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.
Symptoms of Hypothyroidism
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.
Irritability and mood instability
Cold intolerance, increased sensitivity to cold
Headaches, including migraine
Memory problems or brain fog
Dry brittle hair and fingernails
Hot flashes – many a day
Muscle cramps and joint pain
Increased need for sleep
PMS or abnormal menstrual cycles
Loss of outer 1/3 of the eyebrow
Heat intolerance, increased sensitivity to heat
Impaired cognitive function (brain fog) and inattentiveness
Decreased sweating – however, increased hot sweats during menopause often occurs
Low blood pressure (can be elevated too)
Poor muscle tone (muscle hypotonia)
Thinning of the outer third of the eyebrows
What Is 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.
About thirteen million Americans are diagnosed with hypothyroidism, but it is estimated that there are an equal number of people who have it but remain undiagnosed.
Eight out of ten diagnosed are women.
Thyroid disease runs in families.
For women, the most common onset years are between the ages of 35 and 55.
What causes hypothyroidism?
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.
Hypothyroidism and female hormones
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.
Environmental triggers that can impact the onset of hypothyroidism
Prolonged high stress.
Diets high in processed foods and sugar (a big stressor).
Nutritional deficiencies including, iodine vitamin D, omega 3 oils and more – too many to list, which is why a nutritional evaluation is of the utmost importance.
Gluten intolerance – this is an often-overlooked connection and can be misdiagnosed as irritable bowel syndrome.
Diets high in soy can interfere with thyroid function, possibly resulting in a goiter.
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.
TSH (Thyroid Stimulating Hormone)
Thyroid peroxidase antibody (TPOAB)
Thyroglobulin antibody (TgAb)
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.
Home test for hypothyroidism
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.
If the lab tests are within normal limits is it still possible to have hypothyroidism?
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.
What treatments are available for hypothyroidism?
Hypothyroidism with significant symptoms usually does require medication but medications vary significantly—from synthetic hormones such as Synthroid and Levoxyl to Armour thyroid (from dissected pork thyroid).
Nutritional support, decreased stress levels and exercise can dramatically increase thyroid function.
Sometimes supplemental iodine and the amino acid tyrosine can be very effective for marginal hypothyroid. This is not a treatment for autoimmune hypothyroid, as it can make the condition worse.
If free T3 or free T4 is low, the patient may have a conversion problem. 10 mg of zinc may help, as zinc is necessary for the conversion from T4 to T3.
Which medication is the best?
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.
Once someone starts medication can they stop?
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.
Why is it that some people do not respond to thyroid hormone treatment?
There are many reasons people may not respond to treatment. Below are the most obvious considerations:
The patient is on the wrong product or the wrong dose.
The patient is only taking a product that contains T4 when T3 may be needed as well.
The patient is lacking in nutritional support for optimal thyroid function.
Can hypothyroidism be cured?
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.
Does low adrenal function impact the thyroid?
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:
Maintaining an even blood sugar throughout the day by eating more frequently with smaller portions. Nutritious foods are the obvious choice.
Vitamin C 500 mg every 4 hours. The adrenal gland stores and utilizes more vitamin C than any other gland in the body. Human beings do not make vitamin C like other animals so we must obtain it through our diet.
Nettles and astragalus, as a tea, are two of my favorite herbs for adrenal support.
Diet for a Healthy Thyroid
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:
While soy can be a healthy addition to a diet in small amounts, if you suspect that you have a low functioning thyroid gland, avoid all soy foods (yep, that’s right, soy can be bad for you). The worst soy products to ingest are protein bars loaded with soy, and protein drinks. If you can handle soy, fermented soy products are the most digestible forms and include miso, tempe, natto and tamari.
Eat five smaller meals a day rather than 3 large ones. Apples and nuts; organic turkey slices with avocado, carrots and celery; hard-boiled eggs. Simple can be healthy as well as fast.
Eat nutritious food, including vegetables, fruit, whole grains, eggs, yogurt and fish.
There is a wonderful saying in Okinawa, which boasts the oldest and healthiest population living today: “Eat until you are 80% full.”
Avoid overly processed foods (unless you are living in the woods, you know what I mean—cookies, cakes, crackers, soft drinks, etc.)
Avoid raw cruciferous vegetables – broccoli, Brussels sprouts and cabbage.
Nutrients and thyroid function
For insurance it is good idea to make sure that your supplements contain the following nutrients.
Iodine — 100 mcg (micro-grams) per day
Selenium — 200 mcg (micro-grams) per day
Zinc — 15 mg per day, plus 500 mcg of Copper
Vitamin D – 1,000 IU - testing is advised for vitamin D (see lab tests) because some people require higher amounts
Vitamin E — 100 IU
Vitamin C – 1,500 mg /day
Vitamin A — 3,500 IU
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
Processed food may contain added iodized salt. Iodine is frequently found in dairy products. Vegetables grown in iodine-rich soil also contain this mineral.
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.
People who do not eat seafood and sea vegetables regularly
Find a good doctor
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.
Mark D. Danese, Paul W. Ladenson, Curtis L. Meinert, and Neil R. Powe “Effect of Thyroxine Therapy on Serum Lipoproteins in Patients with Mild Thyroid Failure: A Quantitative Review of the Literature J. Clin. Endocrinol. Metab., Sep 2000; 85: 2993 - 3001.
Cooper, David S. “Subclinical Hypothyroidism” N Engl J Med 2001. 345: 260-265.
Robertas Buneviius, M.D., Ph.D., Gintautas Kaanaviius, M.D., Ph.D., Rimas alinkeviius, M.D., and Arthur J. Prange, M.D. “Effects of Thyroxine as Compared with Thyroxine Plus Triiodothyronine in Patients with Hypothyroidism”, N Engl J Med 1999. 340:424-429