The Chameleon That Steals Your Health

By Laurie Heap, MD

What does decreased ability to concentrate, ringing in the ears, hair loss, acid reflux, infertility, chest pain, acne, bad breath, frequent colds, joint aches, brittle fingernails, migraines, and allergies have in common? The thyroid gland! Small but mighty, the thyroid gland is sometimes described as the natural power plant of the body because it sets the rate of our metabolism. When something goes wrong with this unassuming, butterfly-shaped organ found in our necks, nearly every cell in our bodies is affected (because every cell needs energy to do its job). If you can name it, a malfunctioning thyroid can cause it.

Thermostat for Metabolism

The thyroid gland manages our metabolism, and when it fails to function normally, its negative effects are very broad. In order to understand what can go wrong with our thyroid, we first have to take a look at how a thyroid normally works.

The thyroid is controlled by a part of the brain called the pituitary. The pituitary produces a substance ] called thyroid stimulating hormone (TSH) and releases it into the blood. TSH travels through the bloodstream and signals the thyroid to produce an inactive form of thyroid hormone called T4. T4 enters the blood and travels all over the body. The cells of the body absorb T4 and transform it into an active form of the hormone called T3 that is 300 percent more active than T4. T3 stimulates certain biochemical processes in the cells and, shortly after its job is done, T3 is destroyed. The amount of TSH produced by the brain is regulated by the amount of T4 that is in the blood. If the level of T4 is low, then the brain increases the amount of TSH it produces. If T4 is high, then less TSH is produced. This is called a classic feedback inhibition system.

When the thyroid system breaks down, it can result in two disorders. Hyperthyroidism is an excess of thyroid hormone in the body. Too much thyroid hormone overstimulates a person’s metabolism, resulting in fast heart rate, shaking, anxiety, irritability, mood swings, panic attacks, feeling hot, sweating, increased appetite, diarrhea, unexplained weight loss, and (for women) long and irregular menstrual cycles. Hyperthyroidism is relatively rare. In general, hyperthyroidism’s symptoms are dramatic enough to call attention to the condition, which is easily diagnosed.

Hypothyroidism is a deficiency of active thyroid hormone and is more insidious than its overactive counterpart. The symptoms of hypothyroidism like fatigue, weakness, weight gain, aching, constipation, and depression are easy for both patients and doctors to dismiss as overeating, not enough sleep, and life situations or circumstances that will go away with time.

Hypothyroidism results from a breakdown of the thyroid system in three places:

1 // The pituitary gland (brain) can fail to produce enough TSH to signal the thyroid gland to make thyroid hormone.

2 // The thyroid gland can fail to produce enough thyroid hormone in response to TSH.

3 // The cells can fail to convert T4 (inactive thyroid hormone) to T3 (active thyroid hormone).

When the breakdown occurs at the level of the brain and the thyroid gland, diagnosis is simple and straightforward. If the pituitary is not working properly, TSH and T4 are both low. If the thyroid gland is malfunctioning, then TSH is high and T4 is low.

These two forms of hypothyroidism are well known and universally acknowledged in the medical community. It is standard medical practice to test TSH and T4 in patients to look for underactive thyroid—this is not the case for the third scenario. If a person’s hypothyroidism is due to a defect in the conversion of T4 to T3 in the cells of the body, some physicians do not acknowledge this as a problem to be treated.

Physicians, who are broad-minded, acknowledge that there are a large number of patients suffering from hypothyroid symptoms, but standard lab tests do not show hypothyroidism. Dr. Therese Hertoghe, a British endocrinologist, believes the TSH test may only identify 2 to 5 percent of hypothyroid patients. For individuals who are trying to live a more natural lifestyle, it is not surprising that Western medicine has very little to offer patients who do not fit into the standard medical treatment parameters. Natural remedies can go a long way to help this particular disease, called thyroid system dysfunction (TSD).

TSD: The Disease of Hypochondriacs and Head Cases

Thyroid system dysfunction (TSD) is defined as a condition in which the patient may have a large number of symptoms associated with abnormal thyroid function including a low basal body temperature, but standard thyroid tests are normal. It is a chameleon and masquerades as a multitude of other diseases. Individuals with TSD have all sorts of seemingly unrelated symptoms and can often get lost in our modern system of medicine.

