The thyroid is known as the regulator of metabolism. But it also has far reaching effects to mood balance (implicating depression and anxiety), menstrual cycle regulation, sex hormone balance, lipid metabolism, growth, development, carbohydrate metabolism, release of stomach acid for digestion, and gastrointestinal motility among others. Many people show normal thyroid function on laboratory work, but still are clinically hypothyroid.

How the Thyroid Works

The hypothalamus and pituitary release hormones TRH (thyrotrophin releasing hormone) and TSH (thyroid stimulating hormone), to tell the thyroid to start producing hormones. The thyroid then produces roughly 80% as T4 (less bio-active) and 20% as T3 (very bio-active) into circulation. As the hormones are circulating around the body, the liver, kidney, gut, muscles, and central nervous system will convert T4 to T3 as more active hormone is needed. Under stress, whether emotional or physiological, more T4 will be converted to reverse T3. Reverse T3 is an un-usable form that, if in excess, can block normal T3 receptors, making you feel more hypothyroid despite a leveling of hormones in the blood.

Various Types of Hypothyroidism

Because the thyroid has many effects throughout the body, there are many different types of hypothyroidism. When it comes to treatment, you have to treat the specific type of hypothyroid condition to achieve optimal results. A hypothyroid state is not a normal balanced state in the body. To successfully treat the thyroid, you have to address what triggered the condition.
1. Hypothalamus/Pituitary Thyroid Axis: Suppression of the HPT axis can happen anywhere along the line. Specifically, the axis can become suppressed if there is a deficiency in dopamine or serotonin (neurotransmitters that balance mood), cytokines that are released from chronic inflammation or infections, and high cortisol from chronic stress.
2. Auto-immune Association: In certain individuals, a genetic predisposition to a health disorder can be triggered and the immune system may begin attacking the thyroid. This can cause an initial flare inducing a hyperthyroid state, followed by a hypothyroid state.
3. Down Regulating the Production of Hormones: The production of thyroid hormones can be down regulated by low progesterone, high estrogen, oral contraception, elevated cytokines that are released from chronic inflammation or infections, high cortisol levels from chronic stress, low serotonin and dopamine, gastrointestinal dysbiosis (20% of T4 is converted to T3 in the gut via healthy gut flora), poor diet, and deficiency in nutrients that are needed to make the thyroid hormone: iodine, Vitamin A, Vitamin D, selenium, and zinc.
4.·Resistance to Thyroid Hormone: If too much thyroid hormone is produced, the body builds a resistance to it as a form of protection from the active T3 hormone. This can be caused by high estrogen, high testosterone, insulin resistance (commonly seen in diabetes and polycystic ovarian syndrome, or PCOS). The thyroid receptors may also become resistant to the hormone from elevated pro-inflammatory Th1 cytokines from chronic inflammation, persistent elevated cortisol from chronic stress, deficient vitamin A, and methylation defects as seen with elevated homocysteine.

The Gut Connection

Thyroid hormone is needed to produce stomach acid. If the stomach doesn’t produce enough stomach acid during digestion, the pH of the small intestine will start to become more alkaline, the pancreas will release less enzymes, and food will begin to become undigested which you may see in your stool. All of these will start to disrupt a healthy bacterial flora in the small intestine leading towards food sensitivities, inflammation and cytokine release, and a damaged gut lining. The inflammation created will cycle back and disrupt thyroid hormone production and can create thyroid receptor resistance. Thyroid hormones also control gut motility, so having lower levels of the hormones will make you more constipated, again altering the healthy biome of bacteria in the gut.

The Adrenal Connection

When there is chronic stress and elevation of cortisol, T4 gets converted into reverse T3. Reverse T3 binds to the T3 receptors, blocking cells from accessing the active T3 hormone. But stress is more than just emotional. Stress is also a physiological event that is created by elevated cytokines from chronic inflammation, food and environmental sensitivities, undigested proteins, leaky gut, chronic infections (viral, bacterial, yeast, parasite), liver congestion, and heavy metal toxicity.

Laboratory Assessment

Typically a hypothyroid state is not created by just one factor. It is a combination of multiple triggers where over time the body can no longer adapt. The body becomes overwhelmed. Therefore, laboratory assessment needs to take into consideration the various factors that can trigger the thyroid. Some of the laboratory tests to consider include a nutrient analysis to determine which cofactors and nutrients are depleted or too elevated, functional adrenal assessment of cortisol, heavy metal load, gastrointestinal health, iodine status, thyroid antibodies, and conversion pathways of the thyroid hormones.


Epigenetics is the idea of how external factors affect the expression of genes. Especially with individuals who have hashimotos or grave’s disease, treatment goes beyond just giving thyroid medication. Treatment needs to assess the factors that alter gene expression. Very similar to the factors that trigger a hypothyroid state, the items that can trigger genetic expression are usually a combination of events. This can include adrenal dysfunction from chronic stress, inflammation and elevated cytokines from chronic infections, congested liver function, disruption in gastrointestinal flora and abnormal digestion, deficient nutrients, poor nutrition habits, and heavy metal burden.

 Take Home Message

When it comes to assessing thyroid conditions, treatment is much more intensive than just giving thyroid medication. Underlying factors that created the condition need to be addressed. Because thyroid hormones effect every cell, a whole body approach is needed that assesses how each system affects and is effected by the thyroid.
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