6 Patterns of Hypothyroidism
#5 of 6, The Hypothyroid Estrogen Pattern
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You may want to begin with Dr. Shook’s lab guide, “9 Tests Required to Understand Your Thyroid,” and take a look at a a few of the resources below:
1) HAIR LOSS "How Can I Prevent Hair Loss With Hashimoto's?"
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2) THYROID LABS "9 Tests Required To Understand Your Thyroid"
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More...
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You can read the transcript of this video below: 6 Patterns of Hypothyroidism, #5 of 6 The Hypothyroid Estrogen Pattern
| Hi everybody, I hope you're doing well today. Dr. Shook here. In this video, what I'm going to teach you is another one of the patterns that I commonly see in practice that causes hypothyroid symptoms, low thyroid symptoms, even though TSH a lot of the labs look normal. It can be very misleading going to your doctor and then checking your thyroid many times. They just screen by looking at TSH which is produced by your pituitary gland and it doesn't tell the whole story of the physiology, or it can break down. |
| What I'm going to share with you is one of the common patterns that I'll see in practice. What we're going to do is start with how it works, how the body makes your thyroid hormone, and then we'll explain ... I'll we'll explain, I'll kind of explain what's breaking down with the physiology. I'll talk about some of the lab values that you'll see and then behind me here, I'll talk about a lot of the potential causes and reasons that we end up with this type of pattern, okay? Let's go ahead and get started. |
| This entire process of thyroid hormone production begins in the brain. Remember, there's a central structure in the brain called the hypothalamus. The hypothalamus makes thyroid releasing hormone, which is a hormone that stimulates the pituitary, which is another ... The pituitary gland is another brain structure right behind, between your eyes, right behind your skull here. The pituitary makes thyroid stimulating hormone. Thyroid stimulating hormone, or TSH, stimulates the thyroid to ramp up its production of T4 and T3, the primary thyroid hormones. Simplifying, there's a lot of stuff here that I could go into detail, but I'm trying to give you concepts and not the minute details of the bio-chemistry. |
| The thyroid stimulating hormone, the TSH is typically what doctors check to screen your thyroid dysfunction. If TSH is normal, then they reason that everything else is fine and at least that the quantities are fine. There are some other things where this physiology can break down and that's what we're going to talk about. To this point, if everything's working normally, your body will make T4 and T3. This can still happen. A lot of these patterns that I talk about ... When we talk about quantities ... Let's say that your thyroid, none of these patterns ... You see that a lot of times these patterns that I'm discussing and teaching you guys, there's not just one thing happening to you. You might have this pattern plus you have Hashimoto's, which is destroying the gland which makes you unable to produce these hormones. |
| You're like, well what do I do then? Well, you should be taking a thyroid hormone that's replacing it. What happens if you're taking a thyroid hormone that's replacing your T4 and T3, as long as the quantity's right, then we just carry on with the physiology the same way. If you're taking a replacement hormone, this pattern can still occur. If you don't have a thyroid and you're taking hormones, this pattern can still occur because the hormones that you're taking, this is what I'm getting ready to talk about, can still happen to them because quantity is one thing. The ability to take these hormones, convert them into the proper form, transport them to the cells where they're needed and used is another thing. That's what we're going to talk about [inaudible 00:03:06] pattern. |
| [inaudible 00:03:07] I introduced it today. This is thyroid binding globulin elevations, increased basically ... You'll see me note it as increased where an arrow up, TBG. Thyroid binding globulin. That's how it's going to look. This pattern is all about an increase in these binding globulins which are little carrier proteins that carry the thyroid hormone through the bloodstream and then drop them off where they're ready to be used at the cell. Up to this point, we've talked about the thyroid hormone quantities are here. The T4, remember the primary hormone made, it's 93% of the output by the gland. T3 is about 7% of the output by the gland. T3 is the physiologically active hormone that stimulates the cells and gives us the benefits that we want. |
