Healthy thyroid function is critical in keeping the body’s systems in balance. Here’s how to be proactive in helping support optimal thyroid function.
Low thyroid function is very common, yet it is often missed by many practitioners. In fact, low thyroid function is one of the most commonly undiagnosed causes of tiredness, weight gain, dry skin, depression, hair loss, and constipation. (see references below)
Sadly, many of my patients – men, women, and even children – have had these symptoms dismissed by their practitioners. Some of them have been told that their lab results fall within the “normal range,” so there’s “nothing wrong.” Yet they still don’t feel well.
Others who have been diagnosed with hypothyroidism and/or Hashimoto’s (an autoimmune thyroid condition), and may even be taking thyroid hormone medication, and yet they still have the symptoms of low thyroid function.
There’s a lot more to the story – and a lot more you can do. I’m going to go into great detail here, but if you take nothing else away from this post, please understand this: You can be VERY PROACTIVE about supporting and improving your thyroid function to “fill in the gaps” for what your body specifically needs.
Many of these issues can be resolved by addressing food, stress, nutrients, and by getting the right thyroid hormone replacement for your body. So, let’s explore reasons why your thyroid may not be functioning as well as it could, the issues low thyroid function can cause, and what you can do to get your thyroid function back on track.
Understanding the Thyroid
The thyroid is a vital hormone gland located in your neck. It has the job of setting the speed of your metabolism, body temperature, and regulating essential body functions. Metabolism is how your body uses protein, carbohydrates and fats from your food to make energy for your body. If your temperature is low and your metabolism runs slowly, then your thyroid may be under-functioning.
The thyroid gland produces thyroid hormone, called T4, which is released into the blood stream. T4 is converted to the active thyroid hormone, T3, in the liver, heart, muscles, gut, and nervous system. In the gut, the conversion to T3 requires an enzyme made by the gut bacteria – which means the health of your microbiome plays a role as well. So even though we talk about “thyroid function” as though it all happens in your thyroid gland, in actuality, much of your thyroid hormone levels are determined outside of your thyroid.
Many factors influence the ability of the thyroid gland to make T4. Many other factors affect the cells’ ability to convert T4 into T3. This is because the conversion from T4 into T3 happens in the mitochondria of the cells. So, anything that negatively affects mitochondria (such as pesticides, mold toxins, and nutrient deficiencies) will decrease active thyroid hormone levels.
Here’s the way I think about it. When your thyroid and thyroid hormone production is optimal, it’s at 100%. If your thyroid and thyroid conversion is decreased by half, you’d be at only 50%. You’d then need to take steps to either:
- Help improve the thyroid function to get it back up to 100%, or
- Fill in the missing 50% with an external source of thyroid hormone.
Optimally, we would be able to rely on our own thyroid to do the majority of the work. However, depending on your medical history, you may be reliant on external sources of thyroid hormone “filling” in the gap. This is particularly true for those who have had surgery to remove all or part of your thyroid (due to cancer or thyroid nodules), or those with autoimmunity, referred to as Hashimoto’s autoantibodies, which may have damaged part of your thyroid.
The most common cause of low thyroid function is due to an autoimmune condition where the immune system attacks the thyroid tissue, damaging it and resulting in lower thyroid hormone production. Hashimoto’s is eight times more common in women, and the onset is mainly between ages 40 and 60, however it can occur in children and men as well. Because the symptoms of low thyroid function might not occur until after the antibodies increase, many people have no idea that they have Hashimoto’s antibodies until blood tests are completed. Hashimoto’s does have a genetic predisposition and has been found to be triggered by stress, gluten exposure, and potentially a viral infection, such as Epstein Barr Virus (EBV).
Stress and the Thyroid
Stress, in any form, can decrease thyroid function due to an increase or decrease in the levels of our main stress hormone, cortisol. The body produces extra cortisol in periods of elevated stress. Normally, once the stress is over, cortisol levels return to a healthy amount. But when you are exposed to stress on a consistent basis, without enough recovery, the stress response gets out of balance and cortisol levels remain too high or too low. This affects thyroid function – leaving you with low thyroid function. We see the same effects on other hormones besides thyroid. And cortisol also disrupts the digestive system, the nervous system, and the immune system, predisposing you to autoimmunity.
