Thyroid Yoga

You've heard the analogy that your thyroid acts as your body's "gas pedal" by releasing energy hormones that modulate the metabolism of your organs and cells. Your thyroid determines how fast your engine runs.

In previous posts, I've commented on the interdependence of your thyroid with other key glands, particularly your adrenals and ovaries. The adrenals act, as we continue the car analogy, like a steering wheel. Your sex hormones (estrogen, progesterone, testosterone), on the other hand, serve as the ignition -- sparking the life of your engine. I think of the engine as your liver: our livers govern how we metabolize hormones, and the liver in turn is significantly controlled by leptin and insulin.

How complicated. 

Where can we simplify and just find a little relief? What can I offer when your gas pedal is sluggish or sticky or slammed to the metal of the car floor? When your slow progress toward euthyroidism (normal thyroid labs AND normalized symptoms) is frustrating you endlessly, Yoga comes to mind. Not just because I’ve found yoga to be the best system I’ve encountered for extraordinary living, but because yoga has helped my thyroid provide a smooth ride for 35+ years (I started practicing yoga as a kid, seriously) as well as those of my patients.

We know that yoga provides balance. It is a middle path, and for many of us with lazy thyroids, this is welcome news. We know that most of us seek yoga to manage stress, and that yoga is incredibly effective at balancing stress hormones such as cortisol. It lowers cortisol when it’s high and giving you that tired-wired feeling, and it raises cortisol when it’s low and giving you that “I-need-to-lie-down,-immediately” vibe (provided you don’t have the severest form, called Addison’s Disease).

In the yoga tradition of the past 2500 years, the thyroid is related to the vishuddhi chakra, which is the psychic center that purifies the toxins of the body and turns them into nectar of immortality. Good health of the entire neuroendocrine system is understood to be vital to our higher awareness.

OK, OK, Get Me to the Practical Stuff….

Here’s a Yoga Class, featuring the yoga practices that best balance your thyroid.

Shoulder Stand

If you’ve ever practiced yoga, you probably know that shoulder stand is the mama of all poses (asanas) for healing your thyroid. When you properly come into shoulder stand, you place robust pressure on your thyroid, squeeze out much of the huge blood flow of our little butterfly organ with the chin against your trachea (windpipe), and when released, new and fresh blood infuses your little gland. Old secretions and hormones get washed away, circulation improves, and the nerves are stimulated, reminding the gland to wake up and assume more tasks. In the yoga tradition, you send awareness and prana to your thyroid in shoulder stand, and prana or life force is the vehicle of healing.

Shoulder stand also places robust pressure, in fact the weight of most of your body, onto your little cervical vertebrae in the back of your neck. Make sure you do the pose properly, with an experienced teacher watching your every move until you are safe and skillful at it.

After shoulder stand, we traditionally perform matsyasana or fish pose, to allow all that delicious prana to move into the thyroid.

If daunted, move on first to some of the other asanas described below which are less risky.

Ujjayi Pranayama (“Victory Breath”)

This breathing exercise acts also directs prana to the throat area and stimulates some of the reflex pathways of the through associated with breathing and swallowing. Many call it the “Ocean-Sounding Breath” or more colloquially, “Are you trying to breathe like Darth Vadar?” Learn this from a teacher – it is the basic breathing practice of Ashtanga and many vinyasa classes.

Viparita Karani (“Legs Up the Wall Pose”)

This is a really simple exercise that nearly all of us can do with little experience. Lie on the floor next to a wall. Create an L-shape with your legs up the wall, at a 90-degree angle to your torso, which is on the floor. Lie here for 10 minutes with your eyes closed and allow the pressure to weigh down on your thyroid and breath like Darth Vadar, constricting your glottis as you inhale for 5 seconds and exhale for 5 seconds.

There are many other scrumptious practices for the thyroid such as Nadi Shodhana (another breathing exercise that balances your hormones), Surya Namaskara, Supta Vajrasana, and Jalandara bandha, but that’s all I have time for today.

Thyroid Goddessness

When I was 38, I discovered that my thyroid was a laggard. After having trouble losing weight post-partum from my second baby, and had a vague feeling that Kaiser's version of what constituted a normal thyroid test was different from my version. I decided to test my T3, and low and behold, the sucker was low. Soon I started a small dose of Armour Thyroid, and all was good in the world again: my body responded to exercise by losing fat, I didn't have to be as fastidious about what I ate, and my energy was vastly improved.

 As with many issues in integrative medicine, there's a gigantic gap between what conventional medicine has to say about what is normal thyroid function and what integrative or functional medicine offers. Daily I discover that my patients have a low free and/or total T3, the active version of thyroid hormone that makes you leap out of bed in the morning.  Or I find that they have autoimmune thyroiditis, and even thought their Thyroid Stimulating Hormone (TSH) is normal, they are making antibodies to their thyroid and heading toward a crash.

Many symptoms characterize an underactive thyroid but the top two are: weight gain and fatigue. Here are some other common symptoms: constipation (which I define as less than two bowel movements per day), cold hands and feet, depression, hair loss, joint achiness, poor memory and executive functioning, and increased cholesterol. The list is long and I have a questionnaire for you on the blog right here. Take the quiz to see if you should test, and consider performing a thyroid panel home test via Canary Club for free T3, TSH, free T4 and thyroid peroxidase antibodies. I am also a big fan of following your reverse T3 but I don't know where you can order that as a home test.

When you have thyroid issues, your diet requires your rapt attention. Got goitrogens in the food you're eating? 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.

For more info on thyroid, I highly recommend Mary Shomon's excellent books as well as Thyroid Power by Dr. Richard Shames, MD. I challenge you to have goddess-like thyroid function, which is, after all, your birthright.

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.

How's That Thyroid?

I'm re-posting this great thyroid questionnaire, modified from the Hotze Health and Wellness Center. If the question addresses a concern that applies to you, record the number. When done, total the numbers.

1. Do you experience fatigue (4)?
2. Is your cholesterol elevated (4)?
3. Do you have difficulty losing weight (2)?
4. Do you have cold hands and feet (2)?
5. Are you sensitive to cold (2)?
6. Do you have difficulty thinking (2)?
7. Do you find it hard to concentrate (2)?
8. Do you have poor short-term memory (2)?
9. Are your moods depressed (2)?
10. Are you experiencing hair loss (2)?
11. Do you have fewer that one BM per day (2)?
12. Do you have dry skin (2)?
13. Do you have itchy skin in winter (1)?
14. Do you have fluid retention (2)?
15. Do you have recurrent headaches (1)?
16. Do you sleep restlessly (1)?
17. Do you experience afternoon fatigue (2)?
18. Are you tired when you awaken (2)?
19. Do you experience tingling in hands or feet (2)?
20. Have you had infertility or miscarriages (2)?
21. Do you have decreased sweating (2)?
22. Do you have muscle aches (2)?
23. Have you had recurrent infections (2)?
24. Do you have joint pain (2)?
25. Do you have thinning of your eyebrows or eyelashes (2)?

Score < 11? You are unlikely to have a thyroid problem.
Score 11-30? Low thyroid function is a possibility.
Score >30? Low thyroid function is probable.
Get tested if your score is > 11, including a free T3 and TSH.