Episode 5: Understanding Your Thyroid

Hi, I'm Dr. Tabitha, the functional gynecologist. I'm a board certified, OB, GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling with hormone imbalance, weight gain period issues, anxiety, insomnia, you name it, then you've come to the right place. I want to be your functional gynecologist. So welcome. Hi, guys. Welcome back to the functional gynecologist. I'm Dr. Tabitha. This is Today on episode number five, your thyroid. I'm going to help you understand how our thyroid works, how it affects most of the systems in our bodies, why thyroid disease so often goes undiagnosed or untreated. Appropriately, how our diet and lifestyle choices directly affects how our thyroid functions and how we can utilize this information to create the optimal environment for a thyroid to function. Well, you've probably noticed that thyroid disease, autoimmune thyroid in particular, has garnered a lot of attention over the past few years. There are many books on Hashimoto's the thyroid diet and autoimmune protocols. What is this all about? And if you've heard my story, then you know I have suffered from Hashimoto's autoimmune thyroid disease for over 20 years now. So this topic affects me on a daily basis. I also deal with it every day in my office seeing patients. This is one of the most common reasons why women initially come to see me. They feel like they have a thyroid condition, but they've been told they're fine or they've been diagnosed and are on Synthroid, but they don't feel any better. If this sounds like you or someone you know, then I'm super glad you're listening today. So let's talk about some basic anatomy and physiology. Your thyroid gland is located in the neck in front of your windpipe. The shape of the thyroid is similar to a butterfly with two halves or lobes. The two portions are connected by a band of thyroid tissue called the isthmus. The loose connective tissue allows the thyroid to move and change position as we swallow. Here's some jeopardy trivia. The thyroid is actually developed in the back of the tongue and has to migrate to the front of the neck before birth. That's kind of cool. So on average, the thyroid can weigh up to 2 ounces. Each lobe contains many small sacs called follicles which store thyroid hormones. The thyroid Gland uses iodine to make two main hormones, triiodothyronine, which we call T3, and thyroxine, which we call T4. As a side note, the thyroid also produces calcitonin, which is a hormone that helps control calcium and phosphate levels in the blood by inhibiting the breakdown of your bones. This opposes the action of your parathyroids. Interestingly, high levels of calcitonin are seen in the rare type of medullary thyroid cancer. So, back to its main function. Our bodies cannot make the mineral iodine, which is why it's required in our diet. Iodine is absorbed into our bloodstream from the food in our intestines. It's then carried to the thyroid gland, where it's eventually used to make thyroid hormones. Thyroid cells are unique in that they are highly specialized to absorb and use iodine. Thyroxine is called T4 because it contains four iodine atoms. To exert its effects, T4 is converted to triiodothyronine by the removal of the iodine atom. A thyroid that's functioning normally produces approximately 80% T4 and 20% T3, though T3 is the stronger of the pair. T3 and T4 travel in your bloodstream to reach almost every cell in your body and regulate the speed with which your cells work. For example, T3 and 4 regulate your heart rate and how fast your intestines process food. So if T3 and 4 levels are low, your heart rate may be slower than normal and you may have constipation and gain. If T3 and 4 levels are high, you may have rapid heart rate, diarrhea and weight loss. The hypothalamus and pituitary gland in your brain control your thyroid. When thyroid hormone levels drop too low, the hypothalamus, located at the base of your brain, secretes a hormone, alerting the pituitary gland to produce tsh, or thyroid stimulating hormone. The thyroid responds to this chain of events by producing more hormones. The amount of TSH that the pituitary sends into bloodstream depends on the amount of T4 that the pituitary sees. Once the T4 in the blood goes above a certain level, the production of TSH is shut off. You can imagine this cycle like a heater and a thermostat. When the heater is off, it becomes cold. The thermostat reads the temperature and turns on the heater. When the heat rises to an appropriate level, the thermostat senses this and turns off the heater. Thus, your thyroid and pituitary, like A heater and thermostat turn on and off. In conventional medicine, doctors check TSH and free T4, that is the heater and the thermostat being checked to see if they are in balance. Although this is a good starting point, this does not look at the full functioning of your thyroid and how your body is utilizing thyroid hormone to work. So what are the functions of the thyroid? The thyroid is responsible for regulating the body's metabolic rate as well as heart and digestive function, muscle control, brain development, mood, and bone maintenance. So, like I mentioned earlier, its correct functioning depends