Did you know low thyroid can lead to high cholesterol, depression, fatigue, cold hands and feet, hair loss, and reduced strength and stamina? These are just some of the symptoms.
Statins and anti-depressants are among the most prescribed medications. But what if high cholesterol or depression are just the symptoms of low thyroid; not the real problem? Is it possible people are often treated for the wrong issue?
Low thyroid affects one in seven. It causes fatigue, reduced physical performance, and can lead to symptoms of depression.
Hypothyroidism often goes undiagnosed, yet it’s quite easy to identify and correct. About 12% of people will develop thyroid dysfunction during their lifetime.
It will be diagnosed in women five to eight times as often as in men.[i] However, that doesn’t mean that men don’t need to be concerned. They’re just less likely to get their health issues checked out.
My hope is that if you are a female, you’ll encourage the guys in your life to read this too. And if you’re a guy, be sure to pass it along to some other dudes as well.
Thyroid Hormone Basics
The thyroid gland sits on the front of your neck, and is the main influencer of metabolic rate. The brain releases thyroid-stimulating hormone (TSH), to signal the thyroid gland to produce thyroid hormone. Then, the gland produces triiodothyronine (T3) and thyroxine (T4).
The following are the main thyroid-related markers. You can get your numbers checked through a comprehensive blood test.
Thyroid-stimulating hormone (TSH): TSH is usually the first (and unfortunately, sometimes only) thyroid-related measure doctors use to diagnose thyroid issues. TSH stimulates the thyroid glad to produce T3 and T4, the main thyroid hormones. When TSH is high, it indicates low thyroid function. When TSH levels are low, it indicates high thyroid, or hyperthyroidism.
Lab Range: 0.45-4.21 mIU/L (many integrative health practitioners suggest the range should be 0.45-2.3 mIU/L)
Thyroxine (T4): T4 is the weaker of the two thyroid hormones, but it is 30-100 times more concentrated in the body than T3. Free T4 is the T4 available for use by the body.
Lab Range: 0.93-1.71 ng/dL
Triiodothyronine (T3): T3 is the most powerful thyroid hormone. Some T3 is produced directly by the thyroid gland, and some is converted from T4.
Lab Range: 2.3-4.2 pg/mL
Reverse T3: As a way to remove excess T4, the body converts T4 to rT3. rT3 goes up to reduce your body’s energy expenditure, such as during excessive stress or sickness.
Lab Range: 9.2-24.2 ng/dL
Thyroid Peroxidase (TPO) Antibodies: Thyroid peroxidase is an enzyme necessary for proper thyroid function. When antibodies are present, it is a sign that the body is attacking its own tissue, such as in Hashimoto’s Thyroiditis. The molecular structure of TPO is similar to gluten, so those who have gluten allergies or sensitivities are more susceptible to thyroid-related autoimmune conditions. The body thinks TPO is gluten, so it attacks the cells.
Normal Range: <34 IU/mL
The main difference between T3 and T4 is that T3 has three iodine molecules, and T4 has four molecules. Interestingly, almost all the body’s iodine is bound to these thyroid hormones, making iodine a critical nutrient for thyroid health.
The American Thyroid Association says that 12% of U.S. citizens will develop a thyroid condition during their lifetime. They also say 20 million Americans have some type of thyroid disease. If you don’t have a thyroid issue, you likely know someone who does.
What is Hypothyroidism?
Hypothyroidism is a state of low (hypo) thyroid. Hypothyroidism is often identified only by high levels of TSH. Your brain produces TSH because it senses that your body needs more thyroid. The TSH gives your thyroid gland the message to produce more thyroid hormone.
Unfortunately, doctors often base a patient's thyroid health only on TSH, which is a mistake. It’s also possible for TSH levels to be normal, while T3 and T4 are below normal.
Subclinical hypothyroidism is a form of hypothyroidism, where your TSH is high, but T3 and T4 are normal. Some experts believe this to be an early stage of hypothyroidism.[ii]
Hyperthyroidism is a state of high (hyper) thyroid. This article focuses on low thyroid, or hypothyroidism, although I’ve outlined some of the symptoms of hyperthyroid below as well.
