Should You Blame Your Thyroid?

Is Thyroid Dysfunction Causing Your Health Problems?

The short and scary answer is that it’s definitely possible you’re dealing with thyroid problems (and if you aren’t, someone you know definitely is based on the statistics).

In fact, approximately 12 million Americans have thyroid disease and are completely unaware.

The biggest issue we see with thyroid mismanagement in practice is that many of our clients think they have had adequate thyroid testing, but they have only had one marker of thyroid health assessed – thyroid stimulating hormone (TSH). TSH by itself doesn’t give a full picture of thyroid health. Looking at the thyroid this way could be to blame for mishandled cases of thyroid disease.

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Today, we’re hoping to shed some light on the thyroid and provide education on the following:

• What exactly the thyroid does
• How it’s related to weight
• The gut and thyroid connection
• Labs to request so that your thyroid function is fully assessed

The Prevalence of Thyroid Disease

These stats really surprised us when researching for this post. We knew things were bad – but we weren’t expecting them to be this bad. According to the American Thyroid Association:

• More than 12 percent of the U.S. population will develop a thyroid condition during their lifetime.
  • Women are 5-6x more likely than men to have a thyroid condition; 1 in 8 women will have a thyroid issue (3).
• An estimated 20 million Americans have some form of thyroid disease.
  • Up to 60 percent (or 12 million people) with thyroid disease are unaware of their condition! These people could be subclinical or lack access to healthcare.
  • Subclinical means a disease is present, but it hasn’t been identified. This can happen if someone has a disease and isn’t showing symptoms or if someone has a disease that’s not being found through labwork or upon a physical examination.

When we were researching for this post – that last stat really got us! Twelve million people are suffering from a disease and have NO IDEA! This is where the importance of the full thyroid assessment comes into play. Our guess is that the majority of cases are being missed because of the following:

1. Inadequate lab assessment and/or interpretation – make sure to read below about how to request a FULL thyroid panel for a comprehensive assessment. We’re also going to talk about how to look at your thyroid lab results to make sure nothing gets overlooked.
2. Symptoms are present, but labs are coming back within normal limits. It’s hard to say how often this happens, but we’ve seen it a lot in practice. If thyroid labs aren’t bad enough to qualify someone for a diagnosis, symptoms will be ignored or blamed on something else until labs are bad enough that they are finally “agreeing ” with your symptoms.
3. Thyroid symptoms can also mimic symptoms of other conditions leading to misdiagnosis.

What Does the Thyroid Gland Do?

The thyroid is an endocrine gland, meaning it makes hormones. It’s located in the front of the neck. 

Hormones are chemical messengers that help the body communicate.

The thyroid secretes specific hormones, primarily thyroxine (aka T4) and Triiodothyronine (aka T3), which then enter the bloodstream to be delivered to all of the tissues in the body. 

These hormones interact with the muscles, pancreas, brain, heart, and fat cells by regulating how we use and store energy. 

They also interact with the liver playing a role in the removal of extra cholesterol.

There are several different thyroid diseases, the discussion of which goes beyond the scope of this post.

Most of what we refer to in this post is related to hypothyroidism, where there is low thyroid hormone production and metabolism is slowed down.

Symptoms of Hypothyroidism

Common symptoms of hypothyroidism include:

• Fatigue
• Mood disorders like depression and anxiety
• Memory changes
• Sore muscles and joints
• Muscle weakness
• Hair falling out or thinning
• Dry skin
• Menstrual changes
• Fertility issues
• High cholesterol
• Constantly feeling cold
• Constipation
• Puffy eyes and legs

Causes of Hypothyroidism

• Micronutrient deficiencies such as selenium, iodine, iron, and vitamin D can impair the thyroid gland’s ability to produce adequate thyroid hormone.
• Radiation therapy and x-rays can damage the thyroid gland.
• Thyroid removal – in this scenario, thyroid medication must be taken to mimic thyroid function.
• Hashimoto’s thyroiditis is the autoimmune condition responsible for hypothyroidism.
• Prolonged use of synthetic estrogen, such as birth control (4).

Hypothyroid and Gut Health

To understand this connection, we must first begin by explaining the different types of thyroid hormones and how they’re stored throughout the body.

