Through this analysis we will gain an understanding of the pivotal role the thyroid plays in maintaining homeostasis, as well as the many systemic factors that both influence and are affected by the thyroids state of balance/imbalance. We will also discuss the role Acupuncture plays in regulating the individual and subsequently ameliorating the symptoms that are associated with dysfunction of the Hypothalamic-Pituitary-Thyroid Axis (HPTA).
Due to there being quite a few concepts to introduce and discuss on this multifactorial topic, I will attempt to give structure to this page by addressing the more gross anatomical concepts first, followed by basic physiological cellular interactions, pathological disharmonies and how they manifest and effect within the body, as well as interspersing commentaries on how acupuncture plays a role in assessing and addressing these dynamics throughout the text.
(I would like to note before we begin, that if anyone has any questions in regards to this page or acupuncture in general, please feel free to contact me via the contact details on my webpage.)
Butterfly ... the basic structure of the Thyroid
It is important to not that when the thyroid gland is in a state of balance it is difficult to palpate (feel), however when in a state of dysfunction resulting in inflammation/fibrosis it is possible to feel the gland. Furthermore the fascia and muscular structures/tissues surrounding the thyroid become sensitive to touch and can be spastic/tight due to the effect of the inflammatory process. Therefore, as an acupuncturist this region is of great diagnostic importance and the intention for treatment is to release the pressure pain/tightness found on this diagnostic reflective area for the thyroid gland. This is done through palpation and the use of distal acupuncture points (acupuncture points on the arm and legs) which relate to the individuals constitutional state, (i.e. in the case of kidney deficiency tonifying the correct acupuncture point/s on the foot shaoyin channel should subsequently release the thyroid region). In my experience addressing reflective areas/symptoms through the constitution is of paramount importance for the success of treatment.
The thyroid gland and its hormones in a state of physiology (balance) ...
In order to comprehend thyroid function we need to begin with the hypothalamus, which is located below the thalamus and above the brain stem. You can imagine the hypothalamus as a relay centre that acts as a major link between the nervous system and the endocrine system. It is here at this neuro-endocrine link that thyroid releasing hormone (TRH) is released and travels to the anterior pituitary, causing the anterior pituitary to release thyroid stimulating hormone (TSH). Now TSH travels to the thyroid gland, which is comprised of multiple epithelial cell follicles with a colloid as its centre. This colloid is encapsulated by the epithelial cell ring which constitutes a thyroid follicular cell, and this cell is the functional unit of the thyroid gland. Furthermore, imagine that these follicular cells gather together in groups or aggregations of anywhere from 20 to 40, these groups are referred to as lobules.
Now if we isolate one of these thyroid follicular cells we observe that under the influence of thyroid stimulating hormone (TSH) secreted by the anterior pituitary, the thyroid follicular cell will begin to secrete and produce thyroid hormones, namely T3 (triiodothyronine) & T4 (thyroxine). It is these thyroid hormones that upon reaching their target cell/tissue have the function of raising the metabolic rate or amount of energy expended.
Let’s look at the general mechanism as to how T3 & T4 are produced in the follicular cell. First the main constituents needed are iodine and the amino-acid tyrosine. It is through the capillary that feeds the follicular cell that iodide is able to enter the follicular cell membrane. It does this through a ‘pump’ that allows the entry of sodium and iodide and the exit of potassium. Now we have iodide in the cell we need to get it into the colloid as this is where the synthesis of thyroid hormone takes place. Once in the colloid the enzyme peroxidase coverts the negatively charged iodide to the useable iodine. Tyrosine that was present in the colloid in the form of thyroglobulin undergoes further chemical processes and binds with iodine, finally resulting in the lipid thyroid hormones T3 & T4.
I have included this simplified mechanism to highlight the importance of iodine in the production of thyroid hormone. Endemic goitre (thyromegaly) is a result of not having adequate amounts of iodine in one’s diet. As we can see above not enough dietary iodine can result in inadequate amounts of thyroid hormone being produced, and subsequently hypothyroid signs and symptoms. I would like to stress this is not an issue in Australia these days, as we are not dependant on a local food base (higher iodine levels in soil) and the majority of salt is iodised. However it certainly does relate to populations that are dependent on a local based food source where the regions soil is poor in iodine.
