New studies should change the way every doctor looks at thyroid disorders. Now, and in the past, most doctors consider only TSH (Thyroid Stimulating Hormone) to determine if you have Hypothyroidism, a condition that slows your metabolism and causes weight gain and many other symptoms.
Before TSH was available for use, doctors used a person’s symptoms to make the diagnosis. It turns out symptoms are still the best method. TSH measures one thyroid hormone, called T4. T4 must convert, in the body, to T3, the active form of thyroid. While we do have tests to measure T3 now, it turns out, it is not the best measure either.
In medical school, I was taught to treat the “person”, not the lab test results. This means, if someone has 25 symptoms of Hypothyroidism, but their lab tests are normal, I was taught to treat the symptoms, not just the lab value. Medical studies now support this approach.
The blood tests doctors have been using to decide if your thyroid is working or not, measure only pituitary thyroid. These tests do not measure if the thyroid activity made it into the cells where they are needed. Thyroid hormone must be transported into the cells of the body for everything to work properly. Currently, there is no blood test for this.
Everything can be fine with the pituitary thyroid hormone giving you a “Normal” blood test, but there may be little thyroid hormone reaching your cells, keeping your body from functioning.
There are several conditions associated with abnormal thyroid transport into the cells. These include insulin resistance, diabetes, obesity, chronic and acute dieting, depression, anxiety, bipolar symptoms, neurodegenerative diseases, aging, chronic fatigue, physical stress, cardiovascular disease, fibromyalgia, chronic infections, chronic inflammation, chronic illness and those with high triglycerides and high cholesterol.
That includes just about everyone, doesn’t it?
Dieting actually causes a decreased TSH giving a “false negative” on a thyroid test. Stress significantly lowers T3 in the cells but the pituitary is unaffected, again giving a “false negative” test result.
After repeated dieting, those individuals had a 50% decrease in T4 and 25% decrease in T3 into the cells, yet lab tests continued to be normal. This is why it is so difficult for overweight individuals to lose weight. “As calories are decreased, thyroid utilization is reduced and metabolism drops”. (American Journal of Physiology-Endocrinology and Metabolism)
The summary of these studies report that TSH and T4 blood levels do not correlate with intracellular thyroid levels. It also said that treatment for Hypothyroidism should never be only T4 (Synthroid or Levoxyl) but should also include a form of T3 replacement. The study also said that TSH should not be used to determine proper or optimal treatment dose. This should be done based on the person’s symptoms.
Here is a list of symptoms of Hypothyroidism:
- Weight gain, hard to lose
- Eyebrow thinning, outer 1/3
- Rosy complexion
- Bags under eyes
- Hair loss, course, dry
- Easy bruising
- Fluid retention
- Pain in joints, muscles, lower legs/feet
- Low Body temperature
- Heat intolerance
- Cold hands and feet
- Decreased sweating
- Not motivated
- Numbness or tingling of extremities
- Heart Palpitations
- Short of breath/Difficulty breathing
- Choking Sensation
- Brittle nails
- Gets colds/flu
- Menstrual disorders
- Dry skin
- Impaired memory
- Chest pain
- Emotional instability
- Difficulty swallowing
- High cholesterol
- Slow mental activity
If you have 10 or more of these, you probably have Hypothyroidism and should find a doctor who understands the concept of cellular thyroid transport.
I am glad my medical school taught me to treat the person, not just a lab value. This has enabled me to help many with Hypothyroidism who had normal lab tests. I am glad that the medical research has caught up with what I was taught.