Optimal Thyroid Function

Frequently Asked Questions

• 1

  What complexities does one need to understand when treating the thyroid?

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  Optimal treatment requires an understanding the complexities of thyroid function. Thyroid function has been oversimplified in an attempt to be able to use a simple test (i.e. the TSH) to define "normal" thyroid levels. Simplistic view breaks down when one understands the many steps that are required to achieve optimal tissue thyroid activity.

• 2

  What do the standard tests detect?

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  The standard tests will, in general, only detect dysfunction when the thyroid gland is the source of the problem. While primary hypothyroidism (when the thyroid gland is the source of the dysfunction) is the most commonly diagnosed, other causes of sub-optimal or low tissue thyroid activity are much more common but only rarely diagnosed.

• 3

  What are the other causes of hypothyroidism ?

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  If there is a problem in any one of the following steps below, there will be sub-optimal, or low, tissue thyroid activity that usually goes undetected.

  At Health Renewal we believe that once the many potential sources of thyroid dysfunction are understood, laboratory tests, in conjunction with symptoms and other physiologic signs, can be more effectively used as tools to help determine optimal treatment.

• 4

  How does chronic disease affect the thyroid?

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  • Dysfunction of the hypothalamus and pituitary;
  • Impaired cellular transport;
  • Poor T4 to T3 conversion;
  • Increased formation of reverse T3;
  • Thyroid receptor blockage; and
  • Inhibition of thyroid stimulated gene activation (due to chronic illness, inflammation, depression etc)

  If there is a dysfunction at the level of the receptor or gene activation, which occurs to varying degrees with chronic illness, inflammation, depression, supraphysiologic serum levels of T3 would be needed to overcome this inhibition. In such cases, standard serum thyroid tests become less reliable so other tests must be utilised to best determine optimal tissue thyroid activity.

• 5

  What other tests can be done to determine optimal tissue thyroid activity?

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  These tests may include a:

  • sex hormone binding globulin (SHBG) level;
  • tendon reflex relaxation speed;
  • basal metabolic rate.

  These tests should all be interpreted in conjunction an evaluation of signs and symptoms, which are, of course, a very important means of determining optimal treatment.

• 6

  What Tests are there to Aid in Assessment of Optimal Thyroid Replacement?

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  There are a number of tests that are useful in helping to assess optimal thyroid replacement.

  • TSH- At Health Renewal we consider a TSH above 2 as clear indication that there are low tissue thyroid levels. A normal TSH does not rule out thyroid dysfunction and a low TSH is shown to be an indication of excessive tissue thyroid levels only 20% of the time (80% of the time that is not the case). The TSH becomes an extremely poor marker for tissue thyroid levels if there is any inflammation, depression, chronic illness, chronic dieting, obesity, stress, chronic fatigue syndrome, fibromyalgia, diabetes, insulin resistance, leptin resistance present.
  • T4. The difficulty with T4 levels is that if there is a problem with thyroid hormone transport (T4 and T3 being transported into the cell), high T4 levels may be associated with lower cellular levels of thyroid.
  • Free T3. Generally, the free T3 should be in the upper 25th percentile of the normal range. The 'normal' range is, however, applicable when prescribing T4, which is converted to T3 in the cell and then the amount that leaks back into the serum is the "normal" level. NBBB: When treating with T3, this is not the case so standard reference ranges cannot be used.
  • Reverse T3 - is both a marker for reduced T4 to T3 conversion and for reduced transport of T4 into the cell - and has antithyroid activity (blocks the effect of thyroid) - and should be less than 150.
  • SHBG - Sex hormone binding globulin (SHBG) is a marker for tissue level of the thyroid, so if less than 70 in a woman, consider it a marker for low or suboptimal tissue thyroid activity. If thyroid replacement is given and SHBG does not increase proportionally, this is an indication of thyroid resistance.
  • Leptin - The serum leptin level should be less than 12. The higher the leptin level, the greater the leptin resistance. Leptin resistance suppresses TSH production and T4 to T3 conversion. Thus, the higher the leptin the more useless the TSH becomes.
  • Iron/Iodine - Iron and iodine levels should be checked and deficiencies should be treated, as they are required for thyroid activation.
  • Basal Metabolic Rate (BMR) - Tissue thyroid levels are a major determinant of overall metabolism so the overall metabolic level can be considered the gold standard for the body's thyroid level. Thus, the BMR can be used to help determine the most optimal level. This is a test that can be done in some doctors' offices.
  • Relaxation Phase of Tendon Reflex - Numerous studies have shown that this is a more accurate measure than serum blood tests, as it is more of a measure of tissue activity, rather than serum levels, and the optimal level should be faster than 110 msec.
• 7

  How common are thyroid disorders?

