Causes of Hair Loss in Women – Part 2: Low Thyroid

Thyroid hormones promote healthy growth, help our cells get oxygen, enhance our circulation, balance our reproductive hormones, and they are necessary for our body to use protein for building itself up.

These powerful hormones have both a direct effect on skin and hair, and an indirect effect on the internal processes that relate to overall health.

Two primary thyroid hormones are the most powerful in our body, and they are T4 and T3. Thyroxine (T4) is made in the thyroid gland when the pituitary releases Thyroid-Stimulating Hormone (TSH). But thyroid hormone must be available and bio-active in order to oxygenate our cells. The active form is triiodothyronine (T3), and this gets converted from T4 in the liver and peripheral tissues such as hair and skin.

The graphic below describes the body’s feedback loop for producing thyroid hormones.

Thyroid Hormones and Our Hair

Skin is one organ in which the thyroid hormones have a direct effect. New growing hairs are formed when hair cells come together in the follicle to form the strand, a function for which active thyroid hormone is directly responsible.[1][2] Adequate amounts of T4 and T3 prolong the hair’s growth phase (called “anagen”), and down regulate the programmed cell death (apoptosis) that causes a hair to go into resting (catagen) and shedding (telogen) phases.

Signs of a Dysfunctional Thyroid

When we have thyroid problems, we tend to gradually lose the qualities that make life enjoyable – such as our memory, ability to think, our sense of humor, energy, and playfulness.

Problems with our thyroid leads to premature aging and disease, resulting from cellular damage. There are many clinical terms for thyroid disease, and sometimes the problem is actually hyperthyroidism, which is too much thyroid production. Hyperthyroidism may manifest with hair loss and other problems, but the focus of this post is on the more common problem of low thyroid (hypothyroidism).

Symptoms of hypothyroidism include:

    Fatigue and lethargy, even after sleeping for a long time
    Possible adrenal fatigue
    Inflamed thyroid gland (goiter)
    Slow to process thoughts
    Low sex drive, trouble having orgasms, loss of interest in sex
    Weight gain
    Bloated face
    Dry pale flaky skin
    Hoarse voice
    Amplified sensitivity to cold
    Frail fingernails and hair (including thinning eyebrows)
    Losing hair. Hair might be dry and coarse before it starts falling out. Small “new growth” hairs like the kind on your hairline may fall out first
    Hair starts to thin at the apex of the scalp
    Muscle weakness
    Heavier than usual, irregular, or absent-pre-menopause menstrual period
    Swollen or stiff joints
    Slow reflexes
    Stiff, weak, painful muscles especially in the morning or after attempting to work out
    Sleep disturbance, worry, and rapid heartbeat (especially at night)

“Traditional” Hypothyroidism

In this condition, the thyroid itself has trouble producing T4. Blood tests might show a high level of the hormone TSH in this condition. Thyroid-Stimulating Hormone (TSH) is secreted from the pituitary gland, which tells the thyroid gland to produce thyroxine (T4). This is the primary hormone the thyroid makes and secretes into the body. When there is enough T4 circulating, your body communicates that to the pituitary gland, letting it know to stop trying to stimulate the thyroid. That is why historically, high TSH levels on a blood test have been the main measure of thyroid function.

But a high TSH isn’t always the best way to tell if your thyroid and its hormones are behaving correctly. And many thyroid problems today can’t be known just by measuring your TSH and T4 levels. Sometimes a thyroid problem isn’t reflected by blood tests alone, and doctors may not always take it seriously, as is often the case in “sub-clinical hypothyroidism.”

Sub-clinical Hypothyroidism

If you have symptoms of hypothyroidism (such as low core temperature), yet your blood tests are more or less normal, you may have a more complex disorder. Subclinical types are often labeled “Wilson’s syndrome” after the doctor who started treating patients according to these symptoms rather than merely what blood tests showed.

You may suspect this problem if you’ve been taking normal T4 thyroid supplementation, and your TSH and T4 have come into normal range, but you still have hair loss and other symptoms. You may still be more sensitive to cold temperatures, and have poor circulation with cold hands and feet that sometimes turn purple or white. Your underarm temperature might be down in the 95-97 range. You still have aches and pains in your muscles, and other hypothyroid symptoms that don’t respond to (or get worse with) T4 treatment.

Severe hypothyroid disorders are more easily recognized and diagnosed than sub-clinical disorders. In sub-clinical types, your blood test results may say that everything is completely normal, even if your symptoms say otherwise. In this case, your problem is likely one of T4 to T3 conversion, or of T3 resistance in your tissues outside of the thyroid gland.

