Often times, symptoms we relate to estrogen and progesterone problems are actually caused or made worse by abnormal thyroid function. In this article, I will talk about the how an under active thyroid will throw off female hormone balance.

What does your thyroid do?

The thyroid gland, located in the front of your neck, stores and makes hormones that affect every organ in your body. Thyroid hormone controls metabolism, body weight and energy levels.

Hypothyroidism (too little thyroid hormone) can cause you to experience fatigue, constipation, dry skin, coarse hair, irregular and heavy periods, low libido, cold sensitivity and depression. About 25% of women in perimenopause are diagnosed with this condition.

Hyperthyroidism (too much thyroid hormone) can cause a too rapid heart rate, palpitations, weight loss, insomnia, shaking, nervousness, anxiety, hyperactivity, irritability, moodiness, hair loss, sweating, missed periods as well as a bulging of the eyes.

As you can see from the wide range of symptoms, every organ in your body needs the right amount of thyroid hormone to work properly.

Tell me more about thyroid symptoms?

Thyroid hormones play an important role in balancing female hormones, improving your energy and supporting brain function. It is not surprising that poor thyroid function will produce a wide range of symptoms in many different areas of your body. Symptoms of hypothyroidism are often mistaken for problems with estrogen and progesterone fluctuations:

• Anxiety, Irritability and Premenstrual Syndrome (PMS)
• Hot flashes, night sweats and vaginal dryness
• Thinning Hair and hair loss, loss of eyebrow hair
• Dry skin and dry eyes
• Low libido or low sex drive
• Infertility and pregnancy loss
• Irregular menstrual cycles, Heavy periods, or Painful periods
• Fatigue
• Depression
• Poor memory
• Muscle aches and joint pain
• Weight gain or weight loss resistance
• Constipation

Because thyroid hormones affect so many different systems in your body, patients are often misdiagnosed with other conditions:

• Depression
• Anxiety Disorder
• Fibromyalgia
• Chronic fatigue syndrome
• Bipolar Disorder
• Unexplained infertility
• Polycystic Ovarian Syndrome
• Menopause syndrome

Why are mood disorders so common in women with thyroid disease?

The thyroid hormone affects emotions such as happiness, fear, anger and anxiety

If you have thyroid problems you may suffer from anxiety and depression since the active form of thyroid hormone known as T3 controls the production of various brain chemicals such as serotonin, norepinephrine, and GABA.

Large amounts of T3 are found in areas of your brain that control emotions such as happiness, fear, anger and anxiety. Of note, the amino acid tryptophan is the precursor to both serotonin AND thyroid hormone itself. It is thought that low thyroid function can deplete your body of serotonin and other mood-balancing neurotransmitters.

How does the thyroid affect sex hormones?

The thyroid is at the center of all hormone communication between your brain, your adrenal gland (the gland that manages stress hormone action) and your ovaries.

When this communication is damaged, the interaction between your sex hormones, stress hormones, brain neurotransmitters and energy metabolism falls apart. Symptoms that seem related to problems with estrogen and progesterone, are often caused by thyroid hormone imbalance.

Why is my thyroid not functioning properly?

Although most patients diagnosed with hypothyroidism are treated with thyroid hormone replacement therapy, understanding why your thyroid is not functioning will impact the success of treatment. There are 2 major categories of thyroid disease:

• Autoimmune Thyroid Disease (Hashimoto’s Thyroiditis) refers to a common common condition in which your immune system attacks your own thyroid gland and begins to destroy the tissue responsible for thyroid hormone production. Once a certain amount of destruction occurs, your thyroid will no longer produce enough hormone to support normal cell function and sex hormone balance. This is the most common cause of thyroid disease in the United States.
• Non-Autoimmune Thyroid Disease refers to abnormal thyroid hormone production or function that can occur for a variety of reasons. Examples include:
  
  • Nutrient deficiency (such as low iron, zinc, selenium, and magnesium) reduces the ability to make thyroid hormone
  • Poor conversion from storage (inactive) forms of thyroid hormone (T4) to active forms (T3) due to nutrient deficiencies, excessive estrogen or deficient cortisol
  • Increased Thyroid Binding Globulin (TBG) which is related to other hormone imbalances, medications, liver disease, pregnancy and other high estrogen states. Decreased TBG levels may be due to overactive thyroid, kidney and liver disease, severe illness, Cushing syndrome, certain medications and malnutrition.
  • Thyroid gland destruction or injury – often related to radiation, surgery, certain medications or iodine deficiency
  • Pituitary gland or Hypothalamus injury – these are areas of the brain that send the signal to the thyroid to release thyroid hormone.

Why do we need to find out the cause of hypothyroidism?

In many cases, addressing the cause may help reverse the disease and reduce many of the symptoms of hypothyroidism. Simply replacing thyroid hormone may not work for all patients.

How to diagnose thyroid disease?

Most practitioners will screen you for thyroid disease by testing only TSH (thyroid stimulating hormone) and T4 (the storage form of thyroid). This does not give us a complete picture of thyroid function and may miss cases of hypothyroidism. In addition, knowing the underlying causes of hypothyroidism will guide treatment. If you suspect a thyroid problem, consider including a more comprehensive thyroid blood assessment:

• TSH or thyroid stimulating hormone is released from the pituitary and stimulates the thyroid to produce active thyroid hormone. If the pituitary does not produce enough TSH, you may not make adequate thyroid hormone. When the thyroid gland itself is the problem, TSH levels will either rise in the presence of too little thyroid hormone or drop when there is too much hormone.
• Free T3 and Free T4 — these are the free forms of thyroid hormone that circulate in the blood “unattached.” T3 is the form of thyroid hormone that our cells primarily use. Knowing if there is enough T3 may explain symptoms of underactive thyroid despite “normal” TSH and T4 levels.
• Reverse T3 (RT3) – T4 can convert to T3 (the active form of thyroid hormone) or RT3 – an inactive form of thyroid hormone. RT3 can occupy T3 receptor sites in your cells, preventing free T3 from doing its job.
• Thyroid antibodies – thyroid peroxidase antibodies (anti-TPO), thyroglobulin antibodies (anti-TG), and thyroid stimulating immunoglobulin (TSI) are auto-antibodies implicated in autoimmune thyroid disease.