Thyroid Hormones T3 & T4 ...
Furthermore, let’s say that there is enough T3 & T4 circulating in the blood to meet the demands of homeostasis (balance). We don’t want too much synthesized and secreted by the thyroid otherwise we will have symptoms of hyperthyroidism, (i.e. anxiety, weight loss, brittle hair, tachycardia, diarrhoea…). Thankfully there is a negative feedback mechanism in place that is triggered by too much circulating thyroid hormone which will inhibit the hypothalamus in secreting thyroid releasing hormone (TRH). This halts the pituitaries production of thyroid stimulating hormone (TSH), and ultimately less T3 & T4 produced by the thyroid.
Important points to remember …
Before we go on to look at pathophysiology (imbalance) of the thyroid gland I would like to clarify some key points we have mentioned above.
The thyroid hormones T3 & T4 have the main function to increase basal metabolic rate (BMR), basically this means increase the rate of chemical reactions and thus increase the use of oxygen and glucose inside the targeted cell. Thyroid hormone does this on a cellular level by increasing the number of sodium potassium ATPase pumps present in the cell, and these 'pumps' are what utilise about 70% of the energy in our BMR. Thus the more 'pumps' we have the greater the cellular workload and associated output. Note that this can occur in skeletal muscle (causing growth), the heart (causing increased heart rate & cardiac output), liver, kidneys, among other tissues. Therefore the thyroid function and thyroid hormone effect the body systemically and engages many organs and tissues.
The Thyroid in a state of pathophysiology (imbalance) ... and Acupuncture's role ...
Below I will address hyperthyroid function as seen in Graves ’ disease, as well as hypothyroid function as seen in Hashimoto’s thyroiditis. Furthermore I will address and discuss why many individuals can show normal blood lab results, yet experience very real thyroid related signs and symptoms, and how acupuncture can help.
I would like to note that in regards to aetiology, the thyroid gland and associated functions can reach a state of imbalance due to a myriad/combination of reasons. Some of these include stress, lack of oxygen, various medications, weight loss pills (i.e. using synthroid for this purpose only), some birth control pills, lithium, immune issues, liver issues/failure (poor conversion of T4 to T3), and hormonal issues. Thus it is possible that regulating/removing these aspects from one's life (when possible), can resolve the issue completely.
Here you can see that hyperthyroidism and increased production of T3 &T4 affect a range of tissues and basically increase the cellular metabolic rate, resulting in the above signs and symptoms.
Why does this happen?
If we observe a common instigator of hyperthyroidism being Graves’ disease we need to understand that this is an autoimmune condition. What this means is that the body is not recognising self from non-self, and is ‘attacking’ its own tissues thinking that they are foreign invaders. In Graves’ disease what occurs is an immunoglobulin (i.e. key) that looks very similar in structure to thyroid stimulating hormone (TSH) that as we discussed, is released by the anterior pituitary, binds to the TSH receptor (i.e. lock) which is on the thyroid follicular cell of the thyroid gland. Once this ‘key’ opens the ‘lock’, an auto-immune response is triggered and the associated inflammation and destruction to the thyroid gland occurs. What also simultaneously occurs in Graves’ disease is the ‘key’ & ‘lock’ combination initiates increased iodide intake into the thyroid follicle and this increases the production of thyroid hormone, as well as increasing the release of thyroid hormone into the blood and thus increasing basal metabolic rate.
This mechanism of action is why in Graves’ disease you get both the destruction/inflammation of the thyroid tissue, as well as the increased amount of thyroid hormone synthesis and release, manifesting in hyperthyroid signs and symptoms.
The associated exophthalmos (bulging) eyes that is indicative of Graves’ disease is due to the immunoglobulin also attacking the fatty tissue at the orbital socket, and thus resulting in inflammation behind the eyes, causing the eyeball to exhibit this ‘bulging’ look.
Acupuncture treatment note …
From an acupuncture perspective (based on Kiiko Matsumoto Clinical Strategies) it is integral for the success of treatment to address and regulate the immune system (due to the autoimmune component). There are key diagnostic palpatory areas on the body that reflect the state of the immune system, and effecting a change in these reflective areas through the correct acupuncture points and the associated release of tightness and pressure pain is the objective on the treatment table.