One condition is commonly referred to as Wilson’s temperature syndrome (low-temperature syndrome). There are slight variations to this, but it is primarily a disorder of conversion in the body from T4 to T3. It is also connected with the problem of low metabolism. With this condition, you may have all of the normal symptoms for hypothyroidism, but blood tests may not detect a problem.

What Causes Hypothyroidism?

Many things may affect our thyroid function. Lack of oxygen due to pollution. Nutrient deficiencies like iodine, and selenium. Too much estrogen. Too little melatonin. The aging process can cause thyroid problems if you age in an unhealthy way. Pesticide exposure. Eating anti-thyroid foods that are goitrogenic or that cause excess estrogen such as alcohol, soy, flax, and a huge amount of certain types of uncooked vegetables. Chronically high levels of stress hormones. Chronic low grade malnutrition resulting in low metabolism and mineral imbalances. Excess bacteria in the body can burden the liver so it is unable to convert T4 to T3 efficiently. Exposure to a lot of radiation like X-rays, CAT scans, airplanes. All of these things can compound to create a problem with T4 production.

Impaired Liver Function

Hair loss is a common finding among people with liver conditions.[3] The liver is the organ most responsible for detoxification and burning fat in your body. The liver processes the food and drink you take in, clears your blood of toxins, breaks down excess hormones, stores glycogen, regulates blood sugar, and stores vitamins – doing all of these things on a constant and continuous basis.

The primary causes of poor liver function (outside of chronic disease) are macronutrient deficiencies, alcoholism, stress, drug use, toxins, estrogen dominance, and excess intestinal bacteria. Drinking alcohol is especially harmful to liver function as it has an estrogenic effect. Just two drinks a day is enough to really inhibit the liver’s natural ability to cleanse your body.[4]

When the liver isn’t working efficiently, you have a higher chance of thyroid disorders. Since the liver is the main site for conversion of T4 into active thyroid hormone T3. In an overburdened liver, T3 can’t be synthesized as easily, and reverse T3 may be created instead. As women, our livers are less efficient at converting T4 to T3, so we are more susceptible than men to the types of subclinical hypothyroid problems that are caused by an impaired liver.

When you have a sub-functional thyroid, you will likely have estrogen dominance, which causes the liver to be inefficient. So a liver problem can harm thyroid hormone conversion, which affects every cell and organ of your body.

Normally, the liver breaks down excess estrogens, toxins, and allergens circulating in the bloodstream, but it can become overburdened. The best way to reduce the burden on the liver is to reduce alcohol consumption, reduce the load of toxins going into your body, reduce estrogens coming in, don’t remain overweight long term, consume antioxidants,[5] and phase out allergens from your diet and life.

Josh Rubin of breaks down the T3 conversion problems in a recent video.[6] “It is more of a ‘resistance’ to T3 binding sites,” he says. T4 to T3 conversion happens primarily in the liver. Factors that affect the liver include estrogen dominance, alcohol consumption, eating allergenic foods, or just too much food. Low metabolic rate also affects the functionality of your liver so that it can’t work properly.

Optimal liver function depends on selenium and glucose. “T4 is converted to T3 by an enzyme called 5’-deiodinase, which is found in many of, if not all, the tissues of the body.”[7] 5-prime deiodinase enzyme is found in the liver and it relies on selenium for successful conversion from T4. The liver also relies on glucose for the conversion.

Low Metabolism and Poor Enzyme Function

Your body depends upon healthy enzyme function to catalyze or enable its essential chemical reactions. Enzymes are proteins that are like keys, starting up these reactions within your body. But your enzymes require a certain temperature to work properly, and in a low metabolic state, you tend to run a few degrees cold.

If your temperature is too hot or cold for a prolonged period of time, the enzymes warp so they no longer have the right “shape” and qualities to start your body’s chemical reactions. Like a key that will no longer fit in the lock.

The 5’-deiodinase enzyme is affected (as most of your other enzymes are) by your body’s core temperature, requiring heat to function. The prime determinant of your core temperature is your metabolism, which is largely affected by your thyroid, and affects your thyroid in return.

Your metabolism is affected by stress, blood levels of CO2 and oxygen, how much food you are eating, and other factors. In a low metabolic state, your temperature drops in an attempt to conserve your energy, since stress is already greatly increasing your energy needs. Therefore, active T3 cannot be converted from T4 as well in a low metabolic state.

For more on Metabolism, check out Part 1.


