6 Patterns of Hypothyroidism
Under Conversion of T4 to T3
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You can read the transcript of this video below: 6 Patterns of Hypothyroidism, #3 of 6 - T4 to T3 Under Conversion
HI everybody, Dr. Shook here. I hope you're doing well today. Today, what I want to talk to you about is the third pattern of hypothyroidism that I commonly see in practice. This pattern is actually called a thyroid under conversion. Let me walk you through how things are supposed to work, then we'll talk about how they break down. We'll talk about some of the causes of this pattern and we'll talk about what your labs might look like. Okay?
First of all, if you follow me at all, you should know the story about how your thyroid hormone is produced. If you don't know how your thyroid hormone is produced, you need to watch this video. The entire process of thyroid hormone manufacturing begins in the brain. The hypothalamus, a central structure in the brain, makes TRH (thyroid releasing hormone). TRH stimulates the pituitary gland to make TSH. Remember TSH is the hormone that is most commonly checked to evaluate thyroid hormone production. It's usually the only hormone that is checked to screen for thyroid dysfunction. TSH stimulates thyroid production of T4 and T3, your primary thyroid hormones. 93% of the thyroid hormone produced by your thyroid gland is T4 and 7% is T3. T3 is the physiologically most active hormone that stimulates the cellular function. Keep in mind that T4 has to be converted to T3.
Now, what we're going to discuss is the conversion of T4 to T3 that primarily occurs in the liver. Conversion of T4 to T3 does occur in the GI tract and on a very much lower scale in peripheral tissues like the heart where there are enzymes that allow the conversion will occur. The majority of your T4 to T3 conversion is going to occur in the liver. Obviously, we are discussing thyroid under conversion, and I've got a red "X" drawn through the step of conversion in the liver, so let's discuss poor T4 to T3 conversion.
What happens with poor T4 to T3 conversion that you'll see that on labs
If T4 is normal, the doctor looks at TSH and says, "Well, you know, I don't know what's wrong. It's not your thyroid." The problem is that looking at T4 and TSH is not a complete picture of what is happening to your thyroid. T3 is typically low because you're having
A lot of times the doctors are not aware of poor T4 to T3 conversion because they look to see if the tools that they have in their toolbox fit the problem that you have, or that they think you have. They try to match the tools they have to help you with your problem to the best of their ability. Using that type of model, "Low T3, that means we can give you T3." I mean that's one of the possibilities, and it may help you feel better, though it is not addressing why you are not converting T4 to T3. The poor conversion process needs to be considered. Why is it occurring? Let's talk about that. All of these things are going on, so let's talk about the things that drive this poor conversion of T4 to T3.
Take a look at some of the common causes that we'll see drive poor thyroid conversion T4 to T3 that are listed behind me. One of the most common things impairing T4 to T3 conversion is chronic adrenal gland stress. The adrenal glands sit on top of the kidneys and produce hormones called catecholamines. One of those hormones produced by the adrenal glands is cortisol. That's your stress hormone. Now, adrenal stress typically comes from three things. It typically comes from chemical stress; physical stress which can be
What are chemical stressors? Chronic inflammation will drive a stress response. Your body will produce more cortisol. Chronic inflammation and infections can go hand in hand. An infection will drive inflammation. What the inflammation really does is drive cortisol production, but it also can degrade and break down the cell membranes. Every cell in your body has a cell wall. If you remember from school, there's a cell wall. If you can look at the cell in three dimensions, the cell's like a bubble, right? The entire outside is a wall is made of
Chronically elevated cortisol will suppress T4 to T3 conversion as will inflammation. Inflammation actually can drive cortisol, but it also causes lipid peroxidation which breaks down the cell wall, making the cell wall less efficient, hampering T4 to T3 conversion. On top of this, you have to have adequate vitamins, minerals, and nutrients to make this conversion process occur. There's a lot of different things that can come into play here. These are probably the two most common things that we see drive this process of poor conversion.
I hope that makes sense. What do you think the logical approach to this problem would be? What do you think? How would this best be approached? I mean, it's really a decision that you have to make. My personal opinion, and when I talk to most people is, "Well, is this happening? If this is happening, why? Let's address this so that this gets better and not just treat symptoms." Other people may be happy just taking thyroid hormone replacement, and I'm not saying that T3 wouldn't be helpful because it might be. What if this process of poor conversion is occurring? Could we improve this process and not need medication?
I'll tell you, this is a pattern that I see on blood work, and I see people present with, that we can very often support nutritionally and significantly help. uI
I appreciate you guys a lot. If there's anything that I can do for you, let us know. If you have any questions, post them in the comments below, and we'll do everything we can to help guys out. I appreciate you, hope you have a wonderful day. Thanks.