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Why is it that one woman taking levotheroxin or synthroid feels amazing?
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She has her energy back, she's losing weight, she finally feels like herself again.
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And another woman can be taking the exact same medication at the exact same dose and still feels exhausted.
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She can't lose weight, her hair is falling out, and she's wondering if the medication is even working.
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One of the biggest reasons is T4 to T3 conversion.
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Welcome to the Empowered Thyroid Podcast.
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I'm your host, Dr.
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Rochelle Vong, naturopathic doctor and founder of the thyroid reset system.
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If you've ever been told that your labs are normal, your symptoms don't make sense, or that there's nothing else you can do besides wait or take thyroid medication, then this podcast is for you.
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My team and I have worked with hundreds of women with hypothyroidism and Hashimoto's.
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And one thing that we've learned is that women like you deserve so much more support, education, and guidance than what you're currently getting.
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Every week, we're gonna dive into the root causes behind your symptoms, break down complex health topics through a thyroid-specific lens, and give you practical tools to help you take back control of your health.
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Because the more you understand your body, the more empowered you become.
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Let's dive in.
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Welcome back to another episode of the Empowered Thyroid Podcast.
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Today I want to talk about something that I honestly think every single person with hypothyroidism and Hashimoto's has to understand.
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It's not being talked about enough, and in my experience, it's a conversation that many patients never ever have with their doctors.
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Yet, this is literally one of the biggest reasons why so many of you feel terrible while taking your thyroid medications.
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Today we're going to be talking about T4 to T3 conversion.
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If I've already lost you, don't worry, I'm going to break it all down so that it's super easy to understand so that by the end of today's episode, you're going to know exactly what this T4 to T3 conversion is, why it's even important and relevant to you as a woman with hypothyroidism, and the most common reasons why you might be a poor converter.
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To understand T4 to T3 conversion, we need to start with some basic thyroid physiology.
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Don't worry, I'm not going to turn this into a biology class or anything, but understanding this one concept is going to make everything else click.
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So our brain is in constant communication with our thyroid.
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It sends a signal called thyroid stimulating hormone, or TSH for short, which I'm sure all of you are familiar with, since this is like the one test that doctors run to check for your thyroid function.
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And this signal goes to your thyroid gland.
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Now, your thyroid receives this signal and in effect produces two main types of thyroid hormones.
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The first is called T4.
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Now, this is the dominant thyroid hormone that your thyroid produces.
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So 80% of all thyroid hormones produced by the thyroid are in the form of T4.
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Now, the important thing to know here is that T4 is actually an inactive thyroid hormone.
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What that means is that it doesn't really have the ability to activate any cellular activity.
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The remaining 20% of the thyroid hormones produced by the thyroid are in the form of T3.
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Now, this is the active form of thyroid hormone.
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So T3 goes and binds the cells of your tissues in order to activate them.
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And remember that your thyroid hormones literally affect every single cell in your body, meaning that your T3 hormones play a very important role in regulating so many processes in the body, including metabolism, heat production, digestion, liver function, detoxification, etc.
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So you can see how we need to ensure that we have enough T3 hormones in our body to stay regulated.
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Now let's go back to that inactive T4.
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One of the reasons why so much of our thyroid hormone production is in the form of T4 is because this is the way our bodies can control regulation of all of these different processes.
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At any given time, your tissues can convert that T4 into T3 and therefore activate that hormone so that it can do its job.
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So there's a lot of fine-tuning that the body does in response to whatever is happening in its internal and external environment.
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This is why I always say that the body is just so intuitive and is always trying to maintain calm and stability.
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Now, here's where things get a little finicky.
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When you have hypothyroidism, it means that you don't have enough thyroid hormones.
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That could either be T4 andor T3.
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So when you're given medication like levithyroxin or synthroid, which are the gold standard treatments for hypothyroidism and Hashimoto's, you're actually being given a synthetic form of T4.
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Think about what this means for a second.
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You're being given more inactive thyroid hormone, not the active thyroid hormone.
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And in order for that medication to do anything in your body, your tissues have to be able to convert that T4 into T3, meaning that when you're given these meds, we're actually making really big assumptions that your body is fully capable to do that conversion.
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For some, that's exactly what happens.
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Again, this is a scenario where one woman feels amazing while taking her thyroid meds.
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Her body converts it beautifully and she sees a lot of improvement in her symptoms.
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But for so many others, it doesn't.
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So many of you are what we call poor converters, which means exactly that.
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Your body is doing a terrible job at converting that T4 into T3.
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So what ends up happening is that you're taking your medication religiously every single day, but not feeling any better.
