Dr. Cindy's Basic Guide to Thyroid Dysfunction

Are you sick and tired of feeling sick and tired, but can't seem to figure out why? Do you feel like you're going crazy because you "know" something is "wrong" with you but all your "tests" come back "normal"? Have you just about given up on going to see yet another doctor only to be told, "it's all in your head"? Well, don't give up hope just yet! Just because you can't name it, blame it and tame it doesn't mean you should do nothing about it. Such is the case of thyroid dysfunction.
It is currently estimated that thyroid dysfunction affects approximately 30 million women and 15 million men in the United States. It is also estimated that thyroid dysfunction goes undiagnosed and untreated in more than half of the 45 million people who have it. Thyroid dysfunction is now believed to be more common than diabetes and heart disease.
What Does the Thyroid Do?
The thyroid is a gland that's located in the lower front part of the neck. An important part of your endocrine system, the thyroid releases vital hormones that help to regulate your body's metabolic processes: thyroxine (T4) and triiodothyronine (T3). Hormones are chemicals that are secreted by glands that act like messengers, telling specific body parts what to do. The release of T3 and T4 by the thyroid is controlled by a system that involves the pituitary gland and the hypothalamus. Lowered levels of T3 and T4 result in increased levels of hormones from the pituitary and hypothalamus. The reverse can also be true--when levels of thyroid hormones rise, hormones from the pituitary gland and hypothalamus fail to help keep hormone levels in balance and your metabolism functioning properly. Thyroid hormones help the body make energy, keep body temperature regulated and influence essentially every organ, tissue and cell in your body. Put simply, if your thyroid doesn't work properly, neither do you.
Types of Thyroid Dysfunction
Thyroid disorders may be caused by malfunctions in the thyroid gland itself, or disruptions of the control system in the pituitary and hypothalamus. There are several types of thyroid dysfunction: hyperthyroidism, hypothyroidism, secondary hypothyroidism and Hashimoto's disease. Over-production of T3 and T4 hormones results in hyperthyroidism; underproduction of these hormones results in hypothyroidism. Secondary hypothyroidism results in the failure of the pituitary gland to release thyroid-stimulating hormone (TSH) or thyrotropin-releasing hormone (TRH). This is usually caused by a tumor in the area of the pituitary or hypothalamus. It can also be caused by radiation to the brain. Hashimoto's disease is a type of autoimmune disorder in which the immune system attacks and destroys the thyroid gland. Hashimoto's disease is the most common thyroid disease in the United States, affecting approximately 80 percent of all those afflicted with thyroid dysfunction. Advanced hypothyroidism, known as myxedemia, is rare, and can result in coma or death.
Consequences of Undiagnosed, Untreated Thyroid Dysfunction
Thyroid dysfunction can affect your whole body, mind and emotions. If left undiagnosed and untreated, thyroid dysfunction can mean a lifetime of chronic illness and debilitating symptoms, including chronic fatigue, weight management problems, anxiety, irritability, mood swings, mental sluggishness, menstrual problems, infertility, sleep disorders and chronic pain, along with rises in LDL cholesterol and other fractions of lipids. It can also result in increases in Lp(a), diabetes, accelerated heart disease and even heart failure. Studies reported in the "Annals of Internal Medicine" clearly state that thyroid dysfunction is a major heart disease risk for women. One study found that older women with thyroid dysfunction were almost twice as likely to have blockages in the aorta than women who did not have thyroid dysfunction. These women were also twice as likely to have had heart attacks.
Warning Signs and Symptoms of Thyroid Dysfunction
The signs and symptoms of thyroid dysfunction vary significantly depending on the severity of the hormone deficiency. There is no one-size-fits-all, easy-to-treat set of criteria. In general, however, most problems tend to develop slowly and get worse over time. Because of the gradual onset and individual differences, signs and symptoms of thyroid dysfunction are often misdiagnosed and attributed to stress, depression, age, lifestyle factors, "female problems" or dismissed all together as being "all in your head." Signs and symptoms of thyroid dysfunction may include:
• Fatigue
• Sleep disturbance--hypersomnolence or insomnia or difficulty waking up in the morning
• Unexplained weight loss or gain or trouble losing or gaining weight
• Mental sluggishness, poor memory and concentration
• Moodiness, irritability, depression and anxiety
• Heart palpitations, tachycardia or arrhythmias
• Sensitivity to heat and cold, or cold hands and feet
• Heavy menstrual bleeding, worsening of PMS, infertility or miscarriages
• Low blood pressure and heart rate
• Elevated cholesterol
• Fluid retention (puffy hands, face and feet)
• Constipation or frequent defecation
• Autoimmune disease
• Celiac disease or gluten sensitivity
• Decreased sex drive
• Coarse, dry or brittle hair; thinning of hair or hair loss
• Brittle, cracked, chipped or pealing nails
• Pale, dry skin or cold, clammy skin; acne
• Thinning of eyebrows
• Muscle and joint aches, pains and stiffness
• Slow reflexes
• Hoarse voice
Causes of Thyroid Dysfunction
The most common causes of thyroid dysfunction include genetic predisposition to thyroid problems; hormone dysfunction; exposure to toxic chemicals and heavy metals (e.g. exposure to radiation or radiation treatment, volatile organic compounds, environmental toxins, consumption of large amounts of tuna other large fish or sushi, multiple silver/mercury fillings); chronic stress (adrenal fatigue); chronic inflammation (wheat and gluten is the number one cause of chronic inflammation--causes damage to the gut/digestive system; the number two cause is sugar and refined carbohydrates); toxic food (processed, refined or junk foods); and nutritional deficiencies (iodine, vitamin D, omega-3, selenium, zinc and vitamins B or A).