• Thyroid-stimulating hormone (TSH) is responsible for, doing just as it says, stimulating the production of thyroid hormone.
• About 80-85% of the hormone produced in the thyroid gland is T4, this is also known as the inactive or stored form of thyroid hormone. 
  • T4 can convert to T3 or it can convert to reverse T3.
    • T3 is the active form of thyroid hormone that communicates with other parts of the body.
    • Reverse T3 serves as part of a feedback loop to tell the thyroid how much more or less hormone to make; it’s an inactive form of thyroid hormone.
• The liver is the organ most responsible for converting T4 into the active form of the hormone T3; beneficial bacteria in the gut also help with this conversion.
  • When the body is under stress, cortisol increases which blunts TSH output. Additionally, T3 is reduced, and the body begins producing more reverse T3. This adjustment slows metabolism and other physiological functions in the body.
  • Sources of stress might be really obvious, like a stressful life event – other less obvious sources of stress on the body include nutrient deficiencies, an inflammatory condition, toxic exposure, or even eating too few calories.

Can Hypothyroidism Cause Constipation?

Absolutely! There are a few ways that hypothyroidism can cause constipation. Hypothyroidism causes:

• Slowed transit time of food through the gut – hello, constipation! Long-term constipation can lead to inflammation, infections, and malabsorption.
• Reduced bile flow – bile helps with removing toxins from the body when waste is produced. Reduced bile flow contributes to a sluggish gallbladder and impairs the liver’s detoxification processes.
  • Bile also helps break down fat during digestion, this helps to soften the stool and speed up transit time. So a reduced bile flow can create a harder stool and slow the movement of food through the intestine, which also contributes to constipation.
• Reduced stomach acid secretion – this can lead to the overgrowth of bacteria in the small intestine, which can trigger constipation. It also takes longer for food to pass through your stomach to the small intestine, which can cause acid reflux, bloating, and gas.

Hypothyroid and Weight Gain

The thyroid gland is commonly blamed for unexplained weight gain and difficulty losing weight. But is this blame warranted?

While the thyroid gland is NOT solely responsible for determining weight, it can make weight loss difficult when it isn’t functioning properly. 

Things to know about hypothyroid and weight gain:

• Typically weight gain related to hypothyroidism is around 5-10 pounds (1) and is related to fluid and sodium retention.  The greater the degree of hypothyroidism, generally, the greater the weight gain.
• Thyroid hormones regulate how efficiently food is used to create energy; when there is not enough thyroid hormone, everything will slow down, including the metabolism. 
• The basal metabolic rate (BMR) is a measurement of how much oxygen is used by the body in a resting state. There’s a direct correlation between thyroid hormone levels and BMR, so when thyroid hormone output is low, BMR is low.  This means your metabolism will be slower, so you won’t burn calories as quickly or as easily.
• Thyroid hormones play a role in regulating appetite – in the case of hypothyroidism, you can feel less hungry yet still be gaining weight due to these other factors.
• Fatigue is a common symptom of low thyroid hormone production, which can lead to less physical activity and poor food choices.
• Interestingly, when hypothyroidism is treated, there is often a small amount of weight loss but not as much as some individuals expect. 

Quick Tips for Stubborn Weight Loss

If you’re struggling with weight loss, here’s a short checklist of things you may not have considered yet. It’s important to think beyond thyroid function and calorie counting:

• Nutrition – cleaning up the diet, looking at macros, and addressing nutrient deficiencies.
• Sleep – are you getting 8 hours of good sleep each night?
• Stress management – are you making time for self-care and relaxation?
• Exercise habits – we see a lot of over-exercising! (yes, it’s a thing and can make weight loss harder)
• Inflammation, potential toxic exposure, and chronic conditions must be addressed for metabolism to be optimized.

While some people do try to use thyroid hormone medication just to reduce weight (with no actual thyroid issue), we do NOT recommend this. It’s unlikely to produce drastic weight loss and comes with potential side effects like loss of muscle mass, bone density decline, abnormal heart rate, and increased likelihood of SIBO.

Labs to Check for Stubborn Weight Loss

If you can’t figure out why you’re struggling to lose weight and you’ve been told your thyroid blood test is “normal,” it’s definitely worth looking into a full thyroid panel and understanding what ideal thyroid ranges actually are (we’ve got you covered in the section below).

With stubborn weight loss, of course, a properly working thyroid is important, but you really should consider all markers of metabolic health.

We’ve put together our favorite labs for solving stubborn weight loss problems in our Functional Nutrition Metabolic Panel.

This panel gives a really thorough assessment of metabolic health. If you’re trying everything and nothing works, it’s time to dig deeper.

This panel includes testing for celiac disease, a diabetes panel to assess blood sugar control, and an in-depth look at cardiovascular health, along with the full thyroid panel. These tests will give you the most comprehensive picture of your metabolic health and guide you on a path to weight loss that actually works.

Understanding Thyroid Labs

Underactive Thyroid Symptoms but Blood Test Normal

As we mentioned before, TSH is commonly used to assess thyroid function. It’s produced by the pituitary gland (located in the brain) and tells the thyroid how to regulate hormone production.

