Let’s start with two thyroid facts:
The diagnosis of hypothyroidism (low levels of thyroid hormone) is missed by most physicians. Patients arrive with obvious symptoms of hypothyroidism every doctor learned in medical school: sensitivity to cold, hair loss, weight gain, dry skin, fatigue, constipation, depression, irregular periods, and infertility.
The doctor listens, sometimes attentively, and then orders a TSH (thyroid stimulating hormone) blood test. TSH is not produced by the thyroid itself, but rather from the pituitary gland, a Wizard of Oz grape-size powerhouse sitting majestically in a saddle beneath your brain controlling your thyroid along with your adrenals and your ovaries or testes depending on your chromosomes.
Understand that a high TSH level indicates low thyroid function. Think of your pituitary churning out this hormone in an attempt to stimulate your thyroid. If your TSH is within the normal range (currently 1.0 to 5.0), you’re told that low thyroid is not a problem and you’re sent on your (less than) merry way, tired, cold, sluggish, and depressed, thinking, “I thought it was my thyroid.”
What your doctor should be measuring are your actual thyroid hormones, T3 and T4, and also testing you for the very commonest of the over 100 autoimmune diseases called Hashimoto’s thyroiditis, in which the immune system attacks and slowly destroys the thyroid.
She also should know that many endocrinologists now believe any TSH test result above 2.5 should be treated as an indicator of low thyroid function. Probably 20% to 30% of adults do feel fatigue when their TSH is higher than 2.5.
On the opposite end, patients themselves do have a tendency to overdiagnose their hypothyroidism.
If you go online and start reading websites devoted to the thyroid gland and underactive thyroid, someone somewhere has attributed every possible discomfort the human body can experience to low thyroid.
Take being overweight as an example. Let’s face it: a single daily thyroid tablet for weight loss would be a whole lot easier than eating healthfully and pumping on your Peloton. It’s human nature to pray that the villain of your middle-age spread is an underactive thyroid rather than an overactive fork.
Early Days of Underdiagnosed Hypothyroidism
The first physician to point out that hypothyroidism was likely being badly underdiagnosed by doctors was Broda Barnes, M.D., a Rush Medical College-trained physician and professor at the University of Illinois College of Medicine.
Noting the consistently low body temperatures of low-thyroid patients, he standardized a basal body temperature self-test you can find here.
We use it regularly at WholeHealth Chicago. Barnes drew the line at 97.8 (recently changed to 97.6) and felt that any temperature lower than that in a person who also had symptoms of low thyroid merited a trial of thyroid hormone treatment.
The Barnes self-test never caught on with a majority of physicians, mainly because the TSH blood test was discovered at about the same time and seemed more scientific. These days, an increasing number of you bring your basal temperatures to your doctors as evidence of self-diagnosed hypothyroid status.
It’s likely your doctor hasn’t a clue about Barnes and his work, but to reassure you, your doc may actually order a TSH test. If it comes back normal (below 5.0), you’ll hear, “Your thyroid’s fine,” but in your heart, you know better.
With GREAT perseverance, you’ll eventually locate a physician to write a thyroid prescription based on your symptoms and basal temperatures.
But then you’ll face Challenge #2.
You want natural thyroid. You don’t want the synthetic one—Synthroid, a.k.a. Levoxyl, levothyroxine.
Now you might find yourself facing a stone wall of physician resistance.
“Okay,” you think. “She met me halfway. At least I got my thyroid. What can I lose?”
Well, if you get a copy of Janie Bowthorpe’s, Stop the Thyroid Madness, or visit her website…
She’ll teach you all about natural (desiccated) porcine thyroid. And why, for many people, the synthetic simply doesn’t cut it.
If you struggled to get a thyroid prescription, trying to get a natural thyroid Rx can be epic.
Ineffective Thyroid Replacement: What Next?
But what happens when you take the prescribed thyroid replacement and nothing happens?
Your hopes are dashed. You’re still cold, tired, and, worse than anything, you haven’t lost an ounce. What went wrong?
