And the question I get is ‘Why is the fatigue still there even with my thyroid medication?’ The next question is often ‘Can functional medicine help me?’.

The simple answer is yes. But, that still doesn’t answer why functional medicine can help and why patients still suffer from fatigue even with thyroid medication.

The Thyroid Gland Isn’t a Math Problem

When you take thyroid medication, you might assume that you’re balancing an equation. I should have a certain number of thyroid hormones, so if I just take the right dosage, then I’ll be balanced. Or I have too much thyroid hormone so I’ll just suppress that with medication and subtract hormones until my levels are correct. But your body isn’t a math problem. If you have Hashimoto’s thyroiditis, your body has likely been creating antibodies that destroy the thyroid gland for years before you were clinically diagnosed with hypothyroidism. The underlying cause and symptoms don’t go away post-diagnosis, and taking medication doesn’t eliminate thyroid antibodies either.¹

Hypothyroidism (Hashimoto’s) and hyperthyroidism (Grave’s disease) are both auto-immune diseases that affect the thyroid gland. With hyperthyroidism, the immune system creates antibodies that cause the thyroid gland to make too much thyroid hormone. In a hypothyroidism disease, the thyroid gland does not make enough thyroid hormone. Hashimoto’s, the most common cause of hypothyroidism, happens when the immune system creates antibodies that attack and damage the thyroid gland. Even though hyperthyroid diseases result in too much thyroid hormone and hypothyroid disease result in too little thyroid hormone, both present with fatigue as a major symptom.

Since the thyroid gland’s job is to control the body’s metabolism and how fast the cells work if it's not working correctly, you’ll feel it. If it’s not as simple as balancing a math equation, how should a thyroid work in a balanced way? Let’s look at how it’s supposed to function.

Why You Need a Thyroid Gland

Thyroid hormones are used by nearly every cell to control the way they use energy. When a woman is pregnant, she’s using energy for two, and the gland will produce more hormones to increase metabolism and result in more energy.² The thyroid also helps regulate body temperature, cholesterol levels, menstrual cycle, body weight, heart rate, and breathing.³ So you need this little gland to work well for you to have enough energy to get through the day, stay warm on a cold day, think clearly, and then slow down energy production to sleep well at night. That’s a lot! And clearly, we need more hormones on some days than others to adapt to our environment. A well functioning thyroid steps up hormone production to meet the demand.

The hormones that the thyroid creates and sends out are Triiodothyronine (T3) and Thyroxine (T4).⁴ T3 is the active hormone that can be used by most cells. T4 is an inactive version of the hormone that can be stored and is converted to the active T3 version by other organs like the liver, kidneys, and gut. Both T3 and T4 are made by the thyroid from iodine we’ve consumed in our diet. Iodine is not something our bodies can make on its own. So if your thyroid is the factory producing T3/T4 as its product, iodine is the raw material needed to run the factory.

Your thyroid knows when to crank out the T3/T4 when the pituitary gland places an order. The pituitary gland is a small pea-sized gland at the base of your brain that controls all of your endocrine system.⁵ It functions as the parent company that directs all the other glands in the endocrine system. Your pituitary gland does market research by reading how much T4 is in your bloodstream. When it detects that more T4 is needed, the pituitary places an order by secreting TSH (thyroid stimulating hormone). When your thyroid receives the TSH, it steps up T3/T4 production. After the T3/T4 is made, some T4 is stored in the thyroid gland, and some is distributed where supplies are needed in the body. After T4 is delivered, it can be converted to the T3 form by organs like the liver and brain.

Since T3/T4 are used in almost every cell from your brain to your skin and the creation and delivery system are complex, there are many opportunities for the thyroid hormone pipeline to breakdown.

Low TSH

We need the pituitary gland to check our T4 levels and send out TSH to request more T3/T4 to be made. Low TSH and a pituitary gland that’s not functioning correctly, leaves an opportunity for the thyroid gland to underperform. The opposite could happen if the pituitary gland went into overdrive and began sending out too much TSH, which would cause the thyroid to overproduce T3/T4.

