Hypothyroidism is a common medical problem in the United States with a recorded prevalence of 2-3% in the general population.[i] Using blood levels of thyroid hormones as criteria, it is estimated that another 10-12% of the population has mild hypothyroidism.[ii] Some writers of popular books using medical history, physical examination, and basal body temperature with blood thyroid levels as diagnostic criteria estimate hypothyroidism in American adults to be as high as 40%.[iii]   

Hypothyroidism increases steadily with age, with a prevalence of up to 5% in all persons greater than 65 years old with the Merck Manual of Geriatrics reporting that 10% of those over 65 years of age have sub-clinical hypothyroidism.[iv] Overt hypothyroidism affects women more than men, and is reported to affect 4% to 10% of women, increasing with age.[v]Incomplete development of the thyroid is a common defect and occurs at a rate of 1 out of every 3,000 births, with girls twice as often affected as boys,[vi] causing the developmental condition known as cretinism.    

Our approach to the treatment of hypothyroidism revolves around a commitment to relieving symptoms at the same time working to treat the cause of the problem. We are committed to:

·     Comprehensive, complete, and effective management of low thyroid

·      Diagnosis and treatment of “functional hypothyroidism” “sub-clinical hypothyroidism” or “sub-laboratory hypothyroidism,” all terms describing a person with the symptoms of hypothyroidism in the absence of abnormal laboratory findings

·      Finding the appropriate thyroid treatment for the particular pattern of hypothyroidism diagnosed

·      When using actual hormone in treatment, selecting the right type and amount of supplementation to eliminate the maximum number of uncomfortable symptoms; this includes the appropriate use of Synthetic T₄, CytomelÔ, sustain released T₃ medications, Armour Thryoid™, Naturethroid™, and individualized compound thyroid hormone prescriptions

·      Going beyond the use of conventional laboratory testing to isolate and treat the cause of the low thyroid

·      Diagnosing associated patterns that are aggravating thyroid problems (such as poor diet, adrenal imbalances, toxicity)

·      Helping individuals decrease or discontinue use of thyroid hormone medication (when possible and appropriate) by treating the root of the hypothyroidism

·      The use of Classical Chinese Medicine to treat thyroid problems

 

The biggest hallmark of the low thyroid is, of course chronic fatigue. Individuals will complain of low energy, and an exhaustion from which he/she does not recover easily. There is often coldness in the picture, with complaints of chilliness, cold hands and feet, or needing to cover up with lots of blankets and wear warm clothing. We will frequently see low immunity, or a tendency to get sick often, or poorly recover from illnesses. We will often find constipation , or sluggish , slow, or problematic bowel movements.   Patients with hypothyroidism often complain of weight gain, and problems associated with this, such as high cholesterol, high blood pressure, or other cardiovascular complications. Many individuals with hypothyroidism complain of dry skin, hair falling out, coarse finger nails, and other symptoms that are troubling. 

 

Below is a complete list of the most common symptoms of hypothyroidism.

 

Fatigue

Weakness

Constipation

Weight Gain

Sluggishness

Cold extremities; intolerance to cold

Edema

Muscle Aches

Headaches

Decreased libido

 

Depression

Poor mental concentration

Memory loss

 

Hoarseness

Dry, rough skin

Coarse, dry, or thinning hair

 

 

Additionally, the following conditions are commonly associated with Hypothyroidism:

 

Hypertension

Angina pectoris

Atherosclerosis

Hypercholesterolemia

Hyperhomocysteinemia

 

Menstrual irregularities (amenorrhea, oligomenorrhea, menorrhagia)

Infertility

Premenstrual syndrome

Fibrocystic breast disease

Polycystic ovary syndrome

Reactive hypoglycemia

 

There are many patterns of hypothyroidism.   Sometime the problem of low thyroid revolves around inadequate production of the inactive form of thyroid hormone called thyroxin (T₄), which in insufficient quantity does not yield enough of the active hormone that is made from it, triiodothyronine (T₃). At other times, low thyroid is not caused by insufficient T₄, but rather poor conversion of the inactive T₄ to the active T₃ (most of which occurs not in the thyroid gland, but in the liver and other tissues). It would be simple if these were the only two types of hypothyroidism, but a large number of hypothyroidism cases are actually related to an autoimmune process where the immune system creates antibodies which attack the thyroid gland itself.   This form of hypothyroidism, known as Hashimoto’s thyroiditis, is an autoimmune disease.   Other patterns of hypothyroidism revolve around problems of the binding protein (thyroid binding globulin) that carry thyroid molecules. Still another type occurs when there is a loss of communication between the pituitary gland and the thyroid gland.

