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Thyroid

Author: Dr. George Shanlikian, M.D.  |   Last Updated: February 5th, 2024

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The thyroid gland is one of the largest endocrine glands in the body located in the lower part of the neck. It produces thyroid hormones which play a major role in energy and metabolism. The thyroid does this by controlling the speed of energy usage, protein production, and sensitivity of all hormones in the body.

A healthy thyroid produces several hormones such as T1, T2, T3 (triiodothyronine), T4 (thyroxine) and calcitonin. In humans, the ratio of T4 to T3 is roughly 20 to 1. T4 is converted to the active hormone T3 which stimulates metabolism. The body, especially the liver, constantly converts T4 to Reverse T3 (RT3) to eliminate excess T4 in the body. In any given day, 40% of T4 is converted into T3 and 20% is converted to Reverse T3. But in any situation where the body needs to store energy and use it on something else such as in a stressful situation, these conversions can change – RT3 conversion can go as high as 50% or more and the T3 level goes down. When biological stress is excessive, the adrenal glands produce high amounts of the stress hormone called cortisol to help cope up with the situation and achieve balance or stability (homeostasis). The excess cortisol inhibits the conversion of T4 to T3 by affecting the ability of the pituitary gland to produce thyroid-stimulating hormone.

Potential Health Benefits of Thyroid Hormone

  • Relieves Fatigue and Boosts Energy Levels [4-16]
  • Improves Mood [17-39]
  • Strengthens the Immune System [40-62]
  • Helps Lose Weight [63-85]
  • Improves Cholesterol Levels [86-99]
  • Improves Cognitive Function [100-149]
  • Maintains a Healthy Heart [150-210]
  • Improves Bone Health [211-232]
  • Improves Sleep Quality [233-258]
  • Improves Blood Pressure [266-277]
  • Improves Kidney Function [278-334]

Thyroid Imbalance: Hyperthyroidism and Hypothyroidism

Sometimes, the ability of the thyroid gland to produce hormones can be affected by several factors or thyroid conditions, leading to abnormally low thyroid hormone (hypothyroidism) or excessive thyroid hormone (hyperthyroidism). Both hypothyroidism and hyperthyroidism can be detrimental to health and can significantly affect one’s quality of life because they increase the affected individual’s risk of developing heart disease, bone disorders, skin and hair problems, bleeding issues, sexual and reproductive concerns, and other debilitating medical conditions.

In general, people with hypothyroidism can experience the following signs and symptoms:

  • Abnormal menstrual cycles
  • Cold intolerance
  • Constipation
  • Dry or brittle hair leading to hair loss
  • Dry, pale skin
  • Extreme fatigue even in non-tiring activities
  • Higher cholesterol levels
  • Irritability, depression and low mood
  • Low libido
  • Memory problems
  • Muscle cramps and frequent muscle pains
  • Slower heart rate (bradycardia)
  • Weight gain or difficulty losing weight

On the other hand, excessive levels of thyroid hormone cause hyperthyroidism. This thyroid condition significantly increases metabolism leading to the following symptoms:

  • Anxiety
  • Bone problems
  • Breathing difficulties
  • Difficulty concentrating
  • Fatigue
  • Frequent bowel movements
  • Goiter
  • Hair loss
  • Heart palpitations
  • Heat intolerance
  • High blood pressure
  • Increased appetite
  • Increased sweating
  • Irregular menstrual cycles
  • Muscle weakness
  • Nervousness and irritability
  • Protruding, itchy eyes
  • Sleep disturbances
  • Tremors
  • Weight loss

Causes of Thyroid Problems

Problems with the thyroid gland can be caused by several conditions. For hyperthyroidism, common causes are:

  • Autoimmune diseases such as Graves’ disease.
  • Inflammation of the thyroid caused by a virus or bacteria.
  • Pituitary gland malfunctions
  • Thyroid cancer
  • Thyroid gland nodules, or non-cancerous lumps

On the other hand, hypothyroidism can be caused by the following:

  • Autoimmune diseases such as Hashimoto’s thyroiditis.
  • Certain medical treatments such as radiation therapy and thyroid surgery.
  • Certain medications such as cold and sinus medicines, amiodarone and lithium.
  • Exposure to excessive amounts of iodide (e.g. certain contrast dyes given before some X-rays)

Complexity of Thyroid Disease

Women are at higher risk for developing thyroid dysfunction. According to research, women are five to eight times more likely to have imbalance in thyroid hormones than men, but most don’t know they have it. [1] Most women often overlook their symptoms or mistake them for symptoms of other medical conditions. For example, most women who gave birth experience symptoms that are very similar to that of thyroid disease.

