Six Types of Thyroid Dysfunction

Welcome to Episode 39. I’m so happy you are here. 

I spend a good couple hours cooking several things last night so I would have food to eat over the next week or so. I’ve been trying to double up on meals when I cook so we have stuff to freeze for nights I don’t want to cook. 

I made two whole chickens on Sunday night so I had leftover meat for making soup and for putting on salads. I made a double batch of chili on Monday and Tuesday was a big batch of Thai Beef Stew, braised cabbage and I tried out a meatless dish of grape tomatoes, garlic, basil, chickpeas and spaghetti squash. If you tolerate legumes it was an okay dish. I was hoping for more flavor from the chickpeas. I just sautéed the tomatoes in olive oil, smashed them, added the garlic and chickpeas and sautéed a bit longer. Then I added the spaghetti squash and basil and mixed it through. 

We are having venison chops tonight with sautéed mushrooms and roasted cabbage. 

What are you making for dinner these days?  Head over to my website and comment on this post to let me know what your cooking. Look for Episode 39. 

Today we are talking about the six types of thyroid dysfunction that cause or result in hypothyroidism so let’s get started. 

The thyroid gland is super sensitive to any changes in the biochemistry in our body. It’s job is to perceive even the tiniest of changes in the body and make up for that by changing how much thyroid hormone is released in the body. 

This is one reason you can see such different lab values over time. 

When these changes in our biochemistry become something that is chronic or constantly happening in the body then there begins to be problems with the thyroid gland and the communication between the hypothalamus and the pituitary gland. 

Things like constant blood sugar dysregulation, constant or chronic inflammation in the body, deficiencies in nutrients, poor liver function, toxic burden, low stomach acid, intestinal permeability, poor eliminations and even the use of hormones including thyroid hormones can cause thyroid problems. 

Hypothyroidism or low thyroid function can fall into six different types. Some of these may occur at the same time, and it may be that only one of these will require permanent hormone replacement. 

1.Primary Hypothyroidism. 

This is when there is decreased hormone production by the thyroid gland. So it isn’t making enough T4 or T3. One cause and the most common cause in the US is Hashimoto’s. Worldwide the most common cause of Primary Hypothyroidism is iodine deficiency. (ref)  It is also caused by removal of the thyroid gland. 

This is a dysfunction of the thyroid gland and this is the one type of hypothyroidism that needs to be treated with thyroid hormone replacement. 

If you have Hashimoto’s, you may need medication due to the destruction of your thyroid gland but you also need to understand that this condition is an immune system issue first and a thyroid issue second. 

If you catch Hashimoto’s before too much damage is done, you might be able to support your thyroid nutritionally. Sadly, for me, I am still in need of medication.  If you do not have success bringing TSH down with diet and lifestyle changes, you will likely need hormone replacement. 

Your labs might look like this if you have primary hypothyroidism: 

  • high TSH

  • normal or low Total T4

  • normal or low Free T4

  • normal or low Free T3

  • normal Reverse T3

2. Secondary Hypothyroidism

This deals with your thyroid not putting out enough thyroid hormone due to an issue in the pituitary gland. Remember that the thyroid is regulated by the pituitary gland and the hypothalamus. When these two glands are not communicating and the pituitary doesn’t secrete Thyroid Stimulating Hormone (TSH) like it is supposed to. You may find your TSH at or around 1.8 but still having symptoms of hypothyroidism. 

Chronic stress in the body is usually at the heart of this one. Stress fatigues the pituitary and it can cause a failure to signal the thyroid to produce thyroid hormone. 

Stress: too busy all the time, not enough sleep, living off of coffee and processed foods, inflammation, viral or bacterial infections. All of these will mess with your adrenal function and your thyroid function and remember those two go hand in hand.

You can also have low thyroid function after pregnancy. This is a stressful time for women who tend to be the ones suffering with most thyroid conditions. Pregnancy in and of itself will put a high demand on the pituitary gland. 

If your blood tests come out normal but your doctor puts you on thyroid medication anyway, it can help you feel better for a couple weeks but then you might start to feel worse. You can develop thyroid hormone resistance at your cells much like insulin resistance. 

So your cells are refusing thyroid hormone because there is too much in the blood and you might be given a higher dose making things even worse. You have all this hormone running through your blood so your pituitary gland gets a message it can stop making TSH or it just stops talking to the thyroid altogether. 

You might need medication after enough damage has been done between the communication of the pituitary and the thyroid.  

If you have Hashimoto’s but it doesn’t get addressed, this can become you.

