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December 19, 2014

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.

TriangleThyroidDoctor.com

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.

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© 2014 David Clark. All Rights Reserved.

Dr. David Clark, DC
Functional Neurologist (FACFN)
Diplomate College of Clinical Nutrition
Board Certified Chiropractic Neurologist
Vestibular Rehab Specialist (ACNB)
919-401-0444
1515 W. NC Hwy 54 Ste 210
Durham, NC 27707

URL: http://www.doctordavidclark.com
Twitter: http://www.twitter.com/DrDavidClark
Facebook: http://www.facebook.com/pages/Dr-David-Clark-Functional-Neurologist/92451382182

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.
cause of low thyroid

December 18, 2014

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

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 tesosterone 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.

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© 2014 David Clark. All Rights Reserved.

Dr. David Clark, DC
Functional Neurologist (FACFN)
Diplomate College of Clinical Nutrition
Board Certified Chiropractic Neurologist
Vestibular Rehab Specialist (ACNB)
919-401-0444
1515 W. NC Hwy 54 Ste 210
Durham, NC 27707

URL: http://www.doctordavidclark.com
Twitter: http://www.twitter.com/DrDavidClark
Facebook: http://www.facebook.com/pages/Dr-David-Clark-Functional-Neurologist/92451382182

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.
low thyroid symptoms, PCOS and low thyroid

December 17, 2014

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.

TriangleThyroidDoctor.com

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.

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© 2014 David Clark. All Rights Reserved.

Dr. David Clark, DC
Functional Neurologist (FACFN)
Diplomate College of Clinical Nutrition
Board Certified Chiropractic Neurologist
Vestibular Rehab Specialist (ACNB)
919-401-0444
1515 W. NC Hwy 54 Ste 210
Durham, NC 27707

URL: http://www.doctordavidclark.com
Twitter: http://www.twitter.com/DrDavidClark
Facebook: http://www.facebook.com/pages/Dr-David-Clark-Functional-Neurologist/92451382182

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.

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