Hormone Balancing – Thyroid, Adrenal, Ovaries, Pituitary
Hormones require a fine balance in your body so everything works just right. We live in a society that likes to “spot check” one hormonal gland and treat that gland and only that gland, (and nothing but the gland). However, not only does a hormone need to be balanced within itself, such as progesterone and estrogen from the ovaries, but each hormonal gland will affect another hormonal gland. This is why as in a case of hypothyroidism when the T4 level from the thyroid is low, the TSH (thyroid stimulating hormone) from the pituitary will increase, as the body is trying to “push” out more T4 production. But these days due to lackluster patient care and insurance regulations, most doctors only perform a TSH reading to diagnose the thyroid condition. If the TSH is high as in this example, then they assume that T4 is low and therefore the total thyroid is low so you need a medication such as Synthroid or Armour Thyroid. If the TSH is low, then it must be so because the T4 is high and steps must be taken to slow down the thyroid. All this is done without taking into consideration what the actual T4 level is, or as importantly (perhaps more), the T3 level, which is the ultimate goal in thyroid production. It is very possible to have a high TSH and a high T4, as well as it is common to have both low. Since 90% of T4 is converted into T3 in the liver, the function of that organ is of utmost importance. The two primary reasons why T4 is not converted successfully into T3 is due to high insulin levels and high cortisone levels. The T3 is converted into a hormone called Free T3. This can be measured to verify, but rarely is. This gets us into carbohydrate intolerance and adrenal gland function, which must be addressed to treat the thyroid.
So, if I may take this further – here’s a common occurrence. An individual has blood work done for a TSH level. It reads lower than normal. Most likely a T4 level will then be taken, we hope. The T4 level comes back high and steps are discussed to suppress thyroid activity since the individual is making too much thyroid hormone. But, if the T3 level was taken, many times it is low. The T4 is just waiting to be converted into T3, but can’t because the ever-so-common occurrences of carbohydrate intolerances and adrenal stress disorders. The pituitary was smart enough to lower its output of TSH as to not make any more T4 since there’s already enough.
The adrenal glands most of the time are the center of attention when it comes to hormonal balancing. Too much stress increases cortisone levels in the initial stages of the adrenal stress disorder and this will suppress thyroid, pituitary, pineal, and ovary/testes production. In my opinion, and those who practice functional medicine, an adrenal issue is present before a thyroid issue.
Balancing the hormones involves fine-tuning each area with its relationship to the other involved glands. I like to think of one of those street performers who balances ten spinning plates on sticks. After he gets the third or fourth one going, he’s got to go back and get the first one moving again before it falls; then he can go and start the fifth one. He is constantly paying attention to all the plates, keeping them all going, until the tenth one is up and spinning. One spill and it’s all over.
Hormonal balancing before and after menopause is also extremely important. Read the menopause information in this Health section, it’ll make you shake your head.
Hi Dr. Gangemi – thank you for your informative blog! I happened upon you, as I am currently researching how to properly support my thyroid. I was diagnosed with PCOS about five years ago, though I told I was not a ‘typical’ case (at the time, 5’5″, 115lbs, and my fasting insulin numbers looked good!). I soon started following a paleo diet, following it rigidly for two years. I dropped my carbs to less than 50 g/day for a few months and started packing on weight (I was up to 140 at one point). I think I totally freaked out my adrenals by keeping up high intensity workouts more than five times a week and having my carbs too low. I have since taken off 8 lbs. of that by adding carbs back in, cutting back on the number of workouts/week, and adding in yoga for stress reduction, but I would like to take another 10 off AND restore my reproductive system (at 32 my clock is ticking!).
Anyway, I have an appointment this Friday with an endocrinologist and would like to go in somewhat knowledgeable. Do you recommend asking for a test to see if I’m converting T4 to T3? How do you recommend we go about balancing these systems? I assume something is off with my insulin if I have PCOS, but I’m afraid to cut carbs too much to reset this due to the reasons I’ve mentioned. Do you recommend starting with nutrition?
Thank you for all of the information you provide – it truly is invaluable to people like myself.
Best,
Jessica
Hi Jessica, this is tough because I have to tell you that I think most endocrine docs are not properly educated on how hormones influence the entire body, other hormonal organs, and how they are affected by diet. Take type II diabetes – they still tell their patients to use Nutrasweet and Splenda. They advise if your sugar is low, drink juice or eat carbs. If it is high, take more of a medication. How about thyroid problems? – Well, they’re still behind the ball there and don’t realize that the number one reason for low thyroid function is Hashimoto’s and the number one reason for that is a food intolerance (most often gluten). Those who do look for an autoimmune disease still treat the gland (using T4 or T3) and not the immune system. So you are probably already more knowledgeable knowing what you already know, and to most endocrine docs, you’re also that patient who is a bit dangerous to them and they may not want to listen to you. This is just my experience, of course, dealing with a lot of patients who I see who have been to Duke, UNC, and other centers.
For PCOS you’re typically looking at some carb intolerance, but that could be coming from some gut dysbiosis or adrenal problem. Endocrine docs will not acknowledge an adrenal problem unless there is a pathological disease such as Cushing’s or Addison’s.
So my response may just confuse you more; if it does, let me know. I don’t want to discourage you from seeing an endocrine doc; I’m sure there are some good ones out there – somewhere.
Thank you for your response! I just ordered the Thyroid Revolution book (Mary Shomon), and I plan on devouring it ASAP. Do you recommend something more along the lines of Dr. Mark Hyman’s Blood Sugar Solution for someone with PCOS? I understand it is triggered by insulin resistance. Do you believe that following such a diet would work to improve both insulin and thyroid?
It is all rather confusing to someone without a medical degree, so thank you again for all of the information.
Best regards,
Jessica
I am not familiar with that book. The one I recommend to patients which has become the standard for many is this one here at Amazon.
Paleo Type diets are typically very effective ways to manage blood sugar/insulin levels, unless there is significant gut dysbiosis. In which case, specific gut treatment may be needed and a FODMAPs diet often helps.