An Integrated Look at the Thyroid

Overview

• The thyroid hormone is important for all metabolic activity since it speeds up cellular energy and heat production.
• Low levels of the thyroid hormone can cause a variety of common symptoms, such as feeling cold, fatigue, weight gain, hair loss, depression, brain fog, and sleepiness.
• From a Chinese Medicine perspective, the thyroid gland itself is closely related to lung function, but any organ system can be implicated in a Western diagnosis of hypothyroid.
• Simply treating low thyroid by supplementing with thyroid hormone often misses the deeper issue. Without examining the unique individual this can cause more problems in the long-term.
• Treatment for thyroid issues can include diet, acupuncture, herbs, homeopathy, lifestyle and stress management, all geared towards helping the body self-regulate and return to health.

Thyroid problems are becoming more and more common in Americans. A health survey from 1999 to 2002 reported that 3.7% of all people in the U.S. had a diagnosis of hypothyroidism. Hypothyroid is more common in the elderly population, and more common in women than in men. Also, depending on who you ask, subclinical hypothyroid is much more common, ranging from 15% of the population up to 40%, according to Dr. Broda Barnes in his book, Hypothyroidism: The Unsuspected Illness. Given the importance of the thyroid gland, and the widespread thyroid dysfunction that exists, it is important to understand the thyroid better both from a biomedical and a more integrative perspective.

What does the thyroid do in the body?

The thyroid sits in the throat and produces thyroid hormone in response to thyroid-stimulating hormone (TSH) from the pituitary gland, a small gland that sits behind the eyes and controls much of the body’s endocrine system. The main thyroid hormone produced by the thyroid, thyroxine (T4), is then converted to the active form (triiodothyronine, or T3) in the cells themselves. The thyroid also releases small amounts of T3, but primarily produces T4. While in the blood, less than 1% of the T3 and T4 are available to stimulate the cells, as most of the thyroid hormones are bound to thyroxine-binding globulins and other carrier proteins that keep them inactive.

Once in the cells, T3 goes into the mitochondria and increases energy output. The mitochondria are the cell’s main energy producers, and the thyroid hormone speeds them up, increasing the rate at which fuel is burned. It’s similar to the gas pedal in a car: more T3 means more metabolic activity, which means more energy and more heat. More oxygen gets used, and more calories are burned. Thyroid hormone is important for making proteins, development of the fetus, and maintenance of the nervous system in adults. Thyroid hormone also increases sensitivity to adrenaline in the cardiovascular system by increasing the number of receptors in the blood vessels. This makes the startle response and reaction to acute stress more sensitive.

Symptoms of hypothyroidism

When TSH is high but levels of T3 and T4 are normal this is known as subclinical hypothyroidism. There are typically no symptoms. When levels of T4 and T3 get too low, people develop symptoms. Generally, everything slows down, both physically and mentally. Physically, this manifests as fatigue, feeling cold, weight gain, decreased appetite, dry skin, hair loss, weakness in the extremities, joint pain, constipation, blurred vision, decreased hearing, slowed heart rate, low blood pressure, and swelling. If the hypothyroid is due to Hashimoto thyroiditis (an autoimmune thyroid condition) or iodine-deficiency goiter people can also have a feeling of obstruction in the throat and hoarse voice, as the enlarged thyroid presses on the esophagus and vocal cords. Mentally, hypothyroid manifests as depression, sleepiness, forgetfulness, and difficulty concentrating. If the deficiency is severe there can be a coma.

Chinese Medicine (CM) perspective on the thyroid

As CM organ systems are defined primarily by function and only secondarily by location the thyroid isn’t a separate organ in CM theory. However, by looking at how thyroid hormone works, and the symptoms that arise with too little or too much of it, correlations with existing CM theory are possible. In the following discussion, I will be capitalizing on the CM organ systems to emphasize their functional nature in comparison with the more physically defined organs of biomedicine. Therefore, the lung is related to the lung but is a distinct functional system that both includes elements of the physical lung and goes beyond it. Because CM is functional in nature multiple organ systems can be related to hypothyroidism. What follows is a short investigation of the possibilities.

Lung

The function of a healthy thyroid mirrors one aspect of the CM Lung. The lung is said to govern the qi, and the literal translation of qi is air. If metabolism in the body is conceptualized as a fire, then this fire requires air in order to burn well. The thyroid hormone increases the uptake of fuel and oxygen into the cells in order to speed up metabolism, which is similar to fanning a fire to increase the flames. The lung is responsible for opening and regulating the water channels, promoting the proper movement of fluids in the body. The large intestine is connected to the lung, and the lung is connected to the skin and body hair. If lung qi weakens the process of burning fuel for energy will slow down, cooling the fire of metabolism. Fluids tend to build up in the tissues, causing swelling, weight gain, and edema. Constipation can result due to the lack of qi movement, and the skin can become dry as fluids fail to disperse outwards.

