Stress has become an unavoidable part of daily life. The American Psychological Association's (APA) Stress in America 2022 poll indicates that the average stress levels have remained elevated compared to pre-pandemic levels. Chronic stress comes at a cost, leading to an increased risk of developing cardiovascular disease, sleep disturbance, mental health disorders, neuroendocrine dysfunction, digestive disorders, and autoimmune disease. In fact, the activation of the stress response is associated with up to 90% of human diseases. The irony? According to the 2022 APA poll, 70% of adults reported health care is a significant source of their stress. (1)

Over 12% of Americans will develop a thyroid condition during their lifetime. In the U.S., autoimmunity is the most common reason for thyroid disease, and studies show that stress-related disorders are a critical aspect of developing autoimmune conditions (6). Not only do the conventional medical standards for evaluating and treating thyroid dysfunction overlook stress as a contributing factor, but it appears our healthcare system may actually contribute to developing thyroid disease based on recent statistics.

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Overview of the Thyroid Gland and Its Functions

Considered the master of metabolism, the thyroid is a butterfly-shaped endocrine gland in the neck responsible for synthesizing and secreting thyroid hormones, thyroxine (T4) and triiodothyronine (T3). The thyroid plays a vital role in regulating the body's metabolic processes because its hormones control energy metabolism and many physiological processes, including reproduction, growth, development, and regulating body temperature, heart rate, and blood pressure.

Before diving into the rest of the article, it's important to understand the hypothalamic-pituitary-thyroid (HPT) axis, a complex feedback system that regulates the production and release of thyroid hormones in the body. A region in the brain called the hypothalamus releases thyrotropin-releasing hormone (TRH), which stimulates the pituitary gland (also in the brain) to produce thyroid-stimulating hormone (TSH). TSH acts on the thyroid gland to promote the production of thyroid hormones. Once T3 and T4 reach a certain threshold in circulation, they provide negative feedback to the brain, inhibiting the release of TRH and TSH. This feedback loop ensures that thyroid hormone levels remain within an ideal range to maintain physiological balance in the body. (2)

Another complexity of thyroid hormone production is the conversion of thyroid hormones. T4 is the primary hormone the thyroid gland produces, but it is relatively inactive compared to T3. The peripheral conversion of T4 to T3 is essential because T3 is the biologically active form of thyroid hormone that affects target cells. T4 can also be converted to a relatively biologically inert form of thyroid hormone called reverse T3 (rT3). Elevated levels of rT3 can occur in certain conditions, such as illness and physiological and emotional stress. (2)

The Connection Between Stress and Thyroid Health

The hypothalamic-pituitary-adrenal (HPA) axis is the neuroendocrine system responsible for responding to perceived stress by regulating the hormonal and immunological aspects of the body's stress response. Like the HPT axis, the HPA axis involves a cascade of hormonal signals that ends in the adrenal glands' release of stress hormones, primarily cortisol, into the bloodstream. Cortisol has widespread effects on the body, influencing energy metabolism and the immune system. During acute stress, the HPA axis serves as a necessary means of survival. However, chronic stress can result in HPA dysregulation and maladaptive physiological changes, potentially harming physical and mental health. (3)

The HPA and HPT axes are intricately interconnected. The stress response mediated by the HPA axis can impact thyroid function and vice versa (7). Stress can also influence the HPT axis through its ability to induce thyroid autoimmunity by altering cytokine release, upregulating inflammatory pathways, and increasing intestinal permeability (6).

Hypothyroidism and Stress

Stress can contribute to hypothyroidism, a condition characterized by reduced thyroid hormone production and activity. When cortisol levels are high, it signals the thyroid gland to stop producing as much thyroid hormone, inhibits the conversion of T4 to T3, and upregulates the conversion of T4 to rT3 (4, 5). 

