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By Chris Kresser on August 2, 2010 in Stress, Thyroid Disorders | 31 comments
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We’ve already talked about how blood sugar imbalances and poor gut health can lead to hypothyroidism and Hashimoto’s. The harmful effects of adrenal stress complete the triad. The adrenals are two walnut-shaped glands that sit atop the kidneys. They secrete hormones – such as cortisol, epinephrine and norepinephrine – that regulate the stress response. But these hormones play other crucial roles, many of which are directly related to thyroid health. In fact, as we’ll see in this article, proper thyroid function depends on healthy adrenal glands. Most people are aware of the obvious forms of stress that affect the adrenal glands: impossibly full schedules, driving in traffic, financial problems, arguments with a spouse, losing a job and the many other emotional and psychological challenges of modern life. But other factors not commonly considered when people think of “stress” place just as much of a burden on the adrenal glands. These include blood sugar swings, gut dysfunction, food intolerances (especially gluten), chronic infections, environmental toxins, autoimmune problems and inflammation. All of these conditions sound the alarm bells and cause the adrenals to pump out more stress hormones. In this context, stress is broadly
1) Adrenal stress disrupts the HPA axis By now many people have heard of the hypothalamic-pituitaryadrenal (HPA) axis. The following five mechanisms are the most important. And as we saw in a previous article. The most significant indirect effect the adrenals have on thyroid function is via their influence on blood sugar. It’s a complex network of interactions between the hypothalamus. digestion. the pituitary and the adrenal glands that regulates things such as temperature. and addressing the adrenals themselves is the key to improving thyroid function. In such cases. treating the thyroid is both unnecessary and ineffective.defined as anything that disturbs the body’s natural balance (homeostasis). staying asleep and waking up Mood swings Sugar and caffeine cravings Irritability or lightheadedness between meals Eating to relieve fatigue Dizziness when moving from sitting or lying to standing Gastric ulcers Weak adrenals can cause hypothyroid symptoms without any problem in the thyroid gland itself. blood sugar imbalances cause hypothyroid symptoms in a variety of ways. High or low cortisol – caused by any of the chronic stressors listed above – can cause hypoglycemica. because nearly everyone is dealing with at least one of the factors listed above. But some of the more common symptoms are: Fatigue Headaches Decreased immunity Difficulty falling asleep. immune . But adrenal stress also has more direct impacts on thyroid function. Symptoms of adrenal stress are diverse and nonspecific. because the adrenals affect every system in the body. hyperglycemia or both. Adrenal stress is probably the most common problem we encounter in functional medicine.
Remember that although 93% of the hormone produced by the thyroid gland is T4. T3. free T4. TNF-alpha. In patients without thyroid illness. Countless studies show that chronic adrenal stress depresses hypothalamic and pituitary function. 2) Adrenal stress reduces conversion of T4 to T3 We discussed under-conversion of T4 to T3 in a prior article. The inflammatory cytokines I listed above not only disrupt the HPA axis. Both Th1 and Th2 inflammatory cytokines – IL-6. as levels of IL-6 (a marker for inflammation) rise. which are released during the stress response. down-regulate the HPA axis and reduce levels of thyroid stimulating hormone (TSH). reduced serum TSH. The enzyme 5′-deiodinase catalyzes the conversion of T4 into T3 in peripheral tissues such as the liver and the gut. and decrease the sensitivity of the thyroid to TSH. IFN-gamma and IL-1 beta – have been shown to suppress the conversion of T4 to T3. mood. 3) Adrenal stress promotes autoimmunity by weakening immune barriers . And since these two organs direct thyroid hormone production. free T3 and hypothalamic TRH for 5 days. it is inactive in that form and must be converted into T3 before it can be used by the cells. Studies have shown that the inflammatory cytokines IL-1 beta. anything that disrupts the HPA axis will also suppress thyroid function. reduce thyroid hormone uptake. And injections of inflammatory cytokines into healthy human subjects resulted in a rapid reduction of serum T3 and TSH levels. an inflammatory peptide. Another studyshowed that one single injection of tumor necrosis factor alpha (TNF-alpha). while T4 and free T4 levels were only minimally changed. TNF-alpha was also found to decrease the conversion of T4 to T3. they also interfere with the conversion of T4 to T3. levels of serum T3 fall. sexuality and energy usage – in addition to controlling the body’s reaction to stress and trauma. and an increase in the inactive reverse T3 (rT3) form.system. IL6 and TNF-alpha.
