Hypothyroid Cause #3 of 6 – 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 labsis that TSH will likely be normal, causing this to be a pattern that is very, very frequently missed. If the doctor is just looking atTSH, and does not measure T3 then this pattern will be missed. Now, if you have this pattern, you've got to ask, "Why am I not converting T4 to T3?" We'll talk about the causes which are right here behind me, in a second. The TSH looks normal, the total T4 looks normal. The total quantity of T4 is fine, but what ends up happening is, is that it's not converting to T3, which is the physiologically active hormone. If you don't have T3, then you're not going to have stimulation of the cells and the proteomic response. The stimulation and drive of the metabolism, which every single cell in the body, remember, every single cell in the body requires thyroid hormone to function, to drive the cellular metabolism. It's a critical component tooverall health of every single cell in your body. It's critical.

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 havingpoor conversion of T4 to T3. Free T3 would be low if it were checked. Is T3 checked in most cases? No,its not. Even if T3 is low, what's the doctor going to do? Even if they do check these things, right, what's the typical thing they're going to do? "Well, your T3's low, let's give you some T3." Sometimes they'll prescribeCytomel, or some of these other medications which can be very very helpful and beneficial to people. The question that I want you guys to always ask is, "Why? Why is T3 low? Why am I taking a hormone just to boost T3? Why is my body not converting T4 to T3?" If you want to get to the cause of the problem, you have to ask "why?".

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 bephysical pain can stimulate a stress response; and emotional stressors. Anything that drives an emotional stressor for a long period of time, physical pain for a long period of time, chemical stress for a long period of time will produce a stress response increasing cortisol and adrenaline.

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 oflipids, or fats. What happens with chronic inflammation, is that it damages the cell wall, damages the lipids. It causes a lot of problems with cellular communication that can also affectconversion of T4 to T3.

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. uIjst want you guys to be more aware that it's not just the amount of hormone that you have. It's not just your TSH level. The rest of the physiology has to be considered. I hope this helps you guys out. I really appreciate you. If you would, share this information with other people so that they can be aware of this. There are so many people that are suffering and that have no clue what's going on or where to start, or that there can be anything other than just their TSH. They really need some help, and they need someone to walk them through it and to teach them. That's what I'm trying to do. Trying to help people better understand this.

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.