The common issue of sub-optimal thyroid function in women
If you’re feeling tired most of the time and no matter how much sleep get, you just don’t seem to have that get-up-and-go anymore. Could it be your thyroid?
Hypothyroidism in women
Hypothyroidism is 10 times more common in women than in men. This is perhaps due to autoimmune diseases being more likely in women due to the additional X chromosome which are more prone to mutations.
Further to this, hypothyroidism is very common after childbirth and with the demands of parenting, is when many women really notice it. The classic description of postpartum thyroiditis includes a phase known as thyrotoxicosis followed by hypothyroidism.
The thyrotoxic phase occurs approximately 1-4 months after delivery and lasts for 1-3 months. It can express symptoms such as anxiety, insomnia, a fast heart rate, fatigue, weight loss and irritability. Since these symptoms may often be attributed to changes after delivery and the stress of having a new baby, the thyrotoxic phase of postpartum thyroiditis is often missed.
It is far more common for women to present during the hypothyroid phase. This likely occurs 4-8 months after delivery and typically lasts up to 9 –12 months.
If the hormonal balances and nutrition status remain unaddressed, it’s likely these issues could continue much longer. Symptoms include fatigue, weight gain, constipation, dry skin, depression and poor tolerance of exercise. Most women will regain normal thyroid function within 12-18 months after the onset of symptoms. However, approximately 20% of those that go into a hypothyroid phase will remain that way.
Getting to the root of the issue
Testing with your GP can be helpful to a certain degree if you're dealing with an autoimmune disease where you will see quite clear indicators of low thyroid function (high TSH and low T4 in the blood), but what if you don’t have an autoimmune disease and your thyroid is just operating sub optimally?
Your test results come back as ‘normal’ but you have all the symptoms of low thyroid function, such as low energy, constipation, low mood, dry skin and thinning hair? It certainly still needs addressing.
If testing is the route you want to go down, a full thyroid panel should be taken. This includes looking at your conversion from T4 to free T3 (the form your body can use) to fully ascertain how the thyroid is functioning.
As a nutritional therapist I am often asked what causes suboptimal thyroid function and how to support it.
My first point of call however would be to try to get to the root cause of the issue and as with peeling an onion, there can be many layers and factors contributing to suboptimal thyroid function. It’s crucial to address all of these and more often than not, this can be enough to support the thyroid so that it can begin to function normally again.
Take a good look at the labels on your products. Many products now state if they’re paraben- and phthalate-free so look out for these. Go for fragrance free options where possible too.
If finances allow you to do a complete overhaul of all of your products at once, great. Otherwise as you finish a product, replace it with a better option next time. Eating an organic diet and drinking filtered water is also key to removing these endocrine disrupting chemicals.
Stress and Inflammation
It won't be the first time you’ve heard about how stress can impact your health but you may not have thought about how much it can impair thyroid function.
When we are stressed, we produce more of the hormone called cortisol which is produced by our adrenal glands. Cortisol can inhibit secretion of TSH (thyroid stimulating hormone) from the pituitary gland, leading to suppression of thyroxine, the main hormone produced by the thyroid gland.
As lots of people are more than aware of, reducing stress is easier than it sounds, especially if you're a natural born worrier or simply live in the modern world.
Many studies show the positive impact of just 10 minutes of meditation a day and this is one of the simplest ways to reduce cortisol levels. If you're new to meditation, start with 5 minutes and build up until it becomes a part of your routine. There are many things you can do to reduce stress. See my previous article on this with some helpful pointers in managing stress.
When we think of inflammation, we may think of the inflammation you’d see with an injury. Red, hot, painful, swollen.
This is of course inflammation but this acute form is beneficial in this scenario. It’s the inflammation that you can’t see that will negatively impact your thyroid function.
How do you know if you are inflamed? If you have any of the following it is highly likely you are inflamed; joint pain, muscle pain or indeed any pain, bloating, loose stools, depression, skin conditions, headaches, frequent colds, are overweight, high blood pressure, smoke, a diet of processed foods and drink excessively, these are all indicators and causes of hidden inflammation.
When inflammation is present, cortisol follows and this down-regulates the conversion to T3 meaning less of the active form is in circulation for use by the body.
Optimal gut health is so crucial in the health of our body and mind and that includes the optimal functioning of the thyroid.
