The Hidden Culprit: Thyroid Imbalance and What to Do About It


A sluggish thyroid can leave you overwhelmed, run-down and depressed. This three-step holistic plan can put you back on track and get you moving again.

Six years ago, I was a 38-year-old stressed-out mess, working as a doctor at an HMO and seeing 30 OB/GYN patients a day. I’d wake up exhausted every morning, nurse my infant daughter, and race from one task to another until I’d arrive home to care for my baby again, cook dinner, and fall into bed—only to start all over the next morning. My mood tanked, my weight climbed, my focus suffered, and my sex drive? What’s that? Yoga provided my only respite, but unfortunately, my home practice withered as my to-do list grew.

My mood tanked, my weight climbed, my focus suffered, and my sex drive? What’s that?

How did this happen? As a doctor, shouldn’t I have known better? My Harvard medical training finally kicked in: Could this be my thyroid? Turns out it could—and it was.

A Little Troublemaker

Your thyroid, a tiny butterfly-shaped gland in your neck, may weigh only an ounce, but as I learned firsthand, it wields formidable influence on your metabolism, mood, and body temperature. My symptoms all pointed to a sluggish thyroid, which shoulders the blame for a whole litany of complaints, such as middle-aged spread, hair loss, poor concentration, depression, constipation, aching muscles and joints, low libido, and even rising cholesterol. To add insult to injury, an underperforming thyroid can even raise your risk of Alzheimer’s.

If that list sounds familiar, it’s because we may very well have an epidemic of borderline- to low-function on our hands. Consider these statistics: 20 percent of women aged 40 and over have hypothyroid (low thyroid) symptoms; women are seven times more likely to suffer with thyroid problems than men; rates of thyroid cancer have increased steadily for the past 30 years, for no apparent reason; and some 80 million people worldwide have swollen thyroids (goiters) caused by a completely preventable iodine deficiency. Nor do these numbers tell the whole story: thousands of people go undiagnosed, and thousands more don’t get the treatment they need for the fatigue, depression, and weight gain that accompany low thyroid.

A Brief Physiology Lesson

Before we explore the reasons for such a monumental increase in thyroid problems, let’s take a moment to understand what the thyroid actually does. Your thyroid converses with every cell in your body, as it governs the rate of nearly all the body’s biochemical reactions. Together with the hypothalamus and pituitary gland it forms the hypothalamic-pituitary-thyroid (HPT) axis, which is the master regulator of your metabolism, including your heart rate and body temperature. Using iodine, the thyroid produces two hormones (thyroxine or T4 and triiodothyronine or T3) and stores them, awaiting instructions from the hypothalamus and the pituitary gland. The hypothalamus shoots the pituitary a chemical signal telling it when to deliver the hormones, and the pituitary responds by dispensing thyroid-stimulating hormone (TSH), which tells the thyroid just how much or how little to release.

For people like me who have sluggish thyroids, the thyroid gland releases too little. Others have the opposite problem—the thyroid releases too much into the bloodstream, resulting in weight loss, increased pulse rate, heart palpitations, and muscle weakness.

Why the Epidemic?

No one knows why we have such an astonishing increase in thyroid problems. But we do know that the thyroid is extremely sensitive to environmental toxins. Anything from excess gluten in our food supply to endocrine disruptors in the products we use—Bisphenol-A (BPA) in our water bottles, phthalates in our cosmetics, and flame retardants in our mattresses—can cause it to malfunction. And we can also pin some culpability on that ever-present health wrecker, chronic stress. It plays a part in most of our health problems, so it’s hardly surprising that an unabated stress response would have a role in the emerging slow-thyroid story.

Chronic stress can make you feel like your thyroid is a total slacker that’s not doing its job, even though your blood tests come back normal. What gives? When cortisol, the main stress hormone, either soars too high or sinks too low, it blocks your body’s ability to make T3, the active thyroid hormone, even when your pituitary sends the right signal. So, when your doctor measures the pituitary’s thyroid-stimulating hormone it may indeed be normal, but your body may not be converting the inactive hormones (the T4s) into an active form it can use (T3). If that is the case for you, I generally recommend checking your basal body temperature, a simple way to assess thyroid function, especially if you’re under a lot of stress (see below).

Chronic stress can make you feel like your thyroid is a total slacker that’s not doing its job, even though your blood tests come back normal.

