Nora Gedgaudas

Thyroid issues

Thyroid issues

According to 2014 World Health Organization estimates, thyroid disorders affect more than the 750 million people worldwide and may even be more common than diabetes.[1]  In areas around the world where iodine is notably deficient in the soils or diet, a deficiency of this nutrient tends to be a prevalent cause of goiter and related hypothyroidism; but where iodine deficiency is not a rampant issue, far and away the number one cause of thyroid disorders is autoimmunity.[2]

According to 2014 World Health Organization estimates, thyroid disorders affect more than the 750 million people worldwide and may even be more common than diabetes.[1]  In areas around the world […]

How Does My Thyroid Gland Work?

Your thyroid gland is a butterfly-shaped gland that sits low, and toward the front of your neck.  It is flanked on either side by two parathyroid glands. Your thyroid secretes hormones that influence the various systems throughout the body, including your body temperature, growth and development, and metabolism.  Your thyroid also controls how quickly your body makes new proteins and also serves to control your body’s sensitivity to other hormones. The primary hormones made by your thyroid include T4, or thyroxine (which is inactive and constitutes about 80 to 90% of all your thyroid hormone), T3, or triiodothyronine (the activated form, constituting roughly 10 to 20% of total thyroid hormone)[1] plus your thyroid also produces the hormone, calcitonin, which helps regulate calcium homeostasis and (to some small extent) helps control blood calcium levels and also (to a greater extent) the movement of calcium into bone.

As is typical of hormones, in general, the majority of your thyroid hormones in the bloodstream are actually protein-bound, which renders them unavailable for active use.  Thyroid hormones are specifically bound by the proteins’ known as thyroxine-binding globulin (TBG), transthyretin, and albumin. The unbound thyroid hormones are referred to as “free fraction” and are depicted in blood chemistry reports as free T3 and free T4, denoting their actual availability for action in the body.  This is separate from what is referred to as “total serum T3” and “total serum T4”, which measures the combination of bound and unbound fractions.  All are potentially useful markers in evaluating your state of thyroid functioning, however.

Your Thyroid and Your Brain

Thyroid hormones’ T3 and T4 are also really important for keeping brain inflammation in check, which can become a very real issue for those suffering thyroid autoimmunity.  In adult Hashimoto’s patients, hypothyroidism may be a vector for neurodegenerative conditions such as dementia and Alzheimer’s disease, so diligent, effective management is critical.  Cells of the developing brain are a major supportive target for the thyroid hormones, T3 and T4. Thyroid hormones play a particularly crucial role in brain maturation during fetal development.[2] During infancy, thyroid hormones are additionally crucial for brain development.  Hypothyroidism that develops as secondary to iodine deficiency remains the leading cause of preventable intellectual disability.[3]

The production and release of your thyroid hormones are regulated by another hormone, secreted by the anterior portion of your pituitary gland known as thyroid-stimulating hormone, or TSH.  In turn, TSH is actually regulated by still another hormone known as thyrotropin-releasing hormone, or TRH. This hormone is actually produced by your hypothalamus.  Both your anterior pituitary gland and hypothalamus are structures located in your brain (in case you didn’t already know that).

TSH production can be blocked by the hormone somatostatin (SRIH– a hormone secreted in the pancreas and pituitary gland that inhibits gastric secretion and somatotropin release.  It also inhibits insulin and glucagon secretion).   TSH can also be inhibited by high levels of glucocorticoids such as cortisol (under stress), excess sex hormones (estrogen and testosterone), and excessively high blood iodide concentrations (as with over-supplementation).  Birth control pills and HRT (which increase levels of circulating estrogen) are a little known, potential vector for thyroid suppression and also a potential trigger for autoimmunity.

What Are The Most Common Symptoms Associated With Thyroid Issues?

