Some months ago Oprah shared with millions of viewers that she had been diagnosed with hypothyroidism. Thankfully, Oprah’s show shed light on this condition, which was a great service because so many people have it and don’t realize it. Often the diagnosis of hypothyroidism is missed due to an over reliance on lab tests or improper ordering of lab tests. If the diagnosis is missed, patients may be given other medications, including anti-depressants, cholesterol-lowering medications and anti-anxiety medications.
Once hypothyroidism is diagnosed, treatment options vary depending on the type of health care provider—be it a conventional doctor, acupuncturist, chiropractor, or naturopath. What I have learned is that any of these health practitioners can be knowledgeable about thyroid function and dysfunction if they have made it their business to become so. Lab tests are not the full story, so it is important that a practitioner obtain a complete history and symptoms assessment.
Below is a partial list that includes the most common symptoms. Not everyone will exhibit the same symptoms. For instance, weight gain can be a symptom, but thin people, too, can have hypothyroidism.
Simply put, hypothyroidism is the under-activity of the thyroid gland, which results in a decreased production of thyroid hormones. The thyroid gland, located just below the Adam’s apple in the front of the neck, produces the hormones thyroxine (T4) and triiodothyronine (T3). These hormones control the speed of many vital body functions, influencing heartbeats and the burning of calories, (i.e., the body’s metabolism). So, when thyroid function is diminished, everything slows down. Decreased thyroid function can dramatically worsen the way a person feels and can greatly diminish their ability to carry out daily activities.
There are multiple causes of hypothyroidism. The most common cause is autoimmune thyroiditis (Hashimoto’s thyroiditis). In Hashimoto’s thyroiditis, the thyroid is under attack by the body’s own immune system. This is usually caused by a combination of a genetic predisposition and environmental triggers. The causes of non-autoimmune hypothyroidism include the broad category of “medical treatments”, including surgical removal of the thyroid or some medications including Lithium. There are also rare pituitary problems that can result in hypothyroidism, as well as too much or too little dietary iodine. (See supplement section below for more details.)
In some cases of hypothyroidism, the entire thyroid gland may enlarge, or one or more thyroid nodules may develop. A Goiter is an enlargement of the thyroid gland, and Hashimoto’s thyroiditis is the most common cause of an inflamed and enlarged thyroid gland. Nodules can also develop; they can be benign or cancerous and should be evaluated.
For women over the age of 35, hypothyroidism can correlate with, or be the first indication of, perimenopause. Symptoms are often most noticeable when female hormones are going through dramatic shifts, such as during perimenopause, pregnancy, and puberty. It is also estimated that over 20% of menopausal women in the US are diagnosed with hypothyroidism.
The tests below are the tests to order when symptoms are pointing to an under-active thyroid. Sometimes an ultrasound is ordered, too, when swelling is noticeable or lumps (usually benign) are palpable.
Some people with hypothyroid disease are also anemic. Ferritin, which is the form of iron stored in bone marrow, should be tested, too, as anemia may not show up in traditional tests. Depending on symptoms, estrogen, progesterone, and testosterone hormone tests may also be required.
The underarm basal (resting) body temperature test is a home test to help diagnose an under- active thyroid gland. Thyroid hormones regulate body temperature, and the symptom of cold extremities can be one indicator of hypothyroidism. Some health practitioners use this test as a rock solid diagnosis, but this test is not infallible and should be used wisely and considered as providing a piece of information.
YES! If a person experiences multiple symptoms, especially hair loss, low body temperature and fatigue, it is likely that their thyroid is under-active. When lab tests are normal and in mid-range, nutrition and supplementation of vitamins may be enough to balance the patient. Occasionally, free T-3 is on the low end of normal or TSH is on the high end of normal. Either of these findings with significant symptoms is pointing to hypothyroid.
TSH is a hormone produced in the pituitary gland. This is the primary test that conventional medicine measures to determine if a patient has hypothyoidism. It increases in an attempt to increase production of thyroid hormones. TSH is not the full story and all of the above lab tests should be ordered when significant symptoms are present.
If your doctor insists that you do not have hypothyroid despite multiple symptoms, seek a second opinion.
There is an ongoing controversy regarding the use of synthetic hormones versus Armour (dissected pig thyroid gland). The argument that the pharmaceutical industry wages against Armour is that the doses are not consistent; Armour has been very reliable and has been in use since the 1800’s. In fact, the FDA threatened to pull Synthroid off the market in the late 90’s due to inconsistent batches. Overall, both brands are consistent, but, in my opinion, Armour works best for most people because it contains the most active ingredient, T3, which is fast acting. It works best if it is taken in divided doses - one early in the morning and one around noon. Armour is contraindicated if free T3 is elevated or on the high end of normal.
Armour is a prescription medication and will require a medical doctor or naturopath to prescribe it. It is usually covered by insurance and it is fairly inexpensive.
Yes, some people can go off medications, as their condition is only temporary; however, a patient should not stop unless they are under a doctor’s supervision, since stopping can result in major health consequences.
There are many reasons people may not respond to treatment. Below are the most obvious considerations:
Yes, there are cases where the condition is temporary, such as during pregnancy or in mild forms of hypothyroidism. In some cases, nutritional support can help boost thyroid function to normal.
Yes. In fact, low adrenal function may be the primary cause of symptoms. High chronic stress over time can impact thyroid function. Stressors include lack of exercise, poor eating habits, family problems, emotional stress, etc. I have come to realize that all patients with thyroid disease should also be supported for adrenal function with supplements and herbs. There are three treatments that are a must:
Amazingly, most doctors do not ask patients to fill out a daily food diary. Good nutrition is essential for a healthy thyroid. I have learned from experience that when patients keep a food diary it helps me, as well as them, see precisely what they consume over a seven-day period. The food diary is an important component of a complete nutritional evaluation. Here are some dietary tips:
For insurance it is good idea to make sure that your supplements contain the following nutrients.
Iodine is necessary for the thyroid to produce hormones. Some people are getting way too much of this nutrient and unknowingly may be adding additional harm to their thyroid. Due to iodized salt the average diet provides about four times the recommended amount of iodine. Some studies have linked some goiters, traditionally a disease of iodine deficiency to high iodine intake. A small percentage of people are allergic to supplemental iodine, the first symptom of which can result in an acne-like rash.
Iodine can be tricky – too much in a diet can cause hypothyroidism and not enough can too. Use sea salt instead of iodized salt – sea salt does not contain iodine. Table salt also has other additives that are best to avoid.
Sources of iodine include
Below is a chart comparing sea vegetable iodine content with iodized salt
Who may need iodine supplement? 150 mcg per day is more than adequate.
A doctor who listens well and focuses on diet, exercise and supplementation is essential. They also should have a good understanding of when conventional medicine is appropriate and which medications are the best options. Whether or not a doctor can prescribe, they should be well versed in all available options and help patients make informed decisions about their health care. After all, a doctor’s job is to make sure that patients maintain their physical and mental stability as they age. Just ask anyone over 55 and they understand this completely.