Unfortunately, Western doctors don’t always make the cortisol/thyroid connection. When they detect deficient thyroid hormones in their patients, they immediately start them on synthetic medication, usually T4. But I don’t believe the answer automatically lies in a bottle of prescription pills. When my own thyroid problems surfaced, I turned to a more integrative approach, taking a hard look at my stress levels, as well as my diet and other lifestyle choices.

An Integrative Approach

After my own experience—and as an integrative doc—I know better than to tell anyone struggling with these symptoms to just exercise more and eat less. Janie, a 41-year-old woman, is a case in point. She came to see me hoping to find answers for her flagging energy and cranky moods, as well as her unforgiving metabolism that kept an extra 10 pounds on her frame no matter how much she exercised or how little she ate. “I’m more negative than I used to be,” she said. “The usual life problems feel more difficult to solve, and I can’t concentrate like I used to.” 

She said these symptoms had been going on for two or three years, with her doctor insisting all the while that her hormone levels were just fine; but in reviewing her lab results, I noticed that her thyroid was borderline slow. Instead of trying to solve all her individual symptoms, I suggested we focus on their underlying cause.

Root cause analysis—practiced for millennia in Traditional Chinese Medicine (TCM) and ayurveda—looks into why a set of symptoms keeps occurring. In my case, instead of filling a prescription for synthetic thyroid hormone, I took time to reassess my lifestyle. Could the stress of a new baby plus an over-the-top busy practice and an overachieving personality have anything to do with my hormone imbalance? What could I give up or change that would make my life easier and ultimately healthier?

I helped Janie face similar questions. Together we came up with a plan that also took into account her perimenopausal fluctuations.

I call this thyroid-reclaiming protocol “evidence-based integration,” which means I combine the best of ancient wisdom traditions (yoga, ayurveda, and Traditional Chinese Medicine) and cutting-edge science (bioidentical hormones and even prescription drugs when absolutely necessary) to help prevent or heal thyroid dysfunction. One caveat, however: Overt symptoms, including labored and slow breathing or the more serious thyroid coma, need immediate Western intervention.

3 Steps to Rebalance Your Thyroid

1.  Nutrition and Nutraceuticals: When you know your thyroid is out of balance, take a hard look at your diet. What you put in your mouth may profoundly affect your thyroid function. Certain very common foods and nutritional supplements can help reset your thyroid.

When you know your thyroid is out of balance, take a hard look at your diet.

Eat brazil nuts. Brazil nuts are rich in selenium, which is a crucial nutrient for thyroid function. Selenium has recently gotten attention for its connection to fertility, which may also be directly tied to normal thyroid function. Other sources of selenium include eating shellfish, particularly crab, and foods from composted soils. Many holistic doctors recommend using coconut oil; it’s worth a try, but I could not find convincing evidence that it actually affects thyroid function.

Check your iodine levels. Your thyroid gland depends on iodine to make its hormones. Levels among Americans dropped by half between 1971 and 2000, when bakers in the United States began using bromide instead of iodine as a dough conditioner for making bread. Also found in soda, bromide competes with iodine, which means that it can block your absorption of iodine even when you think you’re getting enough. Solution? Don’t eat bread with bromide or drink soda. Make sure you are getting sufficient iodine to support normal thyroid hormone production by getting at least the RDA (Recommended Daily Allowance). Note: Anyone with autoimmune thyroiditis should not supplement with iodine.

Consider supplements. Unless you live on an organic bio-sustainable farm or eat exclusively from composted soils, you probably lack sufficient levels of minerals—particularly copper, zinc, and selenium—that help convert the inactive thyroid hormone T4 into T3, its active counterpart (see sidebar on page 58). Have your levels tested, and if low, take a daily mineral supplement that contains 500 mcg to 1 mg of copper, 10 to 15 mg of zinc, and 200 mcg of selenium.

Increase your vitamin D. The body needs vitamin D to drive the thyroid hormone into the core of the cell. Otherwise, it can’t perform its task well, and you’ll likely feel slow, tired, and apathetic. Unless you live in a sunny climate year-round, you need to supplement your vitamin D, since food rarely provides adequate amounts. Shoot for the high-normal range—1,000 to 2,000 IU a day. Maximum doses are 10,000 IU per day, and toxic levels are rarely encountered even at these dosages.

