A critically important and often overlooked hormone for wound healing is thyroid hormone.

The pituitary gland (in your brain) produces thyroid stimulating hormone (TSH), which acts upon the thyroid gland, a butterfly-shaped gland that sits astride the trachea (in your neck). TSH stimulates production of the “storage form” of thyroid hormone called thyroxine (abbreviated T4–it has four iodine atoms).

T4 is converted by the removal of an iodine atom to the active form of thyroid hormone, tri-iodothyronine (T3). This conversion occurs in the bloodstream, the liver, the brain, and other “target tissues” of the body. In addition to adequate iodine in your diet, a number of other trace elements and micronutrients such as selenium, zinc, iron, and many of the B vitamins are required for proper thyroid function. A nutrient rich diet with lots of seafood (and seaweed), grass-fed meats, and fresh vegetables provides the essential nutrients.

T3 controls your metabolic rate and the transcription of many genes, which affects wound healing. Those with hypothyroidism (low thyroid hormone levels) experience many symptoms including feeling cold, lack of energy, inability to lose weight, weight gain, thin/dry/brittle skin, loss of the outside portion of eyebrows, problems with hair falling out, depression, slow or foggy thinking, poor wound healing, and a variety of other problems.

Unfortunately, many physicians only diagnose thyroid deficiency when the TSH level goes very high or at least when it goes above the so-called “normal range.” When the brain senses low T3, it increases TSH to stimulate the production of more T4, hopefully to be converted to T3. However, the brain has different sensing mechanisms for appropriate T3 levels than many other tissues, so even if the brain senses an “appropriate” level of T3, various target organs in your body may not be getting enough T3 and you could continue to suffer from hypothyroid symptoms.

Anti-aging and functional medicine physicians often diagnose hypothyroidism by looking at a combination of free T3 levels in conjunction with symptoms of hypothyroidism, rather than looking just at the TSH. A key tenet of functional medicine is to get hormones into their optimal range, rather than just within the “normal” range.

A suboptimal (bottom half of the normal range) T3 level with the patient’s symptoms (including poor wound healing) is very suggestive of thyroid problems. There is a variety of problems including obesity, inflammation, chronic illness, infection, and problems with adrenal function that inhibit the proper conversion of T4 to T3 in the periphery, although not necessarily in the brain. If you have a chronic wound, you almost surely have one or more of these issues. Many physicians treat thyroid deficiency with only synthetic versions of thyroxine called Synthroid™ (levothyroxine.) Many patients on levothyroxine may normalize their TSH levels and be told they are “fine” despite having persistent symptoms of hypothyroidism.

A much better solution in these patients is to treat them with natural desiccated thyroid (NDT). Most NDT preparations are of porcine (pig) origin and have both T3 and T4. It can change lives.

Many doctors are not familiar with a hormone called reverse T3 (rT3). It is made from T4 and blocks thyroid hormone receptors but does not activate them. This mechanism to turn down thyroid stimulation occurs for a variety of reasons, including adrenal dysfunction, diabetes, and iron deficiency. An elevated rT3 with respect to T3 levels (the T3/rT3 ratio is commonly used) can contribute to functional hypothyroidism. Many physicians have never even heard of rT3 and are not familiar with managing the level.

Hypothyroidism diagnoses are rising throughout the developed world; one reason is an increase in a condition called Hashimoto’s thyroiditis. This autoimmune condition is associated with antibodies to thyroid peroxidase (TPO), an important enzyme in the thyroid gland. The most common causes of Hashimoto’s are related to gluten sensitivity or other problems within the gut; thus, it can be improved by fixing one’s diet and/or gut issues. It takes the right doctor to direct patients down this pathway.

Like all hormones, thyroid hormone has an appropriate optimal range— “more is not better.” Being above the optimal range can cause as significant a problem as being significantly below it. Your thyroid hormone levels must be appropriately monitored and treated.

If you have a non-healing wound and you are not on thyroid replacement, or if you are on Synthroid or levothyroxine, have your TSH, free T3, free T4, and reverse T3 checked. If your free T3 is not in the top quartile, you may warrant treatment with a natural desiccated thyroid preparation. This should be considered in conjunction with your diurnal cortisol levels, TSH, free T4, and rT3. You may need to specifically seek out a knowledgeable physician for this. Finally, direct application of compounded T3 to wounds also stimulates wound healing.

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