Thyroid, Adrenals,
and Metabolism

What is the thyroid and what are the adrenal glands?

  • Thyroid: located in the throat, is a small gland that manufactures thyroid hormones. It is essential for all metabolic activity: including ovulation. Two hormones directly affect ovarian function: t3 & t4, and the ovaries have receptors to those hormones. 

  • Adrenals: Two triangular shaped glands that are above the kidneys. They secrete hormones in response to stress, such as cortisol, and androgens like DHEA

  • Your thyroid health is your adrenal health - the endocrine system is a system of communication, of hormones talking & regulating every cell process.

  • The adrenals are the battery of the body, giving you energy to support yourself. If they are not nourished properly, overworked, under stress, or depleted, they will send a message to your thyroid that the body must slow down. 

Types of thyroid conditions

    • This is when thyroid function is slowed

    • This condition is characterized by the thyroid gland not being able to make enough thyroid hormone

    • This is where thyroid function is overactive and faster than usual

    • In this case, the thyroid gland is overproducing thyroid hormone

    • This is where your immune system attacks your thyroid gland, damaging it to the point where you can’t make your own thyroid hormones.

    • This causes hypothyroidism, or a slowed thyroid function.

    • This is the other type of autoimmune thyroid disorder.

    • The immune system malfunctions, releasing abnormal antibodies that mimic the Thyroid Stimulating Hormone.

    • These false signals tell the thyroid to produce more and more thyroid hormone.

    • This causes hyperthyroidism, or an overactive thyroid.

    • Now, The typical focus of clinical medicine is the thyroid gland - what is called glandular hypo or hyper thyroidism.

    • The thyroid gland is what makes the hormones, but ultimately those hormones leave the gland and are transported via the bloodstream, with the end goal being to perform a function inside the cells of your body.

    • The main goal of thyroid hormone is to get inside your cells, and find what is called the nuclear receptor. These receptors, interacting with your genes, are what regulates the metabolism and homeostasis of the cell, and the person at large. 

    • Cellular hypothyroidism is where the gland is making thyroid hormone in the correct levels, and there’s enough circulating in the blood stream, but not enough of that active thyroid hormone (called t3) is able to reach the nuclear receptor inside the cell or, it’s able to get in the cell, but the cell is deactivating it.

    • Cellular hypothyroidism can be developing for months or years before the thyroid gland starts malfunctioning or blood levels on a thyroid test show any abnormality.

    • This complicates the picture when it comes to testing the thyroid and relying on that alone for a diagnosis. 

    • Cellular hypothyroidism is like a cellular resistance to active thyroid hormone, and though many factors can influence it, one of the most impactful is inflammation, which has the ability to downregulate metabolism.

    • Cellular thyroid issues are the precursor to full blown glandular thyroid disease. And once you have glandular thyroid disease, you definitely also have cellular thyroid disease.

    • In places where people get plenty of dietary iodine, there is a strong auto-immune connection to thyroid disorders.

    • The majority of thyroid disorders are going to be rooted in these instances of immune dysfunction.

    • In places suffering from food insecurity, iodine deficiency derived thyroid disorders are more common.

Symptoms

Symptoms are the most reliable indicator that there’s a thyroid issue going on.
Symptoms should be regarded as more important than the reference ranges on a blood test.

Hypothyroidism

  • Fatigue and sluggishness

  • Increased sensitivity to cold

  • Constipation

  • Pale, dry skin

  • A puffy face

  • Brittle nails

  • Hair loss

  • Enlargement of the tongue

  • Unexplained weight gain

  • Muscle aches, tenderness and stiffness

  • Joint pain and stiffness

  • Muscle weakness

  • Depression

  • Memory Lapse

In the menstrual cycle we may see 

  • Excessive or prolonged menstrual bleeding

  • low waking temperatures

  • anovulatory cycles (no thermal shift observed)

  • long cycles

  • prolonged phases of less-fertile quality cervical fluid

  • short luteal phases

  • unexplained infertility or miscarriage

Hashimoto’s thyroiditis

  • All of the above +

  • Swollen thyroid gland (goiter)

  • Elevated TPO antibodies on a blood test

Hyperthyroidism

  • Excessive sweating.

  • Intolerance to heat .

  • Increased bowel movements and diarrhea

  • Tremor (usually fine shaking)

  • Nervousness, agitation, anxiety.

  • Rapid heart rate, palpitations, irregular heart rate.

  • Weight loss.

  • Fatigue, muscle weakness

  • Trouble sleeping

In the menstrual cycle we may see

  • high waking temperatures 

  • short cycles

  • light bleeding during menstruation

  • short luteal phases

  • milk in breasts when not nursing

  • infertility

Graves disease

  • all of the above +

  • Swollen thyroid gland (Goiter)

  • High t3 & t4 on a blood test

Diagnosis

    • One of the best ways to monitor thyroid function is to take your waking body temperatures consistently.