Give up (or limit) certain foods. When I first heard that tofu, broccoli, and even my beloved kale could slow me down by interfering with thyroid hormone production, I refused to believe it. Sadly, reliable data support that theory. While not all goitrogens (foods that interfere with iodine uptake and thyroid function) are well documented, one study in particular showed that isoflavones from soy can reduce T3 by 7 percent in women who have had their ovaries removed. You may want to at least limit these foods to be on the safe side.

2. Targeted Lifestyle Changes: These commonsense lifestyle changes have proven effective in reducing thyroid-related symptoms.

Minimize environmental toxins. Limit exposure to flame retardants found in mattresses; mercury found in fish, high fructose corn syrup, and dental fillings; and plasticizers (phthalates) found in cosmetics to dissolve ingredients and to moisturize the skin.

Try Traditional Chinese Medicine. Most Western doctors learn to treat the thyroid in isolation by tweaking the biochemistry with a pill or surgery. TCM practitioners most often identify kidney deficiency as the root cause and may further see a problem with the heart or liver meridians. TCM is a great place to start if your symptoms are mild, because there are few side effects.

Practice yoga. Although limited data exist showing that yoga increases the release of thyroid hormones, many women report their symptoms improved when they committed to a regular practice. Timothy McCall, MD, a Western-trained internist and author of Yoga as Medicine (Bantam, 2007), points out, “Many things from the yoga tradition that haven’t been tested turn out to be true, and as long as yoga’s done appropriately, there’s little risk in doing asana—and many benefits beyond just helping the thyroid.” B. K. S. Iyengar champions sarvangasana (shoulderstand) as a way to balance the thyroid, because it employs a chin lock. However, I don’t usually recommend unsupported shoulderstand to my patients, especially those who are new to yoga, because of the intense pressure it places on the tiny cervical vertebrae. I prefer ardha halasana (half plow pose with your legs resting on a chair) or viparita karani (legs up the wall pose), both of which offer gentler alternatives.

B. K. S. Iyengar champions sarvangasana (shoulderstand) as a way to balance the thyroid, because it employs a chin lock.

I also prescribe shavasana to my stress-case clients every chance I get. This deep relaxation pose gives the master glands (the hypothalamus and the pituitary) a break from their red-alert vigilance. Ellen Heed, an anatomy teacher for Forrest Yoga’s teacher training program, agrees. “We’ve bought into the idea that we need to spend 75 percent of a 24-hour day in high productivity, and whittle sleep down to six hours per night,” she says. “Deep healing is not possible at night with that approach.” The result? Organs, such as the thyroid, don’t replenish reserves, and metabolism suffers.

Consider structure. Structural issues can also affect the thyroid—something I never learned in conventional medical training, but a core concept in my yoga teacher training. When you hold stress in your jaw, for example, or your neck and shoulders, you chronically tighten the muscles that may, theoretically, reduce the blood flow into your thyroid and prevent optimal outflow of toxins and waste. A consistent yoga practice can not only release that tension, but also help you notice when you start gripping those areas of the body.

Reduce stress. While scant research exists on yoga and thyroid health, studies point to yoga’s ability to reduce the stress hormones—particularly cortisol—that interfere with normal thyroid function. A full yoga sequence, including simple breathing practices, may indirectly have a profound effect on the thyroid. “Your endocrine glands, like the thyroid and the adrenals, need regular doses of deep relaxation to regenerate,” explains Heed. Furthermore, in a very small study at Jefferson Medical College in Philadelphia, participants were able to reduce their cortisol levels doing sequences that included sarvangasana (shoulderstand), halasana (plow pose), and vrikshasana (tree pose).

I suggest spending at least six weeks focusing on nutrition and lifestyle strategies and then having your thyroid hormones and BBT rechecked. (Six weeks is the minimum amount of time it takes for your body to reach homeostasis.) If you don’t see the improvements you hoped for, you may want to consider bioidentical hormones as a short-term solution.

3. Bioidentical Hormones: When changes to your diet and lifestyle still don’t allow your body to produce enough hormones to balance your endocrine system, bioidentical hormones—given in the lowest possible dose—may be your best alternative. These medications, structurally the same as the hormones your body makes, are no panacea, but can often quickly correct irregular thyroid levels.