on having a good supply of iodine in your diet. Your metabolic rate is the rate at which your body burns calories. You can separate the types of calories your body burns into two categories, resting and calories and activity calories. So even when you're sitting on the couch, like watching tv, your body's burning calories. This is considered your baseline or basal metabolic rate. It accounts for about 60 to 75% of your total amount of energy that you burn. So while at rest, your organs and essential biological functions are still working hard for you, which is why they need energy in the form of nutrition even when they're inactive. The energy used for things like eating, walking, and other physical activity is called thermogenesis. You definitely want that functioning properly for weight control. Increased thyroid hormone levels stimulate lipid metabolism. This is the process of using your fat for energy or storing it in the body for later use. Thyroid hormones also stimulate almost all aspects of carbohydrate or glucose metabolism. So if your thyroid isn't functioning properly, you can't tap into your fat storage stores to burn energy. Therefore, you can't lose weight. Your body has to rely on glucose or sugar for fuel. So you get stuck in this vicious cycle of wanting to eat every few hours to maintain your blood glucose levels and not feel crappy. Right? This is no way to live. Our bodies were designed to be able to go for long periods of time on a regular basis without food. But if our thyroid isn't producing enough hormone, then we can't easily go into fat burning mode. Women with autoimmune disease can have a difficult time doing the ketogenic diet because of this, and unfortunately, they are the ones most likely to benefit from it. I'll definitely do an episode on the benefits of intermittent fasting, how to become a fat Burner, and explain how it heals your body through autophagy. So stay tuned for that in a future episode. In addition to metabolism, the thyroid plays a significant role in other several body functions. Thyroid hormones are absolutely necessary for healthy growth in children. Studies actually reveal normal levels of thyroid hormone are essential for the development of the fetal and neonatal brain. So it's critical to have your thyroid monitored regularly. If you have a thyroid disorder and you're pregnant or trying to get pregnant, normal reproductive physiology is dependent on having essentially normal levels of thyroid hormone. Hypothyroidism in particular is commonly associated with infertility. It's now standard of care for infertility patients to be put on synthrate to keep their TSH levels below 2.5 in an effort to sustain a viable pregnancy. Thyroid hormones increase your heart rate, cardiac contractility and cardiac output. They also promote vasodilation, which leads to enhanced blood flow flow to many organs. This becomes important when we women try to exercise. If our thyroid isn't functioning properly, it can make you feel worse and lead to more issues. Both decreased and increased concentrations of thyroid hormone lead to alterations in our mental state. Not enough thyroid hormone tends to make us feel mentally sluggish, while too much induces anxiety and nervousness. So let's talk about hypothyroidism. It's a clinical state in which your body doesn't produce enough thyroid hormone for your body to maintain homeostasis, meaning too little T3 and T4. This condition is more common than the overactive state called hyperthyroidism. Approximately 10 million Americans are likely to have this medical condition. In fact, as many as 10% of women may have some degree of thyroid hormone deficiency. The more concerning statistic is that 90 to 97% of those diagnosed with hypothyroidism are believed to have the autoimmune disease Hashimoto's thyroiditis, but they just aren't tested for it. So why is that, you ask? When I look on the physician led reference website up to date, which I was trained to do, they have a sentence published in there that explains that finding. It says serum antithyroid antibodies need not be measured routinely in patients with overt primary hypothyroidism because almost all will have chronic autoimmune thyroiditis. Unfortunately, this is how conventional physicians are trained. This is how I was trained. The thought is that because we don't have a pill to treat your autoimmune component, we shouldn't bother doing the test to diagnose it. Here's the problem with that. Patients with autoimmune thyroid disease need to be treated significantly differently than those with simple sluggish thyroids for other reasons. The root cause of the autoimmune disease needs to be addressed. So if you aren't getting your thyroid antibody levels checked, then we don't know if your thyroid is being attacked. That is why most patients don't feel better once they start taking thyroid medication like Synthroid or Levothyroxine. Luckily, there are some awesome pioneers in the functional medicine space who have figured this out and have made it their life's mission to get the word out. People like Dr. Isabella Wentz, the thyroid pharmacist. If you have an autoimmune thyroid disease, then you should read her work. I'll put a link in my