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  • Writer's pictureMartha Calihan MD

The Dance of the thyroid

It is like a dance, the way the thyroid regulates our bodies. It is the driver of metabolism for the entire body, and thyroid hormone is an absolutely necessary part of being healthy. Even of being alive; we can’t live without having thyroid hormone.

Thyroid disease is extremely common, with some 20 million Americans having thyroid disease, many of whom have little to no obvious symptoms. Those who do can have a wide variety of symptoms, from cold intolerance, to weight gain, constipation, changes in skin and hair, infertility and cognitive changes.

The thyroid gland, which produces and secretes the thyroid hormone, doesn’t function alone; it is a part of the larger endocrine system referred to as the HPTA axis; the Hypothalamic, pituitary, thyroid, adrenal axis; all hormone secreting glands that are affected by and affect each other. There are elegant feedback loops regulating these hormones, and what affects one can directly or indirectly affect the other(s). So it really is a dance of the hormones that drives and maintains balance in the system.

So what do we think about when we want to consider the state and health of the thyroid? First and foremost, we look at the levels of the thyroid hormone. But even here, there are multiple ways to look, different forms of the hormone that need to be assessed. We want to make sure that we look at the Thyroid stimulating hormone (TSH), the total thyroid hormone (T4) and the levels of the “free” hormone as well; the Free T4 and Free T3. We also often need to measure the Reverse T3 (rT3) which, if elevated, can be an indicator of a problem in how the hormone gets used.

Beyond the levels of the actual hormone, I look for the presence of thyroid antibodies, indicating an autoimmune process involving the thyroid gland. Autoimmune thyroid process can be just the presence of an autoimmune attack of the gland or a full blown disease with complete destruction of the gland with the permanent need for replacement hormone. Lots of people can have the autoimmune process going on for years before the thyroid function numbers reflect it, and checking for the presence of the antibodies is an important part of a full and complete thyroid evaluation.

There are other things to consider in someone dealing with thyroid problems, including nutrient insufficiency, toxins, and the effects of other hormones in the dance of the HPTA axis. The pituitary, hypothalamic and adrenal hormones must all be in good balance for the system, including the thyroid, to work optimally.

Thyroid health is at the center of many people’s well-being, and its important to have a full and complete assessment of the thyroid as part of a health evaluation. There are multiple places, ways and reasons where it can go wrong, necessitation a full and comprehensive look.

Understanding more about how the thyroid works, the feedback mechanisms that regulate its function and how it can go wrong will be what I am teaching in our next Open Office Hours, the new feature that we have included with our newly launched Membership offerings. Our memberships are available in three tiers, created to offer more support to our patients on their functional medicine journeys. We would love to have you join one of our tiers and be a part of the Open Office hours session twice a month, where Lara Lattman, our nutritionist and coach and I will present an educational session followed by an open discussion and Q&A.

If you are interested, or have questions about this new offering, we invite you to call the office and schedule a Discovery call with Lara Lattman.

In health,


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