Hi, everybody. It’s Dr. Eric Balcavage. In today’s edition of Thyroid Thursday, I want to talk about a common problem I see with those being treated for primary hypothyroidism with levothyroxine, or Synthroid, and that is a low TSH below one and an inability to lose weight.
Is there a correlation? There definitely is, and I see this quite a bit, so let me explain how this goes. We know that stress can definitely impact thyroid physiology and stress can be physical: falls, accidents, injuries. It could be metabolic, something compromised in your chemistry: adrenal physiology, hormone physiology, GI physiology. We know emotional stress: finances, relationship. What you think about can create a stress state in the body.
We know that chemistry can have an impact. The chemicals from the foods we eat, the medications we take, pesticides, toxins, all those things. Environmental stressors, even things like EMFs from our Wi-Fi and our phones. And then we know that microbial stress: bacteria, viruses, yeast, parasites. All can create a stress on the body. And when we have an accumulation of these stresses and they become chronic, that chronic stress can trigger something we call the cell danger response, and that cell danger response can trigger an inflammatory mechanism in the body.
Once we have an inflammatory mechanism in the body, the cells are triggered to go into the cell danger response, and part of that cell danger response is the deactivation of thyroid hormones. So, we get increased deiodinase three production in our peripheral cells, which converts T4 and T3, essentially, to inactive forms. T4 is deactivated to reverse T3, which is a test you can have measured on your blood work.
When we have more peripheral cell D3 activation, and more deactivation of our thyroid hormone, this is that state we call cellular hypothyroidism, and this is what causes hypothyroid symptoms. You’re not getting sufficient T3 to the nuclei of your peripheral cells. That’s why you’re triggering or experiencing hypothyroid symptoms.
If this chronic stress persists, phase two, after the cellular hypothyroidism has occurred, and you have symptoms and the stress persists, then we start to see as part of that cell danger response, the activation of the autoimmune attack on the thyroid gland, something we can call Hashimoto’s thyroiditis. If that persists for an extended period of time, we start to get decreased production of T4 and T3, and we start to see TSH rise. Eventually you can get diagnosed now … as TSH is elevated, T4 is lower … with primary hypothyroidism. And this is where your doctor will typically prescribe thyroid hormone medications like Synthroid or levothyroxine.
That thyroid hormone that’s prescribed can saturate the brain with T3, even though we have this inflammatory state going on, because the brain, and especially the hypothalamus, doesn’t have deiodinase three, so it can only activate thyroid hormone. It doesn’t have the ability to deactivate it. So, the brain can get saturated with TSH and this can lower your TSH. But if the peripheral tissues still have this inflammatory response going on, and the deactivation of T4 and T3, you still have symptoms.
So, what’s happened is, we have a lot of patients frustrated that they still have hypothyroid symptoms with a normalized TSH because of the thyroid hormone medications. And now, doctors are thinking that if they push that TSH levels below one, maybe that will help reduce symptoms. The problem is, it creates a problem. When we saturate the hypothalamus with T3, this causes a suppression of something called MC4R. It’s a Melanocortin 4 Receptor. Okay? And so, and when you suppress MC4R expression, the brain does not respond to leptin and insulin and decrease your appetite.
So, typically, when you eat food, and you get enough calories into the system, and those calories are now being stored as fat because you have enough food, the fat then releases something called leptin. Leptin goes up to the brain and as insulin rises, it goes to the brain, and they typically increase the expression of MC4R so that your brain says, “Hey, I’m satisfied. Shut down eating. Shut down appetite. We’ve reached satiety.” Okay? And then the MC4R stimulates the decrease in satiety and the increase of thermogenesis heat, energy production.
So, if the brain is not responding to the leptin and insulin, then you will continue to feel hungry. You will consume more calories that you cannot utilize. You’ll store more fat, and you’ll not have increased energy utilization. So, we have the inflammatory process going on, which creates hypothyroid symptoms. You get the brain flooded with T3. You don’t respond to leptin and insulin. So, instead of feeling satisfied after a meal, you’re going to continue to consume calories. Because you have the cellular hypothyroidism going on, those food calories can’t be utilized appropriately, so then your body stores them as fat. You store that as fat and fat produces leptin and your insulin is rising as well, but the brain’s not listening to it, so you continue to consume calories you don’t need, your body continues to store it, and the whole time, your TSH levels can be normal or even below one.
Another thing that happens as you increase the hypothalamic T3, you increase the sympathetic nervous system, the fight or flight system, which essentially decreases digestion, so you have poorer digestion. That can lead to a host of issues, and the increase in sympathetic nervous system can activate increased blood pressure by the resorption of sodium in your kidneys. So, not only do we have increased weight, we have insulin resistance, we have leptin resistance, we have increased blood pressure, increased anxiousness, anxiety … We have a cascade of problems. This increased sympathetic nervous system also disrupts your sleep patterns, so you can’t sleep appropriately. So, this whole mechanism is still causing you to struggle with hypothyroid symptoms even though you have low TSH, typically below one. All right.
How do you fix this? It’s not easy, but it’s pretty straightforward. You have to address the physical, metabolic, emotional, chemical, environmental, and microbial stressors that are triggering your chronic stress and inflammatory response, the same things that are deactivating your peripheral thyroid hormone. If you don’t address those things, you will not remove your symptoms and you’ll struggle to lose weight. You’re probably not going to find this type of help in the allopathic model. It’s just not what it’s focused to do.
Hope that helps. If you have questions about your thyroid health, schedule a free 15-minute health evaluation, here!