Nutrition, Lifestyle & Environmental Tips for Hypothyroidism

Hypothyroidism is a medical condition in which the thyroid gland (located on the neck) doesn’t produce enough thyroid hormones.

What do thyroid related hormones do exactly?

• Thyroid-stimulating hormone (TSH) comes from the pituitary to stimulate the thyroid gland to produce thyroid hormones (T3 and T4). When the pituitary gland sends more TSH when T3 and T4 levels are low – this is hypothyroidism in a nutshell.
• Thyroxine (T4) and triiodothyronine (T3) are the main hormones produced by the thyroid gland. They both play important roles in energy metabolism, brain development, heart function, among other jobs. T4 is considered “inactive” while T3 is “active.” After being released from the thyroid gland, T4 can be converted to T3 in various places throughout the body.

What are some common signs & symptoms of a sluggish (hypo) thyroid gland?

• Anxiety and/or depression
• Abnormal lipid panel
• Feeling cold
• Constipation
• Excess hair shedding
• Heavy menstrual periods
• Hypertension
• Loss of libido
• Poor memory or “brain fog”
• Swollen/puffy face
• Tired or fatigued
• Difficulty conceiving
• Unintentional weight gain

Who should be checked for Hypothyroidism?

The following populations below should be screened due to increased risk, but if you have signs or symptoms as listed above, this also warrants talking with your healthcare team:

• Patients with autoimmune diseases like type 1 diabetes and celiac disease
• Patients with unexplained unintentional weight gain
• Pregnant women or women planning to conceive as hypothyroidism and/or thyroid antibodies increase risk of miscarriage
• Patients with a family history of hypothyroidism
• Patients prescribed lithium or amiodarone

What labs are commonly looked at in hypothyroidism?

• TSH: In hypothyroidism, TSH levels are elevated because the body is struggling to make enough thyroid hormones (T4 and T3). In allopathic focused medicine, TSH is used to screen for thyroid dysfunction and is often the only test used to diagnose hypothyroidism. Guidelines state that the normal range for serum TSH in adults is 0.4-4.0 mIU/L, and overt hypothyroidism is diagnosed when the TSH gets to greater than 10 mIU/L. This is controversial as many health experts have questioned whether this range was based on a truly normal population, and some believe the upper limit should be 2.5 mIU/L. In pregnancy, most experts agree to have the TSH land between 0.3 to 2.5 miU/L.
• T3 and T4: In hypothyroidism, T3 and T4 levels are usually low. One can be “normal” while the other abnormal, so wise to monitor both.
• Thyroid antibodies: anti-thyroid peroxidase (TPOAb) & anti-thyroglobulin (TgAb) In autoimmune thyroiditis (aka: Hashimoto’s), the immune system can produce these antibodies that attack the thyroid gland. Antibodies tend to precede the development of a sluggish thyroid, and often present years before the TSH elevates to meet diagnostic criteria. Thyroid antibodies can decrease with nutrition and lifestyle interventions.

What are the normal ranges for these labs?

More research is needed to establish universally accepted values as they are heavily debated between multiple branches of healthcare. Reference ranges vary from lab to lab; you can self order a thyroid panel here. Common conventional medicine lab value ranges are:

• TSH: 0.4-4.0 uIU/mL
• Free T4: 0.8-1.9 ng/dL
• Free T3: 1.8-4.2 pg/mL
• Anti-TG antibody : </=40 IU/mL
• Anti-TPO antibody: </=34 IU/mL

Once diagnosed, how does a Physician care for Hypothyroidism?

