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Updated: Jun 17, 2021

The problem

You go to your doctor who is conventionally train. You are not feeling well and report any number of the 300 potential symptoms associated with a thyroid problem. These include fatigue, infertility, dry skin, weight gain (or even weight loss), anxiety, depression, nervousness, irritability, thinning hair, loss of outer 1/3 of eyebrows, cold hands, cold feet, and even infertility.

Your doctor then orders a TSH test. He or she now pronounces that the numbers are in the “normal” range. Bingo! You do not have a thyroid problem. He or she then announces that you are either depressed, imagining your symptoms, stressed, or getting older. Conventional answer: Take an anti-depressant like Prozac. Learn to relax. Or, it is just a part of aging. In any case, it is, according to the TSH test, not a thyroid problem.

However, if your TSH is high enough, he or she may prescribe Synthroid, a drug that contains only T4. You may then take this for years with little change or you may even worsen. Why? See below:

What is Hypothyroidism

Hypothyroidism (low thyroid) is probably one of the most common hormone deficiencies seen, especially in women. Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is the most common cause of hypothyroidism in the United States. It is an autoimmune disorder involving chronic inflammation of the thyroid. This condition tends to run in families.

Hypothyroidism is a problem with your thyroid gland while Hashimoto's is a problem with your immune system. For example, if you suffer from hypothyroidism, a functional medicine doctor or a more holistic doctor, will recommend bioidentical thyroid like Nature-throid, or Armour. He or she may also recommend an iodine/iodide protocol. If you suffer from Hashimoto's, a gluten free diet and selenium, with a low inflammatory diet may be recommended. This works on the inflammatory aspect.

Lab Tests

The thyroid gland, located right below the epiglottis (Adam’s apple), has three lobes. The gland is under the influence of TSH (thyroid stimulating hormone) in the pituitary gland. The thyroid produces five hormones, T1, T2, T3, T4 and Reverse T3. For clinical reasons only, the Free T3, Free T4, reverse T3 and TSH are measured. Many conventionally trained physicians, including generally endocrinologists, test only the TSH and maybe Free T4.

At Seeking Perfect Health, we test Free T3, Free T4, TSH, and Reverse T3. We also test for Hashimoto’s with a lab test named APO ab (thyroid antibodies). So do most physicians trained in functional medicine and bioidentical hormone therapy.

Causes hypothyroidism

  1. People who develop a particular inflammatory disorder known as Hashimoto's thyroiditis have the most common cause of hypothyroidism. Autoimmune disorders occur when your immune system produces antibodies that attack your own tissues. Sometimes this process involves your thyroid gland. Scientists are not sure why the body produces antibodies against itself. Some think a virus or bacterium might trigger the response, while others believe a genetic flaw may be involved. Most likely, autoimmune diseases result from more than one factor. But however, it happens, these antibodies affect the thyroid's ability to produce hormones.

  2. Congenital disease.

    1. Some babies are born with a defective thyroid gland or no thyroid gland. In most cases, the thyroid gland did not develop normally for unknown reasons, but some children have an inherited form of the disorder.

    2. Often, infants with congenital hypothyroidism appear normal at birth. That is one reason why most states now require newborn thyroid screening.

  3. Pituitary disorder. A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce enough thyroid-stimulating hormone (TSH) — usually because of a benign tumor of the pituitary gland. (microadenoma)

  4. Pregnancy.

    1. Some women develop hypothyroidism during or after pregnancy (postpartum hypothyroidism), often because they produce antibodies to their own thyroid gland.

    2. Left untreated, hypothyroidism increases the risk of miscarriage in early pregnancy, premature delivery and preeclampsia — a condition that causes a significant rise in a woman's blood pressure during the last three months of pregnancy. It can also seriously affect the developing fetus.

  5. Iodine deficiency.

    1. The trace mineral iodine — found primarily in seafood, seaweed, plants grown in iodine-rich soil and iodized salt — is essential to produce thyroid hormones.

    2. In some parts of the world, iodine deficiency is common, but the addition of iodine to table salt has virtually eliminated this problem in the United States. Conversely, taking in too much iodine can cause hypothyroidism.

Treatments for hyperthyroidism. People who produce too much thyroid hormone (hyperthyroidism) are often treated with radioactive iodine or anti-thyroid medications to reduce and normalize their thyroid function. However, in some cases, treatment of hyperthyroidism can result in permanent hypothyroidism.

  1. Thyroid surgery. Removing all or a large portion of your thyroid gland can diminish or halt hormone production. In that case, you will need to take thyroid hormone for life.

  2. Radiation therapy. Radiation used to treat cancers of the head and neck can affect your thyroid gland and may lead to hypothyroidism.

  3. Medications. Several medications can contribute to hypothyroidism. One such medication is lithium, which is used to treat certain psychiatric.

Risk Factors:

  1. Is a woman older than age 60? Note: women of any age can have low thyroid including teenagers and even younger? So can some men.

  2. Have a family history of thyroid disease.

  3. Have other autoimmune diseases, such as rheumatoid arthritis or lupus, a chronic inflammatory condition.

  4. Have been treated with radioactive iodine or anti-thyroid medications.

  5. Received radiation to your neck or upper chest.

  6. Have had thyroid surgery (partial thyroidectomy)

  7. Have been pregnant or delivered a baby within the past six months.

Potential Complications:

  1. Mental health issues. Depression may occur early in hypothyroidism and may become more severe over time. Hypothyroidism can also cause slowed mental functioning and memory loss.

