Hypothyroidism and Herbalism
by Michael Lee
Hypothyroidism is a clinical condition where the thyroid gland fails to produce enough triiodothyronine (T3) and thyroxine (T4), the hormones responsible for homeostasis of metabolism, glucose oxidation, and protein synthesis in the body. There are many underlying causes for hypothyroidism: iodine deficiency (most common in underdeveloped countries), radiation or surgical treatment of thyroid or parathyroid cancers (post-therapeutic hypothyroidism), Hashimoto’s thyroiditis (autoimmune hypothyroidism), genetic and congenital (cretinism), drug induced hypothyroidism, and pituitary/hypothalmic diseases (ex. tumor/cancer). Hashimoto’s is the most common form in the United States. Because thyroid hormones regulate metabolism, a decrease in production will produce signs and symptoms of lowered metabolism: chills, increase in body weight, sensitivity to cold temperatures, constipation, puffiness of the face, fatigue and weakness, bradycardia (pulse <60), skin and hair changes (scaly, dry, course), hand and finger numbness (partly due to poor peripheral circulation and from poor cellular glucose oxidation), menstrual complaints, headaches, goiter (especially in iodine deficiency), confusion, poor concentration, depression, and delayed growth in children with the condition (UMMC, 2014; Stienburg, 2008; Orlander, et al., 2014; Sinadinos, n.d.).
In order to understand hypothyroidism, it is helpful to have a strong working knowledge of the physiology of the thyroid gland and the hypothalamus-pituitary-thyroid axis (HPT axis). The thyroid is a part of the endocrine system, maintaining hormone levels via a negative feedback loop. When T3 and T4 hormone levels are low, chemoreceptors in the body send messages to the hypothalamus to produce thyrotropin releasing hormone (TRH) which has receptor sites in the anterior pituitary gland. Once stimulated, the pituitary releases thyroid-stimulating hormone (TSH) which has receptor sites in the thyroid gland. TSH levels increase, stimulating the thyroid gland to produce more T3 and T4. When serum thyroid hormone levels reach an appropriate level, the chemoreceptors in the body decrease the amount of stimulation to the hypothalamus, which decreases its efforts to manage thyroid hormone production, hence a negative feedback loop. Iodine is utilized in conjunction with tyrosine in the thyroid follicles through oxidization by thyropyroxidase (TPS) to produce T3 and T4. T4 is in larger serum concetration than T3 and is used in peripheral tissues as a prohormone to be transformed into T3, the more dynamic and active form of thyroid hormones. The liver is the primary peripheral site of T4 transformation into T3. T4 has a half-life twenty times longer than T3 and inversely, T3 is three to five times stronger than T4 in activity (Stienburg, 2008; Orlander, et al., 2014. Selenium, copper, and zinc are utilized in the peripheral tissue as part of the deiodinase enzyme that converts T4 to T3.
Lab work is helpful as clinical indicators of what kind of hypothyroidism is occuring. In cases of hypothyroidism where the thyroid gland does not produce enough hormones, there will likely be a high TSH level and low T3 and T4 levels. In the case of Hashimoto’s thyroiditis (also known as chronic lymphocytic thyroiditis), you have an autoimmune inflammatory process attacking the thyroid gland, causing scarring and destruction of thyroid hormone producing cells. A thyroid panel (T3, T4, TSH) and thyroid antibody test (anti-microsomal, anti-thyroglobulin antibodies) will positively diagnose Hashimoto’s thyroiditis. In iodine deficiency, there is not enough iodine in the diet, causing the tissue to hypertrophy in an attempt to trap as much iodide (iodine’s converted free form) as possible to convert to monoiodotyrosine and diiodotyrosine, which are used in T4 and T3 production (Marthur, 2014). TSH levels rise while T3, T4, and iodine levels are low. In cases of surgical and radiation therapy in treating thyroid and parathyroid cancers, the tissue is destroyed, thus causing treatment-induced hypothyroidism. A surgical history in conjunction with low T3 and T4 levels would be strong indicators and it is important to note that in these conditions, thyroid stimumating herbs are inappropriate (Stienburg, 2008). A less common form of hypothyroidism stems from a cellular disorder causing insensitivity and inadequate conversion of T4 to T3.
