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The Hidden Culprit: Thyroid Imbalance and What to Do

AboutIt
Asluggishthyroidcanleaveyouoverwhelmed,rundownanddepressed.Thisthreestep
holisticplancanputyoubackontrackandgetyoumovingagain.
Six years ago, I was a 38yearold stressedout mess, working as a doctor at an HMO and
seeing 30 OB/GYN patients a day. Id wake up exhausted every morning, nurse my infant
daughter,andracefromonetasktoanotheruntilIdarrivehometocareformybabyagain,
cookdinner,andfallintobedonlytostartalloverthenextmorning.Mymoodtanked,my
weightclimbed,myfocussuffered,andmysexdrive?Whatsthat?Yoga provided my only
respite,butunfortunately,myhomepracticewitheredasmytodolistgrew.
Howdidthishappen?Asadoctor,
Mymoodtanked,myweightclimbed,myfocussuffered,andmy
sexdrive?Whatsthat?
shouldntIhaveknownbetter?My
Harvard medical training finally
kickedin:Couldthisbemythyroid?Turnsoutitcouldanditwas.

ALittleTroublemaker
Yourthyroid,atinybutterflyshapedglandinyourneck,mayweighonlyanounce,butasI
learned firsthand, it wields formidable influence on your metabolism, mood, and body
temperature.Mysymptomsallpointedtoasluggishthyroid,whichshoulderstheblamefor
a whole litany of complaints, such as middleaged spread, hair loss, poor concentration,
depression,constipation,achingmusclesandjoints,lowlibido,andevenrisingcholesterol.
Toaddinsulttoinjury,anunderperformingthyroidcanevenraiseyourriskofAlzheimers.
Ifthatlistsoundsfamiliar,itsbecausewemayverywellhaveanepidemicofborderlineto
lowfunctiononourhands.Considerthesestatistics:20percentofwomenaged40andover
havehypothyroid(lowthyroid)symptomswomenareseventimesmorelikelytosufferwith
thyroidproblemsthanmenratesofthyroidcancerhaveincreasedsteadilyforthepast30
years,fornoapparentreasonandsome80millionpeopleworldwidehaveswollenthyroids
(goiters) caused by a completely preventable iodine deficiency. Nor do these numbers tell
the whole story: thousands of people go undiagnosed, and thousands more dont get the
treatment they need for the fatigue, depression, and weight gain that accompany low
thyroid.

ABriefPhysiologyLesson
Before we explore the reasons for such a monumental increase in thyroid problems, lets
take a moment to understand what the thyroid actually does. Your thyroid converses with
everycellinyourbody,asitgovernstherateofnearlyallthebodysbiochemicalreactions.
Together with the hypothalamus and pituitary gland it forms the hypothalamicpituitary
thyroid(HPT)axis,whichisthemasterregulatorofyourmetabolism,includingyourheart
rateandbodytemperature.Usingiodine,thethyroidproducestwohormones(thyroxineor
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rateandbodytemperature.Usingiodine,thethyroidproducestwohormones(thyroxineor
T4 and triiodothyronine or T3) and stores them, awaiting instructions from the
hypothalamus and the pituitary gland. The hypothalamus shoots the pituitary a chemical
signal telling it when to deliver the hormones, and the pituitary responds by dispensing
thyroidstimulatinghormone(TSH),whichtellsthethyroidjusthowmuchorhowlittleto
release.

Forpeoplelikemewhohavesluggishthyroids,thethyroidglandreleasestoolittle.Others
havetheoppositeproblemthethyroidreleasestoomuchintothebloodstream,resultingin
weightloss,increasedpulserate,heartpalpitations,andmuscleweakness.