Hypothyroidism Symptoms

  • Fatigue
  • Dry skin and hair
  • Hair thinning/hair loss
  • Depression
  • Morning headaches that get better throughout the day
  • Foggy brain
  • Loss of memory
  • Hoarse voice
  • Puffy face
  • Difficulty concentrating
  • Intolerance to cold
  • Low body temperature
  • Poor circulation/cold hands and feet
  • Muscle cramps with no exertion
  • Weight gain (w/difficulty losing it)
  • Constipation
  • Gallbladder issues
  • Chronic digestive problems, GERD, HCl insufficiency

Hyperthyroidism Symptoms

  • Insomnia
  • Weight loss
  • Heart palpitations
  • Intolerance of heat
  • Hyperactive
  • Emotional reactivity
  • Anxiety
  • Nervousness
  • Tremors of hands
  • Hair loss
  • Missed or light menstrual cycles
  • Shortness of breath

Of the two most common thyroid autoimmune diseases, Hashimoto’s disease and Graves disease, by FAR the most prevalent worldwide is Hashimoto’s, affecting some 90% of all persons having hypothyroidism in the industrialized Western World.[4]  Hashimoto’s is also commonly referred to as Hashimoto’s thyroiditis (also sometimes called autoimmune or chronic lymphocytic thyroiditis).

Other causes of abnormal, low thyroid function can additionally include thyroid cancers, as well as adrenal and pituitary related problems. Of these, far and away the most common relates to adrenal dysfunction– typically due to chronic adrenal over-activation.  –What we’re basically referring to here is chronic stress.  In other words, where your thyroid controls the idle of your internal “metabolic engine”, your adrenals control the gas pedal.  If you have been pushing your “pedal to the metal” too much for too long, sometimes your “central computer” (i.e., brain) will dial down the idle just to try and keep you from blowing a gasket.  Make sense? In cases such as this, one tends to see functionally depressed levels of TSH on the blood chemistry report, along with other depressed thyroid hormones (and typically no sign of thyroid antibodies).  This type of dysregulation will tend to correct itself once a person gets better control of their life demands. But in the case of something like Hashimoto’s, it is a different story.

What is Hashimoto’s Disease?

Discovered in 1912 by a Japanese physician named Hakaru Hashimoto; Hashimoto’s disease is an autoimmune condition where your immune system mistakenly sees your thyroid tissue cells as foreign, produces antibodies against your thyroid cells and begins attacking and destroying them. Once you begin producing inappropriate antibodies against any tissue (including the thyroid), the condition is generally not considered “curable”.  That said, there is a great deal that can be done to manage an autoimmune condition like Hashimoto’s and some form of remission can certainly be possible, if the right approach is taken (please read the article I wrote for The Paleo Way 10-week program member site on autoimmunity).

In the earlier stages of Hashimoto’s disease a person may go back and forth between symptoms of low functioning thyroid, or hypothyroid and symptoms of overactive thyroid, or hyperthyroidAlso, blood chemistry results will tend to vary quite a bit from one to the next.  One month your TSH and other numbers may appear normal, while the next month your TSH maybe high– or low– along with your other thyroid hormone numbers.  It can become very confusing.  All too frequently, your doctor will test for nothing other than TSH to determine your thyroid health— when TSH isn’t even a thyroid hormone! TSH is produced by the anterior pituitary gland, in response to thyroid hormone demand. But to truly and more thoroughly evaluate the health of your thyroid, it is important to look at other (actual) thyroid markers more directly.  I always make a point of looking at serum total T3, serum total T4, free T3, free T4, T3 uptake, and reverse T3 (rT3), in addition to a pair of markers I never fail to test for (and nearly all physicians do fail to test for):  TPO antibodies (TPOAb), and anti-thyroglobulin antibodies TgAb).  If either of these latter two markers are clinically elevated on your blood chemistry report, then this amounts to a positive diagnosis for Hashimoto’s.  This information changes everything.

It is important to point out, however, that thyroid antibodies can also fluctuate from high to low, also—depending on whether you are undergoing active inflammatory thyroid destruction at any given time or not.  If you have reason to suspect thyroid autoimmunity then it makes sense to check these antibody markers more routinely.  Also, if you are able to successfully identify and avoid the things that trigger your cytokine storms, then you can actually quiet these antibodies down and achieve some measure of remission (but don’t mistake the reduction of thyroid antibodies in response to a positive regimen with any sort of “cure”).  The key to successfully living with thyroid autoimmunity is consistent, disciplined, mindful and successful management.

