As a physical therapist specializing in pelvic floor disorders, specifically pelvic pain, I have noticed a strong correlation between chronic pain, the thyroid, and the endocrine system. I wanted to explore what hormonal imbalances can do to chronic pain. The pain was once believed to be a signal of tissue damage, but now, the understanding is that pain is not so specific. Persisting pain is complex, and signals are sent from the brain to the body and from the body to the brain. Pain can build in intensity varying on many factors, including fear, stress, systemic inflammation, hormonal and autoimmune issues, or history of a trauma.
The thyroid is a major player in the endocrine system and there is a link between elevated muscle enzymes and creatinine in the blood which can influence chronic muscle fatigue/pain. During an abnormal stress response, which is associated with chronic pain, dysregulation of the adrenals occurs, resulting in chronic pain and fatigue. Chronic pain of the musculoskeletal system is a common symptom of autoimmune thyroid issues. As a result, it is important to look at the endocrine system, adrenals, nutrition, and the musculoskeletal system when dealing with chronic pain. When the body is under a significant amount of stress, whether it be with chronic pain, emotional stress, physical stress, etc the thyroid becomes compromised and is unable to keep up with the adrenal insufficiency or stress response. In most cases, the thyroid shuts down or becomes overactive, disrupting the homeostasis of your body. Let’s delve into the complex world of the thyroid or endocrine system, shall we?
Quick Facts about the Thyroid:
An estimated 20 million Americans have some form of thyroid disease, and up to 60% of those with thyroid disease are unaware of their condition. The thyroid is a hormone-producing gland that regulates the body’s metabolism. The metabolism is responsible for producing energy and it affects body functions such as heart rate and energy levels. The thyroid gland is relatively small, located at the middle/lower neck, and it produces hormones that influences every single tissue, organ, and cell in the body. The two most common conditions are hypothyroidism and hyperthyroidism. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone. Common symptoms include: fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, muscle weakness, muscle aches, tenderness, stiffness, pain/swelling in the joints, heavy or irregular menstrual periods, thinning hair, depression, slowed heart rate and impaired memory. Hyperthyroidism is a condition causing the gland to produce too much thyroid hormone. Common symptoms include rapid heart rate (tachycardia), heart palpitations, increased appetite, nervousness/anxiety/irritability, tremor, sweating, changes in menstrual patterns, increased sensitivity to heat, changes in bowel patterns, difficulty sleeping and brittle hair.
Hashimoto’s Disease occurs when the body’s immune system attacks the thyroid and destroys the body’s ability to produce hormones. Common symptoms are similar to hypothyroidism.
Graves’ Disease occurs when the body’s immune system attacks the thyroid, causing overproduction of the hormone responsible for regulating the metabolism. Common symptoms are similar to hyperthyroidism.
Here is a very brief overview about the thyroid hormones that are important in regulating the body. Thyroxine (T4) is the major hormone secreted by the thyroid. T4 is then converted in the liver to T3 by the removal of an iodine atom. The important thing to note is the amount of T4 produced by the thyroid gland is controlled by another hormone called your thyroid stimulating hormone (TSH). This is produced in the pituitary gland located at the base of the brain. TSH is the most common thyroid level tested, however, it is important to have your T4 levels checked as well because the amount of TSH that the pituitary sends to the bloodstream depends on the amount of T4 in the pituitary. If the pituitary sees lower levels of T4, then it produces increased TSH so that the thyroid gland will produce more T4. You can think of TSH and T4 as a thermostat. When the heat rises to a balanced level, the thermostat senses this and then turns off the heat. Finally, it is important to note that pregnancy, oral contraceptive use, chronic pain, and autoimmune conditions can change the thyroid levels in the blood.
Thyroid Function Tests:
Thyroid functioning is tested through a blood test. The two most important thyroid levels to address are the TSH and T4 tests. Initially, the TSH level is the best way to see if your thyroid is producing what it should be. Then, combining that TSH test with the free T4 accurately determines if the thyroid gland is functioning.
Normal TSH levels are between .5 and 5.0, which is a wide range. It is important that your levels are closer to a one or two, especially if trying to conceive or if you have an autoimmune condition or chronic pain condition. A recent study was conducted to assess thyroid dysfunction in women of reproductive age and to see if thyroid dysfunction is associated with menstrual irregularities, anovulation, and infertility. The study showed that women who had TSH of less than 3.0μIU/mL had significantly better functional ovarian reserve than the group that had a TSH of greater than 3.0, which is still considered within normal range. From experience with my clients, many thyroid specialists do not think outside of the box and do not take the time to tailor thyroid treatments. If you are within the wide range, they often say you are okay. If you are having the symptoms of thyroid dysfunction and are at a 5.0 of TSH, even though it is “within the range,” you more than likely need a supplement to help support your endocrine system.
Thyroid Deficiency and Iodine:
The American Thyroid Association states approximately 40% of the world’s population is at risk for iodine deficiency. Iodine is an element that is needed when producing thyroid hormones. Because the body does not make iodine, it must be an essential part of your diet. It is found in various foods, including cheese, cow’s milk, eggs, yogurt, saltwater fish, seaweed, shellfish, and iodine-containing multivitamins. This is especially important in the great lakes northwest regions of the US and Canada, where there was a major iodine deficiency in the 1920’s and people were treated with iodized salt to help with “goiter” and thyroid deficiency. These places continue to have decreased iodine in food, and often people must take an iodine supplement in order to regulate thyroid conditions.
Some alternative ways to boost your endocrine system and regulate your body:
Replace processed foods with whole foods
Exercise regularly, and it should be more weight-bearing exercise
Establish regular bedtimes and sleep
Practice relaxation techniques, a great app is Headspace or Calm
Avoid alcohol and stop smoking
Avoid/limit sugar consumption
Identify food intolerances or sensitivities (we usually crave foods we are sensitive to)
Because of all these factors that affect intensity of pain, it is important to look at an integrative approach.
It is important to recognize that your pain is a signal that something is out of balance.
If you have chronic pelvic pain, seek a pelvic floor specialist to help guide you in the right direction to attack the musculoskeletal component.
Adrenal fatigue/autoimmune thyroid conditions are common with chronic pain.
Finally, when finding a thyroid health care practitioner/endocrinologist/naturopath, it is important to find someone who looks at the “whole body” and is open to finding the right thyroid treatment for you.