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July 22, 2009Thyroid: The Most Misunderstood Hormone, After turning 40, I started noticing a progressive increase in fatigue. When others were warm, I was cold. My periods became irregular and my bowels constipated. I felt drained of energy and drive. I gained 15 pounds. I went to several doctors, who either prescribed me some form of antidepressant or brushed me off as being a hypochondriac. I felt worse on the antidepressants and I was frustrated with the lack of help or sympathy I was receiving from my health care providers. —Lisa, 45 I have encountered so many people who say they are truly unhealthy and unhappy—even after seeing every kind of doctor from the endocrinologist to acupuncturist. They have complaint after complaint, and although their hormone levels seem normal their doctors just can't pinpoint exactly what ails them. They are positive they are not in good health. When in actuality they are somewhat healthy—except for one small but significant problem. These people suffer from thyroid insufficiency; a problem that is very common yet overlooked by many physicians. When Lisa was referred to me, she viewed me with a skepticism she had developed from her previous health-care experiences. Her story was not unusual to me and she seemed baffled at my curiosity and probing questions. I measured her TSH (thyroid-stimulating hormone) level, along with her free T3 and T4 levels. She was definitely suffering from an insufficiency in thyroid, although this was the first time anyone had mentioned her thyroid. Many doctors measured her TSH levels (I'll explain what that is later), along with other standard tests, and found that her levels were "normal." In spite of her normal levels, I treated her anyway with a natural thyroid hormone. She had become resigned to thinking her problem was "in her mind," and was relieved to find out that it was her Free T-3 levels that were out of whack and not her head after all. After three weeks, she felt better. "I can actually wake up in the morning and look forward to seeing my husband and going to work. I don’t crash or have to nap halfway through the day.” After two months, her added pounds began to fall off. At her follow-up appointment, the dark circles under eyes had disappeared, and she smiled. "I'm going shopping after our visit to celebrate how good I look and feel." Many doctors feel more inclined to treat blood levels rather than symptoms. This philosophy results in treating the lab test and not the person, a philosophy that makes healthcare very frustrating. As is in most cases, the lab tests are normal to low normal and the patient is just written off. Despite the normal test results, the symptoms people experience will only be resolved when they are treated with thyroid hormone replacement. Remember, normal does not equate to optimal. More often than not, patient’s labs are misread or perhaps their symptoms are merely overlooked. This allows for hypothyroidism (under active thyroid) to go unchecked and untreated. Unfortunately, unchecked or untreated hypothyroidism will only worsen over time. There are three different types of low thyroid conditions. The first type, primary hypothyroidism, is easy to diagnose. However, most patients suffer from the second or third type. In Dr. Gerald S. Levey's article, "Hypothyroidism: A Treacherous Masquerader," he refers to the illness as a subtle illness that eludes doctors. The illness is accompanied by a melting pot of symptoms. Often, thyroid insufficiency or hypothyroidism is misconstrued in people older than 50 or 60 as normal symptoms of aging. Fatigue, slower speech, forgetfulness, weight gain, depression, hair loss and the tendency to feel cold are all symptoms normally associated with aging. However they are more the symptoms of an aging thyroid. The traditional medical community will usually try to treat these symptoms in younger patients, but feel it unnecessary to do the same for older patients. If you feel age has crept up and you recognize the above symptoms, please do not accept this as simply the facts of life. You should not have to tolerate these symptoms as they can be successfully treated. As women age, they are more likely than men to experience hypothyroid symptoms. The problem here is that many times, symptoms of hypothyroidism overlap with those of perimenopause and menopause. Although a woman may be receiving estrogen and progesterone to eliminate her menopausal symptoms, many symptoms persist due to thyroid insufficiency and untreated. Unfortunately, unchecked or untreated hypothyroidism will only worsen over time. I remember a patient, a teacher, whose estrogen and progesterone levels were restored to normal, yet she couldn't shake her depression and fatigue. "I couldn't focus on my lessons. I had a hard time being creative with my students and because I lacked attention span, I couldn't really capture the interest of my students. All I wanted to do was stay in bed. I had no idea how significant the thyroid was until I started taking it. What a relief to find a doctor who understood the problem and could successfully treat it." It took her several doctors and several unsuccessful antidepressants to finally get referred to me. Her symptoms were so classic—hair