Women are at least 10+ times more likely to suffer from an autoimmune thyroid disorder than men. Also, there is a very strong genetic component to Hashimoto’s, and those having other family members with this disorder are at especially high risk.[5]   Once diagnosed with thyroid autoimmunity, you can be assured that your primary problem is not actually thyroid-centered, but is instead immune in nature, and it needs to be approached as such if you want any hope of meaningful or lasting relief!  Again, please refer to the article I wrote on autoimmunity for The Paleo Way 10-week membership program.

Other Autoimmune Thyroid Conditions

If your symptoms are purely hyperthyroid in nature, then a doctor may test you for Thyroid stimulating hormone receptor antibodies (TRAb), which is a marker for the presence of Graves’ disease.[6]  Signs and symptoms of Graves’ disease include many of the same signs and symptoms of hyperthyroidism, such as irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea, and weight loss.  It is also typically characterized through the distinct appearance of bulging eyes. In the case of Graves disease, steps are taken to treat it that typically involve radioiodine therapy, medications or even surgery to remove the thyroid gland.  Graves’ disease occurs in only about 0.5% of all people[7] and is about 7.5 times more prevalent in women than men.[8]  It typically manifests somewhere between 40 and 60 years of age.[9]

Other Possible Thyroid Issues:

Goiter and Industrial Halide Toxicity

A goiter is a form of swelling on your thyroid, frequently associated with iodine deficiency.  Before the widespread use of iodized salt (which actually lacks a critical iodine component needed for fully healthy thyroid function but mainly works to suppress the development of goiters), goiters were much more common in areas referred to as “goiter belts”, where iodine is known to be very low in the soils, and therefore the local food supply.  Goiters can also develop as a result of thyroiditis, an inflammation of the thyroid mostly associated with Hashimoto’s thyroiditis (an autoimmune condition), but potentially through certain viral infections, as well.

Iodine is known as a halogen on the periodic table of elements.  It is also closely related to the elements, chlorine (chloride), fluorine (fluoride) and bromine (bromide). The increased use of these other halogens is also thought to be a contributing factor to the epidemic of thyroid disease. When a person is thyroid deficient–OR if they happen to be exposed to large enough amounts of substances such as chlorine, fluoride or bromide, these can actually displace iodine and replace it in your thyroid gland and elsewhere in the body. Roughly 80% of all your body’s iodine stores are contained within your thyroid gland, but in women, the second most abundant storage place for iodine is in the breast tissue. Toxic, industrial halides are potentially a very real concern when it comes to not only thyroid disease but also breast cancer.[10]  In fact, fluoridation was once prescribed is an anti-thyroid drug[11], and fluoride, alone has been linked with increased rates of hypothyroidism in areas of the world were fluoridation is used. In February of 2015, British scientists reported that fluoridated water in Britain is associated with elevated rates of hypothyroidism. Researchers stated that,

“We found that higher levels of fluoride in drinking water provide a useful contribution for predicting prevalence of hypothyroidism. We found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).”[12]

Numerous other studies and reports confirm fluoride’s clear role in promoting thyroid disease.[13] [14]

Iodine’s other toxic industrial sidekick, bromides or bromine’s are found nearly everywhere, from its use as an anti-caking agent in refined flour in bakery goods (listed as potassium bromate), to pesticides, plastics (used to make computers), to soft drinks/sports drinks like Mountain Dew and Gatorade (listed as brominated vegetable oils, or BVO’s), medications such as inhalers, nasal sprays, ulcer medications, and some anesthesia agents; and bromine is also found in fire retardant commonly used in fabrics, carpets upholstery and mattresses (listed as polybromo diphenyl ethers or PBDEs).  ‘Bromo-Seltzer’, an indigestion and hangover remedy, once using bromide as a key ingredient, actually had its bromide content removed from that product and many others decades ago.  It was supposedly banned in 1975 due to bromide toxicity, though bromides are still allowed to be used as common food preservatives.  Go figure.).  Chloride is perhaps the most widely found halogen and potentially also problematic at high enough levels of exposure, but both fluoride and bromides actually have a stronger affinity for iodine receptors and pose the greater threat.

