by Tara Shimer
Disclaimer: I am not yet a medical professional. This blog should not be construed as medical advice, nor diagnosis. I am writing this blog for Thyroid Awareness Month (January). It may include references to peer-reviewed scholarly articles, as well as books by my favorite health authors. It may also feature a casual, conversational, satirical and/or rhetorical tone of voice, criticism of the current standard practice of care in Western Medicine, advocating for the ketogenic diet, my own experience with thyroid hormone imbalance and treatment, and advertisement of my own company’s products. It could also include none of those; we’ll see. Thanks for reading.
What is the Thyroid?
This, I will hardly cover because I take it as unlikely that you would find yourself here without knowing the basics, but if you do wish to know more about the thyroid in the context of normal, or healthy, function, you can find more information using my recommended literature list near the end of this blog; I don’t wish to waste your time by being redundant of folks who have far greater credentials than I, nor reaffirming something you either already solidly know or don’t care about.
By the way, at the very end of this blog is a section in which I penned a mildly-endearing anecdote showcasing my neurotic inquisitiveness, but feel free to leave the page before you get that far.
Why Does it Matter So Much?
To be brief: the thyroid gland regulates metabolism & stimulates organismal growth
The cells that make it up are the only cells in the human body that can absorb iodine, to which they then combine the amino acid, tyrosine, and together with the enzyme thyroid peroxidase (TPO), produce T4 (thyroxine). T4 is like the “storage” or inactive version of T3 (triiodothyronine), and it is the synthetic version of T4 (Synthroid, etc.) that is most often prescribed to hypothyroid patients; assuming that the body will have no issues converting T4 to T3 as soon as it’s needed, synthetic T4 may suffice.
However, as I’ll get into later, the conversion of T4 to T3 process is another story, entirely. It relies on the enzyme 5’ deiodinase and cofactors like selenium, Vitamin A, Vitamin D and zinc, but is also a sensitive process that can be downregulated easily. In short, this is invariably important because T3 is essential for life, being that it makes the emboldened/underlined things, (aforementioned above), happen.
The takeaway: Thyroid homeostasis is vital to the production of ALL cellular energy. Therefore, ALL organ systems will be negatively impacted by impaired thyroid homeostasis.
Ignorance is NOT Bliss: My Story
From the above, you can probably already infer just how expansive the impact that having even remotely altered thyroid function and/or thyroid hormone can have on your body. Just add the phrase “lack of,” “irregular” or “suboptimal” in front of each and every organ system, all at once; this should lead you to the conclusion that I experienced firsthand: an overall sub-optimal state of being. Granted, the thyroid is just one piece of an incomprehensibly intricate puzzle, and I had and still have more work to do, but I do not say it lightly that this is homeostatic imbalance at its most epitomical...and not to mention, most glaring. Symptoms are, after all, our bodies crying to us for help.
Following was my symptomatic experience:
- Acid Reflux/GERD & IBS
- Menstrual Irregularities (premenstrual dysphoric disorder (PMDD), followed by dysmenorrhea, followed by total loss of a cycle, i.e. amenorrhea)
- More Mood Irregularity (everything from weepiness to rage)
- Sleep Disturbance (I could fall asleep just fine, but staying asleep was no longer a thing)
- Decreased Libido (and less satisfying climax)
- Hair Loss (to the point that I was vacuuming my bed daily)
- Dry Skin, Brittle Nails, Acne
- Recurring Infections
- Joint Pain (everywhere)
- Unexplained Weight Gain (20 lbs. in one month)
- Fatigue (I had to crawl around on the floor to get ready for work)
- Muscle Weakness & Soreness (that did not recover with rest)
- Low Blood Pressure & Edema
- Polycystic Ovaries (diagnosed with PCOS)
- High Blood Sugar (insulin resistance)
- Brain Fog (exacerbated ADHD, including low productivity, forgetting and losing things, and detrimental hyperfocus/obsession)
But perhaps the most alarming one of all was Suicidal Ideation...
Throughout the three years of my steady descent into madness...whoops, that may be a tad dramatic... Although, I truly had felt as though I was under attack, that my body was betraying me, and that no one would ever figure out what was wrong with me, (it changed from day-to-day, which attitude was driving me). I scoured the internet, pouring over blogs and chat forums; overconsuming health podcasts and videos; reading every book I could find within the integrative medicine and paleo/keto spheres. In desperation, I sought out an endocrinologist, but would soon discover that getting the tests that you know you need run, no matter how deeply you know it, is an incredibly difficult task.