Risk Factors
Women between the ages of 30 and 50 are at most risk. More than eight out of 10 people with thyroid disease are women. It is now estimated that at least one in eight American women will develop thyroid dysfunction at some point in their lifetime.
Tests for Detecting Thyroid Dysfunction
If you suspect you have a thyroid problem, the first thing to do is write down an inventory of all your symptoms, including when they started and how they may have progressed overtime, as well as the current level of severity. Next, begin taking your morning basal body temperature. Do this first thing when you wake up in the morning--before you get out of bed--preferably sometime before 6 a.m. Take your temperature every day for at least one month, writing it down in a daily log. A basal body temperature consistently below 97.6 degrees F is considered a positive screen for thyroid dysfunction, along with other signs and symptoms.
At this point, take your inventory of symptoms and basal body temperature log to a physician. Explain your concerns and ask for further testing. There are several blood tests you will want to make sure your physician is familiar with as well as able to run and interpret for you. These tests include TSH, Free T3, Free T4, Thyroidglobulin Antibodies and Thyroid Perioxdase Antibody. In addition to these tests, it might be a good idea to run tests aimed at ruling out celiac disease (e.g. IgA, IgG and AGA) as well as chemical and heavy metal toxicity. An MRI of your pituitary gland may also be needed to look for a tumor. If the physician you have selected is not familiar with these tests or is unwilling to run them, you may want to look for another physician. Don't take a flippant dismissal of your symptoms, patronization or a flat out "no" for an answer!
Emphasize Dysfunction vs. Diagnostic Classification for Disease
Health and disease patterns become more meaningful when we de-emphasize traditional disease classifications through the "numbers crunching game" of standard laboratory findings in favor of attention to the signs and symptoms of individual dysfunction. Standard laboratory tests do not take into account the important factor of individual biochemical variations. One person's test results can vary significantly from another person's, with both test results considered "normal." Unfortunately, this one-size-fits-all approach has led to many "false negative" test results for individuals being screened for thyroid dysfunction--most notably with the TSH test alone. Remember that numbers generated from test results are less relevant than individual symptoms of dysfunction. This is why it is so important to run a variety of more sensitive tests than the stand-alone "gold standard," or TSH, in order to increase the likelihood that you will catch "the full story" of your unique presentation as it relates to potential thyroid dysfunction.
Treatment
Medication can replace the hormones your body is failing to produce and ease the signs and symptoms of thyroid dysfunction. Synthroid is the most commonly prescribed thyroid hormone replacement medication at this time. Unfortunately, it is only comprised of T4, the inactive thyroid hormone. Most doctors believe the body will convert T4 to T3 and all will be well. Unfortunately, pesticides, stress, mercury, infections, allergies and selenium deficiencies can block that process. As such, the medication Armour Thyroid is a better choice. Armour Thyroid contains both T4 and T3, as well as T2. Dosage ranges from 15 to 180 mg, depending on the person. Made from desiccated or dried porcine thyroid (pig hormone), many doctors still hold to the outdated belief that preparation is unstable and dosage is difficult to monitor. That was true with the old preparation of Armour, but not the new one. Go to armourthyroid.com for more information.
Sometimes the only way to find out if you have a thyroid problem is a short trial of a thyroid medication for three months. If you feel better and your symptoms subside, it's the right choice. Once started, it doesn't always have to be taken for life (a common misconception). Once all the factors that disturb your thyroid have been corrected, you may be able to reduce or discontinue the dose.
It also necessary to address many lifestyle factors that may have helped contribute to your thyroid dysfunction in the first place. This may mean you will need to start eliminating toxins from your life--toxic food, toxic relationships, environmental toxins, etc. Optimize your nutrition. Think of food as medicine. The production of thyroid hormones requires iodine and omega-3 fatty acids. Converting the inactive T4 to the active T3 requires selenium, vitamins A and D, and zinc. All of these elements are found in a good whole foods diet and basic supplements. Specific foods to add include seaweed or sea vegetables (iodine); fish--sardines and wild salmon (omega-3 and vitamin D); dandelion greens (vitamin A); and smelt, herring, scallops or brazil nuts (selenium). Specific foods to eliminate include wheat and gluten (barley, rye, oats, spelt, kamut and triticale), which is the most common dietary cause of thyroid dysfunction; sugar and sugar substitutes; and processed or refined "junk foods" and fluoride (toothpaste, tap water). Also consider supplementation for thyroid support: multivitamins, vitamin D-3, omega-3 and kelp (iodine).
Talk to Your Doctor
As with any treatment, always work with an experienced physician when using thyroid medications. Careful monitoring is essential. Taking too much thyroid hormone, or taking it when you don't need it, can lead to undesirable side effects, including anxiety, insomnia, palpitations and over the long-term, bone loss.
Warning
If your adrenal glands are burned out from long-term stress, treating the thyroid without supporting the adrenal glands through stress reduction, relaxation and the adaptogenic herbs (such as ginseng, rhodiola or Siberian ginseng) can actually make you feel worse.
Recommended Books
Blanchard, K. & Abrams Brill, M. (2004). "What Your Doctor May Not Tell You About
Hypothyroidism." Warner Books, New York, NY.
Hyman, M. (2008). "The Ultra-Thyroid Solution."
Shomon, M. (2005). "Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...
That You Need to Know." (Revised Edition). Harper Collins, New York, NY.