Don’t give up! There are several avenues for consideration:
1. Your dose isn’t high enough.
A definite possibility—but don’t increase it on your own. Dose adjustment is not DIY healthcare. Let your doctor adjust your dose by listening to your symptoms and tracking the results of a full thyroid panel (TSH, T3, T4).
Some patients feel best being a scoatch under hyperthyroid (a scoatch is slightly less than a smidgen), but going around in a self-induced overactive thyroid state (called factitious hyperthyroidism) is simply unhealthy.
2. The thyroid replacement product isn’t right for you.
Conventional physicians have been brainwashed to prescribe Synthroid/Levoxyl, a synthetic T4 that replaced Armour’s dried (desiccated) pig (porcine) thyroid in the 1960s (older Chicagoans still remember Armour as a meat-packing company).
T4 triggers cells outside the thyroid to make T3, the active form of the hormone. Some people have better T4-to-T3 conversion systems than others. The original Armour thyroid was a blend of T4 and T3 and very similar to human thyroid.
Several years ago, Armour was acquired by a Big Pharma company that changed the manufacturing process and bollixed it up.
The name of the best natural thyroid is easy to remember: NP Thyroid
It is basically the same as the original Armour thyroid before 1960. It is available in all pharmacies and covered by your insurance.
3. You may have an issue with T4 altogether and may need pure T3 (liothyronine, Cytomel) added to your T4 as a separate prescription.
Since T3 is much more potent than T4, your initial dose will likely be quite small, on the order of 5 mcg (mcg stands for micrograms, one millionth of a gram or one thousandth of a milligram). If you’re prescribed Cytomel, never ever self-treat (“Oh, I’m feeling so fat today, I’ll just take a few extra Cytomel”). Yikes! Too much Cytomel can trigger very unpleasant side effects and potentially dangerous heart arrhythmias.
4. You may be taking Cytomel (T3), but feel an afternoon crash.
This is because T3 has a short half life and disappears quickly from the body. You might feel better if you spread your dose throughout the day–e.g., 5 micrograms three times daily. There are also capsules of slow-release T3 available, but you’d need to get these from a compounding pharmacist. It can be expensive and is rarely covered by insurance.
5. You may be sensitive to one of the ‘fillers’ in your thyroid tablet which is preventing absorption of the thyroid hormone itself.
Since one of the fillers can include gluten, you may improve if you have known food sensitivities. Tirosint a new form of levothyroxine in a capsule with all fillers, etc. removed.
6. You may have forgotten about your adrenal glands.
Your thyroid and adrenals are both pituitary-controlled, stress-responding glands. When you’re under chronic stress, both can become fatigued. If you start treating for low thyroid, your increasing metabolism may place an extra burden on your adrenals. Symptoms of adrenal fatigue can mimic hypothyroidism. Pure Encapsulations ‘Adrenal’ is available from our apothecary. Start two capsules every morning if you don’t feel improvement with thyroid hormone replacement. Consider also an Adrenal Stress Test through your Functional Medicine Practitioner, a one day measurement of your cortisol levels using saliva.
7. You may have overlooked selenium.
It’s only recently been shown that diets low in selenium can mimic hypothyroidism. You needn’t add another supplement for this. Just eat some selenium-rich foods—they’re all quite tasty.
8. Don’t increase your thyroid dose without professional supervision.
I’m well aware of Denis Wilson, MD’s, work and his “Wilson’s Temperature Syndrome,” which is essentially Broda Otto Barnes revisited along with time-release Cytomel in place of desiccated porcine thyroid. But Cytomel is simply too powerful for you to play with on your own.
9. Remember that fatigue is one of the most common problems people bring to their primary care physicians.
There are dozens of causes of fatigue. If your pursuit of hypothyroidism doesn’t pan out, don’t give up. There’s a whole series on our website entitled ‘Root Causes of Chronic Fatigue.” Keep reading and researching. For a complete evaluation of YOUR fatigue issues, schedule with one of our Functional Medicine WholeHealth Chicago practitioners.
Be well,
David Edelberg, MD