Thyroid hormone imbalance affects almost every single organ system in the body and the GI tract is not spared. Thyroid hormones affect the motility of all the hollow organs of the GI system including the esophagus, stomach, small intestine and the colon.

In hypothyroidism, the lower sphincter of the esophagus may become more relaxed and the contractions of the esophagus are weakened so that difficulty swallowing and reflux of acid from the stomach into the esophagus may occur causing heartburn. Research has shown that thyroid hormone treatment will reverse the symptoms of reflux and difficulty swallowing caused by hypothyroidism.

The stomach is as much affected as the esophagus and the emptying of the stomach after food consumption is delayed, when thyroid levels are low. The muscle of the stomach becomes in-coordinated and does not contract properly. This will result in belching, bloating, nausea and in severe situations even vomiting. The delay in stomach emptying is not the only effect of hypothyroidism. The stomach may produce less acid which is crucial for normal digestion of food. This stomach problem could be cured with thyroid medication. The cells that produce acid can also be affected by an autoimmune attack which may co-exist with Hashimoto’s Thyroiditis (the auto-immune condition that often causes hypothyroidism).

In hypothyroidism the intestines, including the colon become sluggish as the function of the muscle that causes contractions and progression of bowel movements becomes impaired. This is the reason for constipation in hypothyroidism. Sluggish intestines can also promote bacterial overgrowth and distention of the abdomen. Bacterial overgrowth has been found in approximately half of the patients suffering from hypothyroidism and this causes abdominal discomfort and bloating. If you develop bacterial overgrowth and distress of the abdomen as a result of hypothyroidism this is not likely to resolve completely with thyroid hormone treatment. Quite often bacterial overgrowth will persist and you may require anti-biotic treatment to correct the effects of the bacterial overgrowth, bloating and discomfort.

In severe cases of hypothyroidism a significant distention of the colon may occur, causing what is called Mega-colon, and even obstruction of the intestines. If you have such a GI complication and you have not been diagnosed with hypothyroidism you may be inadvertently taken to the operating room and be subjected to an unnecessary and dangerous surgery for an obstruction of the bowels which has been caused by a severe hypothyroidism.

A major distention of the intestines caused by low thyroid may result in impaired blood flow to the intestines and can become a dangerous complication. Severe hypothyroidism can also promote accumulation of fluid in the abdominal cavity called Ascites and this effect can resolve completely with appropriate thyroid hormone treatment.

I pay special attention to Vitamin D levels in my thyroid patients for several reasons. The first reason is that Vitamin D is very important for an optimal bone health. Thyroid patients who are taking thyroid hormone treatment might have been over treated with thyroid hormone and this might have resulted in bone loss as a result of too much thyroid hormone in the system.

The second reason is that some thyroid patients are at a higher risk for cardiovascular disease including Coronary Artery Disease and hypertension and there is a great deal of recent research implying that Vitamin D Deficiency may promote or accelerate the occurrence of cardiovascular disease. So it makes sense that if you are a thyroid patient you should be avoiding Vitamin D Deficiency which could become another factor promoting cardiovascular disease.

The third reason is that Vitamin D Deficiency may promote auto-immunity including auto-immune attacks on the thyroid. Therefore if you have an auto-immune thyroid condition it is important to keep your Vitamin D level in an excellent range at all times with adequate treatment and supplements. Vitamin D deficiency can also promote other health problems including cancer.

If you have Vitamin D Deficiency your doctor will prescribe Vitamin D treatment and is going to recommend Vitamin D supplementation. The typical supplement recommendation has been 1000IU of Vitamin D3 daily in addition to a prescription of Vitamin D treatment for 8-10 weeks. However Vitamin D supplementation of 1000IU per day may not normalize your Vitamin D level. The amount of Vitamin D supplementation to achieve and maintain a normal 25-Hydroxy Vitamin D level is different from one person to another. The difference in requirement may be inherent to a difference in the ability of the GI tract to absorb Vitamin D. In fact it is not uncommon for a patient to take very high amounts of Vitamin D and continue to be Vitamin D deficient.

Recent research conducted at the Cleveland Clinic Foundation in Ohio on patients receiving a Vitamin D supplement in the form of Vitamin D2 or D3 and who have not been able to achieve adequate and normal 25-Hydroxy Vitamin D level was conducted. These patients have been receiving the supplement either on an empty stomach or with a small meal but when these patients were asked to take the supplement with the largest meal of the day, their Vitamin D levels went up from abnormally low levels to normal levels. The impressive thing about this study is that the dose of Vitamin D supplement that these patients were receiving varied from 1000IU to 50, 000IU per day. When these patients took their Vitamin D with the largest meal their Vitamin D levels went up by more than 50% 2-3 months after beginning to take their Vitamin D with a large meal. This improvement in Vitamin D level had nothing to do with the type of Vitamin D preparation and whether it was an oil or a solid based. When you take your supplement with a large meal the absorption of Vitamin D improves and this has to do with the fact that Vitamin D is one of the Vitamins that is fat soluble.

If you are a thyroid patient and want to achieve optimal thyroid health I urge you to have your Vitamin D level checked and monitored while taking your supplement. You also need to take your Vitamin D with the largest meal. You need to make sure that your Vitamin D level remains at 45-60mg/ml range. Do not be satisfied with a Vitamin D level at the lower end of the normal range.

Women with auto-immune thyroid conditions, such as Hashimoto’s Thyroiditis, are more likely the have Polycystic Ovary Syndrome (PCOS). PCOS is a common syndrome due to a hormonal imbalance.

The hormonal disturbances of PCOS may result in irregular menstrual periods and symptoms of male hormone excess such as acne, increased hair growth and infertility. PCOS is also associated with Insulin Resistance. Vitamin D supplementation for thyroid patients to achieve and maintain normal Vitamin D levels is beneficial for the immune system, the bone, and the cardiovascular system.

A fairly recent study has shown that Vitamin D supplementation in women with PCOS who are Vitamin D deficient caused an improvement in insulin resistance that PCOS patients have. If you are a thyroid patient with PCOS and you are overweight and insulin resistant it becomes quite important to have your Vitamin D level checked. If you also have Vitamin D deficiency you need to receive appropriate supplementation to help not only with the many components implicated in auto-immune thyroid disease but also perhaps to improve your insulin resistance and help with weight management.