Facts About Thyroid: Hashimoto & other things

Jade Teta ND, CSCS

1) High levels of estrogen interrupt thyroid function. Estrogen increases thyroid binding protein (TBG) taking thyroid out of circulation leaving less to do its job. Estrogen also decreases conversion from inactive hormone to active hormone. This is one of the reasons women have bigger thyroids than men and can often have issues gaining weight when using birth control or HRT.

2) Cortisol is very important for thyroid. Cortisol is needed to sensitize the thyroid receptors, so too little will negatively affect thyroid activity. But, too much cortisol will decrease thyroid conversion into its active form. So, you don’t want too much or too little cortisol. This is the reason excessive coffee, stress, corticosteroids, and over-training can have a negative impact on thyroid.

3) Iodine is essential for thyroid hormone production. Both too much and too little can compromise thyroid function. Taking iodine is not a smart move without knowing your levels. Salt can supply iodine, but it must say “iodized salt” to be sure it contains iodine. Sea salt does not have iodine unless it says it does.

4) Iodine is part of a family of elements called Halogens. Halogens include iodine, bromine, chlorine, and fluorine. The other halogens can interrupt thyroid function because they can also be taken up by the thyroid and displace iodine. Halogens are ubiquitous in the environment. There is chlorine in salt, fluoride in our water and toothpaste, and bromine in certain breads, processed foods, and even sports drinks (check the label on your favorite sports drink and you may see brominated vegetable oil). These things impact thyroid function negatively.

5) Progesterone supports thyroid function by priming thyroid receptors and helping thyroid conversion to active thyroid.

6) Soy can act as a thyroid disruptor by interfering with the thyroid enzyme called TPO. This is not an issue in those with normal iodine status. The issue is many do not have normal iodine status.

7) Cruciferous/brassica vegetables, which include broccoli, cauliflower, kale, chard, bok choy, cabbage, etc., can interfere with thyroid function. Again, having adequate iodine status decreases the impact. Also, unlike soy, cooking these vegetables greatly reduces any impact.

8) Using TSH alone to determine proper thyroid function is not wise. A full thyroid panel is required if you really want to know about thyroid function, and even then you can still be dealing with thyroid issues and not know. At least proper testing provides more answers. A full thyroid panel should include TSH, free T3, free T4, reverse T3, and anti-thyroid antibodies.

9) Gluten and dairy proteins have been implicated in autoimmune thyroid issues. Those with Hashimoto’s or Grave’s disease would be wise to eliminate these foods and go on a 4R gut restoration program. This does not mean these foods have any impact on those without the disease, but they may.

10) Synthroid is T4 and since T4 needs to be converted to T3 before the hormone is active, many can be taking thyroid meds and not be feeling much better. This is likely because a conversion issue was missed. This is why many integrative doctors like to use Armour thyroid which is a mix of T3 and T4. Cytomel which is T3 along with synthroid T4 is often needed.

11) Thyroid medication should be taken on an empty stomach. Many take it with their coffee not realizing this decreases its absorption in the same way.

12) Excessive coffee use can cause issues with thyroid due to its cortisol inducing impact. This would depend on the individual.

13) Vitamin D is a very important thing to address for thyroid. Many people are deficient in Vitamin D. You should seek to get your levels between 50 and 100ng/ml if you have thyroid issues.

14) The adrenal glands have a very close relationship to the thyroid. If you have thyroid issues you should check adrenal function with an adrenal stress index (ASI).

15) Hashimoto thyroid or Hashimoto’s Thyroiditis. This is a condition, named after the Japanese doctor Hakura Hashimoto who first described it. It was the first disease to be recognized as an autoimmune disease, which means the body produces immune cells against its own thyroid tissue. Many people with low thyroid function have these antibodies in their system, but their doctors do not test for them. This is because from the conventional MDs point of view their treatment would not change whether the low thyroid function is caused by an autoimmune process or not.

As an integrative physician, I can tell you they should. I have seen plenty of patients who changed their diets and seen their thyroid antibodies decrease or disappear all together. If you are low thyroid and have not had your thyroid antibodies tested you should. And if you have high thyroid antibodies, called anti TPO antibodies, you should look into seeing a functional medicine doctor familiar with autoimmune diets.

