Hypothyroidism, the name given to low production of thyroid hormone, is vastly under recognized in our country. Many people have vague complaints that they attribute to ‘aging’. Yet when you tie them all together the answer lies in thyroid function. What do we know about the thyroid? This is probably the most common yet least understood and poorly treated issue in all of medicine. We know that for true optimal health you must have balance to the thyroid so the rest of the hormone symphony is in harmony. For example, insulin resistance is worsened with suboptimal thyroid function, which leads to further inefficient blood sugar metabolism leading to further thyroid dysfunction. There is a cross talk between thyroid and insulin as well as thyroid with cortisol and the male/female hormones. A vicious cycle occurs causing dysfunction that must be personalized for success. We must look at the entire symphony and understand the interplay to achieve harmony.

This is true for both men and women, though women have a much higher incidence of thyroid problems-1 in 5 women and 1 in 10 men. Yet up to 50% of people with thyroid dysfunction are undiagnosed and of those on thyroid therapy many are undertreated. The real key to fixing a sluggish thyroid is the right testing to confirm there is a thyroid problem and then personalizing an approach to provide optimal energy, metabolism and balance of all other hormones. If your thyroid is not functioning correctly, nothing else in the body will work efficiently. There are several different reasons for low thyroid function. Many people, especially women, have had this ignored by their doctors-“you are normal, so exercise more and eat less and everything will be fine”. Or they end up on an antidepressant, diabetes medication or cholesterol medication. When all along the thyroid was screaming to be heard.

One young woman came to see me last year with the typical story I hear-30 lbs. over weight and she could not change her body fat no matter what she did. She ate clean, tried every diet, worked with a personal trainer and even saw a psychiatrist for her low mood. She wondered if she had a combination of fibromyalgia and chronic fatigue syndrome and some depression mixed in as well. Her menstrual cycles were irregular and painful with severe mood changes. The problem all along was her thyroid. She had screening health fair lab tests and was told her thyroid was normal. When she had more personalized and advanced thyroid evaluation, her blood tests showed the story. Part of the problem as well is the endocrine societies have changed the ranges (lowered the threshold for what we now diagnose as low thyroid function or hypothyroidism) and few labs have adjusted to the new normal.

You must be careful with blood lab testing. There is a so-called ‘normal range’ that as long as you fit into this range everything is supposed to be all right. But to personalize your metabolism, energy, mood, diabetes risk, hormone balance-you must challenge your doctor to find ‘your optimal’ spot on the bell shape curve of normal. The TSH or thyroid stimulating hormone is the ‘conductor’ of the thyroid symphony and the TSH tells your thyroid to make T4 (thyroxine) which is converted to the active T3-this is the one that truly counts and the range is typically 1.8-4.2 with optimal 3.5-4.0. Your body only converts less than 10% of the inactive T4 to the active T3. So if your active T3 value is 2.0 or 4.0 you should feel the same? Really? If you have a level which is less than half of optimal active thyroid hormone in your body-which controls every single cell in your body-are you going to feel the same as if you had twice as much? Think of the difference between those two values that are both ‘normal’. The T3 is King (or Queen) and controls whether you have good energy, good mood, lower cholesterol, reduced diabetes/insulin resistance/sugar metabolism, normal menstrual cycles and can even be involved in achieving fertility. Think of my client above. Would the ‘calories in vs. calories out’ equation finally balance and she would lose weight? Would her energy improve and no longer have chronic fatigue? Would her other hormones finally find a balance and end her menstrual problems? Would her mood improve so that she didn’t need to be on an antidepressant? YES!

Inflammation is tied to thyroid function just as it is to everything else and the gut leads the way. The food that you eat can affect thyroid function just as it affects blood sugar and cholesterol. Some people with thyroid problems have an inflammatory immune condition called Hashimoto’s thyroid. This is a unique situation that can be difficult to find balance and is usually resistant to traditional medication alone. A comprehensive, integrative, functional medicine approach is key to reversing Hashimoto’s. The key is to eat whole food, organic when you can, as the thyroid is exquisitely sensitivity to toxicity. Processed food is poison on all of your hormone systems and especially the thyroid. Remember to find a balance for yourself with nutrient dense food low in toxicity and reduce your own toxic stress to balance the adrenals-the ‘sister’ gland of the thyroid that will be our topic for the next Functional Medicine Cabinet.

-Dr. Mark Menolascino MD, MS, ABIHM, ABAARM, IFMCP

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