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Six Patterns of Hypothyroidism

Older woman smiling on sofaThis is the way most Medical Doctors view hypothyroidism. It is a valid way to treat Primary Hypothyroidism which is the first of six common patterns of hypothyroidism and is caused by a thyroid gland that does not create enough thyroid hormones.

In this pattern, decreased thyroid hormones (T3 and T4) in the blood stimulates the hypothalamus which stimulates the pituitary gland to release thyroid stimulating hormone (TSH). TSH stimulates an enzyme in the thyroid gland called Thyroid Peroxidase to use iodine to create more T3/T4 which is realeased into the blood. The increase in T3/T4 stop the hypothalamus which stops the pituitary from releasing TSH which stops the production of T3/T4.

In Primary Hypothyroidism, the thyroid gland does not produce enough T3/T4 which means there is chronically low amounts of the hormones circulating in the blood. This causes the hypothalamus to continually send signals to the pituitary which is continually releasing larger and larger amounts of TSH.

Patients with blood test results that show high levels of TSH are prescribed synthetic thyroid hormones to increase the amounts of circulating thyroid hormones and shut down the stimulation of the hypothalamus/pituitary. This decreases the amount of TSH and “normalizes” your blood tests.

But this is only a small part of the “whole body” picture.

Oak Creek Relief & Wellness Looks at the Whole Picture

Pattern 1: Thyroid Metabolism

After the hypothalamus stimulates the pituitary, and after the pituitary releases TSH, and after thyroid peroxidase makes T3/T4 in the thyroid, T3 and T4 is released into the blood and catches a ride on a protein called Thyroid Binding Globulin which acts as a taxi to transfer the hormones.

Roughly 93% of the thyroid hormones is in the form of T4 which is an inactive form and must be converted to T3 before the cells of the body can use it. 7% is made into T3 and can be immediately transfered to cells by thyroid binding glubulin proteins.

In the liver, around 60% of the inactive T4 is converted to T3. Another 20% gets converted to reverse T3 which is inactive and exctreted from the body. The last 20% is converted to T3S and T3AC which are inactive forms of T3. T3S and T3AC are then converted into the active form of T3 by bacteria located in the gastrointestinal tract. It can then be used by the cells of the body to fuel metabolism.

Pattern 2: Hypothyroidism Secondary to Pituitary Hypofunction

What if your pituitary gland never sends out enough TSH to stimulate the thyroid? A blood test would result in low levels of TSH, which would indicate either a normal working thyroid or even a hyperthyroid! The most common cause of a suppressed pituitary is chronic stress. Constant bombardment of the pituitary gland by adrenal hormones causes the pituitary to shut down with the added side-effect of decreasing TSH output.

If the doctor only tests for TSH, he/she would assume that thyroid function was normal (which it would be if there was enough TSH) even though the patient was presenting with signs and symptoms of hypothyroidism. If prescription thyroid medication is used, it may initially help symptoms. However this is a dangerous course of treatment.

Flooding the system with thyroid hormones causes the pituitary to be suppressed even further. Larger amounts doses of hormones are prescribed and the increase of hormones in the system causes cells to become resistant to thyroid hormones (similar to pre-diabetics being insulin resistant). Eventually the pituitary/thyroid communication could be permanently lost requiring a lifelong dependance to prescription medications.

Post-partum depression is another cause of a suppressed pituitary. The stresses of pregnancy and birth can rapidly suppress the pituitary leading to symptoms of hypothyroidism.

Pattern 3: Under-Conversion

In pattern 3, the thyroid and the pituitary are working properly, but the conversion of T4 (inactive) to T3 (active) is hampered. This means that the cells can not use the hormones present in the blood. The properly functioning thyroid means that there is enough hormones present to make the TSH test normal. If the doctor tested for T4 as well (which is often the second test run after the TSH test), this too would be normal.

The cause of under-conversion is once again chronic stress. Chronic infections or inflammation can also play a role in thyroid underconversion by damaging cell membranes which plays an integral role in T4 to T3 conversion.

Additionally, a sluggish liver, which converts 60% of T4 to T3, can lead to thyroid under-conversion.

Dosing with prescription thyroid medication is often futile. Synthroid, a common thyroid prescription, is a synthetic form of T4. It still needs to be converted to T3 before the body can use it. The patient may find temporary relief if prescribed T3, but the increased levels of circulating hormones may cause the suppressed pituitary situation similar to what occurs in pattern 2.

Pattern 4: Over Conversion

Pattern 4 is the opposite of pattern 3. The thyroid and pituitary are again working properly, but this time there is too much T4 converted to T3 (remember roughly 20% of T4 is conversted into reverse T3 which is inactive and excreted). High levels of testosterone is the cause which also has the added effect of decreasing the amount of thyroid binding globulin (TBG: the taxi that carries the thyroid hormones).

The high levels of T3 in conjunction with low TBG causes cells to become resistant to T3. They close the doors and do not allow anymore T3 into the cells. TSH levels will be normal even though the patient is showing signs of hypothyroidism

This pattern is similar to insulin resistance. In fact, patients with thyroid over conversion often also present with insulin resistance and polycystic ovary syndrome (PCOS) which is also caused by increased testosterone levels. Managing blood sugar is extrememly important. Since there is already too much T3, prescription thyroid medication will not help in this pattern.

Pattern 5: Thyroid Binding Globulin Elevation

]Thyroid binding globulin (TBG), as stated earlier, is a protein that acts as a taxi to transport thyroid hormones through the blood. In pattern 5, the pituitary, thyroid and conversion of hormones are all working properly, but there is too much TBG transporting the hormones. Like a real taxi cab, thyroid hormones can not ever reach the destination cells if they never get out of the taxi! Any free thyroid hormone in the system quickly attaches to a TBG and simply drives around without ever getting out and entering cells.

High estrogen levels from oral contraceptives, hormone replacement therapy, our food supply, or hormone creams increase the level of TBG. TSH levels are still normal due to the circulating hormones.

Pattern 6: Thyroid Resistance

Chronic stress or elevated homocysteine levels can cause thyroid resistance similar to what happens in thyroid over-conversion. In this pattern it is not too much T3, but too much cortisol which causes the resistance. TSH levels are again normal and prescription thyroid medication would not have much effect.

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Six Patterns of Hypothyroidism | (414) 761-5777