Hanisha Patel | Ep #32 | Underactive Thyroid Impact during Fertility & Menopause

in integrative fertility thyroid disorders and gut health and hanesha is also the founder of mahan health a naturopathic practice based in columbus ohio in the u.s uh honeyshot welcome to dr podcast and we’re super excited to have you here today yes thank you so much for having me i’m so excited to be here with you all uh well welcome hanisha and to start off our topic today uh you know we are always trying to dedicate it to to our audience and we are all of us in this call or in this recording are part of that target audience which are females that are you know we are quite familiar with hormonal imbalances and looking looking at all the different hormonal glands we noticed that the thyroid is usually overlooked and uh as a reflection according to the american thyroid association they estimate that 20 million americans have some thyroid disease and up to 60 of them are unaware of that condition so this is just reflective of how we kind of overlook this very important hormonal glands and so it would be interesting to to get your take um on on this topic for for today um and so to start off maybe you could start explaining what um the thyroid does and and then draw into uh hypothyroidism yeah definitely yeah like you said um thyroid disorders affect so many people it’s about yeah with that stat it’s like i think it’s about one in five women one in seven or eight men so it is pretty abundant um within our within our culture and in our society in general and so it is something that definitely needs to be addressed and so starting off with what the thyroid does in general the one of the best ways that i can explain it and uh i think i actually got this from a little medical cartoon where they consider the thyroid the king right so the thyroid is the king or the queen of our of our bodies it literally controls everything we have thyroid receptors on every single organ of our body and so that’s where that’s that’s what’s going to literally control how so many of our organs work and so if our thyroid is out of balance that can affect our digestive system it can affect our hormones what we’re going to talk a little bit more about like our reproductive hormones um it can affect our ability to get pregnant or fertility it can affect our bone health our cardiovascular health um our neurological health or brain health or mental health literally everything every aspect of our health can be impacted by our thyroid because it pretty much controls everything so it is uh probably i mean i hate to say it’s there’s any organ that’s more important than any others because they’re all very important but it’s definitely a very significant organ that we have and it’s just this little butterfly shaped um gland that’s right right around our throat and uh the way that it usually works is in an optimal um in an optimal setting the way that it would work is it would you would get signals from your brain so go from your hypothalamus hypothalamus in your brain to your pituitary gland which is kind of around here so all which is all in your brain and then those that pituitary gland will send signals to your thyroid gland to produce thyroid hormone and that thyroid hormone is then distributed to the rest of your body as needed and wherever it is needed and so that’s a very simplified version of what your thyroid does because it like i said it literally does everything and and what what happens to to the body or like what’s the impact on the body when the thyroid isn’t doing what it’s supposed to do right yeah so like i said it it can control pretty much everything every organ in our body um can be affected if the thyroid is out of balance and so i think the main thing we want to talk more about today is hypothyroidism so i’ll go a little bit into hypo and i’ll briefly go over hyper but we’ll we’ll stay focused a little bit more on hypothyroidism but essentially hypothyroidism is an underactive thyroid and so what we’re seeing is that the signals that your brain is sending to your thyroid gland either are not being converted properly or um oh you’re just not producing enough and so that is where we see the underactive thyroid so oftentimes um we have the tsh which comes from our brain and then the free t3 and free t4 which comes from the thyroid gland and then is distributed the um what we see with hypothyroidism is the free t3 and free t4 are much lower free t4 is abundant in our body free t3 is what’s actually active in our body so when we when we lack energy which is a very common symptom of hypothyroidism that’s because we don’t have enough free t3 and that t3 is what gives us that energy it’s the active part of um our thyroid hormone and um so with the hypothyroidism you’ll have less free t3 free t4 and then because you have less of that that keeps sending signals to your brain be like we need to produce more thyroid hormone we need to produce more thyroid hormone and then um what’s in your brain the tsh that gets stimulated and that keeps going up but there’s some sort of disconnect going on right now so now your tsh is really high but your free t3 and t4 still don’t um get there’s still not enough of it um and so that’s what’s happening with hypothyroidism so if i understand correctly because there’s a lot of tsh and t3 and t4s um so if i were to understand correctly what so what is um what produces t sh is this guy right that that comes it’s trh so that’s thyroid releasing hormone that comes from the hypothalamus and that goes to the pituitary gland and tells um produces thyroid stimulating hormone which is tsh okay and then that produce that tells your thyroid gland to produce the free t3 