All About the Thyroid, the Body's ‘Sentinel Gland’

Dr. Robert Rountree INTRO

This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements, and lifestyle approaches to good health. I'm Dr. Robert Roundtree, Chief Medical Advisor at Thorne and Functional Medicine Doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who expressed them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure or prevent any disease. 

Dr. Robert Rountree

Hi everyone, and welcome once again to The Thorne Podcast. This week we're speaking to my good friend and colleague, Dr. Joel Evans. He's a board certified OB-GYN, an international lecturer, who’s lectured all over the world, The founder and director of both the Center for Functional Medicine in Ridgefield, Connecticut, and the Center for Women's Health. And he's also the Chief of Medical Affairs at the Institute for Functional Medicine. Welcome to the show, Joel. How are you doing?

Dr. Joel Evans

I'm doing great. And great to be here, Bob. And, you know, I am one of your biggest fans as I love sitting in the audience watching you lecture and great to now flip things a bit.

Dr. Robert Rountree

We're going to flip things over and give you a chance to share some of your knowledge with our listeners. So what we're going to talk about this week is thyroid health, which is kind of a hot topic these days here. A lot of people talking about thyroid here, a lot of news articles and books coming out on it. So maybe we can start by just talking about what the thyroid gland does.

Dr. Joel Evans

Basically, the thyroid has been labeled, you know, sort of the master gland of the body, if you will. It has an effect on almost every cell of the body, every organ system, and is a major driver on how we feel. And it's a major driver on how we are able to perform with our activities of daily living, whether it be, you know, mental function at work, physical activity, exercise etc... So it really affects everything and affects hormones, mood, cognition, digestion, our immune system. So it's quite an important gland. And the thing about the thyroid is that it's very sensitive. So in the functional medicine world, we use the term that it's the sentinel gland of the body, right? That was coined by Jeff Bland, who's one of the founders of the functional medicine movement. And what he means by that is it's very, very sensitive. It's the canary in the coal mine, if you will, of what we're exposed to, both externally and whatever the toxic chemicals are we make internally. So the thyroid is the first gland to go when things change, either externally or internally.

Dr. Robert Rountree

Now, how does the thyroid become aware of the environment? I mean, is it you know, our eyes can see light, right? Our skin can feel touch, our nose can smell, smells, chemicals. How does the thyroid know what's going on and what kinds of things does it respond to? So this a gland in the neck, right? It's inside. Inside the body. How how does it do it?

Dr. Joel Evans

So how does it do that? It's not like it sits there with X-ray vision. Okay?

Dr. Robert Rountree

Yeah, haha.

Dr. Joel Evans

What happens is that it's a very complex gland in terms of its function. And the thyroid’s purpose in life is to make thyroid hormone. And so—

Dr. Robert Rountree

And what are those hormones called? Just in case people don't know.

Dr. Joel Evans

They're. They're called T3 and T4.

Dr. Robert Rountree

Okay.

Dr. Joel Evans

There are other thyroid hormones that are really not biologically active or important, but the T3 and T4 are the important thyroid hormones. Now, the steps required to make thyroid hormone are complicated in the sense that require a number of enzymes, and they require another thing called cofactors, which are vitamins or minerals that are required for those enzymes to work properly. So the way the thyroid senses about what's going on in the environment is a little bit of a misnomer, when we use the word sense. Really what we mean is the thyroid is impacted by what's going on in the environment because what's going on in the environment will change the concentrations of those cofactors so that it won't be able to make thyroid hormone. It will, for example, if we're exposed to toxins, those toxic chemicals block those enzymes to make thyroid hormone. Mm hmm. Or, for example, if we're under stress, Stress and the chemicals that the adrenal glands make from being under stress directly inhibit thyroid hormone production. So really, when we make a statement like the thyroid is sensitive, that's all true. And then when we look under the hood a bit, the reason it's sensitive to everything is because it's a complex process to make thyroid hormone. And there are so many ways to impact the production of thyroid hormone in a negative way from stress, toxins, nutrients that we don't get because our diet isn't right. Not enough exercise, poor sleep, etc.. So that's why it's the sentinel, called the sentinel gland, because everything that we're involved in, in our existence can impact thyroid hormone production.

