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Hypothyroidism and its Link to Depression, Fatigue and Poor Health

by Belinda Burman(more info)

listed in medical conditions, originally published in issue 102 - August 2004

Depression and its associated symptoms are no doubt the hallmark ailments of the 21st century.

Functioning at sub-optimal levels of health, energy and vitality seems par for the course for so many of us these days. Do you feel inexplicably tired/moody/ depressed/run down/lethargic much or all of the time? Does it seem that you've felt this way forever? Have you tried everything? Exercise? Medication? Nothing seems to work? It could be that you are suffering from an underactive thyroid, or hypothyroidism. Some doctors speculate that as many as 15-40 per cent of the population suffer from some degree of hypothyroidism! But the good news is that it is easily treated once it is correctly diagnosed.

What Is the Thyroid?

The thyroid gland is located in the throat at the base of your larynx, or Adam's Apple. It is shaped something like a butterfly, consisting of left and right wing-shaped lobes. Each thyroid lobe is approximately 50-60mm in an adult, and the entire thyroid gland weighs approximately 25-30g (slightly heavier in women).

What Does the Thyroid Do?

In the main, the thyroid gland has the important job of regulating our metabolism-growth, temperature control, energy production and carbohydrate and fat metabolism. In pregnant women, healthy thyroid function is essential for the healthy development of the baby's brain. (Many scientific studies have linked an underactive thyroid to infertility and an increased incidence of miscarriage, and so it is strongly recommended that women planning a pregnancy and pregnant women have their thyroid checked.)

The thyroid is stimulated by the pituitary gland in the brain, which releases a hormone called TSH (Thyroid Stimulating Hormone). The thyroid gland then produces two main hormones – thyroxine (T4) and triiodothyronine (T3). A little less than one per cent of T4 and T3 is 'active' – that is, able to penetrate cells to regulate energy production. This is called free T4 and free T3, and it is critical for healthy thyroid function.

Most of the T4 hormone must be converted to T3 in the liver, and for this reason you need to ensure that your liver is also functioning well. A test of ferritin levels (that is, levels of iron stored in the liver) can determine if this is the case. If the liver is not functioning well, then the conversion of the thyroid hormone T4 into T3 may be impaired. In addition, impaired liver function will affect the production of cortisol (which is produced in the adrenal glands), and a cortisol imbalance in the adrenal glands will affect the production of TSH, and therefore the production of T4 and T3. In other words, the pituitary gland, thyroid gland, adrenal glands and liver create a system that must be kept in balance to ensure healthy thyroid function. In addition, it is believed that selenium deficiency also will affect thyroid function. Selenium is a trace mineral found largely in plants, and in some meats and seafood. Selenium is essential for the healthy functioning of the immune system and the synthesis in the body of the active thyroid hormone.

What Is an Underactive Thyroid?

Hypothyroidism is the term given to an underactive thyroid gland. 'Hypo' is a Greek word meaning 'under' or 'below'. Hypothyroidism means that the thyroid is not functioning at its optimal level. Because the thyroid gland regulates the metabolism, an underactive thyroid results in a slow metabolism. And although the effects of an abnormally slow metabolism are not always dramatic (although they certainly can be, and often are), there is no question that the symptoms are debilitating and will, if left unchecked, lead to serious illness in the long term.

In real terms, we are describing the constant daily fatigue and malaise from which so many of us – men and women – suffer. (These are two major symptoms. A complete list of symptoms is included later.) We often attribute this to overwork, family and relationship pressures, the environment and having so little personal time, to name but a few defining features of modern life. Now, if you're the type of person who's inclined to brush off these symptoms, I suggest you don't. Or if you've been told "snap out of it", or "there's nothing wrong with you" (even though you know there is), then you may find some answers here. Hypothyroidism is a very real condition.

Food Iodine Content (micrograms per 100gm food)
Salt (iodized)
Dairy Products
Bread and Cereals

Now it's true that sometimes stressful factors create these symptoms. And sometimes it is the case that we simply mistreat our otherwise healthy bodies. But sometimes fatigue and sluggishness are caused by an underactive thyroid and these external forces simply exacerbate an already stressed thyroid gland. Hypothyroidism is serious not only because it can make us ill, but because it reduces our quality of life in all areas and we really do deserve to feel better than we do. But despite its seriousness and almost epidemic proportions – remember it is possible that up to 40 per cent of the population are suffering from this condition – hypothyroidism is very easy to treat.

