Posted 05\/28\/2012<\/p>\n\n\n\n
I went to medical school in London for awhile and quite honestly didn\u2019t learn much. But it was the 1960s and if you were going to be anywhere on the planet, central London was the place to be. The fact that the hospital to which I was assigned had a pub in its basement (where everyone, even a few patients, would gravitate around 4 pm) alerted me to the fact I wasn\u2019t in Kansas anymore.<\/p>\n\n\n\n
I finished my term 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 in a waft of 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 \u201cSir\u201d) inebriate with a W.C. Fields nose: \u201cLab tests. American doctors with their lab tests. If you listen to your patient long enough and use your brain, you\u2019ll make the diagnosis without any of that foolishness.\u201d And the equally valid corollary, \u201cNever rely on a lab test for your diagnosis. Let the lab test confirm your diagnosis, not make it.\u201d<\/p>\n\n\n\n
These simple rules 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 symptoms yet perpetually hear, \u201cWell, I know your symptoms do sound like low thyroid, but see for yourself–your tests are normal.\u201d<\/p>\n\n\n\n
Fatigue, gradual weight gain and inability to lose it, dry skin and dry hair with 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, constipation. Having had low thyroid once myself, I can report it\u2019s a strange sense of internal coldness. You\u2019re outside and it\u2019s in the 90s, yet you feel cold inside.<\/p>\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. 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\u2026via your master gland, the pituitary, which controls both thyroid and adrenals.<\/p>\n\n\n\n
It\u2019s been the medical profession\u2019s over reliance on the familiar TSH test (thyroid-stimulating hormone), developed in the 1960s, that\u2019s led to so much missed hypothyroidism. (You may need to read this next paragraph twice. It confuses medical students, too.) TSH is released by the pituitary to stimulate the thyroid to make more of its hormone. The pituitary has a hormone-sensing system, so when thyroid hormone levels are low TSH goes up to stimulate the thyroid to make more hormone.<\/p>\n\n\n\n
Remember the rule: if you have a high TSH, your thyroid hormone is low. By the way, the opposite is also true. Too much hormone (hyperthyroidism) lowers TSH levels, sometimes as low as zero. Uh, except not always.<\/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 (have low thyroid) and 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 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 You hand him an article from the internet. \u201cThyroid fatigue? Never heard of it.\u201d<\/p>\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
It\u2019s estimated that tens of millions of people have undiagnosed mild hypothyroidism, all because their physicians weren\u2019t in Professor (Sir) Carrick\u2019s lecture hall that morning as I listened to the elderly bleary-eyed old debauchee raise his finger skyward and ring out with, \u201cTreat the patient, not the lab test!\u201d<\/p>\n\n\n\n
It\u2019s a pity we don\u2019t.<\/p>\n\n\n\n
Be well,<\/p>\n\n\n\n
David Edelberg, MD <\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Posted 05\/28\/2012 I went to medical school in London for awhile and quite honestly didn\u2019t learn much. But it was the 1960s and if you were going to be anywhere on the planet, central London was the place to be. The fact that the hospital to which I was assigned had a pub in its […]<\/p>\n","protected":false},"author":2087,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,195,130,3,70],"tags":[471,1390,1391,1392,1327,366,1393,1394,1167,472,576],"class_list":["post-4741","post","type-post","status-publish","format-standard","hentry","category-blog","category-diseases","category-integrative-medicine","category-knowledge-base","category-s","tag-basal-body-temperature","tag-cold-hands-and-feet","tag-dry-hair","tag-dry-skin","tag-hashimotos-thyroiditis","tag-hypothyroid","tag-mental-sluggishness","tag-thinning-hair","tag-thyroid-fatigue","tag-tsh","tag-weight-gain"],"yoast_head":"\r\n