Preview: Here’s a sneak peek at what we’ll be talking about in today’s newsletter:
- What your thyroid does and the role of thyroid hormones
- Potential causes of thyroid disorders and who is most at risk
- How to know when to get your thyroid checked
- How to support your thyroid’s function naturally
I like to think of the thyroid as the control center of the human body. It regulates our physiology by sending and receiving messages that allow our biological systems to communicate with each other—those messages are thyroid hormones.
Thyroid hormones, our chief metabolic hormones, keep our bodies in homeostasis by modulating our basal metabolic rate (BMR), heart rate, temperature, muscle growth, digestion, tissue repair, bone metabolism, energy levels, and many other bodily functions.
As of lately (the past 50 years) thyroid diseases have been on the rise with an estimated 20 million Americans having some form of thyroid dysfunction. Of these, 60% are suffering silently because it’s rarely ever tested for (1). Signs and symptoms are subtle and may be seen as “normal” aspects of aging by conventional doctors (like hair loss, weight gain, low energy, low libido, brain fog, and increased anxiety, just to mention a few).
Before we get into what can go wrong with your thyroid and when testing might be necessary, first let’s get an understanding of how it works.
How your thyroid works
The thyroid is a butterfly-shaped organ that is on the lower front of the neck. It’s the last stop of the hypothalamus-pituitary-thyroid (HPT) axis, a feedback loop that’s activated when thyroid hormone levels fall too low, or when the demand for thyroid hormone is high like in pregnancy (2)(3).
The hypothalamus tells the pituitary to release thyroid-stimulating hormone (TSH), which signals the thyroid to make triiodothyronine (T3) and thyroxine (T4)—our main thyroid hormones. T4 has four iodines attached to thyroglobulin, a protein produced by your thyroid cells, and T3 has three iodines attached (2)(4). In order for iodine to bind to thyroglobulin to make T3 and T4, it needs help from an enzyme called thyroid peroxidase (4).
About 80% of thyroid hormone produced in the thyroid gland is T4, but T3 is the biologically active form. Therefore, T4 must be converted to T3 to be used (5). This takes place peripherally in the liver, GI tract, and kidneys and requires zinc and selenium-dependent enzymes for successful conversion (4).
The rise in thyroid disorders
Before the 1950’s, thyroid disorders were rare, almost unheard of. Now, it’s estimated that more than 12 percent of the US population will develop a thyroid condition at some point in their lifetime (1).
There are two main types of thyroid disorders: hypothyroidism (when your body makes too little thyroid hormone) and hyperthyroidism (when your body makes too much thyroid hormone). There are many reasons why the thyroid pumps out too little or too much thyroid hormone, but today I want to talk mostly about the one that’s most rapidly growing: autoimmunity.
Autoimmune thyroid conditions
Grave’s disease is the most common cause of hyperthyroidism in the US, affecting about 1 in 200 people, and is characterized by the production of thyrotropin receptor antibodies (TRAb) that stimulate the thyroid to make an excessive amount of thyroid hormone (6).
Symptoms of Grave’s disease include fast and irregular heartbeat, frequent bowel movements, weight loss, diarrhea, irritability, and goiter (when your thyroid gland becomes enlarged and has a swollen appearance). The incidence of Grave’s appears to be more common in Asian/Pacific Islanders and African Americans due to different environmental exposures, genetics, or both (7)(8).
Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the US, affecting 5 in every 100 people (9). About 90% of hypothyroid cases are related to Hashimoto’s, an autoimmune thyroid condition characterized by the presence of anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin antibodies (anti-TG) (10). As I mentioned before, thyroid peroxidase and thyroglobulin are essential for thyroid hormone production (11).
Who is most susceptible?
Women between the ages of 30 and 50 are 4 to 10 times more likely to develop Hashimoto’s than men (9)(10). This could be due to men not seeking medical care for hypothyroid symptoms as often as women (12), or because of estrogen’s effect on the thyroid gland (13)(14). However, it’s not clear what happens first; does thyroid dysfunction lead to hormone imbalances? Or do hormone imbalances lead to thyroid dysfunction? The answer seems to vary from person to person.
