Why thyroid disorder is often misdiagnosed?
Part 1 of 2: What is impacting your thyroid health?
Your thyroid is an extremely important endocrine gland, responsible for so many critical functions necessary to maintain overall good health. Every cell in the body has receptors for thyroid hormones. This fact highlights the role the thyroid gland plays in the body.
Millions around the world suffer from thyroid disease and most of them are not even aware they have it. Women are at an increased risk of developing a thyroid disorder, especially hypothyroidism, which happens when the body is not making enough thyroid hormones, and usually due to an autoimmune disorder. Unfortunately, it is often difficult to diagnose a thyroid problem. The symptoms are slow to manifest, and certain symptoms such as insomnia, fatigue, depression, weight gain or weight loss are non -specific. Most of these symptoms are usually mistaken for some other health issue.
In addition, untreated thyroid disorder can increase your risk of other health issues such as osteoporosis, fibromyalgia, infertility, diabetes, depression, heart disease and other autoimmune conditions. In pregnancy, a woman’s body produces more thyroid hormones to meet the increasing energy requirements. If a pregnant woman is not making enough thyroid hormones, it can lead to all kinds of complications for the unborn child, such as abnormal brain development, poor bone growth and an increased risk of miscarriage and birth defects. It is, therefore, important to get a timely diagnosis of thyroid dysfunction.
We bring you a 2-part series on why your thyroid disorder is at risk of being overlooked, and even misdiagnosed. Let’s begin with knowing how your thyroid gland works and what are the factors that adversely affect thyroid health.
Thyroid gland and its workings
The thyroid gland is a butterfly-shaped gland located just under your larynx, also known as the Adam’s apple. The thyroid makes hormones that play a major role in metabolism and are intricately involved in regulating various functions – including energy production, growth and development, reproduction, digestion, body temperature, breathing and more.
The thyroid gland takes iodine from the food you eat and produces hormones – thyroxine (T4) and triiodothyronine (T3) – in a process that is tightly regulated by the signals between the gland, brain and the circulating levels of the hormones in the blood. When T3 and T4 levels in the blood are low, the hypothalamus produces TSH releasing hormone, which further stimulates the pituitary gland to make more of the thyroid stimulating hormone (TSH). TSH now signals the thyroid gland to make more hormones that your body needs to function well. With T3 and T4 levels returning to normal, the pituitary gland slows down the production of TSH.
The thyroid gland produces another hormone called calcitonin, that is responsible for calcium metabolism and bone development.
Conversion of T4 into T3
Your thyroid gland produces T4 in much greater amounts than T3. In fact, more than 90% of the hormone produced by the thyroid gland is in the form of T4, which is metabolically inactive. Your body converts T4 into more active T3 in various tissues with the help of an enzyme group called deiodinase. Most of the conversion takes place in the liver and to some extent in the gut, thyroid gland, brain and kidneys. So, people with liver problems or gut issues may have impaired conversion of T4 to T3, leading to low T3 levels circulating in the bloodstream. There are many other factors that can interfere with proper conversion. We will talk about these factors in the course of this 2-part series on thyroid health.
The liver produces transport proteins, including thyroid binding globulin (TBG), that transport T4 and T3 to various tissues. Most of the thyroid hormone is bound to these proteins. Once the hormones reach their destination, they are released from the proteins in the blood and are now free to bind to the thyroid hormone receptors (THRs), present on the surface of every cell in your body.
Different types of thyroid disorders
It is a condition where the thyroid gland doesn’t produce enough hormones. Symptoms of hypothyroidism include unexplained weight gain, irregular and heavy periods, puffy face, increased sensitivity to cold, constipation, dry skin, coarse hair, thinning hair, brittle nails, lethargy, muscle cramps, muscle weakness, slow heart rate, high cholesterol levels, sexual dysfunction, depression and trouble remembering.
Hashimoto’s disease is the leading cause of hypothyroidism. It is an autoimmune disorder, where your immune system mistakenly attacks the thyroid, affecting its ability to make thyroid hormones.
It is a condition where the thyroid gland produces too much thyroid hormones. Common symptoms of hyperthyroidism include excessive sweating, fast heart rate, insomnia, frequent bowel movements, unexplained weight loss, shaky hands, hyperactivity, bulgy or puffy eyes, double vision, hair loss, fatigue, muscle weakness, short or light periods and mood swings.
