On paper, the thyroid, that small gland in your neck, may seem unimposing. However, the organ and the hormones it produces are more important to the functioning and wellbeing of the body than they may seem. Responsible for growth, metabolism, and the functioning of nearly every tissue in the body, your thyroid may be to blame for a number of health issues you could be facing.

If the thyroid is under-producing the crucial hormones it is responsible for, a person suffers from hypothyroidism, or an underactive thyroid. Dry skin, weight gain, low heart rate, intolerance to cold, hair loss, fatigue, and depression are common symptoms of this condition. For children, an underactive thyroid could mean issues with growth and a lowered IQ as well.

If this sounds all too familiar, do not fear. There are many ways to test for a hypothyroid and treat it. Through basic lab tests, genetic testing, and changes to your nutrition, your thyroid will be good as new.

Basic Testing

While your average blood test may reveal much about your thyroid, it does not always tell the whole story. As a physician, I could easily miss some people who have underactive thyroid glands by doing only one or two tests. Many of my patients could feel better after a more comprehensive evaluation and treatment approach. Luckily, we now have the ability to test for genetic variations that can impact how well the thyroid works and the type of thyroid medication that will work best for each individual patient.

Genetic Component of Thyroid Function

First, let’s look into how the thyroid works. T4 is the main hormone secreted by the thyroid. When it is released, tissues in the body convert T4 to T3, the active form of the hormone. T3 is necessary for full biological activity to occur. What we are now learning is that genetics impact how well the body can convert T4 to T3 in many tissues in the body, especially in the brain. Certain genetic variations may cause some people to have difficulty making this hormone conversion. T4 is often given as medication in a synthetic form (such as Synthroid and levothyroxine) for those who need replacement. However, people who have this genetic variation may have poorer psychological wellbeing with T4 monotherapy. When only given Synthroid or levothyroxine for thyroid treatment, these people feel more tired or depressed, even when adequately treated per the basic lab tests. Giving synthetic T3 (liothyronine or Cytomel) or a product with both T3 and T4 (glandular thyroid such as Armour Thyroid) can help with memory, cognition, and mood in these people. Regardless of what the basic blood work shows, some people, based on their genetics, will do better with T3 or combination (T4/T3) therapy. DIO2 gene testing can help to uncover this variation to better address thyroid issues in each individual.

Nutrition

As part of a comprehensive evaluation, I also pay attention to many nutrients that are necessary for the optimal functioning of the thyroid gland. When working to optimize thyroid function, there are a few key nutrients that I focus on.

Protein

Hypothyroidism can occur in those who are deficient in protein, a nutrient necessary for the production of the thyroid hormone. Even though it is not hard to get enough protein in the US, I still uncover protein deficiencies in some situations, such as in vegans who do not focus on their specific needs. Other patients who are more likely not to reach their protein needs include the elderly, patients with digestive issues, and patients with a higher protein demand. The general recommendation for protein needs is between 0.8–1.5 g/kg of body weight/day. For the average adult, that is about 70 grams of protein per day. Animal proteins have about 7 gm of protein per ounce, 1 egg contains 7 gms and ½ cup of beans typically have about 7-8 grams of protein.

Selenium

Selenium, an important mineral for the optimal production of the thyroid hormone, has been shown to lower thyroid antibodies that occur when people have an autoimmune thyroid disorder. Selenium is found in animal protein, eggs, sunflower seeds, whole grains, and brazil nuts. Just 1-2 brazil nuts a day can give your body all of the selenium it needs. We will sometimes recommend a supplement with selenium for optimal thyroid health. It is important to keep your supplemental intake to less than 400 mcg per day. Too much supplemental selenium can cause toxicity and is actually one of the most common mineral toxicities I come across. When people start taking a few different supplements including a multivitamin, thyroid supplement, and detox supplements, they can be at risk for getting too much selenium.

Iodine

Another mineral that is necessary for thyroid function, but can be a problem in excess, is iodine. Iodine is necessary for the production of thyroid hormone. Triiodothyronine (our naturally occurring T3) was given this name because it has three iodine molecules within it. Seafood and sea vegetables (such as nori, seaweed, and iodized salt) are rich in iodine. Incorporating dried seaweed into your diet is a great way to get more iodine, although you will only need 1 or 2 sheets each day. I also really like dulse flakes. One teaspoon of dulse flakes provides the recommended 150 mcg of iodine that is required for most people per day (although pregnant and lactating women need more). Too little iodine can cause an underactive thyroid and goiter, but too much of the mineral can cause autoimmune thyroid diseases and the growth of nodules in your thyroid.

Zinc

Zinc is a mineral required in the synthesis of thyroid hormones. Zinc-rich foods include oysters, beef, poultry, beans, nuts, and seeds. Reach for some of these zinc-rich proteins at each meal to meet your needs and support your body’s production of thyroid hormones. Zinc is a necessary cofactor in the production of thyroid hormones, and lack of this mineral has been associated with hair loss.

When evaluating your thyroid, it is important to remember that the workings of the gland is much more complex than the results of one lab test. We often need to delve deeper when evaluating the health of someone’s thyroid and working to optimize its function and a person’s health and wellbeing.