We’re tackling the thyroid and how it ties into what I call the bodies ‘web of physiological dysfunction’ but it can really be about any chronic condition e.g. MS, ADD, ADHD, Parkinson’s, Autism, Diabetes, etc. In almost any chronic condition, you could have a same or similar type of physiologic dysfunction.
But in this case, let’s focus on the thyroid as it’s a great example due to its interconnectedness to all the major systems of the body.
It Starts With The Brain
The brain controls everything and things that go wrong with the brain will snowball downhill and affect other systems in many ways. Several important features to take into consideration when thinking of the brain are this it’s comprised of two halves– the left and right hemispheres.
Brain hemispheres must be balanced.
There’s two parts of the brain in particular that deal with the thyroid. They are the hypothalamus and the pituitary gland. We’ll explore that later, but for now know that the beginning of thyroid metabolism starts in the brain.
The brain requires two different types of fuel, glucose (sugar) and oxygen. If you have blood sugar dysregulation or anemia, you’re going to have a brain problem. And that can also lead to thyroid problem.
Another major issue with the brain is inflammation. Often times this inflammation can come from the gut. Gut function is extremely important and roughly 80% of our immune function comes from the gut. Think of it as the first line of defense.
Research has shown a very strong connection between the gut and the brain which is called the gut/brain axis and inflammation in the gut can often lead to inflammation in the brain.
Enter the problem we call ‘leaky gut’. This is where the membrane becomes hyper permeable, allowing things like food particles to leak from your gut into your bloodstream. We’ll get more into this in later articles as well.
The third part of the ‘web of dysfunction’ is in relation to blood sugar. Your normal fasting blood sugar should be between eighty five and ninety nine. This is the measurement of how much sugar is in your blood at that particular instant. There’s also a 120 day marker called hemoglobin A1C which shouldn’t be above 5. Blood sugar itself can be the number one stressor in the body.
The Impacts of Stress
The gland that helps us regulate stress is called our adrenal gland. This little gland is shaped like a hat and sits atop each kidney. There’s an outer layer called the cortex and an inner layer called the medulla.
The outer layer makes cortisol, the ‘stress hormone’, which is produced when your body is under stress. Imagine walking in the woods and all of a sudden you run into a momma bear and her cubs. You’re going to go into what’s called the flight or fight mechanism. What you don’t need to be doing is digesting your food in this mode but instead mobilizing sugars from storage in the liver to the muscles for energy. What happens is some systems are going to be suppressed and others jacked up.
Cortisol is produced to get blood sugar out of the liver but once the threat is over, our body should wind down and go to the other side which is ‘wine and dine’ also known as a relaxation mode.
Some folks can’t do this well or are under chronic stress and this wears out the cortex of the adrenals. Then instead of releasing cortisol, we begin releasing adrenalin.
A good indicator you may have adrenal fatigue is if you’re have trouble falling asleep, you wake up in the middle of the night or you wake up not feeling well rested. Our cortisol levels should only go up under stress or throughout the night to balance out the normal drop in blood sugar from fasting.
If however your blood sugar has been going up and down all day and stressing your adrenals and you don’t have enough cortisol at night to keep your blood sugar up, your adrenals will squeeze out adrenalin instead. And that will WAKE YOU UP like drinking a pot of coffee. These are folks who wake up at 2 to 4 a.m. in the morning , maybe breaking a sweat or having anxiety or just always waking up to pee.
Your Thyroid Hormones
Last but not least, I want to discuss your thyroid hormones themselves. When you go to your medical doctor the only standard of care test they run to diagnose your thyroid is TSH. Occasionally they’ll run a T4.
Have they run a T3, free T3, free T4, free thyroxin index, T3 uptake, reverse T3, and TPO and TGB antibodies? When these are positive, it can be an autoimmune response from your body towards your thyroid called Hashimoto’s.
Let’s now map out the thyroid pathway in more in detail to see why by only looking for TSH and T4, you could be missing a large part of the picture.
