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What to Do If Your Thyroid Is on the Fritz

From weight gain (or loss) to exhaustion, brain fog, depression, anxiety, and dry skin, thyroid dysfunction causes a wide range of symptoms, which affect many more women than men. Its root causes are notoriously hard to diagnose and treat, and, perhaps unsurprisingly, experts agree that it’s woefully underdiagnosed. Conventional tests don’t always identify thyroid dysfunction properly, and even when properly diagnosed, many patients (goop women included) haven’t found conventional pharmaceuticals to be effective at healing their thyroids or their immune systems (for most, thyroid dysfunction is associated with autoimmune disorders).

Dr. Amy Myers, a functional-medicine M.D. with a clinic based in Austin, Texas, has combined conventional and holistic practices to help thousands of women struggling with these issues. Myers, who was diagnosed with hyperthyroidism and Graves’ when she was still in medical school, has tested the methods on herself as well as her patients—both her health and life have been transformed in the process. Her latest book, The Thyroid Connection, explores the underlying causes of thyroid dysfunction, as well as a way forward, making the process of addressing thyroid issues with your doctor clearer and easier. The book is also extremely useful for those of us who haven’t been diagnosed with hyperthyroidism or hypothyroidism, but who share similar, hard-to-treat symptoms: The twenty-eight-day program (The Myers Way Thyroid Connection Plan) that makes up the last third of the book is a powerful roadmap to general well-being. Here, Myers shares her insights into the thyroid and how it affects women’s health, exploring the solutions she’s seen work—in her patients and in herself.

A Q&A with Dr. Amy Myers

Q

How common is thyroid dysfunction, and why is there a discrepancy between the number of women and men affected?

A

It’s very common: About 27 million Americans have thyroid dysfunction of some sort; 60 percent do not know it. Statistics show that women are five to eight times more likely than men to be affected by thyroid dysfunction.

Most thyroid dysfunction is autoimmune in nature—the vast majority is Hashimoto’s Syndrome (autoimmune hypothyroidism)—and women are eight times more likely to have an autoimmune disease than men. This discrepancy is thought to be connected to the estrogen-based fluctuations that women go through in their lives. For women, thyroid dysfunction occurs more often during times of hormonal change: pregnancy, postpartum, perimenopause, menopause. When estrogen is high, there is effectively less free thyroid hormone circulating in the body to be used because there are more proteins available to bind to the thyroid hormone. “Free” means that a hormone is not bound to a protein and can go into our cells; when a hormone is bound to a protein it can’t be used by the body. It’s likely that high levels of estrogen are not good for the thyroid, and that the fluctuation of estrogen levels throughout a woman’s life accounts for the discrepancy between the number of women and men affected by thyroid dysfunction.

Q

What are the symptoms of an underperforming thyroid and an overperforming thyroid?

A

Underperforming thyroid (hypothyroidism): The thyroid is basically our metabolism; with an underperforming thyroid, everything slows down. There are thyroid receptors on every cell in our body, so the range of symptoms can be wide and seemingly vague—every organ in the body can be affected, which is one of the reasons why it can be difficult to diagnose a thyroid issue. The symptoms of an underperforming thyroid include: brain fog, depression, slow heartbeat, dry skin, brittle hair (it can also fall out), feeling cold or low body temperature, weight gain (or difficulty losing weight), slow digestion, constipation.

Overperforming thyroid (hyperthyroidism): Hyperthyroidism is the opposite—everything speeds up. Symptoms include: anxiety, panic attacks, insomnia, restlessness, racing brain, fast heart rate, weight loss, hair loss, feeling warm, diarrhea.

What’s confusing is that you can have symptoms of both hypothyroidism and hyperthyroidism. For instance, someone with hyperthyroidism may feel depressed, as opposed to anxious. When people with crossover symptoms read the checklist of symptoms for hypothyroidism and hyperthyroidism, they often don’t go see a doctor, or a doctor might not think that the patient has thyroid dysfunction, because they don’t fit neatly into a symptom box.

Q

How does the thyroid system work?

A

The hypothalamus (responsible for managing hunger, thirst, sleep, hormones, body temperature), monitors the level of thyroid hormones present in your bloodstream. If it finds that energy levels are low, it sends out TRH, thyroid releasing hormone, to your pituitary gland. The pituitary gland releases TSH, thyroid stimulating hormone, which signals your thyroid to produce more of a thyroid hormone known as T4. This is the storage form of the hormone. When your body needs more power, storage T4 is converted into Free T3, the active form of the hormone. Free T3 attaches to receptors in your body’s cells and powers metabolic processes—it’s like the gas in a car. Some T4, though, is converted into Reverse T3 (RT3), which I think of as the brakes of a car. RT3 tells your body’s metabolic processes to slow down when we’re starving or stressed out, and need to preserve energy and nutrients.

Q

Which tests are best at diagnosing thyroid dysfunction?