It’s as if the thyroid hormone is knocking on the cell’s door. where the cells gradually lose their sensitivity to insulin. inflammation is depressing thyroid receptor site sensitivity and producing hypothyroid symptoms. it must first activate receptors on cells. If this happens repeatedly. While there’s no practical way to measure receptor site sensitivity in a clinical setting. lungs and the blood-brain barrier are the primary immune barriers in the body. decrease the liver’s ability to clear excess . this is a similar pattern. Prolonged cortisol elevations. and promotes poor immune system regulation. In these patients. even though lab markers like TSH. They prevent foreign substances from entering the bloodstream and the brain. 5) Adrenal stress causes hormonal imbalances Cortisol is one of the hormones released by the adrenals during the stress response. Inflammatory cytokines have been shown to suppress thyroid receptor site sensitivity. when these immune barriers are breached large proteins and other antigens are able to pass into the bloodstream or brain where they don’t belong. the research above suggests it is decreased in autoimmune and other inflammatory conditions. 4) Adrenal stress causes thyroid hormone resistance In order for thyroid hormone circulating in blood to have a physiological effect.The GI tract. If you’re familiar with insulin resistance. A perfect example of this in practice is the Hashimoto’s patient who is taking replacement hormones but still suffers from hypothyroid symptoms – often in spite of repeated changes in the dose and type of medication. the immune system gets thrown out of whack and we become more prone to autoimmune diseases – such as Hashimoto’s. but the cells don’t answer. T4 and T3 may be normal. caused by chronic stress. Adrenal stress weakens these barriers. weakens the immune system in general. As we discussed in my previous article on the gut-thyroid connection.
here are some general guidelines for adrenal health: Avoid or at least greatly minimize stimulants Stabilize blood ￼sugar (via a moderate or low-carb diet) Practice stress management and relaxation techniques Have fun. Excess estrogenincreases levels of thyroid binding globulin (TBG). it is inactive.) When TBG levels are high.e. the most common causes of elevated TBG secondary to excess estrogen are birth control pills and estrogen replacement (i. laugh and make pleasure a regular part of your life Avoid dietary causes of inflammation (refined flours. It must be cleaved from TBG to become “free-fraction” before it can activate cellular receptors. and of course. blood sugar swings. (These free-fraction thyroid hormones are represented on lab tests as “free T4 [FT4]” and “free T3 [FT3]“. the percentage of free thyroid hormones drops. food intolerances (especially gluten). these conditions must be addressed or any attempt to support the adrenals directly will either fail or be only partially successful. essential fatty acid deficiencies. Premarin). Aside from adrenal stress. When they exist. This shows up on labs as low T3 uptake and low free T4/T3. With that in mind. When thyroid hormone is bound to TBG. environmental toxins. the proteins that thyroid hormone is attached to as it’s transported through the body. Balancing the adrenals Here’s the tricky thing about adrenal stress: it’s almost always caused – at least in part – by something else. These causes include anemia. highfructose corn syrup and industrial seed oils in particular) Ensure adequate intake of DHA & EPA . chronic emotional and psychological stress.estrogens from the blood. gut inflammation.
.Specific nutrients such as phosphatidyl serine and adaptogenic botanicals like Panax ginseng. However. these are potent medicines and should be taken under the supervision of a trained practitioner.Ashwagandha and Holy basil leaf extract are also helpful in modulating the stress response and supporting the adrenals. Siberian ginseng.