  2. Peripheral neuropathy.

    1. Long-term uncontrolled hypothyroidism can cause damage to your peripheral nerves — the nerves that carry information from your brain and spinal cord to the rest of your body, for example, your arms and legs.

    2. Signs and symptoms of peripheral neuropathy may include pain, numbness and tingling in the area affected by the nerve damage. It may also cause muscle weakness or loss of muscle control.

  3. Myxedema.

    1. This rare, life-threatening condition is the result of long-term, undiagnosed hypothyroidism. Its signs and symptoms include intense cold intolerance and drowsiness followed by profound lethargy and unconsciousness.

    2. A myxedema coma may be triggered by sedatives, infection or other stress on the body. If one has signs or symptoms of myxedema, they need immediate emergency medical treatment.

  4. Heart problems.

    1. Hypothyroidism may also be associated with an increased risk of heart disease, primarily because high levels of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — can occur in people with an underactive thyroid.

    2. Even subclinical hypothyroidism, a mild or early form of hypothyroidism in which symptoms have not yet developed, can cause an increase in total cholesterol levels and impair the pumping ability of your heart. Hypothyroidism can also lead to an enlarged heart and heart failure.

  5. Goiter.

    1. Constant stimulation by TSH of your thyroid to release more hormones may cause the gland to become larger — a condition known as a goiter.

    2. Hashimoto's thyroiditis is one of the most common causes of a goiter. Although generally not uncomfortable, a large goiter can affect one’s appearance and may interfere with swallowing or breathing.

    3. Infertility. Low levels of thyroid hormone can interfere with ovulation, which impairs fertility. In addition, some of the causes of hypothyroidism — such as autoimmune disorder — can also impair fertility.

  6. Birth defects.

    1. Babies born to women with untreated thyroid disease may have a higher risk of birth defects than may babies born to healthy mothers.

    2. These children are also more prone to serious intellectual and developmental problems. Infants with untreated hypothyroidism present at birth are at risk of serious problems with both physical and mental development.

    3. But if this condition is diagnosed within the first few months of life, the chances of normal development are excellent.

Thyroid Symptoms:

Hair falling out, Dry skin, Body temperature below 97 degrees, Constipation, Cold hands and feet, Weight gain, High cholesterol and/or LDL, Headaches, Tingling in the fingers, Infertility or miscarriages.

Thyroid hormones: Thyroid make mostly T4 and some Reverse T3, RT3 is made to reside in the cell and increase in cases of potential starvation, putting the patient in a hypothyroid state., Unfortunately, a Decrease in T3 and usually an increase in Reverse T3 can be seen with:

  1. Stress, most common reason

  2. Lack if iron.

  3. Mercury intoxication or other heavy metals

  4. Dietary deficiencies of selenium and zinc

  5. Low carbohydrate diets

  6. Low protein diets

  7. Low calorie diets

  8. Anorexia, starvation, fasting.

  9. Chronic and acute illness/Surgery

Clinical Pearls

  1. Conversion: Synthroid 0.1 mgm(100ug)= 60 mgm Armour

  2. T4 is not active, only T3.

  3. TSH will always go down with any amount of thyroid replacement, therefore TSH not a good indicator of adequate therapy.

  4. Two conditions with “normal” blood tests but need thyroid.

  5. Thyroid resistance

  6. Subclinical thyroid deficiency

  7. Treat the symptoms, not the blood tests.

  8. Usually start low, i.e., ½ grain and titrate to symptom relief, increasing the dose every two to three weeks.

  9. T4 is important: it passes the blood-brain barrier, T3 does not. A low T4 can be the reason for “brain fog” and brain fatigue. T4 is important that is why we use compound thyroid with both.

  10. Any person with an elevated cholesterol or LDL always think of low thyroid.

  11. 5 most common reason for high cholesterol & LDL

    1. Family history

    2. Diet

    3. Low thyroid

    4. Low testosterone

    5. Stress (cortisol

Recommended Thyroid therapy

  1. Complete Lab Test and Consultation.

  2. Best to start with ½ grain and titrate to symptom relief.

  3. Increase by ½ grain (30mgm) every 2-3 weeks if symptoms not relieved.

  4. Blood tests usually will become normal immediately unless the TSH is extremely high.

  5. TSH over 2.0 is considered hypothyroid according to Mayo Clinic.

  6. T3/T4 ratio should be greater than 3 to 4/1 otherwise hypothyroid.

  7. Symptoms should always prevail when it comes to dosing.

  8. Symptoms of too much thyroid: (classic symptoms of hyperthyroidism)

    1. Palpitations

    2. Tachycardia

    3. Diarrhea

    4. Weight loss

    5. Extreme nervousness

    6. insomnia

  9. Some patients will want to see their thyroid blood test after therapy.

  10. This can become problematic: i.e., TSH < 0.1 and Free T3 over 4.2 or higher. Patient and PCP think they are taking too much!! Remember, symptoms prevail.

  11. Stress will increase SHBG and bind thyroid receptors, thyroid levels high in the blood stream but low in the cells and the patient still with symptoms.

  12. Patients already on synthetic thyroid and doing well, do not change it.

  13. If a patient is on synthetics there is a choice to change to compound or if they are insistence to get the Synthroid from the pharmacy and need more, it is usually a lack of T3. You can order through T3 (triiodothyronine) starting with 5 UGM increasing until symptom relief.

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