falling out, brittle fingernails, coarse skin, and lethargy; I was surprised no one had thought to check her thyroid, let alone treat it. When a woman suffers from hypothyroidism, it deeply affects the menopausal process. Since the symptoms are similar (i.e. forgetfulness, depression, mood swings, muscle weakness, change in skin or hair texture, sleep disturbances, anxiety or irritability, palpitations and irregular periods), many doctors overlook the thyroid and prescribe the normal menopausal treatment. For many women, this does the trick in eliminating the bothersome menopausal symptoms. However, for those women who cannot shake depression and fatigue even after estrogen and progesterone supplementation, they need to have their thyroid levels checked. More often than not, they will find their levels are "low-normal" or insufficient. If their levels are low-normal, the doctor may brush over them without notice as they still fall in the "normal" range. However, the levels need to be restored to optimal ranges if a person wishes to enjoy a healthy and happy life again. This is exactly where the misunderstanding and confusion lie. Most people, over the age of 40 have low normal baseline levels. Normal is not optimal. Normal can cause a person to experience multiple symptoms of hypothyroidism. Many patients will not improve until their thyroid levels are supplemented into the upper range of normal. When thyroid levels are raised to the upper range, symptoms resolve, health improves, and patients truly feel the difference. According to the medical literature, optimal levels are needed to reap the benefits of thyroid. “Normal” means you are just as low as everyone else your age. Thyroid is an Essential Hormone Like all essential hormones, thyroid levels decrease as we age. Thyroid insufficiency or hypothyroidism commonly occurs. Insufficiencies often go undetected. This problem is even more widespread than typically reported. One of the interesting things about thyroid supplementation is most patients experience significant improvement and feel much better once their serum levels are optimized. Symptomatic improvement occurs when serum levels reach this optimal range. Serum levels in the low-normal to mid-normal range are not where a person feels good. Every hormone our body produces is necessary for good health. Thyroid is one of the most vital hormones as it affects every organ, cell, and hormone in the body. The body cannot survive without its presence. When thyroid is simply deficient, the body can suffer from high cholesterol and triglyceride levels, sluggish thought process, memory impairment, weight gain, cold intolerance, constipation, menstrual abnormalities and changes in hair, skin, and nails. It can be difficult to identify thyroid as the culprit given the vastness of the symptomatic spectrum. Many times, patients are shuffled from one doctor to the next and one medication to the other. Low thyroid-induced depression may be treated with an anti-depressant. Hypothyroid-influenced weight gain may be attributed to a poor diet and exercise regimen. When a person is suffering from hypothyroidism or insufficient thyroid levels, an anti-depressant or a low-fat diet/high-caliber exercise program is a waste of time. In spite of normal thyroid levels on a standard blood test, improvement is only accomplished when thyroid is replenished to optimal levels. Along with the thyroid enigma, controversy surrounds the type of thyroid medication which should be used for treatment. Some doctors believe the synthetic form (Synthroid®, Levoxyl®, T4) works the best. Other doctors support the natural, desiccated thyroid. I sit firmly in the Rouzier camp, natural is best. Later in this chapter, I will present the details of the debate and the differences between the two types of hormones. You will quickly understand my position on natural thyroid and why many of my forward thinking colleagues have joined me in prescribing natural thyroid. Natural thyroid most effectively raises the active thyroid hormone called T3. Natural thyroid contains a combination of T4 and T3 and will provide more optimal results than Synthroid® and other synthetic T4 preparations. Since T3 is the more metabolic hormone, low T3 levels result in poor metabolism and thyroid insufficiencies. When pure T4 is given in the form of Synthroid® or Levoxyl®, T3 levels only minimally improve. Many physicians, including endocrinologists, believe T4 is the thyroid preparation to prescribe. The reasoning behind their belief is that the body will automatically convert T4 to T3. This belief is based on theory and not on data. Recent studies show T4 does not adequately convert to T3. Adding T3 to the T4 preparation allows us to optimize T3 levels. This was recently published in the New England Journal of Medicine. Potential thyroid problems include: 1) Lack of production of thyroid hormone. 2) Lack of conversion of T4 to T3 causes low T3 levels and symptoms of low thyroid. 3) Typically prescribed T4 preparations that do not adequately convert to T3, causing symptoms of low thyroid even when supplemented with adequate amounts of T4. 4) Receptor site insensitivity in spite of adequate thyroid levels results in low thyroid symptoms.
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