I had beautiful curly hair down to my shoulders when I entered my medical school residency in 2004. But by the end of my residency three years later, my hair was dry and brittle. My hands and feet were cold and swollen. I had brain fog, memory loss, and constipation. I had hypothyroidism.

Hypothyroidism: a major cause of low energy

Thyroid disease is one of the most common health problems we face today. The majority of people with thyroid dysfunction have hypothyroidism. Hypothyroidism (“hypo” means low) is a condition where the amount of thyroid hormone in your body is less than what is needed for optimal function. According to the American Thyroid Association, more than 12 percent of the US population will develop a thyroid condition during their lifetimes, and more than half will be unaware that they have a problem. Women are five to eight times as likely as men to develop thyroid problems.

The thyroid gland is shaped like a butterfly and found directly below the Adam’s apple, covering the throat. The thyroid produces thyroid hormones (mainly T3 and T4) that regulate the body’s metabolism and affect numerous vital body functions including breathing, heart rate, body temperature, and energy level. When your thyroid hormone levels are optimal, every system in your body works better.

In fact, I’ve found it exciting to observe how improved thyroid function influences other laboratory markers. Cholesterol levels, inflammatory markers, cardiovascular risk markers, congestive heart failure (heart strain) markers, blood sugar, and diabetes markers all improve when thyroid hormone is optimized.

Hyperthyroidism (“hyper” means high) is a condition characterized by the presence of too much thyroid hormone in the body. It can cause fatigue as well, but it is less common, so we are going to focus on hypothyroidism.

Warning! This is going to get a little technical. Bear with me, because understanding the complexity of your thyroid and thyroid hormone will support you in partnership with your healthcare provider. And you are going to need a doctor to prescribe medication if you need it.

Thyroid Physiology (Function)

Optimal thyroid health depends on effective communication between the brain and the thyroid. The hypothalamus (in the brain) stimulates the pituitary gland (also in the brain) to produce TSH, the chemical messenger that is then sent to the thyroid with instructions on how much thyroid to produce. Free T3 and free T4 are the two main hormones produced by your thyroid gland. The “T” represents tyrosine, an amino acid, and the number refers to the number of attached iodine molecules—either three or four. These free hormones send feedback to the brain (the hypothalamus and the pituitary), so thyroid levels can be regulated. For example, during hypothyroidism, the level of thyroid hormone in the body is low. The body sends a message to the brain that it needs more thyroid hormone. The brain sends TSH to the thyroid with a message to make more thyroid, and the thyroid complies.

The body converts T4 into T3 at the cellular level and in the liver using iodine, selenium, and iron. Although T4 is referred to as the “inactive” thyroid hormone, this is a bit of a misnomer because T4 is not inactive—it has important functions and, in many cases, needs to be replaced. We’ll discuss this more when we get to thyroid replacement.

During times of stress, T4 will be converted to reverse T3 instead of T3, and the person will experience symptoms of low thyroid.

Interestingly, new research also shows that our mitochondria (the energy centers of every cell in the body except red blood cells) act on cells to increase their absorption of thyroid hormone. This absorption can be compromised if toxins damage the mitochondria.

Hashimoto’s Disease

Hashimoto’s thyroiditis (or autoimmune hypothyroidism) is the most common cause of hypothyroidism, accounting for approximately 90 percent of cases.

Iodine and selenium deficiencies can also cause hypothyroidism, but this is less common in first world countries.

Hashimoto’s is an autoimmune disorder in which the immune system attacks and breaks off parts of the thyroid gland, resulting in suboptimal thyroid hormone levels. Thyroid antibodies are indicators of autoimmune thyroid disease.

Unfortunately, the natural progression of autoimmune hypothyroidism is a continuous destruction of the thyroid gland, and thyroid levels decrease over time. When a piece of thyroid tissue breaks off, thyroid hormone is released from the cells, and people may report symptoms of hyperthyroidism for a short time. These symptoms include tremors, heart palpitations, insomnia, headaches, weight loss, agitation, anxiety, diarrhea, bulging eyes, and sometimes a goiter (enlargement of the thyroid gland). Then symptoms of hypothyroidism worsen as the thyroid hormone is cleared and they’re left with lower levels of thyroid hormone than they had before.

Consequently, Hashimoto’s is two conditions that need to be treated: an autoimmune disease and a deficiency in thyroid hormone levels.

Another autoimmune condition that affects the thyroid is Graves’ disease. This occurs when the immune system stimulates the thyroid gland to overproduce the thyroid hormones. The immune system produces antibodies that mimic TSH (normally coming from the pituitary gland). These TSH antibodies then stimulate the thyroid to produce too much of the thyroid hormones, and hyperthyroid symptoms result.

Symptoms of Hypothyroidism

You may have hypothyroidism if you have some of the following signs and symptoms:

• Chronic fatigue

• Cold extremities (hands and feet)

• Memory loss

• Hair loss

• Lower leg swelling

• Constipation

• Dry skin and hair

• Brittle nails

• Weight gain or difficulty losing weight

• Elevated blood sugar or diabetes

• Elevated cholesterol

• Elevated blood pressure

• Depression, anxiety

• Heart palpitations or arrhythmias

• Poor cognition (“brain fog”)

Undiagnosed thyroid disease can increase your risk for other serious conditions, such as cardiovascular (heart and blood vessel) disease, Alzheimer’s disease, osteoporosis, and infertility.

• If you have any of the symptoms listed above or suspect you have thyroid disease, the next step is to get labs done.

• Schedule a time for a meet and greet to discuss how we can work together to resolve your issues with low energy.

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