and t4 which are thyroxine okay hormones and and so because it’s under performing because your thyroid is underperforming the the rest is the the the other receptors or the the ones that are supposed to signal the rest of the production of the free t3 and t4 they are just heightened but there’s like the production is just not happening is that correct and so what happened next because what’s that gap of having too much of those um indicators that are supposed to produce those three t3 and t4 yeah so so that is actually so when we do lab testing for hypothyroidism the main test that most uh doctors do in conventional medicine is just the tsh and so when we see that tsh is elevated that’s when we know that there’s some sort of imbalance because the only way it would be so elevated is if we’re not producing enough of those free t3 and t4 hormones and so that is how um how we would know essentially and having too much of them is there another impact does it impact your body in a certain way oh yes definitely so um and and that is so what what is more of an issue i would say than having too much from the tsh is not having enough of the three t3 and t4 because when you don’t have especially the free t3 because that’s the active hormone that’s the one that is sent to all of your organs to support like like i said there’s a thyroid receptor on every organ so that’s where the free t3 goes and it connects there and then it tells that organ to function in whichever way it needs to function when you don’t have enough of those hormones that’s when we can see more of uh the way i like to put it so this way we would say that it’s a slow or sluggish thyroid right so that’s what hypothyroidism is um because there you don’t have enough of the free t3 and free t4 the way i like to put is when your thyroid is slow everything else is slow so that means your digestion is likely slower which means that you’re probably feeling more constipated your energy is lower you’re probably feeling more fatigued most people end up having more depression over anxiety um and because everything is just slowing down so that’s kind of like the best way also your periods are likely irregular because again those hormones are slowing everything down and so that’s kind of the way um the easiest way i i like to think of it is just like when your thyroid is slow everything else is slow right and i think you you touched on a good point where we wanted to kind of highlight that like what is the impact you know women go through uh you know at different many different stages in their lifetime and so you know in adolescence or when you just get into uh get puberty and then when you want to prepare your body for pregnancy and have children and then later on when you have menopause what is the impact on the body when you have hypothyroidism at those different stages yeah um i i love this because our hormones are constantly changing as women right they’re constantly shifting and changing throughout our life cycles and um our thyroid is also constantly shifting because of that because our thyroid impacts our reproductive hormones but then our reproductive hormones also impact our thyroid so there is this bidirectional effect and so um when so starting with puberty for um if that’s like one of the biggest first transitions that we experience um as women what’s really going on is um estrogen estrogen is uh being stimulated so we’re having a lot more estrogen and then this can stimulate um the thyroid growth in general and so this is something that can impa impact the thyroid as well so if we’re not having enough estrogen then then we might not get have enough of the thyroid tissue if we have too much estrogen we might have too much of the thyroid tissue um which could lead to more of an enlarged thyroid gland so this is the opposite of hypothyroidism right it would be hyper so hyperthyroidism would be an overactive thyroid essentially so this is where you would see a a bigger gland here and because the the only time i’ve been you know in touch with what a thyroid is is because i had i’ve seen someone with a with quite uh inflamed um thyroid and so i guess that that signal is and height per thyroid not necessarily not necessarily interesting so we can see an enlarged thyroid with um both hypo and hyperthyroidism okay interesting and why is that so um it’s it’s just because there’s constant activity going on there and usually it really just indicates inflammation of the thyroid in general and so so sometimes what we’ll see so with hypothyroidism for example when we have an underactive thyroid like that and um and the autoimmune component which we haven’t gotten into if we have the autoimmune component where your thyroid gland is actually attacking your um sorry your immune system is attacking your own thyroid hormone which is actually the most common form of hypothyroidism when that is happening that can lead to inflammation in your thyroid which can cause it to be enlarged but you’re actually that can also lead to degeneration of your thyroid in general so i’m sure a lot of women have probably heard of women who’ve had to have their thyroid removed and that is what often happens um is so so it can happen kind of either way interesting so sorry because i kind of interject in and try to understand if there was a link between hyper and hypo but we were talking about at adolescence where you were saying there’s a higher production of estrogen and it can affect the the way uh thyroid could be produced is it usually at that point of time in the adolescence um puberty when you hit puberty is it when there’s a under underperforming or um over-performing uh thyroid yeah so because you’re having this kind of