Millions of Americans struggle with low thyroid symptoms and are told at their doctor's office to take medication and return in three months. Welcome to the standard model of care.
The problem is that many people still have persistent low thyroid symptoms, even when taking the thyroid medication. People live with debilitating symptoms like fatigue, depression, anxiety, hair loss, weight gain and skin problems, and receive very little help from mainstream care.
Thyroid medication normally comes in the form of a synthetic T4 thyroid hormone. T4 is the main thyroid hormone that your body produces naturally, but it needs to be converted into T3 for it to be used actively in the body. I wrote an article for MindBodyGreen that explains in detail the many different causes of low thyroid symptoms that aren't tested for in the standard model of care. Since that article was first published, I've been able to talk to hundreds of people all over the world who are on thyroid replacement hormones and are told they're “normal,” even though they still have symptoms. These people know that how they're feeling is anything but normal.
Because thyroid physiology is so complex, there is rarely, if ever, a “magic pill” that cures the problem. The overwhelming majority of people struggling with low thyroid symptoms are having some sort of autoimmune response. This means that their immune system mistakes the thyroid as an enemy and attacks it. This immune dysregulation can cause systemic inflammation in the body. Inflammation is a normal response to an injury, but when the source of the inflammation, in this case an autoimmune response, isn't addressed, the vicious cycle of systemic inflammation is never broken.
The underlying issues of an autoimmune pattern and inflammation have to be addressed to restore the patient’s health. It's only when you deal with underlying issues like these that you can allow the thyroid hormone to be effectively used in the body.
With that in mind, let’s go over five reasons why your thyroid medication may not be working.
1. Decreased thyroid receptor sensitivity.
Every cell of your body is lined with a membrane that's made up of saturated fat and cholesterol, called a bilipid membrane. This membrane is essential for your health. Receptor sites on the membrane act as communicators with hormones. Cellular inflammation can cause a rigidity of the cell membrane and a “dulling,” or resistance, of the receptor sites. Your body may be producing enough thyroid hormone or you may be on the right dose of thyroid hormone drug, but if your cells aren't communicating with the hormone, your symptoms will persist.
2. Decreased thyroid hormone conversion.
Inflammation will decrease the conversion of the inactive thyroid hormone, T4, to the biologically active and usable form, T3. This hormone conversion happens primarily in the liver and your gut. Your body's systems are intelligently complex; dealing with the interconnected systems of your body is essential for your thyroid hormones to work properly.
3. High reverse T3 levels.
When your body is under chronic stress it can produce higher levels of reverse T3, which is an inactive form of the thyroid hormone. Reverse T3 can't be converted into T3, which means this is another situation when the problem isn't a deficiency in thyroid hormone, but a conversion problem caused by chronic stress and inflammation.
4. Decreased brain-thyroid communication.
Your thyroid doesn't act on its own, but receives information from your brain, specifically the hypothalamus and pituitary gland. Think of your thyroid as an employee of the brain, only doing what the brain tells it to do. This interconnected web of communication is called the hypothalamic-pituitary-thyroid (HPT) axis. Chronic stress, autoimmune responses, and inflammation can negatively impact these communication lines.
5. Selenium deficiency.
Selenium is an essential micronutrient for your health. It plays an important role in thyroid hormone conversion and overall function. Although deficiency of selenium is rare in adults, it's sometimes seen in patients with inflammatory triggers, such as gastrointestinal disease. Selenium is found in nuts, meats, fish and eggs.
Take-Home Health Message:
Inflammation is a common link with all of these underlying dysfunctions. Moreover, inflammation is a common link between all chronic diseases. When I talk about systemic inflammation, I am not referring to a swollen ankle or pain, but a low-grade inflammation of cells throughout your body. A comprehensive health history and lab tests can determine the underlying source of inflammation, whether it is a chronic infection, toxicity, food intolerances, autoimmune response or a combination of these. To truly regain your health, you must first remove the source of inflammation.
Will Cole, IFMCP, DNM, D.C., is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian,The Inflammation Spectrum, and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.