What Causes an Underactive Thyroid?

An underactive thyroid can be the result of an auto-immune problem, whereby the body's own antibodies attack the thyroid gland. This is called Hashimoto's Thyroiditis. Hypothyroidism can also be the result of ageing. Or it can be caused by a problem in another related gland, especially the pituitary gland, as we discussed earlier.

In any event, the most common feature of hypothyroidism is iodine deficiency. In the UK, the recommended daily intake of iodine for children is 70-150 micrograms; for adult men it is 150 micrograms, for adult women 120 micrograms. During pregnancy, this increases to 150 micrograms for women, and 200 micrograms during lactation.

Ensuring sufficient iodine levels in your diet is one way of maintaining healthy thyroid function. Eat small meals regularly throughout the day. That means you should be eating breakfast, morning tea, lunch, afternoon tea and dinner. The largest meal should be breakfast, and dinner should be small. Eating regularly speeds up the metabolism, supporting thyroid function. (You are also more likely to lose weight eating this way.) The following table is an indication of the iodine levels in some common foods:

(Foods produced in areas where the soil is low in iodine will contain iodine levels lower than those listed here. These areas include Tasmania, the Thames Valley in the UK and the north-west region of the USA.) In the UK, iodine can also be found in cow's milk.

You will notice that iodized salt (that is, salt containing iodine) is an extremely rich source of iodine. Since its development in 1924 in the United States by Dr David Marine, a renowned biochemical scientist, iodized salt has almost eliminated the condition called 'goitre' in those countries where iodized salt is used, including the UK.

Goitre is an enlargement of the thyroid sometimes caused by a lack of iodine. This condition is still extremely common in many parts of the world, causing serious health problems in 130 developing countries that do not have access to the salt we put on our table every day.

We are fortunate in the UK that the widespread use of iodized salt has all but eliminated the incidence of goitre. Only small quantities of iodized salt are required to prevent the condition, so there's no need to overdo it. This means that if you are on a low salt diet and you have an underactive thyroid, you may want to consider including more fish in your diet as one part of your healthy thyroid programme.

Not all cases of hypothyroidism are due simply to a lack of iodine, though. In many cases the problem is an inability of the liver to convert the T4 hormone into T3 hormone. The conversion process can be affected by zinc and selenium deficiencies, severe stress, cortisol and the Pill.

Therefore, if you suspect you have an underactive thyroid, consult a medical professional, preferably a holistic GP. Ask your doctor to schedule a comprehensive blood test for all thyroid related hormones, i.e. TSH, free T4, free T3, cortisol, selenium and ferritin, as well as whatever else he or she believes may be helpful, and to determine an accurate course of treatment. Therefore, your course of action in treating an underactive thyroid should include both monitoring your diet and comprehensive blood testing to determine which supplements you need.

So, how do you know if you have an underactive thyroid? Let's look at some of the common symptoms.

Symptoms of Hypothyroidism

Symptoms of an underactive thyroid usually develop slowly over time, and can often be confused with many other common maladies. Consequently, the condition is often misdiagnosed. Symptoms of an underactive thyroid include:

• Depression;
• Fatigue;
• Low body temperature (feeling cold);
• Mood swings and irritability;
• Dry skin, hair and/or eyes;
• Brittle nails;
• Insomnia, or difficulty sleeping;
• Weight gain;
• Hair loss;
• Poor short term memory and concentration;
• Fluid retention;
• Constipation;
• Low blood pressure;
• High cholesterol;
• Muscle cramps;
• Stiff joints;
• Low libido;
• Acid indigestion;
• Heat and cold intolerance.

One of these symptoms by itself may not be enough to indicate hypothyroidism. But if you suffer from a few of these symptoms, or more, you may indeed be suffering from this condition.

I know that most of us would say that many of these symptoms are the result of stressful modern lives, and take many of these symptoms for granted. Or we may think we are run down, or are getting the flu, and so incorrectly medicate for these conditions. This is one reason why an underactive thyroid so often goes untreated. So if you are suffering from any of these symptoms, it is worth having your thyroid checked to make sure this is not the problem. And should it be the case that your thyroid is functioning normally, you might want to consider some lifestyle changes anyway as these symptoms almost invariably lead to illness!