Dr. Robert Rountree

Okay. So just to pick an example, to take that a little bit further, this is something I know you're very aware of. What about women's hormones, estrogen and the thyroid gland? You know what happens with pregnancy or menstrual periods or say, women on birth control pills or hormones? Does that have an impact on how the gland functions?

Dr. Joel Evans

This is such a great question because, you know, you can't say a simple thing like estrogen does this by affecting the thyroid. So in some cases, estrogen can actually inhibit thyroid hormone. And then if you look at it in the other way, estrogen can actually increase TSH, which is the driving hormone for synthesis of free T3 and free T4 or T3 and T4, which is why women feel so much better, often on low doses of hormone, for example. There's different ways that it impacts the thyroid. And so what we're really looking for is we're looking for stable hormonal health. Now, I could tell you a very basic thing, which is when the thyroid is way off, ovulation is off and fertility is impaired and menstrual cycles are off. So the classic thing you have to test for when someone has issues with fertility or with regular cycles is to make sure that the thyroid is normal. So those are the big things. I was just talking about some of these subtle things which can also be there as well, which is why hormone balance is so important when you want to have thyroid balance. And a functioning thyroid is so important when you want to have normal estrogen and progesterone balance.

Dr. Robert Rountree

Now, this might be an oversimplification. I know it is an oversimplification, but in medical school I was basically taught, Oh, you've got this simple mechanism. The hypothalamus, the brain makes a releasing hormone that tells the pituitary to make thyroid stimulating hormone that tells the gland to make T4, that's converted to T3, and that's the whole story. That's what I mean by oversimplification, is that, you know, I was taught either a person's got normal thyroid low or high, and that's the end of the story. What I'm hearing you say is this is a much more complicated system. And if it's more complicated, it means there's opportunities for things to go wrong.

Dr. Joel Evans

Right. And that's why it's the sentinel gland. Now, you know, we were talking about hormones when I said the subtleties where, you know, estrogen may block conversion of T4 to T3, T4 is the main form of thyroid hormone, which is then converted to T3, which is the active form. And so sometimes estrogen and birth control pills can block that conversion, but that's not something that happens frequently. But the subtlety here about the releasing hormone piece is, yes, it's all true and they're supposed to be feedback, but there's such variation that it causes incredible difficulties in interpreting normal levels. And I and I know that we've spoken about this in terms of the challenges of diagnosing someone and saying, oh, your thyroid is functioning well, your thyroid is off. And that's because there's such variation, because the feedback loops aren't always functioning well when you have nutrient deficiencies, etc..

Dr. Robert Rountree

So what are some of the clues that your thyroid may not be functioning well? What are the clues that that there could be a problem and that you may need to get tested or maybe you have certain symptoms and you're tested and the tests don't quite add up, those are two slightly different scenarios. But what what's a tip off that the thyroid is not functioning properly?

Dr. Joel Evans

There are so many what we call manifestations of abnormal thyroid function. And you can really get lost in this long list. But what I like to do is I like to look for, you know, the major ones, right? So for me, if someone has a big lump on their neck where their Thyroid is.

Dr. Robert Rountree

That's a tip off.

Dr. Joel Evans

In terms of the symptoms that we find. It's fatigue, it's constipation, it's hair loss, it's loss of hair in the eyebrows on the edges. It's being colder in a room than other people. It's cold hands or feet. It's abnormal menstrual periods, it's constipation, it's decreased cognitive performance, it's depressed mood. Those are the biggies.

Dr. Robert Rountree

And those are all signs of a low or under functioning thyroid?

Dr. Joel Evans

Correct. The over functioning thyroid is one where people feel almost anxious, they're hyper, they feel their heart beating or their heart racing. They can't sit still. They can be quick to anger, sweating. Those are the overactive thyroid symptoms.

Dr. Robert Rountree

Now, when you if you group all these together, the low end, the high—anything wrong with the thyroid—how common are these? Is this very rare that you almost never see it or I'm leading you on, right?

