If you have been suffering from any thyroid condition and are still symptomatic but cant understand what you’re doing wrong… You are not alone.
You have seen multiple physicians… You easily get upset… You’re cold, you’re hot… You cant get your GI system to function well…. Just to name a few things you have experienced today…. You are not alone.
Your baby/child is hyper emotional, cries often, cant get a hold of their feelings and it doesn’t seem quite “normal” to the extent this occurs…. You are not alone
Before we dive into why you’re still symptomatic, lets briefly go over the basics.
The thyroid is a butterfly-shaped gland located on the front of the neck. It secretes three hormones and affects the developmental, cardiovascular and metabolic system in the body. The treatment for thyroid disorders is very misunderstood by many.
Function
The thyroid secretes three hormones:
- Triiodothyronine (T3)
- Thyroxine (T4)
- Peptide hormone (Calcitonin)
The Thyroid Influences
- Metabolic rate- T4 and T3 hormones help regulate your appetite, the absorption of food and gut motility. This can have an affect on your blood glucose, the way you break down fats, cholesterol, and secretion of bile. Many thyroid patients suffer from Gut dysbiosis, which basically means your gut is off balanced. Gut health is very important in the treatment plan of thyroid patients.
- Cardiovascular- Thyroid hormones help control blood flow and body temperature.
- Developmental- Thyroid hormones play an important role in normal growth and brain development, particularly brain maturation in the first few years of life.
- Calcium homeostasis- Calcitonin regulates blood calcium levels by decreasing it when necessary.
- Other- Sexual function, menstrual cycle, sleep, and thought process are all affected by thyroid hormones.
Thyroid Hormone Regulation
The pituitary and the hypothalamus control the thyroid gland. The production of T3 and T4 is regulated by TSH (TSH is released by the pituitary gland). TSH is regulated by thyrotropin-releasing hormone (TRH), which is produced by the hypothalamus. When thyroid hormones are too high, TSH production is suppressed and vice versa when thyroid hormones are too low. Still with me?…..
-TSH regulates T3 and T4
-Pituitary releases TSH
-Thyrotropin (TRH) regulates TSH
-Hypothalamus produces TRH
These thyroid hormones and regulators are on a continuous feedback loop. Feedback loops refer to the nervous system telling the endocrine system to control body conditions by receiving a signal, responding with the proper hormone and reacting. The hypothalamus acts like a thermostat of a feedback loop, the endocrine glands act like an air conditioning system and both determine if you need added heating or cooling to maintain balance.
- TSH– A high TSH is telling your body to produce more hormones.
- Free T4– This hormone is stored until needed. When the body needs more hormone, T4 will convert to the active form of T3
- Free T3– is the active hormone that is unbound and able to enter and affect the body tissues.
- Reverse T3– An inactive form of T3. Your body will rid of unneeded T4. It is suggested that 40% of your T4 hormone will convert to T3 and 20% of unneeded T4 will go to reverse T3. If you’re sick or your body is under going an inflammatory process (i.e surgery, chronic stress, the flu) then your percentages will change. Your RT3 will look more like 50% and not 20%. This is not good for your body to be in this constant state of flushing out T4 when it is needed to convert to T3.
Thyroid Disorders
Hypothyroidism
Hypothyroidism is low or under active thyroid hormone production. This condition has various causes such as decreased iodine or pituitary gland disorders, just to name a few but commonly resulting from congenital (birth) or autoimmune disorder such as Hashimoto’s
Symptoms
- Constipation, weight gain
- Hoarseness
- Slow heart rate
- Depression, fatigue, impaired memory (brain fog)
- Dry skin, thinning hair, puffy face
- Cold intolerance
- Muscle aches and pain/swelling joints
- Irregular menstrual periods, can be heavy
- Kids- Some kids can experience sensory sensitivity, “bipolar” like episodes from having difficulty with controlling emotional outbursts due to development age.
Hyperthyroidism
Hyperthyroidism is excessive thyroid hormone production. This condition can be caused by various reason such as autoimmune disorder Grave’s disease and excess iodine just to name a few.
