Most of us are not new to the world of thyroids. Even if you don’t struggle with a sluggish thyroid or hypothyroidism, you more than likely know someone who does.

Unfortunately, thyroid health as a whole can be easily overlooked or not addressed properly. The truth is that our thyroid health is complicated and sometimes it’s not just a matter of looking at a lab value (like TSH).

In this post, I want to walk you through what you really need to know about your thyroid big picture, how to know if something is wrong, and what to actually do about it. Now, let’s get after it.

Back to the basics: what is the thyroid gland and what does it do?

The thyroid itself is a butterfly-shaped gland in the front of your neck. It helps the body make many hormones in order to regulate your metabolism, heart, digestion, muscle control, brain health, and mood. 

The first step in all these processes is for the brain to release TSH, or thyroid-stimulating hormone (this is the “go-to” lab to monitor thyroid health in a conventional medical setting). TSH triggers our thyroid gland to make and release T4 (AKA thyroid hormone). 

T4 is converted to T3, or active thyroid hormone, in all kinds of cells in different tissues of the body. This is when the magic can happen. Remember this part for later because when T3 is not able to get inside the cells, we run into issues.

T3 is the influencer for (and I’m repeating myself a bit here) metabolic rate, energy levels, body temperature, cholesterol levels, wound healing, digestion, mood, skin health, mental function, sleep quality, ovarian function, and fertility. THIS IS A LOT! 

The thyroid hormone touches so many areas of our health and can be considered our hub for feeling healthy as a whole.

How do you know if something is wrong?

Oh gosh, there are so many signs.

There are actually two main subtypes of thyroid issues: HYPERthyroid and HYPOthyroid.

Hyperthyroid is the overproduction of thyroid hormone. Weight loss, anxiety, increased heart rate, difficulty sleeping, increased appetite, bulging eyes, and menstrual cycle changes are classic signs. 

This condition is significantly less common and causes can include a thyroid nodule or tumor, an enlarged thyroid or goiter, or an autoimmune condition called Grave’s Disease. Medication, radiation, or surgery are typical treatment options. 

Hypothyroid is the underproduction of thyroid hormones. Unexplained weight gain, feeling cold, fatigue, brain fog, dry skin, brittle nails, hair loss, high cholesterol, depression, and painful and missed periods are classic signs. 

Having hypothyroidism is a sign of a problem, not the problem itself. Read that again. There’s a root problem and we have to figure out why this is happening. The goal is to identify why the body is producing these symptoms or signals.

Some causes for underactive thyroid can include: chronic dieting, eating low-carb long-term, certain nutrient deficiencies (iodine, selenium, vitamin A, zinc, iron) high stress levels, over-exercising, inflammation, hidden infection, high toxic accumulation, and autoimmune thyroid (Hashimoto’s Thyroiditis). 

How to treat the problem:

A typical first step is going to be talking to your doctor about your symptoms and checking your TSH level among other labs to rule things out. 

Unfortunately, the TSH lab value does not give us the full picture for some cases (especially for hypothyroidism). Requesting a full thyroid panel may be needed in order to see T4, T3, and other thyroid-related labs. A functional medicine practitioner is typically more apt to assist with this.

Not to make things more confusing, but there are actually 3 subtypes of hypothyroidism. Being familiar with each type can help you to understand what treatment is going to look like.

1. Glandular hypothyroidism → your brain is making too much TSH, but the thyroid is not making enough T4 (thyroid hormone). This is usually treated with medication through your doctor.

2. Subclinical hypothyroidism → your brain is making too much TSH, but the thyroid is still making enough T4. Typical treatment is just “wait and see what happens.” 

There is debate regarding this subtype because functional medicine practitioners typically would rather not wait for thyroid function to worsen before starting treatment and work on the preventative side of things. Later in this post we’ll discuss specific ways you can do this. 

3. Cellular hypothyroidism → Labs are usually normal, but there are persistent hypothyroid symptoms. 

So, in this case, T3 (active thyroid hormone) is not getting to the cells of different tissues of the body to work its magic. This often happens because there is a stressor of some type going on in the body that needs to be idenitfied. This causes another hormone, reverse T3, to prevent further production of the T3 we need to feel our best.