If your body is subjected to high cortisol and a low temperature for a long time, your enzymes create “reverse” T3 from T4. Reverse T3 blocks the cellular receptor for active T3, preventing cellular metabolism. RT3 also prevents you from creating energy that can heat your body, which further prevents healthy enzyme function. So low metabolism can cause conversion and Reverse T3 problems, and RT3 problems can also contribute to low metabolism.

Since active thyroid hormone promotes higher metabolism, more growth, and caloric expenditure, it makes sense that your body has a system in place to counteract the thyroid’s effect under periods of intense stress or famine. It’s about preservation of your body and its energy. Supplying your body with the protein and energy that it needs in times of stress can help blunt the effect of stress hormones on your metabolism, and thus help you overcome sub-clinical hypothyroidism.

Thyroid disorders also become harder to detect in the presence of stress-induced pituitary/hypothalamic problems. Your hypothalamus is the part of the brain that detects how much thyroid hormone is circulating. And it tells the pituitary gland to send the hormone, TSH, to your thyroid. But during high stress, the hypothalamus becomes insensitive to the fact that thyroid hormones are low. This leads to a condition called “sick euthyroid syndrome” where a person’s thyroid is malfunctioning, even though TSH and thyroid hormone levels appear more or less normal.

Insensitivity in the T3 receptor (thyroid hormone resistance) can also become a problem. This is another subclinical form of hypothyroidism where your tissues stop responding, even to large doses of thyroid hormone. It is similar to insulin resistance in the sense that the receptors malfunction and become “lazy.” Your blood tests for thyroid will probably all come back normal, but you will still be experiencing hypothyroid symptoms.

Thyroid hormone resistance can be a problem when there is high cortisol and stress, so bringing those stress hormones into balance may be the appropriate first step before supplementing with thyroid hormone. In fact, Dr. Ray Peat recommends that you don’t take high amounts of T3 while stressed, probably because it can contribute to this resistance and increase your energy requirements, leading to tissue wasting.

Josh Rubin further advises that in the case of conversion or resistance problems with thyroid hormone, “it can be almost 99% fixed with food itself. Eating the right digestible foods, at the right ratios and frequency for your metabolic needs, and altering the other lifestyle puzzle pieces to regulate metabolism.”

Estrogen Dominance and Progesterone Deficiency

Progesterone is a protective hormone for your thyroid. Progesterone deficiency due to anovulation or to menopause contributes to hypothyroid problems. In the case of low progesterone, estrogen and cortisol go unopposed, which also is unhealthy for the thyroid gland. Estrogen builds up easily in our bodies, from the birth control we use, from being overweight, and from environmental estrogen sources like plastic and chemicals. Our own body fat creates its own supply of the hormone as well, leaving a formula for too much estrogen.

Estrogen dominancecontributes to problems with T3. T3 is carried through the body on albumin in the blood. Estrogen lowers your levels of albumin, the carrier of T3. So a comprehensive approach to treat a T3 problem must also treat causes of excess estrogen such as obesity, stress, ovulation disturbance, and low metabolism.


After pregnancy there is an increase in prolactin, a hormone that breaks down your tissues and suppresses the production of progesterone after pregnancy. High cortisol, high prolactin, and high estrogen may be responsible for the thyroid disorders that sometimes develop during or shortly after pregnancy.

Autoimmune Thyroid Disease

Autoimmune thyroid disorders are becoming increasingly common among women. The symptoms of autoimmune thyroid disease are not very different from regular hypothyroid or sub clinical hypothyroid. Sometimes, people with an autoimmune condition experience hyperthyroid symptoms, perhaps including goiter, swelling of the neck, and difficulty swallowing.

In her autoimmune thyroid disease checklist[8], Mary Shomon lists some additional conditions/symptoms pointing to autoimmune thyroid disorders including:

    Celiac disease
    Dermatitis herpetiformis
    Dry eyes
    Blurred vision
    Eye pain
    Rapid involuntary eye movement
    Irritable bowels
    Carpal-tunnel syndrome or tendonitis
    Slow pulse and high or low blood pressure
    High cholesterol
    Sensation of a lump in your throat when you swallow

Autoimmune disorders of any kind are caused by an over reactive immune system. This can be due to inflammation, low metabolic rate, stress, diet, and other variables depending upon the person. Hashimoto’s and Grave’s disease are the most well-known and most common of autoimmune thyroid disorders.

Triggers for autoimmune thyroid diseases can include toxin exposure, the use of certain drugs or medications, high levels of cortisol or chronic stress, low metabolism, endotoxin overgrowth in GI tract, and any of the other causes of standard hypothyroidism. Allergies can contribute to the inflammatory response as well, and may be cleared once you remove irritating foods from your diet, or increase your ability to handle them.