Food intolerances, stress and dysbiosis can all be a cause of inflammation in the gut and it is this dysbiosis that can lead to issues with how our thyroid functions.
The thyroid gland mostly produces T4, which is inactive. The conversion of over 20% of the T4 to T3 takes place in the gut. It is the job of your healthy gut bacteria to make sure you get the amount of T3 you need.
If your gut is not functioning optimally you can experience symptoms of hypothyroidism, even if your thyroid is healthy.
Another example of how gut function can impact levels of available thyroid hormone is the effect that constipation has on it.
Constipation can create hormone imbalances that lead to increased levels of oestrogen. As oestrogen levels rise, proteins that keep the hormone bound also rise. The actions that lead to excess oestrogen being bound, can also cause thyroid hormone to become unavailable.
It’s a vicious cycle as low levels of circulating thyroid hormone negatively impact gut motility, which can perpetuate the imbalance of hormones.
Healing the gut is a multi-pronged approach most commonly referred to as the 4R program and follows these basic principles:
Remove all intolerances, unnecessary medications, toxins, parasites/bacteria and life stressors
Introduce digestive enzymes and Betaine HCL (in the case of low stomach acid)
Add in pre- and probiotics (in supplemental form as well as ferments)
Introduce foods and supplements to repair the gut. Bones broths and collagen, curcumin, L-Glutamine, marshmallow root, fulvic and humic compounds.
Depending on the extent of the damage to your gut, you may need to complete this cycle a number of times. You may find it helpful to work with a nutritional therapist to help guide you in this process.
The thyroid-liver axis is another illustration of the system-wide impact of thyroid health. In this complex relationship, the liver plays an important role in thyroid hormone activation, transport, and metabolism, and thyroid hormones impact hepatocyte activity and liver metabolism. Therefore, an imbalance in thyroid hormones may consequently influence liver structure and function.
Supporting the liver is therefore key to thyroid health and function. A big part of this was addressed in the first section on endocrine disruptors and reducing the amount of toxins coming into our body and environment is crucial to reducing the burden on the liver. NSAIDs, alcohol, even excessive supplementation at very high doses and herbs all go via the liver eventually.
As well as reducing the load, you can support it with specific foods: cruciferous vegetables such as broccoli, cabbage and kale may support the natural production of liver enzymes.
Bitter foods eaten before a meal, such as rocket and endives, support the liver in its production of bile, which in turn aids in digestion and nutrient assimilation.
Drinking beetroot juice has been shown to have positive health benefits, including reducing oxidative damage and inflammation in the liver, as well as increasing natural detoxification enzymes.
Last but by no means of least importance, it goes without saying that good nutrition is key to support the function of the thyroid. Without the necessary building blocks and nutrients, as with any function in the body, the thyroid relies on a number of key nutrients.
The thyroid requires iodine to regulate the production of the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
The risks associated with selenium deficiency are primarily thyroid-related. Inadequate selenium prevents T3 and T4 hormones from functioning optimally, slowing down metabolism and increasing the risk of disease. A 2016 study* showed that selenium supplementation helped one third of subclinical thyroid patients achieve optimal thyroid health.
All B vitamins and in particular Vitamin B12 are crucial in maintaining hormonal balance. Low B12 status has shown to negatively impact the conversion of T4 to the active form T3.
When we think about thyroid function, it’s important we look at the bigger picture and support the systems that interact with the optimal functioning of the thyroid. We talked earlier about the impact of stress on thyroid function due to the rise in cortisol. This is where adaptogens such as ashwagandha can play an important role in nutrition. Adaptogens, put simply, support your body’s ability to manage stress, reducing the amount of cortisol the body produces.
Protein and Fats:
Eating adequate protein is also important for TSH production. According to findings from a cross-sectional study eating more foods that are high in protein and saturated fatty acids is associated with improved thyroid function.
Hopefully you can now see the importance of supporting the whole body and mind in order to support the thyroid and its normal, healthy functioning.
With any health related issue, it is crucial to look at the whole picture and approach it holistically. That daily meditation class or swapping your shampoo for a more natural option may not seem terribly related to the health of your thyroid, but it’s an important piece of the puzzle that will hopefully lead you back to better energy levels, better mood and optimal health.
Nutritionist and CEO