intense estrogen progesterone uh release in your body when you go through puberty because you’re having that it does increase your risk or just increases your thyroid activity in general because those hormones can impact your thyroid so it depends on the person how it’s impacting them we’re talking more about hypothyroidism so that with that it can actually with estrogen it can stimulate the thyroid to make more of the thyroid hormone precursor so that tsh um and so we could be producing more and then not enough the free t3 for each e4 or kind of or or the opposite essentially um and where you’re not having enough estrogen and so that’s something we’ll see with for example conditions like pcos or if um young women don’t actually start their period um ever right that that’s something that that could actually be because the thyroid is already out of balance right that and that is something that we would need to address during puberty or even before because it’s definitely very possible that their thyroid has already been affected and out of balance and now the thyroid uh can’t keep up with the hormonal shifts and that’s why the hormonal shifts are actually not even occurring or they’re occurring abnormally right so like i guess for someone who is in their adolescence uh and they don’t know if they have a thyroid issue this would be like a good indicator if they haven’t gotten it and they are like you know 15 16 for example yes definitely yeah so that’s something um you know usually young women will reach puberty around um i mean it’s getting earlier and earlier um because of our our environmental factors and you know we won’t get into all of that it’s definitely getting earlier and earlier but um we’ll see from 9 to 13 14 is pretty common on average um and so within that time so by like you said around 15 16 or even 17 if we’re not seeing them have either a regular period or they are not having a period at all that’s when we would want to definitely assess their thyroid to make sure that their thyroid is optimal right and would that be like you know not having a period of having very irregular periods would that be like an extreme uh i guess uh imbalance of your thyroid like an extreme hypothyroidism situation i wouldn’t necessarily say it’s extreme i i think it can definitely happen um and there are a lot of women who do experience that um and i think what would be a little bit more extreme if anything is um is not having a period at all that that is that is definitely less common um would be a little bit more extreme in terms of the the impact that the thyroid might be having on their hormones but irregular periods are so common um and especially if um someone has hypothyroidism the most common causes of having thyroid imbalance even before adolescence which can lead to these abnormal hormonal shifts during puberty will actually be things like gut dysfunction going through some sort of trauma or stress like chronic stress as a child vitamin d or iron deficiency those are very common uh and then even um even a high dose or high uh sorry long-standing history of antibiotics and steroid use so if you know a child has been using a lot of antibiotics and steroids that can definitely increase their um their risk of having more thyroid complications which will then lead to uh complications during puberty as well that’s a really good point to to highlight i think because i think people get feel clueless right when they are in that stage and you’re like but i i haven’t been doing anything unusual so i think thank you for highlighting that um and so yeah you were mentioning about puberty um and so how does it look like for women who are for example um preparing their bodies to to have babies yeah so actually when we go through puberty technically that’s that’s what we’re doing is we’re shifting our bodies to prepare our bodies to to actually have babies uh of course we don’t want to have babies so young when we’re 13 14 um or even you know i mean it’s it’s up to everyone for them to decide um but we usually don’t want to have babies in our teens and early even even early 20s anymore right that’s definitely shifted in the cultures which used to be very common for women to have babies around that time but that is the shift that’s already happening and so in terms of fertility when we think about fertility starting from puberty up until you actually conceive that that time period is actually what we’re looking at that’s that whole period is the fertile stage actually technically your whole fertile stage is not just until you conceive it’s until you hit menopause right um i’d like to throw in a small caveat here um what about when because as you said we are not necessarily getting pregnant uh when we get our first um periods and we we usually go into consult contraceptions and we start taking the pill et cetera and which kind of alters our hormonal production etc and so um say we get off the pill um have you encountered uh female clients that having the having issues with you know kind of getting off the pill and that thyroid oh yes definitely yeah so um the pill has a lot of um it has a lot of adverse effects that are are more subtle and um and therefore not addressed conventionally really at all um because you know it’s pretty much a lot of times conventionally it’s like you didn’t die right so you’re fine um that’s not that’s not how i operate um so or or you’re not in extreme pain so you’re fine um but what the pill does is it does deplete a lot of our vital micronutrients so it depletes a lot of our b vitamins our vitamin c selenium zinc uh magnesium and all of those are essential in optimal thyroid production so when we’re on the pill we are already negatively