Not all Hypothyroidism is Created Equal
The biggest hallmark of low thyroid is, of course ongoing fatigue. People will complain of low energy, and an exhaustion from which they recover only with difficulty. There are other symptoms that are also common: constipation or other bowel irregularities, dryness of skin, brittle hair and fingernails, menstrual problems, weight gain, and cold intolerance. Often a low thyroid function can be the hidden cause of many mysterious symptoms
Unfortunately, standard lab tests are imperfect, and do not always point to a diagnosis of hypothyroidism. We have found time and again that many cases of fatigue and other of mysterious symptoms often revolve around a “sub-clinical” or “functional” hypothyroidism that fails to manifest as abnormal thyroid function tests.
The Epidemic of Hypothyroidism
Hypothyroidism is quite common in the United States with a recorded prevalence of 2-3% in the general population.[i] Using blood levels of thyroid hormones as criteria, it is estimated that another 10-12% of the population has mild hypothyroidism.[ii] Some writers of popular books using medical history, physical examination, and basal body temperature with blood thyroid levels as diagnostic criteria estimate hypothyroidism in American adults to be as high as 40%.[iii]
Hypothyroidism increases steadily with age, with a prevalence of up to 5% in all persons greater than 65 years old with the Merck Manual of Geriatrics reporting that 10% of those over 65 years of age have sub-clinical hypothyroidism.[iv] Overt hypothyroidism affects women more than men, and is reported to affect 4% to 10% of women, increasing with age.[v]Incomplete development of the thyroid is a common defect and occurs at a rate of 1 out of every 3,000 births, with girls twice as often affected as boys,[vi] causing the developmental condition known as cretinism.
It is clear from the above that low thyroid function has reached epidemic proportions. High stress, poor coping mechanisms, toxic environmental factors, poor food choices, and other constitutional markers combine with genetic predisposition toward hypothyroidism to create huge numbers of cases in our practice. Given such prevalence, we have come to specialize in treatment of this condition.
We offer a thorough and comprehensive evaluation of the thyroid. This includes a full health evaluation, metabolic assessment and laboratory testing, putting the thyroid problem in the context of your total health and well-being. At that point we move forward with a treatment plan to relieve your symptoms and correct any underlying problems to insure your return to health.
Recognizing the Common Symptoms of Hypothyroidism
There are many symptoms which when linked together often reveal an underlying problem of hypothyroidism (low thyroid). Fatigue, weight gain, and depression are well known symptoms associated with hypothyroidism. Did you know that there is often coldness in the picture, with complaints of chilliness, cold hands and feet, or needing to cover up with lots of blankets and wear warm clothing?
Below is a complete list of the most common symptoms of hypothyroidism:
- Weight Gain
- Cold extremities; intolerance to cold
- Low immunity with frequent illness and poor recovery
- Muscle Aches
- Decreased libido
- Poor mental concentration
- Memory loss
- Chronic Hoarseness
- Dry, rough skin
- Coarse, dry, or thinning hair
Additionally, the following conditions can be commonly associated with hypothyroidism:
- Angina pectoris
- Hypercholesterolemia (high cholesterol)
- Menstrual irregularities (amenorrhea, oligomenorrhea, menorrhagia)
- Premenstrual syndrome
- Fibrocystic breast disease
- Polycystic ovary syndrome
- Reactive hypoglycemia
Understanding the Different Patterns and Presentations of Thyroid Problems
There are many patterns of hypothyroidism, and when the pattern is clearly identified an effective treatment plan can be implemented.
Low T4: Sometimes the problem of low thyroid revolves around inadequate production of the inactive form of thyroid hormone called thyroxin (T4), which in insufficient quantity does not yield enough of the active hormone that is made from it, triiodothyronine (T3).
Poor Conversion: At other times, low thyroid is not caused by insufficient T4, but rather poor conversion of the inactive T4 to the active T3 (most of which occurs not in the thyroid gland, but in the liver and other tissues).
Auto-immune: It would be simple if these were the only two types of hypothyroidism, but a large number of hypothyroidism cases are actually related to an autoimmune process where the immune system creates antibodies which attack the thyroid gland itself. This form of hypothyroidism, known as Hashimoto’s thyroiditis, is an autoimmune disease. Other patterns of hypothyroidism revolve around problems of the binding protein (thyroid binding globulin) that carry thyroid molecules.
Endocrine System Issues: Still another type occurs when there is a loss of communication between the pituitary gland and the thyroid gland.