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You're still exhausted, your hair is falling out, you're constipated, you have awful brain fog, and it's because you're still not getting enough T3 to yourselves.
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And what I think is the most frustrating part about this is that no one is looking at this conversion.
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Instead, the automatic thought is let's just increase your dose.
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And I see this happen all the freaking time.
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My patients go back to their doctors complaining that they don't feel well, and then they come out with a prescription for a higher dose of medication.
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And the problem is that it doesn't always fix the problem.
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And in a case of poor conversion, it can actually make the problem worse.
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So this is something I'm gonna expand on a little later in the episode.
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So, how do you know if you're a poor converter?
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Honestly, this is something you can easily figure out yourself using your own blood test results.
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And I'm gonna share with you a simple calculation that you can do with just your free T4 and free T3 values.
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And again, this is only applicable for those of you who are taking T4 only medications like levotheroxin, synthroid, tyrocent, levoxyl, or ultroxin.
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If you are taking T3 medications like cytomel or desiccated thyroid, then unfortunately you won't be able to use this calculation.
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So depending on your units, there are two ways to do this calculation.
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And don't worry if you're out and about right now, you don't need to memorize this.
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Just make sure you come back to this part of the episode when you have your blood tests in front of you.
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So if your free T4 and free T3 are in picamoles per liter, then what you do is divide your T4 by your free T3 and you will get a ratio.
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If that number is four and above, this can indicate that you have a conversion problem.
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Optimally, we want that ratio to be around three.
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If your free T4 is in nanograms per deciliter and your free T3 is in picograms per milliliter, then you divide your free T3 by your free T4 to get your ratio.
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And if that number is two and below, this can suggest a conversion issue.
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Optimally, we want to be around 2.5 and above.
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Again, this ratio is not a diagnosis.
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I want to be clear about that and should be interpreted alongside your symptoms and other blood test markers and your history, but it can definitely provide additional clues as to what might be going on.
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I also want to mention that this is irrespective of TSH.
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You can have a completely normal, even optimal TSH and still have a conversion issue.
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And the reason for that is because your T4 medication can feed back to the brain to tell it to slow down TSH production.
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And this is once again the problem with practitioners only testing TSH on blood work.
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You are missing huge pieces of the puzzle.
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All right, hopefully at this point, some of you are breathing out a sigh of relief, knowing that it's not all in your head.
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You're not crazy for thinking that something is wrong with you, and that there is a real reason why you're feeling this way.
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I know how frustrating it can be to be told that everything is normal, your labs look normal, even though you know deep down that something is off, something is wrong, and that you are not okay.
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I always say this, but there is always a reason why you feel the way you do.
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And for a lot of you, it's this conversion issue.
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But again, poor conversion is not a diagnosis, it's a clue.
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So once you've identified that you have a conversion problem, the next step is to figure out why.
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Again, the answer here is not to increase your medication.
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What we need to be doing instead is to investigate the root cause of your conversion issue so that we can help the body become more efficient at using your medication.
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Now, there are five main causes of poor conversion that I want to talk about, and I'll expand on each one in detail.
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So the first one is chronic or intense periods of stress.
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When the body feels threatened, which is typically what happens when we are stressed, it automatically goes into defense mode.
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The body is always trying to protect us.
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So if it detects some level of stress, the body will want to do everything it can to conserve its resources and energy.
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In order to do this, it will downregulate thyroid function, since the thyroid is responsible for metabolism and energy production.
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The way it does that is by redirecting T4 away from producing active T3 and instead increasing the production of another hormone called reverse T3.
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Some of you might have heard about this before, but it's definitely not common knowledge and it's definitely not something I see doctors run on testing.
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But reverse T3 is kind of like the evil twin sister of active T3, because its main job is to slow down metabolism, which is the exact opposite of what we want our thyroid hormones to do.
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But remember, this is a protective mechanism of the body.
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And this is often why we see these decreases in free T3 on blood work and elevated reverse T3.
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This is also why increasing your dose of medication doesn't always improve your symptoms or fix your poor conversion problem.
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I'm a big analogy person, so I love using metaphors and analogies to explain my concepts.
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But imagine a train track with a railroad switch where you can change the route of the train.
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One route leads to the production of active T3, and the other route leads to the production of reverse T3.
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In the presence of stress, the body will switch the track towards the direction of reverse T3.
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And if the body is stuck on that track, which is often what happens when you have stress, adding more trains or T4 in the situation, which is your medication, is only going to lead to more production of reverse T3, which will then strengthen that signal to down-regulate your metabolism.
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Now I want to make it very clear here that when I talk about stress, I don't just mean the mental-emotional stress that we often associate stress to be.