Nodules

Thyroid nodules constitute a small, abnormal mass or lump on your thyroid gland and tend to be pretty common and not typically malignant.   Occasionally they may secrete excess thyroid hormones (as with some adenomas), leading to hyperthyroid problems.  Other times they cause few problems.  Sometimes a thyroid nodule presents as a fluid-filled cavity referred to as a thyroid cyst. Often, there are solid components that are mixed with the fluid. Thyroid cysts most commonly result from degenerating thyroid adenomas (autonomous or hyperfunctioning thyroid nodules), which are typically benign, but they can occasionally contain malignant solid components.  There are a number of potential causes for thyroid nodules, which include iodine deficiency, “multi-nodal goiter”, chronic inflammation of the thyroid due to thyroid autoimmunity, thyroid cysts, thyroid cancer (less commonly), and potentially even an overgrowth of normal thyroid tissue, which is commonly referred to is a thyroid adenoma.

Thyroid Cancer

Thyroid cancer has generally been rare in the past, but seems to be on the increase, quite possibly as a result of nuclear fallout associated with the Fukushima nuclear disaster.  Thyroid cancer is generally considered to be quite treatable through the usual conventional medical treatments (surgery, radiation) as well as hormone therapies.

Thyroid Binding Globulin – high and low

Occasionally, a person may show with abnormally high or low serum T3 or T4 levels, in which case another test for something known as Thyroxine-binding globulin (TBG) may be ordered.   TBG is what is known as a “serum binding protein” for thyroxine (T4) and triiodothyronine (T3) hormones.  Normally, the thyroid adjusts to changing concentrations of TBG by producing more or less thyroid hormone to maintain a constant level of metabolically important free hormone.  But elevated TBG levels are associated with influences such as pregnancy, genetic predisposition, oral contraceptives, and estrogen therapy. TBG levels can decrease with androgenic or anabolic steroids, large doses of glucocorticoids, hypoproteinemic states, liver disease, nephrotic syndrome, and occasionally as a result of normal congenital variations.

Pituitary Dysfunction

Pituitary disease such as Cushing’s syndrome can also result in an overactive thyroid, but this occurs only in about 1% of hyperthyroid cases. Depressed pituitary function due to any number of issues only accounts for about 10% of hypothyroid cases.[15] [16]

What does it mean to have an autoimmune thyroid condition?

As already mentioned, by definition, in any autoimmune condition your body’s immune system has run amok and is basically attacking your own tissues.  In the case of Hashimoto’s, it is your thyroid gland that is under attack, being gradually destroyed by your own immune system.  But the attack isn’t necessarily happening constantly.  There will be times where you may feel relatively symptom-free, then other times (during what is often termed as a “cytokine storm”—typically following some immune trigger such as antigen exposure) when you may experience heart palpitations, feel restless, agitated, emotionally reactive, anxious, nervous, and have problems sleeping or have night sweats (all symptoms of too much thyroid hormone flooding your system from the inflammatory breakdown of your thyroid gland).   There are still other times following all this where you may instead feel tired, sluggish, depressed, have cold hands and feet and may even notice yourself losing your hair… or the outer third of your eyebrows (common symptoms associated with your inability to make enough thyroid hormone).  — The symptoms can literally go back and forth, as can your thyroid marker levels in blood chemistries.  You may also begin to notice more of a puffiness in your face (“moon face”, as it is sometimes referred).  This is a result of an associated condition called myxedema.  Swelling around the lower legs and ankles is also common.  Often it is possible to press into this swelling and see a pronounced, lingering dip in your flesh upon letting go.