• Elevated TSH indicates that there’s not enough circulating thyroid hormone in the body, and the thyroid should produce more. 
• Low TSH tells the thyroid that it should decrease the production of thyroid hormone because there is too much circulating in the body. 

The Importance of a Full Thyroid Panel

Here are a few reasons why TSH shouldn’t be relied on by itself to assess thyroid function:

• TSH can be within range, while other thyroid labs (that aren’t even being looked at) are out of range.
• Perhaps worse is that what’s considered a normal TSH range on a standard lab panel is based on outdated science. Even though The American Association of Clinical Endocrinologists set their upper limit to 3.0mIU/L, some lab companies still use 5.5mIU/L.
• Also, TSH isn’t even produced by the thyroid gland…remember, it’s produced by the pituitary gland, which is in the brain.
• A full thyroid panel gives much better information. Here’s what should be included in a full thyroid panel:
  • TSH – this marker matters, but as we’ve said several times, it does not provide a full picture of thyroid health.
  • Free T4 and Free T3 – help to identify clinical and sub-clinical hypothyroid.
  • Reverse T3 should also be looked at, if it’s elevated, it can be linked to cortisol dysregulation, inflammation, or iron deficiency anemia.
  • Thyroid antibodies: Anti-TPO (thyroid peroxidase antibody) and Anti-TG (thyroglobulin antibody) – are used to identify the presence of an autoimmune response to the thyroid gland (this can translate to Hashimoto’s or Grave’s disease)

Ideal Thyroid Lab Values

A big difference between conventional medicine and functional medicine is how lab values are interpreted.

Functional medicine is more preventative, looking for tighter, more ideal ranges for lab values.

Conventional medicine has wider acceptable ranges for lab values. Conventional medicine waits until there is an actual fire to put out to respond, whereas functional medicine sees smoke and takes action.

We really see this at play for thyroid labs – take a look at the chart below to see what we mean. If you’ve been lucky enough to have a full thyroid panel ordered, you can cross check your results here.

Ranges may vary a bit between labs, but what you’re really looking for is something mid-range for most of your thyroid lab values.

Lab value	Conventional range	Functional range
Thyroid Stimulating Hormone (TSH)	0.45-4.5 microIU/mL	0.4-2.5 microIU/mL
Free Thyroxine (FT4)	.82-1.77 ng/dL	0.61-1.12 ng/dL
Free Triiodothyronine (FT3)	2.0-4.4 pg/mL	2.5-3.9 pg/mL
Reverse T3 (rT3)	9.2-24.1 ng/dL	9-35 ng/dL
Thyroid Antibodies (Anti-TG and Anti-TPO)	Acceptable under 35 IU/mL	Anti-TG < 4.0 IU/mL Anti-TPO < 9.0 IU/mL

How to Order a Full Thyroid Panel

You can request a full thyroid panel at your doctor’s office and reference this post when speaking with your doctor to make sure everything is included.

We also offer this test through our clinic. We love this test from Genova because it highlights the ideal ranges and can quickly identify if you’re trending high or low so the most appropriate recommendations can be made.

You don’t have to be an established client to order labs from our clinic. We believe that everyone should have access to information pertaining to their health.

Here is the sample report from Genova Diagnostics.

To order your test email [email protected] – we will get the information we need from you and ship the kit to your house. Instructions for getting blood drawn can be found on our gut health testing page.

Can You Balance Your Thyroid Naturally?

Chances are if you’re reading this, you suffer from a hypothyroid condition since that is much more prevalent than hyperthyroid conditions (7).

There are so many things you can do at home (even starting today) to help support your thyroid health.

As functional nutrition practitioners, to help you balance your thyroid naturally, we first want to determine the root cause of YOUR hypothyroid. Only when you find the cause can you start to heal by choosing the proper intervention. 