We’re going to start with the hypothalamus. It sits deep inside, right at the front of the brain and behind the eyes. Its right above a little punching bag looking gland called the pituitary.
The hypothalamus is dependent on two neurotransmitters called serotonin and dopamine. So we have to have good levels of neurotransmitters to stimulate the hypothalamus which in turn sends out a hormone called TRH which stimulates the pituitary. The pituitary gland in turn is going to stimulate the thyroid.
The thyroid only has one job which is to produce thyroid hormone.
It produces T4 and T3. T3 drives metabolism in every cell in your body. It goes into the DNA and drives the speed of the proteomic response. This means if it’s a foot cell then it controls the rate that you make more foot cells. So the amount of T3 that gets to the DNA of the cell set’s what we call the basil metabolic rate.
Note that only T3 fits into the receptor site in the cell’s DNA. T4 does not fit and the thyroid only produces around 7% T3. 93% of what the thyroid produces though is T4. This T4 binds to a protein called thyroid binding globulin which is like a little delivery truck. This goes down to the liver.
60% of the time t4 is converted to T3 in the liver and it can then go into the cells to do its thing. 20% of the time it goes into what’s called reverse T3. Think of this like an overflow valve. Another 20% goes into T3 sulfatase and T3 acetic acid which then must go to the gut to be further converted to T3. This means that if you don’t have good stomach acid or the right type of bacteria in the gut, you can have trouble here.
Let’s use an analogy to help understand more clearly how this works. Think of this hypothalamus, pituitary, thyroid axis being a three-story factory. This factory produces some ‘widgets’, being our T4 and T3. Let’s say that our cells are the customer who wants to order some widgets. The customer is going to call the factory on the top floor (hypothalamus), who’s the CEO. The CEO says no problem, we can make some widgets. He gets on the intercom to the plant manager on the second floor (pituitary) and gives the order. The plant manager then yells down at the workers on the bottom floor (thyroid) to get producing. The workers get the assembly line going and widgets are made.
Some of these widgets are perfect and go straight to the customer. These get loaded on the truck and go straight to the customer (T3). This only happens about 7% of the time however. Most of them have some sort of defect on them and need to be loaded up on a delivery truck and sent down to another processing plant (the liver) where they’re going to clean them up. 60% of the time they clean them up there and they’re off the customer. 20% of the time they need even more work and they’re off to one last plant (the gut) for a final tweaking. Another 20% of the time the widgets are so bad that they have to be thrown out, never to be used (rT3) again.
So let’s now discuss what can happen if we have a break down. First is maybe the worker breaks his leg. The manager doesn’t know what’s going on. He just looks out the window and sees that the delivery truck is empty. So he picks up the intercom and starts screaming down to the workers. When we look at this screaming in your blood work, think of the pituitary making more TSH to push the thyroid. TSH should normally run between 1.8 to 3.0 and as the number climbs the high lab range can be somewhere between 4.7 and 5.5. If we get above that we have hypothyroidism and if the problem is the workers leg broken (thyroid) then we have primary hypothyroidism.
This is where the drug works e.g. thyroxin, synthroid. These drugs are synthetic T4. There’s another synthetic T4 factory that pops up and fills the trucks instead. The manager doesn’t really care as long as the trucks full, everything’s good and TSH levels come down to normal. If it’s just that problem, you should feel awesome. But that’s most likely not the case or you wouldn’t be here reading this.
So let’s look at some other pathways. Say that the factory workers fine but the manager falls asleep in his office. The workers end us sitting around because no one’s told them what to do. They’re healthy but still nothing’s making it to the trucks. It’s not because they couldn’t do it, it’s just that no one told them what to do. If TSH drops below 1.8 and it’s not from being over medicated, but due to something above the thyroid e.g. not enough stimulation to the thyroid, then we have low input and low output. That’s a pituitary and above problem.
We could have a problem with the delivery trucks. It can be skewed by testosterone and estrogen. We could have with the liver. We could have a problem with the gut. We could have a problem with inflammation in the cell causing insulin resistance.
