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Hidden Cause #23 Why You STILL Have Low Thyroid Symptoms–High Homocysteine

 Dr. David Clark, DC – Raleigh-Durham-Chapel Hill thyroid expert, explains how high Homocysteine causes Low Thyroid symptoms.

Hidden Cause #23 Why you STILL have low thyroid symptoms even though you may be taking medication, and even though your lab tests look normal is:

High Homocysteine causing a sluggish response to thyroid hormone 

What is Homocysteine?

Homocysteine is a naturally occurinng chemical floating around in your body.  And it’s essentially an inflammatory chemical.  It can dock and attach onto different types of receptors in the human body. (think of receptors as antennae, or as a lock waiting for a key).

How does this relate to our thyroid story? 

Homocysteine can dock onto a cell and stop that cell from having a normal response to thyroid hormone. This causes low thyroid symptoms such as this partial list:

 

  • hair loss
  • weight gain
  • constipation
  • brain fog
  • fatigue
  • needing to sleep an excessive amount of hours just to function
  • infertility
  • miscarriage
  • high cholesterol

Here’s the kicker… even with these symptoms your thyroid lab tests will look completely NORMAL.

The only thing that might show up on a lab test–if the doctor actually runs the test —is  the homocysteine levels may be elevated. 

What qualifies as “elevated” homocysteine? 

…higher than the lab range (usually 13) is “medically” elevated

….higher than seven is “functionally” elevated. The higher the homocysteine levels are, especially when they’re close to 13 or higher, the more they are relevant to thyroid hormone receptor malfunction.

Remember, T4, T3, T3 Uptake, Reverse T3, Free T4, Free T3….all those may look completely normal. 

This is one of those caught between a rock and hard place situations where you have low thyroid symptoms, but your labs are normal and no one knows what’s causing your symtpoms. 

You can imagine what usually happens.  Your doctor tells you “You’re depressed.  I’ll write you a script for an anti-depressant.” However, she may have high homocysteine causing these symptoms.

What cause high homocysteine levels? 

The big factor is a deficiency of methyl donors (a carbon with three hydrogens).  You don’t have to remember all the chemistry but let me tell you what happens…

The two kinds of people at most risk for methyl donor deficiency—and thus high homocysteine–are women who:

  • take estrogen-based birth control
  • take antacids (of any kind)

Women who take antacids create a situation of low stomach acid. The technical term is hypochlorhydria. The antacids decrease your stomach acid. A low acid environment, over time, can cause low methyl donors (and high homocysteine that messes with your thyroid receptors).

NOTE: Low stomach is not a healthy situation. I know you’re inundated with commercials that demonize stomach….but if  you have low stomach acid you cannot extract minerals (like iron and magnesium) from your food….You cannot appropriately digest your food.  Plus, you can end up with depletion of these methyl donors. 

**Certain mutations in the MTHFR gene (SNPs aka single nucleotide polymorphisms) can definitely cause HIGH homocysteine levels. More on this in another post.

What are the symptoms of low stomach acid (hypochlorhydria)? 

Classic symptoms of hypochlorhydria are:

  • Belching and bloating while you eat
  • A sense of fullness while you eat. 
  • Feeling like your food sits in your belly like a rock and just doesn’t move anywhere. 

Those are good signs of low stomach acid. 

What are the causes of low stomach acid (hypochlorhydria)? 

Now you see what we’re doing here, right?  We’re asking the question why?, why?, why? so that we can get to the root of the cause. 

Here are some common causes of low stomach acid…

Hypoglycemia (low blood sugar)–People that are hypoglycemic have a hard time holding onto their B vitamins.  And B vitamins are some of the co-factors you need  to make stomach acid.  

Hypothyroidism (low thyroid)–low thyroid hormones, or low thyroid hormone receptor response causes decreased digestive secretions. 

H. pylori (helicobacter pylori) infection in the stomach—  This is a bacterial infection that disturbs your stomach acid levels.  The best test to detect it is a Urea Breath Test ( you can also use a test for serum antibodies.)

Almost forgoet to mention gluten sensitivity….

Gluten senstivity can lead to malabsorption of zinc. Zinc is a necessary ingredient to make stomach acid. 

There’s three causes, right? 

These make you have low stomach acid…You can’t get these methyl donors, which means your homocysteine levels rise…

…And homocysteine can slow down the normal response of the cell to thyroid hormone. 

You don’t necessarily have to remember all of that.  Here’s what you need to remember:

If you have low thyroid symptoms…and your labs look normal and people think you’re crazy or depressed…You could have high homocysteine.  

Now, hopefully your doctor would know about this issue and would run a homocysteine to rule this out.  Sadly, not many doctors seem to know this crucial information.  So, you’re going to need to find a doctor who DOES know, and who understands that high homocysteine being high could cause all that stuff I just talked about. 

And then–even MORE importanly–the doctor needs to know what to do about high Homocysteine.

It’s a big job for any doctor to handle. 

Be an advocate for yourself and remember that homocysteine is something that could cause your low thyroid symptoms.

© 2014 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional

Hidden Cause #22 Why You STILL Have Low Thyroid Symptoms-Vitamin A Deficiency

Dr. David Clark, DC – Raleigh-Durham-Chapel Hill thyroid expert, explains how Vitamin A Deficiency causes Low Thyroid symptoms.

