1. Thyroid-Fat Loss Connection

2. Overview Thyroid gland: what it is and how it makes thyroid hormone
What the thyroid hormone does for the body
Symptoms of hypothyroidism
Where issues can arise in the thyroid hormone physiology chain
How to evaluate it and steps you can take with clients
Hashimoto’s
Nutrition & Supplement
Clinical practice observations

3. What is the thyroid gland?
Butterfly shaped gland located at the base of your neck
Thyroid hormone is responsible for the metabolic rate of every cell of your body
Thyroid hormone interacts with, and is critical for, other systems of the body to function properly including:
GI system
Endocrine system (hormones)
Neurological system (brain)
Cardiovascualr system
Musculoskeletal system
AND how easy it is for people to lose weight!
Metabolism and metabolic rate doesn’t just refer to weight loss. Slow metabolism can effect every cell of your body. GI tract slow-constipation, won’t make enzymes as well. Metabolic rate of skin slow, poor wound healing, can’t regenerate itself well. Neurons, brain firing-slow, neuron firing slower-depression and fatigue are seen. Everything slowing down.

5. Hypothalamus-master gland, appetite, temperature control, regulate libido, all hormones of the body. Sauna-hypo senses this, hypo decreases TRH etc-cascade of decreasing amount of hormone. Communication system. TSH is low, won’t make thyroid hormone.
Releases a hormone called TRH into pit gland which stimulates pit gland to makes it hormone.
Pit gland makes TSH tells the thyroid gland to make thyroid hormone. Thyroid makes T4 (most- 93%) and T3 (a little-7%). Pit only senseshormones in body. If pit senses a low TH it will make more TSH to try to get thyroid gland to make more TH, Too much, makes less TSH because it doesn’t want thyroid to make more thyroid hormone. T4 and T3 can get directly into cell when they are free or not bound to anything. Has a binding/transport mechanism to get to other cells outside of the thyroid area. Needs to be circulated to other places it is needed in the body. Liver makes proteins and some of them function as a binding protein to carry it around the body, it’s a transportation system (like people in a boat). Thyroid makes TBG (thyroid binding globulin) is made in the liver. TBG is always circulating through your body waiting to bind thyroid hormone. Bound thyroid hormone is unusable. T4 is an inactive thyroid hormone (called a prohormone, little to no metabolic activity). T3 is the active thyroid hormone and there needs to be enough in the “free state”. T4 goes into the liver to be converted into T3. Most T4 is converted to T3 in the liver (kidneys, other organs convert it as well). T4 is really an amino acid (tyrosine) with 4 molecules of iodine attached to it (thyroxin). T3 can be metabolized or detoxified or go directly to the nucleous of the cell (no receptor needed). Reverse T3 is inactive (unusable). T3s and T3Ac can be produced in the liver ( ABOUT 20%) and converted by your gut bacteria in the gut into usuable free T3. Over 99% of TH is bound to TBG, 1% free in blood. IF T3 CANNOT GET IN AND ACT ON THE CELL, CLIENTS WILL HAVE HYPOTHYROID SYMPTOMS EVEN IF THERE TH IS NORNMAL.

6. Thyroid hormone chain defects
Defect #1: Low functioning thyroid (hypothyroidism)
Must be adequate amounts of tyrosine and iodine since TH is made from this
Lab findings:
Elevated TSH
Depressed T4
Depressed T3
Causes: possible iodine deficiency, tyrosine deficiency, autoimmune attack on the thyroid.
Correcting imbalances: nutritional strategies to support thyroid physiology, focus on the immune system, autoimmune protocol for meal plan, immune modulating adaptogens (Th1 & Th2 dominance).
Get Dr. to run TPO and TGB antibodies.
Iodine deficiency-goiter belt in US, middle America, rich in sea products, fish, seaweed, etc. They iodized salt for this reason. Lack of iodine, TH can’t be made. Would have to have a really low protein diet, iodine deficiency far more likely than this. Autoimmunity-immune decides to attack some element of you, parts of your cells are foreign. Immune system can attack the TSH receptor (grave’s disease) and stimulates it so it makes too much TH. Immune system can attach TPO enzyme and you can’t oxidize iodide into iodine. Body is making antibodies against TPO enzymes- TGB enzyme will be attacked as well.

7. Thyroid hormone chain defects
Defect #2: Over functioning thyroid
Usually due to autoimmune condition. Two ways this can occur:
1. Grave’s disease: very low TSH, high-normal T4 and/or T3 (heart palpitations, anxiety, insomnia, tremors)
2. Hashimoto’s: eventually results in hypothyroidism, it can start with overproduction of TH or have fluctuations of high to low.
Lab findings:
Depressed TSH
Elevated T4
Elevated T3
Correcting imbalances: See Dr. , nutritional support once treated.