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It can also be physical stress.
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Things like chronically overexercising or undereating is considered physical stress.
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The body responds to these physical stressors the same way it would with an intense mental-emotional stressor, like dealing with loss or a divorce or work-related conflicts.
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So it's important to recognize any physical sources of stress that might be contributing to the conversion issue that you're experiencing.
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Another cause of poor conversion is nutrient deficiencies.
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When you look at all the processes involved in thyroid hormone production and the conversion of T4 to T3, there are several key nutrients that are essential for these processes to be successful.
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The main ones are iron, selenium, zinc, vitamin A, and B vitamins.
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So if we don't eat a well-balanced diet that contains food sources of all these nutrients, or we have an underlying health issue that doesn't allow for optimal absorption of these nutrients, we run the risk of being deficient in all of these important nutrients.
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Now, I always test nutrients for my patients because I want to see where they stand as far as deficiencies go.
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So it's really important that you ask for your nutrients to be tested on your next blood test so that you know whether this is something that you need to address or look deeper into.
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Now, if you do find that you are deficient in some of these nutrients, the first thing to do is to look at whether or not you're getting enough of these nutrients from your diet.
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Amazing food sources of these nutrients would include lean animal protein, nuts and seeds like Brazil nuts and pumpkin seeds, legumes, and dark green leafy vegetables.
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Now, if you are eating really well, which a lot of our clients are when they're coming into our program, but you're noticing a pattern of chronic deficiencies in iron, vitamin B12, or vitamin D, then there could be more going on.
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And this actually segues really nicely into the next cause of poor conversion, which is poor gut health.
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So again, if you're in that situation where you're noticing that you're always deficient in key nutrients like iron, vitamin D, and B12, then I would absolutely be looking at your gut because more likely than not, it's an issue with absorption.
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I've had so many patients who eat super well take all the supplements like vitamin D and B12 and iron, yet every single time they do blood work, all of these nutrients come back super deficient, which can be so confusing because of the fact that they're eating well and they're supplementing.
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So whenever I see the situation, I automatically think about the gut.
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And in fact, I've had several clients who, after doing proper gut healing, have actually seen massive increases in their nutrient levels without even changing their supplements or their diet.
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So when we're looking at the gut, there are many different areas that we have to address.
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The first is absorption, as I've said.
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If there is a lot of gut inflammation, which can be due to having, say, a really leaky gut, lots of food sensitivities, or bad bugs in the gut, this can cause damage to the lining of the gut.
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And along that gut lining is where we have these little things called microvilli, which are incredibly important for nutrient absorption.
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So if our gut lining is damaged, that means our microvilli are damaged, which will then compromise nutrient absorption.
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This is why with unmanaged or undiagnosed celiac disease, we see so many chronic nutrient deficiencies because there is so much gut inflammation that causes damage to that gut lining.
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The other aspect of the gut that we need to look at is the microbiome.
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Remember, I had said at the beginning of this episode that our tissues need to convert most of our inactive T4 into active T3.
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Now, there are certain areas of the body that are more responsible for this conversion than others.
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The gut is one of those systems.
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The gut is actually responsible for about 20% of the entire T4 to T3 conversion in the body.
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And this conversion is primarily done by our microbiome, which is the bacteria of our gut.
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So if we have dysbiosis, which is an imbalance in that gut bacteria, this can directly impact our ability to do this conversion well.
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And the reason why my team and I do so much functional stool testing is because we can actually see the makeup of your microbiome.
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We can see how much good bacteria you have, how much bad bacteria, if there are any pathogenic microbes like parasites.
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And I often do find that our clients with hypothyroidism and Hashimoto's tend to have more dysbiosis than other people.
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So you can see now why it's so important to ensure that we have an optimal microbiome, since so much of our conversion happens here.
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All right, on to our next main cause of poor conversion is poor liver function.
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And as I said, the gut is responsible for 20% of that T4 to T3 conversion.
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But it's the liver that is actually the main system of the body that does most of this conversion.
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The liver converts almost up to 60% of our T4 into T3, which is huge.
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So you can see that any issues with the liver can affect this conversion.
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Now it's quite common to see in women with hypothyroidism the presence of non-alcoholic fatty liver.
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Our thyroid hormones impact all the functions that the liver carries out, like detoxification, bile production, and cholesterol metabolism.
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So with hypothyroidism, we definitely see a slowdown in all of these processes.
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So our ability to detox from chemicals and environmental toxins is impaired.
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Our bile production slows down, which can affect digestion and blood sugar regulation.
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And cholesterol metabolism is impacted, which can result in higher levels of cholesterol, which we often see in our clients.