Unfortunately, Western medicine is often slow and/or reluctant to diagnose Hashimoto’s for one very good reason:  they have no effective means in conventional medicine to actually treat it. The established conventional “treatment” for Hashimoto’s hypothyroidism in mainstream medicine simply involves the prescription of thyroid hormones such as Synthroid, Westhroid, Cytomel or Armour (etc). Unfortunately, in the case of autoimmune hypothyroidism, these medications may have little effect upon the actual symptoms of the sufferer, even as they might make your blood chemistries look “prettier”.  For all too many sufferers, it may seem as though there are no effective answers, and all too often people with an autoimmune thyroid condition come to feel spiritually broken.

The reason why taking thyroid hormones may not help your actual symptoms has to do with a few different factors. First inflammatory cytokines being produced by your autoimmune condition decreases the conversion of T4 (inactive) into T3 (your active form of thyroid hormone). –It just so happens that the most common form thyroid hormone prescribed is T4 (thyroxine).  If inflammation is blocking its conversion, then it isn’t likely to do you much good.  Also, the presence of certain inflammatory cytokines can actually have a dampening effect on the release of TRH (thyroid releasing hormone) from your hypothalamus; effectively disrupting an important part of your thyroid’s regulatory feedback loop.[17] [18]

Finally, the ineffectiveness of exogenous, prescribed thyroid hormones in treating thyroid autoimmunity has to do with the fact that autoimmune thyroid conditions are characterized by elevated cytokines (inflammatory compounds), which frequently bind to thyroid hormone receptors; leading to the reduced number and sensitivity of your thyroid hormone receptors.  This effectively prevents them from being acted upon by your actual thyroid hormones.  –So the thyroid hormones are there, just haplessly floating around, but your body and brain simply can’t use them.[19] It is an unhappy and sometimes intolerable state of affairs.

The Gluten Connection

Gluten has a well-known and particularly prevalent role in the initiation, development and exacerbation of autoimmune thyroid conditions.[20]  Roughly 98% of all autoimmune thyroid sufferers have been demonstrated to have an immune reactivity to gluten in some way. [21] [22] [23] [24] [25] [26] [27] Therefore, 100% total and permanent abstinence is essential toward the effective management of thyroid autoimmunity, and is 100% necessary if there is to be any hope of remission.  But it is important to point out that roughly 50% of everyone having gluten immune reactivity as an issue also reacts in a highly similar and closely related fashion to dairy proteins.[28] [29] [30] [31]

This phenomenon is known as “cross-reactivity”. Cross-reactivity occurs when a particularly sensitive immune system becomes confused and mistakes one type of protein for another and reacts to it in exactly the same, destructive way.  In other words, you can be dutifully eating a gluten-free diet, but if you our consuming dairy products and happen to have this cross-reactivity, then it’s as if you never stopped eating gluten as far as your immune system is concerned. The effects can be equally devastating to your health.  Cyrex Labs here in the United States does testing for cross-reactivities and can readily identify these issues. Unfortunately, unless you happen to live in the US, the UK or in Ireland, this valuable testing is not yet available.  The best alternative– especially if you have any form of autoimmunity (including thyroid autoimmunity)–is to simply avoid both gluten and dairy products altogether.  It’s important to point out, too, that potentially antigenic trace dairy proteins are also present in things like butter, heavy cream and even ghee.  Only one specific ghee product that I am aware of has been actually certified as protein-free, and this particular product is made and independent lab-certified by a company called Pure Indian Foods (www.pureindianfoods.com) located in the US and is referred to by them as their Cultured Ghee.  As far as I know, theirs is the only one.   Camel’s milk (of all things), oddly enough, seems overwhelmingly to be an exception to the rule, and typically does not exhibit the same cross-reactive characteristics that all other dairy products do (including raw milk pastured dairy, goat milk and/or sheep’s milk products).  The popularity of this exotic milk source seems to be growing exponentially and numerous online forums for things like autism are extolling its healing and beneficial virtues, while those seeking it are paying top dollar for its acquisition.  Some even pay upwards of $500 for a single gallon!  Unless you are independently wealthy, though, or have a pregnant female camel in your backyard, your best bet is to simply avoid the dairy products, which are nonessential to adult humans anyway.  Conventional dairy products have numerous potential problems associated with them on top of all this and one would be hard-pressed to even get a baby cow to consume them.

