Hypothyroidism and its consequences
Hypothyroidism is a condition in which the body cells are not receiving sufficient amounts of thyroid hormones. It is a common problem these days and is a reflection on stress, some illnesses (such as Hashimoto’s thyroiditis), environmental oestrogens, environmental toxins, obesity, poor diet and deficiencies of trace minerals and vitamins.
People, who have had a radical treatment for Graves’ disease, such as thyroid removal or radioactive iodine treatment may also suffer from hypothyroidism. This occurs when the thyroid hormonal therapy is suboptimal. The common hormonal replacement given to people with hypothyroidism is levothyroxine (T4 hormone). However, this therapy is not sufficient in many cases.
The thyroid gland produces T4, T3, T2, T1, T0 and calcitonin hormones. T3 hormone is the main bioactive hormone responsible for energy and protein production in the body. Thyroid gland supplies a small amount of this hormone but the majority is obtained through the conversion of T4 hormone into T3 in peripheral tissues other than the thyroid gland. Some people have problems with T4 into T3 conversion due to many different issues. Therefore, people who have problems with hormonal conversion (common with thyroid autoimmunity) and do not have a functioning thyroid are very vulnerable to hypothyroidism.
The consequences of suboptimal thyroid hormonal replacement and hypothyroidism are powerful and can create many health problems. They lead to a health disaster as every cell in the body would be affected in a negative way. After all, we would not be alive without the energy produced in our mitochondria (cell energy factories) and T3 is an integral molecule in the process of energy production.
Suboptimal supplementation with thyroid hormones after thyroid surgery or radioactive iodine treatment may lead to prolonged or severe hypothyroidism becoming worse over time. This may be due to a partial failure of the 5’deiodinase enzyme, impairing the conversion of T4 to T3 as hypothyroidism affects the levels of nutrients required for its function. Thyroid hormone receptors may also become desensitised (if you don’t use it, you lose it) and have problems receiving hormones (due to effects of hypothyroidism, such as adrenal exhaustion, low progesterone and poor sugar control). An oxidative cell stress can be seen in both hyperthyroidism and hypothyroidism as the optimal thyroid hormone levels are required to prevent generation of excessive free radicals in mitochondria, which damage cells. Mitochondrial dysfunction has been connected to fibromyalgia (sore, weak muscles) and other health problems. It relates to an increase in the acidity of body cells and imbalances of specific nutrients and hormones. A mitochondrial dysfunction has also been connected to the development of cancer.
Nutritional deficiencies are consequences of hypothyroidism due to a lower production of hydrochloric acid in stomach, bacterial flora imbalance in the gut and an impaired liver function. In the state of hypothyroidism, gastrin levels are usually reduced, which causes low levels of hydrochloric acid in the stomach and a poor digestion. Even mild hypothyroidism leads to a magnification of problems over time as the thyroid hormones are not able to access the cells due to nutritional deficiencies (mainly vitamin B12, vitamin A, zinc, selenium, iron and essential fatty acids). Hypothyroidism reduces not only the absorption of nutrients but also the methylation status of molecules (such as B vitamins). Vitamin B12 needs to be methylated to be used by the body and it is extremely important molecule for a proper body functioning and healthy red blood cells. Deficiencies of methylating nutrients, manganese, iron, selenium, chromium, natural vitamin C and other minerals can contribute to a copper accumulation, which is then connected to many health problems. Night blindness may also be a result of hypothyroidism due to low levels of vitamin A. When T3 is not sufficient, the metabolism of cholesterol into bile acids is lowered. Fat is not properly digested. Fat soluble vitamins (A, K, D and E) and the essential fatty acids are not properly absorbed. Poor liver function tests and ‘fatty liver’ (not necessary in an overweight person) are often seen. Higher cholesterol levels may be seen as the liver and gallbladder do not work effectively. Gallbladder function may also be impaired in hypothyroidism.
Iron deficiency is a common problem in hypothyroidism. Low iron absorption may cause iron deficiency anemia. In people with low thyroid, copper is preferably absorbed to iron in the gut. Vitamin B and C deficiencies and low stomach acid, often seen in hypothyroidism, affect the absorption of iron negatively. The liver plays a part in maintaining normal iron levels and when it is sluggish due to hypothyroidism, levels of iron become low. Dark circles under the eyes and tiredness may indicate low iron levels in the body and adrenal exhaustion.
Hypothyroidism effects oestrogen metabolism, lipid metabolism and the sugar balance as the liver is negatively affected and it is a major player in these functions. Oestrogen is an important hormone, present in higher amounts in women as it is involved in reproduction and immune system functions.