Kidney

The basic fire of metabolism that produces energy and heat in the body is kidney yang. This can be conceptualized as the mitochondria themselves and their ability to produce cellular energy. The kidney organ system is also in charge of grasping and containing the qi. Kidney yang is distributed to every cell via the Triple Burner, the “messenger” organ system. The kidney and Triple Burner work together to transform qi and move water and fluids in the body. If kidney qi and yang are weak the person will feel cold, tired, and have trouble with fluid metabolism, all symptoms associated with low thyroid function. As the kidney connects to the head hair, the loss of hair with hypothyroidism is a reflection of reduced kidney vitality. The Triple Burner is correlated with the extracellular matrix and lymph channels, areas that tend to retain fluid with hypothyroidism.

The yang of the kidney energizes the large intestine, and waning kidney yang can result in constipation. This yang also feeds the heart, and therefore a slowing of the heart and low blood pressure can result from kidney deficiency. Many of these processes are associated with the adrenals and their production of cortisol. Though cortisol is often called the stress hormone it is vital for activating numerous cellular functions; cortisol works together with thyroid hormone to promote energy production, and without cortisol, the entire body will shut down. If cortisol is insufficient the body may attempt to increase thyroid in order to compensate. This can fatigue and weaken the thyroid over time which will result in low thyroid hormone.

Spleen

The spleen organ system is responsible for absorbing nourishment from the digestive system and providing this nourishment to the cells, enabling the production of metabolic energy. When spleen function is impaired digestion suffers and the ability of the blood to provide nourishment is weakened. Symptoms can include fatigue, weakness, generation of damp (un-metabolized food substances and mucus), forgetfulness, and brain fog. The physical organs associated with the spleen organ system include the pancreas, the spleen, and the liver. Insulin resistance, which leads to too much glucose in the blood, is an example of Spleen deficiency and dampness.

There is evidence that insulin resistance is associated with hypothyroidism in some cases. Thyroid hormone is necessary for the liver to convert carbs to glycogen, which is stored in the liver in order to regulate blood sugar. This function of the liver falls into the realm of the spleen, and a spleen deficiency in this area would result in lowered glycogen storage, contributing to issues with blood sugar. Similar to the relationship between cortisol and thyroid, if fuel is insufficient (low or unavailable blood glucose) the thyroid may work harder in an attempt to compensate. Over time this results in lowered thyroid hormone.

Heart

The heart governs the blood vessels and controls circulation. Whenever the heart qi is weak, there can problems of poor circulation in any area. Dr. Hammer, in his article, The Chinese Medical Model in Thyroid Disease, describes how sudden circulatory congestion in the throat area that results from heart deficiency can cause an apparent enlargement of the thyroid that is associated with hypothyroidism. Since the heart is a fire organ, and the nature of fire is to flicker, this thyroid enlargement tends to come and go depending on the state of the heart. The heart is connected externally to the face, which is considered a mirror of the condition of the heart. In hypothyroidism, there can be a dullness or coarseness to the face, reflecting a diminishing of Heart qi. Even though it is the kidney that supplies yang to the heart, slowed heart rate and low blood pressure from decreased thyroid hormone can also be a direct reflection of heart qi deficiency.

Liver

The liver is responsible for the smooth flow of qi in the body. It is also in charge of storing the blood and works with the spleen to keep the blood full of nourishment. In Chinese Medicine, blood is also the storage place for emotions, and repression of emotion can cause the flow of liver qi to become obstructed. In cases of thyroid enlargement, the liver is often involved and the physical congestion is a result of repressed emotion, especially anger. If the liver is weakened it can have difficulty moving the qi, also resulting in congestion at the thyroid. Since the nature of liver qi is to push, if it is obstructed it can escape the normal channels and push against other organ systems. When the liver pushes against the lung or the spleen, it can create thyroid issues. The smooth flow of qi can be correlated with the proper secretion and elimination of hormones, such as thyroid or cortisol.