Dr. Joel Evans

Yeah. Yeah. So again, this is based on how we define a thyroid problem, right? So there are major groups of physicians and guidelines, etc. and they estimate one in eight people.

Dr. Robert Rountree

One in eight?

Dr. Joel Evans

Yes.

Dr. Robert Rountree

Wow.

Dr. Joel Evans

Which is really, really common. I see that more often because I'm looking for it. Right? That's one of the things I'm always looking for when my patients either have different symptoms, they have a disease or they want optimal health, longevity, medicine, whatever you want to call it. Whatever the reason is they're coming to see me. I need to make sure that their thyroid is functioning optimally, not just quote/unquote normal.

Dr. Robert Rountree

So I'm guessing one in eight is probably a lowball for your practice?

Dr. Joel Evans

Correct.

Dr. Robert Rountree

Is it fair to say that it affects women more than men?

Dr. Joel Evans

It is. It is especially low thyroid.

Dr. Robert Rountree

Why?

Dr. Joel Evans

You know, we don't have all the answers to everything.

Dr. Robert Rountree

Yeah, yeah.

Dr. Joel Evans

The key link here is with autoimmune disease, because one of the main causes of underactive thyroid is autoimmune disease, which we know is more common in women. And so that's what I would say, you know, the link is.

Dr. Robert Rountree

Is your suspicion that that's because of hormones or because of something to do with having two X chromosomes instead of an X/Y? Is that, I know that's a theory, but what's your impression?

Dr. Joel Evans

You know, I think it's hormonal. I just don't think we know the full mechanism. But like when you look at other autoimmune diseases and I know this is your area of expertise, Bob, you know, I'm always surprised about the relationship of the gut to anything that I'm looking at in functional medicine. And so what we find is when we talk about gut health, when we talk about inflammation in the gut. We're always the first thing people always talk about i's gluten, for example. And if you look at the most extreme form of sensitivity to gluten, which is celiac disease, those patients can be three times more likely to have thyroid disease.

Dr. Robert Rountree

Wow.

Dr. Joel Evans

Right? So that's something that I remembered, you know, non gluten, celiac or non-celiac gluten sensitivity, which is the more common form of, you know, sensitivity to gluten also has an increased risk of thyroid disease. And then when you take gluten away from those patients, their thyroid clears up almost 60% of the time.

Dr. Robert Rountree

So you're saying if you caught hypothyroid or Hashimoto's autoimmune thyroid ism thyroiditis early enough and you took the person off gluten and maybe gave them some supplements, which you could mention, are you saying you could reverse that thyroid disease? Absolutely.

Dr. Joel Evans

No. The big the big, you know, foundational assumption there is that they have some sort of sensitivity to gluten. Yes. Yes, absolutely.

Dr. Robert Rountree

Yeah. And do they have to be tested for celiac or gluten sensitivity or can you just say, hey, try it? I mean, you know, is this a don't try this at home or is this go ahead.

Dr. Joel Evans

This is go ahead and try it at home and see what happens. I think that there's you know, a lot of reasons where you need to see a functional medicine practitioner. But there's also a lot of things that people can do at home beforehand to see if they can make themselves feel better. Right? So I never want someone to not see a doctor and miss a diagnosis, right? If someone's tired, I never want them to not realize they're anemic and not realize that the source of their anemia is an occult colon cancer. Yeah, but, you know, we never want that. But what we want is to say, You know what? See if you feel better off of gluten. Mm hmm. Mm hmm. Yeah, that's something they could do. See, if you feel better reducing the stress in your life, see if you feel better with more sleep, with physical exercise, with eating a cleaner diet without processed foods, spending more time in nature. These are things that everyone says. Oh, that all makes sense. And at the same time, there's incredible support in the literature that says that this is helpful for Thyroid

Dr. Robert Rountree

Which is interesting because, you know, a lot of endocrinologists would basically say, well, either you need thyroid hormone or you don't. And so if you don't, that's kind of the end of the story. And you're saying that's just the beginning.

