The Specialist: Thyroid Disorders and Heart Health

Photo of board-certified physician Sarah Akhunji, MDDr. Sarah Akhunji

“Having these health issues brought me more empathy. I know what it’s like when a patient’s cholesterol or thyroid levels are off. I understand that level of fatigue. And the frustration of not wanting to exercise.” — Dr. Sarah Akhunji

 

Sarah Akhunji, MD, a board-certified family doctor in Arizona who focuses heavily on integrative medicine and thyroid and autoimmune conditions, never even suspected she had a thyroid issue. She was actually out at lunch with a friend, a radiologist, who began looking at her neck sort of strangely. 

“They asked me, ‘Have you noticed it looks a little swollen and not quite symmetrical?’”

It was at that moment she realized that her thyroid was indeed enlarged. At that point, she felt “a bit off,” but generally was unaware of the slight bulge at the base of her neck where the thyroid is located.

Dr. Akhunji then went to see her sister, an endocrinologist, at her clinic. They did a biopsy and found thyroid nodules on the right side of Dr. Akhunji’s thyroid.

She had thyroid surgery to remove nodules — and began experiencing thyroid and heart health issues

Fortunately, doctors found that the nodules weren’t presently malignant, but that they could become malignant over time. She ended up having part of her thyroid gland removed after her surgeon said, “If you were my mother or my sister, I’d tell you to just get it removed. That’s the best thing for you.”

After the surgery, her thyroid hormone levels looked okay. “I knew they would change but I didn't know when,” she says. “Then I started to feel sluggish and tired, [and I saw] skin changes, weight gain, and I didn't feel like working out.”

Eventually, with half her thyroid gland gone, her thyroid hormone levels dipped, which ended up having an effect on her overall health — including her heart. Specifically, she learned that her LDL (low-density lipoprotein), or bad cholesterol, had increased. 

How the thyroid and heart are connected

The thyroid is a major player in the human body. In fact, the small, butterfly-shaped gland is responsible for hormones that can affect every organ in your body.

Your thyroid can affect your heart in several ways:

  • In hypothyroidism, low levels of thyroid hormone can slow your heart rate, making the arteries less flexible, increasing blood pressure, and elevating cholesterol (which further damages the arteries).
  • In hyperthyroidism, excess thyroid hormones can lead to high blood pressure, heart palpitations, and atrial fibrillation (an abnormal heart rhythm) 

Poorly managed thyroid conditions can worsen existing heart problems, too — or they can mask issues that are undiscovered as of yet.

Dr. Akhunji says she had a family history of high cholesterol, but her thyroid condition certainly didn’t help.

“Abnormal thyroid levels can elevate cholesterol, which can lead to heart disease,” she says. When you have high cholesterol, fat deposits can clog your arteries, making it harder and harder for enough blood to flow through. This can lead to clots, causing heart attacks and strokes.

Although heart health and thyroid health are inextricably linked, Dr. Ahunji says she tackled her low thyroid levels and her increased cholesterol as two separate issues; this allowed her to focus on both without getting overwhelmed.

She started taking thyroid medication

To treat her thyroid, she started taking Synthroid (also known as levothyroxine), a synthetic compound that is identical to the thyroid hormone T4 (levothyroxine). It’s used very commonly to treat hypothyroidism caused by thyroid removal, T4 deficiency, and other issues.

From there, “I started to feel better and exercise more, and my desire for certain kinds of food changed,” she said. “I got scared. I didn't want to die young from a heart attack.”

In addition to medication, she focused on wellness — beginning with meditation

With her medication regimen underway, Dr. Akhunji turned her attention to three core areas that she knew could improve both her thyroid levels and her heart health: mental health, diet, and exercise.

“Try not to make all these changes at once, or make them terribly complicated,” she advises.  

Dr. Akhunji began by embracing meditation, which she also recommends as a first step to others. She even meditates with her patients — simply showing them how to breathe in and out — to teach them how easy it can be.

“Just focus on breathwork,” she says. “Take five minutes to breath in and out. The whole idea is to decrease the sympathetic response, which is stressful for the heart.”

When the sympathetic nervous system is activated — whether by daily stressors, or even hormonal health issues like PCOS — your heart rate can accelerate, your blood pressure can increase, and a whole other range of issues can occur.

That’s why meditation is such a profound help; breathing in and out can help tell the body to slow down. Practicing meditation, Tai Chi, or mindful breathwork each day can, over time, teach the body not to overwork the sympathetic nervous system.