Chronic stress that results in elevated cortisol reflects the stagnation of liver qi, as the liver stop eliminating excess cortisol from the circulation. This stagnation could also be reflected in cortisol receptor resistance (similar to insulin resistance), where the body no longer responds to cortisol in the same way. Excess cortisol can also be due to slowed liver metabolism, and when the liver slows down the metabolism of all steroid hormones slows, leading to excess estrogen as well. This increases the binding proteins in the blood, locking up thyroid hormone and causing hypothyroid symptoms. Cortisol inhibits the conversion of T4 to T3, a representation of liver qi pushing against the lung. The rhythmic secretion of hormones such as cortisol or thyroid can be considered a part of the liver function, and interruption of these biorhythms can cause issues even if average levels of the hormone are normal.

Treating hypothyroidism

Conventional treatment in cases that don’t involve iodine deficiency is simply to supplement with thyroid hormone, either T4 or a combination of T4 and T3. Patients often take thyroid medication for life. This approach is not optimal, however, because the rhythmic secretion of hormones in a healthy person cannot be replicated with oral medications. An optimal approach would also recognize the need for the body to self-regulate, and any treatment that relies on lifelong medication is missing the deeper issues. I don’t accept the premise that hypothyroid can only be managed, but not cured. A more integrative approach provides treatments that can more completely address low thyroid. Making sure to address any potential adrenal fatigue is extremely important. Optimizing digestion, fixing leaky gut, and working with blood sugar dysregulation is vital. Working with stress management, releasing contained emotions, and regulating the nervous system with meditation or breathing exercises will help rebalance the system. In some cases, a small amount of thyroid hormone supplementation – for a short time – is helpful to restore energy and function while the body is being healed.

Though acupuncture is quite effective I won’t go into specific treatment protocols or point selection here. Similarly, with homeopathic remedies, the number of different remedies is broad enough that speculation without a detailed history would be pointless. However, some basic aspects of diet and possible approaches for herbal treatment can be considered.

Diet

As diet is most closely related to spleen and stomach function in Chinese Medicine the fact that many hypothyroid cases involve some degree of spleen deficiency makes diet recommendations relatively straightforward. When the spleen is weak it is important to eat warm, easily digestible foods. This means at the very least that one should avoid eating anything cold or raw. No raw fruits, no raw vegetables, no cereal with cold milk, no ice cream, no cold leftovers. Food should be warmed up before eating, and even fruit should be lightly steamed. Though weak spleen qi often leads to cravings for sugar and processed carbohydrates these should be avoided if possible. Instead, eat complex carbs that have been thoroughly cooked, like grains and root vegetables.

Carbohydrates are important for spleen function, and carbs are important for balancing blood sugar if the liver is not storing glycogen well. Especially with grains, cooking overnight in a crockpot or slow cooker is best to make them more digestible. Warming spices such as ginger, cinnamon, cardamom, black pepper, cumin, coriander, or fennel are also good in small amounts. Season food with a bit of these spices to help the digestion and support the spleen.

A small amount of bitter food, such as pickles, can be eaten to stimulate the appetite. A good tonic to take before meals is a tablespoon of apple-cider vinegar in some water, which will help increase Stomach qi and stomach acid. If there are signs of Stomach counterflow, such as heartburn, reflux, bloating, or nausea, a small dose of digestive bitters will help settle the stomach.

Herbal therapy

The mainstay of herbal treatment will be to tonify qi and yang. Qi and yang tonifying herbs often work on multiple organ systems but the following herbs are considered to work primarily on the kidney and spleen. Subhuti Dharmananda reports on good results from studies that used herbs such as astragalus (Huangqi), codonopsis (Dangshen), epimedium (Yinyanghuo), aconite (Fuzi), cinnamon (Guizhi)l, ginseng (Renshen), atractylodes (Baizhu), ginger (Ganjiang), and others. Heiner Fruehauf, in his Classical Pearls herbal formulas series, has a number of formulations that he recommends for hypothyroid (depending on the individual), many of which contain combinations of the above herbs. Western herbs of note according to Matthew Wood include siberian ginseng (Eleutherococcus), nettles (Urtica), gotu kola (Centella), and kelp (Fucus) for the iodine content. Chinese medicinals from the ocean such as seaweeds and seafood are also used for their iodine content in cases of hypothyroid.

For people with excess cortisol, usually due to chronic stress, herbs that address liver qi stagnation and help regulate cortisol are helpful. These include herbs such as Chinese skullcap (Huangqin), bupleurum (Chaihu), bitter orange (Zhishi), magnolia (Houpo), and others. For liver deficiency, formulas that contain evodia (Wuzhuyu) can be helpful, along with the yang tonics listed above.

The best treatment approach is an individualized one that takes into account the person’s unique presentation and history. If you or someone you know is ready to move past symptom management with thyroid hormone and get to the root of the issue, find an integrative practitioner or schedule an appointment at Whole Systems Healthcare to help you understand, and treat your unique situation.