Over many years of practice, I have found that there are three primary systems that are key to successful thyroid healing. This includes Hashimoto’s, the most prevalent form of hypothyroidism. These are the liver, the gut, and the adrenal glands. They are all interconnected, as is everything else in the body, and healing one has the effect of improving the others.

While I don’t want to give the impression that I elevate one above the others, let’s start with the GI system as it usually gets the most attention.


Good Thyroid Health Depends on Good Gut Health

When you have hypothyroidism, it’s easy to get caught up in thyroid lab values and which thyroid meds and supplements work the best, but as long as you struggle with a leaky gut, gut inflammation, gut infections or parasites, heartburn, poor digestion, chronic constipation coupled with diarrhea, you’ll never experience optimum thyroid health.

Poor gut health drives Hashimoto’s

For 90 percent of Americans, hypothyroidism is caused by Hashimoto’s, an autoimmune thyroid disease. Since most of the immune system is situated in the gastrointestinal (GI) tract, poor gut health is a significant factor in triggering and exacerbating autoimmune diseases such as Hashimoto’s. An important step in taming Hashimoto’s is to repair gut health.

The microbiome (gut flora) and T3 conversion

20 percent of thyroid function is dependent on healthy gut bacteria to convert T4 to T3. Poor diet and digestion, dysbiosis, excessive bad bacteria that crowds out the beneficial bacteria, inhibit the production of active thyroid hormone (T4). We also know that bacterial gut infections decrease thyroid hormone levels, dull thyroid hormone receptor sites, increase the amount of inactive T3, decrease TSH, and promote autoimmune thyroid disorders. Also, studies have found connections between Yersinia enterocolitica and Hashimoto’s disease—antibodies to this bacteria are 14 times higher in people with Hashimoto’s. Maintaining healthy gut flora and addressing bacterial overgrowth is an important component of good thyroid function.

Decreased HCL (stomach acid)

This is a real dilemma because low thyroid function leads to a decrease in hydrochloric acid (HCL). Low HCL leads to poor digestion, especially digestion of proteins. This slows the digestion time leaving food in the stomach longer where it begins to rot and putrefy. Poor digestion reduces T4 to T3 conversion, which cycles back to even poorer digestion.

Sluggish gallbladder function

The gallbladder is critical to fat digestion and emulsification. Bile from the gallbladder facilitates mineral absorption and reduces gut irritation. Hypothyroidism causes slowing of the gallbladder, which further complicates things by inhibiting the liver’s ability to detox.

Poor gallbladder function backs up the liver and reduces its ability to convert T4 into T3. It also reduces the liver’s effectiveness in eliminating excess estrogen. Estrogen increases the body’s need for thyroid hormone. This also explains one of the reasons hypothyroid disease is more frequently seen in women than men.

Repairing the GI system begins at the plate

This is a massive and multifaceted subject on its own and one of, if not the hottest topic, in functional and lifestyle medicine today.

Let’s, therefore, make it simple and distill it down to its most fundamental principal. You must eliminate anything that causes irritation and inflammation of the gut. It’s that simple and at the same time that difficult. And, just because it’s not rocket science, doesn’t mean in any way that it’s easy. It isn’t easy. When I found out that I had a problem with gluten, I remember thinking that  going gluten-free seemed at the extreme of impossible. Fortunately, there is an ever increasing supply of resources for doing this. To keep it manageable, think of it this way:

  1. Sugars cause inflammation. Carbohydrates are sugars. Carbohydrates have to be radically reduced. Remember, there is no such thing as an essential carbohydrate. This includes grains and, especially, gluten containing grains.
  2. Gluten, in addition to being a grain, causes the gut to release a substance called zonulin. Zonulin destroys the gut lining. This causes a lot of problems including inflammation and leaky gut. A topic for another time. Gluten has to go. Think of gluten like pregnancy. You are or you aren’t. You can’t just be pregnant on the weekends. And you can’t be pregnancy reduced. Just do it.
  3. Anything sprayed with glyphosate. Glyphosate is the active ingredient in Roundup. Any genetically modified food that is sprayed with Roundup destroys the gut lining and must be avoided. Trust me, I’m not liking this anymore than anyone else, but it’s that important.
  4. Anything else that you know or suspect gives you trouble should be checked out and avoided if necessary. This could include things like dairy, nuts, legumes, and some fruits.

