Thyroid hormones are crucial in regulating important physiological and developmental processes. Since every cell in our body has receptors for thyroid hormones, every organ in our body is affected by its fluctuation. Under the control of the pituitary gland, the thyroid gland secretes the hormones T3 and T4.
Introduction
The pituitary gland in the brain sends Thyroid Stimulating Hormone (TSH) to the thyroid gland telling this gland to secrete the thyroid hormones triiodothyronine (T3) and thyroxine (T4) – mainly T4. A negative feedback loop tells the brain to secrete more or less TSH depending on the levels of T4 in the body. If there is a lot of T4 (hyperthyroidism), the pituitary gland will send less TSH. If TSH is high, this would indicate that the person has very little T4 (hypothyroidism).
T4, about 93% of the hormone secreted by the thyroid gland, is not usable by our cells and needs to be converted into T3. About 60% of this conversion happens in the liver, so a low T3 could be an indication of a sick liver. The other 40% of the T4, 20% gets converted into Reverse T3 (rT3). This is not active (does not stimulate the cell), but it competes for the same binding site as T3. While rT3 is a natural by-product of thyroid hormone production, stress, inflammation and chronic illness can increase this level. And because rT3 binds to the same T3 receptors, a person under a lot of stress can have symptoms of hypothyroidism and not be detected if someone is only looking at TSH, T3 and T4. The final 20% of T4 gets sent to the gut. There is evidence that some T3 is converted in the gut as a consequence of a healthy gut microbiome.
Thyroid dysfunction and fertility:
For most people without obvious symptoms of thyroid dysfunction (feeling tired or lacking energy even after getting enough sleep, sudden weight loss or weight gain that cannot be explained by changes in diet or exercise, mood swings, irritability, anxiety, or depression), a TSH bloodwork should be enough to confirm a healthy thyroid. Although the normal lab range for TSH is between 0.45 to 4.5, most practitioners practicing functional medicine agree that the normal range should be between .50 and 2.5.
There is an understanding among the medical community that hypothyroidism and hyperthyroidism can each negatively impact fertility—both the ability to become pregnant and the ability to carry a fetus to term. When looking at the published data, however, to try to understand if there is any correlation between a thyroid dysfunction and infertility, one fails to find conclusive evidence.
For example, a paper published in 2020 by Best Practice & Research Clinical Endocrinology & Metabolism titled “Impact of thyroid disease on fertility and assisted conception” mentions that the treatment of hypothyroidism (with levothyroxine) usually restores a normal menstrual pattern, reverses hormonal alterations, and improves fertility. However, the authors of the paper also mention that some women with treated hypothyroidism still fail to conceive and seek infertility treatment, including controlled ovarian hyperstimulation and/or IVF.
“...some women with treated hypothyroidism still fail to conceive and seek infertility treatment..."
Another study published in 2012 by the Indian Journal of Endocrinology and Metabolism titled “Hypothyroidism in Pregnancy” showed that hypothyroid women have a decreased fertility rate than normal women, and even if they conceive, the children born will have a significant impairment of IQ levels, learning abilities, and neuropsychological issues.
“...hypothyroid women have a decreased fertility rate than normal women..."
And yet, another study published in 2020 by Fertility and Sterility, titled “Preconceptional thyroid stimulating hormone level and fecundity: a community-based cohort study of time to pregnancy” concluded that: Preconception TSH level was not associated with fecundity in a healthy community-based population. Women attempting pregnancy with a TSH level ≥ 2.5 mIU/L can be reassured that they are unlikely to have an increased time to pregnancy.
“Women attempting pregnancy with a TSH level ≥ 2.5 mIU/L can be reassured that they are unlikely to have an increased time to pregnancy."
In 2012, the American Thyroid Association (ATA) recommended that TSH levels should not exceed 2.0-2.5 mU/L during the first trimester to avoid adverse pregnancy outcomes. This recommendation has been taken very seriously and the treatment of hypothyroidism in pregnancy is mandatory and consists of levothyroxine therapy adjusted to achieve normal trimester-specific serum levels of thyroid stimulating hormone (TSH). Because of this recommendation, most fertility clinics will make sure that patients going through ART have a TSH as close as possible to 2.0.
According to Mayo Clinic some of the side effects of levothyroxine include: chest pain, discomfort, or tightness, decreased urine output, difficult or labored breathing, difficulty with swallowing, dilated neck veins, extreme fatigue, fainting, fast, slow, irregular, pounding, or racing heartbeat or pulse, fever, etc.
Thyroid dysfunction and Acupuncture:
According to the World Health Organization (WHO), acupuncture can be used to treat thyroid diseases. As integrative therapy or alternative medicine, acupuncture is safe and economical. A meta-analysis review published in 2018 by the Journal of Integrative Medicine titled “An overview of the contribution of acupuncture to thyroid disorders” concluded that:
“Acupuncture can reduce symptoms and improve relevant biomarkers of thyroid dysfunction. ”
An on-going randomized controlled study of a total of 284 eligible patients, titled “The efficacy of acupuncture for the treatment and the fertility improvement in child-bearing period female with Hashimoto Disease: a randomized controlled study”, designed by Chengdu University of Traditional Chinese Medicine, Chengdu, China, and published by Medicine in July of 2020, concluded that:
“Acupuncture can delay the progress of Hashimoto's thyroiditis and improve fertility. ”
In March of 2021 the Journal of Acupuncture & Meridian Studies published a case series describing 5 patients who had been suffering from hypothyroidism for a period of 5 years. This is a unique study in the sense that this was the first clinical study reporting the effect of acupuncture and cupping on hypothyroidism with a follow-up period of 3 months. Previous studies have shown the effect of acupuncture alone, or acupuncture and Chinese herbs, but this was the first time that acupuncture was combined with cupping. The study demonstrated significant improvement in the thyroid function, reduction in BMI levels and medication dose. The study concluded by saying: “The present study reiterates the efficacy of acupuncture in the management of hypothyroidism. Acupuncture and cupping therapy have not only shown to restore the normal physiological level of thyroid hormones but also reduce the need for medication in treating hypothyroidism, which is reported as a greater challenge in the management of hypothyroidism”.
“ Acupuncture and cupping therapy have not only shown to restore the normal physiological level of thyroid hormones but also reduce the need for medication in treating hypothyroidism... ”
Conclusion
The thyroid gland is a vital hormone gland and it plays a major role in the metabolism, growth and development of the human body. It helps to regulate many body functions by constantly releasing a steady amount of thyroid hormones into the bloodstream. Maintaining a healthy level of thyroid hormones is crucial for maintaining a healthy life. Although there’s currently some lack of evidence regarding the optimal level of TSH while trying to conceive, there’s clear evidence that a TSH too high or too low could be devastating for the mother and the fetus. As presented in this article, there is plenty of evidence suggesting that acupuncture (and cupping) is very effective in the treatment of thyroid dysfunction.