Small but mighty, the thyroid powers a huge number of our bodily functions and plays a large role in the good (or bad) we feel day-to-day. That’s because, at its most basic level, the thyroid influences how well the rest of our organs function, says Kerri Masutto, MD and internal medicine doctor at Parsley Health in San Francisco.
Masutto calls the impact of the thyroid “profound,” and says the consequences are equally impactful if it doesn’t work quite right. Short term effects include things like poorly regulated blood pressure, heart rate, body temperature, energy levels and mental clarity. Long term, these impacts compound, making it difficult to get your systems back on track, she says.
“It’s the thermostat for the entire metabolic system,” Masutto says.
The thyroid produces a hormone called T4. When it hits the bloodstream, it becomes T3, the active form of the hormone that does the regulating work of the thyroid.
According to Masutto, hypothyroidism—which means your thyroid isn’t producing enough T4—is one of the most underdiagnosed conditions in “traditional medicine.” Hyperthyroidism—overproduction of T4—is less common, affecting only around 1.4 percent of the population, according to the National Institute of Diabetes and Digestive and Kidney Diseases .
So why do thyroid conditions go undetected in many? Traditionally, primary care doctors only measure TSH, and even that’s not part of a traditional blood panel, Masutto says. Symptoms of hypothyroidism mirror life stressor systems, Masutto says, citing things like chronic fatigue or lethargy, weight gain, constipation or dry skin and brittle hair. “Doctors don’t think to check unless patients ask,” Masutto says. “It’s often missed.”
TSH, or thyroid stimulating hormone, is produced by the brain to tell the thyroid how much T4 to make. Masutto metaphorically describes TSH as the “manager” of your thyroid. Normal levels indicate a “quiet” boss who doesn’t need to stimulate more production. High levels indicate the manager is “yelling” because the thyroid isn’t working.
Masutto says only looking at TSH gives an “incomplete picture” of what’s going on within the body and, therefore, limits the number of possible treatment interventions and their efficacy.
Masutto advocates for measuring TSH as well as T4 and T3. This can help to identify any issues earlier—for example, recognizing a delay in conversion from T4 to T3 before the TSH “manager” starts shouting for more—as well as specify the source of the problem in order to better match the solution.
“If you don’t know exactly what the problem is, then you’re making treatment recommendations based on incomplete data,” Masutto says.
Part of the issue has been that research has historically fed into the conventional opinion that measuring TSH levels is an adequate screen for thyroid health. A 2003 study concluded that T4 tests only needed to be used when initial blood work showed abnormal TSH levels.
Hypothyroidism can most often be attributed to one of two issues—an autoimmune deficiency or lifestyle factors, Masutto says, saying your blood work reveals if your thyroid is just chronically stressed or if it has already devolved into a clinical condition.
Many doctors will recommend a prescription drug called levothyroxine to treat hypothyroidism, which is a replacement thyroid hormone, but there are also natural remedies for hypothyroidism that can improve thyroid function. In many cases, with these changes, someone may be able to work with their doctor to get off of a prescription drug or reduce their dose.
The autoimmune variation of hypothyroidism requires a more aggressive treatment plan that requires fairly dramatic nutrition changes, Masutto says. This may include eliminating more inflammatory foods like gluten from your diet entirely.
“The antibodies your body makes against gluten look similar to those made against the thyroid. They cross-react causing the stimulation of more antibodies against the thyroid,” she says.
For those who discover their thyroid is operating at lower levels due to lifestyle factors, stress may be to blame. When you’re under chronic stress, your body produces excess levels of the stress hormone, cortisol . Elevated cortisol levels stunt the production of T4. Committing to a stress-relieving activity in your life, whether it be exercise, cooking, meditation , or journaling, can be a great natural treatment for hypothyroidism.
Masutto recommends nutritional changes to mitigate stressors on the body. “Make sure you’re eating a wide variety of plants, lots of colors, and generally adhering to a healthy diet,” she says. “But also try to incorporate more sea vegetables and iodized salt [as opposed to sea salt] because iodine molecules are the building blocks of T4 production and T3 conversion.”
She also recommends taking magnesium and selenium under the guidance of your doctor or taking a natural thyroid medication or thyroid supplement like Parsley Health’s Thyroid Balance . This supplement contains nutrients like selenium and zinc , which have been shown to improve thyroid function and rhodiola, an adaptogen that helps support energy levels and combat stress-induced fatigue . Research has shown rhodiola can stimulate the nervous system, decrease depression, enhance work performance, and eliminate fatigue, all features of clinical hypothyroidism.
A recent study also points to ashwagandha as a possible supplement that could also help to lower stress and, therefore, support thyroid function. Over eight weeks , 50 people with hypothyroidism took 600 milligrams of the adaptogen daily. They saw a 41.5 percent increase in T3 and a 19.6 percent increase in T4 levels as well as a 17.5 percent decrease in TSH. The results suggest lower cortisol levels could aid effective hormone conversion and, in turn, allow TSH to stabilize.
Carly Graf is a San Francisco-based journalist with experience covering health, fitness, social justice, and human rights. She graduated from Northwestern University’s Medill School of Journalism with a graduate degree and a focus in social justice reporting. Her work has been published in the Chicago Reader, YES!, South Side Weekly, and Social Justice News Nexus, Outside Magazine, and Shape. When she's not reporting, she's almost certainly running or playing in the mountains with her dog, Chaco (yes, like the sandal).