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Thyroid function is crucial to our well-being — so why is it that this crucial gland has gone haywire in most of us?

Thyroid dysfunction is highly prevalent in the United States, affecting 3.7 percent of Americans, according the the National Health and Nutrition Examination Survey (NHHES).

Conventional medicine largely looks to Thyroid Stimulating Hormone (TSH) to determine your thyroid health. TSH is a hormone released from your pituitary that tells your thyroid to release Thyroxine (T4). T4 is largely “inactive” and needs to be converted to the “active” Triiodothyronine (T3). T3 can be both free or bound to Thyroid Binding Globulin (TBG). Free T3 is what acts on thyroid receptors throughout the body to stimulate numerous body functions.

Low thyroid function can be a result of kinks in any part of the pathway.

The problem with low thyroid function can be due to a low release of T4, an insufficient conversion of T3, not enough T3 freed from TBG, or T3 being blocked from attaching to its target receptors throughout the body. It can seemingly get quite complicated.

There can also be autoimmune imbalances that lead to unwarranted attacks to your thyroid tissue (Hashimoto’s thyroiditis) or an over stimulation of thyroid production (Graves’ disease). While the number one reason of low thyroid function worldwide is iodine deficiency (needed for production of T4 and T3), the number one reason in the United States is Hashimoto’s thyroiditis. This condition by the way has been linked to Epstein Barr virus in many cases.

While TSH can tell us if thyroid function is generally high or low; it tells us very little about “Why?” If there is an immune component – then the question should be “Why is the immune system out of balance and affecting the thyroid?” These questions are not being asked when your doctor just measures TSH.

Why someone’s thyroid gland is slow-functioning or slow-converting is a very different question from why someone’s immune system is disrupting healthy thyroid function.

The Sucky Side Of Stress

One missing link in the thyroid debate is the impact of stress. Stress affects thyroid function in a variety of ways, from appropriate signaling and hormone binding, to actual T3 conversion and eventual detoxification of inactive metabolites.

First, stress is communicated through the body largely through a hormone known as cortisol. Cortisol generally helps us by keeping our blood sugar stable and helping to bring down inflammation. Too much cortisol, over time, can deplete our ability to respond to stress — and can begin to affect other systems like thyroid function.

  • Chronic stress suppresses the pituitary gland which is responsible for releasing thyroid stimulating hormone (TSH) which then leads to T4 and T3 release.
  • High cortisol slows conversion of inactive T4 into active T3 by affecting the enzyme responsible.
  • Not all T4 is converted to active T3. Some T4 is converted to T3 Sulfate (T3S) and triiodothyroacetic acid (T3AC) which are inactive intermediates. This isn’t meant to be a chemistry lesson so it is only important to understand that these T3 middle guys require action by bacteria in the gut to convert them into active T3! Stress interferes with gastrointestinal integrity, leading to bacterial imbalances, that over time can deplete the production of “active” T3.
  • High levels of cortisol put stress on the liver’s ability to detoxify – as cortisol itself is detoxified by the liver. T4 is also converted to an irreversibly inactive form of T3 called “reverse T3” (rT3) — rT3 is cleared out by the liver. With chronic levels of stress, the body may become inefficient at clearing out inactive rT3. This inactive form interferes with normal T3 activity. It binds to thyroid receptors and blocks the active T3 from binding. This is one reason why blood levels of T3 and TSH can be normal, yet dysfunction could still be present, in part due to stress!

It is enjoyable to paint “linear” stories of how the body functions. But the body works dynamically. Molecules morph in and out of active forms. Proteins bind to the hormones affecting their activity. Even the receptor sites are highly regulated. It’s a beautiful system to think about, yet a frustrating system to “treat”.

In truth, there are many people who may actually experience hypothyroid symptoms when the blood values appear “normal”.

Stress is just one example of the physical, psychological, and chemical factors involved in thyroid health. The body is a series of interconnected webs of activity. This way, the body can pull from multiple streams of resources when certain systems become overloaded. Too much stress over time will deteriorate the balance of the streams.

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Thyroid Function

6 Strategies For Improving Thyroid Function

  1. Ask your health professional for a complete thyroid panel that may include TSH, T4, T3, Free T3, TBG, rT3, and autoimmune markers like Thyroid peroxidase (TPO), Thyroglobulin antibodies (TgAb), TSH receptor antibodies (TR ab), and Thyroid Stimulating Immunoglobulins (TSI).
  2. Promote immune system balance: address hidden infections, ensure adequate Vitamin D levels, decrease stress, minimize toxic exposures.
  3. Ensure adequate intake of micronutrients like selenium and iodine which help with T4 and T3 production.
  4. Promote healthy liver health. Reduce toxin exposure from the environment and support healthy detoxification.
  5. Protect the gut. Remove sensitive and allergic foods, promote integrity of the gastrointestinal lining,  and maintain healthy levels and diversity of flora.
  6. Maintain stress balance with exercise, mindfulness, and surrounding yourself with people who share the same values toward life and health. You do not have to be going through emotional/psychological stress to be “stressed”.

Alexander Rinehart, DC, MS, CNSAlexander Rinehart, DC, MS, CNS is a Certified Nutrition Specialist with a Master’s degree in Applied Clinical Nutrition, is the owner of the AZ Nutrition Center in Phoenix, AZ. You can learn more about Dr. Rinehart and read his articles at

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