National Thyroid Awareness Month
January is National Thyroid Awareness Month and gives us a good opportunity to talk about the thyroid. The thyroid is a gland in the neck that produces thyroid hormone, which is vital to so many metabolic functions of the body. Thyroid is so important to the heart, brain, liver, kidneys and skin; just to name a few.
Symptoms of hypothyroidism listed by the Mayo Clinic are as follows:
- Increased sensitivity to cold
- Dry skin
- Weight gain
- Puffy face
- Muscle weakness
- Elevated blood cholesterol level
- Muscle aches, tenderness and stiffness
- Pain, stiffness or swelling in your joints
- Heavier than normal or irregular menstrual periods
- Thinning hair
- Slowed heart rate
- Impaired memory
- Enlarged thyroid gland (goiter)
What we are noticing is that hypothyroidism goes undiagnosed. It usually takes months or years before it is formally diagnosed. There may be a reason for that and the reason for this discussion. Science surrounding the thyroid conditions has grown tremendously over the last decade or so.
Much of the undiagnosed thyroid conditions could be due to the lab testing done. Traditional medicine only test for Thyroid Stimulating Hormone (TSH) and Thyroxine (T4). That is the way medical, nursing, and pharmacy schools trained us. However, many healthcare providers have not kept up with the advances in health care, particularly to the thyroid.
We have found out there are three different enzymes used to control thyroid function. T4 mentioned above is the inactive form of thyroid hormones. T4 must be converted to the active form, Triiodothyronine (T3) for proper thyroid function. The three enzymes are Type 1, Type 2, and Type 3 Deiodinase. We will refer to these as D1, D2, and D3 going forward.
Now to explain why traditional testing may not be adequate for diagnosing thyroid dysfunction. This will get a little technical, so please hang in there. D2 is the primary enzyme converting T4 to T3 in the pituitary, while there is little D1 in the pituitary. D1 converts T4 to T3 at the cellular level. This is where the metabolism and other functions of thyroid has its important effects on the body.
D3 converts T4 to anti-thyroid T3 or reverse T3 (rT3). D3 competes with D1 and Reverse T3 competitively blocks the receptors for the active T3 thyroid hormone. It also prevents the uptake of T4 and T3 into the cells.
What does all this mean? To keep it simple, blood test for TSH and T4 can be normal, but T3 can be suboptimal. Therefore, rT3 and T3 should be tested as well. One can have normal blood levels of TSH and T3 with hypothyroidism at the cellular level. You can be deficient in T3 in the tissue, causing hypothyroid symptoms when the blood levels of TSH and T4 do not indicate it.
The following conditions can up-regulate the D3 enzyme converting T4 to rT3 and causing worsening of the above situation:
- Chronic emotional or physical stress
- Chronic illness
- Insulin resistance
- Leptin resistance
- Chronic fatigue syndrome
- Both dieting and weight gain.
So, what would be a better lab testing for making sure we do not miss anything surrounding the thyroid? What is now recommended in thyroid testing is TSH, T4, T3, rT3, TPO antibodies, Antithyroglobulin antibodies, Iron, and Ferritin. The antibodies are checked to make sure there is no auto-immune situation going on with he thyroid. Iron and Ferritin are important to the production of the thyroid hormones and need to be checked.
What about treatment or support? We have a very good evaluation form that we send out by email to patients needing counseling. Once we get it back and review the labs and evaluation forms, we can make recommendations to the patient and to their doctor. Even with the forms being prefilled out, I will still spend close to 45 minutes to an hour with the patient. The protocol is relatively simple, but thorough. We make recommendations based on all the above.
Here are some examples of what we may recommend to you and your physician:
- We do recommend Iodine or T4 if a patient has a goiter.
- We will recommend T3 or T4/T3 if the T3 is low.
- We will recommend decreasing the T4 or eliminate it if the patient is taking T4/T3 combination if the rT3 is elevated.
- We recommend Selenium and Zinc for thyroid support. These minerals are necessary for proper thyroid function.
For Hashimoto’s disease, an autoimmune disease where antibodies attack its own thyroid, we recommend a gluten free diet, 4 R Program (restoring gut to a healthy state), Liposomal Glutathione (a very potent antioxidant), and Low-Dose Naltrexone (LDN). Check out our blogs discussing LDN if you are interested in learning more about LDN.
I found a great website that does an excellent job with this discussion at the National Academy of Hypothyroidism. It has cited 283 articles from medical journals as references! That is a lot of supporting evidence.
Do you have any questions concerning thyroid function or testing? You can call us at 251-626-2820 or toll free at 866-591-6337. You can also click on the button below for consultation for patients and we can get you scheduled. We can email you the evaluation forms and schedule a full consult if needed.
C. Craig Wells, RPh