Symptoms
- Difficulty sleeping, fatigue
- Increased appetite
- Heat intolerance
- Nervousness, anxiety, irritability
- Weight loss
- Sweating, thinning of the skin
- Rapid heartbeat, tremor
- Changes in menstrual pattern
- Enlarged thyroid gland
Congenital Hypothyroidism
Congenital Hypothyroidism is a deficiency of the thyroid hormone present at birth. It can be due to many reasons
- Abnormal location of the gland (ectopic thyroid)
- Under developed gland (thyroid hypoplasia)
- Lack of Thyroid gland (thyroid agenesis)
- Low TSH signal- the signal between the pituitary and the thyroid gland does not work. This can be associated with pituitary hormone deficiencies.
- Ineffective functioning thyroid
- Maternal hashimoto’s (hypothyroidism) or maternal anti-thyroid medication usage (for hyperthyroidism)
Early diagnosis and treatment is crucial due to the nature that the thyroid plays a major role in fetal brain development. Hypothyroidism in an infant can lead to neuro-developmental disorders such as intellectual disabilities and cretinism. Other symptoms associated with congenital hypothyroidism….
Symptoms
- A puffy-looking face
- Large, thick tongue
- Hoarse cry
- Feeding problems (sleepy for feedings and difficulty swallowing)
- Constipation, umbilical hernia
- Hypotonia (poor muscle tone, floppy)
Other Thyroid Disorders
- Goiter- Swelling of the thyroid. Usually represents iodine deficiency
- Thyroid nodule- A small nodule. Common. Can be cancerous but usually not. May secrete excess hormones resulting in hyperthyroidism.
- Thyroiditis- Inflammation of the thyroid.
- Thyroid cancer
- Thyroid storm- High thyroid levels causing severe illness
Diagnostics
There are numerous diagnostic tests to determine a thyroid condition. However, in regards to babies and children…
- Lab work- See below
- Newborn screening- This is the heel stick your baby gets at birth.
- Ultrasound- This is usually a follow up to the newborn screening and/or if your child’s lab work comes back abnormal. The ultrasound will determine if a thyroid is present including the size, location, etc.
Labs to consider
Most physicians request only a TSH, some will request a TSH, T4 and T3, and then there are some really intelligent doctors out there who think outside the box and will order an entire thyroid panel. THOSE are my kind of doctors.
If your child is diagnosed or believed to be suffering from a thyroid disorder, these are the labs that should be ordered every single time their levels are assessed in order to be properly treated. I repeat… Every. Single. Time. You can’t treat a thyroid patient with half the information. If your child’s physician does not understand the importance of these labs, find one who does understand or one who is willing to learn
- TSH- This is a messenger hormone. It does not tell you the amount of hormone that is in your body.
- Free T4
- Free T3
- Reverse T3- These levels can go up due to low iron, high cortisol, inflammation
- Thyroid Antibodies
- Iron Ferritin, serum iron, % Saturation, & TIBC
- Vitamin D- This vitamin plays a role in modulating your immune system. Although it is not conclusive, there is evidence pointing toward Vitamin D affecting the incidence of autoimmune disease.
Other labs to consider during initial diagnosing
- Comprehensive metabolic panel (CMP)- Minerals like Magnesium, Potassium, Sodium can get depleted with thyroid patients. Also, low levels with certain minerals can indicate other hormone issues such as aldosterone related to adrenal insufficiency. Aldosterone is produced in the Pituitary and remember we said the Pituitary releases TSH. If the pituitary gland is not functioning properly, how is your body supposed to release the hormones it creates to control the thyroid. Its a domino affect.
- 24 hour saliva cortisol
- sex hormones
- MTHFR Genes
- Selenium, iodine
Common Medications
There are plenty of medication options to choose based on lab values. It takes a bit of commitment to design a care plan specific to the thyroid patient needs but it is worth it in the long run to have some symptomatic relief. Thyroid patients suffer from subtle and not so subtle symptoms that can be a nuisance or very debilitating. It is so so so important to learn what works for you to find relief. Below is a few different forms of medication to educate yourself about.
T4-
- Synthetic– Synthroid, levothyroxine are medications that are generally prescribed. However, a T4 medication is more often than not, enough to provide optimal thyroid levels. T4 converts to T3, however, some people have difficulty converting. For example, Low iron can stop the conversion of T4 to T3.