1. Overt hypothyroidism (TSH>10 mIU/L) is often treated with Synthyroid, a synthetic version of T4. This pill is commonly prescribed to be taken each morning, one hour before food and then titrated based on labwork. Another prescribable option are desiccated thyroid extract (DTE), which are made from the thyroid glands of pigs and contains both T4 and T3. Armour, NP thyroid, WP Thyroid, Nature-Thyroid, Thyrolar are all T4/T3 combo prescriptions. T3 medications (Cytomel and SRT3) can also be used. T3 medications are often not prescribed for concern of hyperthyroid symptoms and they are more labile in how they perform. The goal of using prescriptions is to help the patient feel better and to get TSH, T4, and T3 into normal ranges.
2. Subclinical hypothyroidism (TSH 4-10 mIU/L) is not treated by many conventional doctors and is a controversial topic. The exception is that many experts agree on treating pregnant women or women trying to conceive with the goal of using medication to get the TSH to 0.3 to 2.5 mIU/L to prevent miscarriage.

Endogenous or Exogenous T4 doesn’t always properly convert to T3.

This means the T4 your body makes or the T4 medication you take doesn’t inherently get well activated. Nutrition and lifestyle can make a difference here! These below can all be challenges for the body to convert T4 to T3:

• Alcoholism and excess alcohol intake
• Certain hygiene product chemicals
• Diabetes
• Endocrine disruptor exposure
• Fasting/intermittent fasting
• Iodine intake in excess
• Heavy metal exposure (like lead and cadmium)
• Kidney & liver diseases
• Malnutrition and/or carbohydrate restriction
• Nutrient deficiencies
• Some prescription medications can interfere

How does a skilled Registered Dietitian care for the thyroid?

Ultimately, nutrition recommendations and guidance will be individualized as nuances exist but generally speaking the following nutrition areas have been studied and can support thyroid function and the conversion of T4 to T3:

• Gluten Free Diet: In 2019, one study found that a gluten-free diet significantly reduced thyroid antibodies. This method remains controversial, but there is little to no risk in trying as long as adequate fiber is still consumed. This practice is often adopted by many functional medicine aligned practitioners with goal of trying to prevent or slow progression to hypothyroidisism.
• Myo-inositol is a compound found naturally in food (especially grains and legumes) that can also be produced by the body which is why it no longer considered a vitamin. Myoinositol is required for thyroid hormone synthesis. Several studies have show that supplementation with myoinositol can decrease the TSH and thyroid antibodies.
• Iodine: This essential mineral helps the production of thyroid hormones. A deficiency can cause/worsen hypothyroidism and goiter. It is important to meet the dietary reference intake of iodine (around 150mcg to 300mcg per day depending upon age, gender, and if lactating). On the other hand, excess iodine intake (greater than 1000mcg per day) can actually cause hypothyroidism too. It is important with all nutrients, to look at the sumative intake from both food and supplements to ensure getting the right amount – not chronically too much or too little.
• Zinc is a mineral required for the synthesis of TSH, and also plays a role in converting T4 into T3. Zinc supplementation (30 mg zinc/day) resulted in significantly increased free T3 levels compared to placebo in participants with hypothyroidism in one study.
• Selenium is necessary mineral for efficient thyroid hormone production and conversion of T4 to T3. There have been multiple studies that showed selenium supplementation can reduce TSH and reduce TPOAb antibodies for those with subclinical hypothyroidism and antibody presence. The school of thought is adequate Selenium can also protect the thyroid from damage.
• Iron is a mineral required to produce thyroid hormones. If ingested via supplementation, it is important that it is dosed appropriately and taken at least 4 hours after a prescription thyroid medication. I would recommend getting bloodwork done prior to supplementing to first determine if there is a need as iron overload can be dangerous. People with hypothyroidism have higher risk of low ferritin levels.
• Magnesium: the thyroid gland needs magnesium, another mineral, to help convert inactive T4 to active T3. Low serum magnesium levels have been linked with an increased risk of hypothyroidism and higher levels of thyroid antibodies. Most people need around 300 to 400mg of magnesium each day; however, most do not come close from food intake alone in our Westernized nation. Pumpkin seeds are great source too of magnesium.
• Vitamin D– low levels of this nutrient are linked with higher TPOAb levels and a higher risk for hypothyroidism. Multiple studies have shown significant decrease in TSH and TPOAb levels via vitamin D supplementation in patients with vitamin D deficiency. Important to get your levels checked! Some foods have vitamin D (dairy, fortified dairy alternatives, some fish, mushrooms), but not many especially in amounts needed to reach the dietary reference intake. Humans can also synthesize vitamin D from the sun, but this can be a problem if you are indoors or not living at a latitude where this can more readily occur.