Hidden Cause #22 why you STILL have low thyroid symptoms, even though you may be taking thyroid medication…and even though your lab tests look normal is:

Vitamin A deficiency causing thyroid hormone receptor malfunction 

Let’s talk about what normally happens…

  1. Inside every cell is a RECEPTOR for T3. 
  2. T3 enters the cell and DOCKS on the receptor (like a key in a lock). 
  3. The cell RESPONDS and a message is sent to the nucleus (where DNA and RNA live)
  4. DNA and RNA start to do their thing and code for proteins that make you NOT have low thyroid symptoms

Vitamin A deficiency SLOWS DOWN THE RESPONSE inside the cell. This creates a sluggish response to T3, and low thyroid symptoms like these:

  • hair loss
  • weight gain
  • constipation
  • brain fog
  • fatigue
  • needing to sleep an excessive amount of hours just to function
  • infertility
  • miscarriage. 
  • high cholesterol

This particular kind of problem has nothing to do with your blood levels of T4 and T3, Free T4, Free T3, Reverse T3, or Thyroxine Binding Globulins.  So, blood tests of your “thyroid function” will not show this problem.

Who would have vitamin A deficiency? 

Vitamin A deficiencies should be expected in someone who is iron deficient…or drinks a lot of alcohol…or has liver problems.

Iron deficiency (or Iron need) can be picked up on blood tests by looking at:

  • Ferritin (the most sensitive indicator of your body’s iron status)
  • Serum Iron, Iron Binding Capacity and Percent Saturation
  • CBC with Differential 

NOTE: the lab ranges are REALLY wide and forgiving. I use a “functional” or optimal range.

Liver dysfunction can be detected by testing  “transaminases” or “liver enzymes”:

  • AST
  • ALT
  • GGT

If these markers are above the lab range, there’s probably some kind of liver inflammation going on, and the cause has to be tracked down.

Again, in this scenario of Vitamin A Deficiency affecting Receptors and Response, the thyroid blood tests will look normal.

A woman will usually go to see her doctor because of those low thyroid symptoms I listed above.

And if the doctor runs a T4 and TSH, they’re not going to see anything wrong.  They may even run a “full thyroid” panel (which usually just means testing a Free T4 or Free T3).

Maybe this doctor is really sharp and they run all of the thyroid tests you can order….and the results come back as normal—but you still have low thyroid symptoms. 

Now, the big mistake– is to give you thyroid hormone medication like Synthroid® or Levothyroixine anyway—Even though your quantities of hormones are clearly normal.

I believe if the doctor is going to give you something (medicine, supplement, whatever) they need to have a reason for why they’re giving it to you. 

I mean, the doctor that looks at those normal numbers and says, “Take iodine.”  Mistake. 

The doctor who looks at those normal numbers and says “Take tyrosine.” Mistake.

There’s nothing there.  The doctor needs to consider that there IS another reason for your symtpoms.

What is a symptom vitamin A deficiency? 

The absolute classic sign of vitamin A deficiency is problems with night vision.  Even though you don’t have an astigmatism.  Night vision difficulty with no astigmatism is classic vitamin A deficiency. 

Vitamin A deficiency has to be suspected in someone who has that symptom…

….especially if that person ALSO has iron deficiency, elevated “liver enzymes” or is drinking a lot alcohol.

This particular hidden cause is fraught with a lot of challenges for the clinician and a lot of challenges for the patient.  You have low thyroid symptoms but your thyroid numbers literally do look normal. 

NOTE #2:  please don’t start taking vitamin A without some guidance.  If you take a lot of vitamin A, it can suppress the activity of Vitamin D.  And you can get yourself in a lot of trouble.

My recommendation:

You need to find a doctor who understands that there’s a lot of moving pieces on the chess board here–not just looking at your bloodwork and saying:

“Everything looks fine. You must be fine.” 

This isn’t good enough….because there ARE some causes for low thyroid symptoms in which all the labs look fine.  Vitamin A deficiency could be one of them in your case. 

© 2014 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #21 Why You STILL Have Low Thyroid Symptoms-High Cortisol Blocking Receptors

Dr. David Clark, DC – Raleigh-Durham-Chapel Hill thyroid expert, explains how high Cortisol causes Low Thyroid symptoms.

Hidden Cause #21 why you STILL have low thyroid symptoms even though you may be taking thyroid medication, and even though your lab tests may look normal is…

High cortisol suppressing thyroid hormone receptors.

Now, we’ve talked before about cortisol doing a couple other negative things in terms of thyroid hormone chemistry (affecting conversion and the pituitary).

But this one today is one in which cortisol levels are too high and suppress the receptors for T3. 

What symptoms would high cortisol dampening these receptors cause?

It would cause low thyroid symptoms like these:

  • brain fog
  • depression
  • hair loss
  • weight gain
  • constipation
  • dry skin, dry hair
  • muscle pain
  • infertility
  • high cholesterol. 

If you have those symptoms and go to your doctor–and they order a TSH and T4–you might get diagnosed as hypothyroid and start taking medication like Synthroid® or Armour®….

But, if you have this cortisol problem, you won’t feel any better.

This happens all the time…

So, you could have all the medication you want floating around in your bloodstream.  But even if the hormone docks onto the receptors, nothing happens. Nothing “clicks.”

Another way of talking about this is to call this “resistance.”

See, there’s a receptor on the inside of the cell.  And when the hormone comes along and docks, it causes some changes inside the cell because messages go to the nucleus of the cell and DNA starts to produce different proteins.

High cortisol basically shuts down the message from traveling from the receptor into the nucleus of the cell.  

So, if you’ve got the type of scenario in which you were diagnosed hypothyroid but you’re taking medication AND the labs look normal BUT you still feel low thyroid– well, then this could be one of the reasons why.  


