Saul Marcus, ND
New York City
Naturopathic Doctor

Hypothyroidism Guide Page 3

These pages originally written in 2010 for my first website. I have posted them here for educational purposes. For general information on how natural health can help with thyroid conditions please follow this link to the main hypothyroidism page.

9. Autoimmune polyendocrine syndrome (APS)

Autoimmune thyroid disease often does not stop at the thyroid. It indicates an immune disorder that may affect the entire body.

A 2003 article, “Update on Autoimmune Polyendocrine Syndromes (APS),” found that 52% of patients with Thyroid Autoimmune Disease could be considered affected by APS-3. [58]

APS-3 stands for Autoimmune Poly endocrine Syndrome Type 3. This is not a specific disease, but a group of autoimmune diseases that often come together. The list of auto immune diseases that are associated with hypothyroidism is extensive. However, some of the more common ones are: type 1 diabetes, celiac disease, inflammatory bowel disease, multiple sclerosis, and rheumatoid arthritis.

Treating autoimmune thyroid disease with just thyroid medications

Imagine cleaning your room, by kicking all your garbage under the bed. For a while this might work. Sure there is a mess under the bed, but you can’t see it and nothing else in your room is affected. However, the mess is still there. You didn’t clean it up. You just made it invisible.

This is what taking thyroid medication for autoimmune disease is like. It may make you feel better, but the problem causing the autoimmune disease is still there.

Getting back to the bedroom analogy, eventually you run out of space under the bed, so you open your closet and kick garbage in there.

This is like waiting for the same problem that caused the autoimmune disease to strike again and cause new symptoms. Then you can take another drug for the new symptoms.

Eventually you will run out of hidden spaces to kick the garbage. Now it’s impossible to not see the mess. And it will just get larger and larger until you do the work and get to really cleaning it up.

With autoimmune disease, eventually the problems become so big that people can’t cover up the symptoms with drugs. This may take years, or even decades to develop, but eventually the underlining problems often catch up with people.

The correct use of thyroid medications

Taking thyroid medications is sort of like cleaning up a mess by throwing things under the bed. That’s covering up a symptom, not treating the real problem.

Since standard conventional treatment for autoimmune thyroid disease is the prescription of synthetic T4 drugs, I can say that conventional medicine does not treat autoimmune thyroid disease. They do nothing to stop the autoimmune process. All they do is cover up a symptom.

If you have autoimmune thyroid disease, consider poor digestive function as a possible cause. It may be best to seek help from a qualified holistic practitioner who knows how to get to the root cause of autoimmune disease.

Likewise, it is a good idea to get tested for celiac disease or at least go on a trial, gluten free diet. If you developed hypothyroidism from a negative reaction against gluten, thyroid medications can’t cure the negative reaction to gluten. You therefore want to get off gluten before it causes more damage to other systems of your body.

There are many benefits from this truly holistic approach to treating autoimmune thyroid disease: prevention of other autoimmune disease, the chance of not having to be on thyroid medications for life, avoiding future medical costs and improved health and well being since almost anything done naturally for autoimmune disease can only improve health and vitality.

10. Low TSH and Subclinical Hypothyroidism

We typically think that symptoms are bad. Treatment is therefore directed at stopping the bad symptoms.

However, symptoms for the most part represent the body’s attempt to maintain health in response to stress. True healing is thus not about fighting symptoms. It’s about facilitating the body’s self-regulating/self-healing mechanisms so it doesn’t need to produce symptoms.

Consider a fever. It may make us uncomfortable. Drugs such as Tylenol are commonly used to lower fevers. However, the body produces the fever because to help fight off infection. Suppressing a fever may give the appearance of improved health, but actually aids infection. In fact therapies that help the body to produce a fever may be most helpful. Unless a fever is dangerously high, taking drugs to lower it actually works against the body.

With this in mind, we should not think that hypothyroidism is a disease that randomly strikes out at people, or the result of poor genes. Rather it is the body’s response to some stress.

Consider all the excessive stress, poor foods, environmental toxins, emotional stress lack of sleep and other factors that rob people of their health. The body only has so many resources and energy. If it uses it all up just coping with stressors there won’t be anything left to actually feel well.

And what does thyroid hormone do? It set’s the body’s metabolic rate. It makes every cell of the body do more. Increasing thyroid hormone is like stepping on the gas in your car. Decreasing it is like stepping on the brakes.

