Beyond Traditional Thyroid treatment with Dr. Dana Gibbs
Are you always tired, even after a good night's sleep? Do you feel sluggish, notice your hair falling out, or feel cold when everyone else is warm? Are you gaining weight despite dieting?
These could be signs of thyroid issues. Today, I’m chatting with Dr. Dana Gibbs, a board-certified ENT and thyroid surgeon, and the founder of Consultants in Metabolism, where she helps people with Hashimoto's disease, complex thyroid conditions, and chronic fatigue.
Dr. Gibbs's journey into thyroid treatment started way before her medical career. As a teenager, she was always exhausted, which made her doubt her dream of becoming a doctor. In college, she explored other fields but ultimately returned to medicine.
During her clinical rotations, Dr. Gibbs tried various surgical specialties but found them draining. It wasn’t until her ENT rotation that she found her sweet spot. Despite her professional success, she continued to struggle with fatigue, cold hands, and hair loss. Her TSH levels were normal, so doctors blamed stress. Five years after residency, a lecture on hypothyroidism revealed that her symptoms matched the condition, even with normal TSH levels.
Encouraged, Dr. Gibbs tried thyroid medication and saw amazing improvements. This experience fueled her passion for thyroid treatment and made her a dedicated advocate for comprehensive thyroid care in her practice.
How Your Thyroid Influences Overall Well-Being
From the symptoms mentioned above, I know many of you might be wondering if your symptoms could be related to thyroid issues. But before diving into that, let's make sure we're all on the same page about what the thyroid actually is and its role in the body.
The thyroid is a small, butterfly-shaped gland located in the front of your neck, wrapped around your windpipe and sitting just below your collarbones. Normally, you can’t feel it, but if it’s abnormal and has lumps, you might be able to feel these nodules by placing your fingers above your collarbones and swallowing.
The thyroid is an endocrine gland, which means it secretes hormones into your bloodstream that travel to every cell in your body. These thyroid hormones are responsible for activating the metabolic functions of your cells, influencing things like hair growth, muscle growth, energy levels, and even your body’s ability to burn calories and stay warm. Essentially, thyroid hormones have widespread effects, and when the thyroid goes awry, it can lead to a variety of symptoms.
What's fascinating—and sometimes challenging—is that thyroid problems can masquerade as other health issues due to their broad impact on the body. For instance, treating someone's thyroid condition may relieve chronic headaches they've been struggling with for years. This underscores the importance of considering thyroid health as a potential factor when working up other health concerns.
Understanding Thyroid Disconnection
Many people wonder why diagnosing hypothyroidism doesn’t always match up with the symptoms they see. Let’s break this down.
The thyroid gland is controlled by a hormone called TSH, made in the brain. TSH tells the thyroid to make more hormones when levels are low. If TSH is high, it means the thyroid needs to work harder. If TSH is low, there’s enough thyroid hormone in the body.
But that’s only part of the story. The thyroid mainly produces a hormone called T4. Doctors often give T4 as a pill called levothyroxine. However, T4 isn’t the active hormone. It needs to be converted into T3 to work properly. This conversion happens in body cells, not in the thyroid gland itself. T4 can become either T3 (the active form) or reverse T3 (rT3), which doesn’t help and can even block T3 from working.
Stress, genetics, and dieting can increase rT3 levels, complicating thyroid function and metabolism. Stress can make your body convert more T4 into rT3 instead of T3. Some people have genetic issues that make converting T4 to T3 less efficient, which can explain why they struggle with weight loss. Extreme dieting can also boost rT3 production, slowing down your metabolism even further to save energy.
In obesity medicine, doctors recognize that when people lose weight, their metabolism can slow down, making additional weight loss tough. Those who lose a lot of weight may show hypothyroidism symptoms like hair loss and feeling cold all the time. These changes can happen quickly; fasting for just 48 hours can increase rT3 levels.
Though not widely known, it’s crucial to consider measuring rT3 and T3 levels and adjusting treatment. This can significantly improve symptoms and quality of life for many patients.
Treatment Strategies for T3 and Reverse T3 Imbalance
Now that we understand thyroid issues, let's look at how to treat someone with an imbalance of T3 and reverse T3. This starts with recognizing subclinical hypothyroidism. People in this group can benefit greatly from specific thyroid treatments. If someone has too much reverse T3 and gets high levels of T4, they will make even more reverse T3, often feeling worse. Instead, they need T3, the active hormone.