There’s another scenario in which you never got diagnosed hypothyroid in the first place  because your lab numbers look totally normal the whole time. 

This actually happens quite a bit. 

You still have those low thyroid symptoms we just talked about.  But your T4, TSH, T3, all that looks normal. 

Blood tests don’t look at receptors.  Blood tests can look at levels of T4, T3 etc.  They can look at levels of thyroxine-binding globulins.  They can look at Reverse T3.  But there’s no way for blood tests to look at what’s going on at the level of the receptors. 

So, finding this hidden cause is a process of elimination. 

What causes high cortisol? 

…The three big reasons are:

  1. Inflammation
  2. Stress
  3. Diet

#1 – So, let’s start with inflammation…

Anything that inflames you can cause high cortisol throughout your body. Things like these:

  • Food sensitivities (you probably don’t know you have)
  • Leaky Gut
  • Infections (parasites, viruses, bacteria)
  • Dybiosis (bacterial/fungal/yeast imbalances & overgrowths in the small or large intestine)

…they can all cause you to have HIGH cortisol and suppressed thyroid hormone receptors and low thyroid symptoms. 

#2 – Psychological and emotional stress are a big source of high cortisol. 

Who doesn’t have stress?  The problem is if you have too much stress over the long term…or a super large single stressful event, like a divorce or a trauma…that causes you to secrete a lot of cortisol. 

That cortisol can flood the body…suppress the activity of the thyroid receptor…and you suffer low thyroid symptoms.  

#3- A bad diet can also create HIGH cortisol.  

Eating lots of refined sugars, stimulants (caffeine & artificial sweeteners) and simple carbs will cause high cotisol that will shut down those thyroid hormone receptors. 

High cortisol messing with your thyroid hormone receptors is a hidden cause–and it’s quite a ways down on our list because to find it, your doctor has to eliminate all other possibilities.  

To do THAT,  your doctor has got to be able to give your history a thorough review–not just spend 5 minutes without even looking you in the eye. Your doctor would need to be able to RECOGNIZE what you’ve already tried that didn’t work. 

Or realize that even though your lab tests are “normal”, you could legitimately still have  low thyroid symptoms. Your doctor needs to spend some time really thinking hard about your case.

Sadly, that’s two things  a lot of doctors don’t want to do: spend time and think. 

Based on the stories my patients tell me, there’s a LOT of doctors out there who would really like for you to just show up, pay, leave and the doc never have to talk to you. 

I’ve met doctors like that. 

And I’m beginning to think there’s more and more of them.  I think they all still want to help.  They just don’t want to exert a lot of effort. 

So, to get help you must find someone that understands this fact: there’s a lot of reasons why you can have low thyroid symptoms.  And then tries to work through the possibilities.

How? By AT LEAST asking for a  complete history to discover what you’ve already tried (meds, supplements etc) that has or has not worked.  

Next, obtaining the necessary lab tests to investigate the possibilities I’ve listed above. 

Your doctor has got some work to do. 

© 2014 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #20 Why You STILL Have Low Thyroid Symptoms–Cytokines & Receptors

Dr. David Clark, DC – Raleigh-Durham-Chapel Hill thyroid expert, explains how cytokines affect thyroid hormone receptors and cause Low Thyroid symptoms.

Hidden Cause #20 why you still have low thyroid symptoms even though your lab tests look normal and even though you may be taking medication is…

Elevated inflammatory cytokines blocking &blunting thyroid hormone receptor sites 

Let’s review for a second.

You can take thyroid hormones, but that doesn’t guarantee that you will get any benefits of the hormone. Why?

The hormone has to bind/dock on the receptor…AND…the receptor has to then RESPOND to the docking.

T3 comes along and docks on the receptor—and then the receptor makes the machine inside the cell do what it’s programmed to do.  This system depends on a receptor that is unblocked, unblunted and responsive.  

Cytokines can block, blunt and make the thyroid hormone receptors un-responsive. This causes low thyroid symptoms.

Cytokines are immune system messengers (example: interleukin 2, interferon gamma). We all have cytokines in our body, but people with inflammation, inflammatory conditions or autoimmune conditions have A LOT of cytokines.

If you have a condition such as

  • Hashimoto’s
  • Vitiligo
  • Rheumatoid arthritis
  • Psoriasis
  • IBS
  • PCOS
  • Endometriosis

….chances are you have a large amount of cytokines. And that can affect your thyroid hormone receptors and cause low thyroid symptoms (even if you’re taking medications like Synthroid®, Armour® or Cytomel®)

What causes high levels of inflammatory cytokines?

Here’s a partial list:

  • Psychological stress
  • Food sensitivities
  • Infections: viral, bacterial
  • Autoimmune conditions
  • Chemical sensitivities

Cytokines can shut down the receptors for T3, making you FEEL hypothyroid and actually FUNCTION as hypothyroid–even though your TSH, T4 and T3 lab numbers are “normal” and within the lab range.

You WILL have low thyroid symptoms like these:

  • Hair loss (scalp, eyebrows, body hair)
  • Weight gain — even though you’re eating a low calorie diet, even though you may be exercising like crazy
  • Brain fog–slow thinking, memory problems, can’t think of words
  • Sleeping excessively in order to feel like you’re even normal
  • Constipation
  • Dry skin, dry hair, nail problems. 
  • Infertility
  • High cholesterol

High cytokines can make have any or all of those low thyroid symptoms.