show notes because it's super important to get educated on this so Symptoms of hypothyroidism include sleeping a lot instead of still feeling tired, weight gain or inability to lose weight, coarse dry hair, dry rough, pale skin, hair loss, cold intolerance, rarely being able to sweat, muscle cramps and muscle aches, constipation, depression, irritability, memory loss, abnormal menstrual cycles, decreased libido, recurrent miscarriage and infertility. Hyperthyroidism, which is the opposite where you are producing too much thyroid hormone, causes symptoms like excessive sweating and heat intolerance, excessive hunger, fast heart rate or heart palpitations. Some women are diagnosed initially based on having heart palpitations, weight loss, hair loss, tremor, diarrhea, irregular periods again, mood swings, panic attacks, insomnia and potentially abnormal protrusion of your eyes. They look kind of buggish like both types of imbalances usually develop from a goiter, thyroiditis or cancer. A goiter looks like a bulge in the neck, a toxic goiter is associated with hyperthyroidism and a non toxic goiter or a simple goiter is usually caused by iodine deficiency leading to hypothyroidism. I personally have had a goiter twice. In addition to losing weight and feeling anxious, I constantly felt like something was stuck in my throat or pushing on it. And I was right. My thyroid was so large that it was pushing on my windpipe. You could see it when I swallowed. That was what finally prompted the doctors to investigate further. For some women it may not look very prominent or your doctor may not feel nodules on it. But remember, there's a backside too of your thyroid. So just because the front seems fine doesn't mean it's not growing toward the back pushing on your windpipe. So if you have a persistent symptom like that, keep asking for answers. Ask for a thyroid ultrasound. Don't give up. Symptoms are warning Signs that something is developing and we need to investigate and get to the root cause of it. It's not something to put a band aid on so we don't have to hear the signal anymore. When we do that we get another symptom or five and eventually if we don't put the two and two together then we can't diagnose it properly. So let's stop masking our symptoms and figuring out the root cause. Thyroiditis is an inflammation of the thyroid gland. There are many types of thyroiditis including Hashimoto's autoimmune thyroiditis like I mentioned, Subacute thyroiditis, usually from a virus. Silent thyroiditis which is painless. Postpartum thyroiditis which happens after you have a baby. That was my initial presentation. Drug induced thyroiditis from medications like amiodarone, lithium, interferons, radiation induced thyroiditis and acute thyroiditis, usually from a bacteria or other infectious organism. Inflammation eventually causes the thyroid cells to die, making the thyroid unable to produce enough hormones to maintain the body's normal metabolism. This is why I developed a goiter. Initially I had postpartum thyroiditis. My thyroid was being attacked so it became inflamed and was releasing all of its stored hormone causing hyperthyroid symptoms. But then my cells got destroyed and could no longer make enough hormone so I became hypothyroid. This is a common scenario with thyroiditis and sometimes we recover and don't go on to suffer from any long term thyroid disease. But if you have Hashimoto's autoimmune type, then you most likely will not get better until you remove the triggers and heal your gut with significant diet and lifestyle changes. Stress and inflammation are major triggers that cause your T4 inactive hormone to be converted to reverse T3 and not the active T3. Reverse T3 competitively binds with active T3 at all of your cells receptors. So if your reverse T3 is elevated, your active T3 is not going to be able to bind to the receptors on all of your cells and give the signal it needs to do its job. That reverse T3 is elevated when you have stress, inflammation, trauma, eat a low calorie diet, have toxins in your system, infections like parasite or yeast overgrowth, liver kidney dysfunction and certain medications. So it's super important to minimize those triggers so that you don't create so much reverse T3 that wants to compete with your active T3 hormone. Your body also needs selenium and zinc to convert T4 to active T3. Your cells need vitamin A, exercise and zinc to actually hear the signals of T3 to function properly. So when you are just having your TSH and free T4 level measured, that is not giving us any idea of whether or not the T4 is being converted into the active T3 hormone or reverse T3 and whether or not those hormones are able to bind to the receptors on all of the cells in your body and create proper functioning of those cells. Thyroid cancer is another condition affecting the thyroid. According to the CDC and the National Cancer Institute, it's the sixth most common cause of cancer in women behind breast, lung, colon, uterine and skin. It's usually diagnosed in women between the ages of 45 and 54. However, it's the most commonly diagnosed cancer in women ages 20 to 34. It affects about 35,000 women a year and fortunately the long term survival rates are