Hypothyroidism: The Silent Epidemic?

Could hypothyroidism be the reason you’re not looking, feeling, and performing at your best?

Whether diagnosed or undiagnosed, hypothyroidism affects millions of people around the world.

Common signs and symptoms of low thyroid hormones:

  • Weight gain
  • Difficulty losing weight
  • Fatigue, low energy
  • Low mood
  • Dry skin
  • Hair loss – anywhere on your body
  • Constipation
  • Muscle pain
  • Menstrual irregularities
  • Fertility problems

What is a thyroid gland?

The thyroid is a butterfly shaped gland that sits at the base of the neck, wrapped around the trachea (windpipe). It secretes hormones that control metabolism.

What does a thyroid gland do?

The thyroid gland secretes a number of different hormones but the primary hormone secreted is thyroxine (T4), the inactive form of thyroid hormone.  T4 can then be converted to the most biologically active form, triiodothyronine (T3), as and when required.

T3 is important as it is this hormone that regulates metabolism.

The thyroid gland secretes around 80% T4 and around 20% T3. This conversion is controlled by signals coming from areas of the brain called the hypothalamus and pituitary gland.

Imbalances in these signals from the hypothalamus or pituitary, or in the production of thyroid hormones, can cause thyroid function problems.

So what is hypothyroidism?

Hypothyroidism, also referred to as low thyroid function or underactive thyroid, is when the thyroid gland doesn’t produce enough thyroid hormone.  However, there are various potential underlying reasons why someone may be suffering with hypothyroidism, which is important to understand in order to optimise thyroid function.

How prevalent is hypothyroidism?

Hypothyroidism is ten times more common in women than men and Levothyroxine (a synthetic form of T4), a medication used to treat hypothyroidism, is the third most commonly prescribed drug in the UK - a huge 29 million prescriptions (in 2014).

Hypothyroidism Prescriptions 2014

Is hypothyroidism a silent epidemic?

The real number of people suffering with hypothyroidism could be much higher than the official figures suggest.

A hypothyroid diagnosis is difficult to come by and often only picked up by doctors when there is a significant thyroid hormone imbalance.  This comes down to, in our opinion, a lack of comprehensive thyroid function testing.

Lab test ranges are also commonly too broad - so that more results fall within a ‘normal’ range and people are told their results are normal when an optimal result range would give cause for concern.

Imbalances in metabolism can occur long before a lab test result for Thyroid Stimulating Hormone (TSH) is above the standard NHS normal range.

TSH is the most commonly tested marker for thyroid function, yet what we see too often is that TSH can be within an NHS normal range.

It’s not until a comprehensive thyroid screen has been performed, that we identify imbalances. These imbalances in thyroid hormones manifest as symptoms of low thyroid function.

A hypothyroid diagnosis is difficult to come by and often only picked up by doctors when there is a significant thyroid hormone imbalance.  This comes down to, in our opinion, a lack of comprehensive thyroid function testing.

Lab test ranges are also commonly too broad - so that more results fall within a ‘normal’ range and people are told their results are normal when an optimal result range would give cause for concern.

Imbalances in metabolism can occur long before a lab test result for Thyroid Stimulating Hormone (TSH) is above the standard NHS normal range.

TSH is the most commonly tested marker for thyroid function, yet what we see too often is that TSH can be within an NHS normal range.

It’s not until a comprehensive thyroid screen has been performed, that we identify imbalances. These imbalances in thyroid hormones manifest as symptoms of low thyroid function.

Interpreting ‘normal’ thyroid test results

When optimal ranges are applied to NHS ‘normal’ test results, the interpretation can be different.

Thyroid hormones may be out of the optimal range, or there may be subtleties in the balance between the hormones, that suggest ‘subclinical hypothyroidism’.

In our experience, subclinical hypothyroidism is very common, can result in symptoms such as low mood, inability to lose weight, dry skin, and constipation.

Low thyroid function can be supported through nutrition, nutritional supplement and lifestyle interventions if detected early, but be aware that medication can be the best option if your condition is more advanced or depending on your individual circumstances.

