Thursday, October 04, 2018

Tired, Gaining Weight, Cold, Forgetful? You May Have Hypothyroidism?
Why Normal TSH Numbers May Not Be Normal!

Millions suffer from a mild thyroid disorder but go untreated.

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Doctors have Different Approaches
I am not an endocrinologist so this post is really just about my story. But before I begin, let me speak a bit about how my doctors approached the same problem.

I have two primary physicians. One is a talented board certified doctor trained in a traditional medical school. My visits to her are generally covered by Medicare and normal insurance. The other physician I use is an Integrated Practitioner. Not only is she a board certified doctor, she is a trained herbalist and takes a holistic approach to diagnosis and treatment. Insurance won't pay a penny of my visits to her. I find it very interesting on how differently the two doctors approach things. I typically listen to both and decide what I want to do but most often, I listen to my Integrated Practitioner. My thyroid is a perfect example.

Hypothyroidism is a condition where you have low levels of thyroid hormone which causes a slow metabolism. Women are eight times more likely to have this condition than men. (Thanks Universe - like childbirth wasn't enough!) 

Your thyroid releases thyroid hormone as a result of the pituitary gland releasing thyroid stimulating hormone, or TSH. When the body doesn't respond sufficiently to the increase in TSH and cannot release more thyroid hormone, this is called hypothyroidism. 

Common symptoms of hypothyroid are:
  * Fatigue 
  * Weight gain
  * Feeling cold
  * Mental fogginess, trouble concentrating or remembering 
  * Feelings of weakness, aches in muscles and joints
  * Hair loss
  * Depression
  * Constipation
  * Dry and itchy skin
  * Heavy or irregular periods

The Controversial TSH Test
Allopathic (traditional) doctors and most laboratories in the U.S. consider the reference range for the TSH test from 0.5 to 4.5 to be normal. The holistic practitioners want to see the upper range around 2. So when my TSH results came in once at 4 and later at 5, and I complained about fatigue, some weight gain, always feeling cold, having some trouble remembering things, having occasional leg cramps, hair loss, and dry patches on my skin, here's how my two doctors reacted:

My allopathic doctor said "your thyroid is normal". We can consider subclinical treatment at some point. Let's keep an eye on it.

My Integrated Practitioner wanted to look further, especially because I was demonstrating  these symptoms. Here's what she did:
   * Tested for thyroid antibodies to make sure I didn't have an autoimmune thyroid disease (Hashimoto's thyroiditis) or celiac. (These tests were for thyroid peroxidase (TPO) Ab, and thyroglobulin antibody.) Both tested normal.
   * We also tested for Free T4, Free T3, Reverse T3 to further evaluate the reason for high TSH.  
   * She wanted to rule out gluten sensitivity and didn't think the blood test results were very accurate, so she ordered a more accurate gluten sensitivity stool test from EnteroLab. Sure enough, I have an active dietary gluten sensitivity and must now be on a strict and lifelong gluten free diet. 
   * She ordered a test for iodine which came out a bit low so she had me take a seaweed supplement.
   * Other supplements she had me try were L-tyrosine and forskolin. 

I retook my TSH, Free T4 and Free T3 after a few months of eating gluten free, and taking supplements but unfortunately none helped lower my TSH, although some of my symptoms improved from removing gluten but not all of them. So we finally agreed it was time for me to take thyroid medication. A dear friend who is a naturopath and also has thyroid disease advised me to take Armour, which offers both T4 and T3, as opposed to some of the synthetic medications such as Levothyroxine, a synthetic form of T4. I started on a super low dose (15mg), and will need to be retested 6 weeks from when I started taking it. 

Almost immediately, after starting the low dose thyroid hormone, my afternoon fatigue went away. I also think my mild brain fog is lifting. I'm still waiting to see more results, but it's only been two weeks and I might need a higher dosage after I get retested.

The Point of the Story
The point of the story, is that the TSH reference range is still controversial. The National Academy of Clinical Biochemistry recommended reducing the reference range of TSH levels in 2002. This led to the American Association of Clinical Endocrinologists to recommend that doctors consider treating patients who fall between the TSH level of 0.3 to 3.0 instead of the range 0.5 to 4.5/5.0 (where it still remains today.) If that guideline was changed, it would have expanded the number of thyroid patients from 15 million to a total of around 60 million Americans, most of whom would fall in the underactive hypothyroid category.

Do I think 60 million Americans should be on thyroid meds? It depends on they feel. I would have gladly ignored the high TSH number, given my other doctor said it was "normal", had I not had so many other symptoms. So when your doctor says your test results are "normal", for whatever test you are taking, get the exact numbers and do your own research. And if you have symptoms, make sure your doctor is well aware of them and not just diagnosing you based on standard test results and reference ranges. If you can afford to visit a practice that embraces Integrative Medicine or Functional Medicine, both of whom treat the whole person, not just the disease or the "numbers", do so. Some of these doctors do take insurance, but unfortunately not all. 

This was a huge decision for me as I've been very proud to say I'm 70 and don't take a single medication. But it's a hormone, like vitamin D is a hormone - and I'm happy to take something that can prevent some of the many age-related issues that come along around now. 


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