Fatigue, weight gain, depression, and cognitive impairment are various conditions millions of people suffer with on a daily basis. For most people this is just something they have to accept as it is perceived to be an “age-related” decline in ones quality of life. Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormones, and is characterized by a reduction in a person’s metabolic rate.
Frequently Asked Questions
- 1What is hypothyroidism?
- 2What is the role of the role of the Thyroid?
- 3How do the thyroid hormones function?
- 4How is the production of T4 and T3 regulated?
- 5What affects the availability of free thyroid hormone?
- 6What are the symptoms of Hypothyroidism?
- 7Why does sub clinical hypothyroidism exist?
- 8What are the Consequences of Hypothyroidism and sub clinical Hypothyroidism?
- 9Why should patients diagnosed with Psychiatric disorders and decreased cognitive function be evaluated for thyroid disorders?
- 10How does Hypothyroidism affect the Cardiovascular System?
- 11What other effects does hypothyroidism have on the body?
- 12How is hypothyroidism diagnosed?
- 13What is the most common cause of low thyroid function?
- 14How is hypothyroidism diagnosed at Health Renewal?
- 15What other methods can one use for diagnosing hypothyroidism?
- 16How is it diagnosed at Health Renewal?
- 17How is it managed at Health Renewal?
- 18Why should one not self-medicate?
- 19How do I get started?
- 20How often should I see the integrative Doctor?
- 21What treatments can one expect to be given at Health Renewal?
- 22What Nutraceuticals can support Thyroid Function?
- 23Health Renewal tip: TSH Target
Fatigue, weight gain, depression, and cognitive impairment are various conditions millions of people suffer with on a daily basis. For most people this is just something they have to accept as it is perceived to be an “age-related” decline in ones quality of life. Underactive thyroid (aka hypothyroidism) is a condition that is often overlooked or misdiagnosed and can be the underlying cause of these symptoms. It is a common occurrence that patients and their doctors disregard these common signs of thyroid hormone deficiency, thinking that they normal by-products of aging. Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormones, and is characterized by a reduction in a person’s metabolic rate.
Subclinical hypothyroidism, an often under-diagnosed thyroid disorder, manifests as elevated TSH, normal T4 and normal T3 levels. If an individual suffers from subclinical hyypothyroidism he/she is at greater risk fir developing overt hypothyroidism. Fortunately, this can be prevented by doing a simple blood test for TSH, T3 and T4 which can reveal an underlying thyroid condition and help direct treatment to improve the symptoms.
The thyroid is made up of small sacs, and these gland is filled with an iodine-rich protein called thyroglobulin along with the thyroid hormones thyroxine (T4) and small amounts of triiodothyronine (T3). The thyroid is situated just below the Adam’s apple in the next and had the shape of a butterfly.
Regulating one’s metabolism is the primary function of these two hormones, and it does this by controlling the rate at which the body converts oxygen and calories into energy. It is interesting to note that primarily the metabolic rate of every cell in the body is regulated by thyroid hormones.
The thyroid gland requires iodine and the amino acid L-tyrosine to make T4 and T3. Therefore a diet which contains too little iodine can limit the amount of T4 the thyroid gland can produce, this may lead to hypothyroidism. When the thyroid gland is visibly enlarged, this is referred to as a goiter. Historically, this condition was most frequently caused by a lack of dietary iodine. However, in countries where salt is iodized, goiter of iodine deficiency is rare.
T3 is the biologically active form of thyroid hormone. The majority of T3 is produced in the peripheral tissues by conversion of T4 to T3. There are various factors with interfere with how efficient T4 is converted into T3, and these include: nutrient deficiencies, exposure to drugs, and chemical toxicity.
Another related enzyme converts T4 to an inactive form of T3 called reverse T3 (rT3). Reverse T3 does not have thyroid hormone activity; instead it blocks the thyroid hormone receptors in the cell hindering action of regular T3.
- When levels of T3 and T4 are low, the hypothalamus responds by releasing thyrotropin-releasing hormone (TRH) which then stimulates the pituitary gland to release thyroid stimulating hormone (TSH).
- Cold temperatures also has the ability toincrease TRH levels. This is thought to be an intrinsic mechanism that helps keep us warm in cold weather.
- Elevated levels of cortisol, as seen during stress and in conditions such as Cushing’s syndrome, lowers TRH, TSH and thyroid hormone levels.
