Vancouver Thyroid Centre
Dr. Tasreen Albhai N.D.Naturopathic Physician Read Biography
Have you been told that you don’t have a thyroid disorder? Has general testing from your MD or other physician been evaluated as normal, yet you continue to feel like there has been a mis-diagnosis?
At Vitalia Health Care INC we take an integrated approach to treating thyroid conditions. The first step is an initial assessment with one of our Naturopathic physicians, Dr Tasreen Alibhai ND or Dr Elizabeth Miller ND. From this appointment, thyroid function will be investigated using blood tests. Specific vitamin levels that may affect thyroid function will also be discussed, measured and optimized. If stress is a concern, cortisol and other stress hormones may also be measured as they may impact thyroid hormone levels and conversion. This will be discussed in more detail. Thyroid autoantibodies will also be measured to rule out Hashimotos Thyroidits, the most common cause of hypothyroidism.
Common symptoms of Low thyroid function or hypothyroidism:
- weight gain
- morning aches and pain
- difficulties with recovery after exercise
- low libido
- menstrual irregularities including missed periods or heavy periods
- hair loss, dry skin, dry hair, facial edema
When it comes to your thyroid health, there are various factors that may impact how well your thyroid is functioning and how well your body is responding to these hormones. Through a thorough patient assessment including laboratory testing, our Naturopathic Doctors work with you to develop a personalized treatment plan to optimize your thyroid health and help you feel better!
LABORATY TESTING FOR THYROID CONDITIONS
At Vitalia Health Care we utilize Laboratory testing to assess thyroid function and rule out Hashimoto’s or Graves Disease. The following hormones are typically measured:
TSH (Thyroid stimulating hormone). The normal range for TSH is quite broad. Many people do fall within the normal range but still experience symptoms of low thyroid. Therefore, T4 and T3 levels are also measured to get a more accurate reflection of thyroid function.
T4 is the most abundant hormone produced by the thyroid gland but it is not as active as T3.
T3 is the most active thyroid hormone. About 20% is produced by the thyroid glands. The other 80% is converted from T4. Some people are not able to convert T4 to T3 at an efficient rate. They may experience hypothyroid symptoms even though TSH and T4 levels fall within the normal range. Some people who are taking T4 hormone replacement (Synthroid or Levothyroxine) may also continue to experience hypothyroid symptoms if they are not converting T4 to T3 at the rate the body needs. In this case, a combination of T4 and T3 thyroid hormone replacement may work better for them.
TPO (Thyroperoxidsae antibodies) and TG (Thyroglobulin antibodies) may be measured to rule out an auto-immune thyroid condition or Hashimotos Thyroid.
Our comprehensive thyroid testing starts with a simple blood draw to analyze 7 different markers including free hormone levels, reverse T3, and antibodies. Depending on if the individual has already been diagnosed with Hashimoto’s (auto-immune thyroiditis) and their current symptoms, further tests may be recommended such as:
- Iron and ferritin levels
- Vitamin D *
- Digestive health - food sensitivities, SIBO, microbiology stool testing
- Red Blood Cell mineral levels **
- Inflammatory markers such as CRP and homocysteine
- Methylation and other genetic testing
- Omega 6:3 ratio and lipid profile
- hypothalamus function - prolactin, FSH/LH
- Adrenal and cortisol function, potentially adrenal antibody levels
- Sex hormones such as estrogen, progesterone, testosterone, DHEA
- Heavy metal toxicity
- Multiple other tests are available upon request or as required for a more comprehensive assessment
* Vitamin D is a steroid hormone and influences over 2000 genes in the body. Most people are not reaching optimal levels even with supplementation and should be tested to determine the correct level of dosing. Low Vitamin D levels correlate to many disorders including auto-immune disease.
** RBC Mineral Profile - Nutrient deficiency is common as a result of dietary factors and digestive disorders that inhibit the absorption of minerals from food into the body. Magnesium is estimated to be deficient in more than half the population with normal thyroid function and a much greater proportion in those with abnormal function. In some cases, although selenium is required to convert thyroid hormone, elevated levels of selenium can mimic the symptoms of hypothyroidism. Testing the levels of minerals can be done by a blood draw and examining mineral levels contained within red blood cells which act to transport nutrients through the body.
Complete Thyroid Evaluation
In addition to testing the blood markers specific to thyroid function, other nutritional values and hormones can be assessed to dig deeper. Typical thyroid testing from a medical doctor is only serum TSH (Thyroid Stimulating Hormone) and an additional T4 level ONLY if the TSH is out of range. At Vitalia, our Advanced Profile includes up to 7 blood markers (TSH, free T4, free T3, reverse T3, both antibodies and SHBG) to pick up on the details of thyroid function.
