Thyroid Dysfunction

At the clinic, we have seen a surprisingly large number of patients, mostly women, who present with an array of symptoms that have gone unaddressed, usually for many years- despite persistent complaining to their doctors. Many of these women have been told that they are crazy or at least have psychological problems and they should seek counsel. This is such a large part of our practice that we feel it warrants a discussion. Almost every day, without fail, someone comes in with complaints consistent with hypothyroidism:

  • Cold
  • Constipated
  • Dry skin
  • Hair falling out
  • Swelling and fluid retention
  • Difficulty in concentrating (brain fog)
  • Brittle nails
  • Inability to get fever
  • Weight gain (or can not get it off)
  • Coarse skin-especially heels
  • Yellow palms
  • Cold feet (the spouses will admit to this!)

    These are but a few symptoms.

    Hypothyroidism may be the most under-diagnosed condition in this country and may contribute to a world of sluggishness and malady that can easily be remedied with a $5 prescription. The problem is that physicians are not willing to trust their clinical judgement, and would rather place it in the hands of the laboratory technician. It has become commonplace to draw laboratory studies to make determinations on thyroid function. The gold standard has become the thyroid stimulating hormone (TSH). We have had many patients who presented to the Clinic, reporting that the other doctor did not lay a hand on them. He did, however do a lab test and determine that their function was normal and therefore so were they. Remind you that this was the specialist, who was being seen only after actually begging the primary care doctor. Most of these patients leave the specialist's office discouraged and disappointed, afterall, he is the specialist. Please do not be discouraged. The symptoms you are experiencing are real and can be abated. You are not crazy.

    The problem with all this is the fact that the lab studies can be normal (and usually are most of the time), while the patient can truly be clinically hypothyroid. At the Clinic the majority (greater than 90%) of the patients with suspected hypothyroidism, who are eventually treated with replacement therapy, have normal lab studies.

    Have you all become numbers? Why is it that after so many visits, experts have continued to keep you in the same condition that you have been in for years? Why is it that we have been so jaded by the establishment that we continue to ignore the basic facts that are emphasized (hopefully) in our medical training? That is......examine the patient. It is astounding how many people present to the Clinic claiming that no one laid their hands on them. The sad thing is that it is a hands-on diagnosis, and most of the institutions are teaching a hands-off approach.

    The Basics

    Hypothyroid = Low Thyroid Function
    Hyperthyroid = Excessive Thyroid Function

    Obviously, these diagnoses are on opposite sides of the spectrum-one high, and one low. However, while the diagnosis of hyperthyroidism can easily be made by laboratory studies, the diagnosis of hypothyroidism very rarely follows the labs. Why?
    Without becoming too technical, the answers lie within the cells of the body. Inside of the cells of the body. From a laboratory stand point, we measure the thyroid function by peripheral blood work. We cannot determine moment by moment activity inside of the cells. This is where the true activity of the thyroid hormone is taking place. Thyroxine (or T4), which is produced in the thyroid gland in the neck, must travel to each and every one of the cells in the body and be converted into Tri-Iodothyronine (T3) inside of the cells of the body. The molecular difference between these two substances is essentially very minuscule (T3 has one less Iodine atom), while the functional difference is what makes this discussion pertinent. T3 is the active hormone. That is, it causes all of the metabolic activity that we discussed previously. T4 does not. It must be converted into T3.

    Several things prevent the conversion of T4 to T3:


    Why Can't They Fix It?

    Perhaps this is just plain oversight. It would seem simple to understand that if you could not convert T4 to T3 then why would you continue to give T4 despite the continuation of symptoms? This is what is going on----if you are lucky enough to get your doctor to give you thyroid replacement medications. Most probably, he/she is giving you Synthroid. Problem? Synthroid is synthetic thyroid (syn/throid), and is composed only of T4. The missing component is T3 and needs to be replaced as well. At the Clinic we use Armour Thyroid. It is a desiccated thyroid hormone from the glands of pigs, which contains all of the components (T4, T3, etc.) and is regulated by the United States Pharmacopoeia (USP). Many physicians will tell you that Armour is not regulated, and this is still quite confusing to us as it bears the USP seal and can be found in the Physician's Desk Reference (PDR). They can say what they want, but many thousands of patients have found great relief in replacement therapy with Armour, and a large percentage of those presented while on Synthroid. If you are on Synthroid and you have any of the symptoms listed at the top of the screen, perhaps you should be asking questions. If you have symptoms and your doctor will not address them, get another doctor.

    This is not a monopoly.
    Find someone who will listen to you. Do not give up. You are not crazy.

    Easy Testing For Hypothyroidism:

    Basal Body Temperature-One of the most common complaints from people with hypothyroidism is the fact that they have low temperature. Some patients cannot even generate a temperature when they are seriously ill. You may be or know someone who rarely exceeds 98 or 99 degrees at the height of their flu or pneumonia. This may be confusing for those of you who are going through menopause or peri-menopause, but that is for another discussion. In general, you know who you are (Many of you have been dealing with this since childhood). An easy way to evaluate this is to take your resting body temperatures first thing in the morning.

    You will need a thermometer which is to be shaken down at night before retiring, and placed on the bedside table. Immediately upon awakening, without stirring (i.e., no excessive movements), reach for and place the thermometer in your mouth. Record the temperature each morning for 10 days. Many of you will be below 97 degrees. Do not let your doctor dismiss these findings, especially in the face of some of the aforementioned.

    Exceptional reading for those interested will be found in a book by the late Dr. Broda Barnes entitled Hypothyroidism: The Unsuspected Illness.

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