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9 Responses to Facts About Thyroid: Hashimoto & other things

  1. NutritionMax October 26, 2013 at 11:36 AM #

    Hi Jade,

    Great info. I’ve been trying to collect all these details between thyroid and adrenal glands. My mother has hypothyroidism and I’m going to cure her from it. I don’t think her doctor has tested for adrenal gland function… surprising… I have a few questions I would greatly appreciate it you could address.

    1) I understand that too much cortisol is bad because it decreases T3 and T4 output being in a catabolic situation all the time, but how does too little cortisol had a bad impact? I know of down-regulation of thyroid receptors due to inflammatory markers like IL-1 and IL-6, but am not sure how insufficient cortisol contributes to low T3 and T4 output.. Can you please explain more in detail the process here?

    2) If someone has hypothyroidism, are the adrenal glands ALWAYS the root cause or that something is wrong with that?

    3) What’s most common, overactive or underactive adrenal gland activity? I guess I’m confused if at first adrenals produce too much cortisol initially and start overactive, then become underactive due to adrenal fatigue?

    Thank you very much!

  2. Jade Teta October 26, 2013 at 5:36 PM #

    Hey Justin. Thanks for your comment. let me see if I can address some of these issues for you:

    1) Cortisol is required to “prime” the thyroid receptor so that it is sensitive too thyroid hormone. Many hormones work in this way. For example progesterone and estrogen prime each others receptors as well. Catecholamines also have this impact on the thyroid receptor. In this way, both low and high stress hormones can interfere with proper thyroid function. Many functional medicine practitioners, including myself has seen hypothyroid symptoms resolve from restoring low adrenal function (i.e. raising low cortisol with hydrocortisone/isocort). This has even been documented in the literature http://www.ncbi.nlm.nih.gov/pubmed/23111240

    2) No. They definitely are not always the cause. They are frequently contributing to the issue and often the cause. High cortisol output reduces TSH, blocks thyroid conversion and causes thyroid receptor resistance. Also, thyroid hormone dysfunction put and extra stress on the adrenals. So often this can appear like a chicken or egg (which came first?) issue. In my clinical experience adrenal issues almost always come first and even when they do not, the client does not respond well unless the adrenals are tended to.

    3) most common is overactive. Yes, the most common progression of stress is overactive adrenal function that then leads to underactive as the stress is prolonged

    how that provides some insight

  3. NutritionMax October 26, 2013 at 9:02 PM #

    Thanks Jade.

    Regarding your comments:

    1) Not sure I quite understand. What is the exact process though when you say cortisol “primes” receptors? Aren’t there still pro-inflammatory markers like interleukin-1 and 6 being secreted that block thyroid cell reception?

    Sorry, 2 more things…

    3) I’m in grad school right now and having a current debate in a class about adrenal fatigue being a real medical condition or not. In your opinion, is it a real disease? I have found literally not studies on it as I’ve come to believe that the medical community doesn’t believe it is.

    4) Is saliva testing the best/only way to test for adrenal gland functioning, at least at home? If not, what other tests are available or that my mother’s doctor should run?

    Thanks again!

  4. Jade Teta October 26, 2013 at 10:04 PM #

    1) The relationship between cortisol and thyroid is well known to those working clinically in this area and it is one of the reasons management can be so difficult. The proposed mechanism is that cortisol either increases thyroid receptor number and or sensitivity peripherally and in the HP. I can tell you clinically this is no small thing. Adrenal hypofunction induces

    http://www.ncbi.nlm.nih.gov/pubmed/3108000 (shows cortisol is impacting thyroid receptor sensitivity by as much as 50%)

    http://www.ncbi.nlm.nih.gov/pubmed/10323386 (shows low cortisol is likely impacting thyroid hormone receptor sensing in the HP)

    http://www.ncbi.nlm.nih.gov/pubmed/820709 (shows too much cortisol/dexamethasone decreases TSH. i.e. disrupts HP sensing of peripheral thyroid)

    so taken together with what is very well understood clinically and what little we have in research we think it works this way………..cortisol too low= decrease HP sensing & cortisol too high= decrease HP sensing, decrease thyroid conversion & decrease TPO activity)