A

The standard test most doctors use to screen thyroid dysfunction measures the amount of TSH in the blood—the thyroid stimulating hormone released by the pituitary gland and sent to the thyroid. But this really only tells us what the pituitary is doing based on the hypothalamus feedback loop. It’s a measure of how the pituitary is talking to the thyroid—not a measure of the thyroid itself. For this reason, doctors should also be testing levels of other free hormones; see below for my suggestions.

It’s also important to know if your thyroid condition is autoimmune (again, most are). Hashimoto’s is the likeliest autoimmune disease, but other commonly correlated diseases include: Addison’s, Graves’, premature ovarian failure, type 1 diabetes, lupus erythematous, pernicious anemia, rheumatoid arthritis, thrombocytopenic purpura, vitiligo, and Celiac. Once you develop an autoimmune disease, you are three times more likely to develop another. But there are things you can do to prevent this, and to help you reverse an existing autoimmune condition: i.e. eating an anti-inflammatory diet free of processed foods, sugar, gluten, and dairy—and also ensuring that your leaky gut is healed and you don’t have infections like SIBO (small intestinal bacteria overgrowth) or yeast (more below).

Diagnosing and treating thyroid issues is very much a partnership between patient and doctor. Below are the tests I recommend that doctors order and/or that patients ask about. Although these tests aren’t commonly performed, none are new, and they are all available at conventional labs:

  • TSH: How the pituitary communicates with the thyroid.

  • Free T4: Produced by the thyroid; is the storage form of the hormone.

  • Free T3: This is generally the most important to know—Free T3 is what goes into the cells to activate your metabolism.

  • Reverse T3: Some people can have a normal level of Free T3 but high Reverse T3, which can slow metabolism. Unless someone is starving or dying, she should have more gas (Free T3) than breaks (Reverse T3).

  • TPOAb (thyroid peroxidase antibodies) and tgAb (thyroglobulin antibodies): These are the main types of thyroid antibodies; their presence signals that your immune system is attacking your thyroid and that your thyroid condition is autoimmune in nature. Depending on the level of these antibodies, they may indicate that your body is attacking itself and autoimmunity is brewing, or has already happened.

  • Q

    What typically causes thyroid problems?

    A

    There are identical-twin studies looking at autoimmunity in general that suggest autoimmune diseases are about 25 percent genetic and 75 percent environmental. I see five environment-related factors that often play a role in thyroid dysfunction and autoimmunity: diet, leaky gut, toxins, infections, and stress. These five factors make up a pie: All five play a role in thyroid dysfunction and autoimmunity, but for some people, certain factors have more of an effect, so those pieces of the pie are bigger. For example, gluten could be more problematic for one person, while for another, stress is the biggest issue.

    Q

    Can you talk a bit about the role the gut plays?

    A

    The vast majority of thyroid hormone converts from T4 (storage form) to T3 (active form) in our gut. That conversion can be thrown off if the gut isn’t functioning properly—namely, if you have a leaky gut, which is when the junctions in the intestinal lining break apart, and particles including toxins and undigested food escape from your intestines and travel throughout your body via your bloodstream. Another consequence of a leaky gut: We aren’t digesting and absorbing nutrients properly, and we need proper nutrients (tyrosine, zinc, selenium, iodine, B vitamins, vitamin A, vitamin D) for the conversion of T4 to T3. Often, when the problem is that the body simply isn’t making the conversion from T4 to T3, it’s really due to nutrient deficiency, which can be fixed with diet and supplement changes.

    The main causes of leaky gut are gluten (and other inflammatory foods, i.e. processed and sugary), infections (such as candida overgrowth and intestinal parasites), medications (acid-blocking, antibiotics, and ibuprofen) and toxins (like mercury and lead). Gluten is particularly problematic because the gluten molecules look very similar to our thyroid tissue. Through a process called molecular mimicry, when we eat gluten—particularly if we have a leaky gut—the gluten slips into our bloodstream and our immune system goes on high alert, warning that the gluten should not be there. But because gluten looks so similar to our thyroid tissue, our immune system inadvertently attacks our thyroid, trying to rid the body of gluten. This is one of the theories behind autoimmunity and thyroid dysfunction.

    Q

    What kind of diet do you recommend for people with hypothyroidism and hyperthyroidism?

    A

    The diet that I recommend to patients is something I call The Myers Way ®, which was born out of years of experimenting on thousands of patients and myself. Early on in my functional medicine practice, I used the standard elimination diet from the Institute for Functional Medicine, which included getting rid of toxic (alcohol, sugar, and processed) and inflammatory (gluten, dairy, eggs, and corn) foods. The diet helped many of my patients recover from conditions such as allergies, IBS, headaches, and weight gain. But as I started to see more complex patients, especially those with autoimmunity (including thyroid), chronic fatigue syndrome, and fibromyalgia, I realized that there were additional dietary changes that could help reverse these chronic conditions. I experimented on myself first by removing all grains, legumes, nuts, seeds, and nightshade vegetables (tomatoes, potatoes, eggplant, peppers) for a few weeks, and the results were dramatic. I started using this same protocol with all of my autoimmune patients and the results were again astounding.

