6 Causes of Hypothyroidism You Probably Don’t Know About


6 Patterns of Hypothyroidism

#2 of 6, The Pituitary Pattern


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You can read the transcript of this video below: 6 Patterns of Hypothyroidism, #2 of 6 The Pituitary Suppression Pattern

Hey everyone, Dr. Shook here. In this video what I want to talk to you about is hypothyroidism due to hypo, or low function of the pituitary gland in the brain. We're going to talk about hypothyroidism, low thyroid hormone, due to the pituitary gland not working properly. If you've seen any of my other videos, I'll explain to you how the physiology, the body, produces and stimulates production of the thyroid hormone. It all starts in the brain. A central structure called the hypothalamus. The hypothalamus detects when the blood levels of T4 are low or high, and it adjusts the output of a hormone called TRH, thyroid releasing hormone, It adjusts it, it will increase it if the levels are low, it will decrease it if the levels are high. TRH stimulates the pituitary gland, which is the brain right here between your eyes, right behind your skull here, to produce TSH, thyroid stimulating hormone. Thyroid Stimulating Hormone (TSH) stimulates the thyroid to ramp up production of T4 and T3. Okay?
When those levels are up, the hypothalamus is detecting the levels of T4 and T3 in the blood. If there's high T4, T3, then the hypothalamus decreases output of the hormone, slowing down the pituitary gland, decreasing the output of thyroid stimulating hormone. Because right, if these levels are high, there's no reason to stimulate more production so TSH goes down. The TSH is what's commonly ordered by your doctor to screen for your thyroid dysfunction. It's important to know this one relationship first. When T4 is low, and T3 are low, TSH, if this feedback loop here is working, if the brain can detect the levels that are in the bloodstream appropriately.
If the feedback loop is working, then if these T4, and T3 are normal or high, TSH should be lower, because you don't need stimulating hormone of the thyroid if the levels are high enough, right? So they're inverse. Then if these levels are lower, if the T4 and T3 are lower, then the brain's going to detect a need for hormone and signal the pituitary gland to make more TSH, so TSH rises because it's thyroid stimulating hormone, so we want more TSH to stimulate the production of T4 and T3 which would be low. The idea is that they're balanced, right? If this system works appropriately and that you normal, balanced them amounts.
What happens in this pattern is that the pituitary gland does not put out TSH. It doesn't make enough TSH to stimulate the thyroid, even though there's a need for it. There's not enough hormone here, but the TSH is not rising. Your T4 and T3 are low, but the TSH output isn't high enough to stimulate the gland. Now why would the pituitary gland decrease and not make enough TSH? Okay? Well, this is a functional hypothyroid pattern. We're not talking about the of the pituitary where there's no TSH. We're not talking about pathological. We're talking about these are very common functional patterns that I'll see in practice, that we can support most of these nutritionally, and help to support improving this physiology rather than just taking a medication. Let's look at this pattern in a little bit more detail.
When you see that this pituitary gland is not making much TSH, first of all let's talk about how we detect in on labs, right? On labs what we typically see is a TSH, which remember this is the marker that's usually checked by your doctor, TSH will be 1.8 or below, but it won't be hyperthyroid low. Typically .45 is the bottom of the lab range. It varies from lab to lab but usually we see it around .45. If it's below that it's more suggestive of hyperthyroidism and can be a different problem altogether. It's not usually this pattern. Usually if it's below 1.8 and the TSH is below 1.8 meaning TSH is lower, right? But it's not quite so low that it's hyper, or suggesting hyperthyroidism, which is too much thyroid hormone, that's the first thing.
The second thing is that the total T4, so the total T4 that's made, and usually it will show as TT4, or as a total T4, or total thyroxin, it'll be below six. Okay? So lower than six, okay? So lower than six with the TSH at 1.8 or below 1.8, okay, but not too low. This is what you'll typically see on the labs. Low T4, lower TSH than you would expect. You would expect if T4 is lower, that TSH would be higher. That what you would expect to see. What might be happening here is that there's suppression of the pituitary gland where it's not making enough TSH. Why does that occur? What might be causing that? Let me share a few things that typically cause that.
The potential causes for this type of pattern, number one is going to be stress. Prolonged stress, or an active stress response, what your body does is your pituitary, it drives the production of cortisol, okay? So cortisol is a stress hormone that's made by your adrenal glands. The pituitary gland is involved in signaling the adrenal glands to make cortisol. If you're under stress you're constantly asking the pituitary "Make hormones, make hormones, signal the adrenal glands." You do that with repetition, you can fatigue the pituitary gland and you can decrease it's ability to output TSH. What you'll see is that stress and an active stress response can cause TSH suppression, okay? So that's number one.