In young men, thyroid imbalance can be easily diagnosed with a blood test. However, as men age, thyroid imbalance becomes more difficult to diagnose because the number of symptoms often decrease. To further complicate matters, older men with thyroid imbalance often experience symptoms that are very similar to the normal symptoms of ageing. These include weight changes, low mood, depression, bone problems, cognitive decline, sleeping difficulties, hair loss, and tremors.

To address the complexity of thyroid disease in both men and women, an experienced and skilled doctor must perform a blood test that measures TSH (thyroid stimulating hormone), free T3, and T4. In addition to this, a physical exam must also be performed to assess the signs and symptoms. Once a correct diagnosis is done, your doctor will come up with a medical management that is tailored to your health needs.

Proven Benefits of Bioidentical Thyroid Hormone Replacement Therapy

In order to correct hypothyroidism, bioidentical thyroid hormones are used to restore the balance of thyroid hormones. Bioidentical hormones are safe and effective since they are chemically identical in molecular structure and function to those the human body produces. On the other hand, the medical approach to hyperthyroidism is different. This condition can be treated with anti-thyroid medications that interfere with the excessive production of thyroid hormones in order to bring down its levels to normal.

Since thyroid hormones play a major role in a wide array of biochemical processes in the body, including growth and development of tissues, breathing, energy production, regulation of heart rate, maintenance of brain function, regulation of body temperature, maintenance of the nervous system, digestion, and several other cellular processes, restoring abnormally low levels of these hormones can help alleviate debilitating symptoms and achieve optimal health and well-being. Thyroid hormone replacement has been used for more than 100 years in the treatment of thyroid hormone deficiency, and there is no doubt about its overall safety and efficacy. [2-3] In fact, an overwhelming body of scientific evidence and clinical trials support the diverse health benefits of thyroid hormone replacement therapy.

Relieves Fatigue and Boosts Energy Levels

Fatigue-related complaints are common in people with thyroid hormone deficiency. Studies assessing the beneficial effects of thyroid hormone replacement therapy in patients with hypothyroidism show that it can help boost energy levels by combating fatigue:

  1. Low thyroid hormone levels are strongly linked with extreme fatigue, suggesting that increasing thyroid hormone levels may have beneficial effects. [4-10]
  2. In patients with primary hypothyroidism, stable levothyroxine regimen for at least 6 months improves scores in a series of tests assessing fatigue. [11-12]
  3. In patients with hypothyroidism, T4 monotherapy improves symptoms of fatigue. [13]
  4. In patients with fatigue, combination of T3 and T4 therapy improves fatigue. [14]
  5. In patients with primary hypothyroidism, combination of T3 and T4 therapy decreases fatigue by improving neuropsychological function. [15]
  6. In patients with general symptoms of tiredness and hypothyroidism, thyroid hormone replacement therapy significantly reduces symptoms. [16]

Improves Mood

Thyroid disease can affect overall mood – primarily causing depression, anxiety and low self-confidence. Generally, thyroid hormone levels have something to do with the severity of mood changes, with abnormally low levels associated with severely depressed mood. There is growing evidence that thyroid hormone replacement therapy may help boost mood in people with thyroid hormone deficiency:

  1. In patients with mood disorders, thyroid hormones, usually in conjunction with standard medications, can be used to treat both manic and depressed phases of the condition. [17]
  2. In patients who had undergone surgical removal of the thyroid (thyroidectomy), combined T3 and T4 hormone replacement improves mood. [18]
  3. In patients with thyroid hormone deficiency, combination treatment of T3 and T4 significantly improves mood as well as quality of life. [19-34]
  4. In patients with mood disorders, the use of T3 helps treat symptoms by accelerating the onset of action of antidepressant therapy and enhancing the effect of treatment. [35]
  5. In patients with major depressive disorder and previous history of treatment-resistant depression, T3 supplementation is associated with a twofold greater likelihood of response to tricyclic antidepressant (TCA) therapy. [36-37]
  6. In patients with bipolar depression, supplementation of standard treatment with high-dose T4 improves mood by affecting the function of certain brain areas. [38]
  7. In patients with hypothyroidism, combination therapy of T3 and T4 appears to be effective in alleviating anxiety and depression compared to monotherapy. [39]