White women are diagnosed with hypothyroidism more than any other race or ethnicity, which some studies attribute to socioeconomic status and access to healthcare (12). But Hashimoto’s doesn’t just affect adults. It’s also the most common cause of hypothyroidism in adolescents affecting 1.3% of every 5,000 kids between ages 11 and 18 (15).
Moving forward, I’m going to focus the discussion on Hashimoto’s because I’ve found that it’s a lot more common than people might think. Even if you live a healthy lifestyle, you can still be affected by Hashimoto’s. Take it from me, I’ve been in the wellness space for 20 years, and despite doing everything in my power to live the cleanest, healthiest, and best life possible, I’ve still dealt with thyroid issues.
Where thyroid testing goes wrong
When thyroid issues are suspected, doctors usually only test for TSH, and sometimes they’ll test T4 levels, too. The problem with this is, TSH and T4 only tell us part of the story. If we aren’t testing T3 levels, how are we supposed to know if T4 is successfully converting to the active form of thyroid hormone?
If a person’s TSH is high and their T4 is low, they are usually diagnosed with hypothyroidism and put on thyroid hormone replacement therapy like Synthroid, a synthetic T4. Synthroid works for many people with hypothyroidism, but it assumes that T4 is the only problem. If the patient cannot successfully convert T4 into T3, the medication will not be able to increase the amount of circulating T3 in their body.
Even with the growing number of autoimmune hypothyroid cases, thyroid antibodies are rarely ever tested right off the bat. Research has confirmed that the presence of anti-TPO antibodies is the most accurate way to detect Hashimoto’s. They are found in 95% of Hashimoto’s cases and rarely ever in healthy controls (10).
Anti-thyroglobulin antibodies can be tested for and are often present at disease onset, although they are a less accurate indicator (10). Nonetheless, tests exist that make it possible for your doctor to screen for thyroid antibodies.
So, what’s causing this sudden rise in thyroid antibodies?
Potential causes of autoimmune hypothyroidism
Autoimmunity is the result of a complex interaction between our genes, diet, lifestyle, microbiome, and toxins that causes our immune system to become disoriented. The result is inflammation and an attack on our tissues and organs. In this section, I want to mention the three leading causes of autoimmunity that I’ve learned about over the years from talking to experts like Dr. Elroy Vojdani and Dr. Izabella Wentz on my podcast.
Molecular mimicry happens when our immune system attacks self-tissue because it shares a similar peptide sequence to a foreign antigen (it can be food, chemical, or pathogen). As a result, antibodies are made against both (16).
Another potential cause of autoimmunity, the bystander effect, is similar to molecular mimicry in that the immune system creates antibodies against a foreign antigen. However, in this case, antibodies are also made against the tissue nearest to the site where the immune reaction took place (17).
Then there is leaky gut, the result of inflammation from chronic stress, poor diet, lifestyle, environmental toxins, medications, or a lack of sleep negatively impacting our gut microbiome. This weakens the glue that holds our intestinal cells together (called tight junctions) and allows what’s in our gut (bacteria, food particles, and toxins) to pass through and enter systemic circulation resulting in an immune response, the production of antibodies, and inflammation that destroys our tissue.
Symptoms of Hashimoto’s
- Cold hands and feet
- Constipation
- Hair thinning
- Lateral third of eyebrow thinning
- Dry skin
- Brittle Nails
- Hard time losing weight
- Menstrual irregularities
- Anemic tendencies
- Depression
- Brain fog
- Fatigue
Because Hashimoto’s symptoms are so subtle, it’s hard to know whether or not to talk to your doctor about your thyroid. The Institute for Functional Medicine has a Thyroid Questionnaire with additional prompts that a lot of Functional Medicine doctors give to their patients to help uncover thyroid issues. If you check any of them off it’s probably a good idea to ask your doctor for a full thyroid panel.
