Understanding Your Thyroid
What is the thyroid?
The thyroid gland is a small organ that’s located in the front of the neck, wrapped around the windpipe (trachea). It’s shaped like a butterfly, smaller in the middle with two wide wings that extend around the side of your throat. The thyroid is a gland. You have glands throughout your body, where they create and release substances that help your body do a specific thing. Your thyroid makes hormones that help control many vital functions of your body.
When your thyroid doesn’t work properly, it can impact your entire body. If your body makes too much thyroid hormone, you can develop a condition called hyperthyroidism. If your body makes too little thyroid hormone, it’s called hypothyroidism. Both conditions are serious and need to be treated by your healthcare provider.
Who is affected by thyroid disease?
Thyroid disease can affect anyone — men, women, infants, teenagers and the elderly. It can be present at birth (typically hypothyroidism) and it can develop as you age (often after menopause in women).
Thyroid disease is very common, with an estimated 20 million people in the United States having some type of thyroid disorder. A woman is about five to eight times more likely to be diagnosed with a thyroid condition than a man.
You may be at a higher risk of developing a thyroid disease if you:
Have a family history of thyroid disease.
Have a medical condition (these can include pernicious anemia, type 1 diabetes, primary adrenal insufficiency, lupus, rheumatoid arthritis, Sjögren’s syndrome and Turner syndrome).
Take a medication that’s high in iodine (amiodarone).
Are older than 60, especially in women.
Have had treatment for a past thyroid condition or cancer (thyroidectomy or radiation).
The thyroid gland controls metabolism in every cell of the body. A thyroid deficiency can cause a multitude of symptoms, the classic ones being weight gain, dry skin, poor nails, low body temperature, sluggishness, and memory problems. In women, other common symptoms are blood clots during their periods and hair loss. Thyroid hormone controls the rate at which calories are burned to produce energy. Dr. Atkins, originator of the Atkins Diet, has stated that the number one reason for “metabolic resistance”—the term he uses to describe the inability to burn fat—is a thyroid deficiency.
Two types of thyroid hormones
Although many people don’t realize it, there are actually two thyroid hormones, triiodothyronine (T3 - which contains three iodide atoms) and thyroxine (T4 - which contains four iodide atoms ). The thyroid gland produces and releases T4, which goes to the liver, where it is converted into T3. T4 is essentially a storage hormone. T3, the active form of thyroid, is responsible for about 90% of its functions. Obviously, any problem resulting in a lack of T3 will create low thyroid symptoms.
5 Things You Need Know about Treating Thyroid Symptoms
1) Testing and Medicating
Unfortunately, most doctors test only for T4 and regard it as the barometer of a person’s metabolic health. They don’t realize that some people can have a perfectly normal T4 level and still be hypothyroid (lacking in sufficient thyroid hormone) because of an inability to convert T4 into T3. This situation occurs frequently when people have excess adrenaline. In this situation, people may be under stress, which causes the release of cortisol. Cortisol is an anti-thyroid hormone - it prevents the conversion of T4 into T3, and causes T3 to convert into reverse T3 which has no activity.
The most commonly prescribed medications for low thyroid conditions are Synthroid, Levoxyl, and levothyroxine. These are T4 preparations—which means that most people who exhibit low thyroid symptoms are being given something that may or may not address their problem. Their doctors continue to prescribe the T4 preparation despite the lack of symptom relief because their blood tests show normal T4 levels. Unfortunately, doctors often treat blood tests instead of patients.
T3 preparations are available, but they are often not utilized by the medical community. In addition, there are a number of medications that interfere with thyroid metabolism and prevent or slow the conversion of T4 into T3. This includes statin-type drugs such as Lipitor and Zocor. These lower coenzyme Q-10, a factor necessary for thyroid conversion.
