Pittsburgh, Slow Thyroid and Weight Gain

If you find it easier to gain weight and more difficult to lose weight than it used to be, it could be a shift in your thyroid function. If you live in Pittsburgh, it is more common than you might be aware of.

Thyroid Background;

Practicing as a Functional Medicine, Clinical Nutritionist in Pittsburgh for over 20 years, I have managed thousands of patients who struggled with a slow metabolism and difficulty losing weight due to slowed down thyroid function. The thyroid gland releases thyroid hormone that is vital to controlling the metabolism and growth and development of the human body. It helps to regulate how your body’s cells use energy from food, this is the foundation of your metabolism. “Normal Ranges” for thyroid hormone in blood work do not always tell the whole story and many patients fall through the cracks, thus missing this imperative piece of their overall health and weight loss potential. More on that later.

Your metabolism, how fast or slow things work in your body, affects your body’s temperature, your heartbeat, and how well you burn calories. If your thyroid hormone levels are low your metabolism will be slow and it is easy to gain weight and hard to lose weight. Thyroid hormone is made by extracting the nutrients iron, iodine, tyrosine, zinc, selenium vitamin E, B2, B3, B6, C, D from the blood. From this statement, it is obvious that the health of your diet and ability to absorb these nutrients is a primary part of the potential of your thyroid to sustain a healthy metabolism. But diet alone is not the only factor that can affect this sensitive gland.

Signs and Symptoms of Slow Thyroid;

-Fatigue, slow thoughts, slow movement.
-Easy to gain weight, hard to lose weight.
-Cold or low body temperature, cold intolerance.
-Slow gut motility or Constipation.
-Low Mood or Depression.
-Dry Skin and Brittle Hair.
-Muscle Aches and Weakness.
-Loss of the lateral third of your eyebrows.
-Low Libido.
-Changes in Cholesterol or Triglyceride levels.

Pittsburgh and Slow Thyroid;

Most people who I meet are aware of vitamin D deficiency in Pittsburgh. Optimal levels in blood are between 65-75 ng/dl. Blood reference ranges tragically under-state this with “Normal Values” of 30-100. On average, the blood levels of patients I evaluate are in the low 30’s. This trends down in the winter months. As referenced above, vitamin D is part of the thyroid nutrient support system. Selenium is another critical mineral for optimal thyroid function and soil selenium levels are of the lowest in the country in Western Pennsylvania. Couple these vitamin and mineral deficiencies with environmental toxic exposures and thyroid health takes another turn for the worse. The thyroid gland is highly sensitive to a number of toxins found readily in our environment and homes.

• “The Steel City” and Heavy Metals. Aluminum, Cadmium, Lead and Mercury are all thyro-toxic. If you have silver fillings in your teeth, these fillings can spill mercury into your system from just brushing your teeth. Consider the close proximity of those teeth to the thyroid gland. Eating tuna fish often, is another source of mercury and many people are unaware that there is 25mcg of Mercury in the Flu-Shot. Certain individuals have a predisposed, genetic slow ability to detoxify metals. This means when there is exposure to a toxin it is likely to stay in the body longer and start to cause problems with thyroid function. In Pittsburgh PA, similar to other industrial cities, there are increased levels of Lead in our water supply and environment. Increased exposure is a simple increase in stress on the thyroid and inhibitor of metabolism.
• Flame Retardants are used to reduce the flammability of fabrics, clothing, furniture, and carpeting. Flame retardants contain bromine, a halogen that has the same shape as thyroid hormone. If they are the same shape, they can attach to thyroid hormone receptors and slow down thyroid function.
• Fluoride is added to our water supply to prevent cavities. Sadly, it is another toxin that can damage your thyroid gland and interfere with optimal function. I use a Berkey water Filtration system in my home that removes fluoride from my drinking water. https://www.berkeyfilters.com/
• Herbicides and Pesticides that are used with farming are thyroid toxic. Eating organic is a great way of minimizing exposure. Certain foods have a higher concentration of these toxins, feel free to visit my article on the most important foods to keep organic in your diet: https://drcshaw.com/organic-or-not-what-is-most-important-on-your-plate/
• BPA is an industrial chemical/xeno-estrogen that is used during the manufacturing of many plastics and it binds to thyroid receptors blocking your thyroid hormones ability to work optimally. BPA is used in commonly used food storage containers and beverage containers like water bottles, water supply lines and bottle caps. Shockingly, BPA is what makes the waxy feeling on cash register receipts and is also found in your dryer sheets. Remember, if it touches your skin you absorb it in.

Thorough Blood Work Analysis of the Thyroid;

Your Primary Care Physician will often follow the protocols set forth by the insurance company to only test the TSH (thyroid stimulating hormone) in your blood work. If the TSH is too high or too low they will then look at the levels of the thyroid hormones. Similar to vitamin D analysis, reference ranges in the blood for “Normal” thyroid function are very broad and a slowly functioning thyroid will often be missed by a physician who is observing disease only ranges. This limited approach to evaluating thyroid function would be similar to just checking the level of gas in your car if it was running poorly. There are many more things to look at for your car to run efficiently than just the level of gas.