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  One in eight women will develop a thyroid disorder during her lifetime. And, the number of people suffering from thyroid disorders continues to rise each year. But the bigger problem is that nearly 60 percent of these people are completely unaware of their condition - let alone how to heal it. Millions of people are suffering - trying all kinds of diets, pills, and treatments to clear their mental fog, to boost energy and lose weight. Unfortunately, they will all fail unless they learn how to heal the underlying thyroid issues.

• 8

  How important is thyroid hormone?

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  Every cell in the body has receptors for thyroid hormone. These hormones are responsible for the most basic aspects of body function, impacting all major systems of the body. You can think of the thyroid as the central gear in a sophisticated engine. If that gear breaks, the entire engine goes down with it.

• 9

  What additional symptoms are thyroid disorders associated with?

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  Most people know that thyroid disorders can cause weight gain, digestive problems, and fatigue. But did you know they can also cause symptoms like brain fog, depression, dementia, dry skin, hair loss, cold intolerance, hoarse voice, irregular menstruation, and even infertility?

  Thyroid hormone directly acts on the brain, the G.I. tract, the cardiovascular system, bone metabolism, red blood cell metabolism, gall bladder and liver function, steroid hormone production, glucose metabolism, lipid and cholesterol metabolism, protein metabolism and body temperature regulation. For starters:

  • Wilsons protocol
  • To convert reverse T3 to T 4
  • Exclude infections
  • Trauma
  • Low-calorie diet
  • Certain medications
• 10

  How do goitrogenic goods affect thyroid function?

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  Goiter, which is a swelling of the thyroid gland, is most frequently caused by either iodine deficiency or exposure to chemicals or drugs that somehow block the uptake of iodine or interfere with its utilisation. Now, there’s a little bit of a nuance to the whole goitrogenic story. At relatively low concentrations, they decrease the uptake of iodine in the thyroid gland from other foods that we eat.

  But at high concentrations, goitrogens actually interfere with the incorporation of iodine into thyroid hormone itself, and this means that even if there’s enough iodine in the diet or through supplements going into the gland, it can’t be properly utilized, and therefore, no amount of supplemental iodine or high amounts of iodine-containing foods, like seaweed, would be able to overcome a really high intake of goitrogenic foods.

  In patients with thyroid issues, as long as they are taking enough selenium or getting enough selenium in the diet, iodine doesn’t tend to cause any problems or exacerbate their autoimmune condition, especially if they follow the guidelines by starting with a really low dose, a few hundred or couple hundred micrograms maybe, and then building up really slowly over time. There are a few patients, however, who do react even to a very small dose even when their selenium intake is adequate. And in those cases, they might want to exercise a little bit more caution with goitrogenic foods because they may not be able to increase their iodine intake to the point where it’s sufficient to protect against the potentially iodine-limiting effects or goitrogenic effects of these foods.

• 11

  What foods contain goitrogens?

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  Top 11 Goitrogenic Foods tend to be cruciferois foods:

  • Bok Choy
    
  • Broccoli
  • Brussel sprouts
  • Cabbage
  • Cauliflower
  • Kale
  • Kohlrabi
  • Mustard and Mustard greens
  • Radishes
  • Rutabagas
  • Soy (anything)
  • Turnips

  Foods with Smaller Amounts of Goitrogens?

  • Bamboo shoots
  • Millet
  • Peaches
  • Peanuts
  • Pears
  • Pine Nuts
  • Radishes
  • Spinach
  • Strawberries
  • Sweet Potatoes
  • Wheat and other gluten-containing grains
• 12

  Should You Avoid These Foods?

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  As mentioned, just because these foods are high in goitrogens doesn’t mean you should avoid them; in fact, the benefits far outweigh the downsides (except for soy). If you want to have broccoli once or twice a week, go ahead! Just make sure you don’t eat it raw; cooking reduces the goitrogenic substances by up to a third, except for soy and millet. Don’t eat several foods off the list in one day; they have a cumulative effect.

  Anyone without thyroid problems should be able to eat goitrogenic foods in moderation without issue. Only people with thyroid issues should avoid these foods or eat them in very small amounts. One way to offset the effects is to eat foods high in iodine along with them.

• 13

  Causes of Goiter:

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  Goitrogen ingestion is not the only cause of goiters; in fact, it’s only one of many. The most common cause is iodine deficiency, particularly in countries that don’t use iodized salt. Worldwide, more than two billion people are affected by iodine deficiency. The U.S. FDA recommends that adults get a minimum of 150 micrograms of iodine per day.

  Other causes include congenital hypothyroidism, adverse drug reactions, Hashimoto’s thyroiditis, pituitary disease, Graves’ disease (aka Basedow syndrome), thyroiditis, thyroid cancer, benign thyroid neoplasms, and thyroid hormone insensitivity.The condition of inlarged thyroid is most common among women.