When dealing with hyperthyroidism it is of paramount importance to treat the constitution of the individual. Thus I observe and palpate key diagnostic areas on the body (meridian & reflective areas) that indicate the state of the individual's constitution. Key indicative areas that I focus on, include the reflection of the thyroid gland, pituitary, adrenal gland, kidney meridian (as it dominates the glands), liver (excess/deficiency or both), autonomic nervous system, pericardium meridian, and Ren mai. The reason it is important to treat the complete individual and address imbalances through acupuncture in this manner is because, as we have established imbalance of the thyroid can involve or effect the pituitary, hypothalamus, immune system, heart, skeletal muscle, liver, kidney, and much more.
If we view the signs and symptoms relating to a low functioning thyroid gland we see it exhibits brittle hair, periorbital oedema, facial swelling, constipation (due to decreased peristalsis), slow heart rate and cardiac output, cold intolerance (due to decreased exothermic response), associated with weight gain and depression.
A common cause of low functioning thyroid is Hashimoto’s thyroiditis, which falls into the category of primary-acquired. This condition much like Graves’ disease, is an autoimmune condition however it differs in that the immunoglobulins bind to the TSH receptors and destroy the thyroid follicles. This results in the destruction of thyroid tissue with the associated inflammatory response, as well as the low thyroid hormone levels and associated hypothyroid signs and symptoms.
Again, it is important to note that these immunoglobulins do not just target the thyroid gland but can also damage tissue in the gut, brain, and heart.
This is one of the reasons why individuals on synthetic thyroid hormone medications may show with better blood results, but still feel unwell.
Yes, the amount of T3 and T4 circulating may be better due to the synthetic thyroxine taken, but how are they functioning once they reach the target cell, and is the conversion process of T4 to T3 occurring optimally? Not to mention that destruction due to the autoimmune reaction is still taking place, regardless of blood levels (TSH, T3 & T4).
I am definitely not saying that blood tests are not needed, nor medication, all I am saying is that 'good' blood results are not the final benchmark in assessing whether the condition is under control. There needs also to be an amelioration of the individual's signs and symptoms to conclude that treatment is efficacious.
Acupuncture treatment note ...
It is common in the acupuncture clinic to find individuals who exhibit signs and symptoms of low/high functioning thyroid yet have blood results in the normal range. These people respond very well to constitutional acupuncture treatments, just as individuals who are diagnosed with low/high thyroid function and take medication yet still have the associated symptoms.
The beauty of acupuncture is its ability to assist in regulating the body and thus its processes. As I have stated throughout this page, a thyroid dysfunction is not just a problem with the thyroid and its associated hormones, it is of a systemic ‘whole’ nature. Individuals with the ‘label’ will know that their mood/stress state plays a massive role in their other associated signs and symptoms, or shifts in their diet translate to their ‘thyroid’ signs and symptoms. This is due to the body being an interconnected whole that is inter-dependant to varying degrees on all else that constitutes the ‘whole’.
To highlight this interconnectedness I would like to share with you some ideas on the aetiology of thyroid imbalances that I have come across in my reading and tested in my own clinical practice, some of these thoughts are systematised in Kiiko Matsumoto’s Clinical Strategies.
It is proposed that in Japan the thyroid gland is seen as one of the major ‘shock’ absorbers in the body. Prolonged stressful events, trauma, or perceived trauma, can impact the thyroid gland causing dysfunction as well as impact on the adrenal gland.
From a Classical Chinese perspective the kidney meridians internal pathway passes and relates to these glands, and in my own clinical experience it is acu-points on this meridian that play an integral role in treatment of individuals presenting with these imbalances.
Furthermore, I have seen individuals that present with thyroid imbalances improve dramatically with utilising treatment strategies that are directed at balancing the immune system & autonomic nervous system, when this is what medical history and palpation dictates is a constitutional imbalance for them.
It is through acupuncture that we subtly allow the space for the organism to regulate itself. Through the use of medical history, palpation and improvement in the individuals signs and symptoms we are able to effectively gauge the effect of treatment.
As an acupuncturist the intention is always to create an environment that is conducive to the individuals’ optimal state of health inherent to them.
(As always, if any questions arise in regards to acupuncture or anything else I have written about, please don’t hesitate to contact me – Giancarlo Nerini - Acupuncturist)