Home Test for Underactive Thyroid

If you suspect you might be suffering from an underactive thyroid, there is a simple and fairly reliable method of testing for hypothyroidism that you can do at home. All you need is a mercury thermometer, which you keep by your bed. Here's what you do:

1. As soon as you wake in the morning, even before getting up and going to the bathroom, place the thermometer under your left armpit and lie reasonably still. Keep the thermometer in place for 10 to 15 minutes;

2. Remove the thermometer and record the temperature;

3. Repeat this procedure for five days. (Menstruating women should take this test on days two to six of their cycle because this is when body temperature is lowest. Men and postmenopausal women can take the test at any time);

4. Calculate your average temperature (i.e., add the recorded temperatures and divide the total by five). This is a rough measurement of your metabolic activity, which reflects your thyroid activity.

If your average temperature is 36.4 degrees Celsius or less, then you most likely have an underactive thyroid.

Ten Steps for Diagnosing an Underactive Thyroid.

If you believe you have an underactive thyroid, the next step is to see a doctor. Blood tests are often prescribed to detect an underactive thyroid. However, many prescribed blood tests only test for TSH and so are often only able to detect severe cases of hypothyroidism, which means the majority of sufferers go undiagnosed. In addition, as mentioned earlier, symptoms of an underactive thyroid are often confused with other ailments, and so the condition frequently remains untreated. This is why it is essential to find a doctor who will consider all possible contributing factors in order to make the best diagnosis.

Richard Shames, MD, and Karilee Shames, PhD, based in the USA, specialize in the holistic treatment of thyroid conditions. In diagnosing your condition, they recommend you and your doctor follow a ten-step plan:

1. Consider thyroid the hidden factor in your overall health.
Always consider the fact that an underactive thyroid may be the cause of your general malaise;

2. Learn how low thyroid makes any illness worse.
Be aware that an underactive thyroid affects, and is affected by, your entire system;

3. Use signs, symptoms, and family history to support a diagnosis.
A thyroid condition can be genetically inherited;

4. Realize you may still be low thyroid despite normal tests.
Standard medical tests are generally insufficiently comprehensive to diagnose the condition;

5. Discover your best dose, brand or mix of medicines.
Find a health plan that works for you. There is rarely a single solution for the effective treatment of an underactive thyroid;

6. Re-balance your reproductive system.
An underactive thyroid can affect and be affected by oestrogen, which is of particular concern to women planning to conceive, pregnant women and menopausal women;

7. Determine if low adrenal should also be treated.
A problem in the adrenal glands will affect the thyroid;

8. Boost your medication with natural therapies.
There are plenty of natural treatments for an underactive thyroid. Ask your doctor;

9. Improve the underlying autoimmune condition.
Autoimmune problems are connected to thyroid dysfunction;

10. Reach optimal recovery with an empowered lifestyle.
Naturally, a healthy approach to life-eating well, exercising, relaxing, and having fun-is essential for good health.

These steps are discussed in detail in the book by Dr Richard Shames and Dr Karilee Shames. Thyroid Power: Ten Steps to Total Health. HarperResource. 2002.

How to Treat Underactive Thyroid

Hypothyroidism is most commonly the result of an iodine deficiency. So increasing your intake of iodine-rich foods is important. In addition, sea kelp is an excellent source of iodine and is highly recommended for an underactive thyroid. Sea kelp comes in easy to take tablet form and is readily available from health food stores.

There is also no question that modern life places a great deal of stress on the average person. So, where possible, seek a balance in your life, and include some relaxation time for yourself. Also, eat small amounts of food regularly throughout the day, consuming the largest proportions earlier in the day. This will help to speed up your metabolism. And you may also want to do some research on hypothyroidism for yourself. If you have access to the Internet, a place to start is Other excellent resources are Living Well with Hypothyroidism by Mary J. Shomon, published by HarperResource, and Overcoming Thyroid Disorders by David Brownstein, MD, published by Medical Alternatives Press, Inc., and The Great Thyroid Scandal by Dr Barry Durant Peatfield, Barons Down Publishing. 2002. both of which discuss natural, holistic ways of overcoming hypothyroidism.

And, of course, you should also consult your GP for comprehensive testing, monitoring and further accurate treatment of the condition. Remember, ask that your TSH, free T4, free T3, cortisol, selenium and ferritin levels be tested. And ask your doctor about the many natural treatments available. Then, who knows? Your days of feeling down could be up!


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About Belinda Burman

Belinda Burman is a teacher, healer and freelance writer based in Brisbane, Australia. She has a special interest in energy medicine and holistic living. Belinda Burman can be contacted on Tel: 0403 217 690;


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