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So when we see things like elevated liver enzymes, the presence of fatty liver on ultrasound, insulin resistance, and high cholesterol, we can assume that our T4 to T3 conversion would be impacted as well.
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Now, the last cause of poor conversion that we're going to be talking about is something we often see in our clients with hypothyroidism and especially with Hashimoto's, which is systemic inflammation.
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This is another huge cause of poor conversion, which really just goes back to the way the body deals with stress because systemic inflammation is a big stressor on the body.
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When we see elevated levels of systemic inflammatory markers on blood work like ESR and CRP, this is a sign that there is quite a lot of inflammation in the body.
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Now, this could stem from metabolic issues like insulin resistance and diabetes, or inflammatory conditions like rheumatoid arthritis, or even other autoimmune diseases like celiac disease and Crohn's disease.
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Either way, having high levels of inflammation is a huge warning sign in the body, which then causes it to go into defense mode, which we now know translates to decreased levels of thyroid hormones and slowed thyroid hormone conversion.
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It is not uncommon for women with Hashimoto's to have multiple autoimmune diseases happening at the same time or to be dealing with these metabolic issues like insulin resistance.
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So it's really important to do that investigative work.
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Now, another cause of systemic inflammation that deserves its own conversation is exposure to toxins.
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Often I find that there is a subset of clients that we work with who just don't respond well to our typical treatments for hypothyroidism or Hashimoto's.
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Their blood work shows really high systemic inflammatory markers without any other obvious cause.
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Like we literally throw the kitchen sink at it and just nothing seems to budge.
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And this is actually quite common because of the fact that our detox pathways and our detoxification processes are slowed down and impaired with hypothyroidism.
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So it's sometimes easier for somebody to retain some of these toxins in the body, and it's a lot harder for them to kick it out.
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And it's important to know that these toxins, especially when they're around for a while, can increase inflammation in the body, which results in that impaired thyroid hormone conversion that we see and increases in that reverse T3.
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Okay, so what can you do with all of this information?
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The intention here is not for you to be addressing all of these things at once.
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Don't give in to the overwhelm.
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Instead, the first step is to actually take a step back and look at the big picture.
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First, have you done a comprehensive blood test that includes a full thyroid panel, nutrient panel, inflammatory markers, liver enzymes?
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If not, start there.
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Also, have you been chronically dieting or fasting or even over-exercising?
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Look at your lifestyle.
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Are there obvious signs that you're seeing of things like insulin resistance or systemic inflammation or even liver dysfunction?
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You have water retention, your joints hurt, you're super fatigued.
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And based on your symptoms and your history, is there a need to do deeper investigative work around your gut health?
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Are you bloated all the time?
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Are you constipated all the time?
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Do you have low stools?
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See, this is the beauty of taking a root cause approach to your health.
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And I always say start with the low-hanging fruit.
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If you're doing blood work and you see that you have nutrient deficiencies, start there.
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A lot can be accomplished just by working on the foundations.
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And from there, you will build.
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But ultimately, whatever it is that you're doing and whatever protocol that you're following, it needs to be individualized and personalized to you because your root causes are going to be very different than someone else's root causes, even though you are women with hypotharcism.
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So when you can figure out what that root cause is and address it, this is how we start seeing long-lasting results.
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If you're not already following the podcast, please make sure you hit follow so that you don't miss any future episodes.
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I have so many topics that I cannot wait to dive into with you.
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If there is a topic that you'd love for me to cover on the podcast, send me a DM on Instagram or leave a comment below.
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I genuinely want to hear from you because at the end of the day, this podcast is for you.
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Thank you again for being here, and I'll see you in the next episode.
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Why is it that one woman taking levotheroxin or synthroid feels amazing?
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She has her energy back, she's losing weight, she finally feels like herself again.
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And another woman can be taking the exact same medication at the exact same dose and still feels exhausted.
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She can't lose weight, her hair is falling out, and she's wondering if the medication is even working.
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One of the biggest reasons is T4 to T3 conversion.
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Welcome to the Empowered Thyroid Podcast.
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I'm your host, Dr.
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Rochelle Vong, naturopathic doctor and founder of the thyroid reset system.
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If you've ever been told that your labs are normal, your symptoms don't make sense, or that there's nothing else you can do besides wait or take thyroid medication, then this podcast is for you.
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My team and I have worked with hundreds of women with hypothyroidism and Hashimoto's.
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And one thing that we've learned is that women like you deserve so much more support, education, and guidance than what you're currently getting.
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Every week, we're gonna dive into the root causes behind your symptoms, break down complex health topics through a thyroid-specific lens, and give you practical tools to help you take back control of your health.