The adrenals could affect the pituitary, can block the conversion in the liver from T4 to T3, can create inflammation the in the body by high levels of cortisol and high levels of cortisol is toxic to the brain.
Your body may also be in a catabolic state which means it’s constantly breaking down. Maybe you’re over exercising or have some chronic infection going on. Your body can down regulate T3 to slow your metabolism by shunting it into reverse T3.
When the medical doctor looks at your blood work, TSH and T4, he’s looking at a very small part of this process. We have to convert 93% of T4, synthetic or natural, into T3 because that’s what the cell runs on. If you’re not looking at T3, you’re missing a huge piece of the puzzle.
What trumps all of this is if you have an autoimmune condition called Hashimoto’s. They’re not even testing for it because it doesn’t change what they do, which is to give you synthetic T4. That’s their one trick pony and it’s not even addressing the real problem.
The thyroid is the smoke; the immune system is the fire.
Let’s circle back and discuss leaky gut and then we’ll go over what you need to do testing wise to get this looked at. Think of the individual cells that make up the lining of your intestines as locked together. It’s like your thumbs locked with your palms out and your fingers up in the air. Your fingers would be the villi that project inside the intestines to grab tiny food particles as they pass through the digestive system.
As these particles move through the intestines, enzymes break them down into smaller and smaller particles until eventually the villi pull them through the cells through the submucosa, into our blood stream and we get nutrition into our body.
There’re some bad things that can happen however. We can have food sensitivity, a bacterial over-growth, a parasite, etc. What can happen from that is that those tight junctions open up like little elevator doors opening up, leaving a gap between the cells. This allows large dietary proteins to leak through e.g. ‘leaky gut’.
What do you think happens when this large particle gets through into your bloodstream?
Your immune system attacks. Like a pac-man, it gobbles it up. But your immune system reacts as if it doesn’t know if it’s just this one ‘invader’ or a whole army. It just takes a sketch of it and sends out the message so everyone else is on the lookout.
What happens in people with autoimmune conditions is that the body will attack other tissue as well, almost like an innocent bystander in a drive by shooting. We call this molecular mimicry. In the case of Hashimoto’s, immune cells hanging out near the thyroid start attacking the thyroid whenever they get the message that an invader has come over the wall.
Stored in the thyroid is T3 and T4 and when it’s attacked, those thyroid hormones are dumped into the bloodstream. It’s the workers dumping widgets galore onto the truck and the manager backing seeing there’s plenty and decreasing TSH. But then the attack will pass and TSH will come up to normal again.
Eventually the thyroid will begin to be destroyed and the TSH may show in your blood as a bit high. This deterioration will continue until your thyroid is so damaged that you show high TSH and they diagnose you as hypothyroidism. This is when the doctor may prescribe synthetic T4.
Meanwhile, your thyroid continues to be attacked from this autoimmune process and your levels will continue to fluctuate and symptoms will persist. If you notice that your doctor is continuing to have a hard time regulating your meds for your condition, there’s a good chance that you have Hashimoto’s. Again, the thyroid is the target of the attack and is not the problem.
It’s an immune problem.
There are 95 different tissue types in your body and any can be targets of autoimmune processes. There a condition called polyautoimmunity where multiple tissues are attacked through the same process. Often times we see pernicious anemia going along with Hashimoto’s, for example.
So what do you do now that you know that TSH and T4 are not nearly enough? You have to look at the whole web. There are three tests that we’ll primarily run in our office. The first one is a comprehensive bloodwork panel with over 70 markers. We’re going to look at all the thyroid markers, insulin, inflammation, RBC’s, WBC’s, etc. It’s a huge panel.
We like to look at the adrenals and hormones with a separate test measuring your cortisol pattern. We also check for leaky gut and food sensitivity with certain tests.
To start off, there’s typically just blood work. When you come in for your first visit, we’ll sit down with you after you’ve filled in a few questionnaires; we’re going to build a physiological web of dysfunction specifically tailored to you. There’s nothing cookie cutter for this work. Every single patient is an individual. We’re going to sit down and figure out what your web is, especially outside the TSH/T4 window.