Nutrient Deficiencies and the Thyroid
Our thyroid gland uses tyrosine and iodine to make thyroid hormone in the first place. Iron, zinc, and selenium are also used in the production of T4. B vitamins and CoQ10 are important for mitochondrial function, which is required for conversion of T4 to T3. If you are deficient in any, or all, of the necessary nutrients, your thyroid function may be low, and T3 production decreased.
It’s important to note that leaky gut can make you more susceptible to low thyroid function due to not being able to properly absorb the above-mentioned nutrients.
Symptoms of Low Thyroid Function
Many of the symptoms associated with low thyroid function are easy to overlook – especially with the non-stop schedules that many of us have. You might be thinking the way you feel is “normal” or caused by something else. The pattern of hypothyroidism becomes more apparent as more symptoms arise, and worsen, and as thyroid function decreases further.
Are you experiencing any of the following?
- Low energy at any point during the day, or all day long
- Difficulty losing weight (even with exercise)
- Feeling cold, especially hands and feet (even at normal room temperature)
- Hair loss (head and eyebrows) and/or coarse hair
- Nail changes (ridges, weakness)
- Dry skin
- Poor memory
- Fluid retention
- Joint pain
- Enlarged thyroid gland (goiter)
- Menstrual issues, such as heavy bleeding and PMS
- Fertility issues and miscarriages
Keep in mind that many of these symptoms could have other causes as well. This makes it critically important to look at blood work and other indicators. For instance, we want to look for these other issues:
- Low body temperature – less than 98.6 degrees Fahrenheit
- Decreased reflexes, in particular at the Achilles tendon, and
- An enlarged thyroid gland (it might feel like a lump in your throat).
- Elevated cholesterol levels
Monitor Your Body Temperature
You can do this at home with a thermometer. Normal body temperature is 98.6oF. If your temperature is consistently lower than this, then you may have low thyroid function.
The way I suggest checking your body temperature is to check your ORAL temperature three times per day for five consecutive days. For each day, add the three temperatures together and divide by three to find your average temperature for that day. It’s best to use a mercury-free liquid metal thermometer. This information is based on my training with Dr. Denis Wilson, a thyroid function expert.
Next, it is important to look at blood tests to get a better sense of your overall thyroid function. At the same time, as much as I’d like to say that thyroid blood tests are super specific in identifying low thyroid function, they’re not. We have to consider the whole picture – how you feel, your body temperature, and then also, your thyroid hormone levels in your blood.
Blood Tests for Thyroid Issues
The standard medical and endocrinology approach is to run blood work to check to see if your thyroid is under-functioning… and to what degree. Unfortunately, unless your symptoms are severe, there’s a good chance most doctors won’t even run thyroid tests. And when they do, they won’t consider it low thyroid function unless the levels indicate severe under-functioning.
And the common “thyroid panel” that is run does not provide all the information we need about your thyroid. Instead, we need to see:
- Free T4
- Free T3
- Reverse T3
- Thyroid antibodies – ATA and TPO
These tests are offered by all the common labs, but they are not usually included in annual blood work, so be prepared to ask your doctor to order them, or to order them yourself and pay out of pocket.
It is best to have your blood drawn in the morning, before you eat, and if you take thyroid hormone replacement, have your blood drawn BEFORE you take your thyroid dose for the day.
Even with the information from these tests, we need to consider your individual variability of these levels. I recommend comparing the levels over time to help us identify changes and patterns for your body. There can be variations in your results based on time of day and the lab that runs your panel, so it is best to use the same lab each time.
Let’s talk them through one by one.
Check TSH Levels
TSH (Thyroid-Stimulating Hormone) is a hormone produced by the pituitary gland in the brain that stimulates the thyroid gland. When the number is higher (above 2.5), it means the pituitary is having to “turn up the volume” on the signal to your thyroid gland, which indicates a low functioning thyroid. However, it’s important to know that the TSH is not the only way to identify low thyroid function, because sometimes TSH can be in the “normal” range, and still thyroid function could be suboptimal.
According to endocrinology journals, the optimum range for TSH should be between 0.5 and 2.5, even though the reference range on most lab results is 0.5 to 4.5.
Check Free T3 and T4 Levels
Instead of checking “Total T3 and Total T4” it is much more helpful to know the amount of thyroid hormone that is free to be active in your blood stream. That is why it is important to ask to check “Free T4” and also “Free T3.”
Checking just T4 is not enough information because T4 is the inactive hormone that is converted in the cells of the body to active T3. And we want to know about your ACTIVE thyroid hormone level, so we need Free T3.