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Because the more you understand your body, the more empowered you become.
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Let's dive in.
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Welcome back to another episode of the Empowered Thyroid Podcast.
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Today I want to talk about something that I honestly think every single person with hypothyroidism and Hashimoto's has to understand.
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It's not being talked about enough, and in my experience, it's a conversation that many patients never ever have with their doctors.
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Yet, this is literally one of the biggest reasons why so many of you feel terrible while taking your thyroid medications.
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Today we're going to be talking about T4 to T3 conversion.
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If I've already lost you, don't worry, I'm going to break it all down so that it's super easy to understand so that by the end of today's episode, you're going to know exactly what this T4 to T3 conversion is, why it's even important and relevant to you as a woman with hypothyroidism, and the most common reasons why you might be a poor converter.
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To understand T4 to T3 conversion, we need to start with some basic thyroid physiology.
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Don't worry, I'm not going to turn this into a biology class or anything, but understanding this one concept is going to make everything else click.
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So our brain is in constant communication with our thyroid.
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It sends a signal called thyroid stimulating hormone, or TSH for short, which I'm sure all of you are familiar with, since this is like the one test that doctors run to check for your thyroid function.
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And this signal goes to your thyroid gland.
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Now, your thyroid receives this signal and in effect produces two main types of thyroid hormones.
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The first is called T4.
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Now, this is the dominant thyroid hormone that your thyroid produces.
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So 80% of all thyroid hormones produced by the thyroid are in the form of T4.
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Now, the important thing to know here is that T4 is actually an inactive thyroid hormone.
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What that means is that it doesn't really have the ability to activate any cellular activity.
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The remaining 20% of the thyroid hormones produced by the thyroid are in the form of T3.
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Now, this is the active form of thyroid hormone.
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So T3 goes and binds the cells of your tissues in order to activate them.
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And remember that your thyroid hormones literally affect every single cell in your body, meaning that your T3 hormones play a very important role in regulating so many processes in the body, including metabolism, heat production, digestion, liver function, detoxification, etc.
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So you can see how we need to ensure that we have enough T3 hormones in our body to stay regulated.
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Now let's go back to that inactive T4.
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One of the reasons why so much of our thyroid hormone production is in the form of T4 is because this is the way our bodies can control regulation of all of these different processes.
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At any given time, your tissues can convert that T4 into T3 and therefore activate that hormone so that it can do its job.
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So there's a lot of fine-tuning that the body does in response to whatever is happening in its internal and external environment.
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This is why I always say that the body is just so intuitive and is always trying to maintain calm and stability.
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Now, here's where things get a little finicky.
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When you have hypothyroidism, it means that you don't have enough thyroid hormones.
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That could either be T4 andor T3.
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So when you're given medication like levithyroxin or synthroid, which are the gold standard treatments for hypothyroidism and Hashimoto's, you're actually being given a synthetic form of T4.
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Think about what this means for a second.
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You're being given more inactive thyroid hormone, not the active thyroid hormone.
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And in order for that medication to do anything in your body, your tissues have to be able to convert that T4 into T3, meaning that when you're given these meds, we're actually making really big assumptions that your body is fully capable to do that conversion.
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For some, that's exactly what happens.
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Again, this is a scenario where one woman feels amazing while taking her thyroid meds.
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Her body converts it beautifully and she sees a lot of improvement in her symptoms.
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But for so many others, it doesn't.
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So many of you are what we call poor converters, which means exactly that.
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Your body is doing a terrible job at converting that T4 into T3.
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So what ends up happening is that you're taking your medication religiously every single day, but not feeling any better.
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You're still exhausted, your hair is falling out, you're constipated, you have awful brain fog, and it's because you're still not getting enough T3 to yourselves.
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And what I think is the most frustrating part about this is that no one is looking at this conversion.
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Instead, the automatic thought is let's just increase your dose.
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And I see this happen all the freaking time.
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My patients go back to their doctors complaining that they don't feel well, and then they come out with a prescription for a higher dose of medication.
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And the problem is that it doesn't always fix the problem.
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And in a case of poor conversion, it can actually make the problem worse.
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So this is something I'm gonna expand on a little later in the episode.
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So, how do you know if you're a poor converter?
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Honestly, this is something you can easily figure out yourself using your own blood test results.
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And I'm gonna share with you a simple calculation that you can do with just your free T4 and free T3 values.
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And again, this is only applicable for those of you who are taking T4 only medications like levotheroxin, synthroid, tyrocent, levoxyl, or ultroxin.
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If you are taking T3 medications like cytomel or desiccated thyroid, then unfortunately you won't be able to use this calculation.