• 14

  Which are Thryoid-Supporting Foods:

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  There are several foods that will support thyroid health. Among them are those high in iodine and tyrosine.

  Foods Rich In Iodine

  For most people with goiters, a diet high in iodine is the most common treatment. Iodine is the most important element in thyroid health. Most goiters are caused when the thyroid enlarges in an effort to pull more iodine in out of the bloodstream. Foods that are high in iodine include kelp and other sea vegetables, fennel, Jerusalem artichokes, cow’s milk, eggs, and raisins. If you currently use sea salt or any other salt, check to see if it has been iodized. Sprinkling iodized salt on your foods is the easiest way to get a bit of iodine in each meal.

  Foods Rich in Tyrosine

  Tyrosine is an amino acid that is found in a lot of goitrogenic foods like wheat, peanuts, and soybeans. It’s important to get tyrosine without those goitrogenic properties tagging along. Some good sources include pumpkin seeds, beef, fish, dairy products, eggs, bananas, avocados, poultry, and almonds. These animal-based foods high in protein also tend to be good sources of Vitamin B12 and selenium, which are also important for thyroid health. Salmon, high in tyrosine, are also excellent sources of Omega-3 fatty acids, which are anti-inflammatory and can help with proper thyroid function.

  Non-Cruciferous Veggies and Fruit

  If you’ve got thyroid issues, some of the best foods you can eat (aside from those already mentioned) include non-cruciferous vegetables and fruit. Vegetables and fruit, in general, tend to contain high amounts of antioxidants, especially when eaten fresh. Antioxidants help protect your body against damage from free radicals. Most also have high amounts of electrolytes like potassium and sodium, which contribute to the movement of fluid in body tissues.

  Squash, tomato, bell peppers, green beans, peas, cucumber, asparagus, eggplant, carrots, and celery are all great examples of non-goitrogenic vegetables to enjoy.

  Most fruit is high in Vitamin C and other antioxidants. Some non-goitrogenic fruits you should eat include mangoes, citrus fruits, blueberries, dark-skinned grapes, pomegranates, guavas, cherries, apricots, apples, pineapples, and kiwis.

• 15

  Goitrogens and Paleo Diet?

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  People who follow a Paleo diet already avoid a few of the goitrogenic foods like soy and peanuts, but what about the other foods?

  Chances are, if you eat Paleo-style, your diet is rich in selenium and tyrosine, iodine, antioxidants, and other beneficial nutrients. Eat lots of fish, meat, poultry, and eggs, and enjoy yogurt and grass-fed butter, if you don’t have issues with dairy products.

  If you have access to raw milk, you might want to consider adding it to your diet. Definitely, continue to avoid wheat and soy! Add in all the other downsides (inflammatory properties, gluten issues, and endocrine disruption (from soy)) and there are really no good reasons to eat either of them.

• 16

  How high blood sugar affects the thyroid:

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  Metabolic syndrome is defined as a group of metabolic risk factors appearing together, including:

  • Abdominal obesity;
  • High cholesterol and triglycerides;
  • High blood pressure;
  • Insulin resistance;
  • Tendency to form blood clots; and,
  • Inflammation.

  Metabolic syndrome is caused by chronic hyperglycemia (high blood sugar). Chronic hyperglycemia is caused by eating too many carbohydrates. Therefore, metabolic syndrome could more simply be called “excess carbohydrate disease”. In fact, some researchers have gone as far as defining metabolic syndrome as “those physiologic markers that respond to reduction, in dietary carbohydrate.”

  When you eat too many carbs, the pancreas secretes insulin to move excess glucose from the blood into the cells where glucose is used to produce energy. But over time, the cells lose the ability to respond to insulin. It’s as if insulin is knocking on the door, but the cells can’t hear it. The pancreas responds by pumping out more insulin (knocking louder) in an effort to get glucose into the cells, and this eventually causes insulin resistance.

  Studies have shown that the repeated insulin surges common in insulin resistance increase the destruction of the thyroid gland in people with autoimmune thyroid disease. As the thyroid gland is destroyed, thyroid hormone production falls.

• 17

  How low blood sugar affects the thyroid?

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  But just as high blood sugar can weaken thyroid function, chronically low blood sugar can also cause problems:

  Your body is genetically programmed to recognise low blood sugar as a threat to survival. Severe or prolonged hypoglycemia can cause seizures, coma, and death. When your blood sugar levels drop below normal, your adrenal glands respond by secreting a hormone called cortisol. Cortisol then tells the liver to produce more glucose, bringing blood sugar levels back to normal.