    2) Adrenal fatigue is NOT a true diagnosis. It is not a disease state. Adrenal insufficiency is the diagnosis. Adrenal fatigue is used by functional medicine practitioners in the same way a term like “dysglycemia” or “prediabetes” is used. The question to pose in the debate is “someone who has a fasting blood sugar of 119 is not diagnosed as “diabetic”, but someone with a fasting blood sugar of 120 is. However, we know that the person with the 119 blood sugar is certainly in a dysfunctional range. Rather than call them healthy we call them prediabetic”. If you can understand that logic, you can understand why we call people who are not adrenally insufficient, but demonstrate suppressed adrenal function in response to stress and have many of the clinical symptoms as “adrenal fatigue”. it is an absolutely ridiculous argument to have. Call it what you want……”overtraining”, “sleepy/stressed syndrome”, “dysfunctional adrenal output”, or some other name. The fact remains the adrenals are not functionally optimal, symptoms are present and it can be seen objectively on adrenal testing.

    3) The gold standard to test for adrenal insufficiency is an ACTH challenge. If you really want to understand how the adrenal gland is functioning then free cortisol assessed in its natural circadian rhythm along with DHEA is best. It also happens to be the least invasive, cheapest and most repeatable testing. Salivary testing is not reliable for other hormones, but it is for cortisol and DHEA and may be preferred.

  5. NutritionMax October 27, 2013 at 11:05 AM #

    So, if I’m understanding this correctly, too much cortisol as seen most commonly in hypothyroidism, reduces T3 and T4 output and too low down-regulates thyroid cell sensitivity? Am I correct with what I said earlier about Interleukin playing a role in down-regulation as well?

    Is a TPO test for antibodies a good idea as well?

    Either way, ACTH test or free cortisol, it has to be performed by the practitioner? Saliva is only good for at home?

    If Addison’s Disease is complete dysfunction of hormone production, doesn’t adrenal fatigue come close to that? I guess I’m having a hard time distinguishing between the 2 since Addison’s is an actual disease condition.

    • Jade Teta October 28, 2013 at 7:34 PM #

      Yes, high cortisol negatively impacts thyroid function in the following ways= decreases TSH, decreases T3 to T4 conversion, interrupts thyroid hormone receptor sensitivity and MAY increase TBG in the same way estrogen does. Low cortisol negatively impacts thyroid receptor sensitivity as well.

      When you say interluekin? There are many different interleukins (IL-1, IL-2, IL-6, IL-10, etc), and most of them, not all such as IL-10, are inflammatory mediators. So this would be a chicken and egg thing. Are they doing damage to thyroid or is whatever doing damage to thyroid also causing this inflammatory reaction (i.e. are they the first or the smoke?) Given these work in cascade fashion (i.e. one triggering the next triggering the next) it is likely a bit of both.

      Your last point is exactly the point I was making. Yes adrenal insufficiency (i.e. Addison’s disease) and “adrenal fatigue” are similar in their clinical picture, etc. Adrenal fatigue is not an accepted diagnosis however. But it is what we call the situation when we see the signs/symptoms and low adrenal function that is dysfunctional, but not dysfunctional enough to meet the criteria for adrenal insufficiency if that makes sense? Many people who on an ASI test fall in the adrenal fatigue category may also have a diagnosis of adrenal insufficiency, but certainly not all or even most.

  6. NutritionMax October 28, 2013 at 9:32 PM #

    Makes sense. Sorry, last question and I’ll let you be!

    I had also heard from a clinical nutritionist that can TSH can be high in hypothyroidism and overburden thyroid so much that it cuts back on T3 and T4 output.. True?

    My mother is taking synthroid and has told me that her endocrinologist says she must for life to resolve her hypothyroidism. Her doc said she can’t take iodine rich foods because it will interfere with the drug. Are there long-term negative effects of taking synthroid? Am I helpless in this situation from a nutrition intervention standpoint? Surely, you should be able to slowly reduce dosage and go about it with a natural approach through nutrition? What do you think?

    Thanks again.


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