FACS. leaving half of the thyroid in the neck undisturbed.Hypothyroidism: Too Little Thyroid Hormone Part 1: Introduction. the surgery will be to remove a worrisome nodule. the patient will develop hypothyroidism. Symptoms. Causes. which leaves a large percentage of the cells of the thyroid damaged (or dead) and incapable of producing sufficient hormone. FACE Hypothyroidism is a condition in which the body lacks sufficient thyroidhormone. and Symptoms of Hypothyroidism Written by James Norman MD. In fact. Since the main purpose of thyroid hormone is to "run the body's metabolism. The estimates vary. but approximately 10 million Americans have this common medical condition. But at other times. and Treatments Causes of Hypothyroidism There are two fairly common causes of hypothyroidism. this is often the goal of the surgery for thyroid cancer. Hypothyroidism is more common than you would believe. The first is a result of previous (or currently ongoing) inflammation of the thyroid gland." it is understandable that people with this condition will have symptoms associated with a slow metabolism. Learn More about Hypothyroidism Hypothyroidism Slideshow: Causes. For an overview of how thyroid hormone is produced and how its production is regulated. If the total mass of thyroid producing cells left within the body are not enough to meet the needs of the body. For . and millions of people are currently hypothyroid and don't know it. this remaining thyroid lobe and isthmus will produce enough hormone to meet the demands of the body. check out our thyroid hormone production page. The most common cause of thyroid gland failure is called autoimmune thyroiditis (also called Hashimoto's thyroiditis). as many as 10% of women may have some degree of thyroid hormone deficiency. The second major cause is the broad category of "medical treatments. Sometimes. a form of thyroid inflammation caused by the patient's own immune system. Remember." The treatment of many thyroid conditions warrants surgical removal of a portion or all of the thyroid gland.
Occasionally. So it doesn't. Similarly. dry hair Dry. If the pituitary does not produce enough thyroid stimulating hormone (TSH) then the thyroid simply does not have the "signal" to make hormone. the result of radioactive iodine treatment will be that too many cells are damaged so the patient often becomes hypothyroid within a year or two. Symptoms of Hypothyroidism Fatigue Weakness Weight gain or increased difficulty losing weight Coarse. However. and they will vary with the severity of the thyroid hormone . this is usually greatly preferred over the original problem.other patients. rough pale skin Hair loss Cold intolerance (you can't tolerate cold temperatures like those around you) Muscle cramps and frequent muscle aches Constipation Depression Irritability Memory loss Abnormal menstrual cycles Decreased libido Each individual patient may have any number of these symptoms. The aim of the radioactive iodine therapy (for benign conditions) is to kill a portion of the thyroid to prevent goiters from growing larger or producing too much hormone (hyperthyroidism). it may become apparent years later that the remaining thyroid just can't quite keep up with demand. goiters and some other thyroid conditions can be treated with radioactive iodine therapy. There are several other rare causes of hypothyroidism. however. one of them being a completely "normal" thyroid gland that is not making enough hormone because of a problem in the pituitary gland.
you need to discuss it with your physician. some patients with hypothyroidism have no symptoms at all. Hypothyroidism is completely treatable in many patients simply by taking a small pill once a day. Most importantly. complications can result in severe life-threatening depression. Occasionally. If you have these symptoms. However. Many factors will go into the treatment of hypothyroidism and it is different for everybody. Potential Dangers of Hypothyroidism Because the body is expecting a certain amount of thyroid hormone the pituitary will make additional thyroid stimulating hormone (TSH) in an attempt to entice the thyroid to produce more hormone. and it's not always so easy.deficiency and the length of time the body has been deprived of the proper amount of hormone. Hypothyroidism can often be diagnosed with a simple blood test. In some persons. or coma. If you have already been diagnosed and treated for hypothyroidism and continue to have any or all of these symptoms. Left untreated. You may have one of these symptoms as your main complaint. heart failure. the symptoms of hypothyroidism will usually progress. Additionally. this is a simplified statement. Rarely. however. . This constant bombardment with high levels of TSH may cause the thyroid gland to become enlarged and form a goiter (termed a "compensatory goiter"). a good relationship with a good endocrinologist will almost surely be needed. you need to discuss them with your doctor. while another will not have that problem at all and will be suffering from an entirely different symptom. There are several types of thyroid hormone preparations and one type of medicine will not be the best therapy for all patients. Most people will have a combination of these symptoms. you may need to seek the skills of an endocrinologist. it's not so simple and more detailed tests are needed. or they are just so subtle that they go unnoticed.