What’s the root cause of hypothyroidism?

The root cause of around 90% of hypothyroidism is autoimmune - specifically Hashimoto’s thyroiditis disease - where the body is producing antibodies (an immune response) that are destroying the thyroid gland.

Often these antibody levels are not tested by the doctors, so this goes undiagnosed.

In Functional Medicine, we’re looking to identify and address the root cause(s) of thyroid signs and symptoms, and merely providing medication is not always the answer because it corrects the end result – the hormone imbalance, rather than the root cause, which is often an autoimmune problem.

In our clinical experience, thyroid medication alone, does not always lead to complete resolution of low thyroid symptoms - a root cause, multifactorial, individualised approach is required.

In Hashimoto’s we need to understand what is triggering the immune response for each client, is it a food or drink, an environmental factor, a chronic viral infection, a gut bacteria imbalance, increased intestinal permeability or stress, for example?

Other reasons for hypothyroidism include (but not limited to):

  • Pituitary failure
  • Chemicals, foods or drinks causing problems for the thyroid
  • Nutrient deficiencies / insufficiencies
  • Treatment for over active thyroid function
  • Inability to covert inactive thyroid hormone (T4) to active thyroid hormone (T3)
  • Receptor issues

What should good thyroid testing measure?

Good thyroid health testing should ideally include:

  • TSH
  • Total T4
  • Free T4
  • Total T3
  • Free T3
  • Reverse T3
  • Thyroid peroxidase antibodies
  • Thyroglobulin antibodies

What does regular thyroid testing cover?

‘Standard’ thyroid testing which is commonly available in the UK through the NHS and private health insurance is usually limited to:

  • TSH
  • Free T4

What medication is usually prescribed for thyroid problems?

Levothyroxine (T4)

Are you taking medication for hypothyroidism but still feeling the symptoms of low thyroid function?

There are multiple causes for low thyroid function, it could be low T4, low T3, high Reverse T3, or high antibodies causing damage to the thyroid gland. However, the standard treatment for all cases is usually Levothyroxine.

This may not solve your problem.

Consider for one moment that the prescribed medication Levothyroxine, is T4: inactive thyroid hormone.

What if that T4, being taken as a pill every morning, isn’t being converted to active thyroid hormone, T3?

Well then someone with hypothyroid symptoms, is likely to still experience symptoms of hypothyroidism, even when their lab test for free T4 is within the normal range.

This is one reason why you can still feel terrible despite your lab test results being normal.

The conversion of Levothyroxine (T4) to T3, needs to be supported in order for it to be effective. An enzyme driven reaction aids this conversion.

However for genetic reasons, some people may not be producing enough of the enzyme, or there may be a nutrient deficiency / insufficiency (such as zinc, or selenium) which is required by the enzyme to function optimally.

Additionally, there may be ‘normal’ levels of T4 and/or T3 in the blood, but high levels of Reverse T3, which blocks the action of thyroid hormone, again causing symptoms of low thyroid function.

There are several other reasons too, but you get the picture – comprehensive testing and employing optimal ranges, is a must to understand thyroid function.

Concerned about your thyroid health? Our Nutritional Therapy team can help! 

The clinic team at Optimised can help you both at our Manchester clinic and through online consultations:

  • We take a full case history assessing all aspects of health, including nutrition, lifestyle, family history, medical history, signs and symptoms, so we can make an informed judgement on a course of action
  • Arrange comprehensive thyroid hormone testing (TSH, free and total T4, free T3, thyroid antibodies, reserve T3) to understand the full picture  (additional testing may also be recommended)
  • Support thyroid medication conversion to the active hormone in the body
  • Provide expert and bespoke interpretation of results with nutritional and lifestyle strategies, and ongoing support

You don’t have to feel ‘stuck’ with hypothyroidism, there is a better option!

We hope you found this article useful, if you suffer from some of the problems highlighted here, or know someone who does, please feel free to share this post so we can reach and help more people!

To your lean healthy, optimised future,

Dee & the Optimised clinic team

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