Dr. Joel Evans

That. Exactly. And that's the difference between our perspective and a conventional perspective, because they look at things as black and white, you either need hormone or you don't. And what we're saying is that there's a lot in the middle where people that theoretically are told they need thyroid replacement can do these functional interventions and they end up not needing thyroid replacement because they normalize their thyroid. Right. Or there are people that a conventional doctor would say, you're totally normal. And we say, Oh, no, I see the signs that you're going to develop something in the future unless we address it. So I want you to start taking these thyroid nutrients and you may not be getting in your body, etc., so that we can improve the thyroid after they've been told their thyroid’s normal by their conventional doctor.

Dr. Robert Rountree

Now, I want to clear on something I think I heard you just say is that maybe there's more to the story than just the thyroid being off. Like maybe having thyroid problems is a tip off to even bigger health problems that might need to be addressed. Is that correct?

Dr. Joel Evans

Absolutely. Absolutely. You know, for example, your listeners probably don't know this, but there's a relationship with diabetes in the thyroid, right? So an abnormal thyroid can predispose you to diabetes. Having type two diabetes can predispose you to thyroid problems.

Dr. Robert Rountree

So it's important to be working with the practitioner who basically can think that way and look at other problems.

Dr. Joel Evans

Yeah, right. Because when my patients come in with fatigue and they or come in have just had a diagnosis of, you know, low thyroid and they want to see what a functional medicine perspective could do. And I say, well, let's really look deeply into your blood sugar. They may not understand why, because that didn't happen with their conventional doctor. This is where the functional approach actually enhances is the conventional approach.

Dr. Robert Rountree

We've talked about gluten. Are there any other major nutritional issues that a person with potential thyroid problems should consider deficiencies? For example, is there any particular nutrients that a person should be focusing on? You know, I'll just kind of throw this as a, you know, a ringer, but what about iodine?

Dr. Joel Evans

When you think back to what I started with by saying that the thyroid gland has this very complicated process of making thyroid hormone, there are factors that will inhibit thyroid hormone production and factors that are needed such that deficiencies become problematic. Iodine, Yes, is a big one. Now, you don't want to all of a sudden take a lot of iodine because too much iodine can actually inhibit the thyroid as well. So I always check my patients for that. But iron is important. Zinc is important, Selenium is important. Vitamin E, vitamin D, some of the B vitamins, vitamin A, zinc. So if you're deficient in those, then you'll have a problem. Do we always have to test? No. There are some people that say, I don't want to take a nutrient unless I've been tested and shown to be deficient. And I say that's fine. And then we'll test for all those things or we say, You know what? There are these ways to increase them in your diet, or you can go ahead and just take a thyroid blend supplement, which has these things and see if you feel better. And then, you know, you're so involved in the world of, you know, toxic chemicals, right?

Dr. Robert Rountree

Yeah.

Dr. Joel Evans

So we have to increase those nutrients that are important that we're not getting, and then we need to decrease those things that are negatively impacting the thyroidd. Pesticides, mercury, cadmium, lead, turn the temperature down on any concomitant autoimmune diseases that people might have. Reducing stress, as I said, is so important because stress impacts every aspect of thyroid hormone production, specifically acting on that whole hypothalamic pituitary thyroid axis that you referenced earlier. You know, stress inhibits that directly and so does inflammation.

Dr. Robert Rountree

Well, you know, what you've done, Joel, is you've really opened a lot of doors here and you've made it clear that, you know, it's this is a topic that really is worth of extended discussions that I understand why people have written whole books on it and why there's certain practitioners that specialize in this. So I want to thank you for that, that encapsulated overview. What we're going to do is take a short break and then after that we're going to answer some questions that have come in from our listeners about thyroid so we can take a little deeper dive into certain aspects of this topic.

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Dr. Robert Rountree

And we're back. So now it's time to answer some questions that have come in from our community. The first question this week comes from a listener who asked, I've gone to my doctor because I have all of the symptoms of thyroid disease, weight gain, irritability, fatigue, hair loss, menstrual irregularity, but the test—and they don't say which ones—the tests come back negative. What else could it be? So is it is it a problem with the test or is it that something else is going on or.