The thyroid is behaving "appropriately" under these conditions because it can only make hormone in response to TSH signals from the pituitary. Since hypothyroidism is caused by too little thyroid hormone secreted by the thyroid. The real question in this situation is what is wrong with the pituitary? But in the typical and most common form of hypothyroidism.However. the diagnosis of hypothyroidism is based almost exclusively upon measuring the amount of thyroid hormone in the blood. hypo-thyroidism = a disease of too little thyroid activity. There are normal ranges for all thyroid hormones which have been calculated by computers which measured these hormones in tens of thousands of people.Part 2: Diagnosis and Treatments of Hypothyroidism. Since the pituitary is not making enough TSH. The next question is: When is low too low. More about these tests on another page.. This means that the thyroid is not making enough hormone and the pituitary recognizes it and is responding appropriately by making more Thyroid Stimulating Hormone (TSH) in an attempt to force more hormone production out of the thyroid. while the TSH level will be high. In the more rare case of hypothyroidism due to pituitary failure. and the TSH level is high. such as the presence or absence of . but the TSH level will also be low.keep reading. then the thyroid will never make enough T4. REMEMBER hypo = too little thyroidism = disease of the thyroid Thus. The idea is to measure blood levels of T4 and TSH.. but other factors need to be taken into account as well. If your thyroid hormone levels fall below the normal range. that is consistent with hypothyroidism These tests are very accurate and reliable and are so routine that they are available to everybody. and when is high too high? Blood levels have "normal" ranges. the thyroid hormone T4 will be low. the blood level of T4 (the main thyroid hormone) will be low. the main thyroid hormone T4 is low. its not always so simple. In the typical person with an under-active thyroid gland.
etc) will make the "thyroid function tests" return to the normal range. and very importantly. physicians will often will rely on test results to determine when a patient is on the appropriate dose and therefore doing well. some patients with very "mild" deviations in their thyroid laboratory test results will feel just fine while others will be quite symptomatic.) Because most patients will be improved (or made completely better) when sufficient thyroid hormone is provided on a daily basis to make the hormone levels in the blood come into the normal range. so even if a patient is in the "normal" range. Find a doctor who helps make you FEEL better. It is important for both you and your physician to keep this in mind since the goal is not necessarily to make the lab tests go into the normal range. we cannot always predict just how bad (or good) an individual patient will feel just by examining his/her thyroid hormone levels. First we must realize that not all patients with hypothyroidism are the same. this is accompanied by a general improvement in symptoms making the patient feel better. taking some form of thyroid hormone replacement (synthetic or natural. if only it were this simple all the time! Although the majority of individuals with hypothyroidism will be easy to diagnose with these simple blood tests.symptoms. but to make you feel better as well! We must also keep in mind that even the "normal" thyroid hormone levels in the blood have a fairly large range. The degree of thyroid hormone abnormalities often. The solution for these people is more complex and this is due to several factors. but NOT ALWAYS will correlate with the degree of symptoms. AND. many millions will have this disease in mild to moderate forms which are more difficult to diagnose. you . In other words. For the majority of patients with hypothyroidism. You should discuss your levels with your doctor so you can interpret how they are helping (or not?) fix your problems. Additionally. not just make your labs better because once given this diagnosis. There are many degrees of this disease from very severe to very mild. it may not be the normal level for them. This does not happen to all individuals. (We aim to help you find this type of doctor. these tests have a wide normal range. however. Remember. Oh. and for these patients it is very important to find an endocrinologist who will listen and be sympathetic. pill or liquid.