A poor functioning liver cannot detoxify excessive oestrogen or other toxic molecules properly. The amino acid conjugation system in the liver, necessary for a proper detoxification is commonly found to function poorly in hypothyroidism. Glycine and the other amino acids used for conjugation can often become deficient. This then leads to a toxic overload and accumulation of fat soluble toxins in body fat cells. Toxins raise inflammation. Toxic molecules can cause cancer and heart disease. A sluggish liver is not able to produce enough binding proteins for copper, leading to copper accumulation in tissues. Copper toxicity creates problems with the way insulin works in the body. Hypothyroidism can create a state of oestrogen dominance. The increasing oestrogen metabolite can possibly increase the risk of breast cancer and other cancers. Hypothyroid people tend to put on weight due to a slow metabolism and fat cells can produce more oestrogens in the body.
There is a connection between under-active thyroid and gut health. Patients with hypothyroidism have a sluggishness of the gastrointestinal tract and often suffer from constipation, gas, bloating, re-absorption of intestinal toxins and increased intestinal permeability. The abdomen may feel distended with hypothyroidism. They might also have an imbalance of gut flora. The beneficial bacteria in the gut help to convert the inactive T3 into active form for recycling into the body. Some people with hypothyroidism may suffer from chronic gastro- oesophageal reflux.
Low thyroid hormonal levels cause lowered levels of cortisol hormone due to adrenal exhaustion, leading to body aches and pains, nervousness, irritability, raised testosterone, increased number of allergies, raised inflammation levels in the body, unstable body temperature and frequent upper respiratory tract infections. Hypothyroid people are more predisposed to viruses, colds, influenza and chronic infections because hypothyroidism may cause a reduction in circulating lymphocytes, which fight infections. Infections further deplete adrenal glands. Subsequently, frequent antibiotics and medications disrupt gut health and stress the liver.
People with low T3 levels and autoimmunity problems may have chronic inflammation (due to lowered cortisol levels)and the possibility of other autoimmune disorders. The individual with low T3 may also have low pregnenolone levels, which influence the balance of the immune system and other hormones.
One of the main symptoms of hypothyroidism is depression (brain demands for T3 are not met affecting serotonin levels). Depression may have serious consequences as it threatens the life of sufferer and affects the lives of family and friends. Hypothyroidism significantly lowers the quality of life. Happiness is what we strive for and there is little happiness with insufficient T3. Feeling of being ‘stressed’ is common with low T3. Brain fog, common in hypothyroidism, is most likely due to slowed blood flow to the brain.
Low thyroid hormone levels are associated with a heavy menstrual flow, which leads to anemia and low iron. Hypothyroidism is often associated with low progesterone production. Low progesterone further lowers the absorption of zinc, which is necessary to allow thyroid hormones entry into the cells. Both, T4 into T3 conversion and entry of thyroid hormones into the cells become compromised. Difficulties in achieving and sustaining pregnancy can be connected to hypothyroidism. Lack of T3 hormone in early pregnancy may lead to miscarriage and pre-eclampsia as T3 hormone mediates embryonic and placenta growth. It may also lead to an increased chance of birth defects.
Adrenal aldosterone hormone imbalance is connected to hypothyroidism and may result in a constriction of blood vessels and elevated diastolic (bottom number) blood pressure. High blood pressure can lead to heart problems, inflammation and blockage of blood vessels. Low thyroid hormonal levels result in the inflammation and plasticity loss of blood vessels. This is because thyroid hormones promote the synthesis and action of vasodilators and acts directly on muscles in our arteries. The synthesis of nitric oxide (a powerful chemical, which dilates blood vessels) from L-arginine is stimulated by T3. Imagine your heart trying to pump blood through blood vessels in the body, which cannot effectively dilate and a resulting stress and damage to the cardiovascular system. As adrenal production of aldosterone increases, the production of anti-inflammatory cortisol decreases. Sodium is retained by the body. The person experiences anxiety and body aches. Other symptoms may include water retention and fluctuating blood pressure due to constricted blood vessels and kidney stress. Thyroid hormonal imbalances lead to alterations in the kidney function and structure. Hypothyroidism may lead to kidneys becoming smaller in size. In hypothyroidism, kidneys glomerular filtrations rates fall and elevated serum creatinine is often seen. The consequences of elevated creatinine levels in severe hypothyroidism include dry skin, feeling dehydrated, swelling, nausea, fatigue and shortness of breath. In fact, estimation of creatinine levels may be used to determine thyroid function/adequacy of thyroid hormonal replacement in the future. Kidney stones can occur due to the decreases in renal plasma flow. There are problems in excreting excessive water from the body.