affecting our thyroid in general and so post pill we’ll see a lot of um i actually have seen a lot of women who will experience post pill pcos polycystic ovarian syndrome which can then also affect your thyroid or your thyroid can also affect that right so everything can affect one another it’s all interconnected um and so we’ll see that quite frequently um and what’s going on with the with the pill often it is suppressing your thyroid um it is suppressing your thyroid hormone leading to a potential higher risk of hypothyroidism the complicated part about the pill is that so many young women are given the pill at like 13 14 maybe even 12 years old and so it’s hard to know if they actually had imbalances prior to the pill um whether it’s their thyroid or pcos or whatever we don’t actually know um and then and that’s and so afterwards we don’t know all often we don’t know if it was actually the pill that caused it or they already had some imbalances and so really we can only tell if um you know a woman has gone through her menstruation cycles a few times like you know she started her period when she was 13 but didn’t go on the pill until she was 20. um and then we see things have shifted after when she gets off at 26 let’s say you know using that as an example she gets off at 26 all of a sudden she has those symptoms of an underactive thyroid or pcos where before she when she was 14 to 20 she didn’t have any issues and so um so that’s when we can really see um if the pill is actually the cause or if it’s a combination yeah i mean the the point of of course of us talking about it is that the pill is something that uh in our modern days sometimes cannot be um cannot be avoided and it’s part of how we can you know um for women to feel um a certain sense of control in in their life so we’re not i think i’d like to to put a small disclaimer just like we’re not here to judge but it’s more like it is altering some in in some ways and it’s just for us to know how how and not be surprised when he does and and i guess that uh we have there are solutions as you said there’s always solutions um great and and so usually what is the recovery period from you know that the someone who’ve been taking the pill and who’s off the pill and might be you know experiencing um readjustments with regards to the thyroid um usually how if you you do take action usually how long does it take to kind of get back on yeah so it it really depends on the person it really depends there are some people who just go right back um right you know and and that’s that’s great and that’s um that that can definitely happen there are some people it can take up one to two years uh so so it really just depends on on each individual person and i will say so i i will say that outside of the pill there are other options if the the goal is to prevent pregnancy there are definitely other options and um of the more invasive options i would i usually recommend more of the iud uh just because the non-hormonal iud because it doesn’t have as many of the adverse effects in uh depleting our nutrients but there’s also the fertility awareness method and things like that one of the things i will say i’m completely against is using the pill to regulate hormones because that is not actually getting to the root of the issue it’s actually just suppressing the problem and then when you get off the pill you still have those issues if not worse yeah that makes sense um and and i guess okay so tying that in and from getting off the pill and that journey um what about women who are in you know uh in their menopausal apparent menopausal stage what what does a hypothyroid having hypothyroidism do to their body yeah definitely so as we shift so this is the other big shift right to menopause as we shift to menopause now there’s a decrease in those hormones that we originally had an increase in rate the estrogen and progesterone were going up before now they’re going down and so with them going down again that can affect your thyroid right those estrogen those hormones are going down that’s affecting your um telling sending signals to your brain to produce less thyroid hormone because now we don’t need it to produce that estrogen and progesterone and so um so that can impact your thyroid but then also vice versa too so if you already have hypothyroidism that’s um not well managed then um then we can see how it impacts your estrogen project progesterone production in general and maybe it might even suppress it almost completely where you don’t actually um have much of the hormone left at all and that’s when we’ll see a lot of those postmenopausal symptoms or perimenopausal symptoms like hot flashes vaginal dryness low libido all of those things and so we still want those hormones throughout menopause and um post menopause uh we just want less of them and so it’s about working with our body and shifting um a lot of times it’s shifting our lifestyles with these cycles too because it’s it’s not gonna stay stagnant it’s not the same even our diets um can be a little different we we do better with different diets during different times of our life um and so so yeah kind of working through that but that’s essentially how either one the um the menopausal suppression of those hormones can impact your thyroid or your thyroid can impact um how you transition into menopause there is a smoother process and so that’s gonna be like i said with the the diet and lifestyle like those are those are big shifts um often times during our our fertile years uh when we are menstruating we we’re we’re bleeding out once a month right so we’re we’re releasing a lot of iron that way and so often during those fertile years we actually do much better