Inflammation

Systemic inflammation is an immune response where your body is trying to clear out a bacteria, virus, or foreign substance. When the body confuses healthy tissue for a foreign substance, it creates antibodies to attack healthy tissue, which is an auto-immune response. The thyroid is susceptible to antibodies and can eventually wither and stop functioning. Systemic inflammation and an antibody attack are classic signs of Hashimoto’s. These patients’ inflamed immune systems don’t respond to regulating the TSH level alone.⁶

Gut problems

Our gut or intestinal tract contains a huge part of our immune system and endocrine system. And healthy gut flora not only helps us digest our food correctly, but it also helps convert T4 to T3. People with auto-immune diseases, especially Hashimoto’s, have altered gut microbiota⁷ that affects food digestion, and how thyroid hormones are converted and used. A slow intestinal timeline (constipation) is a symptom of a slow, underproducing thyroid. On the other hand, regular bouts of diarrhea are linked with an overactive thyroid that is running the intestinal tract too quickly. There is a feedback loop that depends on the thyroid gland running the body’s systems like the gut at the right speed and the gut contributing to the conversion of thyroid hormones to keep a steady flow of T3/T4. When the thyroid and gut are working out of sync, you can’t have reliable T3/T4 production, delivery, or a regular digestion schedule.

Liver

Your liver is a detoxification center. It also is one of the organs that serve as a center for T3/T4 conversion. Your liver has a huge job. And just like you can get overworked, so can your liver. If you have a heavy toxic load from your diet or environment, your liver has more toxins to clear. And there is a tipping point when it can no longer get all the detoxification work done and other functions like converting T3/T4. The connection between liver disease and thyroid disease is closely intertwined, and patients with liver problems are likely to develop thyroid disease and vise versa.⁸

It’s Not a Simple Fix

With all the opportunities for a connection in the thyroid pipeline to breakdown, there isn’t a simple fix or just one place to look for a cause. Conventional medicine treats thyroid disorders like that math problem they want to balance. Once thyroid hormones are low, conventional medicine adds synthetic hormone as a way to increase the low levels. If thyroid hormones are high, conventional medicine prescribes medication to supress thyroid hormone production. Neither of those approaches takes into account a body that isn’t converting T4 to T3.  Adding synthetic hormone to the body that can’t turn it into a useable form doesn’t fix the problem or relieve symptoms.⁹

The medical model of pumping a body full of synthetic hormones that can’t use the hormones efficiently is like trying to fill a cup with water, but discovering there is a hole in the bottom. That cup can never be filled without repairing the hole. A study tested hypothyroid patients that take synthetic T4 hormone to see if patients felt better if their medication changed their TSH levels to a normal lab result.¹⁰ The tests showed that the patients had no preference for any T4 dosage and didn’t have symptom relief despite lab results. All of these patients still had thyroid disease and still had the symptoms of that disease.

There are 10-12 million people diagnosed with hypothyroidism in the United States, and around 15% of them have no symptom relief despite following all recommended conventional medical treatments.¹¹ The same study concluded that patients that take synthetic hormone (levothyroxine) that have normal TSH are more overweight, have higher cholesterol, and higher blood pressure than patients without thyroid disease of the same age, gender, and TSH levels. By conventional medicine’s standard, if TSH levels are made “normal” then the there shouldn’t be a difference between thyroid patients’ symptoms, metabolism, cholesterol levels, blood pressure levels or gut microbiota.  However, just altering the TSH level doesn’t stop the body from producing antibodies, fix gut microbiota, or stop patients’ symptoms.

Targeted Testing  

Functional medicine takes a different approach to thyroid diagnosis. Instead of testing in one area to see if the thyroid is being stimulated and base a diagnosis off that one result, functional medicine uses targeted testing. Your symptoms, health history, and physical examination combined are used to decide what tests you need and leave out the tests you don’t need. There are lab tests for thyroid antibodies, T4 and T3 production, T4 to T3 conversion, liver functionality, and more. Instead of a narrow view or a shotgun approach, we look for the root cause for any thyroid imbalance or dysfunction.

Once a root cause is found, then we can work to find what customized nutrition and therapy will correct the underlying problem.

Customized Nutrition and Therapy

Patients with thyroid disease often have triggers or associated diseases like Hashimoto’s and Celiac disease. Doctors found that almost 1 in 6 patients with Hashimoto’s thyroiditis will be positive for Celiac disease, and 1 in 5 patients with Celiac disease will have a thyroid disorder.¹²  It’s only when you know the cause of your thyroid condition that you can work to reduce those illness triggers.

For patients with Hashimoto’s, inflammation and immune problems that target the thyroid with antibodies won’t disappear just because a synthetic hormone is supplemented. However, targeted food plans combined with nutritional supplements have shown to reduce inflammation and improve immune responses.¹³ These are the patients that felt better and reduced symptoms like fatigue that hadn’t gone away with synthetic hormone alone.