When the body is pushed too hard lowering thyroid hormone is a way of putting on the brakes. This is a self protective mechanism.

For some people who are not able to make thyroid hormone, it’s important to replace what their bodies can not make on their own. But for others, taking thyroid medications will only make things worse.

This concept that hypothyroidism is a logical reaction to stress comes straight from the medical textbook:

“Overall the changes are apparently geared to limit the impact of T3 on its target organs, which from a teleologic point of view might be a beneficial adaptation during starvation and illness to conserve energy and substrates and minimize excessive tissue catabolism.” [59]

In other words, when someone is starving (deprived of proper nutrition) or has an illness, in order to stop tissue catabolism (the breakdown, or wasting of the body) T3 (thyroid hormone) is reduced in order to lower the metabolic rate and slow down damage to the body.

We have already reviewed how hypothyroidism can be a consequence of poor digestive function and molecular mimicry. In the following section we’ll see how the following causes decreased production of active T3.

Severe illness
Starvation
Toxic foods
Protein deficiency
Toxicity (from heavy metals, pollutants and prescription medications)
Poor liver function
Chronic stress
Hormonal imbalances including: high estrogen, blood sugar disorders
Lack of sleep
High blood sugar and insulin
Nutritional deficiencies

Therefore, improving thyroid function, by correcting the above factors should a major treatment goal.

Should thyroid hormone be prescribed?

There are two causes of low TSH: hyperthyroidism and euthyroid sick syndrome. In hyperthyroidism thyroid hormone is elevated, along with numerous systems (heart palpitations, weight loss, heat intolerance) that are not common in hypothyroidism, so these two conditions are not likely to be confused.

Euthyroid sick syndrome refers to low thyroid output despite there being nothing wrong with the thyroid gland itself. Rather the brain is producing less TSH, in order to tell the thyroid to make less thyroid hormone. It does this as a self-protective mechanism (as discussed above).

Often hospitalized patients who have just gone through a major physical stress with have Euthyroid Sick Syndrome. Medical doctors know this is a stress response and that it should not be treated with thyroid hormone.

Many people have low-normal TSH levels (somewhere between 0.5 and 1.0), low thyroid hormone, and numerous symptoms. Low TSH indicates that the body is reducing thyroid hormone in response to stress. What is needed is holistic evaluation and treatment for whatever their individual stress is. Some supplements can be used to stimulate the production of TSH. However, thyroid hormone (synthetic or natural) should not be used. Since the body is already trying to lower metabolic rate as a self protective mechanism, forcing metabolic rate up with thyroid hormone is not a long term solution.

11. Euthyroid Sick Syndrome and Low T3 Syndrome

Euthyroid sick syndrome

“Euthyroid,” simply means normal thyroid. Often, severely sick people develop hypothyroidism, despite there being nothing actually wrong with the thyroid gland. This is called Euthyroid Sick Syndrome. [60]

Medical texts cite several severe conditions that cause euthyroid sick syndrome: fasting, starvation, protein-calorie malnutrition, general surgical trauma, myocardial infarction [heart attack], chronic renal failure [kidney failure], diabetic keto-acidosis, anorexia nervosa, cirrhosis [liver failure], thermal injury and sepsis [infection in the blood]. [61]

Euthyroid sick syndrome is not a disease. It is a self protective mechanism.

Stress, such as a systemic non-thyroidal illness…or caloric deprivation, in euthyroid humans, produces characteristic alterations in serum thyroid hormones indices, which, in certain instances, may minimize the catabolic impact of these events. [62]

In lay language the above means: stress on the body such as an illness, or not eating enough calories, will cause the body to lower levels of thyroid hormone, in order to decreased metabolic rate and hence lessen the damage that these stressors have on the body.

The article continues: “It is estimated that over 70% of hospitalized patients display changes in the thyroid hormone indices, without having any demonstrable underlying thyroid disease.”

Low T3 Syndrome

Two triggers of Euthyroid Sick Syndrome are:

Severe illness
Starvation

However, the term euthyroid sick syndrome is usually reserved for severely ill patients. The phrase Low T3 Syndrome best describes people who have low thyroid hormone due to causes such as:

Poor digestion
Toxic foods
Protein deficiency
Toxicity (from heavy metals, pollutants and prescription medications)
Poor liver function
Chronic stress
Hormonal imbalances including: high estrogen, blood sugar disorders
Lack of sleep
High blood sugar and insulin
Nutritional deficiencies

Getting back to the thyroid family chart, much of Low T3 syndrome is caused by either low TSH, or blocks in the conversion of T4 into T3.