WhytheEpidemic?
No one knows why we have such an astonishing increase in thyroid problems. But we do
knowthatthethyroidisextremelysensitivetoenvironmentaltoxins.Anythingfromexcess
gluten in our food supply to endocrine disruptors in the products we useBisphenolA
(BPA) in our water bottles, phthalates in our cosmetics, and flame retardants in our
mattressescancauseittomalfunction.Andwecanalsopinsomeculpabilityonthatever
presenthealthwrecker,chronicstress.Itplaysapartinmostofourhealthproblems,soits
hardlysurprisingthatanunabatedstressresponsewouldhavearoleintheemergingslow
thyroidstory.
Chronicstresscanmakeyoufeellikeyourthyroidisatotalslackerthatsnotdoingitsjob,
eventhoughyourbloodtestscomebacknormal.Whatgives?Whencortisol,themainstress
hormone,eithersoarstoohighorsinkstoolow,itblocksyourbodysabilitytomakeT3,the
active thyroid hormone, even when your pituitary sends the right signal. So, when your
doctormeasuresthepituitarysthyroidstimulatinghormoneitmayindeedbenormal,but
yourbodymaynotbeconvertingtheinactivehormones(theT4s)intoanactiveformitcan
use (T3). If that is the case for you, I generally recommend checking your basal body
temperature,asimplewaytoassessthyroidfunction,especiallyifyoureunderalotofstress
(seebelow).
Unfortunately, Western doctors
Chronicstresscanmakeyoufeellikeyourthyroidisatotalslacker
thatsnotdoingitsjob,eventhoughyourbloodtestscomeback
dont
always
make
the
normal.
cortisol/thyroid connection. When
they detect deficient thyroid hormones in their patients, they immediately start them on
syntheticmedication,usuallyT4.ButIdontbelievetheanswerautomaticallyliesinabottle
of prescription pills. When my own thyroid problems surfaced, I turned to a more
integrative approach, taking a hard look at my stress levels, as well as my diet and other
lifestylechoices.

AnIntegrativeApproach
After my own experienceand as an integrative docI know better than to tell anyone
struggling with these symptoms to just exercise more and eat less. Janie, a 41yearold
woman,isacaseinpoint.Shecametoseemehopingtofindanswersforherflaggingenergy
andcrankymoods,aswellasherunforgivingmetabolismthatkeptanextra10poundson
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herframenomatterhowmuchsheexercisedorhowlittlesheate.ImmorenegativethanI
used to be, she said. The usual life problems feel more difficult to solve, and I cant
concentratelikeIusedto.
Shesaidthesesymptomshadbeengoingonfortwoorthreeyears,withherdoctorinsisting
all the while that her hormone levels were just fine but in reviewing her lab results, I
noticed that her thyroid was borderline slow. Instead of trying to solve all her individual
symptoms,Isuggestedwefocusontheirunderlyingcause.
Root cause analysispracticed for millennia in Traditional Chinese Medicine (TCM) and
ayurvedalooksintowhyasetofsymptomskeepsoccurring.Inmycase,insteadoffillinga
prescription for synthetic thyroid hormone, I took time to reassess my lifestyle. Could the
stress of a new baby plus an overthetop busy practice and an overachieving personality
have anything to do with my hormone imbalance? What could I give up or change that
wouldmakemylifeeasierandultimatelyhealthier?
IhelpedJaniefacesimilarquestions.Togetherwecameupwithaplanthatalsotookinto
accountherperimenopausalfluctuations.
Icallthisthyroidreclaimingprotocolevidencebasedintegration,whichmeansIcombine
the best of ancient wisdom traditions (yoga, ayurveda, and Traditional Chinese Medicine)
and cuttingedge science (bioidentical hormones and even prescription drugs when
absolutely necessary) to help prevent or heal thyroid dysfunction. One caveat, however:
Overt symptoms, including labored and slow breathing or the more serious thyroid coma,
needimmediateWesternintervention.

