Fat, Tired and Inflamed – Could it be your Thyroid?

Balancing all of your hormones, including sex hormones, adrenal or stress hormones, and thyroid hormones, becomes crucial if you want to heal. They are all interconnected; they interact with one another like a musical symphony. When any instrument in the symphony plays out of tune, problems arise. In this blog, I want to focus on your thyroid, and why an out-of-whack thyroid can stall your metabolism and create many other problems. To overcome diabesity, you must identify and treat thyroid imbalances, because your thyroid controls your metabolism. If it is working slowly, your metabolism slows and your risk of diabesity goes up. Thyroid disease affects one in five women and one in ten men, yet 50 percent of people with thyroid disease go undiagnosed. Many who are diagnosed become treated inadequately with medications such as Synthroid®. A vicious cycle erupts because undiagnosed thyroid disease worsens insulin resistance, and insulin resistance worsens thyroid function. To make matters worse, many patients on thyroid hormone replacement are not adequately tested. If your thyroid is low, you can’t adequately balance your blood sugar and your cholesterol or lose weight. That is why using a whole foods diet, nutritional supplements, and optimizing thyroid hormone replacement becomes critical to resolve diabesity. How the Thyroid Gland Functions To understand why an optimally functioning thyroid becomes crucial for metabolism and so much more, we need to briefly look at how this tiny yet vital organ works. The thyroid gland is a small gland located in your neck that is part of your endocrine or hormonal system. It produces two major thyroid hormones:
  • About 7 percent of your thyroid hormone is T3, the “active” version, which acts on special receptors found on the nucleus of your cells that sends messages to your DNA to turn up your metabolism to increase the fat burning in your mitochondria. T3 is critical to making every system in your body work at the right speed.T3 lowers your cholesterol, improves your memory, keeps you thin, promotes regrowth in cases of hair loss, relieves muscle aches and constipation, and even cures infertility in some patients.
  • T4 (about 93 percent) is the inactive form of your thyroid hormone that, if everything works as designed, your body will convert into T3.
Many dietary factors, along with lifestyle and environmental factors, affect this process. The main role of thyroid hormone is to stimulate metabolism, and it affects almost every function of the body. That’s why it can cause so many different symptoms. Remember earlier I said your hormones interact? Thyroid hormone "cross-talks" with all the other hormones in your body, including insulin, cortisol, and your sex hormones. The production and release of thyroid hormones in the thyroid gland are regulated by a feedback system in your brain— the hypothalamus and pituitary glands— that make thyroid-releasing hormone (TRH) and thyroid-stimulating hormone (TSH), respectively. If you produce too little T3, or the T4 you produce is not properly converted into this active thyroid hormone, your whole system goes haywire. Your metabolism and mitochondria don’t get the proper signals, you gain weight, and you suffer from miserable symptoms. You also become more inflamed, develop additional problems with your insulin levels, and have a more difficult time metabolizing sugar in your blood, all of which further compromise your health and your ability to lose weight. One study showed that subclinical hypothyroidism, more on this later, causes high levels of C-reactive protein and elevated insulin levels, further indicators that the stability of your thyroid can have a dramatic impact on your health. (1) This wouldn’t be such a concern if thyroid disorders could be readily diagnosed and treated. The problem is they can’t. And here’s why… Hypothyroidism: An Undiagnosed Epidemic Hypothyroidism, the name for the production of too little thyroid hormone, is a vastly under-diagnosed health problem in this country. Why is it so difficult to diagnose and treat low thyroid function? The main reason is that the symptoms are not very specific and are often present for many reasons besides thyroid disorders. Look at it this way. Anyone can diagnose a heart attack because we typically see someone who is pale and sweaty and clutching their chest while complaining of crushing pain in the chest and down the left arm. Thyroid problems are completely different. Even if you have all the symptoms of low thyroid function, they may still easily be ignored. You may not even realize that the problem is with your thyroid gland. Even if you have the foresight to go to the doctor, your doctor may use traditional methods to test for thyroid problems and find that your thyroid appears to be functioning in the normal range. But many times doctors don’t do the right tests or don’t do enough tests; hence your thyroid problems go undetected. You may be told you have borderline thyroid problems or subclinical thyroid disease