This is a hidden cause mainly because the lab numbers really are “normal.” This can confuse your well-meaning doctor.

If your TSH and T4 are clearly abnormal, the answer is easy: prescribe thyroid hormones.

But if your labs are normal and you have low thyroid symptoms….what does your doctor do? Usually, he/she says you’re depressed and recommends an anti-depressant.

What if you’re already diagnosed hypothyroid AND taking thyroid medication BUT you still have low thyroid symptoms?

The thyroid medication can make your T4 levels look normal–but if you’ve got something that’s suppressing the receptors, you will NOT get the benefit of all that T4 floating around in your blood. 

I hope that makes sense. 

You can have a ton of  Synthroid® circulating, but it’s all for nothing if cytokines are blocking or blunting your receptors.

You will feel like you’re NOT taking any medication because you will still suffer low thyroid symptoms.  And this chain of events will really confuse most doctors because they just don’t know about cytokines and how they affect hormone receptors.

There’s another possibility with cytokines and receptors…you never even get diagnosed hypothyroid because your numbers look normal. The receptors are the problem.

Unfortunately there are NO lab tests that can tell us what’s going on with the receptors.

Women that suffer high cytokines and screwed up receptors but normal lab tests…these women wander in the medical wasteland forever. 

 They’ll see chiropractors, MDs, DOs, acupuncturists, Functional Medicine practitioners…and they’ll get prescribed everything from serotonin to Armor to iodine…but none of it works because that’s not the problem. 

The problem is cytokines and receptors.

Typically, she’ll see 10 or more practitioners before she finally finds someone who understands this point:

“Look, none of these other approaches have worked.  All these other mechanisms are not what’s going on with you.  Maybe it’s inflammation, cytokines and recptors.”

In my practice, I see this EXACT scenario in about 25%  of my new thyroid patients.

How do you deal with high cytokines and blocked/blunted receptors? 

You’ve got to find out what’s causing the inflammation. 

For example, is Hashimoto’s the cause of your high cytokines and blocked/blunted receptors? Hashimoto’s is an inflammatory autoimmune condition featuring high levels of cytokines.  You CAN have both of these mechanims happening at the same time. 

There’s no rule that says you can only have one thing wrong.  You could have Hashimoto’s and the cytokine/receptor problem. I see it all the time.

  • Is it the fact that you’ve got some other autoimmune condition? 
  • Do you have a leaky gut or GI dysbiosis–a gut infection that’s causing inflammation throughout your entire body?
  • Do you have a food sensitivity? Chemical sensitivity?

You’ve got to have somebody that knows how to look for all these factors AND understand that cytokines can block/blunt receptors…AND know what to do correctly address the cytokine problem.  

If you don’t find a doctor who knows these concepts, chances are you’ll go to doctors 16, 17 and 18, and they’ll just offer you slight variations on what all the other doctors tried that didn’t work.

Your doctor has to think outside of that “normal box” and consider that cytokines are shutting down the receptor—even though the lab tests may look normal—even though you might be taking thyroid medication already—but you can STILL have this problem.

© 2014 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #19 Why You STILL Have Low Thyroid Symptoms-High Testosterone & Resistance

Dr. David Clark, DC – Raleigh-Durham-Chapel Hill thyroid expert, explains another way that high Testosterone causes Low Thyroid symptoms.

TriangleThyroidDoctor.com

Hidden Cause #19 why you still have low thyroid symptoms even though you may be taking thyroid medication and even though your lab tests look normal is…

Elevated Testosterone causing low thyroxine binding globulins and too much T4 and T3 leading to resistance.

Let’s pause and take a breath…

The basic problem in this hidden cause is you’ve got too much testosterone…and it’s lowering the amount thyroxine binding gloubins (aka TBG).  TBGs are like little taxicabs that carry T4 and T3 around your body.  You’ve got to have them. 

When there’s too many taxi cabs (TBGs), then the hormones can’t get out of the taxicabs and get into a free-form state. “Free” hormones get into the cells.  If the thyroid hormones aren’t free, you can’t use them.

In this hidden cause you have too few taxicabs… you’ve got tons of “free” hormones floating around…and they cause resistance, which leads to MORE low thyroid symptoms.

Think of Resistance like this… you’re growing a plant. The plant likes to have a little bit of water, but it doesn’t like to have a floord of water because you’ll drown it.  You’ll kill it. 

Well, thyroid hormone receptors  are like that.  They like to have enough thyroid hormones in order to dock and make them work. 

But if you bombard them with lots of thyroid hormones, they shut down and become resistant…

….which means you can have all the T4 and T3 in the world floating around,  trying to get onto this receptor, but it can’t. 

Or… alternately, the hormones can dock on the receptor, but the response to the docking is blunted.

For comparison, another example of “resistance” is women who take Cytomel® T3 and then become more hypothyroid. You’re bombarding the receptors.  There’s too much there and they shut down.

Here’s what high testosterone causing low binding globulins leading to resistance looks like….

A women has totally normal thyroid lab numbers (except maybe her T3 Uptake is >38) but, has these low thyroid symptoms:

  • hair loss
  • weight gain
  • constipation
  • brain fog
  • fatigue
  • needing to sleep an excessive amount of hours just to function
  • infertility
  • miscarriage. 
  • high cholesterol

Those are all low thyroid symptoms that can be caused by thyroid hormone resistance–even though your lab numbers look okay.
 
Of course, this assumes that your doctor is actually running all the numbers you need to look at.  If they just run a TSH and T4, they’ll never pick up this problem.  It will never show up. 

