Friday, July 2, 2010

Memo to Your Thyroid: Role of Adrenals & Estrogen/Progesterone, etc

Somehow I made it through med school, residency and years of medical practice before I figured out a key epiphany: interdependence of the glandular systems of thyroid, adrenals and sex hormones (estrogen, progesterone, testosterone). Turns out I needed to teach it to myself - it's not in the medical textbooks or even conventional medical discourse. Once I got "it," meaning how all these crazy thryoid, adrenal and sex hormones fit together, much of my thryoid chaos fell away, for myself and more importantly, for my patients.

Here's the memo I never got.

1.   Got estrogen? Got too much estrogen? Estrogen dominance is common with hypothyroidism. Symptoms are: moodiness, cysts (ovarian, breast), weight gain, night sweats/hot flashes, irregular cycles. Too much estrogen raises thyroid-binding globulin, and this in turn can bind your free thyroid hormones, even if they are present in the right amounts. Think see-saw: if estrogen is high, free thyroid hormone is low. And vice-versa.
2.   Conversely, hypothyroidism causes sex-hormone binding globulin (SHBG) to decrease – this raises both free testosterone and estrogen. Note the significant overlap between estrogen dominance and hypothyroid symptoms – there is both redundancy in this system and crossover. Best fix: balance both systems simulataneously or sequentially. Most conventional docs will look at you like you’re nuts if you mention estrogen dominance – find an integrative doc here or test yourself.
3.   Adrenals operating properly? Adrenal function and thyroid function have a relationship also like a see-saw: when one is up, the other is down. Get both systems balanced so the see-saw is even.
4.   More on cortisol: correct amount of cortisol (not too much, not too little) helps the conversion from T4 (inactive thyroid hormone with 4 iodine atoms) to T3 (active form – 3-4 times more potent than T4, 3 iodines). You can check a questionnaire to assess for this, or even better, get it tested right here. Another benefit of balanced adrenal hormones is less thyroid inflammation.
5.   Polycystic ovaries? Another key aspect of interdependence is the dance between PCOS, your adrenals and your thyroid.  While the cause isn’t well-delineated, I believe most of PCOS begins with the stress cascade of overtaxed adrenals and too much cortisol in the fight-flight-collapse response, and leading to insulin resistance (typically defined as fasting insulin > 7), which is toxic to the ovary and makes progesterone levels drop. This leads to irregular cycles and imbalanced hormones (high androgens, high estrogens). One treatment is more progesterone, preferably the natural flavor as Chastetree Vitex, progesterone cream or prometrium. But that’s another blogpost for another day. Key point is that high cortisol when stressed can block your progesterone receptors, keeping the progesterone you make from doing its job. Another cause of high cortisol? HYPOTHYROIDISM! Oy, interdependence is a vicious cycle until you understand it. But know this: women with PCOS are four times more likely to have hypothyroidism due to autoimmune thyroiditis
6.   Speaking of inflamed thyroids, have you been tested for thyroid antibodies? Know your titers? Crucial, my friend. More often than not, your under-active or over-active thyroid is a result of autoimmune thyroiditis. What makes autoimmune thyroiditis worse? You guessed it, adrenal dysregulation and estrogen dominance. Oh, and digestive inflammation.
7.     Iodine, as the differentiator between thyroid hormones, is essential to the right balance of thyroid. I find most of my patients are deficient in the Bay Area of California, but too much can cause problems too. Best plan of action is to perform a iodine challenge test, available through Meridian Valley Labs in Washington among other places.
8.     Nutrition – what does that have to do with hormones? A ton. Just going gluten-free reduces estradiol (the key estrogen of our reproductive years and bioidentical hormone therapy in women 40+) by 30-40%. Big help if you’re estrogen-dominance.
9.     Got goitrogens? I’ve never heard a conventional doc talk to patients about foods (called goitrogens) that lower your thyroid function. Tell me your stories of docs who are sharing this info! Yet, as with most things, the info is easy to find online. Raw foods are lightly goitrogenic (cooking inactivates the goitrogenic compounds). Short version: strawberries, pears, peanuts, pine nuts, cassava (yucca), Brassica veggies such as broccoli, bok choy and brussel sprouts. I know, I know – they help your estrogen metabolism but recall the see-saw analogy.
10.  Polyendocrinopathy? Long word, key concept – refers to more than one endocrine gland malfunctioning at a time. Sometimes the thyroid is the first to manifest (or perhaps more commonly, the only one to be tested and/or recognized by your doc), yet one or more endocrine glands is on the wane. This can cause a more complex array of symptoms that are harder to treat. This is where a root cause analysis and step-wise or multi-system hormone treatments can be helpful.
You maybe wondering with all this complexity and interdependence, which is the chicken and which is the egg? Often we don’t know. That’s where balancing all three systems either simultaneously makes the most sense.
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Originally posted on the fantastic site for thyroidistas, Dear Thyroid.

1 comment:

helderheid said...

This is a WONDERFUL post. I just recently had blood drawn to look at my hormones with a doctor that specializes with bio-identical hormone balancing. I have an appointment Thursday to go over the test results. I shared this article with my mom and sister who were thrilled to have this info. Thanks!

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I'm an organic gynecologist, yoga teacher + writer. I earn a living partnering with women to get them vital and self-realized again. We're born that way, but often fall off the path. Let's take your lousy mood and fatigue, and transform it into something sacred and useful.