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Tue, December 1, 2009
Maybe It "Is" Your Thyroid?
Introduction

You have all the symptoms of low thyroid: cold hands and feet, no energy, weight gain in spite of a good diet and regular exercise, dry skin, loss of libido, hair loss, constipation and “brain fog.” You discuss these symptoms with your physician who orders a blood test. The doctor tells you the test result is “normal” and offers no explanation for your symptoms. Well, maybe it is your thyroid despite a “normal” blood test.

The most common test for low thyroid function is the thyroid stimulation hormone (TSH) test. It has a “normal” range from .035 to 5.50 – a relatively large spread from low to high. The American College of Endocrinology would like to see this normal range reduced to an upper limit of normal at 3.0; however, most physicians will not begin treatment unless the level of TSH is far above this value. However, the treatment of hypothyroidism involves actually treating the patient, not treating the piece of paper with the blood test result.

Hypothyroidism is a condition of under functioning of the thyroid gland. The thyroid is a butterfly shaped gland located in the front of your neck just below the Adam’s apple. It is responsible for producing thyroid hormones. Thyroid hormones are responsible for regulating your metabolism. Thyroid hormones act as the body’s thermostat and determine your body temperature and level of energy.

Symptoms

When your thyroid hormone is inadequate or does not work well, you have symptoms typical of hypothyroidism. The symptoms would be those related to an under functioning metabolism. Thyroid hormones affect every cell in your body, so the symptoms of hypothyroidism potentially can and often do affect you from head to toe. The common symptoms of hypothyroidism include:
  • Fatigue – mild to debilitating
  • Cold hands and feet
  • Constipation
  • Hair loss
  • Loss of libido (sex drive/interest)
  • Brain fog
  • Dry, scaly skin
  • Weight gain
  • Carpal tunnel syndrome
  • Swelling of hands, feet, face & ankles
  • Inability to lose weight (despite diet and exercise)
Inadequate amount of thyroid hormone is akin to having an eight cylinder car running with only seven spark plugs working. The car will run, but it will run rough. The function will not be optimal. The vehicle will not burn the right amount of fuel. It will run in a very inefficient manner. In the same way, if the cells throughout your body do not have adequate amounts of thyroid hormone they will function in a suboptimal way.

You will not feel right. You will have fatigue, dry skin, hair loss, and decreased libido. You will have problems with weight gain, constipation, and brain fog. You will feel depressed. You may struggle with insomnia or wake up feeling less than rested. Weight loss will be difficult if not impossible if you are hypothyroid.

Hypothyroidism affects 20% to 25% of the US population. This is over 65 million Americans. Most have not been diagnosed. Hypothyroidism affects women seven times more frequently than men. Women tend to have a much higher incidence of genetic thyroid problems along with hormonal imbalances that affect a female’s thyroid function.

Also, women have an increased incidence of Hashimoto’s Thyroiditis. This is a type of autoimmune illness that results from antibodies being produced that in essence attack the thyroid, hence the term autoimmunity. Autoimmune thyroid problems are by far the most common form of thyroid disorders.

A deficiency of thyroid hormones can affect levels of female hormones and cause menstrual abnormalities and loss of libido or sex drive. Hypothyroidism may also impair fertility and cause miscarriages, premature delivery, congenital abnormalities, or stillbirth. One of the most commonly missed reasons for infertility is an underactive functioning thyroid gland.

Diagnosis

A simple and very inexpensive test that you can do at home to determine if you may have hypothyroidism is a basal body temperature. The basal body temperature is your temperature taken first thing in the morning, before you get out of bed. If your metabolism is slow, indicative of low thyroid function, your basal body temperature will also be low, usually below 97.5 degrees taken orally. Take your temperature for a couple of weeks and determine the average basal body temperature. If the value is below 97.5 degrees (taken orally) then hypothyroidism may be the possible reason.

The diagnosis of hypothyroidism may be made by performing a complete history and physical. An astute physician will be able to suspect hypothyroidism just by talking to you and performing an appropriate physical examination. Some of the commonly seen physical findings include:
  • Cold hands and feet to touch
  • Dry, scaly skin
  • Thinning of the lateral (outside) third of the eyebrows
  • A generalized pallor (paleness) to the skin
  • Swelling of the face, legs, ankles, or hands
  • Tingling in the hands (carpal tunnel syndrome)
  • Delayed or absent deep tendon reflexes (reflex hammer to knee or ankle test)
  • Teeth ridging on the sides of the tongue
  • Thinning hair
  • An enlarged or tender thyroid gland on examination
Blood tests are typically ordered to evaluate thyroid function. Often patients are told their thyroid tests are “normal.” The only test that is done is a TSH or thyroid stimulating hormone test. This test actually measures how the pituitary gland in your brain and the thyroid gland are communicating. It is only a test of how the pituitary gland is working. It is not a direct measure of how your thyroid gland is functioning. The TSH level only indirectly measures your thyroid function. A complete thyroid assessment requires not only a TSH, but a free T4, T3, reverse T3 and thyroid antibodies.

All of these thyroid tests including T4, T3, reverse T3, and thyroid antibodies are essential to help determine actual thyroid function. The T4 and T3 levels measure the actual amounts of thyroid hormones being produced by the thyroid gland. Reverse T3 is a measure of thyroid hormone that is stored and not available for use by the cells (often seen elevated during periods of excessive physical or emotional stress due to an increase in the adrenal hormone, cortisol). Thyroid antibodies measure the degree of autoimmunity of thyroid antibodies that may block adequate thyroid hormone production.

These tests together with your history and physical should allow for a complete and accurate thyroid assessment.

Treatment

The first step in treating hypothyroidism is determining the cause. There may be secondary causes of hypothyroidism. Your physician should be able to sort these out for you.

The next step is to support the nutritional needs of the thyroid. This involves obtaining adequate amounts of zinc, selenium, and iodine either from your diet or with the aid of supplements. The supplements that I generally recommend include:
  • A good multivitamin/mineral supplement
  • Additional zinc – recommend 20 mg daily
  • Selenium – recommend 200 mcg daily
  • Iodine – recommend 12.5 mg daily
Nearly all patients with hypothyroidism require prescription thyroid medication to fully improve their symptoms. Traditionally, a synthetic form of thyroid hormone (Synthroid, Levothroid, or Unithroid) may be prescribed. Although these forms of thyroid replacement may be adequate, they require that the relatively inactive T4 form of thyroid hormone be converted in the cell to the active T3 form of thyroid hormone.

This conversion can not be measured directly and often is inhibited in women due to an excessive amount of estrogen or a deficiency of progesterone. In males, excessive estrogen levels, often found in body fat, will inhibit thyroid hormone activation.

A prescription bioidentical form of thyroid replacement is called Armour Thyroid. Armour Thyroid is available at most pharmacies and contains a mixture of T4 and T3, identical to the ratio made by the thyroid gland. This prescription medication is typically dosed once daily in the morning and should be taken on an empty stomach, 30 to 60 minutes before eating or taking any type of supplement. A compounded prescription form of T4/T3 can also be obtained at most compounding pharmacies and is another good alternative to synthetic forms of thyroid replacement.

Summary

Hypothyroidism is one of the most common misdiagnosed or under diagnosed medical problems seen. The symptoms may be present for years before the diagnosis is made. Tests as simple as taking your basal body temperature and a few simple blood tests should confirm the clinical suspicion of a problem. Treatment with the appropriate supplements and a bioidentical form of thyroid is usually all that is needed to improve your symptoms.

So if you are experiencing some of these symptoms, take time to get the right tests done. Look at the supplements you are taking. You may determine that maybe the problems are really due to your thyroid!

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