If your doctor also funs free T4, free T3 and T3 uptake, then this might show up. 

Your T3 uptake might  be outside the lab range…this would mean your binding globulins (taxi cabs) are low, and your “free” hormones are probably high.

High Testosterone is the main cause of low binding globulins (and high “free” hormones leading to resistance)

How would a woman get too much testosterone? 

The most common reason is from high blood sugar levels and insulin resistance.  Women that have chronically high blood sugar get surges of insulin in an attempt to get rid of that blood sugar. 

That surge of insulin causes them to make more testosterone…and that testosterone is what causes these binding globulins to drop, leading to excess amounts of “free” hormones—>Resistance—>Low thyroid symptoms.

If the doctor doesn’t run all the tests, or get a complete history, he/she may not see the problem. 

The doctor would need to actually run the T3 Uptake (and it’s low) and Free T4 and Free T3 (and they’re high)…then understand what it means if those numbers are abnormal (or at least functionally abnormal).  

What causes irregular blood sugar?

What you’re eating is a HUGE factor. 

If you’re overeating simple carbs (breads, pastas, grains)….

…or you’re eating “crap” food (from a drive-thru or out of a box or bag)

…or drinking sugary drinks (sodas, coffee drinks)

There’s a good chance you’ll end up insulin resistant and have high blood sugar.

Inflammation–from any source– can also make you insulin resistant.  

This could be a bacterial infection (like H. Pylori in the stomach)…Small Intestinal Bowel Overgrowth…food sensitivities…anything that’s inflaming you can lead to this testosterone problem. 

If a woman has Low thyroid symptoms + labs look “normal” + she has insulin resistance symtpoms = must consider high testosterone causing low binding globulins leading to resistance.

The Classic insulin resistance symptoms is getting tired/sleepy 15 to 30 minutes after you eat. 

Other symptoms of insulin receptor resistance include:

  • Crave sweets after you eat. 
  • Hard time going to sleep 
  • Wake up in the morning feeling completely beat up as if you didn’t sleep at all. 

Those are all pretty good signs of insulin resistance.

If you’re getting sleepy after you eat PLUS you’ve got those low thyroid symptoms, THEN insulin resistance might be the issue here…and testosterone could be causing you to have not enough binding globulins, causing too many “free” hormones, which leads to resistance, which causes low thyroid symptoms. 

I know that’s a lot of steps, so it’s really important you find a doctor who knows what I’m talking about.  It’s not as simple as running only a  TSH and T4, or saying “everybody’s got Hashimoto’s” or “all thyroid patients are iodine deficient!

To make this even a little more complicated…

You could really have Hashimoto’s AND this testosterone scenario. Why?

There’s no rule that says you can only have one thing wrong. You have whatever you have…however complicated…howeve simple…

…and you may have Hidden Cause #19: too much testosterone causing too many “free” hormones and resistance.

© 2014 David Clark. All Rights Reserved.Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #18 Why You STILL Have Low Thyroid Symptoms-High Testosterone & Overconversion

Dr. David Clark, DC – Raleigh-Durham-Chapel Hill thyroid expert, explains how high Testosterone causes Low Thyroid symptoms.

Hidden Cause #18 Why you STILL have low thyroid symptoms, even though you may be taking thyroid medication and even though your lab tests are normal is…

Elevated Testosterone causing Over-conversion of T4 into T3 leading to Resistance. 

Okay, that’s a mouthful.  There’s a couple of different concepts we have to understand so let’s first talk about “Over-conversion.

A lot of times you’ll hear me talk about “under-conversion”…under-conversion of T4 to T3 that leads to low levels of T3.

Well, now we’re talking about something being too high.  If you remember the thyroid story…

…97% of what your thyroid gland makes is T4.  T4 is basically inactive. It must be converted into T3.  T3 is the active form of your thyroid hormones.

Conversion primarily happens in the liver, primarily through an enzyme called 5-deiodinase.  

Here, we’re talking about Over-conversion–something is speeding up the conversion of T4 to T3 leading to something called “resistance.” 

Think of Resistance like this… you’re growing a plant. The plant likes to have a little bit of water, but it doesn’t like to have a floord of water because you’ll drown it.  You’ll kill it. 

Well, thyroid hormone receptors (for T3) are like that.  They like to have enough T3 in order to dock and make them work. 

But if you bombard them with lots of T3, they shut down and become resistant…

….which means you can have all the T3 in the world floating around,  trying to get onto this receptor, but it can’t. 

Or… alternately, the hormone can dock on the receptor, but the response to the docking is blunted.

For comparison, another example of “resistance” is women who take Cytomel® T3 and then become more hypothyroid. You’re bombarding the receptors.  There’s too much there and they shut down.

Here’s what high testosterone causing over-conversion leading to resistance looks like….

A women has totally normal thyroid lab numbers but, has these low thyroid symptoms:

  • hair loss
  • weight gain
  • constipation
  • brain fog
  • fatigue
  • needing to sleep an excessive amount of hours just to function
  • infertility
  • miscarriage. 
  • high cholesterol

Those are all low thyroid symptoms that can be caused by resistance–thyroid hormone resistance.

I’ll  back up and explain it again (there’s a lot of moving parts). 

T4 has got to get converted to T3.  When you over-convert, you get lots of T3…and T3 can bombard the receptor and shut it down…making you have more low thyroid symptoms.

Now, I said “testosterone causing overconversion leading to resistance.”  Where does this testosterone come from?

In a woman, the #1 cause for abnormally elevated testosterone is blood sugar instability–insulin resistance. 