- The thyroid gland needs iodine and the amino acid L-tyrosine to make T4 and T3. A diet deficient in iodine can limit how much T4 the thyroid gland can produce and lead to hypothyroidism.
- Various factors including nutrient deficiencies, drugs, and chemical toxicity may interfere with conversion of T4 to T3.
- Oral contraceptives, pregnancy, and conventional female hormone replacement therapy may increase thyroid carrier protein levels and, thereby, lower the amount of free thyroid hormone available. Very small changes in the amount of carrier proteins will affect the percentage of unbound hormones.
99% of circulating thyroid hormones are bound to carrier proteins, which renders them metabolically inactive. The remaining “free” thyroid hormone (the majority of which is T3), binds to, and activates, thyroid hormone receptors, causing biological activity. Very small changes in the amount of carrier proteins will affect the percentage of unbound hormones.
- Oral contraceptives
- Conventional female hormone replacement therapy all the above may increase thyroid carrier protein levels and, thereby, lower the amount of free thyroid hormone available.
Hypothyroidism is characterizes by a reduction of a person’s metabolic rate, because the thyroid gland does not make enough thyroid hormones. Most symptoms can take years to develop. The slower the metabolism becomes, the more obvious the signs and symptoms will be. If hypothyroidism goes untreated, the signs and symptoms could become more severe, such as a swollen thyroid gland (goiter), slow thought processes or dementia. If left untreated, chronic hypothyroidism can result in myxedema coma, a rare, life-threatening condition. Mental dysfunction, stupor, cardiovascular collapse, and coma can develop after the worsening of chronic hypothyroidism.
The main symptoms of hypothyroidism are: fatigue, weakness, increased sensitivity to cold, constipation, unexplained weight gain, dry skin, hair loss or coarse dry hair, muscle cramps and depression.
- There is evidence that the standard blood TSH test reference range may cause many cases of hypothyroidism to be missed.
- Most physicians accept a reference range for TSH between 0.45 and 4.5 µIU/mL to indicate normal thyroid function.
- A TSH reading of more than 2.0 may indicate lower-than-optimal thyroid hormone levels.
Even though TSH levels that fall within normal range, what adverse health outcomes are associated with it?
- TSH greater than 2.0: increased 20-year risk of hypothyroidism and increased risk of thyroid autoimmune disease
- TSH between 2.0 and 4.0: hypercholesterolemia and cholesterol levels decline in response to T4 therapy
- TSH greater than 4.0: greater risk of heart disease
There is another and separate problem brought on by these
- Because of these overly broad normal ranges for TSH, people already diagnosed and being treated for hypothyroidism are often not taking correct doses of thyroid replacement hormone.
- A November 2010 study reported that about 37% of people being treated for hypothyroidism were taking incorrect doses, about half too much and another half too little hormone
Gastrointestinal problems such as:
- Decreased motility in the esophagus, which causes difficulty swallowing, heartburn, indigestion, nausea, or vomiting.
- Abdominal discomfort, flatulence, and bloating occur in those with small intestinal bacterial growth secondary to poor digestion.
- Depression. Every patient diagnosed with depression should have an evaluation of thyroid hormones along with TSH may help avoid misdiagnosis . A study published in 2002 suggests that that thyroid function is especially important for bipolar patients: " results suggest that nearly three-quarters of patients with bipolar disorder have a thyroid profile that may be suboptimal for antidepressant response.”
- Panic disorders, depression, and changes in cognition are frequently associated with thyroid disorders.
- Cognitive decline: Patients with low thyroid function can suffer from slowed thinking, delayed processing of information, difficulty recalling names, etc.
- Decreased speed of sensory and cognitive processing
- Decreased working memory
- Increased levels of blood cholesterol
- Iincreased blood pressure.
- Increased risk of cardiovascular disease.
- High blood pressure: Hypothyroidism has been recognized as a cause of secondary hypertension.
- Increases cholesterol and atherosclerosis which accelerate coronary artery disease.
- The risk of heart disease increases proportionally with increasing TSH, even in subclinical hypothyroidism.
- Thyroid hormone replacement may slow the progression of coronary heart disease by inhibiting the progression of plaques.
- Homocysteine: treating hypothyroid patients with thyroid hormone replacement might decrease homocysteine levels, an independent risk factor for cardiovascular disease.
- Elevated C-reactive protein: Overt and subclinical hypothyroidism are both associated with increased levels of low-grade inflammation, as indicated by elevated C-reactive protein
- Metabolic Syndrome. Slight increases in TSH may put people at higher risk for metabolic syndrome
- Reproductive system problems: In women, hypothyroidism is associated with menstrual irregularities and infertility.Proper treatment can restore a normal menstrual cycle and improve fertility.
