An integrative medicine approach to hypothyroidism

Your thyroid is one of the most important hormones released into your body. It can literally affect every system, from your general metabolism to your cardiovascular health, to your mood and general energy levels. The thyroid is also critically important in fetuses for developing neurons in the brain as they grow.


The thyroid is incredibly important, and also requires a delicate balance. There are thyroid hormone receptors in almost every single cell in your body, which means that correcting imbalances in your thyroid requires an approach well-suited for holistic medicine practitioners.


How does the thyroid work?

The thyroid gland is located in your neck, and it produces two different hormones called T3 and T4. What happens is that your hypothalamus, in the center of your brain, signals the pituitary gland to release something called thyroid stimulating hormone, or TSH. It’s the TSH that then tells your thyroid to produce more hormones.


As you continue to produce more thyroid hormones, the increase in thyroid levels deliver negative feedback to the brain, which then signals to reduce the amount of hormone being produced. It’s really a beautiful and interconnected balance the body has.


Unfortunately, sometimes his system of signaling and feedback becomes out of balance.


Problems with your thyroid gland: Graves’ and Hashimoto’s

Thyroid disease can be broken down into two broad categories: overproduction (hyper) and underproduction (hypo) of thyroid hormones.


The first is if you produce too much thyroid hormone. There are four main ways this might occur:

  • Graves' disease: The production of too much thyroid hormone. One of the most common causes of hyperthyroidism.

  • Toxic adenomas: Nodules develop in the thyroid gland and begin to secrete thyroid hormones, upsetting the body's chemical balance; some goiters may contain several of these nodules.

  • Subacute thyroiditis: Inflammation of the thyroid that causes the gland to "leak" excess hormones, resulting in temporary hyperthyroidism that generally lasts a few weeks but may persist for months.

  • Pituitary gland malfunctions or cancerous growths in the thyroid gland: although rare, hyperthyroidism can also develop from these causes.

What happens in Graves’ disease is that your immune system acts as a thyroid stimulating hormone, either because of an infection or another immune issue. This can trigger your immune system to produce a mimic of TSH, which goes into your thyroid and tells it to produce more.


This leads to an overactive thyroid, which can cause anxiety, heart palpitations, or in severe cases the classic bulging eyes. Graves’ disease is more common in women than men, and more common as you age, especially after 50.


The second and more common (and also more common in women) condition, is when you produce too little thyroid hormone resulting in hypothyroidism. The major reasons for this includes:

  • Hashimoto's thyroiditis: in this autoimmune disorder, the body attacks thyroid tissue. The tissue eventually dies and stops producing hormones.

  • Removal of the thyroid gland: The thyroid may have been surgically removed or chemically destroyed.

  • Exposure to excessive amounts of iodide: cold and sinus medicines, the heart medicine amiodarone, or certain contrast dyes given before some X-rays may expose you to too much iodine. You may be at greater risk for developing hypothyroidism if you have had thyroid problems in the past.

  • Lithium: This drug has also been implicated as a cause of hypothyroidism.

Hashimoto’s thyroiditis is one of the most common types of hypothyroidism, due to your immune system producing antibodies that start attacking your thyroid. This can happen over years or even decades.


It is estimated that 5% of the U.S. population has hypothyroidism, with another 5% undiagnosed.


The traditional approach

Both Graves’ and Hashimoto’s are diseases of the immune system. And, like many diseases, the traditional medicine approach is to either say you have the disease, or that you don’t. But of course, the truth is that having an imbalance of thyroid hormone is a spectrum like everything else.


Usually, traditional medicine won’t “diagnose” hypothyroidism unless the TSH level in your blood goes above 4 mU/L. When you get your blood drawn in a traditional setting, your physician will look at this. However, you can develop what is known as sub-clinical hypothyroidism even if TSH is not significantly elevated. And critically, you can still develop a range of symptoms characteristic of Hashimoto’s disease at these lower levels, even if you have never been formally diagnosed.


Fatigue, constipation, or general weakness can all be symptoms of sub-clinical hypothyroidism.


An integrative medicine approach

When screening for Hashimoto’s, most physicians will check your TSH level and stop there.


But when I evaluate patients where I suspect an imbalance in the thyroid function, I will do a more thorough assessment that includes T3, the active form of thyroid hormone, as well as T4, which is what your body primarily produces and then converts to T3. I also screen for the thyroid antibodies (to thyroglobulin (TGab) and thyroid peroxidase (TPOab)) that are a sign your immune system may be attacking the thyroid gland. Elevated thyroid antibodies can be seen years, and in some cases over a decade, before elevations in TSH.


If the immune system is overactive, you then have to dig deeper and start to ask why the immune system is overactive.


There can be numerous reasons. One category is vitamin and mineral deficiencies, including Vitamin D3, C, selenium or iron. All of these, if they are out of range, can affect your ability to produce thyroid hormone.


Additionally, there is some literature (though not definitive) to suggest that dietary issues can be causal. The best known of those is gluten sensitivity. Gluten sensitivity is an immune-related reaction to gluten, the major protein in wheat. It’s not uncommon for an integrative medicine physician to recommend an elimination diet to get rid of the gluten and then monitor whether that has an impact on the symptoms related to hypothyroidism.


There is also some suggestive literature that people with symptoms of hypothyroidism should be careful about eating large quantities of raw cruciferous vegetables (i.e., broccoli, cauliflower, cabbage). There is another association between hypothyroidism and soy, but that is more commonly the case in patients who are iodine deficient.


In addition to thoroughly examining your nutrition, another part of a holistic approach to thyroid disease is stress management. The balance of cortisol in your system can potentially be a factor, with too much affecting your thyroid function. Mindfulness, meditation, and especially yoga can play a constructive role.


Finally, correcting imbalances in your thyroid function can be an ongoing challenge—but with an integrated, holistic approach, thyroid imbalances can be managed and even reversed.


If you suspect some kind of thyroid disease and would like to discuss any of these issues more, please feel free to book a 15-minute free consultation.


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