| Now, T4 is primarily inactive and it has to be converted. Most of it's converted in the liver from T4 to T3 and then the T3 is put back into the blood stream. The conversion does happen in other places like the GI tract where you have to have good bacteria, good stomach acidity and good intestinal sulphatase for this conversion to occur. It does happen in some other peripheral tissues, like the heart, for example but the majority of this T4 is going to be converted here in the liver from T4 to T3. Once you have T3, it's put back into the bloodstream. Once it gets into the bloodstream, these little blue thyroid binding globulins, which is exactly what we're talking about ... The whole story revolves around all these blue guys today, all these little blue things that I've drawn here. They represent the binding globulins. |
| What they do, when the T3 gets into the bloodstream, the T3 is free. It's considered free floating hormone until it's bound to a protein. When it gets into the bloodstream, it's bound to the protein. The protein carries it through the bloodstream, carries the T3 through the bloodstream, and then drops it off at the cell. When it drops it off if becomes, you notice I have this as a tiny F, free T3. The T3 is free. It's no longer bound to the protein, so it's free and it's available for the cell to attach to the receptors on the cell and stimulate the cellular metabolism, basically what we call a proteomic response, drives all the cellular metabolism. |
| In this pattern, what happens when you have an elevated thyroid binding globulin number, or you have more of these thyroid binding globulins than you need, there is all of the T3 that's put out ... Not all of it, but a lot of it is bound to these little carrier proteins because there's too many of them. Let's talk about that. Why are there too many of these in this particular pattern? Let's go to the causes, okay? What causes you to have too many of these little proteins that hold onto the majority of the T3 keeping it bound so that it's not available for the cell, resulting in feeling hypothyroid is, most common things: oral contraceptives and estrogen replacement therapy. Basically increased estrogens increase these thyroid binding globulins. |
| When you have increased in these thyroid binding globulins, there's just not enough hormone free floating for the cells to use to drive cellular metabolism, so you feel hypothyroid. What you'll see here is ... What you typically see in this pattern is that ... You look at labs, TSH would be normal. Total T4, so this number is normal. What you're going to see is usually the total hormone numbers are going to look normal: total T4, total T3. The total hormones, keep in mind, the difference in total T4 and T4 is just that the total T4 adds all the free floating free T4 and the T4 that's bound to proteins together. |
| What you really look at on this pattern is, you'll see the TSH is normal, T4 is typically normal, T3 uptake, so the ability of the body to uptake and use all the T3 in circulation, is low or near the low end of the range. Near low or low. You'll see that basically there's so many of those little binding proteins, it just holds onto all the thyroid hormone, not making it available to the cell so you feel like you have hypothyroidism, though your TSH looks normal and T4 looks normal. The T3 uptake, which is almost never ran that I see, is low. Then, if you check the free hormones: free T3 and free T4 ... |
| If we look at our diagram here, the hormone, the T3 that's bound to the protein, is the majority of the hormone. There's not much that's free. There's only just two here in my diagram that are free, so there's not enough free. You'll see that the free hormone is low and the free T4 is low. Typically that's what it will look like. The total T4, total T3 will be normal. The free hormones will be low because there's not many of those. A T3 uptake will tend to be low because you're not able to uptake and use the hormone that's in circulation. This is a really important pattern to understand. |
| This is super common in women that are taking oral contraceptives, women that are using estrogen replacement therapy in creams or oral replacement, is very common. This is a common pattern, so we have to address the estrogens. One thing that's really important here to understand is, you've got to address the estrogens. Typically we look to see: are the estrogens essential? Do you have to have those? Why are you taking them? You have to ask that question because if they're causing you to have all these problems, is that a sufficient trade off for you? Are you willing to feel the way you're feeling if the estrogens are causing the problem. You have to have that conversation. Then, what we typically do is we support liver function to help biotransform and break down these excessive estrogens out of the body so that these binding proteins here can normalize in number. |