These are women who have chronically high blood sugar.  The classic symptom of “insulin receptor resistance” is getting sleepy/drowsy within 15 to 30 minutes after you eat. (Not 2 hours later). Other symptoms of insulin receptor resistance include:

  • Crave sweets after you eat. 
  • Hard time going to sleep 
  • Wake up in the morning feeling completely beat up as if you didn’t sleep at all. 

Those are all pretty good signs of insulin resistance.

In insulin resistance you get surges of insulin when you eat…this surge up-regulates an enzyme that makes women make more testosterone. 

Testosterone can cause this Over-conversion that bombards the receptor that leads to resistance and low thyroid symptoms. 

…I know that’s kind of a long story, but that’s what happens.

Women with insulin resistance are often diagnosed with Polycystic Ovarian Syndrome.  The insulin resistance leads to elevated testosterone. 

So, blood sugar instability is often the underlying cause of this high testosterone that we’ve been talking about.  What you eat, when you eat and inflammation are ALL factors that can cause insulin resistance.

We’ve got a lot of pieces on the chessboard…pieces that a good, effective doctor must looking at and thinking about all at one time.

Now, another way that you can develop elevated testosterone is simply if you are using it…or if your husband or your boyfriend is using topical testosterone.  Testosterone gel easily rubs off on you and will can cause this Over-conversion. 

Your doctor’s got to be able to evaluate all of those different possibilities.

Treatment depends on what the actual mechanism is for each individual patient.  If it’s insulin resistance, chances are you’ll have to change your what you’re eating and when.  You have to look for food sensitivities…inflammation (from all possible sources). 

For successful treatment, you’ve got to do ALL the above simultaneously. 

I see a ton of PCOS and Insulin resistance caused by diet and inflammation.

Now, back to the thyroid to wrap it up….

The reason high testosterone causing Over-conversion leading to resistance and more low thyroid symptoms is a hidden cause is because there’s so many links in the chain.

Your doctor needs to have the skills, experience and determination to find these links.

© 2014 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #17 Why You Still Have Low Thyroid Symptoms – Peripheral Dopamine Deficiency

Dr. David Clark, DC – Raleigh-Durham-Chapel Hill Thyroid expert, explains how low dopamine can cause low thyroid symptoms

Hidden Cause #17 Why You STILL Have Low Thyroid Symptoms even though you may be taking thyroid medication, even though your lab tests look normal is…

A peripheral deficiency in the neurotransmitter Dopamine

What would that look like? Well, there’s really not a lot of peripheral signs of dopamine deficiency.

Most of dopamine deficiency signs happen because of it’s effect on your central nervous system and how your brain is working….and those are typically things that look like ADHD: so we’re talking about

  • distractibility
  • impulsivity
  • can’t focus
  • can’t stay on task

But there’s also some sort of, you know, emotional symptoms that go along with that.

Let’s clarify “deficiency.” In most people, absolute low quantities of dopamine are not the problem. In most people the problem is low activity of the neurotransmitter.

Deficiency implicates that you’ve got absolute low levels, but it could be that your levels are fine…and it’s just that the receptors for the dopamine are not doing their job.

So with that in mind, what are some of the emotional signs that go along with dopamine being low activity or deficient?

  • Preferring to isolate oneself
  • Anger under stress

My favorite example of this last one is my own personal example. It was about 16 years ago….

I was in the kitchen cutting up an apple, and the apple fell in the sink and I yelled a 30 second stream of expletives.

My wife ran into the kitchen, struck with terror…“Oh my God, what happened? Are you hurt?”

I screamed back:  “This APPLE FELL in the sink!”

Well, you understand that’s completely out of proportion, right? I had a little bit of stress and I got very angry. That’s a good sign of a dopamine issue.

How would dopamine and thyroid symptoms show up in someone that has that problem?

Well, first thing they could have are low thyroid symptoms:

  • hair loss
  • brain fog
  • fatigue
  • high cholesterol
  • gain weight easily
  • infertility
  • constipation.

Those are those low thyroid symptoms.

Now, if you had those PLUS dopamine sypmptoms, the two could be directly related because what dopamine seems to do to thyroid hormones.

Research seems to say that Dopamine controls the rate of conversion of T4 into T3.

That’s a very big deal because T4 is inactive. T3 is the active thyroid hormone. 97% of what your thyroid gland makes is T4– and so a lot of that has got to get converted to T3 in order for you to have enough T3 for your body to work correctly.

That process is  conversion. And dopamine seems to influence how well you can convert T4 into T3. When you don’t have enough dopamine peripherally (outside the central nervous system) you may not convert very well…

You may develop those low thyroid symptoms. The problem is when you walk into a doctor’s office in saying, “Hey, I can’t focus. I’m distractible. I can’t follow through on things.” Bonk! You’re going to get labeled ADHD and offered a prescription.

But the dopamine medication is going to work mainly CENTRALLY and not work peripherally. You might have an improvement of some of your distractibility and your focus problems, but your low thyroid symptoms may stay exactly the same.

The key is finding a doctor that understands that dopamine has an impact on how thyroid works.

You could be taking thyroid medication. You could have lab tests that look totally normal because when this situation happens your T4 and your T3 don’t really necessarily change a lot to be outside of the lab range, but they can change enough to affect how you feel.

And it becomes very difficult for most doctors to do because they want to treat the labs.

I think a really good doctor/good clinician  doesn’t treat the lab. They treat YOU.

They use the lab for guidance.