Your labs might look like this: 

  • 1.8 or less TSH

  • 6 or less T4

  • symptoms of hypothyroidism. 

3. Your T4 is not converting to T3

This happens when you have tons of chronic stress and high cortisol. So you are making T4 but your body isn’t converting it to T3 which is what your cells need. When cortisol is high, you will likely have some of this going on. 

If your body is dealing with infection or inflammation your cell walls can be damaged by that which also affects T4 to T3 conversion. 

You need to damper the inflammation or infection and support your body in dealing with cellular stress (free radicals). 

T3 levels won’t affect your TSH so your labs might look like this: 

  • Normal TSH

  • Normal Total T4

  • Normal Free T4

  • Low T3

  • Low Free T3

  • Low or normal Reverse T3

4. Your conversion of T4 to T3 is too high.

This would mean you have too much T3 being made and you also have less thyroid binding globulin (TBG). 

Too much T3 will overwhelm the cells and you find yourself in thyroid hormone resistance again. It is common in women with insulin resistance and PCOS. It is often caused by too much testosterone in the body.  If you have developed Type II Diabetes and are taking insulin for this, you may also find yourself in an over conversion of T4 to T3.

If you are using a testosterone cream you can over convert T4 and T3. 

You will have hypo symptoms with this one. 

A big help here will be to reverse the insulin resistance to reverse the thyroid hormone resistance and begin to feel better. 

You may have labs that look like this: 

  • Normal TSH

  • High or high normal Free T4

  • High or high normal Free T3

  • Normal Reverse T3

5. High Thyroid Binding Globulin

Thyroid Binding Globulin is a protein that carries thyroid hormones to the cells so they can use them.  You can develop antibodies to this protein in Hashimoto’s. 

You can find yourself in this situation if you take hormonal birth control or estrogen replacement therapy. 

If you are on birth control, you may have high levels of estrogen you will make too much TBG and thyroid hormones are carried to the cells on TBG so if you have too many TBG proteins in the blood bound to them, you can have less thyroid hormone getting to your cells. 

You have to work to get the excess estrogen out of the body. 

Your labs might look like this: 

  • Normal TSH

  • Low Free T4

  • Low Free T3

  • Normal Reverse T3

6. Thyroid Hormone Resistance

Again, similar to insulin resistance with a root cause being stress. Your pituitary gland and thyroid gland may be making just the right amount of hormone but it just isn’t getting into the cells. It feels like hypothyroidism to you and it is the high amount of cortisol in your body that is causing your cells to resist the thyroid hormone. 

You absolutely must manage your adrenals with this one. 

Your labs might look like this: 

  • Normal TSH

  • Normal Free T4

  • Normal Free T3

  • Normal Reverse T3

You have to make sure your labs are being tested regularly in all cases. 

Ok. That’s it for me. 

I want to remind you all that I have openings in my practice for a few more clients right now so if you are needing help navigating diet and lifestyle changes head over to Help For Hashimoto’s and fill out the contact form. You can also get my report on Five Things Your Doctor Won’t Tell You About Hypothyroidism. 

One last thing, part of the diet and lifestyle changes are to look at what you are putting on your skin. I found Beautycounter to be a trusted source for skin care and make up for me. They ban over 1300 chemicals in their products while the US only has a ban on around 30 ingredients. So, you don’t have to think about safety with their products and I really like that so I became a consultant last year. I don’t work too hard at selling it because my focus is really on nutrition but if you have any interest in checking them out go to beautycounter.com/stephanieewals to shop. I would sure appreciate your support. 

I’m still on a social media break and have no desire to get back on anytime soon. I’m checking the Help For Hashimoto’s facebook group once a day. You can join that if you would like but all the action is in the newsletter which you can sign up for on my website. 

I’m grateful to you all. Please leave me a rating and review on iTunes so more people can find the show and get help. 

Until next time. 

Your immune system and Hashimoto's; Adaptive vs. Innate immunity in Hashimoto’s Episode 38

Welcome to episode 38.

I am 3/4’s the way through a year of podcasting. Thanks for sticking with me and hanging out. I really appreciate it. My end goal is to help as many people as possible have a great quality of life with autoimmune disease.

You can help me with that by sharing this podcast with people you know dealing with thyroid issues and by leaving a rating or a review. I have enjoyed reading the reviews and honestly avoided them for awhile because I didn’t want to see if there were any bad ones. Thankfully there weren’t any. Anyway, I am grateful to those of you leaving reviews. 

Someone in Denver who rides the train to work listens and I want to thank you! I do this for you! So you can begin to feel your best. 

