The diagnosis of “subclinical” hypothyroidism that I discussed last week depends on having a TSH level higher than 5 m IU/ml and lower than 10 m IU/ml. As I mentioned above, new guidelines suggest anything over 3 is abnormal. While an improvement, practitioners following these guidelines may still miss many people who have normal test results and a malfunctioning thyroid system.
It is extremely important that women planning to become pregnant are kept well adjusted, since hypothyroidism can affect the development of the baby. During pregnancy, thyroid hormone replacement requirements often change, so more frequent monitoring is necessary. Various medications and supplements (particularly iron) may affect the absorption of thyroid hormone; therefore, the levels may need more frequent monitoring during illness or change in medication and supplements.
Some findings suggest that many people with Hashimoto’s disease (the most common type of hypothyroidism) have lower levels of vitamin D compared to the general population . That’s bad news, since low D is tied to higher levels of thyroid antibodies. “The antibodies activate the immune system to attack the thyroid tissue, which creates inflammation and makes it harder for the thyroid to do its job,” explains Lisa Markley, RDN, co-author of The Essential Thyroid Cookbook.
The development of TSH assays led to a dramatic reduction in thyroid hormone replacement dosage and the ability to diagnose with certainty milder forms of hypothyroidism. Discovery of peripheral T4-to-T3 conversion gave a physiologic means to justify l-thyroxine monotherapy. In combination with the concerns over consistency and safety of natural thyroid preparations, synthetic l-thyroxine was perceived as a more reliable therapy. These findings laid the foundation for the clinical practice trend away from natural thyroid preparations and toward l-thyroxine monotherapy at doses to normalize the serum TSH. Later, a subpopulation of patients with residual symptoms of hypothyroidism was recognized. It remains to be determined whether this is due to a trend of attributing nonspecific symptoms to minimal thyroid dysfunction, relatively low serum T3 levels and/or high T4:T3 ratio, or the role of Thr92AlaD2 polymorphism, and whether combination therapy with l-thyroxine plus l-triiodothyronine will be beneficial.
**Note: It’s important to realize that thyroid medication is not one size fits all, and there is no ONE right solution for everybody. Dosage is incredibly important, your specific thyroid labs will impact what type of medication is needed and we all have different needs, budgets, goals, and symptoms. So work with a functional medicine practitioner to find the thyroid medication that makes the most sense for YOU!
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From the early 1890s through the mid-1970s, desiccated thyroid was the preferred form of therapy for hypothyroidism (Appendix Table, available at www.annals.org). This preference was reinforced by the unique ability of desiccated thyroid to reproduce a normal serum PBI (33). The predominance of natural thyroid products was illustrated by prescribing patterns in the United States: In 1965, approximately 4 of every 5 prescriptions for thyroid hormone were for natural thyroid preparations (38). Concerns about inconsistencies in the potency of these tablets arose (26) after the discovery that some contained anywhere from double to no detectable metabolic activity (39). The shelf-life of desiccated tablets was limited, especially if the tablets were kept in humid conditions (36). There were reports of patients not responding to desiccated thyroid altogether because their tablets contained no active thyroid hormone. It was not until 1985 that the revision of the U.S. Pharmacopeia standard from iodine content to T3/thyroxine (T4) content resulted in stable potency (38), but by then the reputation of natural thyroid products was tarnished (40).
Although relatively low serum T3 levels could contribute to these residual manifestations, the higher serum T4:T3 ratio should also be considered. This has been well-established for 4 decades (28, 50, 59), but only recently has it been recognized as a relevant measure given that higher serum T4 levels will impair systemic T3 production via downregulation of a deiodinase pathway (9). Thus, some emphasis has recently been directed toward establishing the clinical significance of this ratio (1, 5).
Thyroid disease and disorder symptoms and signs depend on the type of the thyroid problem. Examples include heat or cold intolerance, sweating, weight loss or gain, palpitations, fatigue, dry skin, constipation, brittle hair, joint aches and pains, heart palpitations, edema, feeling bloated, puffiness in the face, reduced menstrual flow, changes in the frequency of bowel movements and habits, high cholesterol, hoarseness, brittle hair, difficulty swallowing, shortness of breath, a visible lump or swelling in the neck, tremors, memory problems, depression, nervousness, agitation, irritability, or poor concentration.
Think milk, butter, cheese, and meat. If you buy the cheap, conventionally raised versions at the supermarket, those types of deliciousness can also disrupt all your thyroid’s hard work. You omnivores (like us) can avoid this dilemma by choosing organic, or at least antibiotic-free and hormone-free meats and dairy. It’ll save you in the end, with fewer medical costs down the line.
90% of all hypothyroid conditions are autoimmune in nature. In other words, most people with hypothyroidism have the condition Hashimoto’s Thyroiditis. But what causes this condition? Numerous factors can trigger an autoimmune response and result in the elevated thyroid peroxidase (TPO) and/or thyroglobulin antibodies you see with Hashimoto’s Thyroiditis. These antibodies will damage the thyroid gland, which is what leads to the decreased production of thyroid hormone. And while taking synthetic or natural thyroid hormone might be necessary for someone who has low or depressed thyroid hormone levels, this won’t do anything to improve the health of the immune system. So the goal is to detect and then remove the trigger which is causing the autoimmune response, get rid of the inflammation, and suppress the autoimmune component of the condition.
Your thyroid is a butterfly-shaped gland in your neck that controls metabolic activities. It does this by producing thyroid hormones that regulate things like heart rate and calorie burning. Underactive thyroids don’t produce enough of these hormones, which can leave you feeling tired, depressed, and like just looking at food is enough to make you gain weight .
Hypothyroidism is a very common condition. Approximately 3% to 4% of the U.S. population has some form of hypothyroidism. This type of thyroid disorder is more common in women than in men, and its incidence increases with age. Examples of common causes of hypothyroidism in adults include Hashimoto's thyroiditis, an autoimmune form of overactive thyroid, lymphocytic thyroiditis, which may occur after hyperthyroidism (underactive thyroid), thyroid destruction from radioactive iodine or surgery, pituitary or hypothalamic disease, medications, and severe iodine deficiency.
For starters, consider the effect that hypothyroidism can have on weight. Hypothyroidism (also called low thyroid or underactive thyroid) is marked by insufficient hormone production in the thyroid — the butterfly-shaped gland located at the bottom-front of your neck. This gland affects the body’s metabolic processes, and often, sudden weight gain is an early sign of low thyroid.
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