Hypothyroidism: Holistic, Root-Cause Treatment
Intro
Hypothyroidism is when individuals have low thyroid hormone, leading to symptoms of chronic fatigue, weight gain, difficult-to-lose weight, constipation, dry skin, and more. This condition occurs in 1 in 300 people and happens more in females than males, and happens more in older patients.
Hypothyroidism is a very common condition that I see in my practice, and have been able to successfully manage symptoms through integrative, holistic, and root-cause means. There are many root causes for hypothyroidism, and licensed naturopathic doctors (NDs), like myself, always try to identify and treat the root cause of a person’s symptoms with integrative medicine to help alleviate symptoms.
5 things you will lead in this blog are:
The symptoms of hypothyroidism
How hypothyroidism is diagnosed & what labs are helpful for diagnosis and treatment
Root causes of hypothyroidism
What subclinical hypothyroidism is
How a licensed ND treats hypothyroidism
Symptoms & diagnosis of hypothyroidism
Having low thyroid hormone affects multiple organ systems in the body, and some symptoms of hypothyroidism include:
Slow metabolism: Weight gain and/or difficult-to-lose weight
Dermatological symptoms: Dry skin, brittle hair, and/or brittle nails
Digestive symptoms: Constipation, heartburn, and/or reflux
Fertility & hormones: Difficulty conceiving, infertility, irregular or no menstrual cycles, and/or delayed puberty
Psychological symptoms: Depression and/or irritability
Others: Fatigue, sluggishness, goiter/enlarged thyroid, feeling cold/sensitivity to cold, high cholesterol, and more
If someone has a majority of these symptoms, it will increase a doctor’s suspicion for hypothyroidism. Diagnosis of hypothyroidism by a doctor includes the clinical picture and a person’s lab results.
labs that are commonly ordered by doctors:
Thyroid stimulating hormone (TSH): TSH is a brain hormone that signals the thyroid to make thyroid hormone. TSH is made in the brain (specifically the anterior pituitary gland) when there is low levels of thyroid hormone, and when someone is hypothyroid, TSH levels tend to be high.
Free thyroxine (Free T4): Free T4 is one of the thyroid hormones made when the thyroid gland gets the TSH signal from the brain. Free T4 is transformed into Free T3, which is the active form of thyroid hormone. For some with hypothyroidism, Free T4 levels may be low or normal.
However, these labs only provide a piece of the thyroid picture, and a more-comprehensive lab order will help understand what is taking place with the thyroid.
Other labs that will give a more-comprehensive UNDERSTANDING of hypothyroidism:
Free T3: Free T3 levels will help doctors understand how well T4 is being converted into the active form, T3. In some cases, people with hypothyroidism can have normal Free T4 and high TSH, and having Free T3 will give doctors more insight as to what is the cause of low thyroid hormone.
Reverse T3: Reverse T3 is another thyroid hormone that is made from T4, and is considered the inactive form of T3. Some integrative medical practitioners like to order this lab to further understand what could be the cause of thyroid dysfunction, as there are multiple non-thyroidal causes of high reverse T3. Note: The Journal of the Endocrine Society states that reverse T3 testing is not recommended in patients who are not taking thyroid medicine.
Anti-thyroglobulin antibody & Anti-thyroid peroxidase antibody: Thyroid peroxidase and thyroglobulin are both found in the thyroid gland cells. Thyroglobulin is a protein that is primarily composed of tyrosine, and is the protein where thyroid hormone is made on in thyroid cells. Thyroid peroxidase is the enzyme responsible for adding iodine to tyrosine on thyroglobulin to make T4 and T3. Antibodies against these thyroid cell components indicate autoimmune hypothyroidism, where the immune system attacks and destroys the thyroid gland.
Vitamin D: Finding out a person’s vitamin D level is important as vitamin D deficiency have been connected to hypothyroidism.
For all of the labs above, there are specific ranges where licensed naturopathic doctors want their patients to have for optimal thyroid function. To learn more about these optimal ranges, speak to your trusted licensed naturopathic provider.
What is subclinical hypothyroidism?
Many people have been speaking about subclinical hypothyroidism in regards to thyroid function. But, what is it?
Subclinical hypothyroidism is when someone has high levels of TSH and normal levels of Free T4 and Free T3, and is usually considered an early stage of hypothyroidism. Subclinical hypothyroidism can happen in 4-8.5% of the population, but is only identified in 2% of the population. The reason why identification rates are so small is that most practitioners do not check for thyroid function if patients are asymptomatic, and people with subclinical hypothyroidism can be asymptomatic.
Root causes of hypothyroidism
Hypothyroidism can be caused by various things, and it is important to work with a provider who can sieve through the different root causes with you in order to get personalized treatment for your personal thyroid dysfunction and hypothyroidism.
Common root causes of hypothyroidism:
Autoimmunity: Autoimmunity is the most common cause of hypothyroidism. In regards to antibodies, there are various root causes of autoimmunity and the development of antibodies, which a licensed naturopathic doctor will be able to help you with.
Reduced thyroid hormone production: Iodine deficiency is the most common cause of hypothyroidism in developing countries, as iodine is a necessary mineral for the production of thyroid hormone in the thyroid gland. However, tyrosine and iron are also other nutrients that are needed for thyroid hormone production, and deficiencies in either of these could contribute to low levels of thyroid hormone.
Other root causes of hypothyroidism:
Thyroid gland removal (thyroidectomy): Thyroidectomy is a treatment for thyroid cancer, and when someone’s thyroid gland is removed, it will lead to low thyroid hormone and high TSH.
Reduced T4-to-T3 conversion: A majority of T4-to-T3 conversion takes place in the liver. And, any conditions causing liver damage, such as cirrhosis, hepatitis, liver cancer, and more, can lead to low levels of Free T3.