3StepstoRebalanceYourThyroid
1.NutritionandNutraceuticals:Whenyouknowyourthyroidisoutofbalance,takea
hard look at your diet. What you put in your mouth may profoundly affect your thyroid
function. Certain very common foods and nutritional supplements can help reset your
thyroid.
Whenyouknowyourthyroidisoutofbalance,takeahardlookatyourdiet.
Eat brazil nuts. Brazil nuts are rich in selenium, which is a crucial nutrient for thyroid
function. Selenium has recently gotten attention for its connection to fertility, which may
also be directly tied to normal thyroid function. Other sources of selenium include eating
shellfish, particularly crab, and foods from composted soils. Many holistic doctors
recommendusingcoconutoilitsworthatry,butIcouldnotfindconvincingevidencethat
itactuallyaffectsthyroidfunction.
Check your iodine levels. Your thyroid gland depends on iodine to make its hormones.
Levels among Americans dropped by half between 1971 and 2000, when bakers in the
United States began using bromide instead of iodine as a dough conditioner for making
bread. Also found in soda, bromide competes with iodine, which means that it can block
your absorption of iodine even when you think youre getting enough. Solution? Dont eat
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your absorption of iodine even when you think youre
getting enough. Solution? Dont eat
bread with bromide or drink soda. Make sure you are getting sufficient iodine to support
normal thyroid hormone production by getting at least the RDA (Recommended Daily
Allowance).Note:Anyonewithautoimmunethyroiditisshouldnotsupplementwithiodine.

Considersupplements.Unlessyouliveonanorganicbiosustainablefarmoreatexclusively
from composted soils, you probably lack sufficient levels of mineralsparticularly copper,
zinc, and seleniumthat help convert the inactive thyroid hormone T4 into T3, its active
counterpart (see sidebar on page 58). Have your levels tested, and if low, take a daily
mineralsupplementthatcontains500mcgto1mgofcopper,10to15mgofzinc,and200
mcgofselenium.
IncreaseyourvitaminD.ThebodyneedsvitaminDtodrivethethyroidhormoneintothe
coreofthecell.Otherwise,itcantperformitstaskwell,andyoulllikelyfeelslow,tired,and
apathetic. Unless you live in a sunny climate yearround, you need to supplement your
vitaminD,sincefoodrarelyprovidesadequateamounts.Shootforthehighnormalrange
1,000to2,000IUaday.Maximumdosesare10,000IUperday,andtoxiclevelsarerarely
encounteredevenatthesedosages.
Giveup(orlimit)certainfoods.WhenIfirstheardthattofu,broccoli,andevenmybeloved
kale could slow me down by interfering with thyroid hormone production, I refused to
believe it. Sadly, reliable data support that theory. While not all goitrogens (foods that
interfere with iodine uptake and thyroid function) are well documented, one study in
particularshowedthatisoflavonesfromsoycanreduceT3by7percentinwomenwhohave
hadtheirovariesremoved.Youmaywanttoatleastlimitthesefoodstobeonthesafeside.
2. Targeted Lifestyle Changes: These commonsense lifestyle changes have proven
effectiveinreducingthyroidrelatedsymptoms.
Minimize environmental toxins. Limit exposure to flame retardants found in mattresses
mercury found in fish, high fructose corn syrup, and dental fillings and plasticizers
(phthalates)foundincosmeticstodissolveingredientsandtomoisturizetheskin.
Try Traditional Chinese Medicine. Most Western doctors learn to treat the thyroid in
isolationbytweakingthebiochemistrywithapillorsurgery.TCMpractitionersmostoften
identifykidneydeficiencyastherootcauseandmayfurtherseeaproblemwiththeheartor
livermeridians.TCMisagreatplacetostartifyoursymptomsaremild,becausethereare
fewsideeffects.
Practiceyoga.Althoughlimiteddataexistshowingthatyogaincreasesthereleaseofthyroid
hormones,manywomenreporttheirsymptomsimprovedwhentheycommittedtoaregular
practice. Timothy McCall, MD, a Westerntrained internist and author of Yoga as
Medicine (Bantam, 2007), points out, Many things from the yoga tradition that havent
beentestedturnouttobetrue,andaslongasyogasdoneappropriately,thereslittleriskin
doing asanaand many benefits beyond just helping the thyroid. B. K. S. Iyengar
champions sarvangasana (shoulderstand) as a way to balance the thyroid, because it
employsachinlock.However,Idontusuallyrecommendunsupportedshoulderstandtomy
patients,especiallythosewhoarenewtoyoga,becauseoftheintensepressureitplaceson
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patients,especiallythosewhoarenewtoyoga,becauseoftheintensepressureitplaceson
thetinycervicalvertebrae.Ipreferardhahalasana(halfplowposewithyourlegsrestingon
achair)orviparitakarani(legsupthewallpose),bothofwhichoffergentleralternatives.
I also prescribe shavasana to my
stresscase clients every chance I
get. This deep relaxation pose
gives the master glands (the hypothalamus and the pituitary) a break from their redalert
vigilance. Ellen Heed, an anatomy teacher for Forrest Yogas teacher training program,
agrees. Weve bought into the idea that we need to spend 75 percent of a 24hour day in
highproductivity,andwhittlesleepdowntosixhourspernight,shesays.Deephealingis
not possible at night with that approach. The result? Organs, such as the thyroid, dont
replenishreserves,andmetabolismsuffers.
B.K.S.Iyengarchampionssarvangasana(shoulderstand)asaway
tobalancethethyroid,becauseitemploysachinlock.

