Sub-clinical hypothyroidism represents for many individuals the first signs of thyroid hormone dysfunction. Changes in the neuroendocrine/immune system have altered thyroid function in many cases. Typical symptoms include low energy, cold hand and feet, fatigue, hyper-cholesterolemia, muscle pain, depression, and cognitive deficits.

A mounting body of evidence suggests that a variety of nutritional, psycho social, and environmental modulators influence the Hypothalamus, Pituitary, Thyroid (HPT) axis any may, therefore, be worth evaluating prior to pharmacological intervention therapy with thyroid hormone replacement.

Thyroid hormones have both gene expression and non-genomic effects on cellular metabolism. Many of these effects are clearly related to nutritional status. Individual needs for specific nutrients are genomically unique, as well.

Does it not make sense than that if nutritional insufficiencies of certain nutrients exist, and the human body has specific biochemical needs, these insufficiencies could translate into altered cell signaling at the mitrochondrial level and other steps in genetic expression that are ultimately realized as complex neuroendocrine immune dysfunctions.

My goal is to approach a sub clinical thyroid dysfunction from a natural perspective. This approach involves the following: by providing adequate natural precursors for thyroxin formation; by reducing antithyroidal antibodies, by improving the conversion of T3 to T4 and by improving receptor binding of T3; and finally activate mitochondrial bioenergetics. All of this may be accomplished by modification of the patients nutrient status, lifestyle, and environmental influences without drugs.

BUT THE DOCTOR SAYS MY THYROID TESTS ARE NORMAL

It is important to note that conditions of low thyroid function can exist even if one's blood tests are normal. However, if a complete thyroid panel is not performed, which most doctors do not do, then you guested it, you have been over looked. Most doctors only test TSH and T4. They fail to test for auto antibodies which indicates auto immune thyroidis (an inflammation of the thyroid gland seen in thyroiditis, which can only be treated with anti inflammatories. Both Drs. Broda Barnes and Dr. Denise Wilson. M.D. have discovered a condition where the thyroid appears normal based on blood work but, in actual fact, a low body temperature exits and a low metabolism exists. You can't imagine how many people have come to me with multiple signs of sub-clinical hypothyroidism and tell me that their doctor tested their thyroid and the tests were normal. That is because a complete thyroid test was not done. M.D.'s usually test TSH and T4, this is not sufficient in detection of sub-clinical thyroid disorders. A case in point, myself, my thyroid hormones were tested (T4 and TSH) and the results were normal. I however had multiple signs and symptoms of hypothyroidism. I decided to do a complete thyroid test myselfcalled The Comprehensive thyroid Panel. Low and behold my T3 was low and I had thyroid antibodies, indicating the possibility of Hasimoto's Thyroiditis. I then had an ultrasound of my thyroid to determine if I had a goiter. Bingo, as it turns out I in fact had a goiter and Hasimoto's Thyroiditis. I immediately went on a thyroid protocol and all of my symptoms are gone and I lost 20 pounds effortlessly within three months.

According to Damien Downing, M.D. the best way to approach functional thyroid problems in a patient is not to treat the laboratory test, but to treat the patient. The combination of good clinical acumen and a functional assessment based on patient-centered review, combined with complete laboratory information, provides a much more reliable review of dysfunction's of the HPT axis.

If a person presents with multiple symptoms of hypothyroidism but tests are normal or low normal they obviously have a sub-clinical hypothyroid problem. The thyroid alone is not to blame. Actually there is a connection between the Hypothalamus, Pituitary and the Thyroid. A complex network of interacting messenger molecules arise from the activation of the HPT axis, which influences the endocrine, gonadal axis and immune system.

The following eight areas appear to be the most reliable measures for evaluating symptoms in dysfunction's of HPT axis:

1. Fatigue, usually persistent, especially on waking; less toward the evening, with slow recovery;

2. Depression; psychological melancholia with a tendency toward depression;

3. Coldness, deep as well as peripheral;

4. Elevated cholesterol, generally seen as LDL cholesterol increases;

5. Muscle cramps and pain in the calves, thighs, and upper arms;

6. Constipation; hard bowel movements, at most every two days;

7. Arthritis; rheumatoid-like pain in the joints, muscle swelling, and muscle pain;

8. Neurological symptoms, such as prolonged Achilles tendon reflex time.

It is apparent that a subclinical thyroid dysfunction can be seen across a number of organ systems, including peripheral nerve dysfunction, depression, increased seasonal affective disorder (SAD), memory deficits, elevated LDL levels and risk to atherosclerosis, skeletal muscle problems including pain, sarcopenia, and fibromyalgia, and exacerbation of allergic disorders and sleep problems.

Secondary Metabolic Challenges of Thyroid Dysfunction

Thyroid dysfunctions are related not only to the primary thyroid gland, but also to a range of secondary metabolic challenges such as nutritional insufficiencies, stress, food allergies, toxic chemical in the environment and total toxic load on the body itself.