8. Thyroid hormone chain defects
Defect #3: Low functioning pituitary
2 causes:
TRH production: hypothalamus needs serotonin and dopamine to stimulate TRH production
TSH production: stress and inflammation
Laboratory findings:
Depressed TSH
Depressed T4
Depressed T3
Possible causes: high cortisol, inflammation, infection
Correcting imbalances: focus on improving pituitary function
Elevated cortisol, adrenal glands, reduce stress
Heavy metals and other toxins: restorative detox
Intestinal dysbiosis: elimination diet with supplement protocol
Nutrient support: zinc, magnesium, manganese, sage leaf extract, rubidium and pituitary glandulars.

9. Dysbiosis
For proper thyroid function, 20% of the thyroid hormone in your body must be converted into its active form, which is done in the GI tract.
In order for this conversion to happen, healthy colonies of beneficial bacteria must be present in the GI tract. An imbalance in the bacteria ratio (of good vs. bad) in the GI tract (dysbiosis) can lead to low thyroid function.
The “4 R’s” to Repair Gastrointestinal Dysfunction:
Remove:  Eliminate known food allergens such as gluten, dairy, eggs, soy, peanuts, etc. Alcohol, caffeine and NSAIDS should be avoided as well. Antimicrobial protocol
Repair:  Supplements to repair the intestinal barrier are taken.
Replace:  Hydrochloric acid and pancreatic enzymes offer digestive support.
Reinoculate:  Probiotics that contain friendly bacteria such as lactobacillus and bifidobacterium are taken to reinoculate proper bacterial colonies.

10. Thyroid hormone chain defects
Defect # 4 Underconversion (T4-T3).
Laboratory findings:
Normal TSH
Normal T4
Depressed T3
Causes: high cortisol, inflammation, selenium deficiency, liver issues
Correcting Imbalances:
Improving enzymatic conversion: selenium and zinc, toxins, heavy metals, oxidative stress and inflammation
Managing stress: adrenal glands/cortisol
Lowering oxidative stress manganese, zinc, copper, selenium, antioxidants like vitamin C, E, beta-carotene, lutein, lycopene, vitamin B2, ALA, CoQ10 and NAC. Herbs like bilberry, turmeric, grape seed extract, green tea and ginkgo biloba.
T4 may convert to reverse T3 which is not active. TSH and T4 may be normal, but conversion to T3 doesn’t happen. T4 from medication, not converting..improve conversion may not need to be on much thyroid hormone.

11. Thyroid hormone chain defects
Defect #5: Overconversion of T4-T3
Laboratory findings:
Normal TSH
Depressed T4
Elevated T3
Causes: possible elevated testosterone, blood sugar issues.
Correcting imbalances focused on blood sugar management (insulin resistance and hypoglycemia).
Low glycemic load, small, frequent, protein-based meal, fats, fiber, exercise, managing stress

12. Thyroid hormone chain defects
Defect #6: Elevated Thyroid Binding Globulin
Lab findings:
Normal TSH
Normal total T4
Normal total T3
Depressed free T4
Depressed free T3
Elevated T3 uptake
Causes: possible estrogen elevation
Correcting Imbalances: improve estrogen clearance and metabolism
improve liver function
Improve gallbladder function
Improve estrogen metabolism
Improving GI binding and clearance of estrogen
Restorative detox, increase levels of fiber (proper elimination of hormones out of the bowel)- fibrous fruits and veggies, flax seeds, apple pectin, psyllium husks (25-50g with increased water and gradual increase).
To much free T3 is bound. Liver may be making to much TBG,
Birth control, IUD

13. Thyroid hormone chain defects
Defect # 7: Decreased thyroid binding globulin
Lab findings:
Normal TSH
Normal total T4
Normal total T3
Elevated free T4
Elevated free T3
Depressed T3 uptake
Causes: possible testosterone elevation, liver issues
Correcting imbalances: improve testosterone clearance and metabolism. Improve blood sugar, clear excess hormones from the body
Improving testosterone clearance:
1. improving liver function
2. improving gallbladder function
3. improving GI binding and clearance of testosterone
Low TBG. Excess of free T3, not getting into cells, hypothyroid symptoms. causes receptors to stop working well (like insulin resistance, too much insulin because receptors are now insulin resistance).

