Thyroid Health: What Canadian's Need to Know
Did you know that one in 10 Canadians have a thyroid condition?
If you're someone struggling, or if you're just looking to learn more about thyroid health, this blog post is for you. We'll discuss some important thyroid hormones, and we'll also take a look at some nutrients that can help support thyroid health. So whether you're dealing with a diagnosed condition or you're just interested in learning more, read on!
Thy-what?
The thyroid gland is a butterfly-shaped endocrine gland located in the front of your throat. It's controlled by the hypothalamus and pituitary glands, which make up part of your brain. The thyroid releases hormones that help regulate your metabolism (the rate at which you burn calories). If it works too hard, you'll feel over-stimulated, anxious and overheated. Though if it doesn't work hard enough you'll feel sluggish, depressed and cold.
What are the thyroid hormones and how are they produced?
There are two main thyroid hormones that regulate metabolism: thyroxine (T4) and triiodothyronine (T3). These hormones are produced when your body processes iodine found in the bloodstream. Iodine is a mineral that's critical for optimal thyroid health; if you're not getting enough iodine from your diet, the gland will start to grow larger (known as goiter) in an attempt to absorb more iodine and produce the necessary hormones.[1]
Control over this process comes from higher up the neurological hierarchy. The hypothalamus releases TRH (thyroid-releasing hormone), which stimulates the pituitary gland to release TSH (thyroid-stimulating hormone). TSH then signals the thyroid gland to release thyroxine (T4) and triiodothyronine (T3). This is why your primary care provider will often order a thyroid panel consisting of the different hormones that maintain proper thyroid health. Understanding the interplay between the hormones allows your care provider to determine an optimal treatment regime, otherwise disparities might arise.[2]
Source: Fullscript (schematic of the hypothalamus-pituitary-adrenal-thyroid axis)
What happens when there is an imbalance?
One of the most common autoimmune diseases in Canada is Hashimoto's thyroiditis, which can lead to a lifelong struggle with hypothyroidism. The condition is caused by antibodies that attack the thyroid tissue and destroy it. It's estimated that about 1% of Canadians have this disease, but many don't know because they're asymptomatic. Women are more likely than men to be diagnosed with Hashimoto's Thyroiditis, but the symptoms are similar and include fatigue, weight gain, dry skin and constipation.
Hashimoto's thyroiditis typically goes through three phases. During the thyrotoxic phase and more acute phase, the thyroid dumps a large number of hormones in to the blood stream. This is followed by the overt hypothyroid phase after weeks to months of the gland releasing hormones. Imagine, for a moment, an assembly line where production declines. This means every person (or cell) waiting to receive their package (or hormone) is left waiting. People who suffer from this often experience symptoms during both of the initial phases; however, some may only develop symptoms after long periods of the condition left untreated. Over time, the thyroid hormones may stabilize and the individual enters the euthyroid state.[3]
What nutrients are required for the thyroid to function?
The most important nutrient for thyroid health is iodine, which plays a role in hormone production and cell metabolism.[4] The World Health Organization recommends that adults consume 150 micrograms of iodine per day (this amount is also known as the Estimated Average Requirement). Health Canada suggests consuming it daily; however, most people don't get enough from their diet alone because many foods outside of salt aren't fortified with sufficient amounts of this mineral (such as vegetables or fruits). This is especially true for women of childbearing age.[5]
Other important nutrients include selenium and zinc.
Selenium supports normal TSH levels which makes sense when you consider that the thyroid gland is where selenium is most densely concentrated per gram of tissue. In those with Hashimoto’s, selenium supplementation reduced anti-TPO antibody levels and improved the structure of the thyroid gland, as assessed with an ultrasound. This nutrient also decreased the prevalence of postpartum thyroiditis and definitive hypothyroidism when given to pregnant individuals. Finally, in those with Graves’ disease, selenium helped them achieve a euthyroid state sooner than others.[6,7,8]
Zinc has been shown to promote healthy immune system functioning by reducing inflammation caused by autoimmune diseases like Hashimoto's. Deficiencies in zinc status exacerbate hypothyroidism while hypothyroidism itself contributes to zinc deficiency as the thyroid hormones are necessary for zinc absorption.[9] In one clinical trial of 132 patients with goitrous thyroids, six months of zinc supplementation improved thyroid status relative to age matched healthy controls.[10]
Most of us are missing the goalpost!
As mentioned, it should come as no surprise that Canadians don't eat enough of this mineral through their diets because we don't predominantly consume seafood and iodized salt! We've established that we need at least 150 mcg per day, but many people are only getting 100 mcg or less...so how can we ensure we're meeting our needs? The best way is to take a supplement that contains kelp extract - just make sure it meets Health Canada guidelines. Kelp is incredibly high in iodine (upwards of 30,000 mcg per serving) and it's also a great source of other minerals like magnesium, potassium and zinc.
Other good food sources of iodine include seaweed snacks, yogurt, milk and eggs. You can also find selenium in Brazil nuts, tuna, crab and salmon, while zinc is found in beef, lamb, pumpkin seeds and cashews. If you're not getting enough of these nutrients from your diet alone, consider talking with a registered dietician or licensed naturopathic doctor. These health providers spent hundreds of hours training on nutrition. They might help you decide whether supplementing with a multivitamin that contains them makes sense for you.
Should I take iodine every day?