Treatment of Hypothyroidism

Once you have been diagnosed with hypothyroidism, most practitioners may prescribe hormone replacement therapy. The standard treatment is synthetic T4 also known as levothyroxine, the inactive form of thyroid hormone. For many patients, this treatment may improve symptoms, however, if you are someone who has poor conversion from T4 to T3 (the active form of thyroid hormone), you may not notice any benefit. Some practitioners will include synthetic T3 in addition to T4 to address this concern. However, without understanding or addressing the underlying cause of hypothyroidism, treatment benefits are generally limited at best and may not create long term symptom relief.

A Functional Medicine Approach to Treating Hypothyroidism

To determine how a functional approach differs from a conventional medicine approach? We ask the following questions:

Do you have autoimmune hypothyroidism, also known as Hashimoto’s thyroiditis?

Although most conventional medicine docs don’t believe that autoimmune disease can be treated without the use of immune suppressing drugs, there are steps you can take to slow down the progression of disease. Most practitioners won’t screen for the antibodies against the thyroid since they feel that treatment is the same regardless: thyroid hormone replacement. However, slowing down or removing the causes of Hashimoto’s and addressing autoimmune disease in general, will improve thyroid function, reduce inappropriate stimulation of thyroid hormone release, and reduce the destruction of the thyroid gland.

• Action Step: Check for thyroid antibodies: Anti-TPO (thyroid peroxidase enzyme), anti-TG (thyroglobulin) and TSI (thyroid stimulating antibodies)

Are you making too much reverse T3 (blocking thyroid hormone)?

To use a car analogy, reverse T3 acts like the brakes in the car to slow everything down, while T3 is the gas pedal that makes you go. If you have too much reverse T3, the active form of T3 won’t be able to bind to the receptors to do its job and you will be in a state of hibernation: sleepy, fat, low energy and generally not fun to be around.

There are 3 main reasons that reverse T3 can be too high:
   » Adrenal hormone imbalance (think stress hormones)
   » Iron-deficiency anemia
   » Systemic inflammation in the body

• Action Step: Check for markers of inflammation such as high-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), Interleukin-6 (IL-6). Check for iron-deficiency anemia (complete blood count or CBC and ferritin level)

Do you have problems converting storage forms of thyroid hormone (T4) into the active form (T3)?

If you have adequate T4, yet your body isn’t converting it to the active form T3, you will not feel well. A functional medicine evaluation looks into the different reasons T4 to T3 conversion is not happening. Many conditions can interfere with this conversion process.

The enzyme largely responsible for thyroid hormone conversion is called 5’deodinase enzyme. It comes in three forms: D1, D2 and D3.

D1 converts inactive T4 to T3 throughout the body and can be suppressed in response to the following conditions:

• Stress (emotional or physical)
• Depression
• Weight gain
• Obesity
• Insulin Resistance and Diabetes
• Inflammation from autoimmune disease or systemic illnesses
• Chronic fatigue and fibromyalgia syndromes
• Exposure to toxins, plastics and harmful chemicals impacting liver detoxification
• Abnormal Gut function

D2 converts T4 to T3 in the pituitary and is a thousand times more efficient than D1 at converting T4 to T3. This explains why TSH levels may be normal (since TSH is released from the pituitary gland that experiences “normal” thyroid hormone production) while thyroid hormone circulating in the body is deficient.

D3 on the other hand, converts T4 into reverse T3 (blocking thyroid hormone). If D3 starts making more reverse T3, it will occupy T3 receptors, preventing active T3 from binding to do its job. Your metabolism will take a big hit and you will develop all the symptoms of low thyroid.

Are your gut bacteria reducing thyroid hormone conversion?

When you have an imbalance between the “good” and “bad” bacteria in your intestines, the conversion from T4 to T3 is affected. Up to 20% of T4 to T3 conversion occurs in the GI tract. Inflammation in the gut triggers the release of cortisol. Cortisol can decrease active T3 levels while raising reverse T3.

• Action Step: If you are experiencing digestive symptoms such as reflux, heartburn, bloating after meals, constipation, diarrhea, or IBS, consider getting a complete stool analysis to screen for inflammation, abnormal bacterial growth, parasites, yeast and the presence of beneficial bacterial species.

Is Adrenal hormone imbalance causing thyroid problems?

When stress levels are chronically high, the resulting increase in cortisol reduces active T3 levels in the tissues and increases reverse T3. Why does this happen?

Your body’s response to high stress is to try to conserve energy. By reducing thyroid hormone activity, you slow down metabolism and save energy sources. This can lead to symptoms of hypothyroidism (weight gain, fatigue, depression and female hormone imbalance). Checking DHEA and cortisol levels is very important as imbalances in adrenal hormones will prevent adequate treatment of thyroid disease. » See my article on Why your blood work can be normal, yet you experience hormone imbalance?

• Action Step: Check a comprehensive adrenal hormone panel such as the DUTCH test by precision analytics, or a 4-point salivary cortisol with a serum DHEAS level and 24 hour urine cortisol collection.