Increased thyroid binding globulin: Oral contraceptives have been shown to increase thyroid binding globulin, which is a protein that holds onto thyroid hormone and prevents them from being used by the body, potentially leading to symptoms of thyroid dysfunction. It has also been seen that pregnancy and high levels of estrogens can increase thyroid binding globulin.
Stress & hypothalamic-pituitary-adrenal (HPA) axis dysfunction: A longitudinal study published in 2020 revealed that working long hours are associated with hypothyroidism, suggesting that stress could play a role in the development of hypothyroidism. Additionally,
Environmental exposures: Exposure to compounds, such as triclosan, have been shown to cause low levels of thyroid hormone in animal models.
Medications: Medications that cause hypothyroidism include methmiazole, carbimazol, propranolol, glucocorticoids, metformin, and lithium.
& more
Integrative, holistic management of hypothyroidism
Integrative medicine means understanding the utility of and effectively using natural medicine and conventional medicine. And, holistic medicine entails understanding the whole picture of the person, and that organs can exert effects on each other to play a role in disease. Licensed naturopathic doctors are trained in integrative & holistic medicine, and can recommend natural and conventional treatments to their patients (given their state licensure’s scope of practice).
With that, licensed NDs can also provide personalized care for better patient outcomes as licensed NDs can also recommend options that address the root cause of a person’s disease state. Some integrative options for hypothyroidism that a licensed ND may recommend are:
Foundational health & wellness:
Therapeutic diet: Goitrogens are foods that interrupt iodine absorption, which means that it could impact the thyroid gland’s ability to make thyroid hormone. Because of this, many providers have recommended to their hypothyroid patients to avoid goitrogens in the past. However, goitrogenic activity can be reduced by simply cooking them. Goitrogenic foods include: Bok choi, broccoli, brussels sprouts, cauliflower, kale, and turnips. Additionally, a gluten free diet may be recommended to those who have tested positive for Celiac Disease.
Exercise: Aerobic exercise has been shown to increase T3 levels and reduce TSH levels in adolescents. It has also been seen that aerobic exercise increases T4 and reduces TSH in hypothyroid pregnant females.
Environmental medicine: Avoidance of environmental exposures and reducing “total load” of environmental excitants. If a provider has an understanding of environmental medicine, they may have specific recommendations to reduce total load of environmental excitants out of the body.
Targeted nutrient repletion:
Tyrosine, iodine, and iron are all needed for the production of thyroid hormone. Those who are vegan or vegetarian may have low levels of iron and tyrosine, and it would be best to speak to a licensed ND about further testing for these. In regards to iodine, iodine deficiency is more common in developing nations, and there is always a possibility of taking too much iodine.
Selenium: Selenium is an important mineral for healthy T4-to-T3 conversion, which could be recommended if labs indicate suboptimal conversion. It has also been shown that low selenium is connected to increased rates of thyroid disease and that selenium can reduce thyroid antibodies.
Zinc: Zinc has been shown to also optimize TSH levels when combined with selenium, and might be recommended by a licensed ND.
Magnesium: Magnesium supplementation may be recommended by a licensed ND since magnesium deficiency has been associated with hypothyroidism and elevated anti-thyroglobulin antibodies. However, more research needs to be conducted to understand how magnesium deficiency could lead to hypothyroidism.
Vitamin D: It has been shown that vitamin D supplementation reduces TSH levels in those with hypothyroid, but no changes to thyroid hormone were found in that study.
Herbal medicine: Ashwagandha has been shown to be of benefit in those with subclinical hypothyroidism, and coleus forskolii could potentially optimize thyroid function. However, there have been some reports of thyroid complications with herbal supplements, and it is best to work with a trained provider, such as a licensed ND, before starting anything new.
Hormone replacement: If labs indicate severe thyroid hormone deficiency and severe hypothyroidism, thyroid hormone replacement therapy may be recommended. There are synthetic T4 medications and natural preparations of combination T4 and T3. Depending on labs, patient preference, and state scope of practice, a licensed naturopathic provider may recommend:
Levothyroine (Synthroid)
Desiccated thyroid (Armor Thyroid, Naturethroid, NP Thyroid, and/or WP Thyroid)
Symptom management: As patients are adapting to their treatments, their doctor may recommend options to help with constipation, heartburn, reflux, fatigue, and high cholesterol.
There are many more integrative & holistic treatments that could be recommended by a licensed ND, depending on extra training and deeper understanding of a patient’s personal root causes.
Summary & Takeaways
Hopefully you found this blog post insightful, and why is it important to understand the holistic picture of a person’s hypothyroidism.
Here’s a summary (and the TL;DR) of this blog:
Hypothyroidism can affect multiple organ systems and can affect energy levels, metabolism, skin health, heart health, mental health, and more.
A comprehensive lab order is helpful for diagnosing & understanding root causes of hypothyroidism. It is also helpful for personalizing and targeting treatment for better patient outcomes.
Subclinical hypothyroidism is when someone has high levels of TSH, but normal levels of thyroid hormone. And, this could indicate early thyroid disease.
The most common cause of hypothyroidism is autoimmunity. Iodine deficiency is another common cause, but more-so in developing nations.
Other root causes of low thyroid hormones include: Thyroid gland removal, reduced thyroid hormone production, reduced T4-to-T3 conversion, reduced free thyroid hormone due to increased thyroid binding globulin, and more.
There are a variety of integrative options to help with the management of hypothyroidism. Depending on a variety of factors, a licensed ND may recommend root-cause treatment and/or hormone replacement treatment to increase thyroid hormone levels.
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