Lifestyle and Environmental Areas to Helping Someone with Hypothyroidism

1. Get a Reverse Osmosis water filtration system
   • Heavy metals can decrease t4 to t3 conversion. I’ve literally seen patients need dose reductions (which is a good thing) just by starting to filter their tap water because they weren’t drinking as much arsenic decreasing the t4 medication into t3 in the body and they were becoming “hyper” on their normal dose.
2. Use Red light Therapy Device over the thyroid gland, if given permission by your doctor
   • There are many studied benefits of using Red light therapy over the thyroid gland. There was an even a study showing that about 50% of participants were able to come over their thyroid medicine completely by adding in regular red light usage.
   • This one is a qualified medical device and you can purchase one using your HSA/FSA card!
3. Check your home for mold! Especially if you have thyroid antibodies
   • Get an ERMI kit. The ERMI kit 1 is an at home dust collection kit and it’s simple to collect. If the report is greater than a 5, then professional inspection and remediation needs to occurs. Toxic indoor mold in clinically significant amounts can worsen thyroid function via multiple mechanisms of action

How toxic indoor mold exposure can affect your thyroid health

Mold, especially the mycotoxins it produces, can have several negative impacts on the thyroid gland and overall thyroid function, leading to various thyroid-related issues. Here’s how mold exposure can harm the thyroid:

1. Endocrine disruption

• Direct interference: Mycotoxins can act as endocrine disruptors, directly affecting the thyroid’s ability to produce and regulate hormones like T3 (active thyroid hormone) and T4 (inactive thyroid hormone).
• Receptor interference: Mycotoxins can mimic or block thyroid hormone receptors, hindering the body’s ability to utilize thyroid hormones effectively. 

2. Inflammation and oxidative stress

• Triggering inflammation: Exposure to mold and mycotoxins can trigger chronic inflammation throughout the body, including the thyroid.
• Impairing enzyme function: Inflammation and oxidative stress can impair the function of deiodinase enzymes (DIO1, DIO2, DIO3), which are crucial for converting inactive T4 into active T3. This can lead to low T3 levels despite normal TSH (Thyroid-Stimulating Hormone) and T4 levels, a pattern often seen in Non-Thyroidal Illness Syndrome (NTIS), also known as Euthyroid Sick Syndrome (ESS). 

3. Autoimmune triggers

• Leaky gut and autoimmunity: Mold exposure can lead to intestinal permeability, or “leaky gut,” which allows toxins to enter the bloodstream and potentially trigger an autoimmune response against the thyroid gland, leading to conditions like Hashimoto’s thyroiditis. You can also see a low MSH (melanocyte stimulating hormone).

4. Interference with nutrient absorption

• Mineral depletion: Mold toxicity can deplete essential minerals crucial for thyroid function, such as zinc and selenium, further compromising thyroid health. 

Big picture make sure you take mold seriously as possibility, check for nutrient deficiencies and stop drinking tap water. There is often a hyperfocus on diets for hypothyroidism and often times what people need more of (in terms of lifestyle recommendations) is to stop frequency exposures to serious toxins and to correct deficiencies that occur even with healthy balanced diets.

People have lots of options to help address their labwork and improve their health. It is important to work with a healthcare team that understand proper and thorough care of your thyroid gland beyond just using medication. Medication helps to treat the disease, but that’s the minimum – let’s thrive and not just survive!

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