    • Your waking temperature over time can tell you with a greater degree of accuracy whether or not you need to give more support to your thyroid.

    • You have a family history

    • You have symptoms of thyroid dysfunction 

    • Your menstrual charts indicate thyroid dysfunction

    • If you have symptoms of thyroid dysfunction & your menstrual cycle also points to this conclusion, I encourage you to advocate for a full thyroid panel

    • Thyroid blood tests can be highly inaccurate for a number of reasons, and only receiving a thyroid stimulating hormone (TSH) test is not sufficient to rule out a thyroid issue if symptoms are present. 

    • Free t3 + Free t4

    • Free t3 - what is available for use by your cells

    • Reverse t3 - When the reverse T3 is high, we know that external physiological stresses are decreasing your metabolic function and may be causing symptoms of hypothyroidism

    • Thyroid Binding Globulin - transport proteins that move thyroid hormone in the bloodstream

    • T3 Uptake - how much is currently bound to the carrier binding globulin molecules & unavailable

    • Thyroid Peroxidase Antibodies (TPOAb)  and Thyroglobulin Antibodies (TgAb) - both antibodies which test for autoimmune dysfunction

    • Reverse t3 to free t3 Ratio - ratio is important because we can see what the cell is choosing in regards to its metabolic choices. For example, when t4 travels from the thyroid gland through the bloodstream and to a cell, it will have to be converted to be used. If the cell wants to stimulate metabolism, it will become t3, but if its favoring shunting the metabolism, it will convert to reverse t3, an inactive form which doesn’t bind to the nuclear receptor and therefore doesn’t stimulate metabolism. Because we don’t know exactly what’s going on inside the cells, this reverse t3 to free t3 ratio can tell us in an approximate way what the thyroid hormones are doing on the cellular level.

    • You also want to request a broad metabolic panel in addition to a thyroid panel. We want you and your practitioners to be able to see exactly what the metabolism is doing.

    • Inflammatory markers like c reactive protein, as well as ferritin levels, homocysteine levels, vitamin d levels can all be helpful to understanding thyroid disorders but especially when they are occurring as cellular hypothyroidism.

    • The thyroid is rarely dysfunctional in a vacuum, so it’s important to look at other markers that could be impacting your thyroid’s overall performance. 

    • TSH doesn’t assess how well the thyroid is functioning in the whole body, it only measures the impacts to the brain and the thyroid gland.

    • The idea is that when thyroid function is low, the pituitary gland tries to make lots more thyroid hormone to compensate, and thus you should see elevated levels of TSH on a blood test. However, this has several limitations.

    • Inflammation (one of the main drivers of autoimmune thyroid disease) can suppress TSH production, this in turn makes TSH levels on a blood test look in the normal range instead of being elevated.

    • A TSH test can be understood as not an early marker of thyroid gland dysfunction, but a late marker of thyroid gland dysfunction, and you’re probably already looking at advanced disease by the time this marker falls out of range on a test. 

    • Deiodinase Enzymes work to convert T4 into T3. If deiodinase enzymes are downregulated, this reduces the conversion of T4 into T3, and you have less active thyroid hormones available for use. This causes symptoms of hypothyroidism, despite the fact that the TSH and T4 levels may be within “normal” ranges on the blood test.

    • High cortisol, or insulin resistance (such as the case with someone with PCOS) also messes with thyroid results because it causes an increase in reverse t3, an inactive form.

    • When there is enough t4 in the blood, the pituitary tells the thyroid to stop making more hormone. This leads to a state where you have normal TSH, and normal t4, but yet you have very little of free t3 active thyroid hormone available for use by your cells.

    • Another limitation to TSH testing is if you are pregnant, thyroid panels are going to look very different even in different stages of the same pregnancy.

    • A normal pregnancy increases the demands of the maternal thyroid gland, because estrogen stimulates the transport proteins resulting in a rise in total t3 & t4 levels during the first half of pregnancy.

    • TSH is suppressed by an increase in human chorionic gonadotropin (hCG or what you measure in a pregnancy test), and therefore your TSH may appear lower in early pregnancy on a blood test.

    • If you are pregnant it’s essential that you work with a practitioner who understands what the thyroid is doing during pregnancy.

Ways underactive thyroid causes irregular menstrual cycles

  • Increases prolactin which suppresses ovulation

  • Robs ovaries of cellular energy needed to ovulate

  • Impairs insulin sensitivity

How hormonal contraception affects thyroid health

  • High dose estrogen in hormonal birth control increases the activity of TBG (Thyroxine Binding Globulin).

  • TGB binds to thyroid hormone leading to lower levels of free thyroid hormone available for use by our body.

