{"id":29919,"date":"2021-10-31T21:19:02","date_gmt":"2021-11-01T02:19:02","guid":{"rendered":"https:\/\/wholehealthchicago.com\/blog\/?p=29919"},"modified":"2022-11-14T13:48:31","modified_gmt":"2022-11-14T19:48:31","slug":"root-causes-of-chronic-fatigue-part-2-minimally-underactive-thyroid","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2021\/10\/31\/root-causes-of-chronic-fatigue-part-2-minimally-underactive-thyroid","title":{"rendered":"Root Causes of Chronic Fatigue, Part 2: Minimally Underactive Thyroid"},"content":{"rendered":"\n

I went to medical school in London for a while and truly it was great fun. This was the 1960s–Beatles, Stones, Carnaby Street–and if you were going to be anywhere on the planet, central London was it.<\/p>\n\n\n\n

The newly released thriller \u201cLast Night in Soho<\/a>\u201d really captures the atmosphere. Middlesex, my assigned hospital, was located in the very heart of Soho. It had a pub in the basement where doctors, nurses, students, and even a few patients gravitated around 4 pm. I knew I wasn\u2019t in Kansas anymore.<\/p>\n\n\n\n

I finished my London rotation with precisely two pieces of memorable knowledge. First, I was endlessly reminded by fellow students, \u201cWe\u2019re not at all like you Americans. Medical students here learn to be gentlemen first, doctors second.\u201d This was usually delivered on a waft of warm beer breath, so I couldn\u2019t take it too seriously, but I liked the line. It went well with the phony British accent I was developing.<\/p>\n\n\n\n

Second, and this from a highly respected (and genuine knighted Sir) inebriate physician with a W.C. Fields nose: \u201cLab tests. You American doctors with your lab tests. If you just listen to your patient long enough and use your brain, you\u2019ll make the diagnosis. Then use the lab test to confirm your diagnosis, not make it. The amateur doctor orders lots of tests and looks for one abnormal result. The expert orders one test to confirm what he already has deduced.\u201d<\/p>\n\n\n\n

Believe me, when you\u2019re a 20-something medical student standing in the corridor of a hospital founded in 1745, that sounds like the key to everything.<\/p>\n\n\n\n

Sadly, the simple rule about listening to the patient and limiting tests never did manage to cross the Atlantic. As a result, millions of women (and many men as well, but women are primarily affected) experience a wide spectrum of underactive thyroid<\/a> symptoms yet perpetually hear, \u201cI know your symptoms do sound like low thyroid, but see for yourself–your tests are normal.\u201d<\/p>\n\n\n\n

Symptoms<\/h3>\n\n\n\n

The primary low thyroid symptom is feeling tired, a sense of fatigue that usually starts in your 30s and slowly gets worse. You\u2019re not so tired that you\u2019re confined to bed, but you\u2019ve started turning down social invitations, and maybe when you\u2019re with friends in the evening you\u2019re the first to go home because you\u2019re just tired out. You didn\u2019t used to feel this way. You wonder if it\u2019s chronic fatigue syndrome.<\/p>\n\n\n\n

You\u2019re also dismayed with your gradual weight gain and inability to lose it. With the dry skin, dry hair, and hair thinning (and thinning of the outer third of your eyebrows), facial puffiness, mental sluggishness, cold hands, cold feet, being always the coldest one in a group of people, and constipation.<\/p>\n\n\n\n

Having had low thyroid once myself, I describe it as a strange sense of internal coldness. You\u2019re outside and it\u2019s in the 90s, but you feel cold inside.<\/p>\n\n\n\n

You mention this to your doctor during your regular wellness exam or Pap smear and all your tests, including a single thyroid screening test, end up being normal.<\/p>\n\n\n\n

Causes<\/strong><\/h3>\n\n\n\n

After age 40, it\u2019s estimated about 25% of people have symptoms of diminished thyroid function, called hypothyroidism. There are two causes.<\/p>\n\n\n\n

First, a condition called Hashimoto\u2019s thyroiditis, an autoimmune disorder in which the immune system starts creating antibodies against the thyroid gland (and only the thyroid gland), slowly but relentlessly destroying it. Most doctors won\u2019t treat Hashimoto\u2019s until hormone levels fall into the abnormally low range<\/p>\n\n\n\n

Second, a controversial condition called thyroid fatigue. In this case, the gland is simply pooped out, exhausted (often along with your adrenal glands) from having received incessant fight-or-flight stress messages along the emergency path from your brain. These messages are relayed via your pituitary, the master gland that controls both thyroid and adrenals.<\/p>\n\n\n\n

It\u2019s been the medical profession\u2019s over-reliance on the familiar TSH (thyroid-stimulating hormone) test, developed in the 1960s, that\u2019s led to so much missed hypothyroidism.<\/p>\n\n\n\n

(You may need to read these next sentences twice. It confuses medical students, too.) TSH is released by the pituitary, located just beneath your brain, to stimulate your thyroid to make more of its hormone. The pituitary has a hormone-sensing system, so when thyroid hormone levels are low, TSH levels will increase in an effort to boost them.<\/p>\n\n\n\n

This is the rule that US doctors are taught: if your patient has a high TSH,<\/p>\n\n\n\n

thyroid hormone must be low. Period. The end.<\/p>\n\n\n\n

If the TSH test is normal, even though you the patient may have every low-thyroid symptom in the book, your doctor will simply not consider underactive thyroid as a diagnosis.  By the way, the opposite is also true. Too much hormone (hyperthyroidism) lowers TSH levels, sometimes as low as zero. <\/p>\n\n\n\n

Depending on the lab your doctor uses, the official normal range for TSH is generally between 1.0 and 5.0. If your TSH is above 5.0, you\u2019re declared hypothyroid (you have low thyroid) and you\u2019ll be started on thyroid replacement hormone. To this day, if you go to the doctor with every single symptom of hypothyroidism listed above and your TSH is 4.9, you\u2019ll be told, \u201cLet\u2019s keep an eye on it\u201d and you\u2019ll leave the office untreated, feeling just as crappy as when you arrived.<\/p>\n\n\n\n

It\u2019s even worse if your hypothyroidism is due to thyroid fatigue, because in this situation, your pituitary, having been bombarded with stress messages from your brain, is fatigued and depleted as well. So you\u2019ll have all the symptoms of low thyroid and a \u201cmysteriously\u201d low TSH. Your doctor may shake his head in wonderment, \u201cI agree. You sure look hypothyroid, and your hormone levels are on the low side, too, but your TSH is so low, why, you\u2019re almost hyperthyroid.\u201d<\/p>\n\n\n\n

You hand him an article from the internet. \u201cThyroid fatigue? Never heard of it.\u201d<\/p>\n\n\n\n

Breakthrough recommendations<\/strong><\/h3>\n\n\n\n

Recent research in laboratory testing has uncovered three important breakthroughs that haven\u2019t filtered down to most conventional labs and therefore to most primary care offices.<\/p>\n\n\n\n