Sock Doc 12: Thyroid Health, Part 1 – The What, How and Why of Thyroid Problems, Testing, Medications and The Impact of Thyroid on Health and Performance

June 18, 2021


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On this episode we have The Sock Doc, Dr. Steve Gangemi, joining us. Steve is a natural health care doctor who founded and practices at Systems Health Care, an integrative wellness center in Chapel Hill, NC. Steve is also a longtime endurance athlete and is a wealth of knowledge for athletes looking to optimize wellness.

In this 2-part series we take a deeper dive into thyroid health and it’s such a big topic that it deserves two parts. In this first we cover:

Thyroid dysfunction basics: What’s going on? How common?

    • Thyroid issues are often confused or misdiagnosed ailments, especially when subclinical.
    • Thyroid often is over-medicated leading to a hyperthyroid state.
    • But also the opposite may occur, with hypothyroid symptoms that aren’t being well treated (can have side issues like sluggish liver and kidney function)
    • Steve says up to 20% of his patients have a thyroid issue, and 50% of those taking medication for thyroid; he works jointly with MDs to adjust thyroid meds to best fit the clinical presentations

Thyroid issues and endurance athletes: are endurance athletes more susceptible?

  • It seems to be that the LSD type training (i.e. long aerobic endurance training) in which you really tax the aerobic system tends to wear out thyroid as opposed to high intensity/ HIIT type stuff which tends to burnout adrenals, sex hormones.
  • In other words, too much aerobic work over time can deplete thyroid.
  • Some hypothyroid symptoms: Leanness turns into puffiness, sluggishness, fatigue, short term memory issues, loss of sharpness (could that be something else? The thing is- all systems are affected it’s just about which is being most negatively affected).
  • Overtraining and LSD can run down thyroid.
  • This is not an unhealthy body image issue, this is just physiology and understanding the changes in your body.

Why are thyroid problems often missed by mainstream medicine? Also What is typically checked by docs vs. what ideally should be checked?

  • Tawnee shares a story of visiting a new OB and the OB only wanted to test TSH, Tawnee had to ask for more and also ask for antibodies, considering she has a history of hypothyroid and wants to be sure things are still going well.
  • Free levels are most important – that’s what circulating in blood and active in tissues and what body’s paying attention to (T3, T4).
  • TSH is “thyroid stimulating hormone” and it is a pituitary hormone. TSH alone shouldn’t diagnose a thyroid issue, nor dictate medication and dosage.
  • Many doctors only test TSH even when the patient requests more, and with this thyroid issues are often missed or mistreated.
  • TSH high – this means the pituitary is trying to thyroid to make more T4, which is classic hypothyroid, and a person might need more meds to help boost thyroid hormones.
  • TSH low – this means the body is trying to lower feedback loop to thyroid, i.e. thyroid making too much hormones, classic hyperthyroid, and we would want to lower medication.
  • You can also have normal TSH, or abnormal or high or low TSH, without the typical presentation so you have to dig deeper on markers.
  • If doc won’t run labs you can fairly cheaply via online testing.
  • Tawnee recommends this lab for thyroid panel if you need to do it on your own.
  • This thing is, it’s not standard to measure these markers in typical endocrinology (ie you won’t see docs running Free T3, free T4, Abs, etc….unless there is a reason)