Number two is postpartum. The demands of pregnancy require that the pituitary gland do a tremendous amount is work and orchestrate all of these hormonal changes in the body. That's very demanding. A lot of women when they're going through pregnancy, it places a tremendous amount of demand on the pituitary gland that can fatigue the pituitary and result in suppressed TSH. Now one of the other things is you got to consider this. These things can happen together, right? What if the mother is stressed, they're already stressed and under a tremendous amount of stress going into pregnancy.
Then they get pregnant, they're carrying a baby, they have all these demands of pregnancy, there are these hormonal demands of pregnancy that fatigue the pituitary. They've got stress on top of that and higher cortisol, that's also fatiguing the pituitary, then postpartum they can actually have lots of problems, and it can result in suppressed TSH and this pattern where there's lower T45 and the TSH is just not responding. This feedback loop, typically if these are low, this feedback, the hypothalamus is sensing and detecting the levels of T4 and T3 in the blood, if they go low then it's going to pump out more thyroid releasing hormone which stimulates the pituitary to make thyroid stimulating hormone, which stimulates the thyroid. This feedback loop can either stimulate, the hypothalamus can stimulate production or it can slow down production, depending on the levels here. What can happen is these things can definitely dampen and suppress the pituitary. Then it can result in low thyroid function, even though it's not really a primary thyroid problem. It's actually due to the pituitary gland.
Okay, so overmedication. If you're overly medicated here's another thing that can occur. With being overly medicated, one of the things that we'll see happen is, if you have too much T4, or too much T3, what ends up happening is instead of just becoming hyperthyroid, like you think if you take more and more thyroid hormones it's going to make you more and more hyper. Well not the case. There's a point when you start exceeding the levels that are optimal for the body that you can actually create thyroid receptor resistance. It's where you have so much thyroid hormone that these cells in the body stop taking it up as well. They become resistant to it. There's just so much they become less sensitive to it, and it can actually cause hypothyroid symptoms.
What happens is when you have higher levels of thyroid hormone in the blood than you need, and than that are optimal, what it can do is, if that happens for a prolonged period of time, the hypothalamus just says "Hey, I don't need to make thyroid hormone. There's always enough here, I don't need to make it ever." What can happen is you can lose this feedback loop and the hypothalamus will stop producing adequate TRH to support the pituitary, and the pituitary gland will just not make enough TSH to stimulate the production of T4 and T3, okay? So overmedication can result in suppression, and then if you stop taking the meds, it may not come back because the feedback loop has been broken. It's been broken through prolonged expose, and in those cases you might need thyroid hormone for a long period of time.
The thing is that we can support a lot of these problems nutritionally and help to improve theses patterns. It's not something that's typically addressed, right? The only tool that's really used is the prescription of T4 and T3, and that's it. Not really an understanding or appreciation in a lot of cases for this, and it's not that your doctors don't care. They definitely care. A lot of them do know these things, it's just that there's not a tool that they have to give you. That's why we use nutritional tools that have been shown in the scientific literature to support improving these endocrine feedback loops. We work with diet, we work with improving the person's overall systemic health so that we can work on decreasing the stress response, improving the hormonal signaling, and then obviously we look at a lot of thyroid hormone markers to get a better idea of your need and appropriateness for those hormones, so we can better determine whether or not you might be getting too much. Obviously if we see laboratory high ranges, that's a potential problem.
Anyway I want to share this, hypothyroidism, so low thyroid function due to pituitary gland, which is the gland that produces your TSH which is most commonly measured. Hypofuction or low function. This is the second pattern that we're going to cover, I'm going t cover a few more. I hope you guys have enjoyed this and if you have any questions just let us know and post comments for us below and we'll get back to you as soon as we can. I hope you guys have a great day.
Dr. Shook is known as one of the most sought after doctors in the United States for helping people with Hashimoto's and autoimmune conditions improve their health naturally. He is famous for his ability to help people recover from Hashimoto's without utilizing medications. Dr. Shook is Board Certified in Integrative Medicine, has trained extensively through the Institute for Functional Medicine, and with Dr. Mark Hyman and Dr. Datis Kharrazian. Dr. Shook has helped people improve their thyroid function for years utilizing all natural approaches that are based on addressing the root cause of poor thyroid health. If you have a thyroid problem and are interested in addressing several common causes of many types of thyroid dysfunction, Dr. Shook's Thyroid Support Program is a great place to start. If you would rather work with Dr. Shook on-on-one to get answers fast, please contact his office for more information at DrBradShook.com, or at (828) 324-0800.

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