It is possible for people to have Hashimoto’s or autoimmune thyroid disease and not have any of these symptoms. These are usually asymptomatic people that have normal TSH levels and low-normal thyroid hormone levels. In some cases, they might be making thyroid antibodies and have a low number of those present.
In any case, if you or anyone you know suspects their thyroid might not be functioning optimally, my protocol has some recommendations you can try to help support your thyroid.
The Protocol
I. Ask your doctor for a full thyroid panel. Like I mentioned above, TSH only gives us a glimpse of what’s going on with your thyroid. Ask your doctor for a full thyroid panel that includes all the parameters I have listed below. This will give you (and your doctor) better insight into how your thyroid functions and whether you might have thyroid antibodies present.
Below I have listed the tests to ask your doctor for in addition to the standard vs. optimal reference ranges referred to in my last newsletter.
- TSH: Standard: 0.45-4.5 µIU/mL | Optimal: 0.5-2 µIU/mL
- Free T3: Standard: 2-7 pmol/mL | Optimal: 5-7 pmol/mL
- Free T4: Standard: 12-22 pmol/L | Optimal: 15-23 pmol/L
- Reverse T3: Standard: 9.2-24.1 ng/dL | Optimal: 11-18 ng/dL
- Anti-TPO: Standard: 0-34 IU/mL | Optimal: <2 IU/mL
- Anti-TG: Standard: 1-115 IU/mL | Optimal: <2 IU/mL
A full thyroid panel is so important because, upon one of my recent lab results, I saw that both my T4 and reverse T3 were in the elevated range. I haven’t been diagnosed with a thyroid condition, but the initial meetings with my practitioners seem to indicate that I’m dealing with a flare-up of leaky gut, which is probably due to some dietary changes I made a few years ago. (I’ll expand more on that in a future newsletter!)
II. Remove potential food triggers. We want to make sure we’re controlling for potential triggers of molecular mimicry, leaky gut, and autoantibody production by removing anything that could be interfering with thyroid hormone production and activity.
1. Gluten/wheat: Gliadin, the main protein in wheat that makes up gluten, looks very similar to thyroid tissue. So if you eat gluten as someone susceptible to autoimmunity, you could produce antibodies that wind up attacking your thyroid. My friend Chris Kresser wrote a fantastic article on the gluten-thyroid connection if you want to dive deeper into the topic.
Note: Not everybody is sensitive to gluten in wheat. It’s more of a problem in the US because of how we produce it (by spraying tons of pesticides and herbicides on it right before harvest). Therefore, glyphosate (the active ingredient in weed killer) is bound to gluten that triggers the immune response.
Either way, removing gluten from your diet is probably a good idea if you live in the US and have a genetic predisposition to autoimmunity or have one or more autoimmune diseases you’re suffering from.
2. Dairy: One of the main proteins found in dairy, casein, is structurally similar to gliadin. So if you react to gluten, there’s a good chance you might be sensitive to dairy, too. Either way, the A1 beta-casein protein in conventional cow’s milk is what makes it highly inflammatory.
Some people do better with dairy sourced from high-quality goat or sheep’s milk because it contains A2 beta-casein, which is far less inflammatory. If you love dairy, try switching it up!
3. Cook your brassicas: Bok choy, kale, cauliflower, broccoli, cabbage, and collard greens are goitrogens which means they inhibit the thyroid’s ability to take and use iodine to make thyroid hormones. Cooking these lessens their goitrogenic properties, making them safer to eat.If you aren’t dealing with symptoms of hypothyroidism, brassica vegetables are safe to eat raw and excellent for your gut health. This is more for people who may suspect or are already dealing with thyroid issues.
4. Soy: Isoflavones in soy have been shown to inhibit TPO activity (18). Again, something to pay attention to if you are worried about your thyroid or have the symptoms listed above.
