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Understanding the Complexity of Hypothyroidism: Part 1

by Dr. Greg Fors, DC - Board Certified Neurologist DIBCN

Many patients live their lives suffering with low thyroid symptoms, especially women. The thyroid hormones control cellular metabolism, in fact, every cell in the body has a receptor for the thyroid hormone. Therefore, when the thyroid system is not working properly, the cells of your patients’ bodies and brains can slow down. This of course can create chronic symptoms of fatigue, weight gain, brain fog, depression, digestive problems, sugar cravings and cold hands and feet.

Many individuals suffer from hypothyroid symptoms even though their basic thyroid tests are “in the normal range”. Additionally, many patients continue to suffer from these symptoms even when they are taking Synthroid or levothyroxine medication. There are solutions for these very common symptoms associated with low thyroid function, and doctors need only look deeper to find the underlying causes.
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The primary problem is that most patients have not had a complete thyroid panel. The usual approach is to measure a hormone from the pituitary gland called thyroid stimulating hormone (TSH), and sometimes the prohormone from the thyroid gland called Total T4. If the results are within the lab’s “normal” range the patient is told that their thyroid is fine. If the patient's TSH is high and/or their T4 levels are low, the doctor will many times prescribe T4 as Levothyroxine or Synthroid. But, there are many problems with this simple approach to this complex syndrome.

The patient may be just within the normal TSH range, but for them this barely “normal” is not good enough to run their cellular metabolism. Presently, TSH 0.5 to 5.0 mIU/L is considered normal for most labs. However, the National Academy of Clinical Biochemistry reported that: "In the future, it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to 2.5 mIU/L because 95% of rigorously screened normal euthyroid volunteers have serum TSH values between 0.4 and 2.5 mIU/L." An optimal value of TSH means the thyroid hormone levels generally match the body’s energy needs and/or ability to utilize the energy.

The thyroid gland stimulated by the pituitary's TSH makes the pro-hormone T4 (thyroxine), which exists to become either T3 or Reverse T3. When the body needs energy, it removes an iodine atom from the T4 and turns it into T3. The T4 that becomes T3 (triiodothyronine) causes ATP to be made in each living cell, to do the work it needs to do. Reverse T3 is made by removing different iodine from T4. Reverse T3 acts just as its name suggests. For the cell it is like placing the wrong key in the ignition, it blocks the ‘working key’ T3 from signaling the cell to make energy. It allows the body to turn down the energy when it needs to conserve it. Just as a car needs a gas pedal and brake pedal for proper function, the same is true for the body. The body needs T3 and RT3 to manage its energy needs.

Most undiagnosed hypothyroid issues today include Under Conversion Hypothyroidism and Reverse T3 syndrome, even in those patients already taking Synthroid or levothyroxine. The problem is this, whether T4 is produced by your thyroid or taken orally, it is not active until the kidneys and liver convert it into the biologically active T3 ‘gas pedal’. In many individuals this process of conversion of T4 to T3 is insufficient for their energy needs. In these cases you may see a high normal Free T4 with a low normal or abnormally low Free T3, with hypothyroid symptomatology.

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The kidneys and liver also create Reverse T3, the biological brake to metabolism. When patients are emotionally, physically, or biologically stressed, such as being chronically ill, after surgery, after a car accident, aging, or even taking drugs like beta blockers they can produce more Reverse T3. If they are taking T4, Synthroid or levothyroxine, they can convert this into excess Reverse T3, causing hypothyroidism while being on thyroid medication! In these cases when only TSH and T4 are tested, patients will be within normal limits even though they are experiencing marked hypothyroid symptoms. In Reverse T3 syndrome you end up with more “brake” than “accelerator”, and patients develop the symptoms of hypothyroidism even though their TSH levels and T4 levels will almost always be within normal limits. This is the problem when a doctor only runs a TSH and possibly T4; the conditions of Under Conversion Hypothyroidism and Reverse T3 syndrome are never properly diagnosed. To fully understand and diagnose a patient's thyroid condition, a doctor must run at least eight different thyroid tests: TSH, total T4, free T4, Total T3, Free T3, Reverse T3, and calculate the Reverse T3 Total T3 ratio.