Getting to the root cause or stressor is the only way to stop this. Therefore, working closely with a functional medicine practitioner is going to be ideal (or a medical doctor with in-depth knowledge about thyroid health). He or she can help with nutrition, supplementation, and lifestyle factors in-depth and, ideally, help your body send out T3 like it’s supposed to. 

Unfortunately, we don’t have a test to help us see how well T3 is getting to the different tissues of the body, so this type of hypothyroidism can be tricky and all the more reason to not give up even if your thyroid labs initially show up “normal.”

I mention these subtypes not to overwhelm you, but simply to inform you that thyroid health is complicated!

As you can see, treatment for your thyroid is going to be different depending on which category you fall into. 

Ways to support your thyroid health NOW:

No matter what type of thyroid condition you’re facing, or maybe you simply want to prevent complications down the road, there are so many lifestyle factors that can be implemented today! Here is the breakdown:

*Reminder, these do not replace treatment with medication if indicated by your doctor

• Make sure you are eating enough in general. Restriction of calories long-term is not going to be helpful.
• Eating for balanced blood sugar.
• Include healthy carbohydrates/avoid a low-carb diet long-term. This can decrease T3 production because our brains require a certain amount of glucose to create the hormone signals involved. 
• Look at the quality of the food you’re eating. Reduce exposure to pesticides, hormones, and antibiotics by choosing organic or local when possible. This will help avoid endocrine disruption.
• In some cases, you may need to trial a gluten and/or dairy elimination diet if autoimmunity is suspected. Work with a Registered Dietitian for a best course of action if you feel like you fall into this category.
• Supplementation of targeted nutrients (iodine, selenium, zinc, vitamin A, B-complex, and thyroid supportive blends). We highly recommend working with your practitioner or Registered Dietitian for this as each case is highly individualized. Supplementation also does not replace proper nutrition from the foods we eat.

When it comes to nutrition, eating a well-balanced diet with plenty of fruits, vegetables, whole grains, nuts, seeds, and high-quality protein is going to be beneficial across the board. There are, however, particular foods that we consider “thyroid superstars” that you can incorporate more often. They include all vegetables for phytonutrients, seaweed or kelp for natural iodine, brazil nuts for selenium, fatty fish for omega 3s, and any good-quality animal protein.

One last area to really think about for thyroid health is your stress levels. Our thyroid is strongly impacted by our stress levels and cortisol. Remember, chronic high cortisol levels can decrease TSH production and this will decrease the amount of T3 (active thyroid) going to the cells to work their magic. This can look a little different for everyone, so consider the following areas:

• Avoid over-exercising (prioritize rest days and avoid multiple high-intensity cardio sessions per week)
• Decrease environmental toxicant exposure (think about your cleaning products, makeup ingredients, soaps and lotions, etc.)
• Increase sleep quality 
• Manage day-to-day stress

In some cases, you and your practitioner may need to really get creative with questions in order to uncover what’s increasing stress to the body, even if you seem to be doing everything right on the outside. Inflammation, poor gut health, past trauma, mold toxicity, insulin resistance….the list goes on and on for possible contributors. Who knew your thyroid could be the brunt of so many things?

Key Takeaways:

Thyroid health is definitely complex and not one-size-fits-all. If you are struggling with persistent signs and symptoms of a thyroid concern, we encourage you to advocate for yourself and get to the root cause. This could mean requesting a full thyroid panel from your doctor and not just looking at TSH, or it could mean seeking evaluation from a functional medicine practitioner.

Also know that if you need medication to support your thyroid, there is absolutely no shame in that! In fact, many cases of hypothyroidism will not improve even if you are “perfect” with nutrition and lifestyle. 

If you found that the lifestyle considerations discussed in this post to be more of a “refresher” than anything new, that’s because they’re not new things! Supporting your thyroid looks very similar to how we try to support our health in general because our thyroid is considered the hub of our health and metabolisms. 

A key resource for this post was @nutritionbyrobyn. If you’re looking for more thyroid-related resources, as well as anything related to hormone health and minerals, make sure to check out her account and blog.

Stay healthy!

Elle, MM Coach