What are Symptoms of Hypothyroidism?
Some symptoms of hypothyroidism are common with other conditions. You’ll even notice some symptoms as similar to symptoms of low testosterone. So, if you see yourself below, understand that symptoms alone can’t accurately identify a disease. You really need to have your blood tested regularly.
|Reduced body temperature, cool skin||Excessive heat, sweating|
|Cold hands & feet||Muscle loss|
|Reduced appetite||Insatiable appetite|
|Weight gain||Weight loss|
|Reduced muscle strength, stamina||Hyperactivity, rapid movement, exaggerated reflexes|
|Puffiness of skin, especially in the face||Short attention span|
|Depression[iv]||Bulging of the eyeballs (exophthalmos)|
|Rapid hair loss||Increased cardiac function|
In women, hypothyroidism causes the ovaries to become poly-cystic, making hypothyroidism a potential contributor to polycystic ovary syndrome (PCOS).[v]
Elevated cholesterol and triglycerides can also indicate low thyroid.[vi] Unfortunately, doctors often prescribe a statin without ever considering thyroid health. Thyroid medication, when used for hypothyroid patients with elevated cholesterol, consistently improves lipid levels.[vii],[viii]
Vitamin B12 deficiency is also common among those with hypothyroidism due to autoimmune disease.[ix]
What Causes Hypothyroidism?
The following are some common causes of hypothyroidism. These probably aren’t the only causes, but they are well-known contributors to hypothyroidism today.
Dietary Causes of Hypothyroidism
Gluten: Gluten sensitivities and allergies reduce the absorption of important micronutrients, causing a greater response from the immune system, and triggering the body to attack gluten proteins, which are very similar in structure to the proteins that make up the thyroid gland. As the body learns that gluten is a foreign substance that it should attack, it also attacks the thyroid gland. This is just one of many reasons to avoid gluten in your diet.
Iodine: Iodine deficiency causes goiter. While goiter isn't common in the United States, it is very common throughout the world. A normal amount of iodine, often consumed as salt, is sufficient to eliminate goiter. However, an excessive amount of salt can also lead to thyroid problems. Those who are hypothyroid may benefit from some iodine, but not an unlimited amount.
Low selenium intake is also associated with low thyroid production.
Goitrogens: Goitrogens are compounds found in some grains, as well as cruciferous vegetables like broccoli and Brussels sprouts. These vegetables are great for helping to remove excess estrogen from the body, but when eaten raw, an excessive amount can block the formation of thyroid hormone.
Vitamin D deficiency: Low vitamin D levels make you more susceptible to autoimmune conditions.
Calorie restriction: Long-term calorie restriction causes a reduction in metabolic rate. Loss of muscle causes some reduction in metabolic rate, but suppressed thyroid function causes the greatest decline.
However, if you stay on a low-calorie diet, you will find it more and more difficult to keep losing weight. The worst part, is your metabolic rate may not return to normal after you go off your diet. You end up eating as much as you did in the past, but you have a lower metabolic rate. As a result, many people gain back more weight than they started with before the diet.
If you do need to lose weight, eat as much as you can while still experiencing weight loss, rather than jumping on a 1200-1500 low-calorie diet.
Carbohydrate restriction: Even when total calorie levels are high enough, some people on a low-carb diet experience reduced T3. Obviously, this makes it more difficult to lose weight on a low-carb diet, and can also lead to a reduction in exercise performance, and even feelings of depression and fatigue.[x]
Lifestyle & Other Factors
Stress: Chronically high cortisol reduces absorption of nutrients necessary for thyroid production. Elevated cortisol also lowers TSH, reducing the production of T4 and T3. And, low thyroid levels increase cortisol, reinforcing why you need to address low thyroid and high cortisol.