Grave’s disease is the most common cause of hyperthyroidism. It is an autoimmune disorder, where your immune system makes antibodies, known as thyroid-stimulating immunoglobulins (TSIs). These antibodies bind to thyroid hormone receptors present on the surface of thyroid cells, stimulating the thyroid gland to make more hormones than required. 
Factors that may be affecting your thyroid health
Factors that can trigger your thyroid gland to haywire include:
- Autoimmunity (Grave’s or Hashimoto’s disease)
- Goiter (enlarged thyroid gland)
- Thyroiditis (inflammation of thyroid gland that can be caused by surgery, pregnancy, viral or bacterial infection, radiotherapy and certain drugs such as interferon and amiodarone).
- Thyroid nodules (abnormal tissue growth)
- Thyroid cancer
While these conditions are the main reasons why you may be suffering from hypothyroidism or hyperthyroidism, there are many other factors that may interfere with the overall workings of the thyroid gland. After all, your thyroid health doesn’t just depend on making the right amount of hormones. There could be issues with uptake of hormones by the cells or with conversion of inactive T4 into active T3.
Certain situations like leaky gut syndrome, high stress levels, chronic infections, systemic inflammation, deficiency of certain nutrients, hormonal imbalances, and exposure to environmental toxins can directly or indirectly impact your thyroid function – including the production or conversion of thyroid hormones.
Let’s have a closer look at how these factors disturb your thyroid gland in more ways than one.
1. Chronic stress
High stress levels can damage thyroid health in more ways than one. During stress, your adrenal glands are working overtime and release high amounts of cortisol, a stress hormone that is associated with poor thyroid health. Chronic stress and excessive cortisol in the blood:
- Causes adrenal fatigue and disturbs the Hypothalamus-Pituitary-Adrenal axis. This suppresses the production of thyroid hormones
- Adversely affects the conversion of T4 into T3
- Increases blood sugar levels
- Lowers the liver’s ability to metabolize and get rid of excess estrogen, leading to increased estrogen levels
- Causes leaky gut syndrome, that impacts thyroid health in multiple ways
2. Poor gut health
Your gut health is very closely related to thyroid health. Poorly functioning gut can create inflammatory conditions, giving rise to autoimmunity. It can also impair the conversion of T4 into T3, the form of thyroid hormone that your cells really need to do their job. Poor gut health also interferes with nutrient absorption, another factor that adversely impacts your thyroid gland at many levels.
Leaky gut and autoimmune connection: Chronic stress, unhealthy diet, gluten, small intestine bacterial overgrowth (SIBO), untreated digestive issues and zinc deficiency can all cause leaky gut. It is a condition where the tight junctions across the gut lining develop spaces or holes, allowing undigested food particles and toxins from the gut to enter the bloodstream. Your immune system springs into action, creating antibodies and launching inflammatory responses to deal with this unwanted leakage. Chronic and untreated gut issues can eventually drive the immune system to even mistakenly attack its own healthy tissues – leading to autoimmune disorders, including Hashimoto’s.
Gut health and T4 -T3 conversion: Your body converts T4 into active T3 and 20 % of this conversion takes place in your gut. Healthy gut flora is a source of an enzyme required for this conversion. If you are suffering from gut dysbiosis (a condition where the balance between friendly and bad bacteria is disrupted), you may experience low thyroid function due to decreased levels of T3.
Poor gut function and nutrient absorption: You need a healthy gut for proper absorption of nutrients that are essential to maintain healthy thyroid functions.
3. Nutritional deficiencies
Production of the right amount of T4 and T3 hormones is not the only thing that you need for healthy thyroid function. It also involves conversion of T4 into T3 and then uptake of T3 by the cells. all these processes require adequate nutrition, where protein, selenium, iodine, zinc, magnesium, B vitamins, vitamin D, iron, manganese and healthy fats play a particularly important role.
4. Chronic infections
Long standing, hidden infections are again one trigger that is often overlooked. Pathogens like Hepatitis C, Helicobacter pylori and Epstein Barr have been associated with autoimmune thyroid disease. Research from 2016 highlights a possible link between Epstein-Barr virus infection and autoimmune thyroid disorders and also notes that “EBV infection can cause autoimmune diseases, such as systemic lupus erythematosus (SLE), multiple sclerosis (MS), rheumatoid arthritis (RA), Sjögren’s syndrome, and autoimmune hepatitis”. 