History and understanding “the why” of thyroid issues

  • Goiter belt history- midwest, thyroid issues with iodine in soil dried up causing iodine deficiency. Thyroid enlarged to find more iodine in the body.
  • These days they’re thyroid nodules (not so much goiter).
  • T4 and T3 4 molecules of iodine attached to a thyroid protein.
  • Need iodine and nutrients to make thyroid hormone.
  • Thyroglobulin – thyroid protein made from tyrosine.
  • Today: You don’t see too much hypothyroid due to low iodine, why? One) because we’ve iodized salt and two) people are eating more seafood even if not on the coast, etc.
  • The #1 reason for hypo these days is autoimmune condition to some degree or another, i.e. this is the immune system attacking thyroid.
  • Why does this happen? Many reasons:
    • Gluten intolerance. Gliadin (protein found in gluten) triggers immune system to attack thyroid, strong correlation has been observed (but you can also be allergic to dairy, nightshades, etc, causing similar issues)
    • Also: Food sensitivities/allergies, viral infections, fungal/bacterial infections can cause or contribute to autoimmune diseases, or even chemical and toxin overload.
    • Can be exposed to toxic environments in workplace, can contribute to autoimmune conditions
  • Graves – hyperthyroid autoimmunity.
  • Hashimotos – hypothyroid autoimmunity.
  • It’s not like your body throws in the towel. First, body musters up bursts of “energy” to try and normalize. Similar to how cortisol changes on the way to adrenal fatigue.
  • “Respiratory bursts” – immune system attacking body at certain times followed by a retreat, and so on.
  • Very rarely does thyroid go one way fast, eg TSH wont just jump or tank.
  • TSH should be between 1-3.
  • Immune system – we just don’t know that much nor are we taught about the level of intricacies it involves.
  • Often with thyroid we need to look more at the immune system, not just the thyroid or lab values.
  • Stereotypes for thyroid conditions that can often not be the case! (Don’t go by these alone):
    • Hypo: fatigue, gaining weight, losing hair, depressed, lethargic
    • Hyper: string bean, overly skinny, bulging eyes, anxiety
    • …Don’t believe that is how it has to be, it can present differently as far as symptoms are concerned. Body does interesting things as a protective mechanism.
  • The major commonalities with hyperthyroid conditions:
    • When you’re making too much thyroid (in particular with meds), you are not going to fall asleep well at night and you can hear your heart thumping on your pillow. Very hard to fall asleep.
    • Case study example of a woman in her 50s who had her symptoms change drastically as medication was adjusted

Understanding T4 and T3, etc. Plus: thyroid medications, and the adrenal connection

  • Make T4 in thyroid and it’s converted to T3, 60% of this happens in liver (needing good liver function), and also a little in kidneys, GI tract , thyroid itself and peripheral (eg adipose tissue).
  • Feedback loop: if not converting well, you will see a jump in TSH.
  • Reverse T3- not converting T4 to T3 efficiently so it’s pushed to RT3 (associated with liver conditions and deficiency in selenium and zinc).
  • If low in selenium and zinc, might not be making enough active T3.
  • Synthroid (prescription drug) – T4, most widely used to treat hypothyroid (when presents with high TSH trying to push up T4 level and lower TSH).
  • What happens with you use meds to the point where TSH is pushed down to <1?
    • Supports this notion that they want to pituitary out of the way, and just a way to control the thyroid markers (T4, T3) directly via medication – but this doesn’t usually resolve symptoms nor the overall condition and can result in hyperthyroid conditions.
    • Presents as hyperthyroid in this case because suppression of the pituitary.
  • Reference to our recent episode with the sock doc on adrenal fatigue and tie in with adrenal gland issues.
  • It is likely that we can heal and improve an adrenal fatigue situation more quickly and easily than a thyroid dysfunction condition.
  • Thyroid- it takes a while to “dig the hole” and also a longer while to “dig yourself back out.”
  • Steve’s experience shows: working on thyroid issues often has the effect of clearing up adrenal issues. However working on adrenal issues doesn’t necessarily clear up any thyroid issues (usually needs a separate treatment)
  • Also, it’s a stretch to think that we create an adrenal autoimmune condition from trashing adrenals (ie HPA axis dysfunction); however, trashing thyroid can more easily turn into an autoimmune condition.
  • Tawnee shares her experience of how her health and lifestyle choices over the course of a decade or so eventually.