Thyroid hormones are not one-size-fits-all. Some women do well with a natural dessicated thyroid medication, such as Armour Thyroid or Nature-Throid. For others, I recommend a synthetic preparation such as levothyroxine (T4) with or without liothyronine (T3). To find out which one is right for you, check with your holistic health practitioner. Tracking symptoms, checking your basal body temperature, and getting the correct blood tests will inform your path and next steps.

Thyroid hormones are not one-size-fits-all.

If you suffer from fatigue, weight gain, depression, and a host of other unexplainable symptoms, try some of these tests and techniques to assess your thyroid, even if your more conventional lab tests come back negative. With a rigorous, integrative strategy, you can get to the root of your malaise. And, believe me, once your thyroid is back working for you instead of against you, you’ll have that longed-for zip back in your step.

Deciphering the Thyroid Players: 

TSH Thyroid-Stimulating Hormone. Released by the pituitary gland, this is the most commonly tested thyroid hormone in Western medicine. Higher levels, above 2.5 mIU/L, suggest borderline- to low-thyroid function.

T4 Thyroxine. T4 is the inactive thyroid hormone, generally kept in storage in the thyroid gland until it’s turned into T3, the active thyroid hormone.

T3 Triiodothyronine. T3 is the active thyroid hormone, which means it has the most profound effect on your metabolism, heat, and weight.

RT3 Reverse T3. RT3 is made in excess during times of stress, which can cause thyroid resistance by blocking the thyroid hormone receptor. In other words, when you’re stressed out, the body responds by making reverse T3, which keeps you from losing weight or controlling your mood swings. Reverse T3 is the body’s way of adjusting metabolism, such as during a famine, and we make too much these days because of stress.

Take the Thyroid Quiz

Three or more of these symptoms may mean that your thyroid is working against you.

  • You’ve packed on a few pounds and can’t get them off.

  • You look at a piece of pie and the extra pounds appear on your hips.

  • Your body feels a little slow, maybe a little tired.

  • What’s that called again? Oh, yes… brain fog.

  • Your reflexes are sluggish.

  • Your hair is dry, tangles easily, or is falling out.

  • Your joints feel geriatric.

  • You wear more layers than anyone you know. Your spouse has terms of endearment for your cold feet and hands.

  • You’ve lost a bit of spring in your step.

  • The world isn’t quite as rosy as it used to be.

  • You’re slower than you used to be—your reactions, your thoughts, and, yes, your thyroid.

Basal Body Temperature

Basal body temperature (BBT) offers an important low-budget assessment of your thyroid function; you should consider taking your BBT even if your blood tests come back within the normal range. BBT measures your T3 activity inside the cells, which is where thyroid truly affects metabolism. Doctors used to recommend BBT mostly for women who were trying to conceive, but now I encourage anyone trying to assess their thyroid health to keep track of their basal body temp, especially those who suffer from chronic stress.

Here’s how to measure BBT. You need a special basal body thermometer, which differs from other thermometers because the temperatures run lower than the usual 98.6ºF. When you wake up, but before getting out of bed, put the thermometer under your armpit for a good 10 minutes. Remain as still as possible; no multitasking. Record the temperature at least three days in a row. If you’re menstruating regularly, measure BBT on days 2 through 4 of your period. The normal range is 97.8ºF to 98.2ºF. If your reading comes in below that, your thyroid is probably underactive and your metabolism too low.

The New Normal

Many clinicians use old-school normal ranges for thyroid hormones and may also neglect to order the correct tests. Some physicians haven’t updated their data bank since medical school, decades before. That’s where your empowerment, knowledge, healthy skepticism, and intuition come in.

More than 10 years ago, doctors were taught that they needed to test only the thyroid-stimulating hormone levels to determine whether your thyroid functioned normally—and that those levels needed to be between 0.5 and 4.5 mIU/L. Ten years ago, the American Association of Clinical Chemistry published new rules that changed the upper limit of normal TSH to 2.5 mIU/L. A year later the American Association of Clinical Endocrinologists jumped onto the bandwagon and lowered the target range for TSH to 0.3 to 3.0 mIU/L. Make sure your primary care physician uses the most recent guidelines.

About the Teacher

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Sarah Gottfried
Sara is a Harvard-trained MD with an integrative gynecology practice in Oakland, CA; a yoga teacher;... Read more