Considerstructure.StructuralissuescanalsoaffectthethyroidsomethingIneverlearned
inconventionalmedicaltraining,butacoreconceptinmyyogateachertraining.Whenyou
holdstressinyourjaw,forexample,oryourneckandshoulders,youchronicallytightenthe
musclesthatmay,theoretically,reducethebloodflowintoyourthyroidandpreventoptimal
outflowoftoxinsandwaste.Aconsistentyogapracticecannotonlyreleasethattension,but
alsohelpyounoticewhenyoustartgrippingthoseareasofthebody.
Reduce stress. While scant research exists on yoga and thyroid health, studies point to
yogas ability to reduce the stress hormonesparticularly cortisolthat interfere with
normal thyroid function. A full yoga sequence, including simple breathing practices, may
indirectly have a profound effect on the thyroid. Your endocrine glands, like the thyroid
and the adrenals, need regular doses of deep relaxation to regenerate, explains Heed.
Furthermore,inaverysmallstudyatJeffersonMedicalCollegeinPhiladelphia,participants
were
able
to
reduce
their
cortisol
levels
doing
sequences
that
included sarvangasana (shoulderstand), halasana (plow pose), and vrikshasana (tree
pose).
Isuggestspendingatleastsixweeksfocusingonnutritionandlifestylestrategiesandthen
having your thyroid hormones and BBT rechecked. (Six weeks is the minimum amount of
time it takes for your body to reach homeostasis.) If you dont see the improvements you
hopedfor,youmaywanttoconsiderbioidenticalhormonesasashorttermsolution.
3.BioidenticalHormones:Whenchangestoyourdietandlifestylestilldontallowyour
body to produce enough hormones to balance your endocrine system, bioidentical
hormonesgiven in the lowest possible dosemay be your best alternative. These
medications,structurallythesameasthehormonesyourbodymakes,arenopanacea,but
canoftenquicklycorrectirregularthyroidlevels.
Thyroidhormonesarenotonesizefitsall.Somewomendowellwithanaturaldessicated
thyroidmedication,suchasArmourThyroidorNatureThroid.Forothers,Irecommenda
syntheticpreparationsuchaslevothyroxine(T4)withorwithoutliothyronine(T3).Tofind
out which one is right for you, check with your holistic health practitioner. Tracking
symptoms, checking your basal body temperature, and getting the correct blood tests will

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symptoms, checking your basal body temperature, and getting the correct blood tests will
informyourpathandnextsteps.
If you suffer from fatigue, weight
gain, depression, and a host of
other unexplainable symptoms, try some of these tests and techniques to assess your
thyroid, even if your more conventional lab tests come back negative. With a rigorous,
integrative strategy, you can get to the root of your malaise. And, believe me, once your
thyroidisbackworkingforyouinsteadofagainstyou,youllhavethatlongedforzipbackin
yourstep.
Thyroidhormonesarenotonesizefitsall.