There are also peripheral things to consider. Excessive ingestion of iodine can also cause hypothyroidism so when the underlying cause is not due to iodine deficiency; replacement should not be a part of the treatment plan. Hypothyroidism causes an increase in cholesterol and thus a higher risk of atherosclerosis and cardiac disease (Kvetney, et al., 2004; Orlander, et al., 2014). Knowing the underlying cause of hypothyroidism as well as post diagnosis morbidities will shape the holistic recommendation plan (Flaws, 2008; Frances, 2002).
There is underlying genetic and gender predisposition towards hypothyroidism (Orlander, et al., 2014). Depending on where the demographic study is done, the ratio of women to men who have hypothyroidism ranges anywhere from 8-11:1. These ratios are talking about Hashimoto’s hypothyroidism. Also, more recent research is beginning to support the possibility that women who have thyroid function on the high end of normal (TSH levels) have subclinical hypothyroidism and would benefit from early treatment as well as the strong possibility that those with high normal thyroid funciton levels and symptoms are subclinically hypothyridic and often times misdiagnosed (Loeth, 2014)
Since Hashimoto’s hypothyroidism is the most common form of hypothyroidism in the United States, that is the type which will be focused on with regards to herbal and holistic (ex. diet, vitamins & minerals, exercise, mental and spiritual) interventions in this article. Recommendations should focus on underlying issues such as hormone metabolism, immune function including hyperactive autoimmunity, inflammation, and individualized care towards symptoms. Herbal groups that might be used include anti-inflammatories, adaptogens, immunomodulators, hepatic tonics, alteratives, qi tonics (from TCM perspective), anti-cholestremics, circulatory stimulants, and the few herbs that are found to stimulate thyroid function.
It is important to note: These are general lists of herbs catagorized by their function. I recommend taking the handful of herbs that will have the most overreaching impact (3-5 herbs) and mix them with any specific herbs that are symptom driven by choice and start with that as an herbal blended remedy. Follow up and reassessment of the client in conjunction with their primary care provider is strongly recommended.
Anti-inflammatories: Anti-inflammatories are used to decrease the inflammatory process that occurs with this autoimmune disease. These include yarrow, ginger, devil’s claw, plantain, mullein, comfrey (topically), arnica (topically or homeopathically), ashwagandha, cat’s claw, calendula, Jamaican dogwood, oats, spikenard, witch hazel, boswellia, turmeric, bromelain, alfalfa, nettles, evening primrose, ginseng (Asian, Siberian, American), licorice, milk thistle, pine bark extract, grape seed extract, ginkgo.
Adaptogens: Chronic and extended amounts of stress negatively affect the body, including an increase in the inflammatory process and dysfunction of the immune system. Adaptogens help the body to adapt to the stressors it is experiencing, including acute and chronic illness. These adaptogens include astragalus, ginseng (Asian, Siberian, American), licorice, ashwagandha, rhodiola, schisandra root, ginkgo, cordycept mushrooms (maitake, shiitake, reishi), codonopsis, goji berries, suma, and jiaogulan (Blakespore, 2014; Hoffman, 2003; Sinadinos, n.d.; Pure essence labs, 2014).
Immunomodulators: Immunomudulators help to bring the immune system back to a normal range of function, meaning that if it is hyperactive or suppressed, the modulator aims to return the immune system back to a state of homeostasis. In the case of hypothyroidism, an autoimmune response is attacking thyroid cells and ultimately destroying the thyroid’s ability to produce T4 and T3. Many immunomodulators are also adaptogens and anti-inflammatory herbs. Immunomodulators may include echinacea, astragalus, ginseng (Siberian, American, Asian), privet fruit, rhodiola, schisandra root, ashwaganda, greater celandine, thunder god vine, gotu kola, Pterodon pubescens, Stephania tetrandra, assam tea, pomegranate extract, Pacific yew, ginger, frankincense, turmeric, copper leaf, garlic, pineapple, Cissampelos sympodialis, turkey tail mushroom, devil’s claw, Chinese senaga root, milk thistle, tu fu ling, cat’s claw, fu-ling (Blakespore, 2012; Hoffman, 2003, 20014; Spelman, et al., 2006).