So if you have dopamine symptoms plus low thyroid symptoms, then your doctor really should have that on the radar and think: what could cause dopamine deficiencies?

The two things that cause low dopamine activity/deficiency: blood sugar irregularity and iron deficiencies.

And that makes you go down another rabbit hole because…

…”why would you be iron deficient?”

…Do you have a parasite?

Do you have an H. pylori infection?

What’s up with your blood sugar? Are you eating? Are you not eating?

There’s a ton of factors to start investigating and thinking about….

And that’s another thing that a lot of doctors just don’t want to do. They just don’t want to think. They’d much rather you come in with your ADHD signs, give you medication for that and hope everything works out.

And when you come back six months later and it’s not working out… it’s YOUR fault, the patient.

Find someone that understands the complexity of that situation and understands that dopamine can be a hidden cause of why you still have low thyroid symptoms.

© 2014 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hidden Cause #16 Why You STILL Have Low Thyroid Symptoms-Peripheral Serotonin Deficiency

Dr. David Clark, DC – Raleigh-Durham-Chapel Hill Thyroid expert, explains how Serotonin can cause Low Thyroid Symptoms.

Hidden Cause #16 why you STILL have low thyroid symptoms even though you may be taking medication and even though your lab tests look normal is…

 A peripheral deficiency in the neurotransmitter Serotonin. 

When I say ‘peripheral’, I’m trying to contrast that to “central,” meaning inside your nervous system, and peripheral, meaning in the nervous system in the rest of your body. 

You have a ton of serotonin outside of your brain. Your GI tract has a huge amount of serotonin. 

In fact, we like to call the GI tract “the second brain” because it really has more neurotransmitters than your brain. 

What would a serotonin deficiency look like? 

  • Intestinal Pain
  • Constipation
  • Diarrhea
  • Bloating

Essentially, any type of GI symptom could be related to peripheral serotonin deficiency.  I realize that’s not  super-specific but it’s the truth.

As for Central Nervous System symptoms of serotonin deficiency….

Classically, the big symptom is “depression.” But what does “depression” look like? 

….losing interest in things that were previously pleasurable

…being sad or down for no reason

…overwhelmed with ideas, can’t manage them

….feelings of inner range and anger

….feelings of unprovoked anger

Those are really what we mean by depression.

If you’re having a few of the above symptoms plus LOW THYROID SYMPTOMS like the following, then Serotonin needs to be on the radar

  • Fatigue
  • Need to sleep excessively just to function
  • Hair loss & hair thinning
  • Dry Skin
  • Constipation
  • Brain Fog
  • Easily Weight Gain
  • Infertility

How does Serotonin affect thyroid hormones?

Research seems to show that Serotonin affects the rate of conversion of T4 into T3. 

And if you remember, T4 needs to be converted into T3 (the active form). 97% of what your thyroid gland makes is T4—so to get T3, you’ve got to “convert” T4 into T3.

Conversion is influenced by how much serotonin activity is going on in the periphery of your body. 

But as I mentioned earlier, we just don’t see a lot of clear signs of peripheral serotonin deficiency other than those that are related to the gastrointestinal system.  So. we have to look more at someone that has central signs of serotonin deficiency (listed above).

What could cause a Central Serotonin Deficiency? 

Since Serotonin is made from the amino acid, L-Tryptophan, you could get into trouble if you weren’t getting enough L-Tryptophan, or absorbing it…

…however, that’s usually NOT the issue.

More often the real problem is LOW Serotonin Activity–in other words, you might be able to make it just fine, but you are NOT making it regularly or consistently…or…your Serotonin RECEPTORS are not responding normally to Serotonin.

Blood sugar regulation and Iron levels are the two critical factors that create Low Serotonin Activity.

If you have low Serotonin symptoms, that doesn’t necessarily mean you need to take L-tryptophan or that you need to take SSRI. 

It DOES mean that the doctor you’re working with has got to put on the detective hat and  figure out what is YOUR problem with Serotonin? 

…Making it (synthesis)

…Using it (receptors)

or both?

This takes some digging.

Im the big picture of Thyroid this hidden cause is pretty darn hidden because it’s  #16 on the list.   Over the last 12 years I haven’t seen that many low thyroid patients with this Serotonin problem–especially compared to the number of women with Hashimoto’s–but they still show up. 

I’ll see a woman who’s been taking thyroid medication because she’s got low thyroid symptoms AND she’s got these serotonin symptoms.

Now, you can guess what happens when she walks into most doctors’ offices.   

She looks depressed. Sounds depressed. So, she gets labeled with “depression.” And is prescribed an anti-depressant–which will not change her thyroid symptoms in the long run.

This is problematic for 2 reasons:

1. If you felt bad for months or years, you might be depressed BECAUSE of that–not the other way around. anyway.

2. A patient can have more than one thing wrong.  This is something that’s very hard to get doctors to understand—doctors of all kinds–that there’s no rule that says a patient can have only one thing.  

You’ll have to look far and wide to find a Doctor that would connect low thyroid symptoms AND low serotonin symptoms to a problem with peripheral Serotonin deficiency.

But the big point is, look, if you’ve got these serotonin symptoms and you feel sad and depressed when there’s no reason for it and you’ve got these low thyroid symptoms, you might need to investigate whether serotonin is an issue for you or not. 

So you’ve got to find someone that would know what to look for and how to help you.  And how to help you is not immediately running out to GNC and buying L-tryptophan.  That’s not necessarily what you need to do.

It’s more complicated than that, and your doctor that you see should know that.