A word of caution: if you are an undiagnosed, but educatedly-guessing, potential thyroid patient seeking a “full thyroid panel” from a baselessly arrogant, run-of-the-mill endocrinologist, you may be met with...resistance. In fact, I was told that “that would be a ridiculous test to run,” and that she “refuse[d] to have [her] name attached to such a preposterous test!”
The “full thyroid panel” I had hoped for, as recommended by my only hope and guidance at the time, www.stopthethyroidmadness.com:
- Free T4
- Free T3
- Reverse T3
- Thyroid Antibodies:
- Thyroid Peroxidase (TPO) Ab
- Thyroglobulin antibody (TGAb)
- Thyroid stimulating hormone receptor antibodies (TSHRAb), including thyroid stimulating immunoglobulin (TSI) and thyroid binding inhibitory immunoglobulin (TBII)
Instead, I got this:
These results were deemed normal, of course, and I was told that my thyroid was not the problem.
Now, while technically that was true - I did not have a problem with my actual thyroid gland, no Hashimoto's nor Grave's disease, no iodine deficiency - I'll explain shortly why this was a dangerous misdirection. On the other hand, my testosterone came back at 212, about SEVEN times the normal mid-range value for a woman of my age. So, she figured she'd found the answer. I left there with a referral to the 5th floor for confirmation of Polycystic Ovarian Syndrome (PCOS). I’ll admit that at that point, I would have been happy and relieved to find out I had any diagnosis, but...
I knew in my gut that PCOS was secondary to hypothyroid, if not to something even higher in the pecking order, because:
- I had none of the typical PCOS symptoms.
- I had most of the typical hypothyroid symptoms, and even some of the more advanced, less common ones.
- I had worked hard to learn that testing TSH & T4 only, as a screen for hypothyroidism, relied on an assumed linear but totally erroneous corollary based on the idea that hypothyroidism has only two causes worth considering:
- Hashimoto’s Thyroiditis (the autoimmune disease that causes hypothyroidism)
- Iodine deficiency (an incredibly difficult problem to come by in the Western world)
I would NEED to see a handful of other doctors before finding one who was willing to run the litany of tests I needed...
The test result that finally shook the tree was that of FREE T3:
Potential Causes of Low T3 Syndrome (a.k.a. Euthyroid Sick Syndrome):
- Poor conversion of T4 to T3 by progesterone deficiency: could point toward the “Pregnenolone Steal” effect, whereby pregnenolone is being shunted toward the adrenal pathway, rather than the steroid (sex) hormone pathway, and turned into cortisol instead of progesterone
- Poor conversion of T4 to T3 by elevated cortisol via chronic stress: see above
- Poor conversion of T4 to T3 by deficiency in cofactors: gut dysbiosis yields low absorption of nutrients from food via lack of diverse microflora, Small Intestinal Bacterial Overgrowth (SIBO), a parasitic or otherwise pathogenic infection, etc.; also can occur via chronic poor nutrition (low nutrient density) and chronic stress
- Poor conversion of T4 to T3 by inflammation via elevated cytokines: chronic viral infections, chronic Lyme Disease, toxic mold or chronic inflammatory response syndrome, and so many other potential things...also, again, chronic stress
- Poor conversion of T4 to T3 by HPA Axis dysregulation via deficient peripheral serotonin or dopamine
- Poor conversion of T4 to T3 by inflammation via elevated testosterone (in women)
it turns out THAT I, AN INDIVIDUAL, need to have my free T3 above the reference range to feel like myself:
My journey with low T3 syndrome is just an anecdote that I share with others experiencing the same or a similar cascade of symptoms but with little hope to continue on with, just as I once had.
Do not settle for “normal." Do not be a sheep.
Recommended Literature for Educating Oneself
The image below is of a diseased thyroid gland. If you ask me, it quite looks like the Batman symbol, and I suppose this could be why I was inspired to title/stylize this blog as if it were “The Blob.” However, the thyroid is far from villainous; aside from serving as an advocate for your life, it’s an incredibly important component of your body, but more on that below. It wraps around your throat, as it were, and, not at all like the antagonist of a monster B-movie, it is most commonly characterized as being shaped like a butterfly. In fact, whenever I see someone with a throat tattoo - which, admittedly is something I totally want, but will probably never get - I cannot help but think “I wonder if the tattoo needle is long enough to pierce the outermost cell layer of the thyroid?” (For the record, I know it’s not, but like…neck skin is awfully thin, so…) That thought is then followed in quick succession by “If so, I wonder if that kind of damage is at all akin to the damage that is done by the body’s own immune system in the context of the autoimmune diseases Hashimoto’s and Graves’?”
Now, not to be terribly presumptuous, but in case you were also thinking it: yes, I am an inquisitive nerd.