Treating Hypothyroidism

Are you sluggish for no reason and prone to weight gain, hair loss and brittle nails? You could be one of the many Americans suffering from thyroid dysfunction without knowing it. The condition is more common than once thought, especially in light of new clinical guidelines.

Physicians are treating more patients for hypothyroidism (underactive thyroid) following research findings that indicate even very mild cases, known as ‘subclinical hypothyroidism,’ can benefit from thyroid replacement therapy. A simple blood test can measure levels of thyroid stimulating hormone (TSH), a key indicator of thyroid function. If the thyroid gland does not produce adequate levels of hormones T3 and T4, the pituitary gland releases higher levels of TSH in an effort to stimulate hormone production. An underactive thyroid can cause the metabolism to slow, resulting in weight gain, fatigue, dry skin, brittle nails, hair loss and sensitivity to cold.

“About 20 years ago, thyroid replacement was the new diet pill because it revs up the metabolism, and for a while physicians were prescribing a lot of it,” says Dr. Teresa Knight, an obstetrician/gynecologist with Women’s Health Specialists of St. Louis. “Then the pendulum swung back the other way, and thyroid replacement wasn’t prescribed as much because it can suppress normal thyroid function in patients who don’t have true hypothyroidism.”

Knight says the debate continues over the range of laboratory test results that indicate treatment. “The challenge is that patients may present with symptoms that point to hypothyroidism, but their TSH levels fall within the ‘normal’ range,” she says. “That’s why I think it is important to test not only TSH, but also the amount of actual T4.”

As of this spring, most laboratories still recognize results between .5 and 5.0 as ‘normal’ reference levels for TSH. But recent recommendations based on new research suggest that patients who have a TSH of 2.5 or higher can benefit from treatment. “I typically treat patients who are at 2.5 or above if they are symptomatic,” Knight says. “I think the new guidelines recognize that we should be treating more patients, and that’s a good thing as long as the patient is monitored to make sure the dosage is appropriate.” She urges all women to request a TSH and T4 test in conjunction with their annual physical exam.

Although a patient may feel better once she’s taking thyroid replacement medication (Synthroid or the generic levothyroxine), Dr. Cheryl Shea, a chiropractic physician with Complete Wellness Center, suggests looking for the cause of the problem instead of merely treating the symptoms.

“In a functional model, we examine which pathways are not functioning,” she says. “Does the body have the materials—iodine and proper fats, to produce the hormone? Is the liver healthy enough to convert T4 to T3? Are the thyroid receptors altered by inflammation, vitamin A or zinc deficiencies?”

Dr. Robert Elder, a chiropractic physician with Metro Chiropractic and Nutritional Wellness Centre, agrees. “We really should be focusing on fixing the problem, not just covering up the symptoms with medications,” he says. “And herein lies our healthcare crisis in a nutshell, treating symptoms instead of addressing the cause of the problem, which is typically poor diet and overuse of stimulants like coffee, tobacco, sugar and pasta.”

Lab results offer only a brief view, Elder says, “like driving by a house at 55 miles per hour and catching a glimpse through a window for a split second. Nutrition response testing, which is the procedure we use, looks at the patient in ‘real time,’ giving us a much more accurate assessment,” he says. Elder says his practice seeks to “help supply the thyroid with the ‘genuine replacement parts’ it needs to heal through properly tested nutritional products.”