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Healing The Thyroid: A Functional Medicine Perspective

Many people often wonder and worry that their thyroid may be imbalanced and believe with great conviction that this is the source of many––if not all––of their health issues.


But what does this really mean?


Thyroid dysfunction does not occur in a vacuum.


The real question we need to ask is why did the thyroid’s function become imbalanced?

What is the thyroid trying to compensate for elsewhere in the body?


How has the thyroid not been adequately supported in order to effectively and efficiently do its job?


Has the thyroid been put in a position to succeed or to struggle?


What mechanisms are underlying its dysfunction and what systems do we need to address in order to return the thyroid to its optimal state of function?

The thyroid itself is a vital hormone gland that plays a major role in the body’s metabolism and growth.


By releasing a steady supply of thyroid hormone into the body, the thyroid can influence a long list of functions.


These include energy, body temperature, heart rate, muscle strength, conversion of food into energy, the release of stored energy from the liver and muscles, and activation of the nervous system to support concentration and reflexes.


When the thyroid is imbalanced, patients are typically diagnosed with either hypothyroidism (under-functioning thyroid) or hyperthyroidism (over-functioning thyroid).


Hashimoto’s disease is an autoimmune condition that causes the body to attack the thyroid, leading to hypothyroidism. Hashimoto’s disease is the most common cause of hypothyroidism.


Grave’s disease is an autoimmune condition that causes your immune system to create thyroid-stimulating globulins, which attach to healthy thyroid cells and cause an increase in thyroid hormone. Grave’s disease is the most common cause of hyperthyroidism.


Thyroid imbalances can be evaluated through a simple thyroid panel blood test. This is the best place to start if you suspect your thyroid function might be off.


A conventional medicine work-up for suspected thyroid imbalance is often simply looking at TSH and perhaps T3 or T4. That’s it. We can’t find what we’re not looking for, so this limited approach can often miss more nuanced thyroid dysfunction.


A functional medicine thyroid panel is far more comprehensive than a conventional thyroid panel. With additional lab markers, we can understand thyroid imbalances at a much deeper level and avoid missing important indicators that something is off with the thyroid.


A functional thyroid panel is likely to include TSH, T3, Free T3, Free T4, Reverse T3, TPO + TG Ab, and Urinary Iodine.


In addition to these thyroid markers, it may be useful to look at additional systemic lab markers that could be indirectly affecting thyroid function, including a Food Sensitivity Panel, Gluten Sensitivity Panel, Vitamin D, CBC, Ferritin, RBC Zinc and RBC Selenium.


Depending on what markers are out of range, there are several approaches to consider.


The standard of care in conventional medicine is often to simply prescribe a synthetic thyroid hormone replacement, such as Levothyroxine, that will effectively take over the function of your thyroid.


If the patient opts for this approach, medication will need to be taken for the rest of their life and once they’ve been on it for more than 3-5 years, it is very hard to ever come off.


In functional medicine, we look for the root imbalances, deficiencies and insults that may be impairing the thyroid's ability to function at an optimal level.


For instance, in order to ensure proper production of thyroid hormones, several nutrients are required to be in full supply in the body. These include Iron, Iodine, Tyrosine, Zinc, Selenium, Vitamin E, Riboflavin, Niacin, Pyridoxine, Vitamin C and Vitamin D.


Running a micronutrient panel allows us to understand what specific nutrient deficiencies each patient may have that are impairing their thyroid, so we can then recommend foods and physician-grade prescription supplements that will address each deficiency in a targeted and therapeutic way.


Factors that may inhibit the proper production of thyroid hormones can include stress, infections, trauma, radiation, pharmaceutical medications, fluoride, pesticides, mercury, cadmium, lead and celiac disease.


Running labs that analyze toxin exposures, heavy metals, stealth infections, gluten sensitivities and cortisol levels will help us to understand which of these may be adversely affecting thyroid function in each patient.


Aside from supporting the appropriate levels of thyroid hormone production, making sure the thyroid hormone that is produced ends up being used in the correct ways and reaching the right places is essential.


To that end, factors that increase conversion of T4 to T3 include an appropriate supply of Selenium and Zinc in the body.


Meanwhile, T4 is more likely to convert to RT3––the metabolically inactive form of T3––with stress, trauma, a low-calorie diet, inflammation, toxins, infections, liver or kidney dysfunction and pharmaceutical medications.


All of these factors must be considered in every patient at an individual level to assess what may be potentially contributing to their specific presentation of thyroid dysfunction.


At the level of each cell, ensuring there is cellular sensitivity to receive thyroid hormone is also key, as both T3 and RT3 compete for binding sites.


Factors that will improve cellular sensitivity to thyroid hormones include Vitamin A, Zinc and exercise.


Assessing these nutrients in each patient, as well as their level of physical activity, will help ensure the thyroid hormone that is being produced is having an effect in the cells.


It’s important to note that one of the most common reasons a patient may be deficient in these essential nutrients is that either their diet is lacking bioavailable, nutrient-dense foods or that their digestion is impaired––or most often both of these things.


This is why closely assessing the diet and running a comprehensive stool analysis are essential in any work-up for a thyroid patient.


This “thyroid-gut access” influences thyroid function in many important ways. The presence of gut dysbiosis, intestinal permeability, inflammation, infections, maldigestion, malabsorption, overgrowths, deficiencies and many other gut pathologies can all inhibit optimal thyroid function.


For instance, the microbiome of the gut influences the absorption of aforementioned minerals essential to the thyroid, including Iodine, Selenium, Zinc, Copper, Vitamin D and Iron.


In addition, the gut plays a role as a reservoir for thyroid hormones, in particular T3, and can thus help prevent fluctuations in thyroid hormone, potentially reducing the need for supplemental T4 support if the gut is balanced and healthy.


If the diet is deficient or the digestion is unable to effectively absorb nutrients from food or supplements, not only will the thyroid suffer, but every other organ and physiological process in the body will suffer, as well.


A comprehensive stool analysis is a first-line assessment that must take place if we are to truly understand the root issues behind thyroid health, and for that matter, all health.


It is also absolutely critical that anyone with an autoimmune-related thyroid disorder––or any thyroid disorder, for that matter––move to a 100% gluten-free diet permanently.


This is due to a phenomenon known as molecular mimicry, in which the gluten protein gliadin mimics the thyroid enzyme transglutaminase.


When the body’s immune system identifies gliadin (from gluten) as a foreign invader, it begins to attack and destroy it. At the same time, it will also unwittingly attack and destroy the thyroid, since it cannot distinguish the difference between gliadin (from gluten) and transglutaminase (in the thyroid).


Adherence to a strictly gluten-free diet is non-negotiable and must receive full compliance in order to begin to heal and balance the thyroid.


So, as you can see, there is much more to approaching the treatment of a patient’s thyroid dysfunction at a root level than simply testing TSH, prescribing a synthetic hormone replacement for the rest of their life and calling it a day.


If that is the approach taken, all the underlying imbalances and deficiencies that are ignored will eventually express elsewhere in the body as new dysfunctions and diseases.


By completing a thorough and in depth investigation into each patient to identify their unique needs, we can treat the body at the root level, resolving the expression of thyroid problems and preventing the development of new health problems in the future.