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So depending on your units, there are two ways to do this calculation.
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And don't worry if you're out and about right now, you don't need to memorize this.
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Just make sure you come back to this part of the episode when you have your blood tests in front of you.
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So if your free T4 and free T3 are in picamoles per liter, then what you do is divide your T4 by your free T3 and you will get a ratio.
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If that number is four and above, this can indicate that you have a conversion problem.
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Optimally, we want that ratio to be around three.
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If your free T4 is in nanograms per deciliter and your free T3 is in picograms per milliliter, then you divide your free T3 by your free T4 to get your ratio.
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And if that number is two and below, this can suggest a conversion issue.
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Optimally, we want to be around 2.5 and above.
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Again, this ratio is not a diagnosis.
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I want to be clear about that and should be interpreted alongside your symptoms and other blood test markers and your history, but it can definitely provide additional clues as to what might be going on.
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I also want to mention that this is irrespective of TSH.
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You can have a completely normal, even optimal TSH and still have a conversion issue.
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And the reason for that is because your T4 medication can feed back to the brain to tell it to slow down TSH production.
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And this is once again the problem with practitioners only testing TSH on blood work.
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You are missing huge pieces of the puzzle.
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All right, hopefully at this point, some of you are breathing out a sigh of relief, knowing that it's not all in your head.
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You're not crazy for thinking that something is wrong with you, and that there is a real reason why you're feeling this way.
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I know how frustrating it can be to be told that everything is normal, your labs look normal, even though you know deep down that something is off, something is wrong, and that you are not okay.
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I always say this, but there is always a reason why you feel the way you do.
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And for a lot of you, it's this conversion issue.
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But again, poor conversion is not a diagnosis, it's a clue.
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So once you've identified that you have a conversion problem, the next step is to figure out why.
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Again, the answer here is not to increase your medication.
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What we need to be doing instead is to investigate the root cause of your conversion issue so that we can help the body become more efficient at using your medication.
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Now, there are five main causes of poor conversion that I want to talk about, and I'll expand on each one in detail.
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So the first one is chronic or intense periods of stress.
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When the body feels threatened, which is typically what happens when we are stressed, it automatically goes into defense mode.
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The body is always trying to protect us.
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So if it detects some level of stress, the body will want to do everything it can to conserve its resources and energy.
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In order to do this, it will downregulate thyroid function, since the thyroid is responsible for metabolism and energy production.
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The way it does that is by redirecting T4 away from producing active T3 and instead increasing the production of another hormone called reverse T3.
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Some of you might have heard about this before, but it's definitely not common knowledge and it's definitely not something I see doctors run on testing.
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But reverse T3 is kind of like the evil twin sister of active T3, because its main job is to slow down metabolism, which is the exact opposite of what we want our thyroid hormones to do.
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But remember, this is a protective mechanism of the body.
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And this is often why we see these decreases in free T3 on blood work and elevated reverse T3.
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This is also why increasing your dose of medication doesn't always improve your symptoms or fix your poor conversion problem.
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I'm a big analogy person, so I love using metaphors and analogies to explain my concepts.
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But imagine a train track with a railroad switch where you can change the route of the train.
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One route leads to the production of active T3, and the other route leads to the production of reverse T3.
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In the presence of stress, the body will switch the track towards the direction of reverse T3.
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And if the body is stuck on that track, which is often what happens when you have stress, adding more trains or T4 in the situation, which is your medication, is only going to lead to more production of reverse T3, which will then strengthen that signal to down-regulate your metabolism.
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Now I want to make it very clear here that when I talk about stress, I don't just mean the mental-emotional stress that we often associate stress to be.
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It can also be physical stress.
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Things like chronically overexercising or undereating is considered physical stress.
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The body responds to these physical stressors the same way it would with an intense mental-emotional stressor, like dealing with loss or a divorce or work-related conflicts.
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So it's important to recognize any physical sources of stress that might be contributing to the conversion issue that you're experiencing.
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Another cause of poor conversion is nutrient deficiencies.
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When you look at all the processes involved in thyroid hormone production and the conversion of T4 to T3, there are several key nutrients that are essential for these processes to be successful.
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The main ones are iron, selenium, zinc, vitamin A, and B vitamins.
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So if we don't eat a well-balanced diet that contains food sources of all these nutrients, or we have an underlying health issue that doesn't allow for optimal absorption of these nutrients, we run the risk of being deficient in all of these important nutrients.
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Now, I always test nutrients for my patients because I want to see where they stand as far as deficiencies go.
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So it's really important that you ask for your nutrients to be tested on your next blood test so that you know whether this is something that you need to address or look deeper into.