Stress and Adrenal Issues: Believe it or not, many problems of low thyroid are related to non-thyroid hormones. Our adrenal glands, one located on top of each kidney, make hormones that modulate our physical responses to stress. One of these hormones called cortisol is produced to control the wear-and-tear on our bodies from stress while at the same time transforming proteins and fats into sugar to make energy. If cortisol is either too high (due to too much stress and poor coping mechanisms) or too low (due to exhaustion), thyroid function will be inhibited. Often treating the adrenals can actually take care of low thyroid function.
While giving thyroid hormone often remains the first treatment strategy, selecting a treatment to address the root cause of low function differs with each of the above patterns, and making the correct selection can lead to addressing the real cause the problem rather than simply addressing symptoms.
“Do I Have Functional Hypothyroidism?”
This term, which is not recognized by all physicians and healthcare practitioners, refers to what Dr. Alan Gaby has called “sub-laboratory hypothyroidism.” Many people have the symptoms of hypothyroidism despite normal conventional laboratory tests. Appropriate clinical evaluation can identify individuals who have an under-functioning thyroid who may benefit from either empirical treatment with thyroid hormone, or other therapies that may stimulate thyroid function.
At Pearl Natural Health, we see a large number individuals with conventional laboratory tests revealing conventionally normal Thyroid Stimulating Hormone (TSH) and Thyroixine (Free T4) levels while leaving a plethora of hypothyroid symptoms remaining, such as debilitating fatigue, coldness, low immunity, weight gain, and constipation. In such cases, we evaluate patients fully using additional tests such as thyroglobulin antibodies, thyroid peroxidase antibodies, thyroid binding globulin, free T3, reverse T3, and others. If enough criteria are met for a diagnosis of functional hypothyroidism, we treat the thyroid imbalance with various treatment methods. In a large number of cases, treatment with thyroid hormone has resulted in improvement of symptoms that have failed to respond to either conventional or alternative treatments. In other cases, simultaneous treatment using Chinese medicine and other forms of therapy have stimulated restoration of thyroid function allowing for the discontinuance of hormonal therapy.
Whenever hormones are used in the treatment of “functional” or “sub-laboratory hypothyroidism, hormone levels are monitored to assure patient safety. Supplemental hormones are given only to the extent that patients’ laboratory values for basic thyroid function tests (such as TSH, FT4 and FT3 continue to remain in the normal range of those hormones).
We are committed to working with you to alleviate your symptoms, by identifying and then treating the underlying cause of the problem. A low thyroid can be the hidden underlying factor in many diseases and should be thoroughly explored.
We offer a full range of tests and evaluative methods to identify and treat the cause of an under-functioning thyroid, including T3 and reverse T3 testing, thyroid antibody testing to determine the degree of auto-immunity, iodine load testing to assess iodine deficiency, adrenal stress testing to determine the role of adrenal imbalance in thyroid problems, and other methods to identify related dis-harmonies and deficiencies.
Naturopathic medicine, acupuncture, nutritional detoxification and assessment, Chinese herbal medicine, as well the possible prescription of thyroid hormones are the therapeutics in a well rounded and effective treatment plan.
If you are taking thyroid medication without satisfactory resolution of symptoms, you deserve help to determine a better medication, or concomitant treatment of related problems or conditions that may be underlying your thyroid problem. Using thyroid hormone alone as treatment for hypothyroidism is incomplete; we make a clinical effort to identify and treat the cause of the low (or high) thyroid.
It is possible to discontinue thyroid hormone under the supervision of your physician, if the underlying cause is treated successfully. The possibility of discontinuance is excluded in cases where the thyroid gland has been destroyed by radioactive iodine treatments for hyperthyroidism, or surgical removal, in which cases thyroid hormone supplementation for life is mandatory.
If you need help in the treatment of thyroid problems call us at:
503 230-8973 today to schedule an appointment
or for a
free 30-minute consultation to explore your treatment options.
[i] Gaby, A., “Sub-laboratory Hypothyroidism and the Empirical use of Armour® Thyroid,” Alternative Medicine Review 2004; Volume 9, Number 2 pp. 157-179 [ii] Murray, M., and Pizzorno, J., Textbook of Natural Medicine, Second Edition: Churchill Livingstone, 1999, p. 1330 [iii] Ibid. [iv] The Merck Manual of Geriatrics, Web Version: Merck and Company, 2005, Chapter 65, Thyroid Disorders, http://www.merck.com/mrkshared/mmg/home.jsp [v] Int J Fertil Womens Med. 2002 May-Jun;47(3):123-7 abstracted as PMID: 12081257 [PubMed – indexed for MEDLINE] [vi] Medline Plus, 9/16/2005, http://www.nlm.nih.gov/medlineplus/ency/article/001193.htm