Along with these tests, thyroid antibodies must be run to determine if the patient has the most common cause of hypothyroidism today, the autoimmune disorder known as Hashimoto's disease. Today autoimmune disorders are growing at an alarming rate and this specific disorder, Hashimoto's disease, is now one of the most common. Common causes of Hashimoto's disease are specific antigens such as a food, a mold, bacteria, or chronic virus that triggers the autoimmune reaction. For example, undiagnosed gluten sensitivity is a very common cause of Hashimoto's autoimmune reaction and thyroid dysfunction. Through exposure to environmental toxins and heavy metals, individuals can develop an immune response that affects the thyroid and other tissues. Over time Hashimoto's thyroiditis destroys the thyroid reducing T4 output and peripherally increases Reverse T3 levels giving the individual a double whammy.

Optimal Thyroid Test Values:
TSH reflects the blood level of thyroid stimulating hormone: 0.3 to 2.5 mIU/L.
Total T4 reflects the total amount of unavailable protein bound T4 and the Free T4 together: 0.7-0.9 ng/ dL.
Free T4 reflects the biologically active form of T4 that can be converted to T3 or RT3.
Total T3 reflects the total amount of T3 present in the blood; unavailable protein bound T3 and the Free T3 together.
Free T3 reflects the active unbound form of T3 that generates ATP production at the cellular level: 3.4-3.8 pg/mL.
Reverse T3 reflects the level of RT3, the metabolic brake to the system allowing conservation of energy: 11-32 ng/dl Total T3 to Reverse T3 Ratio: This ratio is the only way to properly diagnose a Reverse T3 syndrome. Healthy ratios will be 10 to 1 or higher.
Autoimmune thyroid disease: Hashimoto’s Thyroiditis is typically identified by checking antibodies that attach to thyroid tissue. Thyroid Peroxidase (TPO) antibodies are found in about 95% of the cases while Antithyroglobulin Antibody (ATA) is found in about 70% of the cases. Grave’s Disease is typically diagnosed using Thyroid-Stimulating Immunoglobulin (TSI). Generally it is best to follow the lab’s normal range.

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Herbs Shown To Improve Hypothyroidism and Slow Metabolism
Research has found specific botanicals that help counteract the problem of hypothyroidism such as an under conversion of T4 to T3. Research suggests that guggulsterones found in the Ayurvedic herb Guggul helps the body to convert T4 into T3, thereby increasing T3 levels. Guggul extract guggulsterones also activates lipolytic enzymes increasing fat metabolism. Guggulsterones have been found to naturally regulate a gene receptor called farnesoid X receptor (FSX), which specifically turns on and off fat burning in the liver. Guggulsterones have been used in traditional Ayurvedic medicine in India for several thousand years to help weight loss. Coleus forskohlii an Ayurvedic herb has been shown to increase thyroid gland hormone production and secretion into the bloodstream. Researchers have found that Coleus forskohlii also stimulates fat metabolism. Ashwagandha, another Ayurvedic herb used for thousands of years to boost stress tolerance and rejuvenate the body has been shown to help reduce the amount of damaging cortisol released in response to chronic stress. Ashwagandha is also a known promoter of T4 to T3 conversion, in part by improving overall liver function.

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with Dr. Greg Fors

Biospec Nutritionals has been in business for 15 years and is dedicated to bringing physicians premium quality formulations at prices their patients can afford. Biospec Nutritionals is committed to providing doctors with quality information and education, including this issue of Biospec's Nutritional updates. Find us at or call us at 800.825.7921

Dr. Greg Fors, D.C. is the Chief Science Consultant for Biospec Nutritionals, a Board-certified Neurologist (IBCN), certified in Applied Herbal Sciences (NWHSU) and acupuncture. Trained through the Autism Research Institute he is a registered 'Defeat Autism Now!' Doctor. As the clinic director of the Pain and Brain Healing Center in Blaine Minnesota he specializes in a natural biomedical approach to fibromyalgia, fatigue, depression, autism and ADHD. He is a sought after international lecturer for various post graduate departments and state associations. Dr. Fors is the author of the highly acclaimed book, “Why We Hurt” available through booksellers everywhere.