14. Thyroid hormone chain defects
Defect #8: Receptor site or cellular response
Lab Findings: All thyroid markers will be normal, but hypothyroid symptoms will still exist.
Causes: possible inflammation, vitamin A deficiency, high cortisol, high homocysteine
Correcting imbalances:
Test homocysteine levels
Nutritional support for optimal homocycteine levels:
Folic acid (4,000-8,000mcg per day, divided), Vitamin B12: 1-2 mg per day in divided doses, Vitamin B6: mg per day in divided doses, Trimethylglyceine: 2-4 grams per day in divided doses, Zinc: 30-60mg per day in divided doses
2. Salivary adrenal testing
3. Supplement with vitamin A or liver (10,000-30,000IU per day for 3 months)
Homocysteine is an amino acid that can be measured in the blood and has been linked to a variety of health issues including CVD, bone fragility and neurological degeneration. It can decrease the responsiveness of thyroid hormone receptor to thyroid hormone which decreases the ability for thyroid hormone to get into the cells. Normalizing tyroid levels can help reduce homocysteine levels.

15. Blood Chemistry Comprehensive Thyroid Panel
TSH (thyroid stimulating hormone)
Total T4 (thyroxine)
Free T4
Total T3
T3 Uptake
Autoimmune thyroid conditions are statistically a major cause of thyroid dysfunction so doing:
TPO (thyroid peroxidase antibodies)
TGB (anti-thyroglobulin antibodies)
With these markers, you will have an exceptional thyroid panel and will likely be able to identify where in the thyroid hormone chain the primary defect lies. Most Doctors are hesitant to runs all these markers. Thyroid Stimulating hormone (TSH)
Used to diagnose overactive or underactive thyroid
Measures amount of TSH in bloodstream
Reference range
Total Thyroxine (T4)
Storage hormone produced by the thyroid
Meausres total amount of circulating T4 in the blood (total refers to a combination of both the T4 bound to protein and free T4 or unbound to protein.
High value indicates hyperthyroid. Low value indicates hypothyroidism.
When bound, thyroid hormoane is not available to cells so free T4 is a better test.
Free Thyroxine (Free T4)
Measures the free, unbound thyroxine (T4) levels circulating in your bloodstream.
Total triiodothyronine (total T3)
T3 is the active thyroid hormone at the cellular level.
T3 lower than normal in hypothyroidism and higher than normal in hyperthyroidism
Free T3
Unbound T3 in the blood (considered more accurate than total T3),
A standard lab panel generally includes TSH and T4 only. Ranges vary from lab to lab:

16. Basal Body Temperature Test
Decreased body temperature a hallmark of low thyroid function
Have clients take their basal body temperature first thing in the morning for three days, then determine the average. If it’s less than 97.8, you’re likely hypothyroid.

17. Medications

18. Are clients taking medication properly?
Don’t take within 4 hours of calcium supplement. Calcium can reduce the absorption of thyroid hormone.
Don’t take within 4 hours of taking iron, including prenatal vitamins.
Take meds at least an hour after having coffee, coffee can decrease absorption
Take at the same time each day, best taken in morning on an empty stomach about an hour before eating

19. Hashimoto’s
# 1 cause of primary hypothyroidism is hashimoto’s. Studies show that 90% of people with hypothyroidism are producing antibodies to thyroid tissue.
This causes the immune system to attack and destroy the thyroid, which over time causes a decline in thyroid hormone levels.
The available research points to a combination of genetics and environmental triggers as cofactors.
Genetically susceptible people also require one or more environmental triggers to initiate the disease process.
Viral, bacterial, or Candida infections as a trigger or as a direct cause
Ongoing stress, sufficient to cause adrenal insufficiency that hampers conversion of T4 to T3 and weakens the body’s immune defenses
Pregnancy, wherein hormonal and immune system shifts can trigger Hashimoto’s in susceptible women either during pregnancy or postpartum.
Trauma, such as surgery or an accident
Nutrient deficiencies, in particular of iodine and/or selenium
Foodborne bacteria, most notably Yersinia enterocolitica, though this is more common outside the U.S. (Shomon, 2001)
Inability to get T3 into the cell to exert it’s metabolic effect.

20. Research on the Celiac-Thyroid Disease Connection
Anyone with an autoimmune condition is predisposed to developing other autoimmune conditions, and there is a particularly strong connection between celiac disease and autoimmune thyroid disease (ATD), which includes Hashimoto’s and Graves’ diseases.
Estimates indicate that approximately 70% of newly diagnosed celiac do not present with typical gastrointestinal symptoms.
People with celiac disease are more likely to develop ATD than the general public, and the reverse is also true. The increased risk holds despite treatment with a gluten-free diet or thyroid medications
In a recent study, one half of the people newly diagnosed with celiac disease also had thyroid disease.
The largest longitudinal study to date showed that adults with celiac disease had 4.4 times the relative risk of hypothyroidism and 2.9 times the risk of hyperthyroidism compared with the general public.