Moreover, stress-related lifestyle factors can impact thyroid health. Individuals under chronic stress may engage in unhealthy coping behaviors, such as poor dietary choices, lack of exercise, and disrupted sleep patterns, which can all indirectly affect thyroid function and exacerbate the development of stress-induced hypothyroidism (8, 9). 

Hyperthyroidism and Stress

Conversely, stress can also contribute to the development or worsening of hyperthyroidism, an overactive thyroid state. Acute and chronic stress are well-documented triggers of hyperthyroidism because when stress hormones are elevated, they can affect the immune system, causing the loss of self-tolerance and autoimmunity. Graves' disease, the autoimmune form of hyperthyroidism, occurs when the immune system creates a protein that binds to TSH receptors and overstimulates thyroid hormone production.

Functional Medicine Labs That Can Help Individualize Treatment

Functional medicine labs help practitioners personalize treatment options for their patients. Below are some of the most common labs ordered by practitioners to assess thyroid function and the stress response.

Comprehensive Thyroid Panel

Functional medicine doctors usually order a comprehensive thyroid panel, including at minimum TSH, free T3 and T4, and thyroid antibodies, instead of just TSH with reflex to free T4, which is the standard of care. Often, functional medicine doctors will also order total T3 and T4, and rT3. The reason is that a complete panel gives more perspective into the HPT axis and can better identify subclinical dysfunction in thyroid function anywhere along the axis before overt disease develops.

Stress Panel

Just as a thyroid panel assesses the HPT axis, a stress panel can aid in evaluating the HPA axis by measuring salivary cortisol and DHEA.

Chronic stress and thyroid disease commonly manifest as insomnia or other sleep disturbance. Melatonin, the body's primary sleep hormone, works closely with cortisol to control the sleep-wake cycle. This Sleep and Stress Panel measures cortisol, DHEA, and melatonin to assess the natural diurnal rhythms of cortisol and melatonin and evaluate for signs of stress. 

Micronutrient Panel

Maintaining an ideal balance of micronutrients and amino acids is essential for optimal thyroid function, as nutrient deficiency and excess can contribute to hypothyroid and hyperthyroid states. Additionally, chronic stress often leads to micronutrient depletion. Therefore, a micronutrient panel is a beneficial tool for assessing the nutritional consequences of stress and the underlying causes of thyroid dysfunction.

Integrative Medicine Approaches to Managing Stress and Supporting Thyroid Health

Let's explore integrative medicine approaches that provide holistic strategies for managing stress and optimal thyroid health. These strategies offer insights into the mind-body connection and empower individuals to take proactive steps towards a more balanced life.

Nutrition and Dietary Considerations for Thyroid Health

Diet therapy supports optimal thyroid function by addressing foundational aspects of thyroid health. Generally, patients should focus on reducing inflammatory foods, such as processed sugars, refined grains, and vegetable oils, to alleviate chronic inflammation that can interfere with thyroid function and contribute to autoimmunity. Furthermore, identifying and avoiding foods that trigger the thyroid and leaky gut, especially gluten, can benefit individuals with specific sensitivities.

Incorporating foods rich in thyroid-specific nutrients, such as tyrosine, iodine, selenium, magnesium, iron, zinc, and vitamins A, E, and D, provides essential building blocks for thyroid hormone production and conversion (9). 

Balancing blood sugar levels is also a crucial component of diet therapy. During chronic stress, excess cortisol levels contribute to insulin resistance. Research suggests that patients with thyroid dysfunction are already predisposed to dysglycemia and insulin resistance. Eating a well-balanced diet rich in fiber, protein, healthy fats, and complex carbohydrates can prevent fluctuations in blood sugar that can stress the body and further impact thyroid function.