Hepatic tonics (including alteratives): The liver metabolizes hormones, cleans toxins from the blood, and tonics for the liver help with decreasing stress on the immune system, more effectively metabolizing hormones, and removing potential inflammatory toxins from the body. Thyroid hormones also affect the ability of certain detoxifying enzyme families in the liver (Faustino, et al., 2011). Alteratives are considered blood cleansers and purifiers, focusing on cleansing organs such as the liver, kidneys, and skin to remove toxins. Hepatic tonics include dandelion root, milk thistle seeds, turmeric, chicory, artichoke, burdock, wild yam, yellow dock, and garlic. Alteratives include dandelion root, echinacea, wild indigo, chickweed, cleavers, gotu kola, prickly ash, myrhh, celery seed, Spilanthes, blue flag, yellow dock, turmeric, Oregon grape root, poke, alder, sarsaparilla, redroot, violet, peach, rose, cherry, red clover, alfalfa, licorice (avoid large amounts in hyper-adrenal dysfunction and hypertension), barberry, bayberry, black cohosh, blessed thistle, burdock root, elder, eyebright, golendseal, marshmallow, nettles, plantain, St. John’s wort, uva ursi, yarrow, bloodroot, blue flag, buckthorn, and sheep sorrel (Hoffman, 2003; 7 song, n.d.; Sinadinos, n.d; Pure essence labs, 2014).
Anti-cholestremics: Anti-cholestremic herbs help to decrease the level of cholesterol in the body or absorption of cholesterol into the GI tract. Because cholesterol levels may increase due to hypothyroidism, this branch of herbs can help decrease the risk of atherosclerosis, vascular occlusion, and potential heart attack. Anti-cholestremic herbs include garlic, onion, guggal, methi, yarrow, rosemary, turmeric, ginger, soy, ginger tea, alfalfa, psyllium, red yeast rice, butcher’s broom (avoid in hypertension), licorice, and hawthorn (Hoffman, 2003; Weil, 2014 b.), .
Qi tonic herbs: Qi is a TCM concept that translates to Western ideology as ‘life force’ or energy. In TCM, traditional approach to hypothyroidism focused on those patients who had signs and symptoms of hypothyroidism, which was kidney and spleen dampness, and depletion of qi (Dharmananda, n.d.; Flaws, 2008). Kidney and spleen tonics as well as qi tonics were prescribed. In subclinical hypothyroidism, TCM practitioners have had to reevaluate their approach and feel that in these cases liver tonics are more appropriate. Qi tonic herbs include rhodiola root, astragalus, ginsengs, atractylodes, licorice, wild yam, huang jing, codonopsis, jujube, longan fruit, and schisandra (Pure essence labs, 2014; Mountain Rose Blog, 2014; Teeguarden, n.d.).
Circulatory stimulant herbs and cardiac tonics: Hypothyroidism slows down the heart rate, which impedes circulation of oxygen, glucose and nutrients to the body as well as returning carbon dioxide and other metabolic wastes to the lungs, liver, and kidneys. Better circulation also brings nutrients like selenium to the peripheral tissue so that it has a better chance of converting T4 to T3. Since qi pushes blood from a TCM perspective, many circulatory stimulants are also qi herbs (Flaws, 2008). Circulatory and cardiac tonic herbs include garlic, hawthorn, linden, cayenne, ginger, goji berries, ginkgo biloba, prickly ash, parsley, schisandra, rosemary, foods rich in magnesium, nettles, turmeric, dong quai, bilberry, and olive leaf extract (Hoffman, 2003; Pure essence labs, 2014; Degrandpre, 2013; Self, 2011)
There are herbs that stimulate the thyroid gland. Thyroid stimulating herbs will help with increasing the metabolic rate, but do not necessarily address the underlying reasons for Hashimoto’s hypothyroidism. They need to be used in conjunction with herbs that do address the underlying issues. Some herbs mentioned include guggal, ashwagandha, Coleus forskohlii, milk thistle, black cohosh, and bacopa (UMMC, 2014; Stienberg, 2008).
Certain herbs are thought to suppress of the thyroid gland and might want to be avoided in the picture of hypothyroidism. These herbs include lemon balm, motherwort, holy basil (tulsi), fenugreek, and bugleweed (Stienburg, 2008).