21. Things to Avoid
Gluten: Hashimoto’s occurs at a greater rate in those with celiac disease than in the general population. The gluten molecule is very similar to thyroid tissue, and it is thought that the immune system identifies the thyroid gland as gluten and attacks it.
Aspartame: Aside from its other known toxic effects, Aspartame appears to be particularly problematic for the thyroid gland
Iodized Salt: Even though the thyroid gland depends on iodine to produce hormones, this is not the way to get it. Use himalayan.
Unsaturated Oils (including canola oil): inflammation-promoting omega-6 fatty acid
Soy: Also disruptive to the endocrine system, and considered a toxin by some, though it is the isolated and concentrated isoflavones that pose the greatest risk, according to Ken Blanchard, M.D. (2004; p. 190). He points out that infants fed soy formulas are more likely to develop autoimmune conditions later in life than those who are not. The exception to this is fermented soy foods, such as tempeh, natto, and miso.

22. General Guidelines
Provide precursors for thyroxine synthesis. Adequate iodine is essential for the synthesis of thyroid hormones
Support conversion of T4 to T3. Selenium, zinc and copper are cofactors for the deiodinase enzymes that convert T4 to T3. Cortisol interferes with the conversion to T3 and results in conversion to inactive rT3. Adaptogens would be appropriate for those under stress.
Optimize cellular metabolism. Provide adequate vitamin A and zinc to promote proper receptor binding for nuclear transcription.
Reduce antithyroid antibodies. Eliminating foods with known sensitivity as well as potential food antigens caused by foods such as wheat (gluten) and dairy (casein) decreases the chance for cross reactions with the thyroid gland. There is a strong correlation between celiac disease and autoimmune thyroiditis so a gluten free diet is often therapeutic. Additionally, vitamin D appears to help regulate immune sensitivity and may help protect against the development of autoantibodies. Avoid excessive intake of goitrogens.
Goitrogens are foods that can induce iodine deficiency by combining with iodine and making it unavailable for use by the thyroid. Foods such as broccoli, cabbage, cauliflower, Brussels sprouts, turnips, walnuts, almonds and soy are considered goitrogenic. Cooking usually neutralizes the goitrogens in these foods and eating nuts and soy in limited amounts while ensuring adequate intake of iodine and selenium should eliminate any problem.
Encourage routine exercise. Exercise stimulates thyroid hormone synthesis, tissue sensitivity and decreases stress, which can interfere with the conversion to active T3.

23. Things to consider
Reducing inflammation, improving immune system is key:
Antioxidant-Rich Foods
Fats:–6 tablespoons per day of the good fats found in avocados, nuts, and seeds (especially pumpkin, chia, and flax), organic pastured butter and ghee, olive oil, and coconut oil.
Carb sources: focus on real food sources (fruit, sweet potato, squash, beets and other tubers), rice, quinoa, GF oatmeal
Digestive health
Overall detoxification: liver, gallbladder, kidneys, lymphatic
Acupuncture may be very effective to support the thyroid
Stress reduction, adrenal health
Good sleep
Exercise, to tolerance

24. References
Dr. Bryan P Walsh. Fat it’s not your fault. The thyroid-fat loss connection.
Chris Kresser, thyroid e-book.
Guandalini S, Vallee PA. Celiac disease. Updated May 4, Available at: Accessed June 20, 2010.
5. Elfström P, Montgomery SM, Kämpe O, Ekbom A, Ludvigsson JF. Risk of thyroid disease in individuals with celiac disease. J Clin Endocrinol Metab. 2008;93(10):
10. Naiyer AJ, Shah J, Hernandez L, et al. Tissue transglutaminase antibodies in individuals with celiac disease bind to thyroid follicles and extracellular matrix and may contribute to thyroid dysfunction. Thyroid. 2008;18(11):
11. Duntas L. Does celiac disease trigger autoimmune thyroiditis? Nat Rev Endocrinol. 2009;5(4):
12. Ventura A, Neri E, Ughi C, et al. Gluten-dependent diabetes-related and thyroid-related autoantibodies in patients with celiac disease. J Pediat. 2000;137(2):
autoimmune

zinc, exercise and thyroid function

25. Case Studies
Discussion
Questions?