Stress Management Techniques

Effective stress management techniques are essential for maintaining well-being and supporting a healthy stress response. Many evidence-based methods can be implemented into daily routines to achieve this. Mindfulness-based stress reduction (MBSR) is a powerful approach that cultivates present-moment awareness, helping individuals navigate stressors with greater clarity and resilience. Mind-body practices, like meditation and deep breathing, promote relaxation and activate the body's natural relaxation response, reducing stress hormone levels and calming the mind. Regular exercise and physical activity improve physical health, enhance mood, reduce stress, and increase the body's capacity to handle stressors. Finally, adequate sleep is essential for replenishing energy reserves, promoting the body's natural healing processes, and resetting a healthy HPA axis.

Herbs and Supplements for Stress Modulation

The nature of stress can hinder our capacity to prioritize self-care, making it challenging to nourish our bodies and engage in healthy stress management coping mechanisms. Adaptogenic herbs are a valuable resource with unique properties that help the body adapt to stress more effectively. Adaptogens, such as ashwagandha, rhodiola, and holy basil, work by modulating the HPA axis, regulating cortisol levels, supporting a more stable mood, and exhibiting antioxidant properties that counteract the inflammatory effects of chronic stress on the body.

Herbs and Supplements for Thyroid Health

When diet is not sufficient to meet adequate nutrient requirements for thyroid health, supplements may be beneficial to add on board. Vitamins and minerals that can support thyroid health and function include vitamin D, selenium, and magnesium. Research also suggests optimizing the gut microbiome and maintaining an intact intestinal barrier with probiotics can positively influence thyroid function. (10, 11)

Anti-inflammatory and antioxidant nutrients can help treat thyroid autoimmunity by reducing inflammation and mediating the immune system. Glutathione is considered to be the body's master antioxidant. Oral glutathione can be given but tends to be expensive, so other ways to support glutathione stores include supplemental N-acetyl cysteine (NAC) and vitamins C and E (12). 

Omega-3 fatty acids are potently anti-inflammatory, demonstrated by their ability to reduce the inflammatory mediator C-reactive protein (11). 

Other immunomodulatory and anti-inflammatory supplements to consider in supporting thyroid function and reducing autoimmunity include green tea, mushrooms, vitamin D, and curcumin (13, 14).

Acupuncture for Stress Reduction and Hormone Balance

Acupuncture is a traditional Chinese medicine technique that involves the insertion of thin needles into specific points on the body to stimulate the body's energy flow, known as Qi, and restore its balance.

Studies have demonstrated the benefits of acupuncture in treating various health conditions, including chronic pain, seasonal allergies, and digestive symptoms. When it comes to stress reduction, acupuncture has several potential benefits. It helps to promote deep relaxation by activating the body's parasympathetic nervous system, which counteracts the "fight-or-flight" stress response. Additionally, acupuncture regulates the production of endorphins and serotonin, helping to alleviate symptoms of stress, anxiety, and depression. 

Massage Therapy for Relaxation

Massage therapy is a common complementary modality recommended to patients for stress reduction. Studies have shown that massage has positive benefits on the physical body and the mind. Heart rate variability (HRV) measures the variation in time between each heartbeat and reflects how adaptable the body is to stress. A higher HRV indicates a healthier HPA axis and functional stress response. Studies have found that massage therapy increases HRV and reduces salivary cortisol, heart rate, and blood pressure. (15, 16)

Chiropractic Care for Nervous System Support

While it's important to note that the existing scientific literature on the use of chiropractic adjustments to influence nervous system activity is limited and lacks robust clinical trials, there is research to support that spinal manipulations have effects on neurophysiological processes. Promising clinical outcomes noted with chiropractic manipulations include altered pain perception, improved muscle function, balancing autonomic nervous system activity, and changes in neurochemical markers related to pain and inflammation. (17-20)

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Summary

Stress cannot go unrecognized as a significant factor that affects thyroid health and overall well-being. The interplay between stress and the thyroid gland can disrupt the delicate balance of thyroid hormones. Integrative medicine offers a holistic approach to managing stress and supporting thyroid health through diet, physical activity, sleep, dietary and herbal supplements, and complementary and integrative stress-reduction modalities.