Is your physician wrong to follow the guidelines set forth for medical management of the thyroid? No. This is their training and what they are looking for is thyroid disease. Either fast, overactive or Hyper-Thyroid, or Slow, underactive or Hypo-Thyroid. If you don’t have a thyroid disease, there is a good chance that your doctor will let you know that “everything is within normal limits”. Just remember, normal limits in your PCP’s training is establishing a non-diseased thyroid. This is not the same as a Functional Medicine evaluation for optimal thyroid function. We are looking for a shift in the ability to use all of the thyroid hormones optimally to sustain a healthy metabolism (easy to lose weight if you give your body the right fuel).

What is included in a Thorough Functional Medicine Thyroid Panel? I will not be including all blood work ranges for this section as each lab has a different reference interval and I do not want people self-diagnosing ant overstimulating the thyroid.

• TSH is the message from your brain to ask the thyroid gland to release thyroid hormone T4. If TSH is higher than a 2.0, the Functional Medicine community would consider thyroid function to be sluggish. For reference, above a 4.5 or a 5.0 depending on the lab would be diagnostic for hypo-thyroid and your PCP might take action to give you the medication Synthroid, or synthetic thyroid hormone (T4). This test often confuses people because the higher the TSH, the slower the thyroid function.
• Total T4 is the primary hormone that your thyroid will release but is not a great hormone for your metabolism. When it converts into T3 it is now a more active version for energy, mental clarity and weight loss. Here is one missing link in the traditional medical management of thyroid disorders. Synthroid, the medication used by most physicians, is T4 and has to become activated to serve your metabolic needs effectively. I have seen a trend toward some PCP’s looking at T3 in the last 5 years but it is still few and far between.
• Free T4 levels will demonstrate the free or active form of T4. This will be low in cases of hypothyroidism but can be normal in subclinical, early stages of thyroid dysfunction.
• Free T3, is your best friend in the world of weight loss and thyroid health. Factors that can interfere with the conversion of T4 into T3 are stress, infection, trauma, auto-immune disease, gluten sensitivity, fluoride, an unbalanced sleep wake cycle or shift work that interferes with a healthy circadian rhythm. What are the factors that improve conversion of T4 to T3? Selenium and Zinc, coupled with a lower stress non-fluoridated, balanced sleep and non-toxic diet. If T3 levels are very low, there is a prescription that your doctor can give you for synthetic T3 called Cytomel. There are more natural thyroid medications that have both T4 and T3 in them and many people tolerate these very well. Your doctor has to monitor T4 and T3 levels when using these medications and often your physician will lean away from using natural thyroid medication due to conflicting information from the pharmaceutical companies. (Go Figure). It is very common to find a lower than optimal Free T3 in individuals who struggle to lose weight. In this case I will commonly support the adrenal system to improve the body’s ability to tolerate stress, use thyroid converting factors, Selenium and Zinc and have a discussion about stress management. Behavioral modification, counseling, yoga, prayer, meditation, acupuncture, scheduling down time are all effective tools in improving T4 to T3 conversion.
• T3 Uptake, is not a direct measure of T3 levels but is a valuable tool to determine if Estrogen may be binding to the thyroid hormone site and competing for dominance. Because estrogens are stored in body fat and can bind to the thyroid hormone sites, it is very common for overweight women to struggle with sluggish thyroid unknowingly. A low T3 Uptake can confirm this.
• Reverse T3, In opposition of your best friend T3, Reverse T3 is its nasty twin. Reverse T3 does exactly what it sounds like, it slows your metabolism down. Rt3 will bind to the same receptor site as T3 and compete for control. High testosterone or PCOS tendencies can drive T4 into reverse T3 and so can high levels of stress and stress hormone Cortisol.
• Total T3 test result shows us the total amount of the metabolically active thyroid hormone. It allows a doctor to check your body’s ability to convert T4 to T3 and to rule out an overactive thyroid.
  Thyroid Antibodies (TPO) when elevated show an autoimmune attack against the thyroid. This means that the immune system is mistakenly attacking the thyroid like it is a foreign invader. This can happen for a number of reasons. One common finding is toxins stored in the thyroid can engage the immune system and trigger immune awareness of this gland. Most slow thyroid cases are on the autoimmune spectrum, the most common being Hashimoto’s disease. At any given time I have between 150 & 200 active Hashimoto’s patients under my care.

Iodine. Because Iodine is one of the primary minerals used by the body to create thyroid hormone, I include iodine levels as part of my thyroid blood panel. Low levels are always treated and when optimized can shrink enlarged thyroid goiters caused by iodine deficiency.