Too much of a good thing is true for supplements, and there are risks involved with consuming too much iodine - the most common being hyperthyroidism (overactive thyroid).[11] Those who take high doses of kelp supplements or regularly use salt water as an antiseptic may be at risk for this condition. The body struggles to tell how much it needs because it doesn't have rapid natural feedback mechanisms as with thirst or hunger. This means overconsumption is possible without realizing it until symptoms present themselves. You can also overdose on this nutrient by taking potassium iodide tablets which contain large amounts of iodine in one pill - the recommended dose should not exceed that discussed with your doctor.
So, how do you know if you're taking too much iodine? If you experience any of the following symptoms, it's best to speak with a health professional about whether or not your dosage is appropriate:
nervousness or anxiety
heart palpitations
sudden weight loss
increased perspiration
heat intolerance
restlessness
If you have an underactive thyroid and are looking for ways to support its function, be sure to talk with your healthcare practitioner before supplementing with kelp extract or other iodine sources. There are many great botanical supplements out there that can help balance the immune system and reduce inflammation - ashwaganda being one of them. So far, research on ashwaganda is promising, and it's a great alternative for those who are at risk of hyperthyroidism.
Ashwagandha, taken daily for 8 weeks, has been shown in randomized, double-blind, placebo-controlled studies to improve thyroid function by decreasing levels of TSH and normalizing T3 and T4.[12] Ashwagandha fosters resilience and helps those taking it cope better with stress. This is crucial as stress signals can dampen communication between the brain and thyroid.[13, 14] Other herbs that may be helpful include liquorice, ginger and turmeric. The best way to determine this would be through testing with your healthcare provider.
How can I ensure my health care practitioner gets all the information they need?
If you're looking for ways to supplement or treat an under-active thyroid, as mentioned earlier, a comprehensive blood test will help identify deficiencies as well as excessive or even toxic amounts that may be generating symptoms.
Did you know thyroid hormones can also affect your digestion?
As we now know, your thyroid gland is responsible for releasing hormones that help regulate your metabolism. These hormones play an important role in digestion, and they can affect everything from your appetite to your bowel movements. If your thyroid isn't working properly, you may experience problems like constipation, diarrhea, nausea and vomiting.
What about medication? Can I still take supplements to support my thyroid health?
The short answer - it depends! Despite the myth that natural equals safe, there are known interactions between botanicals and conventional medications. One to be mindful of is liquorice root, which may increase the potency of certain drugs. The best way to determine whether a supplement or food will interact with your current medications is by talking to a member of your care team trained in both, like an ND with prescribing rights. We can advise you on how much of each nutrient you need as well as what foods and herbs will work best for your unique situation.
If you're concerned about your thyroid health, or if you've been diagnosed with a condition like hypothyroidism, it's important to talk to your care team. But don't forget that you can also take steps to support your thyroid gland with diet and supplements. Stay tuned for my next article on managing ADHD into adulthood!
Share the ways you manage your thyroid health in the comments below!
References
Shahid, M. A., M. A. Ashraf, and S. Sharma. "Physiology, thyroid hormone. StatPearls." (2021).
Stoll, Kathrin. "Disparities in thyroid screening and medication use in Quebec, Canada." Health Equity 3.1 (2019): 328-335.
Mincer, Dana L., and Ishwarlal Jialal. "Hashimoto thyroiditis." (2017).
Chung, Hye Rim. "Iodine and thyroid function." Annals of pediatric endocrinology & metabolism 19.1 (2014): 8.
Bertinato, Jesse, Cunye Qiao, and Mary R. L'Abbé. "Iodine Status of Canadian Children, Adolescents, and Women of Childbearing Age." The Journal of Nutrition 151.12 (2021): 3710-3717.
Drutel, Anne, Françoise Archambeaud, and Philippe Caron. "Selenium and the thyroid gland: more good news for clinicians." Clinical endocrinology 78.2 (2013): 155-164.
Nourbakhsh, Mitra, et al. "Selenium and its relationship with selenoprotein P and glutathione peroxidase in children and adolescents with Hashimoto’s thyroiditis and hypothyroidism." Journal of Trace Elements in Medicine and Biology 34 (2016): 10-14.
Köhrle, Josef. "Selenium and the thyroid." Current Opinion in Endocrinology, Diabetes and Obesity 20.5 (2013): 441-448.
Betsy, Ambooken, M. P. Binitha, and S. Sarita. "Zinc deficiency associated with hypothyroidism: an overlooked cause of severe alopecia." International journal of trichology 5.1 (2013): 40.
Kandhro, Ghulam Abbas, et al. "Effect of zinc supplementation on the zinc level in serum and urine and their relation to thyroid hormone profile in male and female goitrous patients." Clinical Nutrition 28.2 (2009): 162-168.
Scherger, Joseph E. "Hyperthyroidism Caused By Thyroid Hormone Therapy." American Family Physician 94.7 (2016): 530-533.
Sharma, Ashok Kumar, Indraneel Basu, and Siddarth Singh. "Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: a double-blind, randomized placebo-controlled trial." The Journal of Alternative and Complementary Medicine 24.3 (2018): 243-248.
Franci, C. R., J. A. Anselmo–Franci, and S. M. McCann. "Angiotensinergic neurons physiologically inhibit prolactin, growth hormone, and thyroid-stimulating hormone, but not adrenocorticoptropic hormone, release in ovariectomized rats." Peptides 18.7 (1997): 971-976.
Cremaschi, Graciela A., et al. "Chronic stress influences the immune system through the thyroid axis." Life Sciences 67.26 (2000): 3171-3179.
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