Pathogens can play a role in autoimmune thyroid diseases. In the case of a low metabolism, your immune system can’t kill pathogens as quickly. So they may be hanging around inside your body, waiting for any additional trigger of inflammation so they can hijack the immune system.

Women with other autoimmune disorders such as adrenal autoimmune disease, celiac disease, rheumatoid arthritis, lupus, vitiligo, and pernicious anemia are more likely to develop autoimmune thyroid problems. And a diagnosis of autoimmune thyroid disorder will rely on your symptoms, medical history of the above types of disorders, and the presence of thyroid antibodies on a blood test.[9]

Once diagnosed, autoimmune thyroid disorders can be managed best with a low-inflammatory diet, and removal of allergens as much as possible from your life. Autoimmunity can be lessened by applying the action steps in this book. Supplemental thyroid hormones (sometimes T3-only) are helpful to women trying to overcome this type of thyroid disease.

Dr. Mark Starr, author of Type 2 Hypothyroidism, says that patients with autoimmune thyroid disease don’t do as well on natural desiccated thyroid. And use of desiccated thyroid tends to raise thyroid antibodies in autoimmune hypothyroid patients. He says also that autoimmune thyroid patients also don’t tolerate iodine well. Women with an autoimmune type of thyroid disease may have better results using synthetic hormones in the long run, according to Dr. Starr.[10]

If you have been using natural supplemental thyroid hormones for a while and have found your symptoms becoming worse, consider having your antibodies checked for any autoimmune condition that may have developed.

If you have been treated with thyroid medication based on your blood tests and not your symptoms, consider going to get your blood tested for antibodies, as well as for sub-clinical types of hypothyroidism. You may need to go to a doctor who is willing to prescribe T3-only supplementation or a synthetic hormone for autoimmune cases. Most likely, you will need to deal with issues such as inflammation and stress before these treatments will work their best.

Dr. Jockers describes a cycle that occurs in hypothyroid (low thyroid), showing the connection between adrenals (which make stress hormones), the thyroid, the liver, and the gut:

On the Interplay of Thyroid Disorders and PCOS

PCOS and sub-clinical thyroid disorders share many of the same symptoms. Because thyroid hormone has a strong effect on the sex hormones, thyroid deficiency may lead to chronic anovulation, causing cystic ovaries. Likewise, if you have ovulation problems, make sure you consider the possibility that your thyroid is suppressed as well. Because estrogen dominance occurs during anovulation, and excess estrogen suppresses thyroid function, anovulation may cause thyroid problems.


Thyroid disorders and some of their causes can present us with a question of “egg and chicken.” For example, if you have a thyroid problem, you want to make sure that you consider looking at your ovaries’ health. And if you have PCOS, consider the possibility of a thyroid disorder. It’s worth our learning to put each of these different aspects of our health in order. If there is an imbalance in one, there is likely an imbalance in another. A comprehensive approach will help us create order out of the chaos caused by chronic low grade sickness.


1. An Intimate Relationship between Thyroid Hormone and Skin: Regulation of Gene Expression Dario Antonini, Annarita Sibilio, […], and Caterina Missero
2. J Clin Endocrinol Metab. 2008 Nov;93(11):4381-8. doi: 10.1210/jc.2008-0283. Epub 2008 Aug 26. Thyroid hormones directly alter human hair follicle functions: anagen prolongation and stimulation of both hair matrix keratinocyte proliferation and hair pigmentation. van Beek N, Bodó E, Kromminga A, Gáspár E, Meyer K, Zmijewski MA, Slominski A, Wenzel BE, Paus R.
3.Recognizing and treating cutaneous signs of liver disease Ribhi Hazin, MD., Tarek I. Abu-Rajab Tamimi, MD., Jamil Y. Abuzetun, MD., Nizar N. Zein, MD
4.Estrogen dominance syndrome by Ronald Hoffman, M.D.
5. Food selection based on total antioxidant capacity can modify antioxidant intake, systemic inflammation, and liver function without altering markers of oxidative stress1,2,3 Silvia Valtueña, Nicoletta Pellegrini, Laura Franzini, Marta A Bianchi, Diego Ardigò, Daniele Del Rio, PierMarco Piatti, Francesca Scazzina, Ivana Zavaroni, and Furio Brighenti
9.Srp Arh Celok Lek. 2005 Oct;133 Suppl 1:25-33. [Diagnosis of autoimmune thyroid disease].
10.The Optimal Treatment for Hypothyroidism: Mark Starr, MD Dr. Mark Starr Shares His Approach to Treating an Underactive Thyroid By Mary Shomon

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