5. Gluten sensitivity and other food intolerances
Gluten is a protein found in grains such as wheat, rye and barley. Celiac disease often springs to mind when you think of gluten sensitivity. Celiac disease is an autoimmune inflammatory disorder that affects the small intestine and is triggered by the consumption of proteins found in wheat, barley or rye in people who are genetically prone.
Most people with celiac disease show no obvious symptoms, making the diagnosis a real challenge. Interestingly, individuals with celiac disease are more likely to develop other autoimmune disorders such as autoimmune thyroid condition than the general population. And what’s more, studies show that gluten free diet improves thyroid symptoms in people with active celiac disease. The association between celiac disease and thyroid dysfunction implies that patients with Hashimoto’s thyroiditis should be screened for celiac disease and vice versa. 
Unfortunately, gluten sensitivity or gluten intolerance is often an overlooked factor when it comes to thyroid health. So, how exactly is gluten intolerance tied to thyroid disease? Gluten contains a protein called gliadin. This protein is structurally very similar to an enzyme called transglutaminase, which is present in the thyroid gland in much higher concentrations than other tissues. When a person with gluten sensitivity or celiac disease consume foods containing gluten, it can trigger their immune system to produce antibodies to counter and remove gliadin from the bloodstream. Unfortunately, these antibodies also mistakenly attack and destroy your thyroid gland, leading to impaired production and regulation of thyroid hormones.
In addition, sensitivity to gluten is known to cause leaky gut, which creates chronic inflammation and triggers your immune system to go out of control, creating antibodies. This often increases the risk of developing auto-immune conditions including Graves’ and Hashimoto’s. If you have an autoimmune thyroid problem or any other autoimmune condition for that matter, it is best to completely avoid gluten containing foods in your diet. In fact, eating such foods just once can have long lasting impact as gliadin-attacking antibodies can last up to 6 months, causing destruction to not only the thyroid gland but also to other tissues such as the brain and joints. You may avoid gluten for weeks but still show troubling signs and symptoms affecting your digestive and thyroid health. It is because it may take 6 months to recover from the misdirected immune response that gluten triggers.
6. Estrogen dominance
Women are more likely to suffer from hypothyroidism than men. And experts believe that estrogen could be one significant contributing factor.
What happens is that the levels of progesterone start to gradually decrease after a woman hits her mid 30’s. This disrupts the progesterone-estrogen balance, resulting in higher levels of estrogen. This is called estrogen dominance. Besides aging, there are many other factors that may throw off this balance, such as excessive production of estrogen in the body due to some hormonal disorder, chronic stress, use of birth control pills, hormone replacement therapy, poor liver function and obesity.
There is another important source that leads to high levels of estrogen in the body: xenoestrogens. These are chemicals that work as endocrine disruptors and are found in everyday things such as plastics, pesticides and grooming products such as soaps, shampoos, skin creams, hair sprays, cosmetic foundation, body wash, nail polish, nail polish remover and other cosmetics.
High levels of estrogen is not good news for your overall health. This hormonal imbalance, if left unchecked, can result in many side effects such as fluid retention, uterine fibroids, heavy painful periods, headaches, endometriosis, polycystic ovarian syndrome (PCOS), anxiety, depression and even a high risk of breast cancer.
Estrogen dominance can be especially daunting for your thyroid health. Out of control estrogen levels trigger the liver to produce a specific protein called thyroid binding globulin or TBG. This protein binds to thyroid hormone, making it unavailable for cells to use. This leads to sluggish thyroid function and symptoms associated with hypothyroidism.
In the second part in this series, we will discuss why traditional methods of diagnosing thyroid disorder may not be enough, and how you may need additional nutritional support to treat your thyroid problem holistically.
1. Graves’ Disease. American Thyroid Association.
2. Dittfeld et al. A possible link between the Epstein-Barr virus infection and autoimmune thyroid disorders. Cent Eur J Immunol. 2016.
3. Hadithi et al. Coeliac disease in Dutch patients with Hashimoto’s thyroiditis and vice versa. World J Gastroenterol. 2007