I’ve had a busy week and didn’t do so well with eating enough last week. I had not prepped any food which always makes for days where I just skip a meal which is so bad for my adrenals and my blood sugar. My blood sugar is so sensitive which I think is keeping me from losing the 5-10 pounds I have gained over the last year or two. I have not done anything different with my diet but menopause and insulin resistance have made of mess of my body. I have regularly done the autoimmune strong workouts over the last month- I’m getting them in at least three days a week. I hate working out but I want to be strong as I get older so I just do it anyway. 

I ate out a lot this past weekend but we are so fortunate to have some really cool restaurants that serve at least Paleo type foods. I had a green curry with pastured chicken and organic veggies twice in the last week from a great restaurant called French Meadow in Minneapolis. They have a lot of gluten free options which is so nice and the food is good. It tastes like it is made from scratch.  

I had a yucca crust pepperoni pizza with a cheese made from pumpkin seeds and a chicken curry dish to bring home from another place called Sassy Spoon. They are 100% gluten free which is nice. They are another from scratch type restaurant. 

This weekend I was at a party for a family member and there were gluten free cookies for dessert and I had at least one whole cookie if not a little more. I could feel the effects of that right away on my neck and my face began to itch like crazy. So, despite wanting to devour a ton of them, I didn’t. I didn’t want to suffer the physical consequences. That party had a taco bar with corn tortillas but I skipped the tortilla and just had the meat, lettuce and guacamole with a little salsa- so basically a taco salad. Pretty easy to modify that one if you can tolerate tomatoes. 

On Saturday morning I made my breakfast soup and chicken and veggie stir fry with lots of garlic to eat for the week. As long as I have food to eat during the week, every thing seems to go better for me. My moods are better, sleep is better, energy is better. It is just a matter of taking the time to make the food. 

Monday I ate at a place called Foxy Falafel which even has Autoimmune Protocol menu items. I tolerate chickpeas so I had their falafel which is such a treat. We even got their egg free, gluten free, dairy free brownie and chocolate chip cookie. I over indulged but I have not been to that restaurant in 2 ½ years so it was okay with me. They also sold Hu chocolate which is pretty darn good. 

After all that indulgence over the last week, I filled up on my green juice made in my vitamix which consists of a lemon, 2 stalks of celery, ¼ of an english cucumber, a handful of parsley, water and ice. I always feel really good after drinking that and it kickstarts my digestion for the day. 

Sauerkraut has been in regular rotation too. That helps my digestion work better as well. We have our old refrigerator full of it and everyone complains about the smell. It is sort of infiltrating the whole refrigerator. I love it! 

I’ve been doing hamburger patties on a bed of lettuce too. Quick and easy. 

Okay- let’s get started on todays subject. It is an important one to understand because it plays a big role in your autoimmune disease. 

Today we are talking about your immune system and Hashimoto’s. This episode has some scientific terms in it but I think I have broken it down to make it easier to understand. It is important for you to know how your body works and the immune system is a pretty big deal.

It is our biggest line of defense with many kinds of cells, antibodies, proteins and chemicals all working together like a country’s military defense system works to protect a nation. 

The immune system is divided in to the innate immune system aka the non-specific immune system. This side of the immune system is highly involved in inflammation- like when you hurt yourself and you get a bruise or a bump. When you cut yourself and the area gets all red and becomes scabbed. The job of the immune cells in innate is to keep pathogens out. It acts quickly and does not specify or target any one thing. For the most part, it cannot tell the difference between an invader, damaged cells or healthy cells so healthy tissue sometimes gets damaged. So if you have chronic stress causing inflammation or some kind of infection that won’t go away, this side of the immune system produces chronic inflammation. 

The other side of our immune system is the adaptive immune system which is very specific about the attacks it launches. We will talk a little more about this side in a minute. 

Your immune system needs to be regulated in order for your Hashimoto’s disease to be managed. 

Our immune system is on guard for antigens. Antigens are toxins or other foreign substance which causes an immune response in the body and can create antibodies against it. 

Things like a specific food, mold, bacteria, a chronic virus such as EBV or a parasite. These things irritate the immune system leading to an attack.  Now in Hashimoto’s, gluten is a big antigen which induces an attack on the thyroid gland every time you eat it. Remember that gluten is a protein found in all grains to some degree but the biggies that can be more of a problem for most people are wheat, barley and spelt. 

You can also have an immune response to environmental chemicals or heavy metals but not everyone will develop an immune response to these things.  You might be someone who doesn’t have a huge heavy metal burden or you just don’t react to foods. The exception would be gluten and possibly dairy because the proteins are similar to those of your thyroid so I always recommend people remove those two things from your diet. 

