For those people with hypothyroidism and Hashimoto’s Thyroiditis, the usual conventional medical treatment involves giving the person synthetic thyroid hormone. Although this does help many people with the hypothyroid symptoms, not everyone does well when taking Levothyroxine and other similar products. And one of the reasons for this is because synthetic thyroid hormone only consists of T4.
I’m not going to go into detail about thyroid physiology in this article, but the following is a very basic lesson. In past articles and blog posts I have discussed how problems between the hypothalamus and the pituitary gland can cause thyroid problems. And the reason for this is because the production of thyroid hormone actually begins with the hypothalamus. The hypothalamus releases a hormone called thyrotrophin-releasing hormone (TRH). This hormone stimulates the pituitary gland, which in turn will release TSH. Just about everyone with a thyroid or autoimmune thyroid condition has their TSH measured, as a high value is common in hypothyroid conditions, and the reason for this is because when there is a decreased amount of thyroid hormone, then the pituitary gland will release more TSH to signal the thyroid gland to make thyroid hormone.
I’m not going to discuss the exact mechanism of how thyroid hormone is produced, but most of the thyroid hormone that is produced is in the form of T4, while a small percentage of T3 is produced. T4 is mostly inactive, while T3 is the active hormone. So while a very small amount of T3 is produced by the thyroid gland, the rest of the T3 is produced in different parts of the body, with the liver responsible for a good amount of this conversion. However, in order to convert T4 to T3, the enzyme 5′ – deiodinase is required. And certain minerals are required to activate this enzyme.
It’s Not All About T4
So while most medical doctors will prescribe T4, many times this isn’t enough to manage the person’s symptoms. But why don’t they recommend T3 as well? Some medical doctors do, many in the form of Cytomel, which is a synthetic brand of T3. Other doctors will recommend natural thyroid hormone, such as Armour or Nature-Throid, both of which consist of T4 and T3. Giving synthetic or natural T3 can help with the symptoms, but of course if the problem is that T4 isn’t converting into T3, then just giving the person T3 won’t correct this problem. The obvious goal in this situation is to correct the conversion problem, although it can be challenging to determine what is causing this problem. Here are some of the more common factors which can inhibit the conversion of T4 to T3:
Mineral Deficiencies. I discussed how certain minerals are required to activate enzymes, and specific minerals can therefore play an important role in the conversion of T4 to T3. One of these minerals is selenium, which plays a crucial role in the conversion process. And I have found that many people are deficient in selenium. So if someone has a deficiency in selenium then this can cause conversion problems. Zinc is another mineral which plays a role in the conversion process, and many people are also deficient in zinc. This doesn’t mean that you should begin supplementing with selenium and zinc, but instead you want to get tested to see if you are deficient in these minerals.
Gastrointestinal Problems. If you have gastrointestinal problems, this can cause problems with the absorption of the minerals. And so even if you are not deficient in selenium or zinc, if you have problems with digestion then this can affect the ability to convert T4 to T3. So conditions such as leaky gut syndrome and candida infections can cause or contribute to this problem. Plus, T3 doesn’t become active until it’s activated by an enzyme called intestinal sulfatase. And so hopefully you understand the importance of having a healthy GI tract.
Liver Issues. About 20% of the conversion of T4 to T3 takes place in the liver, and so if you don’t have a properly functioning liver then this can also cause problems with the conversion. And just because the liver enzymes look fine on a blood test doesn’t mean that you don’t have any liver problems. While these tests can be helpful to rule out any serious liver conditions, if someone’s liver has a reduced ability to detoxify due to other factors, such as all of the toxins we’re exposed to through the food we eat and the environment, then this can reduce the liver’s ability to convert T4 to T3. So if someone has a problem converting T4 to T3, then a liver detoxification program may be beneficial.
Adrenal Problems. Having high cortisol levels can affect the conversion of T4 to T3. A lot of people have this problem, and in most cases it is due to stress. So it is of course important to do a good job of managing one’s stress levels. And if one has high cortisol levels, then in addition to proper stress management, certain herbs may be necessary on a temporary basis to help lower the cortisol levels, such as a combination of Ashwaganda and Rehmannia.
Certain Medications. Some medications can interfere with the conversion of T4 to T3. For example, Propranolol, which is a beta blocker, can inhibit the conversion of T4 to T3. Other types of beta blockers can also interfere with the conversion of T4 to T3. Many of my patients with hyperthyroidism and Graves’ Disease take beta blockers to help manage the cardiac symptoms. Cortisosteroids can also inhibit the conversion.
How To Correct A T4 To T3 Conversion Problem
Once again, most medical doctors don’t do anything to address a T4 to T3 conversion problem. And those few that do something will usually just recommend Cytomel, or perhaps natural thyroid hormone. But these don’t do anything to help address the conversion problem. Certain herbs can help with the conversion, such as Ashwaganda and Coleus. And while I’m a big advocate of herbs, just giving someone Ashwaganda won’t address the underlying cause of the problem. It can help to lower high cortisol levels and help the person to better deal with the stress, which is of course important, but it is not a cure for this problem.
As I mentioned earlier, sometimes it can be a challenge to find out what is causing the conversion problem. What makes it more difficult is that some people have multiple problems. For example, it’s not uncommon for someone to have a selenium deficiency, but also have problems with their adrenal glands and/or have digestive issues. Of course the goal is to correct all of these problems, although you don’t always want to address all of the problems at the same time. So if someone needs to go through a liver detoxification and also has a selenium deficiency, usually I’ll have them go through the detox first, and then address the mineral imbalance.
In summary, some people with hypothyroidism and Hashimoto’s Thyroiditis have problems converting T4 to T3. And most medical doctors won’t do anything to address this problem. Some doctors don’t even look at the T3 levels on a blood test, while others will look at this value and recommend synthetic T3 in the form of Cytomel, or in some cases natural thyroid hormone such as Armour or Nature-Throid. But it is rare for any medical doctor to try getting to the underlying cause of the condition, which of course is the goal of any effective natural treatment protocol.