Thyroid Thursday Episode 65: The #1 Reason You Have Hypothyroid Symptoms
Today I want to talk about the number one reason why you have chronic hypothyroid symptoms. This is something that your doctors are missing the boat on if you have chronic hypothyroid symptoms. It all comes down to thyroid hormone availability versus utilization by your cells.
Let me give you a little run through of thyroid physiology again. TSH stimulates the thyroid gland to produce T4 and T3. T4 being the primary inactive hormone that’s made by the thyroid gland. T3 is the active hormone but very small concentrations are made by the thyroid gland. Most of the cells in your body prefer T4 versus T3 because they like to control the activation of thyroid hormone within the peripheral cells.
T4 and T3 is made by the thyroid gland and it enters the bloodstream. T4 and T3 is bound to carrier molecules. The most common is something called “thyroid binding globulin.” The blood flushes over your tissues and cells and when the blood meets tissues and cells that need thyroid hormone, T4 and T3 leave that thyroid binding globulin and become free T4 and free T3. Free T4 and free T3 is then able to actively be transported into the cells and that’s important. It’s an active process, it means it requires energy.
Once inside the cells, T4 can be converted to T3 and that T3 can reach your nucleus. Any T3 that’s coming into the cell directly can go to the nucleus and be used to bind to the nucleus inside your cells. Once T3 binds to the nucleus of your cells, then you can increase cell metabolism. If you have hypothyroid symptoms, this is not happening sufficiently.
Most doctors assume that if you have plenty of thyroid hormone available because your blood values of T4, T3, free T4, and free T3, that the only mechanism that’s going happen is that T4 and T3 is going enter the cells and it’s going to bind to the nucleus. But if you have chronic hypothyroid symptoms, that is not happening.
So, what’s the difference between availability and utilization? Well, let me talk about that.
Thyroid hormone really has three things that occur to it once it’s produced. The first fate of thyroid hormone is this activation step. T4, and T3 enter the cells. T4 gets converted to T3, what we call activation, and T3 binds to the nucleus. Doctors assume that if you have plenty available (T4 and T3) that this is going to happen. Unfortunately, there’s two other fates that can occur to thyroid hormone.
The second fate is deactivation. That means that T4 can be deactivated to reverse T3 and to T2. T3 can be directly deactivated to T2, and T4 can be deactivated to reverse T3, which can then be further broken down to T2. Both forms, reverse T3 and T2, are less active forms of thyroid hormone. They do not bind to the nucleus and therefore they do not stimulate metabolism. That’s one of the problems.
The other fate of thyroid hormone is excretion Not all thyroid hormone makes it to the cell. It can be excreted through the liver, go out in your poop or out in your urine. Once these thyroid hormones enter the cell, they can also be transported back out and go out to the body or be excreted.
Only one of the fates, the activation fate, is going to result in increased metabolism, increased T3 binding to the nucleus, causing you to have healthy metabolism and not have hypothyroid symptoms.
So, the next question might be, “What causes all this deactivation?” Well, we’ve talked about this multiple times on Thyroid Thursdays, and that is that cell stress determines what happens with thyroid hormone. If you have excessive amounts of stress inside your cells or tissues, you’re going to potentially have more deactivation and excretion occurring.
Now, what causes cell stress? Any drop in energy within the cell, and that can be caused by multiple reasons. Toxins and microbes are big causes. Bacteria, viruses, all types of microbes can cause more cell stress and more deactivation of your thyroid hormone.
When your doctor says you have plenty of T4 and T3, free T4 and free T3, they’re saying you have plenty of thyroid hormone available, which may be true, but it doesn’t necessarily mean it’s being utilized to stimulate metabolism. You could have decreased transport into the cells. You can have decreased activation of thyroid hormone. You may not have sufficient levels of T3 occurring. Any of these steps being blocked is going to result in decreased thyroid hormone, T3 specifically, getting to the nucleus of the cells. This is going to result in hypothyroid symptoms.
So, what do you do?
You’re going to have a hard time convincing most of your doctors about this model. It doesn’t matter if it’s your conventional medical doctor, family practitioner, or the endocrinologist. Most just look at hormone availability not the utilization factor.
You need to work many times with a functional medicine practitioner to determine what’s causing this deactivation to occur and this increased excretion. It’s not looked at in conventional medicine. If you find a functional medicine practitioner, one of the things we’re going to focus on is what’s causing your cell stress. If we remove cell stress, then the activation process is going to occur more efficiently. You’re going to get more T3 reaching your cells. And, you’re going to have increased metabolism.
You can work on some of this on your own but understand that any stress; physical, chemical, emotional, or microbial, beyond your cells’ ability to adapt is going to cause deactivation of thyroid hormone and increased excretion of thyroid hormone regardless of how much is available.
Hopefully that answers some of your questions about how you can still have hypothyroid symptoms when TSH, T4, and T3 are normal, and when your gland is functioning fine. This step, this deactivation and excretion occurs away from the thyroid gland, so all this deactivation of thyroid hormone occurs away from the thyroid gland.
Hopefully that helps. Look forward to another Thyroid Thursday in the coming weeks. If you have any questions regarding this or any Thyroid Thursday, you can reach out to me wherever you watch the videos. Just put your comment below and I’ll be sure to answer it. Take care.
Dr Eric Balcavage
Chronic Condition Recovery Center
17 Regency Plaza
Glen Mills, PA 19342