Strengthens the Immune System

Thyroid hormone metabolism and thyroid status are strongly associated with various aspects of the immune response. This suggests that thyroid hormones play an important role in modulating the immune system response and preventing a wide array of infections. Increasing evidence strongly supports the immune-modulating properties of thyroid hormones:

  1. Low circulating thyroid hormone levels are strongly associated with impaired immune function. [40-41]
  2. In patients with thyroid disorders, thyroid hormone supplementation prevents inflammation and other damaging immune responses. [42]
  3. In healthy men and women, combined T3 and T4 treatment improves markers of immunity. [43]
  4. Thyroid hormone administration increases size and growth of cells in the thymus, an organ that produces T cells for the immune system. [44-45]
  5. Thyroid hormones boost the activities of various immune cells such as monocytes, macrophages, natural killer cells, and white blood cells. [46-53]
  6. Thyroid hormones improve immune function by increasing the production of antibodies and other cells of the immune system. [54-58]
  7. Thyroid hormones strengthen the immune system by affecting cell-mediated immune responses. [59]
  8. In mice, T4 treatment suppresses excessive immune response such as antibody synthesis and growth of white blood cells. [60]
  9. In a cell-based study, T4 potentiates growth and reproduction of white blood cells, thereby boosting the immune response. [61]
  10. In mice, both T3 and T4 treatment enhance natural killer cell activity. [62]

Helps Lose Weight

One of the main functions of thyroid hormones is to regulate metabolism. With increased metabolism, weight loss can be achieved. Evidence suggests that thyroid hormones may actually improve body composition and reduce body weight while improving overall health:

  1. Thyroid hormones helps reduce body weight mainly through regulating energy expenditure. [63-64]
  2. Obese women appears to have low circulating levels of T4, suggesting that thyroid hormone deficiency is associated with weight gain. [65]
  3. In people undergoing weight loss diets, higher levels of T3 and T4 are associated with significant reduction in body mass index (BMI). [66]
  4. In overtly hypothyroid patients, T4 replacement therapy reduces weight by improving lean body mass. [67-68]
  5. In obese patients, administration of fresh thyroid juice reduces body weight by promoting diuresis (increased urine production). [69]
  6. In patients with hypothyroidism, T3 therapy is associated with a significant weight loss of 2.1 kg. [70]
  7. In overweight patients, T3 and T4 combination therapy significantly decreases body weight. [71-72]
  8. Thyroid hormones promote weight loss by regulating resting metabolic rate (the rate at which the body burns energy at rest). [73-74]
  9. Combination therapy of T3 and T4 appears to be more effective in reducing body weight in obese patients compared to monotherapy. [75-84]
  10. In rats, T3 promotes weight loss through regulation of lipid metabolism in the brain. [85]

Improves Cholesterol Levels

The body needs thyroid hormones in order to balance cholesterol production and elimination. In case of thyroid hormone deficiency, the body can’t make high-density lipoprotein or HDL (good cholesterol) and remove low-density lipoprotein or LDL (bad cholesterol) efficiently as usual. As a result, LDL builds up in the bloodstream which eventually leads to various debilitating diseases. Interestingly, researchers found that thyroid hormone exerts cholesterol-lowering properties which can help improve overall health:

  1. In patients with hypothyroidism and increased total cholesterol, T4 replacement therapy improves cholesterol levels by decreasing elevated LDL fraction. [86-87]
  2. In premenopausal women with hypothyroidism, combined T3 and T4 treatment appears to be more effective at improving cholesterol profile compared to monotherapy. [88]
  3. In patients with hypothyroidism, T3 or T4 administration significantly decreases total cholesterol by improving lipid metabolism. [89]
  4. In patients with primary hypothyroidism, administration of 10, 20, 25, or 50 micrograms of T3 daily on a monthly basis significantly reduces blood cholesterol levels. [90]
  5. In hypothyroid patients, T3 administration thrice daily (0.5–1.5 mIU/L) reduces total cholesterol and LDL levels. [91]
  6. In patients with hypothyroidism, T4 treatment at a dose of 1.6 microgram/kg body weight reduces total cholesterol and LDL levels. [92]
  7. In hypothyroid patients and those with normal thyroid hormone levels, T4 treatment lowers total cholesterol levels. [93]
  8. In patients with hypothyroidism, combination treatment of T3 and T4 appears to be more effective in reducing cholesterol and triglyceride levels. [94]
  9. In patients with hypothyroidism, thyroid hormone replacement therapy significantly reduces lipid and LDL levels without any adverse side effects. [95]
  10. In patients with hypothyroidism, T4 treatment reduces cholesterol levels by increasing LDL degradation. [96]
  11. In preclinical human studies, the use of thyroid hormone analogs is associated with reduced total cholesterol, LDL cholesterol, and triglycerides. [97]
  12. Long-term thyroid hormone replacement therapy lowers cholesterol levels by improving liver cholesterol metabolism. [98]
  13. Thyroid hormone replacement therapy lowers cholesterol levels by dramatically increasing intestinal absorption of cholesterol. [99]

Improves Cognitive Function

Thyroid hormone also helps regulate the growth and development of nerve cells as well as different processes in the brain. Specifically, there appears to be extensive interaction between thyroid hormones and certain brain chemicals, suggesting that healthy thyroid hormone levels may be beneficial on memory, learning, and other cognitive functions. Strong scientific evidence suggests that thyroid hormone replacement therapy can help combat cognitive impairments associated with aging and other medical conditions:

  1. Low thyroid hormone levels are strongly linked with poorer cognitive function and cognitive disorders such as Alzheimer’s disease. [100-124]
  2. On the other hand, higher thyroid hormone levels are associated with better cognitive function. [125-128]
  3. T3 helps prevent Alzheimer’s disease by inhibiting the production of amyloid beta, which are abnormal proteins and the major cause of the disease. [129-130]
  4. In pregnant women, T4 administration prevents cases of decreased child intelligence quotient. [131]
  5. In hypothyroid patients, T4 replacement therapy markedly improves cognition and emotion. [132-133]
  6. Patients with cognitive impairment appear to respond well to combined T3 and T4 therapy compared to monotherapy. [134]
  7. In patients with hypothyroidism, standard T4 monotherapy improves well-being and cognitive performance. [135]
  8. In patients with hypothyroidism, thyroid hormone replacement therapy leads to normalization of cognitive functions. [136]
  9. In hypothyroid patients, 3-month thyroid hormone replacement therapy significantly increases verbal memory retrieval. [137]
  10. In patients with hypothyroidism, thyroid hormone replacement therapy improves psychological well-being. [138]
  11. Combination T3 and T4 therapy for patients with hypothyroidism appears to be safe and effective in improving cognitive function. [139-140]
  12. In patients with hypothyroidism, T4 treatment significantly normalizes cognitive function. [141]
  13. Combined treatment of T3 and T4 in patients with hypothyroidism after thyroidectomy significantly improves mental status. [142]
  14. Successful treatment of hypothyroidism with T4 is associated with recovery or improvement of neurocognitive function and psychological well-being. [143-144]
  15. In rats, T4 administration enhances learning ability by increasing the levels of acetylcholine, a brain chemical that regulates learning and memory. [145-149]

Maintains a Healthy Heart

Thyroid hormone has important effects on heart muscle, blood circulation, and the central nervous system – all of which are vital for cardiovascular health. This suggests that thyroid hormone levels may help predict heart health. There is growing body of evidence that supports the beneficial effects of thyroid hormone on various cardiovascular markers:

  1. Thyroid hormone helps the heart pump more blood efficiently. [150]
  2. Thyroid hormone improves cardiovascular health by increasing heart rate. [151-154]
  3. Thyroid hormone improves blood circulation within the heart by increasing red blood cell production, total blood volume, and heart contractility. [155-157]
  4. Thyroid hormones also increase venous return, resulting in greater cardiac output and blood volume distributed in different body parts. [158-160]
  5. A deficiency in thyroid hormone compromises the function of the heart muscle, resulting in lower heart rate and weakening of myocardial contraction and relaxation. [161-162]
  6. Thyroid hormone deficiency also leads to lower total blood volume pumped by the heart muscle. [163-164]
  7. Low free T3 levels inhibit formation of new blood vessels in the heart tissue after a heart attack, which would accelerate heart failure and adverse cardiac events. [165-166]
  8. Thyroid hormone deficiency is also associated with abnormal heart rhythm. [167-168]
  9. In people with thyroid hormone deficiency, their risk of developing atherosclerosis (plaque formation), coronary heart disease, and heart failure is significantly increased.  [169-171]
  10. T3 and T4 administration in patients with primary hypothyroidism lower risk of cardiovascular disease by improving lipid profile and body weight. [172-181]
  11. Patients with increased thyroid hormones have increased contractile force and cardiac output. [182-187]
  12. Patients with thyroid dysfunction have reduced exercise tolerance compared to those with healthy thyroid hormone levels. [188]
  13. Evidence obtained from cell and animal models suggest that thyroid hormone treatments promote regeneration of the damaged heart muscle. [189-196]
  14. Thyroid hormone also helps maintain cardiac cell shape and growth. [197-199]
  15. Thyroid hormone protects against ischemic heart (lack of oxygen) by accelerating heart rhythm and increasing contractility. [200-201]
  16. In patients with thyroid hormone deficiency and heart disease, thyroid hormone therapy normalizes heart function and other cardiovascular parameters. [202-204]
  17. In patients with cardiomyopathy (disease of the heart muscle), T4 treatment induces significant improvement in cardiac pump function and functional capacity during exercise. [205-206]
  18. In patients with advanced heart failure and low T3 levels, higher dose of T3 improves cardiac output significantly by reducing systemic vascular resistance (resistance that must be overcome to efficiently pump blood through the circulatory system). [207-210]

Improves Bone Health

Thyroid hormone is also vital for optimum bone health. Because this hormone plays an integral role in skeletal development and establishment of peak bone mass, several high quality studies found that it can help decrease the risk of osteoporosis and other bone disorders:

  1. Deficiency or dysfunction of thyroid hormone receptors leads to growth retardation, delayed bone age, and decreased bone mineral density (BMD). [211-216]
  2. T3 regulates formation of bone cartilage and bone mineralization. [217]
  3. In men and women with thyroid hormone deficiency, there is a significant risk of decreased BMD and other bone disorders. [218-222]
  4. In patients with thyroid cancer, higher thyroid hormone levels are associated with higher femoral neck BMD. [223]
  5. In postmenopausal women, thyroid hormone level above 97.5 percentile is associated with significantly higher BMD at the femoral neck. [224]
  6. In patients with thyroid dysfunction, thyroid hormone deficiency is associated with increased femoral neck bone loss, potentially contributing to increased fracture risk. [225-226]
  7. Women with thyroid hormone levels in the lowest quartile have a higher incidence of vertebral fractures. [227]
  8. In patients with congenital hypothyroidism, treatment with thyroid hormone improves growth and BMD. [228-229]
  9. In postmenopausal women, elevated level of thyroid hormone is associated with a 5.97% increase in femoral neck bone density. [230]
  10. A thyroid disorder that affects thyroid hormone levels is considered as a cause of secondary osteoporosis. [231-232]

Improves Sleep Quality

Whether you’re having difficulty falling asleep or staying asleep, thyroid health can have a profound impact on sleep quality and quantity. This is because the thyroid gland plays an integral part in the regulation of almost all the body’s metabolic function, thus, any imbalance in thyroid hormone levels can negatively affect sleep. In fact, studies assessing the beneficial effects of thyroid hormone replacement therapy in people with sleeping problems have shown positive results:

  1. In people with sleeping disorders, the prevalence of thyroid hormone deficiency is very common. [233-244]
  2. In patients with sleep apnea syndrome (breathing repeatedly stops and starts), thyroid hormone therapy effectively alleviates snoring only after one year of treatment. [245-246]
  3. In patients with obstructive sleep apnea, T4 therapy for 4 months significantly reduces periods of absent breathing during sleep. [247]
  4. T4 therapy in patients with subclinical hypothyroidism and obstructive sleep apnea is associated with less daytime sleepiness. [248]
  5. One study reported that 50–100% of patients with hypothyroidism and obstructive sleep apnea showed an improvement in sleep-disordered breathing with T4 replacement. [249]
  6. In patients with sleep apnea, thyroid hormone replacement therapy reverses symptoms and sleep-disordered breathing. [250]
  7. In patients with sleep-disordered breathing associated with hypothyroidism, T4 replacement therapy alone significantly improves sleep apnea by reducing the total number of episodes of obstructive apnea and improving oxygen saturation during sleep. [251-252]
  8. In patients with sleep apnea associated with hypothyroidism, combination of continuous positive airway pressure and low-dose T4 therapy improves sleep quality. [253]
  9. In patients with obstructive sleep apnea associated with hypothyroidism, thyroid hormone replacement therapy significantly improves sleep quality especially in non-obese patients. [254]
  10. In patients with newly diagnosed sleep-disordered breathing, T4 therapy alone improves breathing patterns, nocturnal hypoxia (diminished oxygen supply at night), and thyroid deficiency. [255]
  11. In patients with hypothyroidism and sleep apnea, T4 replacement therapy significantly improves sleep respiratory abnormalities. [256-258]

Improves Blood Pressure

Thyroid hormone also has a role in blood pressure regulation. After all, there are thyroid receptors found in every cell of your body, thus, fluctuations in the levels of thyroid hormone can significantly affect blood pressure. There is increasing evidence that restoring thyroid hormone to optimal levels may be beneficial in people with hypertension:

  1. Thyroid hormone deficiency is strongly linked with hypertension. [259-266]
  2. In patients with hypertension, thyroid hormone replacement therapy decreases blood pressure by reducing blood vessel stiffness. [267]
  3. T3 has vasodilatory properties, which means that it has the ability to dilate blood vessels, thereby lowering blood pressure. [268-270]
  4. Thyroid hormone lowers blood pressure by reducing vasopressin, a hormone that increases blood pressure by promoting water retention. [271-272]
  5. In patients with hypothyroidism, T4 replacement therapy for 3-6 months significantly reduces blood pressure. [273]
  6. In patients with hypothyroidism, low-dose T4 replacement therapy reduces blood pressure by improving blood vessel function. [274]
  7. In patients with hypertension related to hypothyroidism, thyroid hormone replacement therapy successfully reduces blood pressure without any adverse side effects. [275]
  8. In hypertensive patients, adequate thyroid hormone replacement therapy improves blood pressure by reversing increased central aortic pressures and arterial stiffness. [276]
  9. Thyroid hormones participate in the control of systemic arterial blood pressure homeostasis (balance). [277]

Improves Kidney Function

There are several interactions between thyroid hormone and kidney functions. In fact, thyroid hormones are involved in the development of the kidney and they aid in waste excretion by improving the kidney’s filtering ability. Evidence suggests that thyroid hormone replacement therapy may help improve kidney function and prevent various kidney disorders:

  1. Thyroid hormone deficiency is strongly associated with kidney disease and impaired kidney function. [278-300]
  2. In patients with overt hypothyroidism, T4 treatment improves kidney function. [301-305]
  3. T4 treatment in patients with subclinical hypothyroidism and chronic kidney disease (CKD) significantly lowers the rate of decline in glomerular filtration rate (kidney’s ability to filter waste). [306-307]
  4. In patients with hypothyroidism, T4 replacement therapy reverses edema (fluid build-up) associated with kidney disease. [308]
  5. In patients with various kidney diseases, T4 treatment alleviates urine protein loss.    [309-313]
  6. Thyroid hormone replacement therapy attenuates the rate of decline in kidney function in CKD patients with hypothyroidism, suggesting that the treatment may delay reaching end-stage renal disease in these patients. [314-318]
  7. In patients with hypothyroidism and CKD, thyroid hormone therapy not only preserves kidney function better, but is also an independent predictor of kidney outcomes. [319]
  8. In elderly patients and those with kidney disease, thyroid hormone therapy preserves kidney function by improving glomerular filtration rate. [320-323]
  9. In patients with kidney impairment secondary to hypothyroidism, thyroid hormone replacement therapy reverses kidney dysfunction. [324-325]
  10. In patients with primary hypothyroidism, T4 administration normalizes glomerular filtration rate and blood flow to the kidney. [326-332]
  11. In patients with kidney impairment caused by hypothyroidism, T4 treatment improves water excretion by the kidney. [333]
  12. In patients with kidney disease, T4 replacement therapy improves kidney function by reducing creatinine, a waste product of muscle breakdown. [334]
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