Thyroid Dysfunction: A Functional Medicine Perspective

Dr. Wayne Sodano, D.C., D.A.B.C.I.

Physiologic Effects of Thyroid Hormones

•Development•Growth•Metabolism

Metabolism

Thyroid hormones stimulate diverse metabolic activities in most tissues, leading to an increase in basal metabolic rate and,

therefore, controls body temperature

Lipid metabolism:

Plasma concentrations of cholesterol and triglycerides are inversely correlated with thyroid hormone levels – one diagnostic indication of hypothyroidism is increased

blood cholesterol concentration.

Carbohydrate metabolism:

Thyroid hormones stimulate almost all aspects of carbohydrate

metabolism, including enhancement of insulin-dependent entry of

glucose into cells and increased gluconeogenesis and glycogenolysis

to generate free glucose.

Growth: The growth-promoting effect of thyroid hormones is intimately intertwined with that of growth hormone.

Hormone-Receptor Bindingand Interactions with DNA

Thyroid hormones enter the cell by facilitated diffusion.

Thyroid Hormone Receptors

Receptor for thyroid hormones are members of a large family of nuclear receptors that include those

of the steroid hormones. They function as hormone-activated transcription factors and thereby act by modulating gene expression.

Constructing Thyroid Hormones

The synthesis occurs in three major steps.

1. Accumulation of raw materialsTyrosinesIodide (I¯):

2. Fabrication or synthesis of the hormones on a backbone or scaffold of precursor

3. Release of the free hormones from the scaffold and secretion into blood

HCH

tyrosine

Thyroid peroxidase

diiodotyrosine

O

II

I I

HO

HCH

thyroxine

Thyroglobulin Thyroid peroxidase

I

I

HO HO

HOHCH

I

I

I

I

I

I

HOHCH

HCH H

C=H

Thyroid-Binding Globulin

TBG is the major thyroid hormone protein carrier. It is primarily produced in

the liver and is affected by liver dysfunction.

TRH

TSH

Thyroid Gland95% T4

5% T3

~ 95%

5 deiodinase

rT3Inactive(45%)

T3Active(35%)

5’ deiodinase(Se)

Hypothalamus Pituitary

Liver or Kidney

Cell Nucleus

5’ –Deiodinase Inhibitors

Selenium deficiencyInadequate protein, excess carbohydrates

High insulinChronic illnessStress (cortisol)

Cd, Hg, Pb, and other toxinsCompromised liver or kidney

Impaired glucuronidationImpaired sulfation

Hypothalamus

Anterior Pituitary

Severe Stress Cold Circadian rhythms

( - ) (+) (+)

Somatostatin TRH

( - ) (+)

TSH

(+)

Thyroid

( - )

T4

T3

Excess I.

I.(+)

Thioureylenes

( - )

( - )

Factors That Regulate Thyroid Hormone Secretion

Assessing Metabolic Energy

Sub-optimal thyroid and adrenal functions are the most common causes of low metabolic

energy. Both present with low body temperature and although some signs and

symptoms are shared by both, many are not.

Metabolic Temperature Graph

Patient HistoryPhysical Exam

Past Medical RecordsCurrent Lab Tests

-Standard-Functional (ASI)

Fix Adrenals First

ASI Test

Liver

Kidney

LiverGI Dysfunction

Kidney

Temp Graph UnstableTAS Favors Adrenal Dysfunction

Temp Graph StableTAS Favors Thyroid Dysfunction

Treat ThyroidLiver

GI DysfunctionKidney

Thyroid/Adrenal Symptom SurveyTemperature Graph

Functional Medicine Thyroid

Algorithm

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