Thyroid Lab commonly seen with Low TSH subclinical hypothyroidism:

T4 is normal or high
TSH is normal of slightly low
T3 is low
Reverse T3 is sometimes high [63]

12. hypothyroidism diet

Gluten Sensitivity

For a long time gluten sensitivity was associated only with celiac disease. Today we know that celiac disease is just one of many different presentations of gluten sensitivity. Numerous illnesses, including hypothyroidism, are linked to gluten sensitivity.

Testing for gluten sensitivity, or at least a trial gluten free diet should be one of the first actions taken for hypothyroidism.

Goitrogens

Goitrogens are chemicals found in some foods which block the thyroid from making new thyroid hormone.

Goitrogens are common in the brassica family of vegetables: cabbage, brussels sprouts, broccoli, and cauliflower.

However, warnings that these foods are the cause of hypothyroidism are probably exaggerated. First, the goitrogens are destroyed when these foods are cooked. Secondly, the amount of these foods that someone needs to eat in order to get an anti-thyroid hormone effect is much larger than what most people would eat in a normal diet. Although I would not advise someone with hypothyroidism to eat lots of these vegetables uncooked, I have found no evidence that just eating normal amounts of these vegetables will cause.

Goitrogens may be helpful to include in the diet in case of hyperthyroidism.

Fake foods

Soy has goitrogenic properties as well and could be a problem in people who eat soy all the time.

Soy is commonly converted into fake foods such as most soy milks, soy burgers, soy chicken, soy ice cream, etc. Eating these fake foods all the time may induce a thyroid lowering effect through soy’s goitrogenic properties. Soy may also have an anti thyroid affect by decreasing the absorption of iodine [64].

I have been to several professional seminars on where experts have said the sickest people they see in their practice are vegetarians. Therefore, they say, people should not be vegetarians. While I believe this anecdotal feedback I have received from colleagues on vegetarianism has some merit, I believe it is unfair to say no one should be a vegetarian. It is certainly true that many vegetarians are terribly unhealthy. However, this seems more a consequence of the types of products vegetarians are sold, rather than from being a vegetarian per se.

Bad vegetarian foods

Fake soy products. These fake meats and other soy concoctions are highly processed artificial foods. I recommend people stick with fermented soy products such as tempeh and miso. Although tofu has high protein content, it’s very difficult for the body to digest and use the protein, therefore, as a vegan protein substitute tofu is overrated. Soy milk if consumed should be basically soy nuts and water. Long lists of chemical ingredients are often signs of unhealthy additives such as MSG.
Seitan is a fake food produced from the gluten portion of wheat. Gluten is the highly allergic portion of wheat and trigger of celiac disease. Therefore, seitan is a product that most highly concentrates one of the most allergenic and anti-thyroid foods there is! Celiac disease and the anti-thyroid effects of wheat and gluten foods was covered in section 8.

Considering the toxic effects of fake soy and fake wheat products on just the thyroid it is no wonder why many of my colleagues say vegetarians are the sickest patients they see. It’s very easy to get enough protein. The challenge we face (vegetarian or not) is getting enough quality protein that is not adulterated and full of toxins.

Protein

Most people know that if you eat too little food, the body’s metabolism goes down. In term of thyroid function, a low calorie diet will raise the inactive reverse T3 and decrease the active T3. This causes the body’s metabolism goes down.

In one study, subjects who ate 600 calories or less a day, had a 40% drop in blood T3, and a 100% increase in reverse T3, within 48 hours. Most people get 600 calories a day, unless people are eating way to little in an effort to loose weight, or following certain detox programs like the master cleanse. Doing either of these is not good for the body, or the thyroid. I’ll say a little more on the master cleanse next section [65]

A general problem people have is getting enough high quality protein. Most protein foods come from animal sources, which are products of industrial food industry.

Most whey proteins are processed at high temperatures, which destroy many delicate proteins (and along with them numerous health benefits. Some companies do sell whey protein supplied from health, grass fed cows and is not processed with high heat. These are far superior to typical whey protein isolate.

Pea and rice protein powders should not have long lists of chemical additives. If a protein powder has ingredients you can’t pronounce, or look like it came from a chemistry text book then don’t buy it. Hemp protein looks great in theory (personally, I use is sometimes), but I am not sure how much of the protein is actually used. Raw nuts and seeds are generally difficult for humans to digest.

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