There are numerous great diet programs you can check out including the GAPS diet, Low FODMAP diet, and SCD diet. This is where you will have to either experiment to find what works for you, or find a functional medicine practitioner to guide you.

Let’s move on to the liver and detox.


Thyroid Disease, Hashimoto’s and the Liver

All systems at some level, sooner or later, interact. The liver and the thyroid are a perfect example of this. Here are a few examples:

  1. 60% of the thyroid hormone T4 is converted into the active form of T3 in the liver.
  2. The thyroid influences the synthesis of cholesterol in the liver. Yes…cholesterol is made in the liver. Deceased thyroid function effects lipid production and balance, especially triglycerides which are the form of fat you store around your middle. I know people call it a spare tire but it’s actually a triglyceride storage facility.
  3. Thyroid affects detoxification pathways in the liver. This is another frustrating situation. Decreased thyroid function causes a decrease in T4 to T3 conversion, which in turn causes a decrease in thyroid function.
  4. When active T3 levels are too high, it can elevate bilirubin levels. This damages the mitochondria, creating a toxic environment which puts an even greater load on the liver.

What’s a person to do? I start all of my patients on a comprehensive detox and gut repair program. It’s pretty safe to assume that in today’s modern world full of chemicals and pesticides almost everyone could benefit from a gentle, slow and thorough detox.

What you can do at home is to:

  1. Reduce toxic exposure. Again this sounds easy, but it’s challenging. You can learn a lot at places like EWG.com. Finding and eliminating toxins from your world will be a lifelong journey. Try to see it for the rewarding adventure it can be and not as a burden you have to tolerate.
  2. Support detox pathways. You can try various detox protocols but one way to do this is to sweat. OK, I know, that’s another one of those things that you might not want to do. One of the great things about exercise is that it can be a great source of stress reduction. Whatever you do, do not attempt detox protocols that are too harsh and intense. Aggressive detox can make you worse.


Adrenal Function and Cortisol

I always tell my patients that the thyroid and adrenal glands are like two sides of the same coin. They inversely affect each other and if one is out of balance the other will be compensating in some way. The adrenal glands make cortisol to regulate the energy needs of the body and stress (fight or flight) demands.

Cortisol lowers thyroid hormone

When you have a stress event your body has to choose between thyroid function and adrenal function. When you get cut off in traffic or someone slams their brakes on in front of you, you slam on your brakes. How long did that take? Not long (hopefully). How long did it take you to feel that adrenaline rush and get that feeling in the pit of your stomach? It was immediate.

The adrenal glands respond that fast, and that’s good in the case of a life and death (fight or flight) moment. The thyroid, on the other hand, takes several minutes to respond. Long enough for you to become the lion’s lunch. Elevated adrenal function shuts down thyroid function. You were made this way.

You weren’t made for prolonged stress. Prolonged stress suppresses thyroid function.

Cortisol decreases TSH (thyroid stimulating hormone). When you’re stressed, you certainly don’t want to be wasting energy making thyroid hormone. Cortisol also inhibits the conversion of T4 to T3 and increases the production of rT3 or reverse T3. Every cell in your body has a T3 receptor site (like a lock and key). rT3 can bind to the T3 receptor site on the cell. Which turns the cell off with regard to T3. Turn the cell off and you get hypothyroidism.

Prolonged elevated cortisol, caused by chronic stress, decreases the livers ability to clear estrogen from the body. As we learned just a moment ago, elevated estrogen increases the need for thyroid hormone. This is occurring at the very time when the thyroid is basically “turned off.” This happens through a mechanism related to something called thyroid binding globulin (TBG). TBG binds T3 so it can’t be used. Estrogen increases the levels of TBG thereby decreasing the amount of unbound T3 or freeT3 (FT3), the form of T3 that is available for use.  This is often the issue for people who take T3 replacement hormone and still don’t feel better.

What to Do

I see people every day people who are trying all kinds of supposedly “magic” supplements or special diets, without results. There will usually be one area that seems to be more involved than the others, the root cause, but all three are always linked together in the end. To fix the thyroid, you have to address all three. Simple but not easy.

By properly identifying which system is the root cause and beginning there, repairing thyroid dysfunction is possible.

Thyroid issues do not have to be a lifelong curse. It’s not a badge you have to wear for the rest of your life anymore than having a broken leg means you’ll have a broken leg for the rest of your life.

My goal is always to fix the problem and move on with life.