excellent. Excellent radiation exposure is believed to be the most common cause for developing it, along with a history of having a goiter, being female, being Asian, and having a genetic mutation in the RET gene causing a condition called multiple endocrine neoplasia type 2. So what can we do to help our thyroid function properly? Let's talk about some techniques you can utilize to help boost the health and function of your thyroid gland. So stress, it's a part of life. However, today more people are experiencing higher levels of stress which can wreak havoc on your health. If you haven't already listened to episode number three, hormone imbalance, then I recommend you go back and listen to that for a detailed understanding of what stress does to our hormones. In that episode, I explained how living in a constant state of fight or flight can tax the adrenal glands, which can suppress the hypothalamus and pituitary glands, both of which directly influence our thyroid function. So if your stress is out of control, then your thyroid will be too. So it's super important to find ways to manage our stress through calming activities like meditation, deep breathing, journal writing, prayer and nature walks. How about sleep? The body requires sleep for overall health and healing. Thyroid conditions can impact our sleep patterns and not sleeping well can worsen your thyroid function. Talk about a vicious cycle. So most adults need seven to nine hours of sleep a night. If you're not sleeping well, you need to address that and correct it. Otherwise it's going to be a slippery slope of worsening symptoms and making it more difficult to control your thyroid. Please take your sleep issues seriously and know that you don't have to and should, shouldn't live in sleep deprived misery. I did that for over a decade and it's hard to recover from. I'll just tell you that you definitely want to avoid eating for at least two to three hours before bed. Avoid caffeine after noon. Avoid strenuous activities in the evening because that will spike your cortisol levels and make it difficult to fall asleep. Put away your electronics at least an hour before bed and avoid alcohol because it causes blood sugar disruption and then you're waking up at 2 or 3 in the morning. You can drink a cup of calming herbal tea instead. You could dab a few drops of lavender oil on the bottoms of your feet or take an Epsom salt bath with lavender. You could try a meditation sleep app like 10% happier. I would encourage you to create a nighttime ritual to help your brain prepare to unwind and go to sleep. You your thyroid will definitely thank you. Physical activity is a great way to support hormone production and combat symptoms related to thyroid dysfunction. The key is to listen to your body and do what exercise is right for your situation. If you're experiencing a sluggish metabolism, you want to aim for at least 30 minutes every day of low intensity exercise. Yoga, swimming and jogging are all excellent, excellent options. If you go out and try to do a high intensity cardio workout and then you're down for the count for two to three days, then you know that is not the right exercise for you. You want to focus on full body movements but not stressing your adrenal glands by requiring constant cortisol production. That's what the high intensity cardio does often with thyroid disease. The purpose is to stimulate your mitochondria, the little powerhouses inside all of your cells, to produce more ATP or energy as opposed to using up all the energy stores you have and leaving you down for the count for days. This is accomplished with more restorative type exercises like yoga, pilates, stretching and walking. If you struggle with hyperthyroidism, practicing daily calming activities such as the restorative yoga in Tai Ch will slow your heart rate and reduce anxiety. It's a beautiful thing. Sugar and simple carbohydrates as well as alcohol, like I said, can wreak havoc on your body and your thyroid. These foods cause inflammation, weight gain and blood sugar issues, so get them out of your life. If you have a sweet tooth, try fresh fruit. You'll be surprised how quickly your taste buds will adapt to the natural sweetness and you'll find enjoyment in that much more. Make sure to check the ingredient list to avoid products with added sugar. I talked about this in detail in episode number four. Food is medicine. If you haven't listened to that, I urge you to go back and listen because there's a ton of important information in that episode. A diet rich in essential vitamins and minerals such as selenium, iodine, zinc, thiamine, B12 and vitamin D can help heal your thyroid and reduce inflammation. These vitamins and minerals are necessary for the conversion of inactive T4 to active T3 hormone for your body to be able to utilize it. So fill your plate with dark leafy greens, quality fats like avocados, olive oil, nuts and seeds, and plant based protein sources. You can also try incorporating more sea vegetables like seaweed into your diet. In fact, just one sheet of dried seaweed contains well above the daily recommended value of iodine. But be careful, some of the larger fish, like tuna used in sushi, contains mercury. We