Dr. Joel Evans

Right. So my bet is that there is thyroid disease here. And my explanation is that the criteria that this person's physician is using is the suboptimal criteria. So, for example, TSH is the driver of thyroid function. It's called thyroid stimulating hormone. And if the TSH number is too high, it means that the thyroid is not optimally functioning. It's like a car where you press on the gas pedal. And if you need to go 50 miles an hour, if you just touch on the gas pedal, then you get to 50 miles an hour. Your car is great, but if you have to floor it to get to 50 miles an hour, then it's a problem. So TSH  is like that gas pedal. So when the TSH is high, the gas pedal is being pushed hard. Just because your thyroid numbers may be okay if that TSH is too high, that's a sign that the thyroid isn't functioning optimally. And so the classic number that they use is between four and five. And if it's elevated, they consider that to be a problem. But there's new data now that's very clear that it is above 2.5. Your thyroid isn’t functioning optimally. So I'm going to guess that this question, this listener had a TSH between 2.5 and 4.5 and borderline free thyroid hormone levels. And so it probably is thyroid. So that's what I think is likely there in terms of what else could it be? These really could be a lot of things from adrenal dysfunction. We can see this with autoimmune disease. We see this with, you know, you.

Dr. Robert Rountree

Mentioned anemia earlier.

Dr. Joel Evans

Or anemia. You know, we see this with with everything. But of the money here is thyroid.

Dr. Robert Rountree

I have to say I'm continually amazed at the difference and people's sensitivity to the numbers. Right. That I'll see a person who can have a TSH of 8 and they feel fine. And another person who's TSH is 2.4 and they go, I feel terrible. And I got to get my TSH down to 1.5. Right. So the people are highly, very variable in their sensitivity to these numbers. So you can't go by the numbers alone.

Dr. Joel Evans

Well, what I would say, Bob, is that what you just said is totally true. But there's a whole ‘nother thing that gets added to that, which is there's a tremendous amount of variability on thyroid testing. So both within the population at large, but also within the same person. Yeah. Yeah. So thyroid there, the thyroid numbers, these tests vary throughout the day and they vary on different days between people. So there are some guidelines where you have to have abnormal testing done twice, sometimes three times before you make a diagnosis. So when the thyroid results don't match the symptoms, that's what I start to think about.

Dr. Robert Rountree

So what foods should be avoided if a person has thyroid problem? Are there any?

Dr. Joel Evans

What I would say is that classically people have worry about thyroid and soy. And that has pretty much been shown to be not a problem. And that's in normal amounts, though. If someone has a thyroid issue, I don't want them taking the soy supplement. So, for example, soy supplements can help with hot flashes. I don't want someone who's taking a supplement for hot flashes to choose soy as their supplement of choice. Because a soy supplement has much more soy than you would get in your daily diet. So having soy as part of your diet is absolutely not a problem. I'm not so sure about a soy supplement.

Dr. Robert Rountree

What about broccoli, brussel sprouts, cabbage thing, you know?

Dr. Joel Evans

Yeah. All the cruciferous vegetables, those are not a problem.

Dr. Robert Rountree

Unless you ate a pound of raw broccoli

Dr. Joel Evans

Have a set. Right. So this is right. Right.

Dr. Robert Rountree

So you have to eat a lot of it.

Dr. Joel Evans

You have to eat way too much of it. I don't think any doctor or any food plan would tell you to do in high, high emphasis on one particular food. Right. It's all about, you know, the colors of the rainbow.

Dr. Robert Rountree

Yeah. Yeah.

Dr. Joel Evans

You know that. And that's the way we should eat.

Dr. Robert Rountree

So what happens if a person has a thyroid issue and it doesn't get treated? How serious is that? And they don't mention low or high. So there's going to be a difference there, obviously.

Dr. Joel Evans

Well, in general, thyroid conditions that are untreated progressed.  Whether they're overactive or under active. So it will get worse if untreated. And that can lead to other problems as well. I mean, one of the things that thyroid hormone does is help clear cholesterol right from the arteries and so on. So you don't want to run, you know, be walking around with low untreated thyroid just because you don't want to get fatigued. You also don't want to end up with a blockage in your coronary arteries. Right. So we want to address all of these.