Medicine has become so specialized that it is difficult for doctors to put it all together—we go to a gastroenterologist for acid reflux, we go to a dermatologist for issues with our skin, an ophthalmologist for issues with our eyes, a gynecologist for menstrual problems, a urologist for male issues…

Savvy physicians listen to a patient’s symptoms and ask probing questions, but time constraints and the “that’s not my area of expertise” attitude can get in the way of proper patient care. The vast majority of TSD cases go undiagnosed, and patients can easily be caught in a web of “medicine stacking” to treat all the symptoms: migraine medicine for headaches, sleeping pills for insomnia, antacids for heart burn, lipid lowering drugs for high cholesterol, birth control pills for irregular cycles, antidepressants for depression, etc. Individuals with TSD are frequently labeled as hypochondriacs, “neurotic,” or “head-cases.”

Research has shown 6 percent of the population has some form of thyroid disease. Using standard screening tests, some thyroid experts believe TSD is much more prevalent. Dr. Broda Barnes M.D., Ph.D., who was a leading researcher in thyroid physiology, conjectured that an astounding 40 percent of the US population could have some form of thyroid system dysfunction.

While this number may be a bit extreme, there are undoubtedly a large number of people suffering with hypothyroid symptoms, who have found no solution in standard medical practices.

How do you know if you have TSD?

The diagnosis of TSD is based on three criteria:

1 // Low basal body temperature

2 // Positive list of symptoms (see the A to Z check list on the next page)

3 // A low T3: reverse T3 ratio (This is a lab test that needs to be measured by a physician.

Criteria 1: Basal Body Temperature

Basal body temperature is a good indication of thyroid function because it is affected by the body’s metabolism. In order to perform this test, you will need a basal body temperature thermometer. Shake down the thermometer before you go to bed and place it on your nightstand (or buy a digital thermometer and skip this step). Place the thermometer under your arm right after the alarm clock goes off and before you get out of bed. Press the snooze button and leave the thermometer in place for ten minutes. Normal temperature is above 97.8 degrees. For women, basal body temperature is normally higher in the last half of the menstrual cycle (from the time of ovulation to the beginning of the next period). For the most accurate reading, a woman should measure her temperature three to eight days into her cycle.

Criteria 2: The A to Z Checklist of Symptoms

Many people with TSD struggle for years with a long list of seemingly unrelated problems. Going through the A to Z checklist can help “put it all together.  The following symptoms can be due to other causes (which should be ruled out), but when many symptoms are present and treatments do not seem to be effective, TSD is reasonable to consider as the underlying source.

The top symptoms experienced by patients with TSD include: “I eat chocolate,” fatigue, mood swings, “I drink colas,” irritability, cold intolerance (“I am cold when others are not”), PMS, fluid retention, dry skin, depression, and decreased sex drive.

The Complete A to Z Checklist:

Allergies: allergies, asthma, hay fever, hives, sinus drainage, stuffy nose

Diet: easy weight gain, easy weight loss, excessively tired after eating, food cravings, food intolerances, hypoglycemia (low blood sugar)

Ears: ear infections, ringing in ears

Eyes: blurry vision, dry eyes

Fert ility: infertility, miscarriage, low sperm count, decrease in the length of sperm lifespan

General Well-Being: inability to concentrate, difficulty remembering, decreased sex drive, depression, fatigue, listlessness, irritability, lightheadedness, low motivation, clumsy, anxiety, low self esteem, panic attacks

Hands, Feet, and Joints : carpal tunnel syndrome, numbness or tingling in hands or feet, joint aches, arthritis, muscle aches, slow reflexes

Head: headaches, migraines

Heart and Cardiovasc ular System : low blood pressure, high cholesterol, chest pains, palpitations

Infections: ear infections, frequent colds, frequent sore throats, frequent urinary tract infections

Intestinal Problems: heart burn, constipation, irritable bowel syndrome, ulcers

Skin, Hair, and Nails: brittle fingernails, dry hair, hair loss, prematurely grey, thinning of outside third of eyebrows, acne, light or dark spots, skin blotchiness, coarse skin, dry skin, easy bruising, flushing, increased skin infections, itchiness, slow wound healing

Criteria 3: The “Evil Twin” Wins

Now, we get to the heart of the problem and address the question: “What causes TSD?”

