Over the past year, the emphasis of our series of articles has been on brain function and the fact that brain dysfunction is a core factor in most if not all chronic pain syndromes. So why an article on thyroid function? Two reasons – when thyroid function is poor it creates a lack of oxygen and increased inflammation in multiple parts of the brain. Thyroid malfunction is closely linked with multiple brain related problems. Reason two – there’s been much confusing information out there on thyroid and we’ve had many requests to clear it up inasmuch as to treat the brain you must be highly conversant in thyroid function and how to correct it. While thyroid dysfunction, its diagnosis, and correction is complex, in fact very complex, we offer you here the cliff notes version on this topic which may answer many of your questions as to why your thyroid is not responding to current treatment.
There are 7 major patterns and 22 major biological pathways that must be understood to be able to evaluate and successfully treat thyroid. In this article we will outline six of the seven major patterns as I feel it will accomplish helping the reader to get a valuable general grasp of this amazingly delicate organ and why symptoms may not be responding to your present therapy.
Pattern Number One – Decreased T4 Production on Lab Test
This is a true hypothyroid and is highly uncommon despite the fact that it is the number one most rendered thyroid diagnosis. Only 10% of thyroids diagnosed as hypothyroid are actually hypothyroids. When this diagnosis is correct, this is the only diagnosis that responds to medication. Stop and think about that.
Pattern Number Two – Pituitary Hypofunction
The pituitary puts out the thyroid stimulating hormone (TSH) that is the one marker always measured in thyroid lab tests. TSH is negatively affected by chronic stress, postpartum depression, inappropriate thyroid medication (see pattern number one. This is very very common) and too much estrogen. Thus, the pituitary gland stops putting out TSH which then comes up in the labs as low TSH which is then misdiagnosed as hyperthyroid. But the patient has hypothyroid symptoms. This finding drives doctors crazy. The solution for this pattern is usually to address the chronic emotional and adrenal stresses that generally accompany life and pregnancy and to be diligent about discussing your thyroid meds with your doctor when the medications aren’t working.
Pattern Number Three – Thyroid Over Conversion
In other words, the inactive T4 hormone that must be changed to active T3 hormone in order to create energy is over converted and too much T3 is made. This is caused by increased testosterone in a woman caused by PCOS, insulin resistance, poor gut function, and chronic stress. Metabolic syndromes, and testosterone creams are the cause in men, and in diabetics of both sexes taking insulin is the culprit. What happens is that the active T3 hormones overwhelm the cells in which T3 helps to make energy. The overwhelmed receptor sites where the cells let T3 enter the cells then become resistant to the T3 hormones. Thus, the T3 doesn’t get into the cell and no energy is created and you develop hypothyroid symptoms. Problem is T4 and TSH are normal on your blood tests and the doctor doesn’t know what to do with you. The solution in this case is finding the cause of the inflammation (testosterone creams, metabolic syndromes, insulin resistance, PCOS, poor gut function) and improving antioxidant status.
Pattern Number Four – Too High of Estrogen in Women
Premarin, estrogen creams, HRT, etc. There are proteins that carry the inactive T4 hormone from the thyroid to the liver, small intestines, and cells where it is converted into usable T3. When the brain becomes aware that there is too much estrogen in the system it tells the body to create too many carrier proteins. These carrier proteins then over enthusiastically suck up all T4 and T3 hormones so that not enough gets to the cells. Thus, no energy, hypothyroid symptoms, and the diagnostic challenge that your thyroid lab values of TSH, T4 and T3 again read as normal. The treatment – get rid of exogenous estrogen and detox the liver.
Pattern Number Five – Thyroid Under Conversion
The receptor sites mentioned above simply stop working and no thyroid hormone can get into them to create energy. Result – low thyroid symptoms. Cause – adrenal stress (everything – emotional, infections, inflammation, NSAIDS and other medications). The diagnosis of this condition is poor because low T3 doesn’t affect TSH and T4 thyroid markers – which are frequently the only markers run. Translation – labs are normal again! Treatment – remove stress, inflammation, infection.
Pattern Number Six – Thyroid Resistance
This is another stress-related pattern in which the pituitary and thyroid glands function normally and make the right amount of thyroid hormones, but the hormones are not getting into the cells to take effect. Symptoms of hypothyroidism appear. Again, elevated levels of the stress hormone cortisol cause the cells to become resistant to thyroid hormones. Managing fight flight response, adrenals and other causes of stress related inflammation indicated by increased homocysteine levels is the treatment.
As stated in the first paragraph of this article we have briefly outlined six of the seven major patterns of the biochemistry, immunology, and neurology that cause thyroid symptoms. For the record the astute diagnostic physician must do a relevant history, full physical exam, and then testing to determine the presence of these causes and this goes even more so for number seven. Number seven is not really a pattern. It’s a condition called autoimmunity and is the cause of both Graves’ disease and the controversial, complex, and omnipresent condition of Hashimoto’s thyroiditis. Next month we will discuss these conditions in as much detail as the space allows.
Tsigos C, Chrousos GP. Hypothalmic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res 2002 Oct; 53 (4):865-71
LoPresti, JS and Nicoloff JT Thyroid response to critical illness, endocrinology of Critical Disease Human Press, Totawa N.Y. 1997 Pp 157-173
Datis Kharrazian, DHSC, DC, MS, Chapt 4 Six patterns of Low Thyroid Function and How to Find Them on a Blood Test; Pps 67-95 Why Do I Still Have Thyroid Symptoms When My Blood Tests are Normal, Morgan Jamed RBL, Garden City, NY 2010