| One of the potential problems with increased estrogens is, increased estrogen levels are not good. They are excessive estrogen in the body. You can actually convert some of these things to very dangerous forms of estrogen like 16 hydroxy. It's a hydroxylated form. 16 hydroxy estrogen is associated with tissue proliferation and growth. I've seen it higher in numerous cases where a women's had a history of, or has endometriosis or a lot of cyst formation. They had higher levels of 16 hydroxy estrogen. I've seen that association. It can also, your body can make 4 hydroxy estrogens. Really, your body makes all these forms: 16 hydroxy, 4 hydroxy estrogen, 2 hydroxy extrogen. It makes them all. It's just, are they in normal ratios, normal amounts? |
| When you see an over production of 16 hydroxy, you start worrying about tissue growth. I've seen it associated more with endometriosis and cystic cyst formation. The other thing is the 4 hydroxy estrogens. If you have high 4 hydroxy estrogens, we know that those are carcinogenic, they damage DNA, and that they can promote cancers. Are these estrogens causing this problem? What else are they causing? Are they causing, are you forming these dangerous metabolites? If so, you need to know that and you need to know that there are some things that we can do to support it nutritionally to help support a shifting of those metabolites like the 16 hydroxy, the 4 hydroxy estrogens into a safer form, but you have to address the estrogens. You have to look at the whole picture and see what's going on here. |
| This is a really common pattern. I've seen it a lot and quite frankly, you see a lot of these patterns overlapping. It's not just always clear one way or another. It's not. There's usually a few things that are happening at once at minimum, if not several things happening at once. I want to share this with you guys, especially women that are using contraceptives or hormone replacement therapy, this is so important for you to understand, and then to also understand what you might see on labs. A lot of times, your doctors aren't going to understand this, not because they're not capable. They're very capable. They just may not be exposed to it. It may not fit into their practice, their model of practice. |
| You've got to realize, your doctors, they are trying to help you so much. I don't know anyone that got into any type of health care or medicine that didn't want to help people. This is just something that under a typical insurance based model, it becomes very challenging to practice for a lot of people. You don't have a lot of time to dig into this, but at the same time, that's why I'm teaching it. You guys need to be empowered with information so that you can be your own advocate and you can think for yourself and be an active participant in your health care and not just a bystander. You need to be able to ask questions and think for yourself. Thank goodness for the internet I think. There's a lot of [inaudible 00:12:20] the internet. There's a lot of potential problems, but anyway ... |
| This is a very common pattern that I see. I want to share this with you guys, especially if you're a women. Oral contraceptives, estrogen replacement therapy can create way too many of these binding globulins that can hold on to all the thyroid hormone, not making enough available for the cell, making you feel hypothyroid. In addition, these estrogens can cause a dominance of very dangerous estrogen metabolites that can lead to tissue proliferation or even cancers. These are things that we can check. We can check those metabolites by the way, the 16 hydroxy, the 4 hydroxy, the 2 hydroxy estrogens, to see how you're metabolizing and breaking down estrogens. Those are typically, as far as I know, they have to be done via a urinary test. They're not available in a serum. |
| Just want to shout out to you guys, I appreciate you so much. Please, please share this as much as you can. There's so many people, millions and millions of people, that are suffering that have no idea how to help themselves, no idea. They think, well my thyroid's normal. Well, if TSH is all that's checked, that's not a very thorough investigation but I will tell you, that is considered the standard of care. It's not that your doctors are being negligent or anything like that. It is just the model of health care that we're in right now. Believe me, your doctors are frustrated too. They're trying to help you. Please don't go to them as an adversary. Don't do that. They're trying to help you. Just empower yourself. |
| I appreciate you guys so much. Please do, let me know if you have any questions. Place comments below, and we'll do our best to get back to you. I appreciate you so much. Hope you have a wonderful ... |