- Fatigue and weakness: are common in hypothyroid patients.
There are various clinical signs to look out for, and in addition a simple blood test can be done to confirm the diagnosis.
An autoimmune disease called Hashimoto’s thyroiditis is the most common cause of low thyroid function. The body’s own immune system mistakenly attacks the thyroid tissue impairing the ability to produce hormones. Hypothyroidism, which is caused by Hashimoto's disease, is treated with thyroid hormone replacement agents.
Cardiovascular Disease: Hypothyroidism and subclinical hypothyroidism are associated with increased levels of blood cholesterol, increased blood pressure, and increased risk of cardiovascular disease. Even those with subclinical hypothyroidism were almost 3.4 times as likely to develop cardiovascular disease than those with healthy thyroid function.
Thyroid stimulating hormone (TSH) level is the most common test for screening for thyroid dysfunction. It is now recognized that the TSH measurement is a more sensitive test than T4 for detecting both hypo- and hyperthyroidism. As a result, some countries now promote a TSH-first strategy for diagnosing thyroid dysfunction in patients.
In 2008 many labs adopted the reference range for TSH, 0.45 to 4.50 μIU/mL, recommended by both the Endocrine Society and the American Medical Association. Although this range is an improvement over the previous 0.45-5.5 mIU/L, it is still considered too broad by many clinicians. The American Association of Clinical Endocrinologists now recommends an upper limit of 3.0 mIU/L.61
The National Academy of Clinical Biochemistry point out that "more than 95% of normal individuals have TSH levels below 2.5 [µIU/mL]."62 This panel suggests that the upper limit of TSH should be reduced to 2.5 µIU/mL
At Health Renewal, the upper limit of TSH is taken 2.0 µIU/mL.
This was decided since some studies have noted that a TSH above 2.0 may be associated with adverse cardiovascular risk factors. In addition, a TSH between 1.0 and 2.0 µIU/mL has been associated with the lowest subsequent incidence of abnormal thyroid function. Health Renewal advocates additional testing, including Free T3 and T4 levels, to provide a more complete evaluation of the thyroid.
Note: TSH values do fluctuate with time of day, infection, and various other factors. No single measurement of TSH should be considered diagnostic and repeat studies should be done.What is the most common cause of low thyroid function?
1.Basal Body Temperature: The temperature is taken when the body is at complete rest, immediately after waking and before beginning any activity. The normal basal temperature is 36.4 – 36.7 ºC, and some alternative practitioners believe that a 5-day consecutive temperature reading below 36.4 ºC is indicative of hypothyroidism. However, a thyroid panel blood test should be taken to accurately evaluate the thyroid function.
2.Tests for T4 and T3: Thyroid hormones can be tested in both their free and protein-bound forms. Tests for the protein-bound forms and unbound form of T4 or T3 are generally referred to as Total T4 or Total T3 respectively; unbound forms are called Free T4 and Free T3. Each of these tests gives information about how the body is making, activating, and responding to thyroid hormone. Levels of free T3 and T4 will be below normal in clinical hypothyroidism. In subclinical hypothyroidism the TSH will be elevated while the thyroid hormone levels are still in the normal reference range.
3.Reverse T3: Certain individuals with apparently normal T4 and T3 hormone levels still display the classic symptoms of hypothyroidism. This may be due to an excessive production of reverseT3 (rT3). rT3 is inactive and may interfere with the action of T3 in the body. Stress and extreme exercise may play a role in lowering thyroid hormone action by suppressing production of TSH and T3 and elevating rT3 levels.
4.Autoimmune antibodies: When evaluating the thyroid it is also important to consider that the most common cause of overt hypothyroidism is an autoimmune disorder known as Hashimoto’s thyroiditis. This condition causes the body to produce antibodies to the thyroid gland and damage the gland. Hashimoto’s thyroiditis is diagnosed by standard thyroid testing in conjunction with testing for the presence of these antibodies called antithyroglobulin antibodies (AgAb) and thyroperoxidase antibodies (TPOAb). Some people with celiac disease or sensitivity to gluten are at increased risk for developing autoimmune thyroid disease and should be evaluated.