In some cases, symptoms of hypothyroidism are present yet even the Advanced Profile appears relatively “normal”. The tricky part about labs is that the values assessed are only a measure of the levels found in the blood. Hormone levels can be made at optimal amounts and travel to the cells by blood, yet not be transported into the cells efficiently. This results in cellular hypothyroidism and can be caused due to limited thyroid receptors on the cell, insensitivity of these receptors, decreased transportation of thyroid hormone and poor utilization of hormone.
Vitamin D, iron, iodine and selenium are some of the most important nutrients to enable proper production, transport and utilization of active thyroid hormone. Deficiencies will lead to “hypometabolism” (aka low or slow metabolism) despite good thyroid function. A Complete Thyroid Evaluation measures these nutrients and thyroid markers to determine and understand the whole thyroid system. In some cases, other hormones such as the stress hormone cortisol play a role in the biochemistry of thyroid hormones and is also easily evaluated by saliva.
Our Complete Thyroid Evaluation uses samples of blood, saliva and urine. It includes:
- TSH, free T4, free T3, reverse T3, Anti-TPO, Anti-thyroglobulin
- Vitamin D
- Urine Iodine, Selenium, Bromide and Cadmium
- Adrenal Salivary Stress Index (4 point cortisol, insulin x2, DHEA, progesterone, salivary IgA, anti-gliadian antibodies)
Often further exploration of digestive function is important to ensure that nutrients are absorbed from food and supplementation and any causes of inflammation are eliminated. A high portion of people with auto-immune thyroiditis (Hashimoto’s) have an imbalance in the microbiology of their digestive system. Conditions such as SIBO and candida can be tested for and treated both with diet, supplementation and in some cases prescription medications.
Hashimotos thyroiditis is an autoimmue condition where the immune system affects the thyroid gland, reducing its production of thyroid hormone. It is the most common cause of hypothyroidism in North America. It is more prevalent in women than men.
Hashimotos is diagnosed through positive antibodies (TPO and / or TG) or an ultrasound. Antibodies may appear several years before any increase in TSH levels.
TREATMENT FOR LOW THYROID FUNCTION
The first line of treatment for low thyroid function is thyroid medication. Options include T4 (Synthroid or Levothyroxine) or a combination of T4 and T3 hormone. Some patients feel better on a Dessicated thyroid replacement. Your Naturopathic Physician will discuss options that may work best for you.
VITAMINS AND LOW THYROID FUNCTION
Vitamins and herbal medicine may be recommended as a part of a comprehensive thyroid support program. These include:
- Vitamin B12: 30-55% of those with Hashimotos are B12 deficient https://pubmed.ncbi.nlm.nih.gov/28290237/
- Iron: Iron deficiency may be found in up to 60% of hypothyroid patients https://pubmed.ncbi.nlm.nih.gov/28290237/
- Vitamin D: There may be a correlation between low vitamin D levels and the presence of HM https://pubmed.ncbi.nlm.nih.gov/25514898/
- Selenium: may improve overall thyroid function, reduce TSH levels and reduce thyroid antibody levels https://pubmed.ncbi.nlm.nih.gov/28255299/
- Iodine: a deficiency may contribute to low thyroid hormone production https://pubmed.ncbi.nlm.nih.gov/25314342/
DIET AND THYROID FUNCTION
An anti-inflammatory diet may be recommended by your Naturopathic Doctor. These may include avoiding Gluten , avoiding Soy products, a Mediterranean Diet , or an Autoimmune diet.
Celiac disease is associated with about 2-5% of Hashimotos thyroidits https://pubmed.ncbi.nlm.nih.gov/18056028/, However some patients who are Gluten intolerant, but do not have Celiac disease, also may experience improvement in symptoms following a Gluten free diet. Your Naturopathic Physician at Vitalia Health Care INC will discuss if a Gluten free diet may help improve your thyroid function.
HOW DO WE TREAT THYROID CONDITIIONS?
Our approach at Vitalia Health Care incorporates the following;
- An initial assessment with your Naturopathic Physician
- Laboratory testing for thyroid hormones and any associated nutrient deficiencies
- Recommendations of medications if appropriate
- Recommendation of vitamins/ minerals / herbal medicines based on your medical history and lab values.
- Diet recommendations
- If you have been diagnosed with Hypothyroidism or Hashimotos Thyroiditis and would like to learn about how Naturopathic Medicine can help you manage your thyroid condition, call us today! Dr Tasreen Alibhai, ND and Dr Elizabeth Miller ND are available to meet with you. Check out their availability here
Depending on the state of thyroid dysfunction along with patient and doctor preferences, there are a wide variety of treatment options. If a patient requires extra thyroid hormone support, medications such as desiccated thyroid, combinations of levothyroxine (T4) and liothyroxine (T3) and/or herbal and mineral combinations are used. Medications can often be compounded to use forms without dyes and other additives and to provide individual doses not conventionally dispensed in regular pharmacies. Blood thyroid levels are monitored carefully when changes of medication or dose are made until a stable state is achieved.