long time. There is more than one drug. there is more than one lab test. It comes in multiple strengths. when its not. symptoms. however. It is important that the correct amount of thyroid hormone is used.. how you feel. Too high a dose could cause symptoms of nervousness. you need a physician who is willing to spend the time with you that you deserve while you explore different dosages other types of medications (or alternative diagnoses). slow the risk of heart disease and osteoporosis. Some patients will notice a slight reduction in symptoms within 1 to 2 weeks. but the full metabolic response to thyroid hormone therapy is often delayed for a month or two before the patient feels completely normal. make sure your physician knows it so he/she can check the levels at least yearly. this simple approach does not hold true for everybody. For these reasons you should not be shy in discussing with your doctor your blood hormone tests. The dose should then be re-evaluated at least annually. If you are on this medication. . Not enough and the patient may have continued fatigue or some of the other symptoms of hypothyroidism. The dosage should be reevaluated and possibly adjusted monthly until the proper level is established. Also. make your body last longer. some patients just don't do well on some thyroid medications and will be quite happy on another. Occasionally the correct dosage is a bit difficult to pin-point and therefore you may need an exam and blood tests more frequently. which means that an appropriate dosage can almost always be found for each patient. Treatment of Hypothyroidism Hypothyroidism is usually quite easy to treat (for most people)! The easiest and most effective treatment is simply taking a thyroid hormone pill (Levothyroxine) once a day. Note: Just like we discussed above. The goal is to make you feel better. and the type of medicine you are taking.in addition to making your blood levels normal! Sometimes that's easy. preferably in the morning. and there is a "just right" doctor for everybody. This medication is a pure synthetic form of T4 which is made in a laboratory to be an exact replacement for the T4 that the human thyroid gland normally secretes.are likely to carry it for a long..
Some recent studies have suggested that too much thyroid hormone may cause increased calcium loss from bone increasing the patient's risk for osteoporosis. it is of great importance that the diagnosis be firmly established and you have a good relationship with a physician you like and trust. However. Patients taking cholestyramine (a compound used to lower blood cholesterol) or certain medications for seizures should check with their physician about potential interactions. We don't want too much given or subtle symptoms ofhyperthyroidism could ensue. Even a slight excess may increase the patient's risk for heart attack or worsen angina. Synthetic T4 can be safely taken with most other medications. Often blood samples are also checked to see if there are antibodies against the thyroid. and too little would not alleviate the symptoms completely. an optimal thyroid dose is particularly important. Remember. . a sign of autoimmune thyroiditis. You may want to consult with your physician or pharmacist on the most cost effective brand since recent studies suggest that none is better than the other. There are other potential problems with other drugs including iron-containing vitamins. There are three brand name Levothyroxine tablets now available. Women taking T4 who become pregnant should feel confident that the medication is exactly what their own thyroid gland would otherwise make. they should check with their physician since the T4 dose may have to be adjusted during pregnancy (usually more hormone is needed to meet the increased demands of the mother's new increased metabolism). Once treatment for hypothyroidism has been started. Once again. After about one month of treatment.palpitations or insomnia typical of hyperthyroidism. Therefore. Some physicians feel that more frequent dose checks and blood hormone levels are appropriate in these patients. pregnant women (and all women and men for that matter) taking iron supplements should discuss this with your physician. this is the most common cause of hypothyroidism. hormone levels are measured in the blood to establish whether the dose of thyroid hormone which the patient is taking is appropriate. it typically will continue for the patient's life. For patients with heart conditions or diseases.
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