Physically, low thyroid levels reduce the body’s ability to generate ATP. If a personal trainer doesn’t understand this, he or she might push a client beyond their exercise capacity, and make their thyroid problems worse. In my opinion, until a hypothyroid client corrects his or her thyroid levels, they should never be pushed to failure, exhaustion, or fatigue. That includes CrossFit or Alpha training.
In addition to the reduced performance, low thyroid causes a transition of muscle fiber type from type I (fast twitch) to type II (slow twitch), reducing speed and strength.[xi]
Genetics: Some people are born with a genetic propensity toward low thyroid production. If low thyroid runs in your family, you might avoid it through good nutrition, exercise, lifestyle, and supplement choices.
Environmental toxins: Environmental toxins such as heavy metals and polychlorinated biphenyls (PCBs) disrupt thyroid production. Some of the most common PCBs include phthalates, brominated flame retardants, and perfluorinated chemicals.
Disease & Medication Causes of Hypothyroidism
Hashimoto’s thyroiditis: Hashimoto's is the most common cause of hypothyroidism. In Hashimoto’s, the body attacks its own thyroid tissue. Eventually, when enough thyroid tissue is attacked, the body will no longer produce thyroid hormone. While it is not convenient, Hashimoto’s is not a death sentence, as thyroid can be taken in the form of medication. Women are diagnosed far more often than men, likely because their immune systems are more reactive than those in men.
Cancer treatment: Treatment for childhood cancer can cause hypothyroidism later in life. Radiation and medications can damage the thyroid, although symptoms may not appear until long after treatment ends.[xii]
Radiation therapy for breast cancer can also damage the thyroid and cause hypothyroidism. If you receive radiation for breast cancer, be sure the radiology technician properly shields your neck.[xiii]
Lithium: Lithium is often used as a treatment for severe mood disorders, and one of its possible side effects is hypothyroidism.[xiv]
What Can You Do to Support Your Thyroid?
Medication may be necessary for some people. I have to use it myself. However, we can do much to support thyroid health through lifestyle, nutrition, exercise, and supplement choices. I’ve shared some of the most important practices below.
Nutrition & Lifestyle Support for Thyroid
Carbohydrates: Long-term, low-carb diets can reduce thyroid function. However, low-carb diets also improve insulin sensitivity and blood sugar levels, and may improve symptoms of metabolic syndrome.
Personally, I’m a big fan of low-carb diets for overweight, obese, and/or insulin resistant men and women. Research shows low-carb diets are superior to calorie-restricted or low-fat diets. So, in my opinion, the benefits of following a low-carb diet to lose weight outweigh the risks of lowering thyroid levels.
With that said, I also believe that once someone has improved his or her insulin sensitivity and maintained an ideal body weight for a while, it may be wise to eat a modest level of carbohydrates.
Go gluten-free: When it comes to gluten, you can't be “mostly gluten-free” to protect your thyroid. You're either in, or your out. This is especially true for those with autoimmune conditions like Hashimoto's disease. The smallest amount can trigger an immune response, and some experts believe the response can last weeks to months.
Stress & sleep: Sufficient, quality sleep supports all of your hormones. Your body produces hormones in certain rhythms throughout the 24-hour cycle of a day. By getting regular, quality sleep, you help your body maintain a normal circadian rhythm, which helps it produce hormones on an expected cycle.
Supplements & Thyroid Function
Black Cumin: In patients with Hashimoto’s thyroiditis, a daily dose of 2 grams per day of Black Cumin (also known as Fennel Flower or Nigella sativa) lowered thyroid peroxidase and TSH, showing that it improved the markers of the autoimmune condition while improving thyroid function.[xv]
L-Carnitine: Thyroid hormone increases the excretion of l-carnitine, an amino acid important for fat metabolism. Hypothyroid patients who begin using thyroid medication may experience a deficiency of l-carnitine, contributing to the feelings of fatigue. A 12-week study of hypothyroid patients on levothyroxine (i.e. Synthroid), showed that those who supplemented with 1980 mg of l-carnitine per day eliminated feelings of fatigue.[xvi]
Coenzyme Q10: Although hypothyroidism leads to mitochondrial dysfunction, supplementing with other nutrients such as Coenzyme Q10, NADH, and alpha-lipoic acid have not shown consistent improvements in fatigue-related symptoms.[xvii],[xviii],[xix],[xx] That said, thyroid medication may deplete Coenzyme Q10 levels, so it may be wise to supplement with it.