Research-based Treatment Strategies to improve Hashimoto’s Thyroiditis:
Thyroid-Gut Axis: How Does the Microbiota Influence Thyroid Function?Nutrients June 2020
Relationships between the thyroid and gluten (celiac and non-celiac reactivity), Vitamin D, Iron, Iodine, Zinc, Selenium, Vitamin D and probiotics have been clinically and research-based correlated. This literature research provides rational behind supplementation and dietary restrictions for auto-immune thyroid patientsNutrients June 2020
How this applies: Normal, healthy digestion is the first place to start when beginning to address thyroid disease. If important nutrients are low and beneficial bacteria are low, how can we expect the body to have optimal levels of thyroid hormone and low levels of auto-immune markers?
The February 2020 edition of Therapeutic Advances in Endocrinology and Metabolism showed when the common bacterial infection by Blastocystis hominis was treated, significant reduction in Hashimoto’s antibodies were achieved. The study looked at healthy patients and Hashimoto’s patients ‘blood thyroid hormone and antibody markers and the presence of B. hominis in the stool. The immune marker Interleukin 17 was also measured. After treatment, TSH, Anti-TPO and IL-17 also decreased and free T3 improved.
What does this mean to the Hashimoto’s patient? Testing the microbiology of the digestive system using GI 360 and eradicating invasive microorganisms will lower inflammation throughout the body. Less inflammation can result in less symptoms, a general overall improvement with health and preservation of thyroid function. Using a variety of herbs and sometimes the right antibiotic or anti-fungal, unbalanced flora can be corrected.
Supplements and Hashimotos Thyroiditis:
Selenium supplementation. In the International Journal of Endocrinology June 2020, a dose of 200mcg of selenium was given to 40 patients with normal thyroid function for 3 months. Blood markers were tested before and after. The anti-thyroperoxidase antibody had a significant decrease in levels after treatment.
In other words: We all make some level of antibodies against aspects of our thyroid. This is normal and can be thought of as the body dealing with dysfunctional or old proteins that need to be recycled. When antibody levels are above a threshold and a person exhibits thyroid-related symptoms, Hashimoto’s is diagnosed. This study showed that the most common antibody found in Hashimoto’s can be lowered using the mineral selenium.
Of note: Overdosing or taking too much selenium can cause a person to have hypothyroid symptoms, which is interesting because deficiency does this too. Ideally, testing selenium levels using a Red Blood Cell Elements test can be used prior to supplementing.
A newer approach to auto-immune and inflammatory disorders is showing to be beneficial with Hashimoto’s thyroiditis. Low dose naltrexone, or LDN therapy helps to stabilize and improve the immune system by up-regulating endorphins and promoting anti-inflammatory pathways. LDN for inflammatory conditions is an off-label use of the drug naltrexone and is currently being used to improve conditions such as Hashimoto’s, IBS, fibromyalgia, multiple sclerosis, cancer, psoriasis, rheumatoid arthritis and more. For more information, the LDN Research Trust has details on their website.
As there are often many components to hypothyroidism, a patient can expect to look at the body as a whole and not just the thyroid. This includes examining digestion, other hormonal dysfunction such as high or low cortisol, estrogen or progesterone deficiencies or imbalance, blood sugar levels and insulin resistance and concomitant auto-immune disorders.
Low Dose Naltrexone (LDN) Therapy
In the last 10-15 years, the use of the pharmaceutical drug naltrexone in low doses (LDN) has gained attention and popularity. When administered at about 10% of the dose, it has an immune-modulating effect in part by releasing endorphins and reducing pro-inflammatory pathways. This means when used to treat Hashimoto’s and other auto-immune or inflammatory conditions, LDN can reverse and work to remove the cause of symptoms and disease. By balancing the immune response to a more homeostatic state, patients feel better.
A documented study of Hashimoto’s patients showed that after 13 months of LDN treatment, 65% of the individuals had a statistically significant decrease in auto-immune antibodies against the thyroid. It is important to note that LDN is a medically supervised treatment that requires regular monitoring in order to insure safety. At Vitalia Healthcare, we are pleased to provide LDN therapy for those that meet the criteria. For more information on LDN, please visit the LDN Research Trust Organization
Also Read These Related PagesStres Impact on Thyroid
What does the Thyroid Do?
Comprehensive Thyroid Assessment
January is Thyroid Awareness Month!
Low energy? How thyroid conditions can be overlooked.
How Supporting Your Thyroid Can Help You Achieve Your Wellness Goals