If possible, you should also ask for the Reverse T3, which shows if T4 is getting converted to active T3 or inactive T3 (called Reverse T3).
Check for Thyroid Antibodies
Thyroid antibodies tell us whether your immune system is making autoimmune antibodies directed at your thyroid gland. That means that your immune system is protecting you from your own thyroid gland. Over time, your own immune system can destroy your thyroid tissue, which causes a decrease in thyroid function. The two antibodies that cause low thyroid function – referred to as Hashimoto’s thyroiditis – are anti-thyroglobulin (ATA) and thyroid peroxidase (TPO).
Note that Grave’s disease is a different thyroid autoimmunity which causes hyperthyroidism, or over functioning of the thyroid gland, and can in some cases be triggered by the above mentioned antibodies, but more often by thyroid stimulating antibodies. And the treatments for Grave’s most always result in hypothyroidism in an effort to turn off the thyroid gland.
Additionally, in blood work, ask to check for the nutrients that are important for thyroid function and preventing thyroid antibodies:
- Iron – the blood test is Ferritin
- Zinc, RBC
- Vitamin D
These blood tests are fundamental for getting a clear picture of your thyroid health. You’ll want to plan to recheck these levels four to six weeks after each step you implement and after you make any changes to your thyroid hormone prescription. That is the best way to evaluate and make sure your doses are helping you as best they can.
Other Tests to Address Thyroid Function
- Cortisol levels. We check cortisol levels (in urine or saliva) at different times of day – morning, mid-day, evening, and bedtime. This panel is offered through my office.
- Adrenaline and neurotransmitter levels. These tell us about whether you need tyrosine, and whether stress has disrupted the neurotransmitter levels, potentially causing some of the same symptoms caused by low thyroid function. We need all of them to be in balance for you to feel well. This panel is offered through my office.
- IgA and IgG food sensitivity panels. These tests are important because they identify if certain foods are triggering inflammation that can affect your thyroid and mitochondria. Gluten, for example, is associated with Hashimoto’s antibodies and low thyroid function. Plus, the results will indicate whether or not leaky gut is present, and whether we need to address it. This panel is available to be done at home here.
- Organic acid panel. This test is the best way to check on mitochondrial function. It is a urine panel that looks at metabolites in the body, including the mitochondrial metabolites. In addition to telling us how your mitochondria are working, this panel has other benefits as well. It can indicate if you may have toxicity due to mold, overgrowing yeast or bacteria, and/or nutrient deficiencies. All these factors can help us understand the underlying causes of your low thyroid function so we can come up with a treatment plan. This panel is offered through my office.
If you have determined that your thyroid could be working better, it’s time to consider options, including diet changes, herbs*, and nutrients to help your thyroid function better. This can be done alongside thyroid hormone replacement.
In doing so, we can determine an individual approach that matches your body.
Improving Thyroid Function
After helping hundreds of patients with low thyroid function over the last 20+ years, I always start by understanding the cause in each person, gathering information from your symptoms and test results before identifying the best first step—which can be different for each person. There is no one right answer for everyone.
I have low thyroid function—as does my mother—so I know from first-hand experience, that it is not something that should stop you from feeling well. I’m going to share exactly what I’ve done for myself, and suggested for my mom and patients over the past 20 years.
The 5 Steps to Get Back to Healthy Thyroid Function
Step 1: Dietary considerations
I’ve seen patients who got their thyroid back to optimal function simply by changing what they eat.
The first thing we need to know is whether you are eating anything that could be slowing down your thyroid function. There are several possible ways that food can affect thyroid function. Let’s look at these in particular:
- Goitrogenic foods (which can interfere with iodine and lead to a goiter) include soybeans and soy products, raw cruciferous vegetables (broccoli, cabbage, cauliflower, and turnips), peanuts, flaxseeds, strawberries, pine nuts, pears, peaches, spinach, and sweet potatoes. It is only if you eat too much of these foods that it could inhibit your thyroid hormone production. What’s too much? If you eat them three times a day every day, for example.
- Gluten interferes with thyroid function by causing leaky gut and potentially triggering the production of autoimmune antibodies that attack the thyroid and slow thyroid function.
A great place to start is with the Stress Remedy Program, which guides you to avoid gluten, as well as dairy, soy, egg and sugar. It is a program to help you get your foods working for you instead of against you. And to start you on the path of healing leaky gut and recovering from stress.