5.Elevated thyroid antibodies are often associated with chronic urticaria, also called hives. Studies report that as many as 57.4% of patients with hives have the presence of anti-thyroid antibodies. A 2010 study suggests that treatment with T4 improves the itching associated with urticaria, but did not advise treatment with T4 unless the patient was hypothyroid.
6.Additional testing: Sometimes biopsy or enzymatic studies are required to establish a definite diagnosis for thyroid dysfunction. Major abnormalities of the thyroid gland detected in physical exam can be further assessed by ultrasound or a procedure known as scintigraphy.
7.Hypothalamic pituitary axis (HPA): There is an intimate relationship between the thyroid, the adrenal glands and the sex hormones. If hypothyroidism is suspected, an evaluation of the adrenal glands as well as the sex hormones is suggested. Your doctor will perform a clinical examination and request some blood tests.
Tests to diagnose and monitor hypothyroidism include: Thyroid Stimulating Hormone (TSH), Total T4, Total T3, Free T4 (fT4), Free T3 (fT3), Reverse T3 (rT3), Thyroid peroxidase antibody (TPOAb), Thyroglobulin antibody (TgAb). At Health Renewal , the upper limit of TSH is taken 2.0 µIU/mL
The initial medical consultation at Health Renewal will be approximately 45 minutes. You will have to complete an in depth questionnaire before the consultation so please arrive 20 minutes before the time. During the 45 minute consultation your Health Renewal doctor will obtain a full medical history from you to determine your personal risk . A physical examination will be done after which he will decide which blood tests need to be requested from your local pathology laboratory . These results will then be analyzed by your Doctor and this will be discussed with you at your follow up appointment. This will determine whether a definite deficiency exists and you will be advised on your treatment options. These options may range from prescription medications, nutraceuticals, bio-identical hormonal creams / tablets or alternatively to having bio-identical implants / pellets inserted.
For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. Please do not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified medical practitioner, you could be not treating vital deficiencies or conditions such as elevated blood pressure and high sugar levels. In addition, there is no single supplement given to clients as there is no magic bullet that can support all the essential nutrients that one's body needs.
Make an appointment to consult with your Health Renewal Doctor and they will assist you in determining your risk factors and how best to prevent any problems/ conditions that you may be susceptible to.
Depending on which form of supplementation you and your Health Renewal Doctor have decided on, one could expect to follow up with your physician from anything between every 3 months to once every 6 months.
Upon receiving the results of various blood tests, and with your clinical signs and symptoms taken into account, the doctor will prescribe nutraceuticals and prescription medication, if needed.
The most common treatment for low thyroid hormone levels consists of thyroid hormone replacement therapy. The goal of thyroid hormone replacement is to relieve symptoms and to provide sufficient thyroid hormone to decrease elevated TSH levels to within the normal range. Conventional treatment almost always begins with synthetic T4 (levothyroxine) preparations like Eltroxin. Low doses are usually tried at first because a rapid increase in thyroid hormone may result in cardiac damage.
1.Iodine: The body needs iodine to make thyroid hormone. The WHO estimated in 2007, that over 30% of the world’s population (which amounts to 2 billion people) has insufficient iodine intake as measured by urinary iodine excretion below 100 micrograms (mcg)/liter. To prevent this deficiency one can add iodized salt in your daily diet, which can be an effective preventative measure.
2.Selenium: After iodine, selenium is probably the next most important mineral affecting a person’s thyroid function. The thyroid contains more selenium by weight than any other organ in the body. Without this potent mineral there would be no activation of the thyroid hormone as it is a necessary component of the enzymes that remove iodine molecules from T4 converting it into T3. Whilst testing selenium levels of patients with thyroid disease, it was found all of them had lower levels than normal healthy individuals. Some researchers suggest that selenium supplementation will improve conversion of T4 to T3. The cells of the thyroid generate hydrogen peroxide and use it to make thyroid hormone. Selenium has the function of protecting the thyroid gland from the oxidative damage caused by these reactions. Without adequate selenium, high iodine levels lead to destruction of the thyroid gland cells.
3.Additional nutraceuticals which can be taken are: Zinc: Copper, Curcumin (as highly absorbed BCM-95®), Natural Vitamin E, Vitamin C, Iron, Vitamin B12 , DHEA, Pregnenolone, Rhodiola, L-tyrosine
When supplementing with thyroid hormones, for hypothyroidism, an ideal TSH level is between 1 and 2 µIU/mL. TSH levels lower than this may increase risks and symptoms associated with hyperthyroidism. TSH levels higher than this may increase the risks and symptoms associated with hypothyroidism.