More on medications

  • Armour – desiccated pig, often a good alternative to Synthroid that many people do better with.
    • Armour is a 4:1 ratio T4 to T3.
    • Natural thyroid is 12: 1 ratio; Armour will make up the difference.
  • Cytomel – prescribed in 5mg doses for hypothyroid, which can be combined with another medication to find the right ratio and fix for someone’s thyroid needs.
  • Nature Throid- this med is desiccated beef and there have been a lot of negative outcomes reported by patients. There has also been a recall on it. Overall, seeing a trend that people don’t do as well on it.
    • Why? Seems that patients feel worse due to conversion issues, hyperthyroid symptoms, liver detox issues, etc.
  • Take home: If any med isn’t working for you, then talk to your doc and change it up! You often have to adjust medications to fit the right ratio for best outcome.
  • Take thyroid medication in the morning!
    • Not before bed. Usually between 6-8am (not earlier because that’s still technically nighttime).
  • Why are functional docs so much more supportive to thyroid meds compared with other prescription medications?
    • When thyroid is in rough enough shape, medication really helps to get them out of that hole.
    • Also when you’ve been on a thyroid medication for long enough your body isn’t necessarily good at making it on its own anymore and you’re committed to continuing it to experience the balanced health. If you have to stay on thyroid medication, it’s not the worst one to be on ongoing, very little risks or side effects. Very few problems with long-term thyroid medication and they don’t generally screw up the body in other ways compared with other meds that have much higher risks and side effects.
    • If you want to get off meds fully, it can be done, but it’s a huge commitment. Not easy.
  • Interesting fact: Oxygen advantage research says- when you increase your blood oxygen lactate threshold (BOLT) or CP, you improve breathing and carbon dioxide sensitivity, which has the effect of improving thyroid health! If on medication, monitor closely so you don’t go hyperthyroid (often able to lower meds or get off them).

Sex hormones and their role + male vs female differences

  • Why are women more susceptible to thyroid issues?
  • Hypothyroid Antibodies: Thyroid peroxidase enzyme (TPO), thyroglobulin protein(TGB) – most common ones that are elevated with hypo.
  • Hyperthyroid Antibodies: Thyroid stimulating immunoglobulin (TSI) Ab, Thyroid receptor antibody (TRA).
  • Progesterone – stimulates TPO enzyme production which makes and increases T4 and T3, thus you need adequate progesterone to stimulate actual  production of T4 and T3.
  • On flip side thyroid hormones sensitize your body’s cells to progesterone, sluggish thyroid may give symptoms of low progesterone.
  • Sluggish thyroid could decrease progesterone.
  • Usually presents as normal progesterone but body not using it effectively but body not using P effectively because tissues are desensitized to P due to low thyroid hormone.
  • Testosterone does NOT have that effect.
  • Estrogen is good at making T3 into reverse T3 (inactive form), so now a thyroid conversion issue.
  • Excess estrogen – could be either high estrogen overall or an estrogen/progesterone imbalance aka perceived high estrogen in relation to low progesterone.
  • Thinking of this sex hormone tie in – we can further see the relationship between HPA axis dysfunction (sex hormone imbalance) and thyroid dysfunction and how the two relate, eg how low progesterone can affect thyroid.

Coming next, thyroid health and optimization, part 2……

Comments (3)

  • Bree says:

    Hi guys
    I’m coming off six years of total stress and insanity and was working with the naturopath to figure out some hormonal symptoms I was having. On bloodwork my TSH is low but so is my free T3 T4. I have low thyroid symptoms. Conclusion was H PA disfunction i’m supplementing vitamin C B magnesium and taking some adaptogens. Trying to run/exercise for fun – no gadgets,yoga etc
    Is there anything else I should be looking at/doing?

  • Dr. Gangemi says:

    Hi Bree,

    Thanks for the comment. This could be more of a direct pituitary issue since everything is low and that could be from the crazy stress you were under or an immune condition (provoked by the stress) suppressing your endocrine system. Without giving specific advice, I’ll use, depending on the person, either rhodiola, ashwagandha, or holy basil. I’ll also sometimes use organic minerals and pituitary PMG from Standard Process to help get things moving in the right direction. This is of course on top of the whole diet/lifestyle modification. I hope that helps and maybe some things to check with you ND about!

  • Dan Harrod says:

    Bottom line?

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