There are many different web pages, articles and books describing the details of hypothyroidism. I provide some links at the bottom of this page for those who wish to read further about the condition. I describe here a summary of the integrated medicine approaches to treatment.

 

Conventional medicine’s first-line approach is to offer replacement therapy to correct the deficiency of the main form of thyroxine, T4, and to help people live with the condition rather than aim for a return to normal function or a ‘cure’. If benefit is not forthcoming, an endocrinologist may then offer the more potent Liothyronine, T3, normally derived intracellularly from T4.

 

The cause of thyroid gland dysfunction is rarely explored except to identify if it is an autoimmune condition (Hashimoto’s disease – named after the doctor who identified this) and in some cases of suspected pituitary or hypothalamus gland dysfunction (the glands in the brain that exert control of thyroid and thyroid hormone activity). The underlying reason for thyroid failure, or the cause of the development of autoimmunity or, the highly underestimated poor response to thyroid hormones due to blockage or damage to thyroid hormone receptors around the body are not investigated. This is because there is no simple drug that treats those causes.

 

Part of the problem with treating hypothyroidism is that too much emphasis is placed on blood test results rather than a patient’s symptoms. There is also a lack of understanding of what constitutes a normal result. Reference ranges should not be called ‘normal’ levels. An interpretation of what is high or low for an individual must be based on that individual. I expand on this on my website here: https://drsharmadiagnostics.com/hypothyroidism/

 

The causes of hypothyroidism can be classified along these lines:

 I summarise the main causes here, and you can read more about these in the section lower down ‘Further Reading’

• An autoimmune disease (Hashimoto’s disease) where antibodies, the body’s own immune response, reduces thyroid activity.
• Environmental pollutants and toxins – chemicals, metals, oestrogens, foods and drinks can all cause problems.
• Receptor damage affecting thyroxine receptors and the receptors for Thyroid Stimulating Hormone.
• Intestinal disorders such as increased intestinal permeability (The leaky Gut Syndrome) are considered a possible cause of autoimmune disease. There are clear links between the balance of healthy bowel bacteria and thyroid function.
• Stress hormones damaging receptors and thyroid hormone binding proteins. (The more bound the less available for activity and vice versa)
• Oestrogen dominance and lack of progesterone affecting the thyroid
• Iatrogenic (doctor or therapy-caused) treatment for hyperthyroidism, oncology, thyroid surgery or radioactive iodine treatment
• Lack of intra-cellular conversion of the less active T4 to T3.
• Genetic dysfunction. This may be inherited, may be due to damage to genes/chromosomes in utero or even be programmed to fail at some time in adult life (a predisposition). Epigenetics is the name given to the effects of external components attaching to and affecting gene behaviour – viruses, environmental pollutants, toxins and effects from stress hormones are all implicated. A gene variation of the DIO2 gene alters the T4 to T3 conversion.

Therapeutic Options

Treatment can be initiated based on taking an in-depth medical history which may give clues as to the underlying cause. Preferably, a range of tests and investigations can be undertaken to try and clarify where a problem might lie.

Recommended natural therapeutic options and advice.

• Discuss the use of natural desiccated thyroid (NDT) with an integrated medicine Doctor.
• Never stop prescribed thyroxine supplementation or change dosage without medical guidance.
• Consider removing gluten from the diet as a correlation is relevant for some. Adherence to the Palaeolithic Diet for at least 3 months can help. 
• Techniques for dealing with stress such as yoga, or specific therapies such as CBT, or Neurolinguistic programming (NLP), can be considered.
• Suggestions for treatment must be based on each individual but may include some of the nutrients listed here.  Ideally, dosages should only be governed by doctors or nutritionists trained in integrated medicine. 
• Kelp or iodine supplementation to replenish iodine (best done after testing)
• Thyroid multi nutrients
• Myrrh-based supplements that support T4 to T3 conversion 
• Multi nutrients with magnesium and B complex
• Probiotics
• L-Glutathione for detoxification
• Blue-green algae for detoxification
• Anti-parasitic and immune-boosting botanicals (herbal, plant extracts)
• Specific therapy with bioidentical progesterone, increased focus on gut integrity, metal chelation and detoxification may be required if tests suggest specific areas of concern.