Ironically, one of the most common reasons for an elevated cholesterol level is an under-active thyroid. This means that people who take statin-type drugs for cholesterol are using a thyroid-blocking drug to treat a condition that may be caused by an under-active thyroid in the first place. Quite often, people with an elevated cholesterol might be low in thyroid. In fact, in the old days, cholesterol used to be called “the poor man’s thyroid test.”
Beta-blockers such as atenolol and Lopressor are an additional type of medication that interfere with thyroid metabolism. They also block the conversion of T4 into T3. These drugs are often prescribed by cardiologists for their heart patients to reduce the workload of the heart. However, they almost guarantee weight gain, which is, ironically, one of the most significant risk factors for coronary artery disease.
2) Thyroid Stimulating Hormone
One cannot underestimate the importance of knowing about thyroid metabolism. My sense is that millions of people are being improperly treated, or not treated at all, for an under-active thyroid condition. The reasons are twofold: the failure of many doctors to treat patients rather than lab tests, compounded by the failure of many doctors to interpret laboratory tests logically.
Most physicians regard the test for TSH, or thyroid stimulating hormone, the most sensitive of all thyroid tests—in fact, it’s often the only thyroid test that’s ordered. If the pituitary gland detects suboptimal thyroid levels, it sends out TSH to stimulate the thyroid to make more hormones. “Normal” levels of TSH are considered to fall between 0.3 to 5.5. If your TSH level is within this range, your test is considered normal and no thyroid will be prescribed. However, the fact is that any TSH level greater than 1.0 can mean your pituitary is saying “you need thyroid.” The normal range was arbitrarily established by determining the TSH levels of 100 medical students, with no concern as to how their thyroids were functioning.
A factor that is rarely appreciated by doctors is that there are basically two different types of hypothyroidism, primary and secondary. Primary hypothyroidism is a situation where the thyroid itself is not manufacturing enough T4. A classic example of this is known as Hashimoto’s thyroiditis. Secondary hypothyroidism is a situation where the pituitary fails to make TSH. Unfortunately, in those instances when only a TSH is ordered to assess thyroid function, this type of hypothyroidism is never determined. In other words, a TSH test by itself, should never be used for screening for an underactive thyroid.
3) Evaluating Symptoms and Patient’s History
A proper thyroid evaluation should include taking the patient’s history, looking at the patient, and ordering the proper tests. Signs and symptoms of low thyroid, as I mentioned before, include: dry skin (without using moisturizers), brittle or soft nails, blood clots with periods, low body temperature, fatigue, poor memory, dry and brittle hair, elevated cholesterol, and weight gain. Sensible thyroid testing would include:
Note: Free T4 and free T3 does not mean there is no fee involved. Rather, “free” refers to thyroid that is unbound and biologically active and so is not affected by levels of thyroid binding globulin.
4) T3 Preparations
To my way of thinking, proper thyroid dosing usually includes replacement of both thyroid hormones. There are various T3 preparations, such as Armour, Thyrolar, and Cytomel. The first two are combinations of T3 and T4. However, the T3 is short-acting (three hours), and neither preparation has enough T4. Cytomel is a synthetic T3 and is also short-acting.
My preference is giving a sustained-release form of T3 (obtainable only through a compounding pharmacy) to be taken once or twice a day. If the free T3 level is below 2.8 pg/ml, I prescribe 7.5 mcg of T3-S/R. In addition I prescribe the proper dose of L-thyroxine (Levoxyl or Synthroid), usually 0.125 mg, corresponding to a free T4 level of about 1.1 ng/dl.
5) The Effects of Adrenaline
Note that people with increased adrenaline, such as those with ADHD, almost always have low thyroid levels. If a patient has undiagnosed ADHD (a common occurrence) and the doctor is only treating lab tests and not symptoms (also a common occurrence), the patient may experience uncomfortable side effects, such as palpitations, headache, or a rise in blood pressure, after starting on thyroid. Both adrenaline and thyroid are stimulants, so it is important to lower adrenaline levels prior to starting thyroid. You can read more about ADHD in my Blog.
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