Additionally known potentially cross-reactive foods with gluten include oats (yes– even the gluten-free variety) [32] [33] [34] [35] [36], corn[37] [38] [39] [40], millet[41] [42], rice[43] [44] [45] [46], baker’s yeast[47] [48] [49] [50] [51] and potentially even cheap, commercially processed coffee grounds/instant coffee products.[52] The latter on the list seems to be exclusively associated with the cheap, commercially processed varieties of coffee and instant coffee (typically sold in greasy-spoon diners and served in public waiting areas) on the market and not necessarily whole, organic roasted coffee beans.  Although this is still under investigation, it is believed that there is either an issue in the storage and processing of commercial coffee grounds where gluten cross-contamination may take place, or possibly changes that occur in the structure of the proteins therein during processing.  In either case, cheap coffee grounds can generate some of the most pronounced, virulent cross-reactive effects of all (adding to the list of why it should basically be avoided by everyone).

Nutrients Needed for a Healthy Thyroid

Iodine is the mineral that helps your body build T3 and T4 thyroid hormones. Although most people immediately think of iodine when it comes to building or maintaining thyroid health, iodine supplementation is actually contraindicated if you happen to have in autoimmune thyroid condition. It sounds counterintuitive, but the reason is simple: iodine is used to make thyroid peroxidase (TPO), which happens to be the very thing your immune system is attacking.  Trying to help a self-destructing thyroid by giving it iodine is a little like trying to put out a fire by throwing gasoline on it.  If you have been diagnosed with low thyroid function, it is absolutely critical that you ascertain through blood testing whether or not you are producing thyroid antibodies.  Don’t let any healthcare provider prescribe iodine for you until you know whether the nature of your thyroid issue is autoimmune or not. If it is autoimmune, the iodine has the potential to make you much, much worse.

Selenium is a particularly important mineral when it comes to the optimal functioning of your thyroid.  It is involved rather critically in the conversion from non-active T4 thyroid hormone into active T3 thyroid hormone. Together with vitamin E-complex, it combines to form glutathione peroxidase, which is exceedingly important for improving glutathione levels and managing the function of your immune system in an autoimmune state (not to mention your immune system, in general).  Selenium may also play a role in healthy blood viscosity, helping prevent excessive clotting in the blood.  Healthy levels of selenium have also been associated with a reduced cancer risk– but I digress.

Additional minerals that are important for healthy thyroid function include zinc and magnesium— both of which are needed in order to make TSH (thyroid-stimulating hormone) by your anterior pituitary gland.  This is the hormone responsible for sending the message to your thyroid gland that it’s time to make more T4.

Specific vitamins that are known to be critical for healthy thyroid function include the fat-soluble superstars, vitamins’ D3 and activated vitamin A (retinol)— both of which are almost exclusively found in animal source foods/fats.  These two fat-soluble vitamins, in particular, allow active thyroid hormone (T3, or triiodothyronine) to communicate directly with your DNA to effectively increase your metabolism.  Vitamin B6 (commonly deficient as a result of high carbohydrate diets and alcoholism) is needed to convert iodine into thyroid hormones and can help with the absorption of zinc.

As an aside, coconut oil may also have a uniquely enhancing effect on active thyroid function and weight loss.[53]

Protein is an underappreciated nutrient in the thyroid equation, and it’s proper digestion (requiring sufficient hydrochloric acid in the stomach) is necessary for its breakdown into the amino acids, which are the building blocks for all of the things that protein does in your body.  One of these critical building blocks is known as L-Tyrosine. L-Tyrosine is an amino acid that can either be gotten directly from food or supplements, or manufactured from the essential amino acid, L-phenylalanine from complete (typically animal source) protein in your diet.  Tyrosine is where the “T” in T3 and T4 actually comes from and in part serves as an essential precursor to your thyroid hormones, which are actually made from a combination of L-tyrosine and iodine.