DecipheringtheThyroidPlayers:
TSH ThyroidStimulating Hormone. Released by the pituitary gland, this is the most
commonly tested thyroid hormone in Western medicine. Higher levels, above 2.5 mIU/L,
suggestborderlinetolowthyroidfunction.
T4Thyroxine. T4 is the inactive thyroid hormone, generally kept in storage in the thyroid
glanduntilitsturnedintoT3,theactivethyroidhormone.
T3 Triiodothyronine. T3 is the active thyroid hormone, which means it has the most
profoundeffectonyourmetabolism,heat,andweight.
RT3 Reverse T3. RT3 is made in excess during times of stress, which can cause thyroid
resistancebyblockingthethyroidhormonereceptor.Inotherwords,whenyourestressed
out, the body responds by making reverse T3, which keeps you from losing weight or
controllingyourmoodswings.ReverseT3isthebodyswayofadjustingmetabolism,such
asduringafamine,andwemaketoomuchthesedaysbecauseofstress.

TaketheThyroidQuiz
Threeormoreofthesesymptomsmaymeanthatyourthyroidisworkingagainstyou.
Youvepackedonafewpoundsandcantgetthemoff.
Youlookatapieceofpieandtheextrapoundsappearonyourhips.
Yourbodyfeelsalittleslow,maybealittletired.
Whatsthatcalledagain?Oh,yesbrainfog.
Yourreflexesaresluggish.
Yourhairisdry,tangleseasily,orisfallingout.
Yourjointsfeelgeriatric.
You wear more layers than anyone you know. Your spouse has terms of endearment
foryourcoldfeetandhands.
Youvelostabitofspringinyourstep.
Theworldisntquiteasrosyasitusedtobe.
Youre slower than you used to beyour reactions, your thoughts, and, yes, your
thyroid.

BasalBodyTemperature

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Basal body temperature (BBT) offers an important lowbudget assessment of your thyroid
functionyoushouldconsidertakingyourBBTevenifyourbloodtestscomebackwithinthe
normalrange.BBTmeasuresyourT3activityinsidethecells,whichiswherethyroidtruly
affectsmetabolism.DoctorsusedtorecommendBBTmostlyforwomenwhoweretryingto
conceive,butnowIencourageanyonetryingtoassesstheirthyroidhealthtokeeptrackof
theirbasalbodytemp,especiallythosewhosufferfromchronicstress.
HereshowtomeasureBBT.Youneedaspecialbasalbodythermometer,whichdiffersfrom
otherthermometersbecausethetemperaturesrunlowerthantheusual98.6F.Whenyou
wakeup,butbeforegettingoutofbed,putthethermometerunderyourarmpitforagood10
minutes.Remainasstillaspossiblenomultitasking.Recordthetemperatureatleastthree
daysinarow.Ifyouremenstruatingregularly,measureBBTondays2through4ofyour
period. The normal range is 97.8F to 98.2F. If your reading comes in below that, your
thyroidisprobablyunderactiveandyourmetabolismtoolow.

TheNewNormal
Manycliniciansuseoldschoolnormalrangesforthyroidhormonesandmayalsoneglectto
order the correct tests. Some physicians havent updated their data bank since medical
school, decades before. Thats where your empowerment, knowledge, healthy skepticism,
andintuitioncomein.
More than 10 years ago, doctors were taught that they needed to test only the thyroid
stimulating hormone levels to determine whether your thyroid functioned normallyand
that those levels needed to be between 0.5 and 4.5 mIU/L. Ten years ago, the American
Association of Clinical Chemistry published new rules that changed the upper limit of
normal TSH to 2.5 mIU/L. A year later the American Association of Clinical
EndocrinologistsjumpedontothebandwagonandloweredthetargetrangeforTSHto0.3
to3.0mIU/L.Makesureyourprimarycarephysicianusesthemostrecentguidelines.

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