and your doctor will watch it. What will he or she watch for? For you to get really sick? Thyroid problems are actually extremely common. More than 10 percent of the overall population and 20 percent of women over 60 years of age have subclinical hypothyroidism. “Subclinical” implies no symptoms and slightly abnormal thyroid tests. What it really means is subtle symptoms that are often missed by doctors! Even people who have “normal” thyroid results but suffer from symptoms may benefit from thyroid treatment. It all depends on how we define “normal.” Your gender, height, weight, even your occupation could redefine “normal” and therefore, the range. If you are a seven-foot-tall basketball player, weighing 300 pounds – your “normal” range would be very different from that of a five-foot, three-inch female. As we continue to learn more about the way our body was meant to work and how evolution (physical and social) continues to change how our bodies are actually working, the normal values in medicine are constantly redefined. We recognize that what we thought was the norm isn’t anymore. To use just one example, in 1998, normal weight was a body mass index (BMI; kilograms per meter squared) of 27; now it’s 25. We are wising up and recognizing that more subtle changes in function can have significant health consequences. The same is true with thyroid disease, but mainstream medicine has not yet caught on. We doctors need to rethink how we approach thyroid problems by:
  • Recognizing the problem through analyzing a patient’s medical history
  • Using the right tests
  • Properly diagnosing and treating the causes of thyroid dysfunction
  • Supporting the thyroid function with lifestyle changes, diet, and supplements
  • Prescribing thyroid hormone replacement therapies and dosages specifically designed for individual patients
Right now, most people within the medical community are not doing these things. However, there are a few things you can do to improve the function of your thyroid, and armed with the proper information you have a much better chance of being diagnosed correctly. How Low Thyroid Function Affects Your Health Hypothyroidism doesn’t just make you a little tired — it can lead to more serious problems, including heart attacks and diabetes. I see this all the time in my medical practice: Patients come in with vague complaints that alone may not seem too significant. But when you put them all together, they tell an important story. I remember the story of one patient who was 73 years old. This woman came to see me because she had been to her doctor with complaints of fatigue, sluggishness, poor memory, slight depression, dry skin, constipation, and mild fluid retention. Her doctor’s response was, “Well, what do you expect? You’re 73, and this is what 73 is supposed to feel like.” But I just don’t believe that is true. Most symptoms of aging that we see are really symptoms of abnormal aging or dysfunction that is related to imbalances in our core body systems. I have to be a medical detective to find clues where no one else is looking and put together a story about why a person is suffering. This gets them the answers and the tools they need to get well. In this case, we tested the patient for a number of things and found that she had a sluggish thyroid. She did not quite meet all the criteria of conventional medicine for hypothyroidism, but she had an autoimmune reaction that caused her thyroid to function poorly. By simply replacing her missing thyroid hormone, supporting her nutrition, and implementing some simple lifestyle changes, she went from feeling old to feeling alert, energetic, and youthful — and all of her other symptoms cleared up. I had another patient who was a 28-year-old woman who was chronically constipated. She thought it was normal to go to the bathroom every three or four days. She also felt quite tired in the mornings and had trouble getting going. She needed coffee every morning. And at night she had trouble staying up and being with her friends and being an active 28-year-old woman. She thought that this was just sort of a constitutional problem and that she was stuck living like that. No one had diagnosed her sluggish thyroid. But as soon as we supported her nutrition and eliminated her food allergens (particularly gluten), which create inflammation and interfere with thyroid function, she felt better. Her constipation resolved, she was energetic in the morning, did not need her coffee, and was able to stay up until 11:00 or 12:00 at night without any fatigue or limitations. Ideally, a Functional Medicine practitioner can help detect these subtle yet profound symptoms and optimize your thyroid. He or she can tell you what tests are available, which ones you need to take, and which hormone treatment therapies work best for your condition. Like anything else, treating hypothyroidism is not a one-size-fits-all approach. It’s critical to understand that your thyroid is not just linked to energy and other symptoms that I described here. Remember, this is the master metabolism hormone that controls the function and activity of almost every organ and cell in your body. When it is sluggish or slow, everything slows down. Do You Have Hypothyroidism? The first step is to find out if you have any of the chronic symptoms of hypothyroidism or any of the diseases associated with hypothyroidism. Ask yourself if you have any of the following symptoms:
