Proper Approach to Assessment of Your Underactive Thyroid

According to the statistics of the American Thyroid Association, over 20 million Americans have been diagnosed with and treated for hypothyroidism. It is likely that an additional 20 million people are suffering with poorly functioning thyroid glands but have received no treatment. The vast majority of patients who seek out medical care for hypothyroidism are treated conventionally with synthetic thyroid hormone. I find this unfortunate because while some of these people do require management with this medication, most people with hypothyroidism can effectively be treated without prescriptive thyroid hormones. More often than not a thorough history, physical exam and proper testing will clearly reveal subtle nutritional deficiencies, environmental toxicities or imbalances in the endocrine and cardiovascular system. Once these underlining issues are addressed, thyroid imbalances often resolve spontaneously.
Unfortunately, most physicians use a "reductionist" model to assess health. That is, they view the thyroid as an isolated entity. The constellation of symptoms such fatigue, weight gain, depression, sensitivity to cold, muscle or joint aches, brain fog, poor memory, PMS and brittle nails are perceived as being an indication of a need for thyroid hormone. Sometimes, thyroid hormone supplementation helps for a short time, but invariably these symptoms tend to return.

It is much more appropriate to recognize that the thyroid gland exists within the context of several systems of the body including the endocrine, nervous and cardiovascular systems. It produces hormones that affect virtually every tissue in the body. In this way, it is an excellent "canary" to gauge the vigor of a patient. Even minor disturbances in the status of the thyroid gland can have a dramatic effect on a patients' overall health. Many factors affect the health of the thyroid, including age, food choices, stress, sleep quality, reproductive or menopausal status, toxic load, current medications, blood sugar metabolism and perhaps most importantly, the health of the adrenal glands and sex glands. It is prudent for a physician to examine all of these points prior to administering medication. The physical exam should be meticulous as well. For example, an inability of the iris to remain contracted upon direct exposure to bright light is suggestive of adrenal dysfunction. Adrenal imbalances often are associated with hypothyroidism. Failure to address this issue will lead to poor clinical outcomes.

Regarding labs, medical guidelines recommend using thyroid stimulating hormone (TSH) to evaluate thyroid function. TSH is a hormone produced by the pituitary. It travels to the thyroid gland where it stimulates the thyroid to produce hormone. From a laboratory perspective, an elevated TSH, convention dictates, is sufficient to substantiate a need for prescriptive thyroid hormone. In practice, however, TSH is a poor tool for determining thyroid health. Prescribing based on TSH alone can be a risky endeavor, as such an approach allows the true cause of the symptoms to go unaddressed, and can lead to more serious conditions such as osteoporosis and cardiovascular disease. I recommend at a minimum to test TSH, along with both thyroid hormones (free T3 and free T4) as well an additional hormone called "reverse" T3, a form of thyroid hormone produced by the liver that actually prevents activated T3 from doing its job. Additionally, I always test salivary adrenal status and DHEA. This is important because high DHEA can lead to high levels of thyroid hormone while high cortisol can lead to low levels. At the same time, it is important to understand that lab results are only guidelines. A high TSH for one person may be perfectly normal for another. Finally, tests are available that can assess the liver's ability to detoxify, can elucidate toxic load and that can identify any subclinical nutrient deficiency which may be associated with hypothyroidism.

The bottom line is that hypothyroid symptoms are often a early warning sign of other systemic imbalances. It is these issues that must be addressed.