- Natural– Armour and Naturethroid are natural desiccated thyroid medication and comes from animal thyroid. It provides T4, T3, T2 and T1. Some providers will not prescribe this because the medication does not have exact measurements of each thyroid hormone but it is very effective for those who do not respond to synthetic T4 and/or would prefer a natural approach. Some react better to Armour and others to Naturethroid because of the way it is compounded and the additives utilized to form the medication. When you consider natural, it is trial and error for patients who are dedicated to finding a balance that works for them. I cant say how important it is to find this balance for your child or even for yourself.
- NP THYROID- A brand of desiccated thyroid. The Active ingredients are listed as 38 mcg levothyroxine (T4) and 9 mcg liothyronine (T3).
T3-
- Cytomel (liothyronine) are T3 medications. Some have described this as the Holy Grail to their thyroid treatment because it is straight T3 active hormone ready for use.
Iron
- When your thyroid is under active (hypo), people tend to have low stomach acid, and this causes a malabsorption including iron. Other contributing factors to low iron in thyroid patients is chronic inflammation, gluten sensitivities or food allergies, and having MTHFR. Low iron can stop or slow the conversion of T4 to T3 sending you deeper into a hypothyroid state with symptoms. Thyroid peroxidase is an enzyme responsible for chemical reactions resulting in T3 and T4 production. This enzyme is dependent on iron to function properly. First, find out if your iron is low. Next find out why your iron is low. Lastly, consider taking vitamin C to help absorb the iron in your body.
Other Considerations
Is your gut in check? Thyroid disease and GI disturbances go hand-in-hand. A big part of the immune system is in the gastrointestinal tract. Poor gut health can exacerbate autoimmune diseases by the body initiating an immune attack on foreign (undigested food particles). Hypothyroidism also contributes to hypochlorhydria (low stomach acid) leading to acid reflux. There is a big misconception that high stomach acid can cause reflux. This can be true in some cases, however, more often than not, low stomach acid causes reflux. When your stomach acid is low, you dont have the proper tools to break down food causing food particles to sit in your gut leading to bad bacteria also known as SIBO but that is for an entirely different conversation. Another factor the thyroid can affect in the GI system is the gallbladder. If your body does not metabolize fats properly, this can cause a sluggish, congested gallbladder leading to gallstones. A sluggish, congested gallbladder also leads to poor liver detoxification hindering conversion of T4 and T3, and also preventing eliminating excess hormones such as estrogen. The above mentioned GI issues are one of the reasons a lot of woman have hormone disturbances. Repairing the gut starts here…..
- Educate yourself about proper nutrition. Most people think they have a “healthy diet”, however, there are a lot of hidden ingredients. Read your labels. A good rule of thumb is to try and avoid the inside aisles of the grocery store.
- Start a journal. Keep a journal with food intake, GI habits, and symptoms. This will help determine if there are any food intolerance. A pattern will trend and this will help your physician determine what works and what does not.
- Discuss with your physician about starting a digestive enzyme and probiotic. A good probiotic needs to be refrigerated.
Another thing to consider for kids who are having a hard time coping with emotional and/or sensory difficulties is Counseling/behavior modification therapy. Counseling can help your child with understanding why and how to cope with emotional highs and lows stemming from thyroid disease. Behavioral modification will help achieve the same thing but also educate the care giver to work with your child during the highs and lows.
If you take anything from this, it is that you are your child’s biggest advocate
The thyroid is a very complex gland because it controls our hormones. I even at times, have difficulty wrapping my brain around how it functions in our body including how lab levels and medication can affect that function. The thyroid plays a part in other systems of the body. It has a domino affect on your other hormones in that when one hormone is affected, they all are affected because one takes from the other but that conversation is for another time when we dive into the adrenal glands and sex hormones. If you take anything from this, it is that you are your child’s biggest advocate with their health care. Seek a physician that will listen to your concerns and help treat the cause not the symptoms. A physician that will hear you when you/ or child is still symptomatic despite the lab levels are in “normal” range. A physician who will think outside of the box and dig deeper into labs and diagnostics that help answer these “why” questions. If your child is still having symptoms, seek a physician who is willing to explore alternative options. YOU know your child best and only YOU can help them live their best life with optimal health care. I know too many people who are symptomatic and continue to suffer.
Do you or someone you love suffer from a thyroid disorder? If so, how do you manage your disorder? Will you share your story with us?