Thyroid function can break down for various reasons according to Dr. Biamonte. Here is a simple explanation of what can go wrong.

1. Thyroid hormone is made from a protein called TYROSINE. Tyrosine can be made by converting phenalalinine, another protein, into tyrosine. This is done using iron. If iron is too low, this will not occur.

2. Once tyrosine is made, it goes to the thyroid gland. The mineral manganese is then used to help convert it into thyroxin. Thyroxin is also called T4. This is the same substance that doctors give as medication. Iodine found in kelp and sea food is also involved.

3. Once thyroxin is made it goes to the liver. Some of it is set aside as reserve.This is called reserve T4.The body puts some in reserve for times of illness or stress. In the liver, it is changed to T3. T3 is the active hormone the body will later use.

This conversion is dependent upon zinc. Excessive levels of copper will interfere with the conversion of T4 to T3.

4. Once converted, T3 must be accepted by the cells of our body. Our cells are more or less responsive to T3. Excess amounts of calcium make the cells less responsive while potassium makes them more responsive. So elevated calcium can depress potassium and interfere with responsiveness

5.Once in the cell, the mineral selenium helps the hormone work. Low levels of the mineral selenium will cause inactivity of the hormone. Selenium also helps the production of an enzyme that aids in the conversion of T4 to T3.

Imbalances of the above nutrients can cause a condition where the enzymes involved in T3 conversion and in helping the hormone to work can be hogged by reserve T4. During times of illness and stress the body forms more reserve T4 thinking it will soon need it so conversion does not take place.

The underline cause of low thyroid conditions which do not show up in routine blood work are due to nutrient insufficiencies involved in the conversion of T4 to T3. So, while the hormone levels may show up normal in the blood, the hormone is of poor quality and does not work well.

A NATURAL SOLUTION!!!

Based on my own personal experience, I have discovered the best approach to these problems entails a five step program to help restore proper thyroid function:

The first step is in proper testing of the thyroid hormones to determine a base line.This goes without question. As discussed inadequate testing misses subclinical thyroid dysfunctions. The Thyroid Profile by Great Smokies Lab is by far the most comprehensive test available today. Next one needs to eliminate any infections, particularly viruses, which can attack the thyroid and to reduce any antigen responses which effect the immune system such as food sensitivities by doing a Comprehensive Allergy Profile. A variety of food antigens could induce antibodies that cross-react with the thyroid gland. There is a relationship between celiac disease (wheat allergy) and autoimmune hypothyroidism. Once food sensitivities or allergies are determined, a food elimination diet utilizing gluten-free grains, elimination of wheat and dairy are necessary while clearing the liver. Also a four day rotation diet is implemented at this time.

The second step is to detoxify the liver and digestive tract so that the nutrients needed for thyroid function can be utilized. Remember it is in the liver that T4 is converted to T3. Implementing a detoxification approach focused on correct nutritional support of phase I and Phase II liver detoxification is crucial here. Also providing adequate levels of vitamin D, which supports the immune system, may be beneficial during this phase. A number of environmental toxins, to which we are now exposed, such as dioxins and PCBs, have abnormal effects on thyroid function that can result in neurological impairment. These compounds act as agonists or antagonist for receptor of the thyroid-steroid-retinoic acid super-family of nuclear receptors. The resulting "twisted molecules" serve as endocrine disrupters that have an adverse influence on the function of the thyroid axis. Organochloride compounds interact with thyroid-binding globulin and disrupt thyroid hormone metabolism. Part of my Thyroid Protocol enables these insoluble chemicals to become soluble and excreted from the body.

The third step is to identify and detoxify the body from toxic metals such as mercury and copper which are commonly found in excess in low thyroid function. The Toxic Elemental Profile will not only determine heavy metal toxicity but deficiencies and more importantly, imbalances in crucial minerals needed for proper thyroid function; such as Calcium to Potassium ratios and Potassium to Sodium ratios and deficiencies in selenium and zinc. Research suggests that zinc supplementation affects the metabolism of thyroid hormones and reduces antithyroidal antibodies in Down syndrome children, thus reducing the incidence of subclinical hypothyroidism. In addition, a recent study of older-aged individuals found that low T3 to T4 ratio was related to impaired zinc and/or selenium status. The role of these two minerals in promoting proper thyroid function is as follows; selenium works through deiodination and zinc by its role as a cofactor for the thyroid receptor.

The fourth step is adrenal support. By supporting adrenal function one can reduce excess production of cortisol (a stress hormone) or enhance cortisol detoxification. This is important because high levels of cortisol, along with high levels of inflammatory cytokines, have been associated depressed levels of the active thyroid hormone T3, especially in fibromyalgia patients, suggesting they may down regulate the activity of the HPT axis. Stress increases the levels of glugagon, lowers levels of T3, and elevates levels of rT3, producing the outcome of secondary borderline hypothyroidism.