5. Charred foods: Although they taste great, charred foods contain high concentrations of carcinogenic compounds, which cause oxidative stress and inflammation. To ensure inflammation doesn’t get out of control, antioxidants are used up, and low circulating antioxidant levels are associated with thyroid disease (19)(20). If we removed everything from our diet that was causing potential harm, we’d probably end up eating nothing. The goal isn’t to be off of these foods forever, but rather to understand that removing them for a targeted period of time while you work with a practitioner to bring your body into harmony, could be a great plan for health.
II. Remove potential environmental toxins. These interfere with thyroid function at multiple sites, including thyroid hormone production, excretion, and activity in the body. Most of these toxins interfere with thyroid hormone production and function in the body by either impairing TSH secretion, binding to thyroid hormone receptors, and inhibiting iodine uptake.
Check the ingredient label and do your research to see if what you’re buying contains the following:
1. Phthalates: personal care products (cosmetics, lotions, shampoo, soaps, perfumes, hair spray, nail polish), toys, detergents, etc.
2. BPA: plastics (water bottles, containers, food packaging), the lining of metal cans.
3. Mercury: dental amalgams, large fish (king mackerel, albacore tuna, tilefish, swordfish), burning charcoal
4. PCBs: coolants, lubricants, adhesives, inks, plasticizers
5. Pesticides: Buying organic is the best way to reduce your pesticide exposure, but I understand that it can get expensive. If anything, buy organic for the “Dirty Dozen” list from the Environmental Working Group.
III. Lower your stress. Chronic stress can impair your ability to convert T4 to T3 (21). High cortisol levels will convert T4 to reverse T3 (rT3) instead of T3 (your active thyroid hormone). This is your thyroid’s way of stepping on the breaks to conserve energy to fight whatever is stressing you—your body is always trying to save your life!
And it doesn’t just have to be psychological stress. Physical stress from super intense and prolonged exercise could also play a role. I’ve met multiple hard-core female marathon runners who were very healthy but developed a thyroid disorder from extreme training. This is also one of the reasons that longer fasts are not recommended for people dealing with autoimmune thyroid conditions.
Try This:
1. Ashwagandha. In addition to supporting a healthy stress response, evidence also supports ashwagandha as a therapeutic tool in hypothyroidism.
One study found that people with hypothyroidism who took 600 mg of ashwagandha root extract daily had a 41% increase in T3, a 20% increase in T4, and an 18% decrease in TSH compared to placebo (22). This effect was likely due to ashwagandha’s cortisol-lowering abilities. Consult with your doctor first before taking ashwagandha. Since it raises thyroid hormone levels, you want to know what’s going on with your thyroid first.
It’s important to note that ashwagandha is considered a nightshade, so if you are sensitive to nightshades, or deal with a lot of food sensitivities, it might not be a good idea to use.
2. Nigella sativa. A science-y name for black cumin seed oil has many reported health benefits. It’s been shown to help with anxiety and depression symptoms through its powerful anti-inflammatory properties (23), although more clinical studies are needed.
In a clinical trial, Hashimoto’s patients on thyroid hormone replacement therapy given 2 g/day of Nigella sativa (1 g in the morning and 1 g at night) had significantly lower levels of TSH, anti-TPO antibodies, and inflammatory markers. They also showed increased T3 and T4 levels, reduced body weight, and BMI.
It’s important to note that this was an 8-week trial (24). There isn’t a ton of evidence regarding Nigella sativa and thyroid support, but because it’s a whole food, most practitioners regard it as safe. As always, talk to your doctor about any concerns.
IV. Generally recognized as safe: your thyroid support package. Here are some vitamins and minerals to consider supporting your thyroid’s function and ability to produce thyroid hormones.
1. Vitamin D3/K2: Vitamin D is essential for thyroid health, immune function, gut health, mood, chronic disease prevention, and so much more. However, it’s one of the most common vitamin deficiencies because sunlight is the best source, and most people aren’t getting enough to put their levels in the optimal range (50-80 ng/mL). Research shows that 50,000 IU of vitamin D3 per week can significantly lower TSH levels, which equals about 7,000 IU/day (25). It might not be necessary to take this amount long-term. It’s more so to get your vitamin D levels in the desirable range to promote optimal health. That’s why if you’re supplementing, it’s crucial to get your vitamin D levels checked every 3 to 6 months.
