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Introduction to the thyroid
Thyroid conditions is something I have seen a lot during my 18 years of practice and therefore I want to highlight the importance of thyroid conditions and what you can do to help from a holistic point of view.
Your thyroid is an important gland that is located in your neck near your Adams Apple
The thyroid gland releases thyroid hormones which control many activities in your body, including how well you burn calories into energy and how fast your heart beats
Your thyroid gland communicates with a part of your brain called the HPA axis (Hypothalamus Pituitary Axis) where TSH (Thyroid Stimulating Hormone) is released and regulates thyroid hormones circulating in your body via a "feedback loop"
Your body has two different circulating thyroid hormones t3 and t4
Depending on how much or how little your body produces these thyroid hormones, you may feel more tired or restless, or you may loose weight or gain weight
Thyroid conditions can be hereditary and women are more prone to thyroid problems especially during menopause and after pregnancy. It is estimated that 1 in 8 women will experience thyroid issues in their lifetime
How do thyroid problems affect women?
Problems with your menstrual period
Thyroid issues can cause your period cycle to shorten or lengthen, to bleed heavy or light or to stop all together (amenorrhea).
Affect fertility
Thyroid issues can affect a woman's fertility not only affecting period cycle but also ovulation, making it harder to get pregnant
Problems with thyroid in pregnancy can happen which can cause issues for the mother as well as the baby
Affect weight
Thyroid issues can affect your ability to loose or gain weight as it governs your metabolism, which in turn controls your body's ability to burn calories and fat.
Digestion
Thyroid can have a huge impact on how sluggish you feel and how well you empty your bowels. In fact I usually can tell whether someone has thyroid issues on their gut behaviour alone especially when other questions have been raised such as magnesium supplementation (i can write a whole other three page blog on just magnesium alone) and other intolerances and allergies have been looked at.
Feeling hot or cold
Feeling hot or having hot episodes or feeling the cold easily are also some of the signs of thyroid dysfunction, however these signs are very subjective to the individual and hard to work out. Sometimes thyroid issues are confused with menopause as well. This is when blood tests come in handy!
What kind of thyroid diseases are there?
Theses are the most common diseases which affect thyroid function
hypothyroidism
hyperthyroidism
thyroiditis
thyroid nodules
thyroid cancer
I will discuss hypothyroidism and hyperthyroidism as these are the conditions I treat more often in practice and have better expertise in
Hypothyroidism
This condition is the most common one I have seen in my practice and I think i am treating it a lot more as time goes on.This is when your thyroid does not produce enough thyroid hormones. It is also called an under active thyroid for this reason. It can be caused by various factors including lifestyle factors and nutrient deficiencies. This can be diagnosed by a blood test or most of the time, signs and symptoms are subclinical, i.e; the patient will exhibit signs and symptoms of low thyroid function but blood tests indicate that hormones are within reference range. I see this ALOT. Especially when it comes to weight and fertility issues.
It also can be due to an autoimmune condition known as Hashimoto's disease where the bodies own immune system mistakenly attacks the thyroid gland which then doesn't manufacture enough hormones. I see this in patients whom have gone through a long period of unresolved stress or an acute trauma. Some autoimmune diseases are triggered this way and often also have a genetic predisposition.
Environmental toxins and or viral/bacterial infections can also be triggers. Therefore as well as thyroid hormones, immune system markers such as white blood cells, autoantibodies, vitamin D, red cell zinc and inflammatory markers such as ESR, CRP, homocysteine are good to get tested via your GP or pathology lab (at your own expense)
Hypothyroidism can also be caused by not having enough minerals or particular proteins in the diet, the most useful being zinc, selenium, iodine and the animo acid tyrosine. These nutrients are key to keeping the thyroid gland healthy and also for converting the non active thyroid hormone t4 into the active thyroid hormone t3 in your bloodstream.
So many people are iodine deficient as they do not used iodised salt in their cooking or eat too many processed foods and also iodine competes with fluoride meaning that your body doesn't absorb the iodine because the fluoride has flooded it instead through the water we drink, having a bath or shower with fluoridated water and brushing our teeth with fluoridated toothpaste. Therefore it is more important to increase your iodine intake to make up for the fluoride in our food and environment.
You can do an iodine patch test to see how much iodine your body has or you can request pathology to test if you are iodine deficient by a 24 hr urine collection.
Hypothyroidism also can be caused by:
Hyperthyroidism treatment (radioiodine)
Radiation treatment of certain cancers
Thyroid removal
Signs and symptoms of low functioning thyroid
Feeling cold when other people do not
Constipation
Muscle weakness
Weight gain, even though you are not eating more food
Joint or muscle pain
Feeling sad or depressed
Feeling very tired
Pale, dry skin
Dry, thinning hair
Slow heart rate
Less sweating than usual
A puffy face
A hoarse voice
More than usual menstrual bleeding
Carpel tunnel
Loss of outer eyebrows
You also may have high LDL or "bad" cholesterol, which can raise your risk for heart disease.
Just be aware that these symptoms can creep up on you over the years and with people experiencing Hashimotos's disease, they may get opposite symptoms to the ones above and so it can overlap Graves disease as well. This is discussed further on in the blog.
How is it treated?
Hypothyroidism if picked up early and most likely at the subclinical stage, it can be treated with some supplements, correcting those nutrient deficiencies and/or herbs if needed. The dosage is usually started low and slowly increased. It also depends on what the cause or if there are any underlying issues such as stress or immune dysfunction evident as well, such as in Hashimoto's disease, and thankfully there are wonderful herbs that nature has provided us with that can help there as well. A unique blend or concoction of herbs can therefore be made up for the individual's signs and symptoms.
