Thyroid Balance

Q: For the last few months I’ve been a wreck. My joints hurt, I’m tired and depressed, and I’ve even started to gain weight—for no apparent reason. My doctor says I have hypothyroidism. How did this happen? Will I really need to be on medication for the rest of my life?

A:  Hypothyroidism is medical speak for a low functioning thyroid, the tiny butterfly-shaped gland at the base of your neck. This rather common condition affects around 10 percent of women over 40; and unfortunately, once you reach menopause, you’ve nearly doubled your chances of such a diagnosis. Depending on the severity of the problem, your doctor will probably prescribe a daily thyroid hormone replacement pill. However, before you resign yourself to a lifetime of pill swallowing, I think a little research is in order to determine the cause of your sluggish thyroid. And, I’m happy to note, several holistic options exist that can help get it functioning optimally. 

First, a Little Physiology

Think of this gland as the “metabolism manager.” When it does its job, we have good energy, adequate warmth, and normal bowel function; when it malfunctions, we feel sluggish, cold, and constipated.

To understand why hypothyroidism causes so many different problems, it’s important to understand what the thyroid does. Think of this gland as the “metabolism manager.” When it does its job, we have good energy, adequate warmth, and normal bowel function; when it malfunctions, we feel sluggish, cold, and constipated. When it speeds up too fast—a condition called hyperthyroidism—we feel restless, overheated, and prone to diarrhea. 

But the thyroid does more than regulate energy, temperature, and digestion. It basically affects every function in the body. A healthy thyroid improves your skin, hair, muscles, bones, joints, nerves, heart, mood, and sexual function. So, yes, you can blame your weight gain, muscle and joint pains, and depression on your sluggish thyroid. Hypothyroidism has also been linked to nerve entrapment (such as carpal tunnel syndrome), menstrual irregularities, high cholesterol, and heart disease. It can even cause swelling in the face, ankles, and neck. 

How Does This Happen?

In a healthy body, the thyroid makes thyroxine (T4) and triiodothyronine (T3) in response to the pituitary gland’s thyroid stimulating hormone, or TSH. Some of the T4 is then converted into the more active T3 hormone, and together they regulate metabolism throughout the body. Any interference with even one of these processes (stimulation, production, or utilization) can cause symptoms of hypothyroidism. Here are some common possibilities: 

• Mineral Deficiencies. An adequate supply of iodine and selenium is essential to thyroid hormone production. It used to be easy to get enough iodine—it was added to table salt in the 1920s to prevent goiters. But iodine deficiency has become a rising problem as so many of us shun salt to avoid blood pressure problems or switch to gourmet salts that lack iodine. 

• Hormones. Studies suggest that any disruption in the balance between estrogen and progesterone impedes normal thyroid hormone production or its utilization. Pregnant women and perimenopausal women, whose hormones fluctuate wildly, are particularly at risk. 

• Stress. Cortisol and adrenaline, two hormones made by the adrenal glands, rise excessively with unrelenting stress, blocking TSH production in the pituitary andimpeding the body’s ability to convert T4 to the more active T3. When T3 levels are too low, the body responds by making even more of these stress hormones to rev up its metabolism, which further prevents the conversion to T3—a vicious cycle. 

• Autoimmune Disease. A fairly common cause of hypothyroid problems is thyroiditis, a condition in which the immune system attacks and damages the thyroid gland, creating inflammation and scarring. Hashimoto’s disease, one example of thyroiditis, is the number one cause of hypothyroidism in the West. 

• Environmental Toxins and Drugs. Pesticides, exposure to radiation, fluoride, and even cigarette smoke contribute to thyroid problems. Prescription drugs such as lithium and some seizure medications are also linked to lowered thyroid function. 

What is Your Alternative?

