Hypo-Thyroidism

“Jane” visits her doctor complaining of fatigue, muscular weakness, pain and joint stiffness. She also tells her doctor that her memory isn’t what it used to be, her thinking seems to be “fuzzier” and she is having difficulty concentrating.

She has put on weight in the past year or two although she actually eats less than she used to; and no matter what she does, she simply cannot lose weight. Her skin is dry and scaly, her hair is falling out and her fingernails are cracked, thin and grooved.

Her menstrual periods are more irregular and heavier than they used to be, even though she is only 35 years old. She also seems to be depressed more often even though nothing has radically changed in her personal life.

After doing a quick, general physical, her doctor orders blood tests including a complete blood count and metabolic chem, lipid and thyroid panels. The results come back and, except for elevated total cholesterol levels, all the others are within normal limits.

The doctor prescribes a cholesterol lowering drug and tells her everything else is OK. Jane leaves the doctor’s office with all the symptoms she originally had, and her depression and symptomology grows worse, while taking a drug she doesn't really need..

What was missed? Doctors must not treat lab results. They must treat the patient. Jane’s signs and symptoms suggest strongly a state of hypo-thyroid (low thyroid) function. There are many people who are not being properly treated for low thyroid function because their thyroid levels (Total T4, free T4, T3 and TSH) are within the normal range.

The hypothalamus secretes TRH (thyrotropin-releasing hormone), a signaling hormone that notifies the pituitary to secrete TSH (thyroid-stimulating hormone). TSH is released from the pituitary gland and tells the thyroid gland to produce T4. T4 is a thyroxine molecule with four Iodine molecules attached (hence T4) which is mainly inactive thyroid hormone. The body uses an enzyme (deiodinase) to remove an Iodine molecule from the thyroxine and converts T4 to T3, which is the active thyroid hormone. Most of the conversion from the inactive hormone (T4) to the active hormone (T3) occurs outside the thyroid in body tissue. To make the conversion properly, a person needs enough thyroid hormone (T4) and the converting enzyme (deiodinase) in order to produce enough T3.

In the classic hypothyroid condition, TSH will be elevated and the thyroid hormones will be low. But, a person also can have low TSH and low thyroid hormones but can also have normal TSH and normal thyroid hormone lab results. This was the case in Jane’s visit, and it is the danger of relying on a blood thyroid panel only to diagnose a hypothyroid condition.

When a lab comes back the persons results are compared to a normal "range" which represents 90% of lab results from "healthy" individuals. This range is often called "normal" but can be quite erroneous in representing actual health conditions. That is why it is imperative for doctors to treat patients and not lab results!

Many naturopathic physicians use a patient’s basal body temperature (BBT) to help diagnose a hypothyroid condition. People with hypothyroid have a low body temperature. Normal body temperature is between 98.4 and 98.8 degrees.
To test your body temperature, place a basal thermometer under your arm for five to 10 minutes upon awakening and before getting out of bed in the morning. Record the temperature in a journal. Take your temperature again at 10 a.m., 1 p.m. and 4 p.m. and record temperatures. After your 4 p.m. temperature check, average your temperature for the day. Do this for three days in a row (but not the three days before your menstrual cycle, if you are female).

If your average daily axillary basal body temperature is less than 98.0 degrees, you may be hypothyroid and should discuss treatment with your doctor.

There also are some foods that interfere with thyroid hormone production and therefore contribute to a hypothyroid state. These foods are called "goitrogens". Foods that are goitrogenic include turnips, cabbage, mustard, soybeans, peanuts, pine nuts and millet. Cooking these foods usually inactivates their activity; but, if you have a hypothyroid, you may want to avoid them, altogether.

If you are diagnosed with hypothyroidism, treatment can include diet, supplements, stress reduction, exercise and/or medications. Naturopathic physicians often use Armour Thyroid, a prescription drug that provides both T3 and T4. By providing both T4 and T3 Armour Thyroid will be effective in patients who do not produce enought converting enzyme deiodinase. Synthroid is a T4 replacement, but may not be effective in patients unable to convert T4 to active T3, which is why so many patients do not respond favorable to Synthroid.

If you have symptoms similar to Jane’s; and, if your basal body temperature is low even when your blood labs appear normal, consult with a naturopathic physician who will look beyond the lab results and treat you, the individual.