Let me start by saying that the majority of board-certified endocrinologists give me a pain. They’re internists, like me and our newest WholeHealth Chicago physician Neeti Sharma, MD, but they have additional training via endocrinology fellowships.
Somewhere along the way, many of them become almost too academic, no longer actually listening to patients but rather focused totally on lab test results.
This can be a real disservice to their female patients especially. Women, far more than men, can sense when their hormones are out of whack, whether they’re feeling the effects of an underactive or overactive thyroid, adrenal fatigue, or some imbalance in the monthly hormonal roller-coaster ride of their menstrual cycles (or the relentless downhill course of hormone depletion in menopause).
Moreover, women are eight times more likely than men to have thyroid problems.
I’m not suggesting that women are 100% accurate in their ability to self-diagnose conditions such as subclinical hypothyroidism, estrogen-dominant premenstrual syndrome, or adrenal fatigue, but rather that they deserve more than being dismissed with a brusque “Your TSH is normal” or “There’s no such thing as adrenal fatigue.”
Powerful, powerful hormones
Hormones, which are molecules produced by your endocrine glands, are astonishingly formidable little units. They’re made even more powerful because certain cells (called target cells) have actual hormone landing sites (called receptor sites).
How mighty are hormones? Well, for example, the amount of estrogen in a typical birth control pill is measured in micrograms, or one millionth of a gram. If you removed all the binding material from a birth control pill, the amount of hormone it contains would be virtually invisible. You cannot actually see something that’s one millionth of a gram.
But ponder the power of a birth control pill when you take it. Not only is it capable of shutting down ovulation (release of eggs), but glance at the package insert and brace yourself for the hundreds of side effects these micrograms can trigger.
Thyroid hormones, underactive and overactive
Today let’s discuss your thyroid gland and the hormones it releases. Future Health Tips will address functional medicine’s approach to your adrenal glands and your sex glands.
Here’s a list of symptoms associated with hypothyroidism (low thyroid). Brace yourself.
–Dry, coarse and/or itchy skin
–Dry, coarse and/or thinning hair
–Feeling cold (wearing a sweater in summer!)
–Feeling rundown and sluggish
–Infertility and miscarriage
–Irregular menstrual flow
–Low sex drive
–Unexplained or excessive weight gain
Other signs that are potential symptoms of hypothyroidism and Hashimoto’s thyroiditis (the most common cause of hypothyroidism) include:
–Candida (yeast overgrowth)
–Difficulty expressing yourself
–Digestive discomfort or diarrhea
–Feeling socially distant
–High LDL cholesterol
–Hypoglycemia (low blood sugar)
–Irregular menstrual flow
–Lack of motivation
–Low level of vitamin B12
–Low level of ferritin (iron) or anemia
–Low level of vitamin D
–Low sex drive
–Muscle cramps and muscle loss
–Throat discomfort and/or tightness
Now, honestly, if I showed this list to any second-year medical student (or really anyone who uses Dr. Google regularly), he or she would diagnose hypothyroidism. But to this day, physicians are encouraged to limit their thyroid testing to one test only: the TSH (thyroid-stimulating hormone).
TSH is a hormone that isn’t even produced by your thyroid gland, but rather by your pituitary gland, the so-called master gland that stimulates the thyroid when it senses thyroid underactivity.
Thus the TSH test measures your thyroid levels only indirectly. If your pituitary is producing too much TSH, it’s inferred that your thyroid must be underfunctioning.
Endocrinologists have decided that if your TSH level is 4 or higher you probably have an underactive thyroid. It is truly ironic that this number was only established relatively recently. For decades the standard was 5 or higher and it’s estimated the number of missed hypothyroid diagnoses was in the millions.
But hypothyroidism isn’t the only thing affecting your TSH. Your test result can be influenced by what you eat, your stress levels, the time of day your blood is drawn, and even the lab chosen by your physician.
Am I making it clear that relying solely on a TSH test result to diagnose thyroid problems is not a good idea? Instead, docs need to test thyroid function.