Get thyroid nutrients from your food:
- Seaweed – high in iodine
- Pumpkin seeds, cashews, and chicken – all high in zinc
- Brazil nuts, sunflower seeds, and chicken – high in selenium
Step 2: Nutrients, Herbs, and Supplements
In general, it is good to start by taking a multivitamin* (such as this one) that contains the most bio-available forms of B vitamins, including riboflavin (B2), methyl-folate, and methyl-cobalamin (B12), minerals, and iodine.
It is also important to consider taking a probiotic, because healthy gut bacteria help with thyroid hormone conversion from T4 to T3.
From there, we want to address any nutrients that are low on your blood results, such as iron and iodine. It is important NOT to overdo the iron or iodine, so be sure to work with a practitioner and recheck your blood levels every 3-6 months to be sure you are getting in the perfect range for your body.
There are many herbs* that support thyroid function including:
- Nettle leaf
- Blue Iris root
There are formulas available that contain the nutrients and herbs that are important for thyroid function, including iodine and tyrosine, as well as the herbs that support it. Here is an example.
In addition to nutrients and herbs, or for those people who are sensitive to other approaches, homeopathic remedies can offer gentle support. These are remedies that support thyroid function using minute doses of herbs or other substances in pill or liquid form. A practitioner with training in homeopathy (like me) can help you determine the right remedy for you.
Khavinson Peptides (which I’ve spoken about at length here) are becoming widely regarded for their ability to connect with and reset specific areas of the body. In this case, we would use the peptide for thyroid to reset the function of your thyroid gland. Find it here
Step 3: Exercise
Exercise increases thyroid function. But it’s important you don’t overdo it. If you feel very tired, it may be that we need to start with diet changes and hormone balancing to get you feeling better and your body ready for exercise. Interestingly, singing and breathing exercises have been shown to get your thyroid working better.
When you are ready to exercise, it is important to know that Hashimoto’s can predispose you to more lax joints, which means you could experience injuries during exercise and lifting weights, more so than other people. And yet, strength is important and helpful for thyroid function. So I recommend checking out and learning from my friend and colleague, Dr. Emily Kiberd who has figured out the best way to exercise when you have Hashimoto’s.
Listen to the podcast where I discuss this with Dr. Kiberd.
Learn about Dr. Kiberd’s Thyroid Strong ONLINE exercise program.
Step 4: Adrenal Gland Optimization
From beginning to end of this process, it is important to assess adrenal function and cortisol levels in order to determine whether optimization is needed. The thyroid and adrenal glands are interdependent. Under-functioning in one can cause lower function in the other. It is only when we ensure that both are working well that you can optimize your energy, mood, weight, hair, and more.
This may involve taking herbs, nutrients, Khavinson peptides and/or adrenal glandular to support adrenal function depending on whether you need more or less cortisol. You can read more about optimal cortisol levels here: Is Your Cortisol Optimal?
I encourage you to work with a practitioner who has a lot of experience because so many people struggle to get their adrenal function optimized, and there are important phases that make the process more efficient.
Step 5: Natural and Synthetic Hormones (Medication)
Depending on how much Steps 1 through 4 help to improve your thyroid function, you may need to take thyroid hormones in a pill form to make up for the missing thyroid function.
In essence, the medication will “fill in” for your reduced thyroid function by boosting the amount of thyroid hormone available in your system. Unfortunately, there is no test that can tell us exactly how much additional hormone you need; the only way to know is to try it, observe the effects, and adjust the dose. With careful monitoring, your blood work (and the way you feel) will indicate that your thyroid function is improving.
It is also important to take your thyroid hormone pill away from certain other things that can bind to it and prevent it from being absorbed. That’s why you have been told to take your thyroid medication on an “empty stomach.” Here’s the thing – it can be easiest to take your thyroid first thing in the morning, but it doesn’t have to be away from everything. As long as you take it at least an hour before or after the following list of 5 substances, that will be fine.
Don’t take your thyroid pill at the time as:
* Coffee and black tea
* Fiber (like psyllium)
There are two options for thyroid hormone – synthetic (man-made) and glandular (from an animal source).
The most common prescription form of thyroid hormone replacement is levothyroxine or Synthroid. It contains T4 which still needs to be converted to T3 in your body. Studies have shown that many people who take Synthroid still have low thyroid symptoms.