Thyroid Friendly Diet;

The most critical deficiency in the standard American diet that affects the thyroid would be Veggie-Deficiency. The phytonutrients found in all of the colors of vegetables support the function of all body systems. Most people simply do not eat enough veggies. Checking to see if you have iodine in the salt that you use can be of benefit due to the iodine/thyroid hormone connection. If there is one food that tends to pose the biggest challenge to thyroid function it is Gluten. Many people find that the removal of gluten from their diets increases energy, balances thyroid function and promotes weight loss. Going gluten free is not healthy though, if you switch over to buying gluten free breads, cereals, pastas and processed products. The starches and sugars in most gluten free “replacement” foods are also compromising to health and metabolism.
Moving over to a whole foods, gluten free, high vegetable, balanced protein diet often tends to serve the thyroid very well. An omelet with veggies for breakfast, grilled chicken or salmon on a salad for lunch, brown rice, turkey and asparagus for dinner with almonds or veggies and hummus as snacks would be a great snapshot of a heathy gluten free day. It is important to reference that there is no one “thyroid diet”. Dietary individuality is extremely important to honor. Gluten may not be an issue for your thyroid, it could be dairy, corn, soy, rice, nightshade or nuts and seeds that interfere with optimal function. Food allergies are not always the trigger. Often food sensitivity (delayed reactions) or combined sensitivities are behind metabolic sluggishness. Let’s not forget proper hydration, drinking 50% of your body weight in ounces daily can be very supportive of your entire system as well as the thyroid. Working with your Functional Medicine practitioner to determine your individual diet and nutritional needs would be very important for accuracy.

Thyroid and other hormones for metabolism.

Thyroid hormone is actually one of six hormones that can affect a person’s metabolism and body weight. In Functional Medicine, considering the whole picture is important to assessing not only thyroid health but metabolic potential. Cortisol, insulin, estrogen, progesterone and testosterone are also major players for your metabolsim. The balance between these hormones is critically important in the ability to optimize your weight loss potential. As referenced above, certain levels of estrogen can bind to thyroid and slow it down so the inter-play here is critical to optimizing health. In women, high levels of testosterone can create elevated levels of unbound estrogen that will slow the thyroid down. High levels of stress will interfere with turning your T4 hormone into the more active T3 hormone. As you can see, evaluating all combinations of sex and stress hormones for thyroid interference is important.

Seasons and Thyroid function;

With 23 years of managing thyroid dysfunction in Pittsburgh, I have observed a trend that I call “Hibernation Mode”. Many people tend to require more thyroid support during the Winter months than other times of the year. This could be partly due to the connection with vitamin D trending lower in the winter or less fresh veggies being available, but I believe it is deeper than that. There is no doubt that we tend to be less active in the winter months too. Due to the temperature shift my dog walks are, on average, 20 minutes shorter and metabolism changes because of the decreased activity. With all of that, it is common to see the need to increase thyroid support or medication in the winter too. So, there is the possibility that we are slowing down and hibernating like many animals do. Maybe we should move South in the winter with the birds . Many people do and it makes sense.

Natural Support for thyroid function.

So, what do we do if our thyroid function is slow but not slow enough for our physicians to be willing to give us medical support? There are natural supports available for thyroid function that are often enough to move the metabolic potential of a slow thyroid into an optimal space. I have a formula called Thyro-Mend that brings all of the support together required for balancing thyroid function in one pill. Adding vitamin D will benefit those whose lab levels are below the optimal 65-75 ng/dl. Don’t feel shy to ask your doctor to run vitamin d blood work for you. It is often very low this time of year and worth evaluating, not just for thyroid health, but for immune function and mood as well. If my patient is not on thyroid medication, weighs between 140 and 180 lbs and I find a TSH above 2 and below 3.5 I will start them on Thyro-Mend 1x day with breakfast. With a TSH above 3.5 and below 6 I will use Thyro-mend, 1 capsule 2x day. I will use blood work to evaluate vitamin D and iodine status and support accordingly.

Summary;

Optimal function of the thyroid gland is imperative to sustaining your metabolism. Evaluation of optimal thyroid function requires a deep dive into all thyroid hormones not just TSH and T4. Along with TSH and T4,  T3, Reverse T3, T3 uptake, Thyroid antibodies and Iodine levels should all be considered. Living in certain areas of the country, like Pittsburgh, thyroid imbalances are rather common. If your thyroid is sluggish but not slow enough to garner medical management there are natural supports that when coupled with some dietary changes can shift.

At the intersection of toxic exposure, hormone imbalances, individual dietary needs and vitamin and mineral deficiency we find a rather complex and volatile thyroid system. Your Functional Medicine, Clinical Nutritionist is trained to manage all aspects of this system for optimizing function and metabolism. If your P.C.P. or Endocrinologist is not willing to order the complete thyroid panel your Functional Medicine doctor will. Take the time to research and learn about your individual system. On the other side of this research you may find answers to unlocking multiple keys to a healthier lifestyle.

Stay Well!
Dr. Conan Shaw
Board Certified Clinical Nutritionist
Certified Functional Medicine Practitioner

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