The adrenal glands are small crescent-shaped organs that sit on the kidneys like two crowns. The adrenals rule over and manage the body’s stress. These small glands produce a hormone called cortisol in response to mental and physical distress.

The thyroid gland and the adrenal glands are either good friends working in harmony or mortal enemies that feed into each other's weaknesses. In the case of TSD, they are the latter, which creates a slow spiral downward of our wellbeing and health.

The initial cause of TSD is believed to be chronic stress. When a person experiences stress, cortisol is produced by the adrenal glands. Cortisol affects blood sugar, suppresses the immune system, and stimulates the growth of fat cells— but it also affects the conversion of T4 to T3.

In the presence of elevated cortisol levels, due to chronic stress, the conversion of T4 to T3 is blocked. Not only does cortisol block the formation of T3, but it promotes the production of reverse T3. Reverse T3 is the active T3’s evil twin. It binds to receptors in our cells, but does not promote the chemical reactions we need to maintain a healthy metabolism. Thyroid scientists call this "reverse T3 dominance." Once reverse T3 dominance is established, it is difficult to correct. Even when cortisol levels are reduced, reverse T3 itself blocks the conversion of T4 to active T3 and a vicious cycle is established.

Very few physicians recognize and few patients know the connection between chronic stress, cortisol levels, and thyroid function. The effects of stress on the thyroid can cause health problems and wreak havoc on our sense of well-being long after the stress has been resolved.

TSD and Family History

Family medical history is a significant, but not essential, clue in the diagnosis of TSD. A family history of thyroid problems, diabetes, fibromyalgia, or chronic fatigue is not a necessary criterion for the diagnosis of TSD, it is just one more piece of the puzzle. Hypothyroidism does run in families and, if you have close relatives with a history of these problems, there is an increased likelihood your symptoms are due to TSD.

TSD Treatment: Women Are More Complicated Than Men!

Like many complementary and alternative medicine solutions, treatment is focused on getting at the root of the underlying problem. For men, three steps to wellness are necessary. Women require four steps to treat the underlying problems associated with TSD.

Step 1: In this stressful economy, make sure your thyroid is well funded: take vitamins and supplements that support the thyroid.

Iodine: The thyroid needs 150 micrograms of iodine per day to function. Taking an iodine supplement is good as long as you don’t overdo it. Too much iodine can actually have the opposite effect and shut down the thyroid gland.

B-Complex Vitam ins: Our cells need the B vitamins to convert T4 into active T3. A good natural source of the B complex vitamins is Brewer’s Yeast.

Selenium: Cells also need selenium to convert T4 to T3. Plants and vegetables absorb selenium from the soil. Most Americans consume enough selenium in their diets, making supplements unnecessary and even dangerous. There are parts of the United States that have selenium deficient soil. These areas are mainly in the Pacific Northwest and down the Eastern seaboard into Florida. For people living in these areas, a supplement may be needed. The maximum dose of selenium should not exceed 400 micrograms per day. Including foods like liver, shellfish, and Brazil nuts is a safe way to ensure that our bodies have enough selenium to keep the thyroid happy.

Other supplements include: Be sure you're getting enough zinc, magnesium, omega-3s, and copper.

Step 2: Break the vicious cycle of reverse T3 dominance by supplementing T3 in the form of desiccated thyroid, or slow release T3, from a compounding pharmacist.

Armour Thyroid, Westhroid, and Nature-Throid tablets are a mixture of active and inactive thyroid hormone. Dessicated thyroid tablets are less potent than straight T3 from a compounding pharmacist and may be a better place to start. Conventional treatment for hypothyroidism is to give thyroid hormone in the inactive T4 form. A new study, published in May of 2010, found that a significant number of patients respond better to Armour Thyroid tablets than T4, especially with respect to mood symptoms like depression.