Dr. Robert Rountree

You know, I've definitely seen that. In fact, I've seen people who had high triglycerides, high blood fats weren’t improving with the usual dietary things. And then I checked their thyroid. It was off. I treated it. And their lipids, their blood lipids got better. Yeah, that's yeah, kind of amazing. Can thyroid imbalance cause depression?

Dr. Joel Evans

Absolutely. We're seeing, you know, more and more mental health professionals referring their patients to get their thyroids evaluated if they can't order the testing themselves. And I'm certainly getting a lot of referrals from even psychiatrists because they're beginning to understand about the difference between a classic diagnosis of a thyroid problem and then the functional perspective of looking for optimal thyroid function. And they want their patients to have optimal thyroid function.

Dr. Robert Rountree

So even if they don't have all the other symptoms, we talked about the hair loss, right?

Dr. Joel Evans

Depression, Yeah, depression can be it. And they routinely feel better if their thyroid even just gets improved a little bit with just some of these thyroid gland supplements.

Dr. Robert Rountree

Is there a link between thyroid function and breast cancer?

Dr. Joel Evans

You know, it's interesting that one of your listeners asked this because this is sort of leading edge stuff. So we don't understand the biological mechanisms. We think it has to do with iodine, but there is a link, there is a link. Women that are hypothyroid get more breast cancer and women with breast cancer are more likely to be hypothyroid. And so we think it has to do with iodine. iodine is protective for breast. One of the ways we think it may be protective is that it has a anti-inflammatory effect. And cancer is an inflammatory disease.

Dr. Robert Rountree

What about seaweed? Is seaweed a good thing for women at risk of breast cancer, like eating kelp or sprinkling kelp on their food?

Dr. Joel Evans

Well, it's a great way to get iodine. There's also lots of other benefits to seaweed. I'm a big seaweed fan. There were. You know, when I think about it, if I see it in my market, I'll buy some seaweed.

Dr. Robert Rountree

So it's a good thing.

Dr. Joel Evans

And I love those seaweed snacks that you can get. Yeah, it's a great thing.

Dr. Robert Rountree

When does thyroid issues typically begin in life?

Dr. Joel Evans

You know, in general middle age, there's this, you know, postpartum type of hypothyroidism, which most obstetricians know about. But if you take that away, it's usually in midlife.

Dr. Robert Rountree

I've been told that I have hypothyroid. Is that going to go back to normal or is this the new normal for me? And we sort of talked about that earlier, but.

Dr. Joel Evans

Right. It won't go back to normal if you do nothing. But if you do, at a minimum, you know, and this will depend what you do depends on how severe it is. So it's either lifestyle and see how you do and then take medicine or you take the medicine and do the lifestyle and then back off the medicine. One of those two approaches.

Dr. Robert Rountree

What about ashwagandha? I've been told that herbal tea with ashwagandha is good for my thyroid health. And I got to point out ashwagandha. I've seen it in the news a lot lately. Is there any science behind ashwagandha?

Dr. Joel Evans

Yes, Ashwagandha helps. You know, it really does. It helps with thyroid function. And, you know, it's a great herb for perimenopausal and menopausal patients because it can help with hot flashes and help with thyroid function, which is, as we said, can decline a little bit with middle age. So that's a great intervention for both those particular issues.

Dr. Robert Rountree

Awesome. All right, folks, that's all the time we have this week. Dr. Joel Evans, thank you so much for coming on the podcast. If people want to follow more of your work, how do they track you? How do they find out about what you're doing?

Dr. Joel Evans

So my website, the C-F-F-M-dot-com, Charlie Frank Frank Mary dot com is probably the easiest and best way you know Facebook as well. And of course I'm doing a lot of work at IFM so following the IFM website, Institute for Functional Medicine.

Dr. Robert Rountree

Excellent, Excellent. As always. Thank you everyone for listening and will talk to you next time.

Dr. Robert Rountree OUTRO

Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @ThorneHealth. You can also learn more about the topics we discussed by visiting Thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of The Thorne Podcast.