Your immune system might be reactive to bacteria. Many people with Hashimoto’s have antibodies to the bacteria Yersinia enterocolitica. 

Whatever your issue is you need to remove the antigen either by removing the offending food, detox the heavy metal or get rid of the bacteria to calm the immune system and manage Hashimoto’s. 

When dealing with autoimmune disease and specifically Hashimoto’s we want to look at TH-1 and TH-2 cytokines which can be high while T-suppressor cells will be low. 

A cytokine is a category of tiny proteins that work to signal cells of the immune system and are produced by cells in the immune system and a number of other places. They have many jobs in the body one of which is to work with the immune system to protect us. 

T-suppressor cells are also known as regulatory T cells which work to modulate or regulate the immune system and help us maintain tolerance to antigens against our self which helps prevent autoimmune disease. The T regulatory cells are immunosuppressive- they suppress the immune system. 

So, if we have high cytokines and low T-suppressor or T-regulatory cells then you have an immune system that is all out of balance and giving you symptoms of Hashimoto’s and maybe even causing destruction to your thyroid gland. 

Now let’s look at TH-1 and TH-2 cytokines specifically because most of us fall in to either TH-1 dominance or TH-2 dominance. 

TH-1 are T helper cells involved in an innate, or immediate immune system response. This is the adaptive immune system which is a part of the immune system that creates memory after dealing with an antigen. This means it will always remember that particular antigen whether it is a food, mold, heavy metal or parasite or bug. Every time that substance enters your body your innate/adaptive/acquired immune system will attack. It is very specific about what it reacts to. This is the part of our immune system that, once we have measles, will protect us from ever getting it again.  It is the line of defense against the pathogens.  

Sometimes it doesn’t distinguish the difference between an invader from non invader when it enters the body. It gets confused which can result in things like hay fever, asthma or an attack on the thyroid. 

When you have TH-1 dominance your immune system is overactive in the TH-1 pathway.  The majority of people with Hashimoto’s have TH-1 dominance but there are some Hashimoto’s patients with TH-2 dominance. 

You might also switch back and forth between the two depending on what your body is needing or getting too much of. Maybe you are deficient in some minerals or or getting too much of a mineral. These can trigger either TH-1 or TH-2 dominance. 

The best way to manage this is to focus on the whole body. Reduce inflammation throughout the body. Remove the triggers for your immune system. 

Once you have an autoimmune disease, you can put it in remission but you will have it forever and will have to work to manage your diet and lifestyle so your immune system can relax a bit. You must restore balance to the body. 

High TH-1 or TH-2 immune cells block thyroid receptors on your cells so your thyroid hormone cannot get in and do its job giving you symptoms of hypothyroid. 

Type 1 Diabetes, Hashimoto’s, MS and chronic viral infections are associated with TH-1 dominance. 

Lupus, dermatitis, asthma, and chemical sensitivities are mostly associated with TH-2 dominance. 

This is not always the case- remember that. As with everything there are exceptions. 

TH-2 are T helper cells involved in a delayed immune system response. Helper cells work to direct immune system activity as do the regulator cells and suppressor cells stop an immune reaction when needed. 
There are some different ways these immune cells could be affecting you. 

    • You might not make enough of the T-suppressor cells that regulate your immune system and tolerate antigens. Not enough T-suppressor cells keeps the immune system on high alert and attacking self. Your thyroid gland can be a victim of this problem. 

    • Maybe you make too much of the chemical messenger Interleukin-2 (IL-2) that tells other immune cells to attack and kill an invader. Too much of this one puts tissue not involved in the attack at risk of being an innocent bystander that gets attacked. 

    • You might make too many Interleukin-4 (IL-4). This releases B cells that look for intruders and mark them for death. Again, here your thyroid tissue can be damaged. 

    • Not managing your blood sugar or not being able to handle increases in insulin due to consuming sugar and refined carbs can send those B cells in to over production. 

    • Having food sensitivities and eating those foods anyway or dealing with a parasite will increase Interleukin-4 and increase production of the B cells. 

    • A chronic virus such as EBV will increase the Interleukin 2 creating more natural killer cells and cytotoxic T cells. 

Let’s get to know what these terms mean. 

Interleukin- these are a type of cytokine. Cytokines are chemical messengers within the immune system cells. Some cytokines kill pathogens on their own. 

B cells- a white blood cell that is circulating in the body and is on the lookout for for antigens that they have antibodies to. When these cells activate, they are quick to divide and grow. Some of these have memory and will forever recognize an antigen when it enters the body. 