There are also prescription forms of T3, and T4 combined with T3, available. The dosing with T3 can be difficult because it needs to be taken at exactly the same time of day, every day, but it can make a world of difference if your body is struggling to convert T4 to T3.
Glandular thyroid (or natural thyroid hormone) contains both thyroid hormones (T3 and T4). This can be a very helpful approach in that you’re not as reliant on your body doing the conversion.
There are over the counter and prescription forms of glandular thyroid – the most well known are Armour and Nature Throid. Some, like Armour and Nature Throid, are made from thyroid hormones taken from pigs while others come from cattle. Different people will respond differently to these glandular thyroid replacements, especially because many of them contain other ingredients (such as lactose) that may trigger a negative response. The only way to know which is going to work best for your body is to try them out.
Note: If you have thyroid antibodies, it is also possible that your immune system could react to the glandular thyroid and make you feel worse. The best thing to do is to work with a practitioner who can help fine-tune the dose for you.
Improving your thyroid function can make every difference in your health. It can affect everything from how you feel on a daily basis to addressing particular issues such as fertility.
Working with a practitioner to monitor your symptoms and blood levels can help ensure you are reaching the optimal range for you. (NOTE: If your thyroid function is too high it can cause anxiety, sleep issues, weight loss, and bone loss – so we don’t want that either!)
- I highly suggest considering my Adrenal Recovery and Wellness Program which includes a food panel and a cortisol panel, both of which are beneficial to identifying and addressing the causes of low thyroid as mentioned above.
- We can also schedule a Quick Insights or Comprehensive Consultation as a starting place to determine what you need to do to improve your thyroid function and to address the underlying causes.
- You’ll find thyroid supportive products (nutrients, herbs, and homeopathic remedies) that I have vetted for quality and effectiveness online at DrDoniStore.
- If you’d like to work with a naturopathic physician (ND or NMD), it’s important to know that NDs can prescribe thyroid hormones in certain states. This is limited to certain states that license NDs to prescribe (AZ, CA, HI, ID, KS, ME, MT, NH, OR, WA, VT). I am licensed and practice in Arizona, Washington and California.
More than anything, I want you to know this: Don’t ignore low thyroid function. It is real and has real consequences. Addressing the underlying causes of thyroid function can make a world of difference in terms of your energy, mood, memory, digestion, skin, hair, and body weight.
Plus, low thyroid function is associated with increased risk of heart disease, for both men and women, and dementia, so in my mind, it is essential to keep your thyroid function as well as possible.
All the best to you, as always!
4th June 2020
*Please use any and all supplements with caution. This include nutrients, herbs, enzymes, or other. My recommendation is that you seek the care of a naturopathic doctor (with a doctorate degree from a federally-accredited program) and that you have a primary care physician or practitioner whom you can contact to help you with individual dosing and protocols. If you ever experience negative symptoms after taking a product, stop taking it immediately and contact your doctor right away.
- Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado Thyroid Disease Prevalence Study. Arch Intern Med. 2000;160(4):526–534. doi:10.1001/archinte.160.4.526
- Peterson SJ, McAninch EA, Bianco AC. Is a Normal TSH Synonymous With “Euthyroidism” in Levothyroxine Monotherapy?, The Journal of Clinical Endocrinology & Metabolism, Volume 101, Issue 12, 1 December 2016, Pages 4964–4973, https://doi.org/10.1210/jc.2016-2660
- Sheehan MT. Biochemical Testing of the Thyroid: TSH is the Best and, Oftentimes, Only Test Needed – A Review for Primary Care. Clin Med Res. 2016;14(2):83‐92. doi:10.3121/cmr.2016.1309
- Losurdo G, Principi M, Iannone A, et al. Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm. World J Gastroenterol. 2018;24(14):1521‐1530. doi:10.3748/wjg.v24.i14.1521. doi: 10.3748/wjg.v24.i14.1521.
- Krysiak R, Szkróbka W, Okopień B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Exp Clin Endocrinol Diabetes. 2019;127(7):417‐422. doi:10.1055/a-0653-7108
- Liontiris MI, Mazokopakis EE. A concise review of Hashimoto thyroiditis (HT) and the importance of iodine, selenium, vitamin D and gluten on the autoimmunity and dietary management of HT patients.Points that need more investigation. Hell J Nucl Med. 2017;20(1):51‐56. doi: 10.1967/s002449910507