Functional medicine and your thyroid
A functional medicine approach to your thyroid begins with the doctor herself having in mind that hypothyroidism is more common than most doctors realize and is likely the single most overlooked diagnosis.
An underfunctioning thyroid (hypothyroidism) or overfunctioning thyroid (hyperthyroidism) likely affect one quarter of women over 30. And up to 60% of this group are unaware that thyroid function is an issue. If a doctor is always suspecting hypothyroidism, she’ll rarely miss the diagnosis. This requires that she listen, listen, and listen some more to her patient.
(A nice pair of rules I learned in medical school: If you listen long enough and carefully enough to your patient, she’ll tell you her diagnosis. Use tests to confirm what she’s told you.)
Now go back and glance at that list of possible symptoms. Obviously, for virtually all of them, there are other possible causes, but a relatively small number of lab tests can eliminate any that aren’t being caused by hypothyroidism.
Functional medicine tests for thyroid issues
So what tests are needed to diagnose an underactive thyroid? Here’s the list from Janie A. Bowthorpe’s excellent Stop The Thyroid Madness website. A list like this lies at the heart of functional medicine because each item revolves around how your body is functioning with its current supply of thyroid hormone. (Bowthorpe’s book is really good too.)
—TSH (thyroid-stimulating hormone). Since this hormone comes from the pituitary gland, at best it tests pituitary function. High TSH usually means underactive thyroid, but low TSH in the presence of hypothyroidism means pituitary insufficiency.
—Free T3 and Free T4. These are measurements of the actual thyroid hormones themselves.
—Reverse T3 (rT3). This is an “inactive” hormone that can appear in some cases of hypothyroidism. Your body should convert inactive T4 to the active hormone T3, but under certain stresses it makes rT3 instead. By itself, reverse T3 is not a helpful test, but it should be viewed in context of thyroid function.
—Thyroid antibodies. The most common autoimmune disease and cause of hypothyroidism is Hashimoto’s thyroiditis. The presence of thyroid antibodies clinches a Hashi diagnosis. Some physicians, especially in Europe and the UK, start thyroid hormone replacement when antibodies are present.
—Iron profile (ferritin, percentage iron saturation, iron binding capacity). Symptoms of low iron are often indistinguishable from hypothyroidism.
—Saliva adrenal cortisol. The same goes for adrenal fatigue, but more about this next week.
—Vitamins D, B-12 and folate. More on this next week too.
—Sex hormones (estrogen, progesterone, testosterone) measured throughout a one-month cycle. Single-day test is fine for postmenopausal women.
—MTHFR gene mutation tests susceptibility to heavy metals damaging thyroid. If MTHFR inherited from both parents, test for metals.
—Complete blood count and comprehensive metabolic profile. This is the standard wellness profile your doctor orders when you get a general check-up. It can yield a lot of useful information.
–Basal body temperature measurement for five days in a row. This is your oral temperature just as you emerge from sleep (click here for full instructions) If you’re a menstruating women, take your temp for five straight days beginning with the second day of your period (to avoid the normal temperature rise that occurs with ovulation). An average temperature of 97.6 or lower make a diagnosis of mild hypothyroidism a strong possibility. The test is less useful for adjusting your dose once you’ve started thyroid replacement.
Endocrinologists rarely order anything like these tests when approaching a patient with low thyroid. This is a problem that reflects being over-trained in a single specialty instead of taking a more holistic view and treating the whole patient.
When it comes to treatment, endocrinologists like the synthetic Synthroid (Levoxyl) and disparage any use of natural (desiccated) thyroid as old fashioned. They may be unaware that when Synthroid was first released the advertising campaign was based on denigrating natural thyroid (then called Armour thyroid, though today there are several brands).
In other words, endocrinologists dislike desiccated thyroid because they fell for an advertising campaign. A campaign, in fact, that years later was proven false and misleading and which subjected its Big Pharma company to a hefty financial penalty.
Oh well. Nobody ever said that having an MD after your name immunizes you from gullibility.
David Edelberg, MD