The cliche “I have a glandular problem” to explain obesity has become more of a joke. But perhaps it shouldn’t be. I see many patients with undiagnosed thyroid problems in my practice. The primary problem is that the range of normal on the lab results is too broad. I interpret the results with a more conservative optimal range when assessing a patients thyroid function. Obviously the patient is also sitting in my office with usually chronic and vague health complaints or symptoms.
The thyroid gland is a butterfly shaped gland that sits below the Adams apple in the front of the neck. It produces hormones that regulate metabolism which is how cells convert calories and oxygen into energy. The way these hormones are released is a multi-step,carefully regulated process starting in the brain; however, sometimes this process can become inefficient.
The thyroid releases hormone in response to Thyroid Stimulating Hormone (TSH) released by the pituitary. The thyroid makes about 80% Thyroxine (T4) at 20% Triiodothyronine (T3). The T3 is the more active hormone and is converted from T4 in the peripheral tissues.
Though TSH is an indirect measure of thyroid function, it is the most common and, I have found, the most sensitive screen for thyroid function. TSH is a negative feedback hormone; it goes up as the thyroid function declines. An elevated TSH is diagnostic of Hypothyroidism (too little thyroid hormone).
While the laboratory “normal range” for TSH .45-4.5 mIU/L, it seems this range is too broad. In 2003 the American Association of Clinical Endocrinologists, recommend reducing the upper range of TSH level to 3.0. If you are symptomatic, I’m suspicious of a TSH above 2. There is evidence that a TSH of 2 or above is predictive of thyroid decline. The optimal TSH level seems to be individual and not related to the severity of one’s symptoms. Some patients feel incapacitated with a TSH slightly over 2 while others barely feel any symptoms with a TSH over 10.
Thyroid dysfunction often runs in families, and women are susceptible to thyroid dysfunction during times of hormonal change such as pregnancy and menopause. In addition there is evidence that chemicals that are ubiquitous in our environment and our tissues, such as BPA (plasticizer), perchlorate (jet fuel additive) and PBDE (fire retardant in household products) cause thyroid dysfunction.. There is also a link between gluten (wheat) intolerance and an association between Hashimoto’s (autoimmune) Thyroiditis and Celiac Disease (autoimmune gluten intolerance).
Symptoms associated with hypothyroidism include: weight gain and difficulty losing weight, constipation and other digestive complaints, feeling cold, fatigue, weakness, poor memory and brain fog, losing hair, general physical aches and pains, heavy menstrual bleeding, depression and anxiety, low libido, dry eyes and skin, sensitivity of the neck or a sensation of a lump in the neck, allergies, and asthma. Having low thyroid function slows the body down affecting all the body systems and causes a generalized increase in inflammation contributing to pain and disease. Hypothyroid is also associated with carpal tunnel syndrome, tendonitis, poly-cystic ovarian syndrome, mitral valve prolapse, depression, infertility and high cholesterol.
Treatment for low thyroid involves thyroid hormone replacement. The conventional doctors prefer synthetic T4 hormone replacement usually Synthroid or Levoxyl. Naturopathic practitioners favor natural thyroid hormone replacement including Armour thyroid or Naturethroid. These are made from pig thyroid glands which is most similar to human and was the only option before the synthetic option was available. The critique of the natural thyroid replacement is that the doseage is too variable and not controlled carefully enough, but studies show that there is evidence for the same problem with the synthetic thyroid replacement.
The benefit of taking the natural thyroid replacement is that it contains T4 and T3. It is theorized that many patients with slightly elevated TSH’s (within the normal range) may not have a lack of T4 production, but may be having trouble converting the T4 into the more active T3. Regardless, many patients get better results on the T4 & T3 combination. T3 is also found to be effective for people suffering depression, either used with an antidepressant or in place of an antidepressant.
Trying to lose weight with hypothyroidism is like trying to swim up stream. Not only is it going to be more difficult metabolically, you are going to feel more tired and less motivated to exercise or make healthy diet choices. I’ve seen many patients who have struggled with their weight for their lifetime and who have many other symptoms but have never had their thyroids assessed or treated adequately.