Sustained-release T3 has some pretty potent effects when too much is taken too quickly. Overdosing with T3 can cause hyperthyroidism. “Start low and go slow” is a good motto when using T3. It is necessary to monitor your pulse, body temperature, and blood pressure, as well as look for hyperthyroid symptoms to make sure you are not overdoing it. Careful monitoring and following your doctor’s recommendations is essential when dealing with T3.

The good news is that once you break the reverse T3 cycle, you should be able to gradually decrease the amount of T3 or Armour Thyroid tablets you require. If you work on lowering cortisol levels while supplementing with T3, your body is able to clear the reverse T3 from your blood and break the vicious cycle of reverse T3 dominance keeping you down.

You will have to work with a doctor to implement this solution. The following resources will help you find a physician who can help:

Step 3: Decrease cortisol levels.

Stress and unhappiness increase cortisol in the body, and start the vicious cycle of TSD. Boosting mood and learning to deal with stress in a healthy way is an essential aspect of treatment, which can prevent recurrence in the future.

Age-old wisdom and sayings, such as “a long and happy life”, often turn out to be true when scientists test them as the hypothesis in a research project. Over the past two decades, a new area of psychology has emerged which focuses on happiness. Positive psychology studies have unequivocally proven what we have known for centuries—happiness, health, and longevity go hand-in-hand. The link between a long life and a happy life undoubtedly has something to do with the thyroid-cortisol connection.

Chronic stress leads to the vicious cycle of TSD. The body doesn’t distinguish between physical and psychological stress; both increase our cortisol levels. Chronic illness, infection, and pain are physical causes of stress. Depression, anxiety caused by financial pressures, toxic relationships, and high-pressure careers are a few examples of psychological stressors relevant to our lives today. The relationship between psychological stress and cortisol is one area where the mind-body connection is well-known and concrete.

According to psychological studies, happiness decreases cortisol levels and unhappiness increases cortisol levels in our bodies. Chronic stress is anything that makes us habitually unhappy. Lower cortisol is one of the reasons happy people live longer.

“Don’t worry, be happy” is easier said than done. When something as desirable as happiness is elusive, it is beneficial to turn to science for help. Positive psychologists have found that happiness lies in using our signature strengths in serving others and attaching our lives to some bigger purpose.

Optimism, gratitude, and forgiveness also have a profound effect on our satisfaction in life.

Dr. Martin Seligman, known as the father of positive psychology, has studied how to change our attitude from pessimism to optimism. The technique is called "learnedoptimism.” His research has shown that how we respond to adversity, not the absence of adversity, is important. Here are some steps we can take to change our attitude towards life:

• Look at the facts: If we are intellectually honest about the situation, often the facts show us that this is not a permanent setback. Making “this, too, shall pass” your motto is a good idea.

• Stop the ruminating, set a time to think about the problem later, and work toward a solution.

• Being others-focused, rather than me-orientated, can go a long way towards making us happier. Positive psychology has shown that happiness comes when we stop focusing on our own enjoyment and focus on doing something good for the people and world around us. Ironically, when we change our goals from personal pleasure to philanthropy we find the joy we desire.

TSD and Women

Just as a woman is more interpersonally oriented and usually more intimately connected with others, so is her thyroid. A woman’s thyroid not only has an interdependent relationship with the adrenal glands, but is also connected to, and affected by, the ovaries. Thyroid system dysfunction is much more common in women. Some thyroid experts believe the increased rate of TSD in women is partially due to this interdependent relationship with the female reproductive system.

How Are The Ovaries Involved?

During a woman’s cycle the ovaries are in charge of ovulation and producing the two major sex hormones in a woman’s body—estrogen and progesterone. In the first part of a woman’s cycle, the ovaries prepare for ovulation and produce increasing amounts of estrogen. After ovulation has occurred, the ovaries switch gears and produce large quantities of progesterone. The two female sex hormones have opposite actions in a woman’s body and balance each other’s effects over the course of each month. In addition to a woman’s fertility, this beautiful and delicate balance promotes heart, brain, breast, bone, immune-system and skin health.