What’s more, vitamin D also increases calcium absorption. Therefore, it’s essential to make sure you’re taking vitamin D3 with K2 to direct calcium to your bones and teeth instead of your blood vessels, where it can calcify your arteries.
A general rule of thumb is to take 45 mcg of vitamin K2 for every 1,000 IU of vitamin D3 and to take the MK-4 form because it’s the most active. It’s important to note that certain medications can inhibit the absorption of vitamin K2. If you are on blood thinners, vitamin K2 can block their effectiveness, so always consult your doctor before taking it.
A friend of mine, Dr. Steven Lin, wrote an in-depth, evidence-based article on choosing the right K2 supplement you can read here.
2. Magnesium: Necessary for converting T4 to T3 (along with 600 other reactions in the body), many people who suffer from hypothyroidism are magnesium deficient (26). Try supplementing 500 mg/day with a form that helps raise magnesium levels in the body, like magnesium glycinate. Or, you can try BiOptimizers Magnesium Breakthrough that contains all seven different forms of magnesium that can help with sleep, energy, headaches, and overall health.
3. Selenium: 100-200 mcg/day of selenium (selenomethionine or selenocysteine is best absorbed) (27)(28), or 2-4 Brazil nuts per day have shown to decrease thyroid antibody levels (29). Be careful not to overeat Brazil nuts—too much can cause toxicity.
4. Zinc: 30 mg/day enhances thyroid function in people with Hashimoto’s (30).
5. Omega-3s: Supplementing with an omega-3 supplement can help counteract inflammation that comes with autoimmune thyroid disease. Check out my omega-3 newsletter for a detailed list of omega-3 supplement recommendations.
6. Get the RDA of iodine. Not getting enough iodine can lead to hypothyroidism and developing goiter, but getting too much iodine can exacerbate symptoms, especially if you’re taking thyroid hormone replacement medication. The RDA of iodine in the US ranges from 90 mcg per day in toddlers to 150 mcg per day in teens and adults. Pregnant and breastfeeding women call for higher iodine intake levels, 220 mcg/day and 290 mcg/day, respectively. Most prenatal vitamins contain at least 150 mcg of iodine (31).
It’s easy to meet the RDA of iodine by eating a balanced diet that includes iodine-rich foods like seafood (5-oz of sardines contains 35 mcg), seaweed (40 mcg/sheet), and iodized salt (¼ tsp contains 70 mcg, almost half the RDA).
7. Eat organ meats once a week. Organ meats are a superfood for your thyroid. Liver contains vitamin A (good for thyroid hormone metabolism), B12, folate, copper, iron, zinc, and chromium. I talk about the benefits of organ meats and how to incorporate them into your diet in a previous newsletter.
In the newsletter, I mention my previous interview with my dear friend Dr. Terry Wahls who I recently had the chance to interview again (you can listen here). She told me all about her Wahl’s Protocol, which includes eating organ meats to combat autoimmune disease. Having a fully functioning thyroid gland is an essential piece for optimal health.
There’s no way for us to feel and function our best without the right amount of thyroid hormones. The chronic disease epidemic we face today is the result of us living in the modern world. Diet, lifestyle, stress, poor sleep, and toxic chemicals all contribute to the diseases we see today, but it seems like our thyroid gland is especially vulnerable.
Because of the rise in thyroid disorder, it’s time to take action—talk to your doctor about getting a full thyroid panel done to guarantee everything is working correctly and use the tools I laid out above to start supporting your thyroid. Thyroid disorders like Hashimoto’s are treatable under the proper care of your doctor, the right medication, and a balanced diet and lifestyle.
Here’s to your health,
Dhru Purohit