© 2014 David Clark. All Rights Reserved.

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.

Hashimoto’s Autoimmune Thyroiditis and Vitamin D Deficiency

Dr. David Clark, DC — Raleigh-Durham-Chapel Hill, NC– helps you understand the critical connection between Vitamin D Deficiency and Hashimoto’s autoimmune hypothyroidism.

I’m going to explain why Vitamin D deficiency is connected to Hashimoto’s hypothyroidism.

Vitamin D is a critical regulator of your immune system and research has already established that Vitamin D deficiency is highly associated with other autoimmune diseases like Multiple Sclerosis and Type I Diabetes.

And Vitamin D deficiency IS associated with Hashimoto’s hypothyroidism–another autoimmune condition.

What is Hashimoto’s? 

Hashimoto’s is an autoimmune attack on the inside of your thyroid gland.  Over time, your immune system destroys the inside of your thyroid gland—so much, that you can’t make enough thyroid hormones and you suffer low thyroid symptoms.

What low thyroid symptoms does Hashimoto’s hypothyroidism cause? 

Here’s a short list:

  • weight gain
  • constipation
  • hair loss
  • brain fog
  • a need to sleep excessively in order to function
  • high cholesterol
  • infertility
  • joint pain.

Last year a great scientific study looked specifically at Hashimoto’s patients and Vitamin D.
 

The researchers took 161 confirmed Hashimoto’s patients (meaning these people had positive TPO antibodies and/or positive TGB antibodies) and measured their Vitamin D levels. 

The results of their study are downright scary.

92% of the Hashimoto’s patients had Vitamin D deficiency. 

This study defined Vitamin D deficiency as less then 30 ng/dl.

148 out of 161 had Vitamin D deficiency.  Crazy, right?

It gets worse. 

They even broke down the results into three categories of Hashimoto’s patients:

  • Overt Hypothyroidism
  • Subclinical Hypothyroidism
  • Euthyroid

Let me explain what those mean. 

Overt Hypothyroidism Hashimoto’s means:

  1. The person has high TPO and/or TGB antibodies
  2. Their TSH is high
  3. The person has low thyroid symptoms (I see these every day).

Subclinical Hypothyroidism Hashimoto’s means:

  1. The person has high TPO and/or TGB antibodies
  2. Their TSH is high
  3. The person does NOT have low thyroid symptoms ( I don’t see many of these).

Euthyroid Hashimoto’s means:

  1. The person has high TPO and/or TGB antibodies
  2. Their thyroid lab test numbers are “normal.” (I see quite a few of these people in my practice).

Now here’s how they broke it down.

94% of Overt Hypothyroid Hashimoto’s patients had Vitamin D deficiency. 

98% of Subclinical Hypothyroid Hashimoto’s patients had Vitamin D deficiency.

86% of Euthyroid Hashimoto’s pateints had Vitamin D deficiency. 

(The researchers say that it’s not statistically significant in the euthyroid group.  But I’m telling you it is clinically, practically significant.)

Look at those numbers again….see how many of those Hashimoto’s patients had Vitamin D deficiency? Huge.

We know for sure that Vitamin D has something to do with Hashimoto’s. But what exactly does Vitamin D do?

Here’s the short answer… 

Vitamin D is a critical regulator of your immune system. 

Without Vitamin D your immune system can become over-exuberant. Without Vitamin D your immune system easily  can become unbalanced.  Vitamin D deficieny can lead to an expression of an autoimmune attack on a tissue.

So for example in Hashimoto’s….

if you carry the gene for Hashimoto’s and you become Vitamin D deficient your gene can turn on and you can start expressing it and start attacking your thyroid.  Over time you become low thyroid and you develop low thyroid symptoms.

And then…you go see a doctor who probably doesn’t test you to see if you’ve got Hashimoto’s (Medical doctors have nothing to offer but replacement hormones anyway).   They just put you on Synthroid® or Armour®

…but in the long run you end up not feeling much different because the replacement hormones just don’t do much for the underlying autoimmune process.

Sadly, this is exactly what usually happens to a woman with Hashimoto’s. 

Does this mean that you should buy Vitamin D and start supplementing? 

No, it doesn’t. 

Because even though Vitamin D is relatively harmless, you don’t know how much you need.  Plus, there’s a complex situation in which if you take the wrong dosage of Vitamin D— read carefully— if you take the wrong dosage of Vitamin D you can actually make yourself worse. 

Taking the wrong dose of Vitamin D can make you have MORE low thyroid symptoms—even if you really are Vitamin D Deficient.

That scenario nvolves something called 1, 25-dihydroxy vitamin D, and is a little bit beyond what I want to explain here. 

The takeaway message….

Even though there’s a 90% chance that you’re Vitamin D deficient if you have Hashimoto’s— this doesn’t mean you should go out and start supplementing Vitamin D. 

You need to find someone who understands exactly what I’ve been telling you about, someone that understands there’s other things to look at… and that Vitamin D, even though it’s important, is not the magic bullet.

In my practice we see a lot of people that need Vitamin D but some people need more or less than others–and many times it’s the difference between the person feeling good or feeling worse.  A small number people can’t take Vitamin D at all—even though they’re defiicient.

Find someone that knows what to do, because Vitamin D deficiency and  Hashimoto’s  are almost the same thing.

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© 2014 David Clark. All Rights Reserved.

 

Disclaimer: The contents of this site are for educational purposes only. Nothing here should be construed as medical advice. Nothing here is a substitute for actual medical care. Consult a qualified healthcare professional.