with having more meat in our diets in general but then during menopause we actually want to shift into probably a more vegetarian or plant-based diet in general with less meat um because now you’re not bleeding out as much and so transitioning there but then also your workouts and things like that so likely because everything else is slowing down you want to slow down your workout so things like walking and yoga are great um but you probably don’t want to be doing as much like high intensity that’s where i see a lot of my women who are transitioning to menopause that are doing like high intensity workouts they continue to gain so much weight and um that’s because every all their hormones are slowing down their production and they’re trying to ramp it up and it’s just you’re not working with your body you’re working against it and so your body kind of rebels and it’s like i don’t know what to do with all this excess stress and it turns it into fat and so um so that’s one of those things that i always try to recommend for my patients is like as you transition you want to change some of these lifestyle habits if you haven’t been moving at all you really need to start moving too walking is super super helpful and important and like i said yoga too can be very powerful it’s it’s very interesting to what i’ve um kind of remembered is like you have to adjust your lifestyle to your life cycle right and so it’s the transition to change that is the stress factor and and sometimes the where the resistance comes from um because people don’t like to change isn’t it right right and that’s and and i think that’s one of the issues with our our society today is that we try to i mean even if we look at celebrities too like we try to do this like anti-aging anti-like change in general so like women are supposed to look the exact same way until they’re like 80 you know or if they don’t then then they’re they’re forgotten or they don’t matter as much anymore right and this like this idea is all really messed up because we’re supposed to change our bodies are meant to change are and that’s a thing maybe a little waking during menopause or post menopause is actually normal and okay right like because your body is there to support you but but we’re so afraid of our like we want our 19 year old body for some reason which is like not even realistic right so understanding that that’s okay to shift and change and um and that’s right like the only constant is change and i think it’s it’s accepting that change in general i think that’s a big part of all of these transitions so now that we’ve been talking about uh you know the changes that we experience with hypothyroidism um at the different stages of our lives for women what can women do today to support themselves or their family members or friends that are experiencing hypothyroidism yeah that’s a great question so in in general as like i said being okay sorry retract that the first thing i’m going to say is the first thing that i think is the most important is the mindset so it’s something that we were just talking about right accepting that change is inevitable um and and it can be beautiful and that that’s how we can grow and evolve and so i think the mindset is really really important um in helping supporting us through all of our all aspects of our journey right this this journey called life um accepting that and then working on our mindset in general to be like we we can get through this and i don’t need to suffer through this and so that’s why i know i talked about how i’m against that anti-aging movement but i am pro-aging gracefully that’s that’s what um i i am a proponent of is that that we can age without pain uh we can go through that and i and i you know i’m still i’m still pretty young i’m only 30 but i um but i know people who are in their 90s and even 100 years old 80s 90s 100 years old who feel great still right and that is to me that’s the goal that’s that’s how i want to age is i don’t care what i look like as long as i feel good as long as i i want to keep dancing and moving and you know living my life and enjoying it and that’s what i see with those people and that’s and and i think that starts with the mindset and um so so that’s that’s the first thing that i’ll say is like let’s always keep working on our mindset the next thing would of course be working on um our lifestyle right in general so so the nutrition movement um stress management all of these things are really important and you know the more research i do the more i find that you know you could eat write and exercise do all the things but if you don’t have um you don’t have the support within your community you’re not getting you’re not able to manage your stress well you’re likely still going to have a number of different health issues so addressing that and so the thyroid is no different the thyroid um is impacted by our diet our lack of movement or movement right it could be too much like i said doing too much high intensity um can be too much for our thyroid um but it’s also impacted by medications that we use so beyond beyond the antibiotics and steroids i talked about in the beginning and then the pill that we talked about a little bit later it can also be impacted by things like ibuprofen and antidepressants and anti-anxiety medications really anything can impact your thyroid because it does need to process it and so um so if you are finding yourself needing one of those things so if you need an ibuprofen for the menstrual cramps again let’s go back and address those while you’re having that right if you need uh feel like you need an antidepressant let’s go back and address why you feel like you need that and what could be causing