    I’ve found that eliminating grains and legumes, in particular, is a really good thing for most people. Grains and legumes contain certain amino acids and proteins that can be very irritating to the gut if you don’t soak and cook them properly. Also, many of my patients have small intestinal bacteria overgrowth (SIBO) or candida (yeast) overgrowths and the way to get rid of these infections is to really starve them out by getting rid of carbs, even the healthy ones.

    Neither the diet or lifestyle components of my recommended treatment plan differ much for people with hyperthyroidism and hypothyroidism, because we aren’t trying to treat a problem of the thyroid; we are treating a problem of the immune system that happens to be affecting the thyroid. With autoimmunity, the problem is in your immune system, not a particular gland or organ (and indeed, more than one can be affected).

    I also recommend the same general treatment plan for thyroid dysfunction even if you haven’t been diagnosed with an autoimmune disease. You may not have hit autoimmunity yet (it’s also hard to diagnose in the first place), but your body is still vulnerable to the same things (for instance, toxins). And you’ll want to do the same general things to heal the thyroid and immune system: Repair the gut, relieve stress, and so on. Many women find that they can add back in some of the foods they eliminated after going through the program, but everyone can benefit from it.

    Q

    What about supplements?

    A

    Supplements are one area of the program that differs depending on whether a patient has hypothyroidism or hyperthyroidism. With hypothyroidism, you need key nutrients such as selenium, zinc, and iodine to support the conversion of T4 to T3—so a high quality multivitamin is very important. There are a host of supplements that are specific to hyperthyroidism, which help replenish the nutrients that the body is burning through. Also, rather than taking harsh medication to shut down the thyroid (which is what I initially did when I was diagnosed), there are a number of calming thyroid herbs that are safer and can help to suppress an overactive thyroid, like motherwort, bugleweed, and lemon balm.

    Q

    Which toxins are problematic for the thyroid?

    A

    In your cleaning and beauty products, you especially want to avoid parabens (preservatives) and phthalates (plasticizers), which are both endocrine disruptors, meaning that they affect estrogen and other hormone levels. These toxins are harmful because they look and act like estrogens in the body, and as a result more proteins are secreted, which bind to your thyroid hormones. When the thyroid hormones are bound they cannot go into the receptors in our cells where they do their job, potentially leading to hypothyroidism. So using these chemicals can have a large impact on your estrogen levels and your thyroid.

    Q

    What’s your stance on iodine?

    A

    The thyroid needs iodine to produce its hormone and to function optimally. Humans used to eat a diet rich in iodine (with sea vegetables, seafood, iodized salt), but the modern diet is iodine-deficient. On top of that, environmental toxins—including bromine, chlorine, and fluoride, which are all halogens—displace iodine in our body. Bromide is in our food, clothes, mattresses, sofas, and rugs. Chlorine is in our water, and fluoride is in toothpaste, medication, and water. Conventional medicine can make iodine seem taboo to those with thyroid dysfunction, but I’ve found that supplementing the body’s iodine intake can be very helpful—along with eating a diet rich in seafood/seaweed, limiting exposure to halogens and endocrine disruptors by doing things like putting a water filters on your shower, choosing nontoxic products and mattresses, and avoiding packaged foods. You need to be cautious with iodine supplements, but I often recommend a multivitamin with micro amounts of iodine to my patients because most of us are very deficient.

    Q

    What about stress?

    A

    The Myers Way Thyroid Connection Plan addresses the five factors that I’ve found to be at the root of thyroid dysfunction: Diet, leaky gut, toxins, infections, and stress. There’s a twenty-eight day recovery plan in the book, with each day laid out for readers, including recipes, gut-healing and stress-relieving techniques.

    Stress is a bigger part of the puzzle than I initially recognized. We can’t get rid of our stress entirely, but we can learn to relieve it. Things like how you prepare for bed are important—in addition to helping your body’s natural detox abilities, a good night’s sleep decreases stress levels. The first step in the morning (after you get up and drink two cups of water with lemon juice to get rid of toxins) is doing something calm and centering for yourself—and this is also how you should end the day. My plan has stress relieving options for everyone—there are simple and free tips that only take a few minutes each day, as well as more comprehensive ones to try weekly or monthly, such as neuro-feedback, massage, acupuncture, or going to a float tank.

    Dr. Amy Myers is the founder and medical director of Austin UltraHealth, a functional medicine clinic based in Austin, Texas. Dr. Myers specializes in women’s health issues, particularly thyroid dysfunction. She is also the New York Times bestselling author of The Autoimmune Solution and The Thyroid Connection.

    The views expressed in this article intend to highlight alternative studies and induce conversation. They are the views of the author and do not necessarily represent the views of goop, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.

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