By Dr. William Cole
June 21, 2013 5:00 AM EDT
It is estimated that more than 20 million Americans suffer from low thyroid problems or hypothyroidism. One in eight women will develop a thyroid disorder during her lifetime. Weight loss resistance, fatigue, brain fog, irritability, depression, hair loss, brittle nails have all been linked to low thyroid function.
If you have these symptoms, you can go to your primary care physician or endocrinologist and have tests run. Typically they'll run TSH (thyroid-stimulating hormone) and T4 Tests. If your TSH is high, you'll be given a thyroid replacement hormone drug. In my experience, thyroid replacement hormones do very little to sustainably relieve symptoms in most cases, let alone fix the condition. This leaves many of those suffering with these symptoms left to fend for themselves. As with any chronic disease, the training in the mainstream system is to diagnose a disease and match it with a corresponding drug. So if your TSH lab is “normal,” you're told you're “normal,” even if you still have symptoms.
The standard of care for people struggling with low thyroid symptoms is incomplete and inadequte. In functional medicine, we look at a much narrower range that shows ultimate health and function. This detailed lab interpretation gives answers to millions of people in the “gray area.” People who have symptoms but are considered “normal” in the eyes of the mainstream care
There are six patterns of hypothyroidism that won't show up on conventional lab tests and are not effectively helped by thyroid replacement hormones:
1. Hashimoto's Disease
Some research estimates that up to 90% of all thyroid cases are Hashimoto's or autoimmune thyroiditis. In this case the thyroid isn't the true culprit, but is the victim of the immune system. TSH can be normal, but until you deal with the underlying autoimmune response you'll always struggle with low thyroid symptoms.
2. Thyroid Resistance
Similar to insulin resistance, thyroid resistance is caused by cellular inflammation, which decreases hormone communication with the cell membrane. Thyroid hormone production isn't the problem in this pattern, and TSH will be normal but the person will have symptoms. Labs such as homocysteine and reverse T3 will give us a look at the inflammation and hormone receptor site blunting that is seen with this pattern.
3. Thyroid Under-Conversion
This pattern has been covered in medical literature for years, but is not effectively alleviated by thyroid replacement hormones. The majority of thyroid hormone is in the form of T4, which is metabolically inactive, and has to be converted to T3 for use in the body. Most thyroid drugs are synthetic T4, which isn't deficient in this pattern. It's the conversion of the hormone, which takes place in the liver and GI system, that's the problem. This pattern is common with chronic adrenal stress and elevated cortisol levels in the body.
4. Thyroid Over-Conversion
You would think that if the body produces more T3, the metabolically active form of thyroid hormone, it would be a good thing. Too much of a good thing will overwhelm your cells and cause a resistance pattern. This thyroid pattern is seen in people with elevated testosterone levels, insulin resistance, type II diabetes and in women with PCOS (Polycystic Ovarian Syndrome).
5. Thyroid Binding Globulin Elevation
Thyroid hormones, as with all hormones, get transported throughout the body on protein carriers. When these protein carriers, thyroid-binding globulins (TBG), are elevated this will cause an increase of protein bound thyroid hormones which are inactive. This pattern is common with excess estrogen levels and women using birth control pills or estrogen creams.
6. Hypothyroidism Secondary to Pituitary Hypofunction
In this pattern the pituitary gland, which sits at the base of your brain, isn't communicating with your thyroid gland. There's nothing wrong with the thyroid itself, it's just not being told to get to work! This pattern is associated with chronic stress levels or chronic bacterial and viral infections.
As you can see, thyroid physiology is complex and unique to the individual. There's no such thing as a magic pill for everyone, and we need to get a comprehensive diagnosis to gain insight as to why someone is struggling with the symptoms they have. I consult people all over the world via Skype and phone consultations, clinically investigating these underlying factors.
Dr. William Cole, DC, graduated from Southern California University of Health Sciences in Los Angeles, California. He has his post doctorate education and training in Functional Medicine and Clinical Nutrition.