Thyroid function has direct and indirect effects on the ovaries. Direct influence occurs throughout a woman’s cycle. In the first part of the cycle, active thyroid hormone is necessary to promote the normal preparations in the ovary that lead to ovulation. After ovulation, thyroid hormone is necessary for the normal production of progesterone. A decreased amount of active T3 leads to a progesterone deficiency in the last half of the menstrual cycle. A deficiency of progesterone translates to an estrogen-dominant state in the woman’s body.

TSD is indirectly associated with estrogen dominancethrough the adrenals. Progesterone is the main building block of cortisol. If a woman is under a great deal of stress, the increased demand for cortisol can cause a decrease in the amount of progesterone circulating in her body, making the estrogen dominance worse.

Estrogen dominance and TSD share many common symptoms including: depression, anxiety, PMS, tiredness, irritability, insomnia, menstrual irregularities, painful periods, and headaches.

In addition to causing troublesome symptoms that affect a woman’s day-to-day quality of life, estrogen dominance can increase a woman’s risk for breast cancer, cardiovascular disease, infertility, and uterine cancer.

With the rise in the numbers of couples struggling to get pregnant, it is helpful for women to be aware of the connection between TSD, estrogen dominance, and infertility. In the 1950s, most women having trouble conceiving were given a thyroid supplement. This practice was lost after reproductive technologies were introduced into medicine. Reproductive specialists often overlook more natural remedies; studies have shown this leads to over-treatment of infertility. Treating TSD and estrogen dominance may prevent over treatment and make technological solutions unnecessary for many couples.

TSD Treatment for Women

The most effective treatment of TSD in women is aimed at correcting the trio of underlying problems involving the thyroid, the adrenals, and the ovaries.

Because of the relationship between these organs, the treatment of TSD alone may resolve an estrogen dominance issue in a woman's body. However, if symptoms like irritability, insomnia, depression, migraines, and food cravings linger after the underlying thyroid problems have been addressed, then treatment for estrogen dominance may be necessary.

In the treatment of estrogen dominance, timing is as important as what you take for it. Bioidentical, natural progesterone is the most effective treatment for estrogen dominance—if you take it at the right time of the month.

There are three different forms of progesterone:

1 // Natural progesterone creams found in natural food and health stores. The amount of cream needed depends on the concentration of progesterone. Most creams contain 15 to 20 mg in every 1/4 teaspoon. A premenopausal woman needs 20 mg per day in the last half of her cycle.

2 // Bioidentical progesterone cream or suppositories from a compounding pharmacist.

3 // Prometrium is a pill containing bioidentical progesterone. When you take progesterone in a pill form, the amount that gets into the body varies greatly from woman to woman. Most women require around 200 mg per day because only 10 percent of the progesterone is absorbed.

Timing is everything. When it comes to bioidentical progesterone supplementation, you start the progesterone three days after ovulation and continue it for nine days. In order to time it effectively, a woman needs to be able to identify when she has ovulated by charting her cycle, taking her temperature or using an ovulation monitor. This is called cooperative bioidentical hormone supplementation. Supplementing with natural progesterone after ovulation restores the natural hormone balance in the woman’s body and corrects the underlying problem. The benefits of restoring natural hormone balance include a renewed sense of well being, decreased risk for heart attack and stroke, and a decreased risk for breast cancer.

Our sense of well-being has a profound effect on our success and enjoyment in daily life. Work performance, relationships, and personal interests all suffer when we do not feel 100 percent. TSD is a disease that can have a significant impact on all these areas of life, but acts as a chameleon disguised as a multitude of other diseases. TSD is often ignored or overlooked by conventional medicine and leaves those who suffer with its consequences frustrated and discouraged.

Natural and complementary medicine offers hope to those who have struggled for years with seemingly unrelated symptoms and received little relief through conventional medicine. Natural and holistic solutions are particularly valuable in the treatment of TSD because of the mind-body connection between chronic stress, the adrenals, and thyroid hormone. Helping the body heal itself is the key to treating this problem and living a long and happy life.