According to statistics revealed at the Middle East Otolaryngology Conference & Exhibition last year, about 5 percent of people in the UAE suffer from thyroid disease.
Many more suffer from symptoms of low or dysfunctional thyroid, which are often misdiagnosed or undiagnosed. Thyroid problems in women occur up to seven times more often than in men. Globally, it is estimated that 200 million people live with thyroid disorders.
Not only has thyroid disease has become a silent epidemic of our times, it can create more serious health problems down the road. The metabolic responses from abnormal thyroid function can lead to high blood pressure and cardiovascular disease, chronic fatigue syndrome and an increased risk for cancer.
The thyroid explained
The thyroid is a butterfly-shaped gland that sits just below the voice-box in the neck and is responsible for producing hormones that regulate growth and energy production in the body, making it the master gland of metabolism. But that’s not all. The thyroid influences and interacts with other hormones in the body and is essential for proper functioning of all organs, including the heart, musculoskeletal system and brain.
Hypothyroidism and hyperthyroidism are at opposite ends of the spectrum of thyroid disease. A healthy thyroid gland is initially governed by the pituitary gland in the brain, which senses low thyroid hormone in the blood and sends a messenger to instruct the thyroid to make more hormone. This messenger is TSH, or thyroid stimulating hormone. The thyroid gland then produces the hormones T3 and T4, and only the biologically active T3 hormone exerts physiologic effects in various cells throughout the body.
An underproduction of these hormones will slow down metabolism, resulting in hypothyroidism that creates symptoms such as weight gain, feeling cold, fatigue, irregular menstruation, brain fog, depression, increased blood pressure and cholesterol, dry skin, hair loss and constipation. On the other hand, overproduction leads to hyperthyroidism that speeds up the body’s metabolism. Classic features include weight loss, nervousness, anxiety, intolerance to heat, excessive sweating, palpitations and insomnia.
Hashimoto’s and Grave’s diseases are autoimmune conditions of the thyroid, where the immune system begins to attack the thyroid gland. Hashimoto’s is the most common cause of hypothyroidism and can be diagnosed by testing thyroid antibodies. Some studies suggest that up to 90 percent of people with hypothyroidism have Hashimoto’s disease. Grave’s disease causes the thyroid to become enlarged and overactive, which results in hyperthyroid symptoms.
Causes of thyroid dysfunction
Thyroid physiology is complex and is interconnected with other endocrine glands, immune system, the gut and various cellular signals. A multitude of factors influence thyroid function, which if overlooked may worsen the condition.
• Stress is an inescapable part of modern-day life and is a major contributor toward thyroid issues. Chronic or high stress elevates cortisol, which when prolonged, fatigues the pituitary and adrenal glands and interferes with TSH. Infection and blood sugar imbalances further elevate cortisol levels resulting in inadequate TSH production, and therefore insufficient T3 and T4 levels. Many overweight individuals attribute weight gain to low thyroid function, not realizing the connection to high stress and cortisol levels, which further inhibit weight loss.
• Conversion of T4 into T3 is another key component. Remember that T3 is a biologically active thyroid hormone and T4 is inactive. Most thyroid patients receive a medication called Thyroxin, which is mostly T4. This is not effective if conversion into T3 is problematic. T4 comprises 90 percent of thyroid hormone, however up to 60 percent of conversion into the active T3 form takes place in the liver.
• A sluggish liver, despite normal liver enzymes on lab tests, will impede conversion. Toxins from the environment and food need to be detoxified effectively by the liver. Some 20 percent of the conversion into T3 takes place in the gut, so healthy digestive function is vital for thyroid health. Leaky gut syndrome, caused by food intolerances from gluten or dairy, and malabsorption of nutrients and minerals can cause or contribute to autoimmune and low thyroid function. Dysbiosis, or unfriendly gut bacteria, interfere with conversion into active thyroid hormone as well.
• Mineral and vitamin deficiencies are common since iodine (present in T3 and T4), selenium, iron and even vitamin D are all necessary for proper thyroid function and are involved in converting T4 into T3. Tyrosine, zinc and methylfolate are also major players, which if deficient can lower T3. Genetic variations in the enzymes that use and activate these nutrients (such as the MTHFR gene) further impact thyroid health.
• Hormonal imbalances, in particular excess estrogens from birth control pills, xenoestrogens from plastics and toxins in the environment, and hormone-injected meats – all of these lower thyroid hormone. Hormones interact with each other and excess estrogens interfere with thyroid function by increasing the protein that binds to thyroid hormone (TBG) making it inactive.
Most physicians believe that the thyroid is fine if TSH values are within the normal range. However, the TSH value is unreliable at determining low thyroid function. Often, patients are either given prescription medication for low thyroid or dismissed because their TSH and T4 levels are “normal” according to the conventional understanding.
The upper limit for TSH accepted conventionally is between 4 and 5 milliunits per liter (mU/L). However from a naturopathic perspective, the acceptable upper limit is 2.5 mU/L, with most patients feeling best at 1.5-2 mU/L. This discrepancy of opinion is one of the main factors resulting in under-diagnosis that affects health and quality of life.
• Measuring free T3 and free T4 levels is essential. Fluctuating levels along with TSH measurements can distinguish between cellular resistance to active T3 or conversion problems from T4 to T3.
• Thyroid antibodies must also be tested to ascertain any autoimmune issues and is the best way to diagnose Hashimoto’s. The common antibodies tested are Anti-TPO (thyroid peroxidase) and Anti-TGA (thyroglobulin).
• Reverse T3 testing is crucial as it is the third most abundant form of thyroid hormone. Active T3 can sometimes be diverted back into an inactive “reserve” form that happens during times of illness or stress.
Look at lifestyle
For those who continue to suffer physically despite having had thyroid issues ruled out medically, a professional will seek the root of a patient’s continuing problems through functional blood tests, cortisol and reproductive hormone panels, and tests for food intolerances, nutrient deficiencies and toxicities. Then a treatment plan can help to regulate or restore thyroid function, as well as improve gut imbalances and function.
Gene-based testing offers an important glimpse at genetic susceptibilities and weaknesses. Stress management and adrenal health are equally important because mental or emotional concerns that increase the stress response, also increase inflammation and disrupt thyroid health. Exercise, meditation, developing a sense of purpose and appreciating beauty are all necessary elements for healthy thyroid function and vitality.
Dr Faryal Luhar is a Canadian naturopathic doctor at The Hundred Wellness Centre in Dubai.