  • Sluggishness in the morning
  • Poor concentration and memory
  • Low-grade depression
  • Dry skin
  • Hoarse voice
  • Thinning hair
  • Coarse hair
  • Being very sensitive to cold and having cold hands and feet
  • Low body temperature
  • Muscle pain
  • Weakness or cramps
  • Low sex drive
  • Fluid retention
  • High cholesterol
After I have asked my patients about all these symptoms, I do a physical examination for clues to a low-functioning thyroid. I check for a low body temperature. Anything lower than 97.6 degrees F may be a sign of hypothyroidism. I might also find fluid retention, a thick tongue, swollen feet, swollen eyelids, an enlarged thyroid gland, excessive earwax, a dry mouth, coarse skin, low blood pressure, or decreased ankle reflexes. I might even find that the outer third of the eyebrows is gone. These are all physical signs that can be put together along with other symptoms to form a story of what is causing the problem. Once I have done that, I perform specific blood tests that give me a full picture of thyroid problems. Then I design a nutritional, lifestyle, and supplement regimen and hormone replacement plan as needed to help people regain their health. What Causes Hypothyroidism? Numerous culprits contribute to hypothyroidism. However, if I had to narrow it down to just a few, I would name these four:
  1. One of the most important factors that lead to hypothyroidism is exposure to environmental toxins, such as pesticides, which act as hormone or endocrine disruptors and interfere with thyroid hormone metabolism and function. In fact, one study found that as people lost weight they released pesticides from their fat tissue. (2) These pesticides then interfere with thyroid function and cause hypothyroidism. Heavy metals, such as mercury, can also affect thyroid function. I see many people with chronic hypothyroidism and other thyroid problems because mercury interferes with normal thyroid function.
  2. There is an intimate interaction between stress hormones and thyroid function. The more stress you are under, the worse your thyroid functions. Any approach to correcting poor thyroid function must address the effects of chronic stress and provide support to the adrenal glands.
  3. The biggest source of chronic inflammation is gluten, the protein found in wheat, barely, rye, spelt, and oats. Gluten is a very common allergen that affects about 10 to 20 percent of the population. This reaction occurs mostly because of our damaged guts, poor diet, and stress. I also think eating so-called Frankenfoods, such as hybridized and genetically modified (GMO) grains with very strange proteins, makes us sick. Our bodies say, “What’s this? Must be something foreign. I’d better create antibodies to this, fight it, and get rid of it.” This chronic inflammatory response interferes with thyroid function — and contributes to the epidemic of inflammatory diseases in the developed world.
  4. Nutrient deficiencies. Lastly, nutritional deficiencies play a big role in thyroid dysfunction. These include deficiencies of iodine, vitamin D, omega-3 fats, selenium, zinc, vitamin A, and the B vitamins.
How You Can Overcome Hypothyroidism If you suspect hypothyroidism, I encourage you to take the following steps to rebalance your thyroid:
  • Make a thorough inventory of any of the symptoms that I mentioned above to see if you might suffer from hypothyroidism.
  • Get the right thyroid tests. Ask for a full-spectrum thyroid test that includes TSH, free T3, free T4, TPO, and anti-thyroglobulin antibodies.
  • Check for celiac disease with a celiac panel.
  • Consider heavy metal toxicity testing.
  • Check your vitamin D level.
Once you have confirmed that a sluggish thyroid is contributing to your symptoms, the good news is that there are many, many, many things you can do to help correct thyroid problems. In part two of this blog, I will present a six-strategy approach to treat hypothyroidism. I want to emphasize that getting the right tests and working with your Functional Medicine doctor are crucial. Once you have determined your thyroid is malfunctioning, taking the comprehensive approach I will discuss can ameliorate your condition. Wishing you health and happiness, Mark Hyman, MD. References (1) Tuzcu A, Bahceci M, Gokalp D, Tuzun Y, Gunes K. Subclinical hypothyroidism may be associated with elevated high-sensitive C-reactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr J. 2005 Feb; 52( 1): 89– 94. (2) Chevrier J, et al. Body weight loss increases plasma and adipose tissue concentrations of potentially toxic pollutants in obese individuals. Int J Obes Relat Metab Disord. 2000 Oct;24(10):1272-8.
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