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Now, if you do find that you are deficient in some of these nutrients, the first thing to do is to look at whether or not you're getting enough of these nutrients from your diet.
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Amazing food sources of these nutrients would include lean animal protein, nuts and seeds like Brazil nuts and pumpkin seeds, legumes, and dark green leafy vegetables.
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Now, if you are eating really well, which a lot of our clients are when they're coming into our program, but you're noticing a pattern of chronic deficiencies in iron, vitamin B12, or vitamin D, then there could be more going on.
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And this actually segues really nicely into the next cause of poor conversion, which is poor gut health.
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So again, if you're in that situation where you're noticing that you're always deficient in key nutrients like iron, vitamin D, and B12, then I would absolutely be looking at your gut because more likely than not, it's an issue with absorption.
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I've had so many patients who eat super well take all the supplements like vitamin D and B12 and iron, yet every single time they do blood work, all of these nutrients come back super deficient, which can be so confusing because of the fact that they're eating well and they're supplementing.
00:14:33.360 --> 00:14:37.919
So whenever I see the situation, I automatically think about the gut.
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And in fact, I've had several clients who, after doing proper gut healing, have actually seen massive increases in their nutrient levels without even changing their supplements or their diet.
00:14:49.759 --> 00:14:53.840
So when we're looking at the gut, there are many different areas that we have to address.
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The first is absorption, as I've said.
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If there is a lot of gut inflammation, which can be due to having, say, a really leaky gut, lots of food sensitivities, or bad bugs in the gut, this can cause damage to the lining of the gut.
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And along that gut lining is where we have these little things called microvilli, which are incredibly important for nutrient absorption.
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So if our gut lining is damaged, that means our microvilli are damaged, which will then compromise nutrient absorption.
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This is why with unmanaged or undiagnosed celiac disease, we see so many chronic nutrient deficiencies because there is so much gut inflammation that causes damage to that gut lining.
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The other aspect of the gut that we need to look at is the microbiome.
00:15:40.639 --> 00:15:48.399
Remember, I had said at the beginning of this episode that our tissues need to convert most of our inactive T4 into active T3.
00:15:48.799 --> 00:15:53.840
Now, there are certain areas of the body that are more responsible for this conversion than others.
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The gut is one of those systems.
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The gut is actually responsible for about 20% of the entire T4 to T3 conversion in the body.
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And this conversion is primarily done by our microbiome, which is the bacteria of our gut.
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So if we have dysbiosis, which is an imbalance in that gut bacteria, this can directly impact our ability to do this conversion well.
00:16:18.000 --> 00:16:25.759
And the reason why my team and I do so much functional stool testing is because we can actually see the makeup of your microbiome.
00:16:25.919 --> 00:16:33.360
We can see how much good bacteria you have, how much bad bacteria, if there are any pathogenic microbes like parasites.
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And I often do find that our clients with hypothyroidism and Hashimoto's tend to have more dysbiosis than other people.
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So you can see now why it's so important to ensure that we have an optimal microbiome, since so much of our conversion happens here.
00:16:50.559 --> 00:16:55.840
All right, on to our next main cause of poor conversion is poor liver function.
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And as I said, the gut is responsible for 20% of that T4 to T3 conversion.
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But it's the liver that is actually the main system of the body that does most of this conversion.
00:17:07.920 --> 00:17:14.240
The liver converts almost up to 60% of our T4 into T3, which is huge.
00:17:14.400 --> 00:17:19.200
So you can see that any issues with the liver can affect this conversion.
00:17:19.440 --> 00:17:25.839
Now it's quite common to see in women with hypothyroidism the presence of non-alcoholic fatty liver.
00:17:26.079 --> 00:17:34.640
Our thyroid hormones impact all the functions that the liver carries out, like detoxification, bile production, and cholesterol metabolism.
00:17:34.799 --> 00:17:40.400
So with hypothyroidism, we definitely see a slowdown in all of these processes.
00:17:40.640 --> 00:17:45.279
So our ability to detox from chemicals and environmental toxins is impaired.
00:17:45.519 --> 00:17:50.319
Our bile production slows down, which can affect digestion and blood sugar regulation.
00:17:50.480 --> 00:17:57.839
And cholesterol metabolism is impacted, which can result in higher levels of cholesterol, which we often see in our clients.
00:17:58.000 --> 00:18:11.519
So when we see things like elevated liver enzymes, the presence of fatty liver on ultrasound, insulin resistance, and high cholesterol, we can assume that our T4 to T3 conversion would be impacted as well.
00:18:11.839 --> 00:18:23.359
Now, the last cause of poor conversion that we're going to be talking about is something we often see in our clients with hypothyroidism and especially with Hashimoto's, which is systemic inflammation.