Recommended investigations

Ideally, extensive testing is a good place to start, as it narrows down areas where therapy might be of particular benefit. However, there are costs associated which have to be borne in mind. The tests I recommend are:

• Leaky gut test.
• Cellular toxicity (blood test looking at DNA and mitochondrial toxins/adducts)
• Metal sensitivity testing
• Halide toxicity and iodine levels (including possible pre-and post-iodine loading, urinalysis)
• Gluten cross-reactivity or broader food allergy testing
• Salivary female hormone testing (in women)
• Genomic (DIO2) and gene adduct testing

In addition, stool testing may be advisable if the gut is an area of concern.

Further Reading

My colleague, Dr Sarah Myhill best describes the role of the environment here:

A whole range of chemicals have been shown to be goitrogenic (substances that suppress the function of the thyroid gland by interfering with iodine uptake) and/or suppressors of the HPA axis and/or suppressors of thyroid hormones uptake and/or suppressors of T3 uptake.

These include perchlorates (washing powder), phthalates (added to plastics to increase their flexibility, transparency, durability, and longevity) and bisphenol A (in plastic wrappings), pyridines (cigarette smoke), PCBs and PBBS(fire retardants in soft furnishing), UV screens (sun-blocks and cosmetics), and many others [including fluoride].

http://drmyhill.co.uk/wiki/Thyroid_-_the_correct_prescribing_of_thyroid_hormones    

 Iodine and other halides such as fluoride and bromide are important to consider. Blockage of iodine receptors by environmental toxicity from these compounds is potentially underestimated.

http://www.drlaurendeville.com/conditions-treatments/halide-toxicity-bromine-fluorine/

I also consider there to be other issues affecting the thyroid through autoimmunity. Please consider visiting this site to get the e-book by Chris Kresser for reasoning behind my following comments. http://chriskresser.com/thyroid/

Gluten and other intolerances, as described here, need to be considered – http://hypothyroidmom.com/leaky-gut-the-missing-piece-in-many-autoimmune-diseases-like-hashimotos-thyroiditis/   

Testing for such through intolerance testing (as opposed to IgE testing) I think is best done through cross-reactivity testing – if you have sensitivity to cross-reactive foods you probably have gluten/gliadin sensitivity too. This reduces costs http://www.joincyrex.com/page/2196/Array-4-Gluten-Associated-Cross-Reactive-Foods-and-Foods-Sensitivity

An alternative is to use the Paleo Diet as Kresser describes here: http://paleocurebook.com/  

There is considerable emerging evidence of Oestrogens and exogenous oestrogens casing disruption. 

http://hypothyroidmom.com/progesterone-thyroid-a-hormonal-connection-essential-for-optimal-womens-health/

and

http://www.naturalendocrinesolutions.com/articles/polycystic-ovarian-syndrome-thyroid-health/

In part this may be associated with lower than optimal progesterone and we now know Progesterone supplementation can increase thyroxine levels:

http://www.medscape.com/viewarticle/808684 

and

http://hypothyroidmom.com/progesterone-thyroid-a-hormonal-connection-essential-for-optimal-womens-health/

Stress has a strong link and association with your thyroid issue

http://chriskresser.com/5-ways-that-stress-causes-hypothyroid-symptoms/

http://www.naturalendocrinesolutions.com/articles/chronic-stress-thyroid-autoimmunity/

The Gut –Thyroid Connection is, in my opinion, a very big issue. Kresser once again provides a very readable explanation:

https://chriskresser.com/the-thyroid-gut-connection/  

Working on the microbiome is very important as is assessing whether increased intestinal permeability is an issue and comprehensive stool assay may be of benefit too http://hypothyroidmom.com/leaky-gut-the-missing-piece-in-many-autoimmune-diseases-like-hashimotos-thyroiditis/ and http://chriskresser.com/category/thyroid-disorders/  

Infectious agents, viral and parasites in particular are underestimated, perhaps as having a direct and indirect effect on the thyroid

http://www.naturalendocrinesolutions.com/articles/parasites-thyroid-health/  

Next steps

If you wish to expand your reading around the subject. You could consider obtaining this book: https://tinyurl.com/ymnrzatd

Consider following the Palaeolithic diet.

Your eventual decision would be to decide whether to go with a therapeutic course or to investigate in part or in total.

Work with an integrated doctor to establish optimum T4 and T3 supplementation until you are better.

References for reading about Hypothyroidism:

A balanced and broad insight: http://www.thyroiduk.org.uk/tuk/about_the_thyroid/hypothyroidism.html

The NHS guide: http://www.nhs.uk/conditions/Thyroid-under-active/Pages/Introduction.aspx

Hmmm….!

The conventional attitude : http://www.btf-thyroid.org/information/leaflets/29-hypothyroidism-guide

Dr R. Sharma