  The problem is that cortisol (along with epinephrine) is also a sympathetic nervous system hormone involved in the “flight or fight” response. This response includes an increase in heart rate and lung action and an increase in blood flow to skeletal muscles to help us defend against or flee from danger. Cortisol’s role is to increase the amount of glucose available to the brain, enhance tissue repair, and curb,  functions – like digestion, growth and reproduction – that are nonessential or even detrimental in a fight or flight situation.

  Unfortunately for hypoglycemics, repeated cortisol release caused by episodes of low blood sugar suppresses pituitary function. And as I showed in a previous article, without proper pituitary function, your thyroid can’t function properly.

  Together, hyperglycemia and hypoglycemia are referred to as dysglycemia. Dysglycemia weakens and inflames the gut, lungs and brain, imbalances hormone levels, exhausts the adrenal glands, disrupts detoxification pathways, and impairs overall metabolism. Each of these effects significantly weakens thyroid function. As long as you have dysglycemia, whatever you do to fix your thyroid isn’t going to work.

• 18

  How low thyroid function affects blood sugar?

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  We’ve seen now how both high and low blood sugar cause thyroid dysfunction. On the other hand, low thyroid function can cause dysglycemia and metabolic syndrome through a variety of mechanisms:

  • It slows the rate of glucose uptake by cells;
  • It decreases rate of glucose absorption in the gut;
  • It slows response of insulin to elevated blood sugar; and,
  • It slows the clearance of insulin from the blood.

  These mechanisms present clinically as hypoglycemia. When you’re hypothyroid, your cells aren’t very sensitive to glucose. So although you may have normal levels of glucose in your blood, you’ll have the symptoms of hypoglycemia (fatigue, headache, hunger, irritability, etc.). And since your cells aren’t getting the glucose they need, your adrenals will release cortisol to increase the amount of glucose available to them. This causes a chronic stress response, as I described above, that suppresses thyroid function.

• 19

  How to keep your blood sugar in a healthy range:

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  It’s important to understand that whether you have high or low blood sugar, you probably have some degree of insulin resistance. I described how high blood sugar causes insulin resistance above. But insulin resistance can also cause low blood sugar. This condition, called reactive hypoglycemia, occurs when the body secretes excess insulin in response to a high carbohydrate meal – causing blood sugar levels to drop below normal.

  In either case, the solution is to make sure your blood sugar stays within a healthy range. There are two targets to consider. The first is fasting blood glucose, which is a measure of your blood sugar first thing in the morning before eating or drinking anything. I define the normal range for fasting blood glucose as 4.16 – 5.27 mmol/ although 5.5 mmol/ l often considered the cutoff for normal, studies have shown that fasting blood sugar levels in the mid were predictive of future diabetes a decade later. And although 4.4 mmol/ l is often defined as the cutoff on the low end, plenty of healthy people have fasting blood sugar in the mid-to-high 3.9 mmol/ l (especially if they follow a low-carb diet).

  The second, and much more important targets the post-prandial blood glucose. This is a measure of your blood sugar 1-2 hours after a meal. Several studies have shown that post-prandial blood glucose is the most accurate predictor of future diabetic complications and is the first marker (before fasting blood glucose and Hb1Ac) to indicate dysglycemia.

  Normal post-prandial blood sugar one to two hours after a meal is 6.6 mmol/ l Most normal people are under 5.5 mmol/ l two hours after a meal.

  Now that we know the targets, let’s look at how to meet them. If you’re hypoglycemic, your challenge is to keep your blood sugar above 4.16 throughout the day. The best way to do this is to eat a low-to-moderate carbohydrate diet (to prevent the blood sugar fluctuations I described above), and to eat frequent, small meals every 2-3 hours (to ensure a continuous supply of energy to the body.

• 20

  What is the best way to keep control of blood sugar level?

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  If you’re hyperglycemic, your challenge is to keep your blood sugar below 6.6 mmol/ l two hours after a meal. The only way you’re going to be able to do this is to restrict carbohydrates. But how low-carb do you need to go? The answer is different for everyone. You figure your own carbohydrate tolerance by buying a blood glucose meter and testing your blood sugar after various meals. If you’ve eaten too many carbs, your blood sugar will remain above 6.6 mmol/ l two hours after your meal.

  I highly recommend you pick up a blood glucose meter if you have a thyroid and/or blood sugar problem. It’s the simplest and most cost-effective way to figure out how much carbohydrate is safe for you to eat. There are a lot of meters out there, but one that gets a lot of good recommendations is the ReliOn Ultima. It’s pretty cheap, and the test strips are also cheap, which is where the major expense lies.

• 21

  Why does one need to control thyroid function to improve insulin resistance?

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  Finally, if you have poor thyroid function it’s important that you take steps to normalise it. As described in this article, the cycle works in both directions. Dysglycemia can depress thyroid function, but thyroid disorders can cause dysglycemia and predispose you to insulin resistance and metabolic syndrome.