Low thyroid hormone levels are connected to higher homocysteine levels and higher cholesterol, which are then related to an increased risk of heart problems. Hypothyroidism increases the risk of heart attacks and strokes. Generally there are many changes to the way heart works in hypothyroidism and these include: decreased cardiac output, stroke volume, heart rate and pulse pressure. People with hypothyroidism may experience heart palpitations and arrhythmias (free T3 hormone protects the heart from arrhythmias). The worst result of a prolonged hypothyroidism may be congestive heart failure. Changes in low voltage ECG can show prolonged PR interval and flat T wave. There are many studies indicating that sufficiency of thyroid hormones lowers the risk of heart attack. Thyroid hormone are important for the production of vitamin K-dependent proteins. Vitamin K activates these proteins, which keep the blood vessels healthy. Vitamin K does not work well with insufficient amount of thyroid hormone.
Symptoms of low T3 may include lethargy, severe muscle spasms, muscle and joint pain. Muscles become depleted of glucose and energy with low T3 hormone levels. Fibromyalgia (muscle stiffness) also relates to under methylation of body, which may be a problem in some people with hypothyroidism. When thyroid hormone levels are low, so are methylation processes. In hypothyroidism, the function of MTHFR enzyme is reduced and it is not producing enough FAD or active riboflavin B2, involved in a proper methylation, also raising homocysteine levels. Low levels of vitamin B2 are connected to migraines. Homocysteine elevations have been shown to be an associated risk factor for cardiovascular disease, dementia, neurodegenerative diseases and cervical dysplasia. Methylation processes are extremely important as they are required for the liver detoxification and neurotransmitter production. The production of SAMe (the main methyl group donor) is reduced and its low levels have been linked to depression. High histamine levels are connected to hypomethylation as it is removed by the body by a methylation process. High histamine levels are connected to allergies.
Poor sugar control is a resulting consequence of hypothyroidism. When T3 is not sufficient, it does not activate thyroid hormone receptors properly in the liver, which can lead to a fatty liver and insulin resistance. Low T3 causes poor liver function and impaired glucose metabolism in peripheral tissues, which may lead to diabetes. Under methylation issues has been postulated as a possible mechanisms, which increase insulin resistance. Hypothyroid people store less glucose in the liver as glycogen and are more prone to a low blood sugar. As a consequence, both adrenaline and cortisol start rising at night. Adrenaline can peak around 2am and a person can wake up with heart palpitations.
In my research, I had come across a saying that “just a few grains of thyroid hormone can make the difference between an idiot and Einstein”. The slowing of a brain process, clumsiness, irritability, loss of short term memory, disorientation, depression and melancholia may occur with low levels of T3. A part of the brain known as the hippocampus, which is responsible for short term memory and special navigation, is strongly affected by not only stress but also hypothyroidism, which slows nerve generation and function in this area of the brain. Thyroid is a major player in this part of brain (hippocampus is very vulnerable region) and brain in general as it modulates glucose metabolism and insulin signalling. Damage to hippocampus has been connected to dementia and Alzheimer’s disease. It may also be connected to the development of type 2 diabetes.
The levels of neurotransmitters are altered in hypothyroidism. T3 hormone is a neurotransmitter. Low thyroid hormone levels cause low dopamine, a neurotransmitter important for motivation and willpower. As methylation process is impaired, the production of SAMe, the main methyl donor is impaired, which affects the balance of neurotransmitters in the brain. When T3 is low, the brain does not work properly and the levels of serotonin go down. Depression is a common symptom of hypothyroidism.
It is easier to put the weight on when metabolism is slow due to hypothyroidism. Hypothyroid people tend to put weight on all over the body. They tend to crave carbohydrates (bread, potatoes, rice, sweets and starchy food) due to the adrenal exhaustion and altered sugar metabolism. When you do not have a proper detoxification in your body, toxins accumulate in the fat cells and make weight loss difficult to achieve. An inflamed body stores excessive water. The levels of glutathione, the main toxin remover, go down. Hypothyroidism is also connected to spikes of cortisol, oestrogen dominance and insulin resistance and thus poor sugar control. All this leads to weight gain.
Hypothyroidism affects many aspects of body functioning and creates multiple health issues. These issues are often looked at separately but are due to one main problem of hypothyroidism. The thyroid hormones are powerful body chemicals and their effects should never be underestimated.