While your doctor may very well prescribe synthetic thyroid hormone to replace what’s missing, alternatives do exist. Plenty of people have successfully decreased their medication—and many have gone off completely—by making dietary and lifestyle changes. Here’s how to get started: 

1. Get your iodine and selenium levels checked. The goal is to take in a minimum of 150 mcg of iodine and up to 1,000 mcg a day. But don’t overdo it—too much iodine can shut down T4 to T3 conversion. Along with an iodine supplement, fortify your diet with sea vegetables like kombu and nori, or take a seaweed supplement—kelp (Laminaria sp.) and bladderwrack (Fucus vesiculosis) both contain large quantities of iodine, as well as zinc, iron, calcium, and magnesium. The recommended dietary allowance for selenium is 55 mcg a day, which is achievable through a plant-based whole- foods diet, depending on the selenium levels in the soil. If your selenium levels are low, supplement with 200 mcg a day. 

2. Make sure you eat well. Foods high in antioxidants (vitamins A, C, E), B vitamins, and omega-3 fatty acids all support the thyroid and its functions. Eat a wide range of whole foods—from beans, veggies, and grains to fish, nuts, seeds, and nutritional yeast. 

3. Manage your stress levels. Practicing deep, slow diaphragmatic breathing every day for 5 to 10 minutes helps your nervous system know how to get from the “fight or flight” state to the “rest and digest” state. Regular practice (not just when you feel overwhelmed) makes that relaxed state more accessible and can prevent a major crisis. Meditation and yoga also help. 

4. Practice specific yoga poses. Yoga therapists recommend poses that emphasize flexion and extension of the neck to treat thyroid problems. Shoulderstand(sarvangasana) and its counterpose fish (matsyasana) bring increased blood flow and energy to the throat center. Add camel pose (ustrasana), bridge pose (setu bandhasana), the “roar” of lion pose (simhasana), and some ujjayi breathing to further balance the thyroid. 

5. Support thyroid health with herbs. Coleus forskohlii, a member of the mint family, is an ayurvedic herb shown in modern studies to stimulate thyroid hormone production. The usual dosage is 50 to 100 mg daily in two divided doses. Similar effects can be gained from taking 10 mg of forskolin, the active ingredient of coleus, instead of the whole-herb extract.

6. Kanchanar guggulu (we reccomend Banyan) is another ayurvedic preparation historically used to treat enlarged glands or thyroid issues. Kanchanar bark, an astringent, is mixed with trikatu (an anti-inflammatory and metabolism booster), triphala (an anti-oxidant and digestive aid that tones and cleanses the bowel), and guggulu (a resin that is warming and detoxifying). 

7. Learn to express yourself. From a holistic standpoint, I like to encourage my hypothyroid patients to literally and figuratively find their voice. According to the subtle anatomy of yoga, the throat (the fifth chakra) is the center of creativity and expression. If you’ve never been encouraged to express yourself, go ahead and sing, shout out loud, take a theater class—get those creative juices flowing and experience what it feels like to hear your own voice. Since the throat center is also the nexus between the head and the heart, you can move toward a more harmonious balance here by contemplating the authenticity in your life. Ask yourself questions like, Am I doing the work in the world that I truly want to do? How can I more fully embody my genuine self?

Yoga therapists recommend poses that emphasize flexion and extension of the neck to treat thyroid problems.

If you’ve never been encouraged to express yourself, go ahead and sing, shout out loud, take a theater class—get those creative juices flowing and experience what it feels like to hear your own voice.

The Scoop on Goitrogens

One indication of a malfunctioning thyroid is a swelling in the neck called a goiter—often caused by iodine deficiency. Goitrogens are substances that can block the absorption of iodine (and therefore potentially contribute to a goiter). They are found in various foods, including the brassica vegetables, such as kale, cabbage, broccoli, Brussels sprouts, cauliflower, and turnips; soy; and, to a lesser extent, pine nuts, peaches, strawberries, and spinach. If you have hypothyroidism and you know your iodine levels are low, cut down on eating goitrogenic foods in raw form. When cooked or fermented, however, these foods have little effect on iodine metabolism, so you can safely enjoy their other nutritious properties.

Although gluten is not a goitrogen per se, gluten intolerance has been linked with autoimmune thyroid diseases. If you do have hypothyroidism, get tested for gluten sensitivity to find out whether you should avoid grains such as wheat, barley, and rye.