Natural Ways to Balance Your Thyroid Hormones

• Stress management – long-term unmanaged stress = less T3 (gas for your metabolism) and more reverse T3 (brakes for your metabolism). Here are some of our favorite stress management techniques:
  • Proper sleep habits
  • Supporting the adrenal glands
  • Adult coloring books
  • Guided meditations or Headspace App
  • Spending at least 30 minutes outside each day
  • Deep breathing techniques: Box breathing or Alternate nostril breathing
  • For even more ideas, check out 15 Ways to Destress
• Avoid endocrine (hormone) disruptors. Unfortunately, these are everywhere and probably impossible to avoid completely. Common hormone disruptors including, bisphenol A (also known as BPA and is well known for being plastics), triclosan, and phthalates block thyroid receptors.
  • An easy change to make to avoid BPA is to switch to glass containers to store your leftovers and reusable glass water bottles. Ditch plastic altogether – it’s better for you and the environment. Even BPA-free products aren’t free of harmful chemicals, they are just free of BPA.
  • An in-depth discussion of endocrine disruptors is beyond the scope of this post. Check out The Environmental Working Group’s website for safe sunscreen, makeup, and household cleaning products to reduce your exposure to these common endocrine disruptors.
• Optimize gut flora since the gut microbiome plays a role in converting T4 to T3.
  • Add probiotic foods and drinks to your diet such as kimchi, sauerkraut, kefir, yogurt and kombucha
  • Take a high-quality probiotic such as one of our favorites: Megasporebiotic
• Make sure your drainage pathways are open to support detoxification since the liver is a key player in converting T4 to T3.
  • Consume more cholagogues to increase bile flow. Cholagogues include artichokes, radishes, and mustard greens, which promote bile from the liver. Note: this is NOT recommended if you have a history of gallstones, liver disorders, or obstructive jaundice.
  • If you’d rather try a supplement to help with this, we love Cellcore’s Advanced TUDCA  – this stimulates the release of bile and contains additional ingredients to further support liver detoxification. 
    • How to order: create a customer account with CellCore by using the patient direct code rNTD3V7I.
• Rule out celiac disease – people with celiac disease are more likely to make antibodies against their thyroid, are at risk for nutrient deficiencies, and have an increased risk for SIBO.
• Cover your thyroid when getting x-rays to avoid the damaging effects of radiation.

Anti-Inflammatory Diet for Hypothyroidism

If you have Hashimoto’s (autoimmune hypothyroidism), it’s even more critical to eat an anti-inflammatory diet. In our clinic, we’ve seen clients feel better and lower their thyroid antibodies through doing the LEAP MRT protocol or the Autoimmune Protocol Diet.

If you’re not ready for a total diet overhaul, you can try removing common inflammatory triggers from your diet to see if that makes you feel better (typically this includes dairy, gluten, corn, sugar and soy). Check out our Elimination Diet Guide for all things elimination diet.

Nutrients to Focus on for Thyroid Health

One of the most important things you can do to support thyroid health is to make sure you’re getting sufficient amounts of nutrients in your diet. Specifically for thyroid health, you’d want to pay special attention to the following:

• Protein –proteins are responsible for transporting thyroid hormones to all of the body’s cells.
  • The recommended dietary intake (RDI) for protein is 0.8g/kg of body weight – this recommendation is the minimum amount to prevent malnutrition (5). That’s not what we want!
    • For optimal health, we recommend 1.2-2.4 grams of protein per kilogram of body weight. Of course, you could be on the higher end or the lower end of that range depending on exercise, your body composition goals, and age (6).
    • Use this protein intake calculator to calculate your optimal protein intake.

• Iodine – this is required by the thyroid gland to make hormones.
  • Food sources: cheese, yogurt, eggs, saltwater fish, seaweed, and shellfish.

• Vitamin D – is needed for the production of thyroid hormones and is a very common deficiency.
  • Check out this blog post to learn if you’re deficient and how to boost your levels.

• Iron – this is commonly associated with hypothyroidism.
  • Food sources: red meat, chicken or beef liver, pork, and poultry.

Foods to Avoid If You Have a Thyroid Problem

In addition to the anti-inflammatory diet recommendations above, goitrogens and specifically soy should be limited for those with thyroid disease.

• Goitrogens – these are compounds that interfere with your cell’s ability to use iodine (which is key for thyroid hormone production). Cooking helps to reduce goitrogen activity, so the foods listed below should be eaten cooked instead of raw when limiting goitrogens:
  • Cruciferous vegetables (broccoli, bok choy, Brussels sprouts, cabbage)
  • Peaches
  • Strawberries
  • Millet
  • Radishes
  • Spinach
  • Peanuts

• Soy – this is also a goitrogen, and its activity is not reduced by cooking. The research is conflicting with soy, so some people prefer to limit it altogether.

Conclusion

Sometimes thyroid medication is needed – however, about a third of patients (33%) who are on thyroid medication continue to have thyroid symptoms.

If Synthroid or synthetic T4 is the only treatment used and symptoms still persist, we encourage you to work with a functional medicine practitioner for a more in-depth look at your thyroid health.

One of our favorite things about functional nutrition and being able to order testing for our clients is that there’s always more we can look at! It’s really encouraging for our clients to know that if one thing doesn’t work for them, we have several other tools to try.

Also, if something we recommend doesn’t solve a problem, it’s nice to be able to check it off the list, and sometimes it gives us a clue as to what direction to go next.

Make sure you’re getting what you need from your doctor. Don’t be afraid to speak up and ask for extra labs to be run. Remember, your doctor works for you and should be open to working with you when it comes to your health. ❤️