The American Thyroid Association estimates that 60% of people with thyroid disease are undiagnosed and unaware of their condition.¹⁴ The variety of symptoms that people with thyroid disease is huge, but fatigue and weight gain are some of the first symptoms that patients report. For people with hypothyroidism, fatigue stems from a slow thyroid that’s underproducing. For people with hyperthyroidism, fatigue is often the result of insomnia and poor sleep since an over-producing thyroid keeps the body in overdrive. For both thyroid disorders, there are several possible underlying causes. Functional medicine dives into your medical mystery to find the trigger and address the cause of your thyroid condition, so you can find relief from fatigue and truly improve your health. 

I hope this information helps you on your journey!

P.S. You can take our free thyroid analyzer quiz to begin your journey to find your root cause and end thyroid fatigue now!

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Endnotes

¹ “Q And A: Can Thyroid Disease Be Cured?” American Thyroid Association, 2019, www.thyroid.org/patient-thyroid-information/what-are-thyroid-problems/q-and-a-can-thyroid-disease-be-cured/.

² InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the thyroid gland work? 2010 Nov 17 [Updated 2018 Apr 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279388/

³ InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the thyroid gland work? 2010 Nov 17 [Updated 2018 Apr 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279388/

⁴ InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the thyroid gland work? 2010 Nov 17 [Updated 2018 Apr 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279388/

⁵ InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. How does the thyroid gland work? 2010 Nov 17 [Updated 2018 Apr 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279388/

⁶ Walsh, John P., et al. “Small Changes in Thyroxine Dosage Do Not Produce Measurable Changes in Hypothyroid Symptoms, Well-Being, or Quality of Life: Results of a Double-Blind, Randomized Clinical Trial.” The Journal of Clinical Endocrinology & Metabolism, vol. 91, no. 7, July 2006, pp. 2624–2630., doi:10.1210/jc.2006-0099.

⁷ Zhao, Fuya, et al. “Alterations of the Gut Microbiota in Hashimoto's Thyroiditis Patients.” Thyroid, vol. 28, no. 2, 28 Feb. 2018, pp. 175–186., doi:10.1089/thy.2017.0395.

⁸ Huang, Miau-Ju, and Yun-Fan Liaw. “Clinical Associations between Thyroid and Liver Diseases.” Journal of Gastroenterology and Hepatology, vol. 10, no. 3, 1995, pp. 344–350., doi:10.1111/j.1440-1746.1995.tb01106.x.

⁹ Walsh, John P., et al. “Small Changes in Thyroxine Dosage Do Not Produce Measurable Changes in Hypothyroid Symptoms, Well-Being, or Quality of Life: Results of a Double-Blind, Randomized Clinical Trial.” The Journal of Clinical Endocrinology & Metabolism, vol. 91, no. 7, July 2006, pp. 2624–2630., doi:10.1210/jc.2006-0099.

¹⁰ Walsh, John P., et al. “Small Changes in Thyroxine Dosage Do Not Produce Measurable Changes in Hypothyroid Symptoms, Well-Being, or Quality of Life: Results of a Double-Blind, Randomized Clinical Trial.” The Journal of Clinical Endocrinology & Metabolism, vol. 91, no. 7, July 2006, pp. 2624–2630., doi:10.1210/jc.2006-0099.

¹¹ Rush University Medical Center. “Hypothyroidism Symptoms Linger despite Medication Use, Normal Blood Tests.” ScienceDaily, ScienceDaily, 12 Oct. 2016, www.sciencedaily.com/releases/2016/10/161012132038.htm.

¹² Hadithi, Muhammed. “Coeliac Disease in Dutch Patients with Hashimoto’s Thyroiditis and Vice Versa.” World Journal of Gastroenterology, vol. 13, no. 11, 21 Mar. 2007, p. 1715., doi:10.3748/wjg.v13.i11.1715.

¹³ Hadithi, Muhammed. “Coeliac Disease in Dutch Patients with Hashimoto’s Thyroiditis and Vice Versa.” World Journal of Gastroenterology, vol. 13, no. 11, 21 Mar. 2007, p. 1715., doi:10.3748/wjg.v13.i11.1715.

¹⁴ “General Information/Press Room.” American Thyroid Association, 2019, www.thyroid.org/media-main/press-room/.