What Effect Will A Low-Carb, Fat-Based, Ketogenic Paleo Diet Have On My Thyroid?  (portions here excerpted from my upcoming book, to be announced in the coming months)

The short answer is that you can actually expect it to improve your thyroid’s health and efficiency.  Once you have adopted fat is your primary source of fuel and aren’t constantly overheating your metabolic engine by trying to rely on sugar, your thyroid literally will not have to work as hard as it did to do the same job.  The way that this shows up on a blood chemistry panel is that all of your thyroid markers look completely normal, except that your T3 levels may be slightly lower, and your reverse T3 levels (which puts the brakes on too much thyroid activity) may be slightly increased.  You need to know and understand that this is not only normal and desirable, as well as a sign that you have successfully metabolically adapted to fat burning as a primary source of fuel, but it even is a marker associated with increased health and longevity![54]

There are a few alarmists ignorant to the nature of these subtle and beneficial metabolic changes who want everyone to believe that a low carb, ketogenic approach to eating is somehow damaging to your thyroid.  There is little evidence and even less reason to believe that this approach to eating has any harmful impact upon your thyroid, whatsoever.  As I mentioned earlier, I am literally the only female member of my family that does not have a thyroid condition.  Furthermore, as anyone can plainly see I still have my eyebrows and all of my hair!  If you have a pre-existing thyroid condition I will not make the claim that this approach to eating will cure it, but it will certainly not make it worse (as long as your dietary focus is upon food quality, and as long as you maintain healthy digestive function)– and in fact may serve as the single healthiest foundational approach to giving you a fighting chance to better manage your thyroid issue and even help it more easily achieve remission.  There are no scientific papers published that have established a causal relationship between low carbohydrate diets and actual hypothyroidism.  Even poorly formulated ketogenic diets, which may be associated with a whole list of potential side effects, have not shown hypothyroidism as one of them.  Both T3 thyroid hormone and the hormone, insulin have a role in controlling your blood sugar.  When your need for blood sugar is reduced (through what amounts to a far healthier primary dependence upon ketones and free fatty acids) then in part, the slightly lower levels of T3 associated with that are mainly a function of your reduced need to metabolize glucose.[55]  Your reduced metabolism will typically have more to do with the reduced calories one tends to consume on a fat-based diet and not so much the reduced or somehow “insufficient” carbohydrates. There literally is no such thing as a carbohydrate deficiency established by science.

There is a more pronounced version of what has been called “Low T3 Syndrome”, also sometimes called “Euthyroid Sick Syndrome (ESS), or “Non-thyroidal Illness Syndrome” (NTIS) that is associated with impaired T4 to T3 thyroid hormone conversion.  It typically manifests in places like hospital wards where patients are either ill or recovering from surgery.  It is not necessarily considered a form of pathology (or is at least a controversial assumption) and may well simply be an adaptive response to the stress associated with convalescence.  Moderate and severe versions of this additionally involve some effect upon TSH (which becomes elevated) and T4 (which tends to lower), or may involve all of the aforementioned the thyroid hormones shifting outside the normal range.  In any event, the mild versions of this strictly involving mild, non-pathological reductions in T3, with concomitant mild elevations in rT3 (reverse T3) have never been demonstrated as harmful, as long as the numbers remain within normal clinical ranges, and no ill effect on normal T4 levels has been demonstrated. [56] [57]  In fact, one study even showed an increase in total T4 (thyroxine) and free T4 index levels![58]  The same study concluded that, “Thus, we conclude that a carbohydrate-restricted diet resulted in a significant reduction in fat mass and a concomitant increase in lean body mass in normal-weight men, which may be partially mediated by the reduction in circulating insulin concentrations.”  Furthermore, there is no evidence that such a state impairs anyone’s capacity for physical or athletic performance in any way, and in fact has been shown to have a performance and endurance-enhancing effect once appropriate metabolic adaptation to a reliance upon fat as a primary source of fuel has taken place.[59]

What If I Feel Like I Am Developing Thyroid Symptoms?

