Thyroid Dysfunction: Is your immune system to blame?

     ​​​​​​The thyroid gland is a small butterfly-shaped organ that is responsible for some vital roles in the body, from controlling our metabolism to regulating our brain development. It also influences our heart rate, body temperature, muscle strength, body weight, and even cholesterol levels. The thyroid gland makes up part of the endocrine system, which is a combination of glands that produce, store, and release hormones into the bloodstream for the purposes of cellular communication. The three main hormones involved in thyroid function are TSH (thyroid stimulating hormone), T4 (triiodothyronine), and T3 (thyroxine).
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     Unfortunately for some, the thyroid ceases proper functioning and a whole host of symptoms often emerge. Determining what treatment will be best to treat a thyroid hormone imbalance begins by first determining what the root cause of the dysfunction is.

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The most common causes of thyroid dysfunction include:
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- Deficiencies in iodine, selenium, and iron, leading to inadequate production of thyroid hormone   
- Poor conversion of inactive to active thyroid
- High reverse T3 causing competitive inhibition of active hormone
- Poor supply of hormones from primary failure of the thyroid gland
- Drug-induced by the following medications: amiodarone, nitroprusside, sulfonylureas, thalidomide, interleukin, lithium, perchlorate, and interferon-alpha therapy (1)
- Autoimmunity attacking the gland and/or receptors (Hashimoto's or Graves’ Disease)
 
There are two primary thyroid hormone imbalance types: an overproduction of thyroid hormones, called hyperthyroidism; and an underproduction of thyroid hormones, called hypothyroidism.

• Hypothyroidism is marked by a decrease in Triiodothyronine and thyroxine (T4 and T3) hormones and a rise in thyroid-stimulating hormones. A person diagnosed with hypothyroidism may experience increased sensitivity to cold, hair loss, weight gain, muscle weakness, unrelenting fatigue, lethargy, constipation, and irregular menstrual bleeding. The autoimmune induced form of hypothyroidism is known as Hashimoto’s Disease. 

• Hyperthyroidism is marked by an increase in triiodothyronine and thyroxine (T4 and T3) hormones and a drop in thyroid-stimulating hormones (TSH). A person diagnosed with hyperthyroidism may experience changes in appetite, mood swings, insomnia, heat intolerance, heart palpitations, diarrhea, weight loss, and hand tremors. The autoimmune induced form of hyperthyroidism is known as Grave’s Disease.

 
Whether you have been diagnosed with hyper or hypothyroidism, knowing if it is autoimmune-related is important. In essence, autoimmune disorders cause the body to attack itself by releasing antibodies to destroy self-tissue, ultimately disrupting hormone production. If your thyroid condition is related to an underlying autoimmune disorder, treatment should include management of the autoimmune disorder as well as addressing the thyroid hormone imbalance.
 
Testing for Autoimmune Thyroid Conditions
 
Fortunately, determining whether or not your thyroid hormone imbalance is caused by an autoimmune disorder is relatively simple. A blood test can help determine the presence of antibodies, indicating autoimmunity.

• Thyroid Stimulating Immunoglobulin (TSI): this immunoglobulin looks identical to thyroid-stimulating hormones, the stimulating hormone responsible for regulating T4 and T3 hormone production. When anti-TSI is present, an overproduction of T4 and T3 occurs, causing Grave’s Disease.

• Anti-thyroid Peroxidase (Anti-TPO): Thyroid Peroxidase is an enzyme that facilitates the movement of iodine into the thyroid gland to help produce hormones. If anti-thyroid peroxidase antibodies are present, the body can no longer move iodine properly, and triiodothyronine and thyroxine hormones cannot be produced. The presence of anti-thyroid peroxidase is seen in 83% of Hashimoto’s patients, and 53% of Graves patients (2). 

• Anti-thyroglobulin: Iodine attaches itself to thyroglobulin — a protein formed from the amino acid tyrosine — to make the Triiodothyronine and thyroxine hormones. When anti-thyroglobulin antibodies are present, the thyroid is missing an essential protein necessary for thyroid hormone production. The presence of anti-thyroglobulin generally indicates that the thyroid condition is autoimmune-based, creating hypothyroid symptoms.

 
Furthermore, it’s important to note that some people present with mild (or subclinical) hyper or hypothyroid symptoms before the TSH, T3, and T4 become abnormal. This can be a result of antibody presence. Just because you’ve been told your “thyroid hormones” are normal, it does not rule out the presence of autoimmunity. If you have symptoms, your antibodies should be assessed.
 
Treatment Options
 
Several treatment options have been shown to improve symptoms related to autoimmune thyroid hormone imbalance disorders.

• Ashwagandha: An 8-week study of patients with hypothyroidism found that taking 600 mg of ashwagandha root extract daily led to significant improvements in thyroid levels, compared to placebo. If fact T4 and T3 levels increased by 19.6% and 41.5% respectfully, and TSH decreased by 17.5% (3). It also helps reduce stress, leading to better T4 to T3 conversion (3). However, ashwagandha can exacerbate hyperthyroid symptoms, and should not be used in graves disease (4).

• Myo-inositol: a naturally occurring sugar that helps regulate several hormones including insulin and TSH, shown by research to significantly reduce both anti-thyroid peroxidase and anti-thyroglobulin antibodies.

• Selenium: this trace mineral (found in high concentrations in Brazil nuts) has been shown to reduce anti-thyroid peroxidase antibodies in Hashimoto’s patients. It can also be taken as a supplement.

• Natural Desiccated Thyroid: If the gland has stopped functioning, replacement of the hormone will be necessary. Natural desiccated thyroid (NDT) is a glandular therapy taken from porcine sources, containing a 4:1 ratio of T4: T3. Some feel superior on this product to T4 therapies like Synthroid or levothyroxine, because of the T3 contents (which pharmaceutical interventions do not contain). This is a prescription-only therapy and should be discussed with your Naturopathic doctor to see if it's the right option for you.

• Vitamin D: found in fatty fish, like salmon, and supplemental vitamin D, in combination with other treatments, like levothyroxine, can reduce thyroid antibodies.

 
It's important to understand the cause of thyroid dysfunction before treatment is initiated. For example, jumping to thyroid hormone replacement would be preemptive if the cause if nutrient deficiency. Furthermore, if the gland has unfortunately failed, spending time with herbs and minerals will only delay the inevitable need for hormone replacement (Natural Desiccated Thyroid, or synthetic T4: Synthroid, levothyroxine, etc).
 
For more information about thyroid hormone imbalance treatment options, and to discuss the use of Natural Desiccated Thyroid as an option for your thyroid management, please contact your Toronto Naturopathic Doctor, Dr. Courtney Holmberg at 647-351-7282 to schedule an appointment today.

1. https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/labmed/drug-induced-hypothyroidism/
2. https://www.ncbi.nlm.nih.gov/pubmed/8088002
3. https://www.ncbi.nlm.nih.gov/pubmed/28829155
4. https://www.ncbi.nlm.nih.gov/pubmed/22394559