that depression is it the thyroid itself because that is something that i see all the time where you know patients get labeled with having depression and are given an antidepressant but it turns out their thyroid was under active the whole time which will lead to depression right so if we address the hypothyroidism that’s when we can start to see benefits and now they’re not experiencing this neurochemical depression right there’s always going to be situational um things that happen but they’re not experiencing a neurochemical depression and that’s that’s what we want to get out of um so the one one food or one type of food protein that actually affects your thyroid more than any other type is gluten um and so i know there’s a lot of like you know things that out there where so many people are going gluten free but if we consider how you know how many percent i forget it was like one in five women have hypothyroidism then they one in five women would probably benefit by removing gluten from their diet because that is the one um protein that has been studied that negatively affects your thyroid gland and so that actually contributes to something called molecular mimicry which um essentially is this the gliadin protein in gluten uh will essentially act like your thyroid hormone so it looks a lot like your thyroid hormone but it isn’t obviously it looks a lot like it so your thyroid receptors will actually take it in thinking that it’s your thyroid hormone um but then what happens is it goes into the cell and then the rest of the cell realizes like this is a foreign invader calls a code red and now your immune system attacks your own cell and that’s when we’ll have the autoimmune type of hypothyroidism and so um so i did want to mention that is one really big thing that if you’re already if you’ve already been diagnosed with hypothyroidism or you know um or you even suspect it might be helpful to remove gluten from your diet temporarily just to see how you feel because likely you’ll feel better so reduce gluten in your in your diet be open to change and uh in general just um increase um like we look at the root cause of potential um thyroid issues in your current lifestyle and and adjust it um and so as we like to um close off our conversation with our rapid fire questions so the first question for us uh to you is uh what is the worst health advice you’ve ever received in your life i feel like just eating low fat in general is is very terrible advice um i and and or eating artificial sweeteners i feel like people say that diet is better um but they actually significantly also affect the thyroid which is definitely something that we’ve been talking a lot about um but also um impact your insulin levels and blood sugar in general so um so yeah i would say those two things like um how artificial sweeteners are quote unquote better um and in low-fat anything i’m i’m a huge proponent of eating a lot of healthy fats that’s a good one um and the second one is if there was one habit we should all adopt today what should it be after everything i said i think i’ll say uh meditation actually we didn’t talk about it at all but i i think that’s the one thing i feel like everyone everyone no matter where what your situation is what’s going on in your life i feel like everyone can benefit from meditation and with that said i will just you know put the caveat that it is a practice and so i know there are people who are like i can’t meditate um it’s too hard or i’m bad at it and i’m like you can’t be mad at it you just can’t uh it’s a practice and um so so just practicing it and just just the act of practicing it has um has been shown to help improve neural plasticity and um and just help reduce stress in general so which can of course help everything so that’s why i would say meditation yeah i think it’s a common denominator for all this be it be more conscious being open to change uh being eating more consciously and uh listening to your body uh listening to those signals so yeah i think that’s a that’s a great one and the last question for us for you is if you were to put a song uh or soundtrack to your life what would it be i like this question this is good i think it would be feeling good by nina simone michael buble did a he did he did his own version of it um which may be more popular but i i really like nina simone’s version personally um i don’t do you all know her yeah yeah yeah her voice and i mean the emotion and the wrongness in it that’s just so it’s so beautiful it really is and i think that’s what it is like the soul in it that like you said the emotion like it feels so raw like it’s it’s uh i would say that’s probably it and that’s actually the ironically the soundtrack to my podcast too so going into my podcast i have um a remix version of the media yeah i’ve heard it before yeah nice yeah so and that’s why it’s there because i feel so deeply connected to it nice awesome well thank you so much for that anisha and thank you for sharing your insight on hypothyroidism hopefully we can help some women uh start their journey into healing that uh if they have that definitely i hope so too yeah all right thank you all and i will just end by saying that you know we talked about a lot of things but it really is important to work with someone who knows your individual health and so these are great places to get started but um but it’s it’s so important to to have someone who can go over this lab work with you and go through these things with you so definitely reach out to a naturopathic doctor or integrated doctor who understands how they can support you if if this is a part of your journey or someone who loves journey that’s a great disclaimer thank you bye