Giving T3 can be tricky because of its short half-life, meaning how quickly it’s broken down in the body. It can't be taken just once a day and must be introduced gradually to avoid side effects like jitteriness, shakiness, or heart palpitations. It's best to start with half of the smallest pill twice a day and slowly increase the dose. If the patient is also on levothyroxine, its dosage should be gradually decreased to maintain balance.
The goal is to keep T3, T4, and TSH levels within normal ranges without creating dangerous extremes. The treatment involves a careful and gradual approach to ensure safety and effectiveness. It starts with a detailed history to understand the underlying causes, often including trauma. Managing stress and supporting adrenal function with recommended supplements are also essential parts of the treatment strategy.
Addressing Side Effects and Related Conditions
We have to be cautious with the dosing of thyroid medications like liothyronine (T3) and levothyroxine (T4). Some patients on these medications may experience side effects or feel worse, but this can often be attributed to factors unrelated to the thyroid medicine itself. One significant factor is the use of stimulants. For example, someone with long-term low thyroid levels might rely on large amounts of caffeine, such as a pot of coffee a day, to stay awake. When their metabolic activity increases with T3 treatment, the same amount of caffeine can cause shakiness, palpitations, and sweating. In such cases, gradually reducing caffeine intake is necessary to avoid withdrawal symptoms.
Another reason for adverse reactions is insulin resistance. If a person with insulin resistance consumes carbs that trigger a significant insulin release, and then their metabolic activity increases due to T3, they may experience hypoglycemia. This low blood sugar leads to adrenaline release, causing symptoms like rapid heartbeat, shaking, and sweating. This roller coaster of blood sugar levels and adrenaline dumps can mimic the side effects of stimulants.
Additionally, there is a notable correlation between hypothyroidism and insulin resistance. Many people with low thyroid function also struggle with insulin resistance, although the exact reason for this connection remains unclear. It's a common issue among my patients, and managing both conditions simultaneously is often necessary.
My patient population often deals with weight and insulin resistance, and a significant number also have hypothyroidism. By addressing these interconnected issues, we can better tailor treatment plans to improve overall health and well-being.
Emotional Triggers and Cortisol Release
There are five specific emotions in our brain that trigger the release of cortisol: anger, fear, shame, disgust, and sadness. Without these emotions, cortisol isn’t released into our system. This is pretty mind-blowing and important to understand.
Shame is a common emotion among patients, especially those struggling with their weight. Even people who are successful in other areas of their lives often feel a lot of shame about their weight. And it's not just about weight; this pressure extends to various parts of life, especially for women and professionals like doctors. There's this societal expectation to be perfect in every role—whether as a mom, doctor, church member, wife, or just a superwoman overall.
This pressure leads to self-shaming. Shame is one of our survival emotions, and cortisol is a survival hormone. Our primitive brain thinks that any action that might lead to social exile is dangerous, so it triggers feelings of shame to protect us from being ostracized. This was crucial for survival historically, but it's not as helpful in our modern world.
Key Points for Those on Thyroid Medication
For those already on thyroid meds and not feeling their best, two key things can make a big difference. First, docs often say you can take levothyroxine once a day because it has a long half-life. But that idea started back in the '50s as a marketing trick for Synthroid. Back then, natural thyroid was taken three times daily to avoid ups and downs that lead to making too much reverse T3, which messes with your thyroid even more. Splitting your dose and taking it twice daily can help even though it's a bit of a hassle.
Second, when you get your blood tested, do it at the same time every time. Thyroid hormone levels spike a few hours after taking your meds and then drop. If you test before taking your pill, it might seem like you need more. If you test too soon after, it might look like you're overmedicated. These ups and downs can lead to unnecessary dose changes by your doc, leaving you feeling off.
Additionally, adding a total T3 divided by reverse T3 ratio to your lab set can provide valuable information. This ratio should be at least 10 to 1. Reverse T3 doesn’t have a free form, so you need to compare the total T3 to the reverse T3. If the ratio is below 10, it indicates that you’re making too much reverse T3, which can block your thyroid function.
Understanding these points and incorporating them into your treatment strategy can significantly improve your thyroid management and overall well-being.
Exploring the function of your thyroid can greatly influence how you manage symptoms such as fatigue, changes in weight, and emotional health. By delving into treatment approaches, medication management, and understanding emotional triggers, you gain valuable tools for your health journey. If today's discussion resonated with you, consider listening to the full episode for further insights on enhancing your well-being. Remember, consulting with a healthcare professional is crucial to tailor these strategies to your specific needs.
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