The last step is to rebalance the body with specific nutrients. When the body has accumulated proper levels of nutrients, the thyroid has a chance to begin working again. We have seen that body temperatures begin to rise again after a few month of nutritional intervention in most cases. This proves that medication is not always the answer. In fact, there are many individuals that are on medication but that still have multiple symptoms of hypothyroidism, indicating they need nutritional intervention in addition to their medications! In addition to the above mentioned nutrients, a number of medicinal plants have constituents that facilitate increased conversion of T4 to T3 such as Guggulu, which induces T3 production from T4 by increasing the liver T4 to T3 deiodinase activity. The Indian medicinal plant Ashwagandha increases the production of T4.

A number of environmental and nutritional agents can modify orphan nuclear receptors and, therefore, have potential for altering the effect of T3 at the gene transcription level. These modifiable factors include vitamin A intake and its effect on retinoic acid synthesis and activation of the retinoic acid receptor. In addition, substances like omega 3 fatty acids, including EPA and DHA, as well as conjugated linoleic acid (CLA), may play roles in normalization of thyroid function. DHA increases TSH concentrations. These substances increase PPAR activity thus improving thyroid function by the effects they have of T3 induction of enzymes involved with mitochondrial activity. Vitamin C and E play a role in the antioxidant-sensitive T3 effects in inducing mitochondrial function

It is important to note that deficiencies in the regulation of this thyroid-modulated mitochondrial pathway can also have adverse impact on growth hormone synthesis and regulation of other anabolic functions.

Clinical Effects: of this activity my be observed as poor thermogenic responsiveness and a tendency to gain weight associated with insulin resistance, hypercortisolimia, and under-conversion hypothyroidism. This is characterized by postprandial insulin, decreased level of T3 with increased rT3, low axillary body temperature on waking, elevated triglycerides with a reduced HDL level, and a tendency to gain weight as visceral adipose tissue with an increase in waist-to-hip ratio.

In this case it would be important to do an Insulin/Glucose Tolerance Test, a Essential Fatty Acid Profile, and Growth Hormone Profile or IGF1.

THYROID ANTAGONISTS

High levels of soybean intake in animals has been implicated in diet-induced goiter in many studies. As soy isoflavones are increased in the diet, there should be an increase in iodide and selenium in the diet. One other study recently identified antagonist of thyroid hormone is L-carnitine. It is however effective for hyperthyroidism.

Some times patients who are put on medication will find that after an initial improvement, their symptoms either return or even worsen. This is because after taking thyroid medication the thyroid gland will actually stop producing thyroid on its own. Also, some people have an auto-immune problem where their own body is attacking the thyroid gland. It usually does this as a result of a viral or parasitic infection in the gland. Once the infection is eliminated, the person must be very careful to not take anything too stimulating to the thyroid as it can cause the immune system to attack the gland.

The most important thing is to be tested by a nutritionist in order to determine if you have any vitamin or mineral imbalances that are involved in thyroid function. Excesses of vitamins and minerals can also cause this condition by blocking the function of the nutrients above.

Diets low in protein and high in fats can interfere with thyroid function. Adequate protein is required in order to produce thyroid hormone. Fat has been found to be antagonistic to thyroid function and lower metabolism.

Thiocyanates found in vegetables from the cabbage family have an antagonistic effect to the thyroid such a broccoli, cabbage,cauliflower, turnips, mustard greens, kale, spinach, brussel sprouts, kohlrabi, rutabagas, horseradish, radish and white mustard . Excessive intake of Thiocyanates can cause a goiter. Goiter is an enlargement of the thyroid gland. The thyroid also becomes slow and under active with excess intake of these foods. These goitrogens have been demonstrated to decrease thyroid production as effectively as anti-thyroid drugs such as thiouracil.

The good news is that there is hope in correcting slow thyroid function in many people. Age is not a factor. As long as someone still has a portion of their thyroid gland undamaged, it is possible that it may begin to produce the hormone again on its own. However, nutritional therapy and an understanding if the intricate interrelationships between body systems can provide the foundation for a sound nutritional program. A comprehensive natural approach will address the entire problem, not just the symptoms. Nutrition for the thyroid should include support for the adrenals, liver, pituitary and the spleen.

I don not recommend that you try supplementing on your own with any of these nutrients. The purpose for this article is to educate you so you can make informed decisions about your health. I do recommend you seek the help of a trained nutritionist.

Call to set up a nutritional consultation so that tests can be performed and a comprehensive strategy of lifestyle, dietary modification and nutrient supplementation can be implemented to aid you in reversing this disorder.

For an appointment, contact our office at: 800-956-7083 and visit our web site www.completehealthinstitute.com go to lab tests and click on appropriate test for information.

Dr. Rispoli, Ph.D., L Ac. has had a clinical practice for over 20 years. Her programs work because she is so thorough in testing and providing a nutritional approach. Remember that the body can heal itself if given the proper nutrients.

The information herein is not intended as diagnosis, treatment or a cure. Should you have a medical condition please seek the advice of your medical doctor.