Cardiometabolic Health and The Thyroid


Cardiometabolic health is often an overlooked aspect in the management of hormonal health and, specifically, thyroid health. The two are intricately connected, displaying a complex, weblike relationship that is both interdependent and bidirectional. 

Many are aware of the connections between the thyroid and atherosclerosis (the buildup of fats, cholesterol and other substances in and on artery walls, commonly known as plaque), hyperlipidemia (an abnormally high concentration of fats or lipids in the blood) in patients with hypothyroidism and atrial fibrillation in hyperthyroidism. However, the connection reaches much further, and what is often overlooked is the impact of cardiovascular disease on the thyroid by the processes of oxidative stress and inflammation. So, the implications are more complicated and circular than once believed. 

Oxidative Stress and Inflammation

Inflammation and oxidative stress, produced by adipose tissue, an antioxidant-poor diet, inflammatory diet, and environmental stressors, have a negative impact on the thyroid. Both hyperthyroid and hypothyroid disease is associated with increased oxidative stress. It is my belief that inflammation and oxidative stress are often disregarded in patients with thyroid disease, especially in those who continue to struggle with symptoms despite receiving treatment. 

Insulin Resistance, Diabetes and Glucose

The connection between the endocrine system and cardiovascular disease is something physicians see frequently in patients with insulin resistance and diabetes. What many don’t know is that by improving glucose control, we can improve thyroid hormone profiles and function. Additionally, research shows that individuals with increased insulin (resistance) have a higher incidence of thyroid nodules, larger thyroid volume and a higher incidence of thyroid cancer, which seems to be somewhat mitigated by using Metformin, a drug prescribed to control high blood sugar in patients with type 2 diabetes.  

Cholesterol, Hypertension and Cardiovascular Disease

Thyroid disease is a risk factor for cardiometabolic disease. Even patients who are considered “euthyroid” or “normal,” but have positive autoimmune antibodies, are found to have been at an increased risk for cardiovascular disease. Both hypo and hyper thyroid states have noted associations with cardiac disease, and there is an intimate connection between the heart and the thyroid, which are linked embryologically. Unfortunately, what is rarely discussed with patients is the impact of thyroid hormones on virtually every physiologic, anatomic component of the entire cardiovascular system, including the blood vessels. 

For those with thyroid disease or cardiovascular disease, it is important that we remain mindful of the interconnectedness of these conditions and we do not treat them in isolation.

Worth Reading

Azar, Sami T., Hage, Mirella, Zantout, Mira S., Thyroid Disorders and Diabetes Mellitus, PMC/2011

Chao, Liu, Chen, Guofang, Derwahl, Michael, et al., Metformin and thyroid disease, Journal of Endocrinology/2017

Duan, Yan, Fu, Jing, Liu, Jia, et al., Association Between Thyroid Hormones, Thyroid Antibodies, and Cardiometabolic Factors in Non-Obese Individuals With Normal Thyroid Function, Frontiers in Endocrinology/2018

Gao, Ling, Lu, Ming, Yang, Chong-Bo, et al., Mechanism of subclinical hypothyroidism accelerating endothelial dysfunction, Spandidos Publications/2014

Grais, Ira Martin, Sowers, James R., Thyroid and the Heart, PMC/2014

Monostra, Michael, Metabolic management restores thyroid function in adults with type 2 diabetes, Healio/2020

Every Patient Has a Story to Tell: Narrative Medicine

Narrative Medicine uses a patient’s background and language to assist in clinical practice and research

Narrative Medicine uses a patient’s background and language to assist in clinical practice and research and is an effective and often cathartic approach to individualized healing. When physicians are able to address the personal “stories” that may work in conjunction with physical illness, we can validate the experience of the patient and promote a stronger relationship between patient and physician. 

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COVID-19 Brings Attention to Cardiometabolic Health

COVID-19 Brings Attention to Cardiometabolic Health

Every day I see patients with varying health challenges, many of whom are additionally metabolically unhealthy. With the risk of COVID-19, poor cardiometabolic health has gained more attention, and some experts are even referring to it as a pandemic within the pandemic. As a preventive integrative physician, I see this as an opportunity for many to focus on metabolic health and, hopefully, make lemonade from lemons.

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Genetic Testing Needed in Routine Health Care


As many of you know, throughout my career in medicine, preventive medicine, identifying and reducing the risk of disease, has been ​my passion.​ Genomics, or the study of a person’s genes, has become a game-changer in the field of preventive medicine, not solely because of what health complications may affect our futures, but mainly because of what is happening in our bodies today. Research shows that genetic testing may be a more sensitive indicator of health than family history, personal history, exams, or imaging studies. For this reason, I feel strongly that genetic testing should be a part of routine health care.

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Our Changing Climate, Our Health

There are significant impacts of climate change on the brain, heart and gut

The next time you see your physician, consider discussing the impact that climate change and environmental hazards are having on your health. While the interactions of human health and the environment are complex, we are seeing dynamic and interacting forces that span from the level of personal to global. One of the world’s oldest and most respected medical journals, The Lancet​, has referred to climate change as the “​biggest global health threat of the 21st century​.”

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Optimal Ferritin Levels May Surprise You

Optimal Ferritin Levels Blog Image

Often patients express worry that their ferritin levels are too low, when, in fact, I am concerned about the opposite.

Ferritin is a large protein molecule, and while its role is complex and still unclear, ferritin is generally considered a surrogate marker for total iron storage in the body and often acts as a biomarker of health. Optimal ferritin levels and reference ranges are not currently well defined, but what are considered “normal levels” may actually be too high, and some researchers are advocating for a change in what is considered normal. While we still don’t know the “optimal” numbers, aiming for below the 50 percentile is most likely healthier (20-40 for women, 50-70 for men). Ferritin specialist William R. Ware, PhD, suggests that we should aim even lower for some patient populations (those with cardiometabolic disease, non-alcoholic fatty liver, etc.).

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Preventive Integrative Medicine, the Ideal Approach to Care

How could this have been prevented? This is a question I have been asked hundreds of times throughout my training and over the course of my career. As a resident learning about surgical procedure as pertains to obstetrics and gynecology, I clearly recall thinking beyond the surgery to how the need for the surgery may have been prevented. It was during this time that I decided to switch my concentration to family medicine, which would allow me to further focus on prevention.

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