There are any number of underlying conditions that can mimic a thyroid condition. Among them may include anemia, chronic infections, PCOS and other forms of metabolic syndrome, as well as adrenal dysfunction (please see my book, Rethinking Fatigue: What Your Adrenals Are Really Telling You and What You Can Do About It.).  In other words, it’s important not to make assumptions and to always seek medical confirmation of any suspicions you might have.  That said, one characteristic of the dietary approach that we promote through The Paleo Way 10-week program is a fairly strict approach to protein moderation (for important reasons covered elsewhere).  IF going into this program you already have impaired hydrochloric acid (HCl) production, also known as hypochlorhydria— not at all uncommon nowadays— then the question becomes whether you have enough HCl to sufficiently break down and effectively assimilate the smaller amount of protein you are consuming, as well as enough to ionize the critical minerals (like zinc, iron and magnesium, plus other divalent and trivalent cat-ions such as calcium, copper, selenium, boron and others) needed to properly absorb, utilize those minerals and support healthy thyroid function, along with other bodily systems.  If this happens to be the case, then it would not be unusual to see some hair loss and experience some associated fatigue and other similarly related symptoms to malnutrition.  The problem in this instance is not your diet, but your digestion.  If you tend to have feelings of excessively prolonged fullness after meals, indigestion or bloating, symptoms of reflux, or evidence of B12- or iron-deficiency anemia, then it becomes extremely important to address your digestive insufficiency through

  • supplementation with HCl capsules/tablets (sold as betaine hydrochloride) during meals

and

  • examining the underlying cause of that digestive insufficiency/hypochlorhydria.

Common causes of hypochlorhydria can actually include pre-existing low thyroid function, zinc deficiency (due to chronic infections, stress, excessive consumption of phytates in grains/legumes or “non-activated” nuts and low HCl levels), insufficient B-vitamin intake or deficiency (common to high carbohydrate diets and alcoholism), and chronic elevated stress levels/sympathetic over-arousal—which effectively shut down your digestive activity.  –Remember: digestion is a parasympathetic process.  You need to be in a relaxed, calm state in order for digestive juices to flow and proper digestion to occur!  Finally, it is common for HCl levels in the gut to diminish with age, and individuals over 40 tend to have more problems with this, as do the elderly.  Again, the solution is not necessarily to jack up your dietary protein levels (you’re only adding to your digestive load and potential adverse by-products of putrefying protein in your gut), but instead to take assertive measures to improve your digestion.  One home remedy that may show some mild benefit is to sip on a little diluted raw apple cider vinegar (@ 2 TBS mixed into roughly 8-12 ounces of warm water) during meals.  Some also find some improved digestive relief using digestive (liquid herbal) bitters following meals.

Thyroid issues are a common problem today and may have a complex etiology.  Nonetheless, once clearly identified, as well as their underlying cause, most are typically quite manageable.  The realm of natural foods, nutrients and lifestyle ultimately rule the realm of thyroid management and hold the key to your most optimal health and well-being.

Introduction references:

[1] Gharib H. “Endocrine and Metabolic Medical Emergencies – Section Introduction: Emergent Management of Thyroid Disorders.” Endocrine Society Journal.  June 2014.  DOI: http://dx.doi.org/10.1210/EME.9781936704811.part4

[2] Vanderpump MP.  “The Epidemiology of thyroid disease.” Br Med Bull. 2011;99:39-51. doi: 10.1093/bmb/ldr030.

Article references:

[1] Stephen Nussey and Saffron Whitehead. The thyroid Gland in Endocrinology: An Integrated Approach. (2001) Published by BIOS Scientific Publishers Ltd. ISBN 1-85996-252-1 .

[2] Kester MH, Martinez de Mena R, Obregon MJ, Marinkovic D, Howatson A, Visser TJ, Hume R, Morreale de Escobar G. “Iodothyronine levels in the human developing brain: major regulatory roles of iodothyronine deiodinases in different areas”. J Clin Endocrinol Metab 2004; 89 (7): 3117–3128. doi:10.1210/jc.2003-031832

[3] Longo D, Fauci A, Kasper D, Hauser S, Jameson, J, Loscalzo J. (2012). Harrison’s Principles of Internal Medicine (18th ed.). New York: McGraw-Hill. pp. 2913, 2918. ISBN 978-0071748896.

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