If you think you require assistance or would like more information, you can book a consultation with Silvia.
For hypothyroidism which is advanced and does not respond to herbs or supplements over time, medication such as Thyroxine can be given that gives your body the thyroid hormone it needs to work normally. The most common medicines are man-made forms of the hormone (t4) that your thyroid makes. You will likely need to take thyroid hormone pills for the rest of your life. When you take the pills as your GP tells you to, the pills are very safe. But don't just rely on this medication to work. You also need other co factors and nutrients which influence how well your medication works, such as nutrients which convert the inactive t4 hormone into the active t3 hormone. As well as the role diet plays on your thyroid health. This explains why some people on medication still experience hypothyroidism signs and symptoms.
Hyperthyroidism
Hyperthyroidism or overactive thyroid, causes your thyroid to make more thyroid hormone than your body needs. This speeds up many of your body's functions, like your metabolism and heart rate.
The most common cause of hyperthyroidism is Graves' disease. Graves' disease is a problem with the immune system which can also be triggered by unresolved stress, a traumatic event, pregnancy, environmental toxins and viruses just to name a few as well as an underlying genetic predisposition. Smoking and being female also increase your risk.
Signs and symptoms
At first, you might not notice the signs or symptoms of hyperthyroidism. Symptoms usually begin slowly. But, over time, a faster metabolism can cause symptoms such as:
Weight loss, even if you eat the same or more food (most but not all people lose weight)
Eating more than usual
Rapid or irregular heartbeat or pounding of your heart
Feeling nervous or anxious
Feeling irritable
Trouble sleeping
Trembling in your hands and fingers
Increased sweating
Feeling hot when other people do not
Muscle weakness
Diarrhea or more bowel movements than normal
Fewer and lighter menstrual periods than normal
Changes in your eyes that can include bulging of the eyes, redness, or irritation
Hyperthyroidism raises your risk for osteoporosis, a condition that causes weak bones that break easily. In fact, hyperthyroidism might affect your bones before you have any of the other symptoms of the condition. This is especially true of women who have gone through menopause or who are already at high risk of osteoporosis. Hyperthyroidism can also be the underlying cause of AF (Atrial Fibrillation) which causes your heart to beat faster and irregular.
How is it treated?
Choice of treatment will depend on your signs and symptoms and the cause of your hyperthyroidism.
If signs and symptoms are not too severe then herbal medicine can be used to correct and balance thyroid function. Herbs such as as Bugleweed and Lemon balm can not only balance the thyroid hormones but target the inflammation, usually caused by the autoantibodies produced by the dysfunctional immune response. There is also Echinacea for it's immune modulating properties, as well as Hemidesmus for its immune suppressing properties, similar to how corticosteroids function. Other anti inflammatory herbs such as Licorice and Rehmannia can be used as well.
Confused as to what to take? Booking in for a consultation with Silvia will ensure that the right herbs and dosage are prescribed for you, with or without medications.
My studies in Western herbal medicine also has taught me that the gut microbiome is implicated in thyroid conditions as well, with both hyper and hypothyroidism. Assessing whether there are signs and symptoms of a "leaky gut" or "gut dysbiosis" is also something I look at during a consultation and usually that has to be addressed first or concurrently with herbs for the thyroid condition.
Diet and lifestyle advice also is given in the consult as there are certain foods that act as goitrogens (foods that impede the uptake of thyroid hormones in your body). An example of this is the brassica family of vegetables..always cook them even if it's for a few minutes! Gluten or the gliadin in wheat and foods made from wheat can also add to the inflammatory response. This fact is so well established, that even the well respected integrative GP Dr Kerryn Phelps mentions this and other inflammatory foods in her integrative medicine text book!
The autoantibodies in Graves disease bind to thyroid-stimulating hormone (TSH) receptors on follicular cells of the thyroid gland, resulting in proliferation and enlargement of the thyroid gland, with excessive activation and production of thyroid hormones T4 and T3.
Although autoantibodies can be observed in healthy individuals, in roughly 2.5 percent of the population, their presence is a trigger for autoimmune disease such as Graves’ disease. Graves’ disease immunoglobulins are a type of immunoglobulin G (IgG) and are referred to as thyroid-stimulating immunoglobulins (TSIs), which may be detected in the blood and confirm the diagnosis of Graves’ disease. However, other types of thyroid-suppressive antibodies may also be present and contribute to the oxidative stress and inflammation in the thyroid gland, explaining some of the overlap between Hashimoto’s thyroiditis and Graves’ disease.
Chinese herbal medicine can also help and is prescribed according to individual signs and symptoms and what we as Chinese medicine practitioner's call according to the patients "pattern of differentiation"
Western medicine treatments include (referral to General Practitioner):
Medicine.
Antithyroid medicines block your thyroid from making new thyroid hormone. These drugs do not cause lasting damage to the thyroid.
Beta-blockers block the effects of thyroid hormone on your body. These medicines can be helpful in slowing your heart rate and treating other symptoms until one of the other forms of treatment can take effect. Beta-blockers do not reduce the amount of thyroid hormones that are made.
Radioiodine. This treatment kills the thyroid cells that make thyroid hormones. Often, this causes permanent hypothyroidism.
Surgery. Thyroid surgery removes most or all of the thyroid. This may cause permanent hypothyroidism.
A big thank you to womenhealth.gov and the wonderful resources and previous seminars from Dr Kerry Bone and colleagues from Mediherb, the Mediherb library and the book General Practice, The Integrative approach by Kerryn Phelps & Craig Hassed, 2010 in helping me write this blog.