Other aspects of holistic health need to be considered in terms of hypothyroidism. Mental and spiritual health, diet, exercise, and the consideeration of vitamins and minerals should be reviewed with the client as well as herbal recommendations. State of mind is critical in facing and managing any chronic condition. A person is not defined solely by their condition and this is not their master role in life. They are not ‘hypothyroid guy’ or ‘Hashimoto’s girl’. It is important to clearly point this out to clients and encourage them to identify when they mentally take on this kind of attitude with a cognitive behavioral approach. They should immediately stop what they are doing, take a few slow breaths to a count of ten, and then actively recall all the other aspects of who they are as well as recognizing the faulty assumptions they might have about themselves based on having this diagnosis. Behavioral cognitive therapy is used to examine and disrupt skewed self-perception. The client’s internal and external resources and support should be identified and used to help maintain stability if needed, especially if depression is a current symptom of condition. Meditation, yoga, tai chi, and similar body-mind exercises can help a person adjust to stressors in their lives (Bhutani, 2014). Low impact aerobic exercise (ex. walking, water aerobics) and strength training burn calories and improve mood without putting overt strain on joints. Spiritual support may be gained by relying on one’s faith in the face of stressful experiences to get them through those tough times. For some, organized religion is off-putting, and so a different approach to spirituality might need to be considered. Spiritual connection does not necessarily have to be within the parameters of any specific religious faith. Spiritual connection may be gained by interacting with family and friends, through interaction with pets, walking and communing with nature, or being involved in service to the community through volunteer work. These acts of spiritual connection can help support a person while experiencing emotional and physical stressors.
Diet has a strong impact on the body’s metabolic function. Highly processed, refined, and nutritiously devoid foods should be avoided. Foods that are high in fats and sugar are not metabolized as quickly due to decreased metabolic state and will increase risk of weight gain and morbid obesity. Dietary exclusion when possible should also include alcohol, caffeine, cruciferous vegetables (they contain goitrogenic phytochemicals), and omega-6 rich oils with little or no omega-3 in them (sunflower, safflower, soy, peanut, corn, cottonseed) due to use of omega-6 by the body in the inflammatory cascade process (Bowthorpe, 2015; UMMC, 2014; Sinadinos, n.d.). Iodine and high iodine herbs (kelps, seaweeds, bladderwrack, etc) are not appropriate treatments in Hashimoto’s hypothyroidism. It is not an issue of iodine deficiency and excessive iodine intake is more likely to exacerbate the hypothyridic state than help (Orlander, et al., 2014). Although several research studies have shown soy products do not interfere directly with thyroid function, it does interfere with the absorption of thyroid hormone replacement and should not be taken within 3 hours of ingestion of thyroid medications (Weil, 2014 a.). It has been suggested to avoid gluten due to the potential for GI induced systemic inflammation, especially in gluten intolerance as well as when inflamed bowel tissue occurs which can impede thyroid medication absorption. Several sources mention foods that inhibit the absorption of thyroid medication. One thing to keep in mind with these concerns about absorption is that physicians recommend taking the pill on an empty stomach an hour before eating. This helps circumvent any absorption issues.
Adequate vitamin and mineral intake in food sources are also important for adequate thyroid function. Vitamin A and vitamin D are required for production of TSH and conversion of T4 to T3. Vitamin D also protects the thyroid from autoimmune attack. Vitamin E is thyroid protective. Selenium, copper, magnesium, and zinc are needed for peripheral tissue conversation of T4 to T3. B complex vitamins are required for metabolic functions. Tyrosine is important in that it is the amino acid used in conjunction with iodide to make T4 and T3. A diet with a wide range of vegetables and fruits, whole grains, nuts, legumes, and lean meat (preferably skinless poultry and fish) should adequately cover the daily need for these vitamins and minerals.
This article was compiled from a wide range of references and viewpoints dealing with hypothyroidism and holistic recommendations in treating it. David Hoffman points out in Medical Herbalism that because the endocrine system is a newer system to be understood and treated in the medical world, there is less research available supporting how herbs affect it. Much of what is available is based on the theory and practice of modern Western herbalism, TCM, Ayurveda, and on traditional Western herbal practices documented over the last 2000 years. I strongly recommend that anyone considering working with herbal blends, tinctures, and healthcare plans addressing hypothyroidism take this article as a beginning point in exploring holistic approaches to the disease and expand on it with their own research to clarify for themselves what is sound and appropriate in their own philosophical holistic practice.
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