just can't catch a break, can we? So I opt for vegetarian type sushi like California rolls. A handful or two of Brazil nuts contain more than your daily recommended value of selenium and it kick starts the production of your active T3 hormone. One egg contains about 20% of the daily recommended value of selenium and 15% of your iodine. Garlic is thyroid friendly because it supports blood sugar metabolism and can fight inflammation. And then lentils are an excellent source of plant based protein and they provide iron to the body. Low iron levels have been linked to poor thyroid function. We know that most women with thyroid dysfunction have heavy irregular periods and usually therefore low iron levels. Another vicious cycle that we need to break. When planning a meal, you want to limit foods that cause inflammation sensitivity or allergic responses like highly processed foods in boxes and bags. Okay, so did you know that bromine is added to breads, pastas, sports drinks and Mountain Dew? Bromine displaces iodine and causes functional hypothyroidism. So even if you don't have a pathological reason to have thyroid dysfunction, what you're eating could be causing underactive thyroid. That's crazy and that is not okay. All the more reason to avoid those processed foods. Please avoid unhealthy fats like vegetable oil, canola oil, sunflower oil, cinnamon margarine, salad dressings, coffee creamers, and cheap industrialized oil that many restaurants use for deep frying. These are very inflammatory. You want to avoid toxins that can trigger immune responses like pesticides. So try to eat non GMOs and organic as much as possible. Lastly, you want to avoid endocrine disruptors. According to the National Institute of Environmental Health Sciences, endocrine Disruptors are chemicals that interfere with the body's endocrine system and may produce adverse developmental, reproductive, neurological and immune effects in both humans and wildlife. Endocrine disruptors are chemicals that mimic our hormones. Essentially when this occurs, the chemical disruptor interferes with the messages our hormones are trying to send to our cells. A wide range of man made substances cause endocrine disruption, including pharmaceutical drugs, dioxin, dioxin like compounds, polychlorinated biphenols, DDT and other pesticides, and plastic creators like bisphenol A. So endocrine disruptors can be found in our everyday products including plastic bottles, metal food cans, our detergents, flame retardants, on our clothes and furniture. It's in our food, our toys, cosmetics and pesticides used in our yards. So to reduce the exposure to endocrine disruptors, choose glass containers over plastic containers. Never heat your food in plastic. Please drink filtered water and buy organic produce. Opt for non toxic natural bath and beauty products, household cleaners and laundry detergents. This will decrease the toxins getting into your cells competing with your hormones. If doing all these things doesn't get your thyroid under control, then you may have an underlying condition like which is small intestinal bacterial overgrowth, you may have intestinal yeast overgrowth, parasites or increased intestinal permeability, also known as leaky gut. A functional medicine physician can help you find these root cause issues and treat them. So don't give up if you don't feel well. Search for answers. They are out there. So that's it. We've covered the basics and what your thyroid does, how it functions and interacts with our other systems, how it's affected by your diet and environment, and how to keep it working properly. To have your thyroid function completely and accurately assessed, you should ask your doctor to measure TSH total and free T4, total and free T3, reverse T3, thyroglobulin antibodies, thyroid peroxidase antibodies and vitamin D levels. And some people also need thyroid stuff stimulating antibodies and receptor antibodies measured along with zinc, selenium and iodine. If your doctor isn't comfortable or willing to check those tests, then you should find one who is. You need to get a complete picture of how your thyroid is functioning, interacting with your cells and whether or not it's being attacked. This information will guide your treatment and give you the best chance at remission of your thyroid disease. Thank you for joining me today. If you got any useful information out of this video listening to this podcast today, please share it with your friends co workers, sisters, your mom or grandma or your social media friends. I want you to be empowered and know what's going on with your body. We need to support each other on our journeys back to health. I'd be super honored if you'd leave me a five star review on itunes or wherever you're listening to this. It will let me know that what I'm doing is worth my time and will help get this information out to all the women who need it. Please follow me on Facebook and Instagram @ Dr. Tabitha that's t A B A T H A all A's. No I Leave me questions or comments. I want your feedback. You can also check me out on my website, www.drtabitha.com I am here to support you ladies, so thank you for letting me be your functional gynecologist. Have an awesome day. It.