1 in 10 adults in India suffer from hypothyroidism. Incidence rate is higher in women and 1 in 6 women have some form of thyroid dysfunction. Thyroid is a small butterfly shaped gland in your neck that controls how your cells use energy. The Hypothalamus in the brain senses the energy needs of the body and releases what is known as Thyrotropin Releasing Hormone (TRH). This in turn sends a signal to the pituitary gland to release Thyroid Stimulating Hormone (TSH). In response to this TSH, the thyroid produces two main hormones: T3 and T4. To produce these, it uses iodine and selenium from your diet.
T3 is known as Triiodothyronine and is the active form while T4 is known as Thyroxine and is the inactive storage form. T4 is converted into T3 by your liver and kidneys
Once inside the cells, T3 increases the size and number of mitochondria which leads to increase in energy production. You burn more calories and generate more heat. It signals the cells to build proteins for muscle repair, hair growth, etc. The entire system is self regulating. The pituitary gland keeps sensing the levels of T3 and T4 and releases TSH if the levels drop and stops releasing them if the levels are high.
The system can technically break at any of the 3 levels: the hypothalamus which is the master controller or pituitary gland or thyroid itself. In most of the cases, it is the thyroid function that breaks:
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Hypothyroidism: The pituitary gland senses the low levels of T3/T4 and produces TSH but the thyroid is just not able to produce T3/T4 despite getting the signal from pituitary. One of the leading cause of hypothyroidism is Hashimoto’s – an auto immune condition in which the immune system starts attacking the thyroid cells
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Hyperthyroidism: In this case, the pituitary gland senses the high levels of T3/T4 and shuts off TSH but the thyroid gland still continues to pump T3/T4. This is what happens in Graves’ disease where immune system creates specific antibodies that keep the thyroid stuck in running position
In rare cases, the pituitary gland itself fails to send a signal in the form of TSH to the thyroid. This typically shows up as low TSH and low T4 both in blood test reports
While the most common cause of thyroid dysfunction is auto-immunity, in some cases, nutrient deficiency also leads to the condition as thyroid needs two key elements – iodine and selenium to function. Iodine helps build the T4 molecule while without selenium body cannot convert T4 into active T3.
One of the obvious questions therefore is: What leads to this autoimmune disorder? The answer often lies in one of these 3: (a) specific genes that make the immune system more suspicious or (b) a case where immune system gets activated against thyroid after an infection owing to molecular similarity of the thyroid cells with that of virus / bacteria it was fighting or (c) gut health or “leaky gut”.
If you have any of the symptoms of hypothyroidism (fatigue, weight gain, feeling cold) or hyperthyroidism (weight loss, feeling hot), it is important to first understand what is happening inside your body in order to get the right care and to have an informed dialogue with your doctor or healthcare provider. Getting to the underlying requires a comprehensive screening via a simple blood test for the following markers:
TSH or Thyroid Stimulating Hormone: A high level indicates that your brain is pushing your thyroid to produce more T3/T4 and your thyroid is less active than it should be (hypothyroidism). Whereas, a low TSH generally indicates an overactive thyroid (hyperthyroidism)
Free T4 or Thyroxine: the raw material / storage form which converts into T3.
Free T3 or Triiodothyronine: the active form
TPOAb or Thyroid Peroxidase Antibody: This is the most common marker for Hashimoto’s. The presence of these antibodies indicates that your thyroid is under attack by body’s own immune system
TgAb or Thyroglobulin Antibody: This is also another antibody which is found in Hashimoto’s
TSI or Thyroid Stimulating Immunoglobulin: This is the marker for Graves’ disease. This is the antibody that keeps your thyroid active at all times and ideally should not be there at all.
TRAb or TSH Receptor Antibody: Indicates presence of antibodies which could either be stimulating or blocking your thyroid gland. In case they are stimulating (which can be confirmed with a separate TSI test), it confirms Graves’ disease
Reverse T3: T4 can turn into active T3 or reverse T3. If your T3 is low but reverse T3 is high, it means your thyroid is working but your body is not able to use the energy – often caused by stress or inflammation or chronic dieting.
Vitamin D: Vitamin D regulates the immune system and low Vitamin D can lead to higher antibody count.
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