  • Hormonal contraception can cause & exacerbate hypothyroidism over time.

Treatment

    • Levothyroxine is a synthetic thyroid hormone that is chemically identical to the T4 that your thyroid gland makes. This prescription drug is the most common medication prescribed for hypothyroidism.

    • Side effects of include tremors, headache, nausea, vomiting, diarrhea, nervousness, irritability, excessive sweating, changes in menstrual cycling, and temporary hair loss.

    • As T4 is not the thyroid hormone actively used by the body, the use of levothyroxine still requires the patient’s body to convert T4 into T3.

    • The goal of using levothyroxine is to return TSH into the normal range if it is elevated, and to improve symptoms.

    • For some people this will not be the case, and symptoms may continue even if TSH returns to a normal range.

    • Another clinical treatment that is perfectly safe and useful is desiccated thyroid from pig, sheep, or cow

    • Desiccated thyroid naturally contains both t3 and t4 as opposed to Levothyroxine which is just t4.

    • Both are considered natural, and bio-identical to our bodies own hormones.

  • Supplements that help HYPOthyroid (slow thyroid): 

    • Dessicated Thyroid supplements  (great natural source of t3 and t4)

    • Ashwagandha for hypothyroidism works best when taken for at least three months. Ashwagandha has been found to increase serum T4 and T3 in animal studies.

    • Gum Guggul has long been used medicinally. It’s been shown to stimulate the thyroid in animal studies. It can also reduce high cholesterol and improve metabolic function. Gum guggul contains compounds, known as ketosteroids, which can increase the uptake of iodine by the thyroid gland and improve the activity of the enzymes in the thyroid. It can improve the ratio of T3 to T4.13

    • Iris versicolour, or blue flag iris, is a helpful anti-inflammatory agent and can reduce enlargement of the thyroid in patients who have Hashimoto’s thyroiditis.

    • Coleus Forskohlii is a plant that can activate T3 and T4 secretion from the thyroid cells in an action that is quite similar to TSH. It improves iodide uptake from the thyroid gland and increases the production of thyroid hormones. It also increases something known as cyclic AMP, which can raise the metabolic function and lower blood sugar.

    • Vitamin B Complex preferred, but especially B12 - use as directed - (regulates adrenals, metabolism)

    • Selenium supplement 

    • Vitamin D - get outside in the sunshine at least 5 times a week

    • Vitex & Dong Quai

    • Eat whole foods with their natural fats included

    • Animal fats & proteins, shellfish, red meat, liver, and skin

    • Cooked dark leafy greens &  vegetables

    • Egg yolk has vitamins A & D, which nourishes your bones & endocrine system

    • Bone stocks have liquid amino acids, & easily absorbable collagen

    • Traditionally prepared, and iodine rich foods. The best sources of iodine in foods are fish, shellfish and other seafoods, seaweed, dairy, and eggs. Iodine is also found in beets, cranberries, asparagus, and iodized salt, though the salt loses iodine potency with age and humidity. 

    • Animals must be raised outside the industrial food system, and have lived in their natural habitat with access to biodiverse foods 

    • Switch from denatured processed food

    • Avoid gluten if sensitive

    • Some foods contain anti-nutrient compounds called goitrogens which block the absorption of iodine in the thyroid gland. Goitrogens are another class of anti-nutrients present in high amounts in soy. If you have known thyroid problems, you may also want to limit your intake of soy, or raw cruciferous vegetables like brussel sprouts, broccoli, cabbage, and kale. If you do want to eat these vegetables, you must cook or ferment them in order to reduce the goitrogen content. Strawberries, plums, figs, peaches, and red wine also contain goitrogens.

    • Processed foods, not sleeping enough, and environmental toxicity are going to contribute to inflammation which has a very negative affect on your thyroid function. 

    • We need to protect the thyroid from being damaged by chemical exposure. Thyroid damaging substances include plastic chemicals (plastic water bottles, food containers, canned foods lined with BPA or touching thermal receipts, flame retardants found on clothes, furniture, and household items, bromine which is added to food or found in agricultural chemicals, dyes, insecticides, and pharmaceuticals, chlorine in drinking water, triclosan in antibacterial soaps, fluoride in toothpaste and in tap water, non stick chemicals on Teflon pans, parabens in personal care items and more. Doing a proper review of your water sources, food sources, cookware, and personal care items is needed when trying to heal your thyroid.

How To Use Charting for Thyroid, Adrenal, and Metabolic Health

Fertility awareness is an asset for anyone struggling with diagnosing or managing a thyroid issue.

Once you have a few cycles of data, you can use the range of waking temperatures to determine the state of your metabolic health. Abnormally higher than average or abnormally lower than average waking temperatures are an obvious symptom of thyroid dysfunction. 