Adaptogens: Adaptogens are herbs and extracts that help maintain normal cortisol levels. They help to bring the body back into balance, so if cortisol is high, they help bring it down. If cortisol levels are too low, adaptogens can help bring levels back up.
Some of the most powerful and popular adaptogens include ashwagandha, astragalus root, cordyceps mushroom, eleutherococcus senticosus, holy basil, licorice root, Panax ginseng, rhodiola rosea, and tribulus terrestris.*
Synthroid and Armor Thyroid are the two most common thyroid medications. Synthroid is the brand name of levothyroxine, which is a synthetic form of T4. It’s also sold under the brand names of Tirosint, Levoxyl, Levothroid, Unithroid, and Novothyrox. Taking T4 obviously increases T4 levels. Also, most people can convert T4 to T3, so taking T4 alone may help correct T4 and T3 levels. However, some doctors find their patients do not see an improvement of T3, while taking levothyroxine. In these cases, the patients probably have an issue converting T4 to T3, so this medication may not be the most effective.
Armor Thyroid is created with desiccated thyroid or thyroid extract. Since this medication is made with thyroid gland, it contains both thyroid hormones. Some argue that this makes it a superior form thyroid medication. I use Armor myself. On the other hand, it's possible that in those with autoimmune issues, they may attack this medication, just like their own thyroid, making the medication ineffective.
From the research I’ve read on the two options, I don’t know that one is significantly better than the other. Both medications improve metabolic rate, heart rate, body weight and fluid levels.[xxi] That said, a good physician will consider changes in a patient's lab work, as well as changes in how they feel. It may be that one type of medication helps someone feel better than another, even though both may help the thyroid levels improve.
Even if thyroid levels are brought back to normal with medication, some people still experience fatigue, muscle aches, depressed mood, decreased memory, psychological distress,[xxii] and cognitive dysfunction.[xxiii] This is why I feel it’s prudent to still use thyroid-supporting supplements and make healthy lifestyle, nutrition, and exercise choices.
In the future, hypothyroidism might be resolved through the use of stem cells.[xxiv] Stem cell treatment would be especially exciting for those who develop thyroid cancer.
One final thing to note…Your thyroid hormones act in partnership with many other hormones in the body. Sometimes, low thyroid levels aren't the issue. It's something else. An experienced holistic doctor looks at all possible causes of someone's symptoms before prescribing medication. Your job as a consumer is to select the best practitioner.
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[i] General Information/Press Room. American Thyroid Association. Retrieved April 15, 2017. http://www.thyroid.org/media-main/about-hypothyroidism/
[ii] Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012;379:1142-54.
[iii] Anthony W Norman, Gerlad Litwack. Hormones. Academic Press, Inc. 1987. Orlando, FL.
[iv] Sosci F, Fava GA, Sonino N. Mood and anxiety disorders as early manifestations of medical illness: a systematic review. Psychother Psychosom. 2015;84(1):22-9
[v] Singla R, Gupta Y, Khemani M, Aggarwai S. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocrinol Metab. 2015;19(1):25-29
[vi] Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526–534
[vii] Razvi S, Ingoe L, Keeka G, Oates C, McMillan C, Weaver JU. The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function, and quality of life in subclinical hypothyroidism: Randomized, crossover trial. J Clin Endocrinol Metab 2007;92:1715–1723
[viii] Meier C, Staub JJ, Roth CB, Guglielmetti M, Kunz M, Miserez AR, Drewe J, Huber P, Herzog R, Müller B. TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: A double blind, placebocontrolled trial (Basel Thyroid Study). J Clin Endocrinol Metab. 2001;86:4860–4866.
