No gland, no problem? If only it were that simple…
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I get a lot of clients who have had a thyroidectomy or had their gland destroyed because they had hyperthyroidism, Graves’ disease, or some abnormal tissue development, whether it was thyroid cancer or it looked like it could potentially develop thyroid cancer.
They’re essentially told, “Hey, we’re going to take out your gland, we’re going to put you on thyroid hormone replacement, and you’re going to be back to normal.”
No problem, right? But it doesn’t always work out that way…
I just had one of these calls this week, where someone was told that they had Graves’ disease, or maybe it wasn’t clear whether it was Graves’ or just a thyroid storm.
Regardless, the doctors were concerned, so they did a biopsy and it showed that it wasn’t cancer, but they decided to take out the thyroid gland anyway. And they said, “Listen, you’re going to be fine. We’re just going to put you on thyroid replacement therapy. We’ll replace what the gland can’t make, and you’re going to be fine, right? It’s pretty simple. The thyroid gland makes primarily T4. We’ll put you on T4, it’ll convert to T3 inside the cells’ tissue. You’re going to be great.”
The problem is, it doesn’t really happen that way. So he wound up trying lots of different doses of T4, and when he got to a dose of thyroid medication that his doctors thought would be appropriate, he still didn’t feel well. They gave him a little bit more, he’d feel more hyperthyroid, brain anxiety, insomnia, and still feel hypothyroid peripherally.
He was just struggling. They couldn’t find the right dose, and went back and forth with this for a long period of time. Eventually, they added some T3 and a little bit less T4. Initially, he said he felt a little bit of a boost, but now they’re back to doing the same thing.
He’s still taking T4 and now they’re trying to tinker with the dose of T3. But if he gets too much, he feels hyperthyroid. If he doesn’t get enough, he still feels hypothyroid. So he’s got these mixed hypo-hyperthyroid symptoms. He’s frustrated, his physicians are frustrated and he’s calling for help.
So you want to know why is this happening? Here’s what I explained to him…
Something caused that thyroiditis, the Graves’, the thyroid storm… Some type of immune-inflammatory process was creating the damage at the thyroid gland.
Whether you remove or destroy the gland, that doesn’t change the fact that there’s likely still an immune-inflammatory process going on, and it doesn’t change what’s driving that immune-inflammatory process. The damage to the gland is the effect. It’s not the cause.
So you take out the effect, you take out this damaged gland, but that doesn’t change what’s driving the process. The thing that was actually creating the problem is still there.
So now you have no thyroid gland. You’re essentially a person with hypothyroidism because you don’t have the ability to make thyroid hormone. And you’re in the same camp as the vast majority of people who have been diagnosed with hypothyroidism, whether they’re diagnosed as primary hypothyroidism or Hashimoto’s autoimmune thyroiditis and primary hypothyroidism.
Putting thyroid hormone into the bloodstream is only part one. If you have a thyroid gland, the thyroid gland makes thyroid hormone, but it actually makes more than T4 and T3. But let’s just keep it simple for this story…
Most of the T3 (the active hormone in the body) isn’t made at the thyroid gland. Only 5, maybe 10 micrograms per day is made at the gland.
Typically, the other 25 to 20 micrograms of T3 is made by the peripheral tissues bringing thyroid hormone in and converting it to T3. Once you destroy the gland or remove the gland, you now become a hypothyroid patient. And if this immune-inflammatory process is still going on just like our hypothyroid patients or our Hashimoto’s patients, the immune-inflammatory process is going to have an impact on your ability to convert T4 to T3 in the periphery. So you’re going to wind up with conversion issues.
Remember, thyroid hormone production by the gland is one part of thyroid physiology. The other part is getting it from the bloodstream into the cells and tissues, and they all regulate thyroid hormone a little bit differently. You can have some cells and tissues that are upregulated and have a higher metabolic rate, and you can have other cells that are downregulated at the same time.
This “peripheral conversion” is essentially the part that’s virtually ignored in allopathic medicine, and to some degree in functional medicine, because we don’t consider the fact that the cells and tissues get to weigh in.
They get to decide, “Do I want to increase my metabolism and convert more T4 to T3, or do I want to down-regulate the metabolism and convert more T4 to reverse T3, more T3 to T2, and essentially slow down the metabolism?”
I think in allopathic medicine, they just assume it’s going to happen. And to some degree in functional medicine, a lot of practitioners believe that the body “forgot how to do it,” and so therefore they need to give T3 to optimize the physiology.
But just putting T3 into the bloodstream, just like T4, doesn’t necessarily restore the problem, which is what’s creating this cell stress or inflammatory process.
The immune-inflammatory process that caused the Graves’ disease, the thyroid changes, the thyroiditis, the hyperthyroid, this abnormal tissue is likely still present. Even though you’ve removed or destroyed the gland, that doesn’t change the fact that we’ve got this immune-inflammatory process going on as a result of some type of excessive stress load.
These same processes that trigger the damage at the thyroid gland are also going to have an impact on the ability to convert T4 to T3 at the cell and tissue level. The same thing that triggers the thyroiditis can also trigger “cell danger response,” which is what we call adaptive or allostatic thyroid hormone regulation. This basically means the cells are starting to perceive some type of threat, some type of danger signal. Certain tissues are going to be downregulated, other tissues are going to be upregulated.
So now, when we give more thyroid hormone, those tissues that are upregulated are going to become more hyperthyroid. The tissues that are already downregulated are going to become more hypothyroid. They’re not going to convert more of that thyroid hormone and upregulate their metabolism.
If you are under stress, or somebody’s attacking you, you’re not going to put a lot of energy into eating or having sex or taking a nap. You’re going to put energy into survival, fighting, running, trying to get away from the threat or beat down the threat. The same thing happens at the cell.
Just because you put more thyroid hormone into the system – or any nutrient into the system – and want it to do something, doesn’t mean the cells are going to do that.
If you put more thyroid hormone into the system, but the cells are perceiving danger, the cells that are already upregulated are going to convert more of that T4 to T3 to upregulate. The defense mechanisms and the cells that are already being downregulated are going to deactivate more of that thyroid hormone. So certain tissues are going to become more hyperthyroid, certain tissues are going to become more hypothyroid, and you’re going to have these mixed hypo and hyperthyroid symptoms, which is what this person had.
So what do you need to do? We need to identify what’s driving this excessive cell stress response. Is it organisms? Is it toxins? Is it disrupted sleep? Is it emotional stress or trauma? Is it poor respiration? Is it GI disorders? Is it excessive physical stress?
We need to uncover what’s driving the stress response, and it’s usually not one thing. It’s not sexy. It takes work, it takes some time, but ultimately that’s the best long-term solution.
Once we identify what the stressors are, and usually it’s more than one, we need to remove or reduce them as much as possible so that we can downregulate the cell stress response, and then we can support the recovery of the cells, the tissues, the systems from this allostatic stress response back to a homeostatic normal regulating response.
That’s how we’re going to help somebody get their health, their quality of life, and their thyroid physiology back in order. It’s not some type of magic supplement that makes conversion better. It’s by addressing the root issues. That’s functional medicine.