  • Normal Thyroid Temperatures:

    PREOVULATORY 97.0°F - 97.5°F / 36.11°C to 36.39°C

    POSTOVULATORY 97.6°F - 98.3°F / 36.44°C - 36.83°C

    Some clinicians believe that any consistent pattern of pre-ovulatory temps below 97.3F should be tested, [especially when other symptoms are present]

  • Hypothyroid/slow thyroid temperatures:     

    PREOVULATORY 95.5°F - 96.6°F / 35.28°C to 35.89°C

    POSTOVULATORY 96.7°F -97.2°F / 35.94°C to 36.22°C

  • Hyperthyroid/fast thyroid temperatures: 

    PREOVULATORY 97.5°F - 98.6°F / 36.39°C to 37.00°C

    POSTOVULATORY 98.7°F -99.2°F / 37.06°C to 37.33°C

Thyroid Health And Pregnancy

    • T3 & t4 help egg growth & maturation through synergizing with follicle stimulating hormone. 

    • Thyroid function plays a role in progesterone & estrogen production because T3 & t4 also stimulate the absorption of intestinal & liver cholesterol. This cholesterol is the building block of every sex hormone you make.

    • The thyroid hormones also contribute to egg fertilization, and embryo viability

    • The thyroid, along with estrogen itself, enhances insulin sensitivity which is important to keeping your cycling hormones functioning properly

    • Progesterone stimulates thyroid function & increases metabolic rate during the second half of the menstrual cycle (think about how your temperatures rise after ovulation, you essentially need more energy for that & therefore your metabolism is increased). 

    • Without a healthy thyroid physiology, including in the cells, it’s very difficult to get pregnant. Unfortunately because labs are only really testing for the thyroid gland, someone can have normal labs and still have a difficult time getting pregnant because of cellular hypothyroidism.

    • If you have a history of thyroid issues or you are experiencing multiple miscarriages, make sure to get a full thyroid panel before you become pregnant again. And it’s essential that your practitioner be well versed in the changing thyroid hormone levels during each stage of pregnancy, as up to 1 in 5 thyroid test results will be misinterpreted because they are not using pregnancy specific ranges to interpret lab work.

    • Most especially, it is essential that thyroid antibodies to measure auto-immune conditions are taken, as these are the most linked with adverse pregnancy outcomes.

    • Pregnancy puts a greater strain on your thyroid gland than normal. A fetus doesn’t produce its own thyroid hormones until the second trimester, and maternal thyroid hormones continue to be transferred via the placenta during the entire pregnancy

    • Production of thyroid hormones increases about 50% in the first trimester and remains that way until you give birth.

    • Iodine and thyroid hormone are absolutely essential to fetal brain development, and a lack of these can result in lower IQ or permanent intellectual disabilities.

    • Thyroid hormone is crucial for intrauterine neurodevelopment because it regulates migration, proliferation, and differentiation of fetal neuronal cells that form grey matter later in life, as well as synaptogenesis and myelination.

    • Nutritional needs are increased in general during pregnancy, and many of these have direct correlation with increased thyroid production.

    • If you don’t eat a lot of seafood, or are having pregnancy related dislike or nausea with seafoods, make sure your prenatal vitamin contains the RDA for iodine. You’ll need to check the label because about half of prenatal supplements fail to include iodine.

    • Iron needs increase from 18 mg in non-pregnant people to 27 mg per day in pregnant people. Low iron levels are linked to hypothyroidism in pregnant people.

    • Selenium helps reduce thyroid antibodies and protects against postpartum hypothyroidism.

    • Environmental toxicity is even more dangerous during pregnancy. Parabens are known to affect sex hormone and thyroid hormone levels in pregnant people. Prenatal pesticide exposure can harm the developing brain resulting in developmental problems.

    • Higher rates of preeclampsia (high blood pressure) are reported in pregnant people who were exposed to PFCs, which also damage and impair thyroid function in both the pregnant person and the newborn. Fluoride crosses the placenta, and can result in fluoride exposure to the fetus.

    • Developing thyroid issues within 1 year of giving birth is called postpartum thyroiditis and affects 1 in 4 people post-pregnancy.

    • If you did get your thyroid tested while you were pregnant and had some issues show up, you’ll need to be careful in the year after giving birth to avoid the development of auto-immune thyroid conditions.

    • The stress of a pregnancy on the body and the thyroid itself can put you into a tough state where you are feeling the effects of thyroid disease just as you are trying to get back to being yourself, go back to work, take care of your baby, or thinking of having more children in the future.

    • Postpartum thyroid dysfunction is linked with postpartum depression. 

    • Symptoms of postpartum thyroiditis are the same, the difference is that pregnancy is what triggered it. Your postpartum lab work may also come back curiously normal, but if you don’t feel right, follow what your body is telling you and perform a thyroid healing regimen anyway.