If you have no idea where to start, that’s okay, Dr. Akhunji says. She recommends finding a five-minute breathwork video on YouTube and letting it guide you.

She changed her eating habits

Dr. Akhunji decided to make real changes in her dietary behaviors when she saw how high her cholesterol was.

“I don't like to think of dietary changes as ‘oh, I'm going on a diet,’ which is all about deprivation,” she said. Instead, she explains, “it was easier to fill my food choices with healthier foods.”

Here’s what she recommends:

  • Limit saturated fats and sugar
  • Eat foods found on the perimeter of the grocery store (meaning the produce), focusing on colorful fruits and veggies
  • Reduce inflammation through healthy eating. Because thyroid conditions like Hashimoto’s can have an inflammatory component, you’ll want to eat anti-inflammatory foods like garlic, ginger, turmeric and antioxidants (like blueberries and green tea). You’ll also want to decrease inflammatory foods like red meat and processed items. 
  • Focus more of your energy on adding healthy foods, which leaves less room for the unhealthy foods

Again, Dr. Akhunji suggests that patients turn to YouTube, which is a robust — and free — resource for people looking for heart-healthy recipes and educational channels.

She began working out more by doing what felt right, little by little

Dr. Akhunji made sure to fit exercise into her schedule naturally. For her, it was more about just moving rather than burdening herself with complicated, long workouts. The point? Any movement is medicine.

Exercise is heart-healthy for a few reasons: It helps the heart muscle become more efficient at pumping blood, as well as helping to maintain a healthy heart rate and blood pressure.

It’s also beneficial for thyroid health for a few reasons. For one, exercise can help you manage your weight if your thyroid medications aren’t helping with weight management. And it can, over time, boost your energy, which can help in cases of hypothyroidism.

A 2019 study in the medical journal Heart Vessels also found that exercise increased thyroid hormone levels and decreased arterial stiffness in people with low thyroid levels.

Just be sure to clear any exercise with your doctor; and avoid ramping up your workouts too quickly after starting thyroid medication for hypothyroidism especially, as rapid changes to your heart rate might not be safe.

Dr. Akhunji’s favorite workout? “I like to run. I don’t go far or fast, since I have arthritis in my knees. I just slow jog around the neighborhood. I [also] play tennis and do Tik-Tok dancing with my daughter — it’s not coordinated but there’s lots of laughter.” Another fun workout she loves? Using a weighted hula hoop.

She recommends, for anyone needing a bit of exercise inspiration, to start with walking for about 20 minutes a few times per week. To kick the sweat level up a notch, and to reach muscle fatigue quicker, add one-pound ankle weights.

“Just start walking. It takes about 30 days for a commitment to a habit,” she says, so just stick to it daily. You can even use YouTube walking workouts a few times throughout the day to get your movement in if you’re stuck at home or in your office.

In the end, embrace a creative workout that is fun for you; that could be dancing or cycling or swimming. Just keep doing it.

If you’re feeling very sluggish, tell yourself you’ll move for five minutes, she says. “Invariably, people won’t stop at just five minutes; they tend to go longer.”

A few last pointers

There are a few additional things Dr. Akhunji recommends to her patients with thyroid and heart health conditions:

Check your sugar levels, especially with hypothyroidism, which can increase glucose levels. 

Spend time in the sun; not only will you increase your vitamin  D levels — which can help boost your energy if you’re sluggish — but it may also improve your mental health.

Get tested for vitamin D deficiency. If you are deficient in vitamin D, consider supplementing with 1000 to 5000 IUs daily. The sun alone won’t do it.

How her own health issues changed her practice

In the end, Dr. Akhunji says experiencing heart and thyroid health conditions changed the way she practices medicine — especially when she speaks to middle-aged women or young women who come to her with health problems and debilitating fatigue. She says women especially need to pay attention to their wellness, since they typically focus a lot of their energy on others (like family and community).

“Having these health issues definitely made me a good listener, too, and it brought me more empathy. I know [what it’s like when their] cholesterol or thyroid levels are off. I understand that level of fatigue. And the frustration of not wanting to exercise,” she says.

For this reason, she doesn’t judge her patients when they’re struggling — and she gives credit where it’s due (for example, when they begin to add more greens to their diet or get out more for short walks).

“Everyone is just doing the best they can,” she says. “Everything makes a difference.”

Dr. Sarah Akhunji, based in Tucson, Arizona, is a board-certified family doctor with deep expertise and understanding of thyroid and autoimmune conditions. She works with Paloma Health and is Medical Director of Care Coordination at Banner University Medical Center Tucson. 

 

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