00:18:23.680 --> 00:18:35.039
This is another huge cause of poor conversion, which really just goes back to the way the body deals with stress because systemic inflammation is a big stressor on the body.
00:18:35.279 --> 00:18:46.480
When we see elevated levels of systemic inflammatory markers on blood work like ESR and CRP, this is a sign that there is quite a lot of inflammation in the body.
00:18:46.720 --> 00:18:59.680
Now, this could stem from metabolic issues like insulin resistance and diabetes, or inflammatory conditions like rheumatoid arthritis, or even other autoimmune diseases like celiac disease and Crohn's disease.
00:18:59.839 --> 00:19:15.359
Either way, having high levels of inflammation is a huge warning sign in the body, which then causes it to go into defense mode, which we now know translates to decreased levels of thyroid hormones and slowed thyroid hormone conversion.
00:19:15.599 --> 00:19:26.160
It is not uncommon for women with Hashimoto's to have multiple autoimmune diseases happening at the same time or to be dealing with these metabolic issues like insulin resistance.
00:19:26.319 --> 00:19:29.440
So it's really important to do that investigative work.
00:19:29.839 --> 00:19:36.799
Now, another cause of systemic inflammation that deserves its own conversation is exposure to toxins.
00:19:37.039 --> 00:19:46.079
Often I find that there is a subset of clients that we work with who just don't respond well to our typical treatments for hypothyroidism or Hashimoto's.
00:19:46.240 --> 00:19:52.640
Their blood work shows really high systemic inflammatory markers without any other obvious cause.
00:19:52.799 --> 00:19:56.799
Like we literally throw the kitchen sink at it and just nothing seems to budge.
00:19:56.960 --> 00:20:06.640
And this is actually quite common because of the fact that our detox pathways and our detoxification processes are slowed down and impaired with hypothyroidism.
00:20:06.880 --> 00:20:14.480
So it's sometimes easier for somebody to retain some of these toxins in the body, and it's a lot harder for them to kick it out.
00:20:14.640 --> 00:20:28.079
And it's important to know that these toxins, especially when they're around for a while, can increase inflammation in the body, which results in that impaired thyroid hormone conversion that we see and increases in that reverse T3.
00:20:28.960 --> 00:20:32.079
Okay, so what can you do with all of this information?
00:20:32.400 --> 00:20:36.880
The intention here is not for you to be addressing all of these things at once.
00:20:37.119 --> 00:20:38.960
Don't give in to the overwhelm.
00:20:39.200 --> 00:20:45.359
Instead, the first step is to actually take a step back and look at the big picture.
00:20:45.680 --> 00:20:54.559
First, have you done a comprehensive blood test that includes a full thyroid panel, nutrient panel, inflammatory markers, liver enzymes?
00:20:54.799 --> 00:20:56.400
If not, start there.
00:20:56.720 --> 00:21:01.440
Also, have you been chronically dieting or fasting or even over-exercising?
00:21:01.680 --> 00:21:03.039
Look at your lifestyle.
00:21:03.200 --> 00:21:10.480
Are there obvious signs that you're seeing of things like insulin resistance or systemic inflammation or even liver dysfunction?
00:21:10.640 --> 00:21:14.559
You have water retention, your joints hurt, you're super fatigued.
00:21:14.799 --> 00:21:21.359
And based on your symptoms and your history, is there a need to do deeper investigative work around your gut health?
00:21:21.440 --> 00:21:22.559
Are you bloated all the time?
00:21:22.640 --> 00:21:23.920
Are you constipated all the time?
00:21:24.000 --> 00:21:25.200
Do you have low stools?
00:21:25.440 --> 00:21:29.440
See, this is the beauty of taking a root cause approach to your health.
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And I always say start with the low-hanging fruit.
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If you're doing blood work and you see that you have nutrient deficiencies, start there.
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A lot can be accomplished just by working on the foundations.
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And from there, you will build.
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But ultimately, whatever it is that you're doing and whatever protocol that you're following, it needs to be individualized and personalized to you because your root causes are going to be very different than someone else's root causes, even though you are women with hypotharcism.
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So when you can figure out what that root cause is and address it, this is how we start seeing long-lasting results.
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If you're not already following the podcast, please make sure you hit follow so that you don't miss any future episodes.
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I have so many topics that I cannot wait to dive into with you.
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If there is a topic that you'd love for me to cover on the podcast, send me a DM on Instagram or leave a comment below.
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I genuinely want to hear from you because at the end of the day, this podcast is for you.
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Thank you again for being here, and I'll see you in the next episode.
