-ups
- Modulation of the immune system
- Supporting recovery of flare-ups
There are several medications that can interact on thyroid function and metabolism, such as cholesterol-lowering medication, anti-inflammatory and pain medications, antibiotics, hormone replacement therapy and antacids or other acid-supressing medications.
Cytokines (chemical mediators of the immune response) can:
- Impact receptor sites
- Impact conversion issues
- Activate glial cells
- Environmental/Toxin Interactions
- Stress/Neurofeedback Loop Interactions
- Endocrine/Hormonal Interactions
- Infection/Chronic Inflammation
- Nutrient Deficiencies
- Liver Function
All of these mechanisms and interactions must be considered in successful management of thyroid conditions.
Content provided by Datis Kharrazian, D.C., Mastering the Thyroid, Nov. 12, 2010