[ix] Collins AB, Pawlak R. Prevalence of vitamin B-12 deficiency among patients with thyroid dysfunction. Aisa Pac J Clin Nutr. 2016;25(2):221-226
[x] Bandini LG, Schoeller DA, Dietz WH. Metabolic differences in response to a high-fat vs. a high-carbohydrate diet. Obes Res. 1994;2(4):348-54
[xi] De Andrade PBM, Neff LA, Strosova MK, et al. Caloric restriction induces energy-sparing alterations in skeletal muscle contraction, fiber composition and local thyroid hormone metabolism that persist during catch-up fat upon refeeding. Front Physiol. 2015. https://doi.org/10.3389/fphys.2015.00254
[xii] Lee HJ, Hahn SM, Jin SL, et al. Subclinical Hypothyroidism in Childhood Cancer Survivors. Yonsei Med J. 2016;57(4):915-922
[xiii] Tunio MA, Al Asiri M, Bayoumi Y, et al. Is thyroid gland an organ at risk in breast cancer patients treated with locoregional radiotherapy? Results of a pilot study. J Cancer Res Ther. 2015;11(4)684-9
[xiv] Shine B, McKnight RF, Leaver L, Geddes JR. Long-term effects of lithium on renal, thyroid, and parathyroid function: a retrospective analysis of laboratory data. Lancet. 2015;386(9992):461-468
[xv] Farhangi MA, Dehghan P, Tajmiri S, Abbasi MM. The effects of Nigella sativa on thyroid function, serum Vascular Endothelial Growth Factor (VEGF) – 1, Nesfatin-1 and anthropometric features in patients with Hashimoto’s thyroiditis: a randomized controlled trial. BMC Comp Alt Med. 2016;16:471
[xvi] An JH, Kim YJ, Kim KJ. L-carnitine supplementation for the management of fatigue in patients with hypothyroidism on levothyroxine treatment: a randomized, double-blind, placebo-controlled trial. Endo J. 2016;63(10);885-895
[xvii] Dai YL, Luk TH, Yiu KH, Wang M, Yip PM, et al. Reversal of mitochondrial dysfunction by coenzyme Q10 supplement improves endothelial function in patients with ischaemic left ventricular systolic dysfunction: a randomized controlled trial. Atherosclerosis. 2011;216:395-401.
[xviii] Rosenfeldt F, Marasco S, Lyon W, Wowk M, Sheeran F, et al. Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue. J Thorac Cardiovasc Surg. 2005;129:25-32.
[xix] Alegre J, Roses JM, Javierre C, Ruiz-Baques A, Segundo MJ, et al. (2010) [Nicotinamide adenine dinucleotide (NADH) in patients with chronic fatigue syndrome]. Rev Clin Esp. 2010;210:284-288.
[xx] Mach J, Midgley AW, Dank S, Grant RS, Bentley DJ. The effect of antioxidant supplementation on fatigue during exercise: potential role for NAD+(H). Nutrients. 2010;2:319-329.
[xxi] McAninch EA, Bianco AC. The History and Future of Treatment of Hypothyroidism. Ann Intern Med. 2016;164(1):50-56
[xxii] Saravanan P, Chau WF, Roberts N, Vedhara K, Greenwood R, et al. Psychological well-being in patients on ‘adequate’ doses of l-thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf) 2002;57:577-585.
[xxiii] Wekking EM, Appelhof BC, Fliers E, Schene AH, Huyser J, et al. Cognitive functioning and wellbeing in euthyroid patients on thyroxine replacement therapy for primary hypothyroidism. Eur J Endocrinol. 2005;153:747-753.
[xxiv] Kurmann AA, Serra M, Hawkins F, et al. Regeneration of Thyroid Function by Transplantation of Differentiated Pluripotent Stem Cells. Cell Stem Cell. 2015;17(5):527-42