People come in to my West Los Angeles Thyroid Institute every day with symptoms suggestive of a hypothyroid condition. It shocks me that these patients have very little understanding of the thyroid-brain connection. People think about low energy, thinning hair, and weight gain as the primary evils of hypothyroidism. One very common symptom is brain fog, these are the people who say “Dr. Beckingham I can’t remember things like where my keys are, why can’t I focus, I forget people names”. I have to educate these people that the weight and energy issues are valid but my real concern is the neuroendocrine component of low thyroid function, as well as the blood sugar issues. The blood sugar issue is for another story. I want to focus on the Brain and nervous system for now.
It has been clearly demonstrated that thyroid hormones exhibit very powerful microglia modulating properties. Microglia are a type of glial cell that are the resident macrophages of the brain and spinal cord, and thus act as the first and main form of active immune defense in the central nervous system (CNS). Microglia constitute 20% of the total glial cell population within the brain and spinal cord. Each neuron in the brain can have around 10 glial cells to work with it. Basically microglia kill bad things that should not be in the brain. Some studies go on to imply that excessive microglial reactions in the brain are associated with the lesions of neurodegenerative diseases. So brain degeneration is linked to excessive immune response in the brain.
I give patients the easy to understand example of a pimple. In a common pimple on the body the bacteria and oil present cause a noticeable immune response. The pimple becomes inflamed, red and tender to the touch. The same principle holds true in most immune reactions. So immune reaction in the brain causes inflammation in the brain tissue. It is this inflammation that causes damage. Clearly stated inflammation in the brain slows down the brain by blocking nerve conduction (communication) hence the brain fog. Microglia reaction causes inflammation that over prolonged periods causes brain damage.
If thyroid hormones help to regulate the brain immune response and keep in it check what happens if your thyroid does not work properly, brain degeneration! Thyroid hormones have been shown to promote neurogenesis (new cell growth), dendretic/axonal growth (the communication end pieces of nerve fibers), myelinnation (the insulation of a nerve), and synaptogenisis (the building of communication points of the brain). Thyroid hormones help promote serotonin reception which in turn activates the frontal cortex of the brain. So low thyroid could cause depression, lack of motivation, bowell issues, and poor coordination. How many thyroid patients have we seen with this presentation?
As we dig deeper it has been shown that T3 hormone (the active thyroid hormone) works hand in hand with acetylcholine and low T3 will result in poor brain function causing brain degeneration in particular the cerebellum (balance center, fear/pleasure response, posture control, coordination). So bad cerebellum function equals poor movement with balance problems. On top of that the things in life patients used to enjoy they do not anymore, I see this in my clinics all of the time.
Low thyroid function hurts memory by slowing hippocampus function by damaging glutamate receptor activity which also causes low dopamine levels. If you have low dopamine you are likely to get Parkinson’s disease. When I see my Parkinson’s patient’s they have been mismanaged because they have been diagnosed far too late. Parkinson’s for me functionally speaking has 8 stages with #1 being loss of smell, #2 loss of proper gut movement, all the way to #8 shaking of the body. A true text book diagnosis does not happen until stage 8, extremity shaking. My goal is to catch it early and modulate the Parkisonian reaction before too much damage is done. This is a whole other story.
The worst part of all of this is the previously mentioned brain neurotransmitters; Serotonin, Dopamine, and acetylcholine all play a role in helping the thyroid gland work. This causes a vicious cycle. Bad thyroid causes bad brain function which in turn causes worse thyroid. This is why just giving patients thyroid hormones without a full lab workup and brain assessment is borderline negligent practice. Remember most thyroid problems in the first place are autoimmune and the thyroid is just a victim of the body attacking itself.
To find out if you have an autoimmune disease I insist on antibody testing on all my chronic condition patients. An antibody is a protein marker. The body’s immune system produces antibodies in response to unwanted material like molds, virus, bacteria, and parasites. These substances are labeled antigens. Antibodies can be produced when the body has a reaction to a food it is sensitive to or comes in contact with a harmful chemical. Antibodies can mistakenly be produced against a bodies own healthy tissue when the immune system becomes confused. The antibody marks the tissue for removal and signals the immune response. This is the cause of autoimmune reactions. I like to check for gluten antibodies, myelin (fatty sheath around the nerves) antibodies, cerebellar (back part of the brain controlling balance, coordinated movement, and spinal muscles) antibodies.More examples of this could be antibodies to skin tissue often called psoriasis, antibodies to the thyroid tissue called Hashimoto’s disease, or antibodies to the nerve cells conductive coating known as multiple sclerosis.
In summation we have to focus on the whole patient not just one system, we have to look at the whole symptom presentation, we have to do full lab testing panels including antibodies, and we have to do a full neurotransmitter assessment. Educate our patients and help give them control over the condition without it controlling them.