Natural Killer cells- white blood cells that go to an infection site to destroy cells infected by a virus. They play a role in the adaptive immune system having a memory to viruses. They do not need to be activated to kill cells in the body. 

Cytotoxic cells- T cells that attack cells infected with a virus and certain bacteria. They release chemicals called cytotoxins which cause infected cells to die. 

Our ultimate goal here is to bring the immune system back in to balance. 

You need to support your immune system and you can start with Vitamin D in the form of cholecalciferol. This specifically supports the T regulatory cells so they can do their job right. Remember these are the ones that help regulate the immune system. 

Make sure you are taking an emulsified version which means it is mixed with some kind of oil so that your body can use it. Poor quality vitamin D supplements with be mixed with soybean oil or with canola oil. Look for one with MCT oil (a form of coconut oil) or I have seen them with olive oil too. Biotics makes a nice one called Bio-D Mulsion Forte. 

Fish oil will also support the T regulatory cells but taking any fish oil in large amounts isn’t a good idea. 

There are some studies to show that people with Hashimoto’s are not able to process vitamin D naturally so they may need higher amounts than the average person. If you have a Vitamin D test that shows normal levels yet your immune system is still struggling and you are doing everything else right to reduce inflammation and immune responses you may think about raising the amount you take. Having high normal levels is best for thyroid patients. 

You may need a therapeutic dose and should have your levels checked by your doctor once a year or more to make sure you don’t over do it. 

Excess vitamin D can cause calcification of the heart, kidneys or lungs and you can have too much calcium circulating in your blood. 

Glutathione (a big antioxidant in the body) in a cream form and superoxide dismutase (an enzyme that acts as an antioxidant to protect your cells). These will both help regulate the immune system. 

Don’t waste your money just trying these to see if they help. Work with someone who can first help you get your diet and lifestyle dialed in, get your digestion working well and making sure you are able to digest fats and absorb vitamins and minerals. 

Back to TH-1 and TH-2 Dominance. It is helpful to know which way you go here so you can know which things will continue to stimulate your TH-1 or TH-2 cells. 

Things that stimulate TH-1: Echinacea, Maitake mushrooms, glycyrrhiza from licorice (so if you take licorice for adrenal health and you feel worse because of it then it could indicate TH-1 dominance), lemon balm. 

Things that stimulate TH-2: caffeine, green tea extract, grape seed extract, pine bark extract, white willow bark, lycopene (found in tomatoes) , resveratrol. Taking any of these will stimulate the immune system further and cause you to feel worse. 

Again, work with someone who can help you with monitoring these things. 

Things that regulate TH-1 and TH-2:  probiotics, vitamin A, vitamin E and colostrum. 

Things that quiet interleukin one that would activate TH-1 or TH-2: Boswellia (frankincense is a species of the Boswellia species), pancreatic enzymes (often sold as digestive enzymes), Turmeric or its compound curcumin. 

It is probably best if you have some sort of immunologic testing done to find out if you are TH-1 or TH-2 dominant before messing around with the things mentioned, aside from Vitamin D. 

You also will want to work on diet, keeping your blood sugar stable, get your adrenal health dialed in and make sure your digestion is working top notch. 

After all of this is completed and you know where your body stands, where your immune system stands then you can work to find those specific antigens, the things triggering the immune response. A gluten free diet is very important because gluten is one of those foods that is inflammatory as I stated in the beginning. 

Healing leaky gut or intestinal permeability will be important too but we can discuss that in another podcast if I haven’t covered it. I don’t remember what I did yesterday hardly and being 38 episodes in, I cannot remember from week to week what I have covered. 

Thanks so much for listening. Again, if you could leave me a review on iTunes, I would really appreciate it. 

I am on a social media break and not sure when to return. I am checking the Help For Hashimoto’s facebook group once a day, otherwise I’m avoiding all social media.  

If you have a question, you can email helpforhashimotos@gmail.com or you can go to my website and fill out the contact form. 

Have a comment or question about this episode? Leave it on the blog post on my website helpforhashimotos.com under episode 38. I’d love to hear from you. You can also get my free ebook 5 Things Your Doctor Won’t Tell You About Hypothyroidism while you are there. You’ll get a weekly recipe and some nutritional nugget of information each week. 

I’m taking new clients right now so if you are in need of help navigating your autoimmune disease and especially Hashimoto’s, I am here to help. You can reach out to me on my website. You can make an appointment for a 15 minute free call to see if we are a good fit for working together. 

Until next week my friends.