1 in 5 women will be affected by a thyroid disorder in their lifetime. This stat is extra startling considering that thyroid issues often go undiagnosed.


In the Western World, far and away the leading cause of low thyroid is an autoimmune attack on the thyroid gland known as Hashimoto’s.

(Autoimmune diseases cause the body to attack normal tissues, such as the thyroid gland, that it’s inappropriately identified as foreign, i.e. not part of you).

As common as it is, unfortunately this condition is simply not being managed well for most women. Even if their thyroid issue has been identified – although many times women are told they are “fine” based on a minimal thyroid panel but they have the entire litany of low thyroid symptoms – most are still suffering. As well, the autoimmune component is being overlooked entirely.

The thyroid is the gas pedal of your metabolism, if it’s not being stepped on and not pumping out fuel and that fuel is not getting to the engine, you’re going to be stalled in your weight loss and feeling tired, cloudy headed and depressed. All the while your periods can be painful and abnormal, your hair is falling out and you just don’t feel like yourself.

Typical management is with medications that replace thyroid hormones. These may be synthetic or natural and there’s great debate over what’s best. But the bigger issue is that there are many, many steps that need to be supported as a hormone, whether made by the body or taken in pill form, gets processed in the liver, gets transported to the cell, enters the cell and bind internal receptors and cause a result.

As you can see, there’s lots of room for error – and lots of room for nutritional support, lifestyle and nutrition changes and better thyroid function.

Do you have a thyroid condition?

When you’re suffering with low levels of thyroid hormones you can deal with a widespread  range of symptoms from brain fog, fatigue, hair loss or weight gain to fertility or menstrual issues, digestive complaints (often constipation), dry skin and depression. These symptoms span your brain, ovaries, tummies and fingernails because nearly every cell in the body has receptors for thyroid hormones.

Whether you have a diagnoses thyroid issue or not, it’s important to take constant stock of your low thyroid symptoms so that you can have a conversation with your doctor about medication or supplement changes or further lab evaluation. This is so important because when cells don’t’ have robust thyroid hormones each cell’s metabolism, regeneration and basic functions struggle to play out. This is often an unfortunately rapid unraveling of hormonal  balance for many women.

If you want a full list of thyroid symptoms or you’re wondering how what your thyroid hormones are trying to tell you, be sure to take my Thyroid Quiz.

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Thyroid 101

While you don’t need a fellowship in endocrinology, to advocate for yourself you do need a basic understanding of thyroid physiology.

It starts in your brain: TRH from the hypothalamus (which is not tested for typically) stimulates your pituitary to release TSH. TSH is the signal to the enzyme TPO (thyroid peroxidase) in your thyroid to start making T4, and a bit of T3 (94% and 7% respectively).

At the thyroid: T4 is released and converted to T3 (various locations but mostly in the liver), the metabolically active form of thyroid hormone.  This T4 to active T3 conversion occurs to about 60% of your T4. About 20% of it is converted to an inactive form (this is a protective mechanism to avoid overstimulation of your metabolism but can be cranked on high due to stress or inflammation) called reverse T3. And the last 20% is converted to T3 forms called T3S (T3 Sulfate) and T3AC (T3 acetate).  These two are also inactive forms but, they can be reactivated by healthy gut bacteria (one of many reasons a healthy gut is KEY to having enough thyroid hormone).

In the blood steam: hormones are predominantly found in the blood steam bound to a protein carrier (in this case, mostly stuck to thyroid binding globulin or TBG).  At some point, the hormone has to come off the carrier and become “free” T3 so it can bind to the internal, nuclear receptor of a cell and cause metabolic activation of that cell (this requires vitamin A and a healthy vs. excessive inflammatory state).

And you guessed it; you can have trouble anywhere along this cascade from production to conversion to going excessively down the wrong, inactive pathways.

A thorough thyroid panel will help you see where you can best intervene along this cascade so that you’re addressing your thyroid in the exact way YOU need. And absolutely you can have more than one snafu in this chain of events.

Furthermore, you can have issues in the thyroid cascade but also remember that most hypothyroidism has an autoimmune attack on various components of your thyroid as it’s root cause so that also should be elevated. I recommend women get screened for anti-thyroid antibodies yearly or even more frequently if they’ve recently been pregnant, are going through perimenopause or have a family history of autoimmunity or thyroid disease.

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