 

Believe it or not, many problems of low thyroid are related to non-thyroid hormones. Our adrenal glands, one located on top of each kidney, make hormones that modulate our physical responses to stress. One of these hormones called cortisol is produced to control the wear-and-tear on our bodies from stress while at the same time transforming proteins and fats into sugar to make energy. If cortisol is either too high (due to too much stress and poor coping mechanisms) or too low (due to exhaustion), thyroid function will be inhibited. Often treating the adrenals can actually take care of low thyroid function.  

 

While giving thyroid hormone often remains the first treatment strategy, selecting a treatment to address the root cause of low function differs with each of the above patterns, and making the correct selection can lead to addressing the real cause the problem rather than simply addressing symptoms. 

 

We believe the evaluation of the thyroid should be thorough and comprehensive. We offer a full range of tests and evaluative methods to identify and treat the cause of an under-functioning thyroid, including T₃ and reverse T₃ testing, thyroid antibody testing to determine the degree of auto-immunity, iodine load testing to assess iodine deficiency, adrenal stress testing to determine the role of adrenal imbalance in thyroid problems, and other methods to identify related disharmonies and deficiencies.

 

This term, which is not recognized by all physicians and healthcare practitioners, refers to what Dr. Alan Gaby has called “sub-laboratory hypothyroidism.” Many people have the symptoms of hypothyroidism despite normal conventional laboratory tests. Appropriate clinical evaluation can identify individuals who have an under-functioning thyroid who may benefit from either empirical treatment with thyroid hormone, or other therapies that may stimulate thyroid function (see Dr. Gaby’s article, Altern Med Rev. 2004 Jun;9(2):157-79 at http://www.thorne.com/altmedrev/.fulltext/9/2/157.pdf).

 

At Pearl Natural Health, we see a large number individuals with conventional laboratory tests revealing conventionally normal Thyroid Stimulating Hormone (TSH) and Thyroixine (Free T₄) levels while leaving a plethora of hypothyroid symptoms remaining, such as debilitating fatigue, coldness, low immunity, weight gain, and constipation. In such cases, we evaluate patients fully using additional tests such as thyroglobulin antibodies, thyroid peroxidase antibodies, thyroid binding globulin, free T₃, reverse T₃, and others. If enough criteria are met for a diagnosis of functional hypothyroidism, we treat the thyroid imbalance various methods. In a large number of cases, treatment with thyroid hormone has resulted in improvement of symptoms that have failed to respond to either conventional or alternative treatments. In other cases, simultaneous treatment using Chinese medicine and other forms of therapy have stimulated restoration of thyroid function allowing for the discontinuance of hormonal therapy. 

 

Whenever hormones are used in the treatment of “functional” or “sub-laboratory hypothyroidism, hormone levels are monitored to assure patient safety. Supplemental hormones are given only to the extent that patients’ laboratory values for basic thyroid function tests (such as TSH, FT₄ and FT₃ continue to remain in the normal range of those hormones). 

 

1. Complete assessment of thyroid and underlying causes

2. Complete health history and indicated physical exams

3.  Constitutional Assessment

4. Determination of thyroid pattern

5. If only marginally indicative of low thyroid function, nutritional, botanical and other simple approaches are utilized while other possible causes of current symptoms are examined and treated

6. If there is ample evidence indicating low thyroid, there is immediate consideration of a trial of appropriate thyroid medication which may include L-Thyroxine (T₄),    Triiodothyronine (T₃), Thyroid USP (e.g., Armour Thyroid, Naturethorid, or Westthroid), Compound T₃ (sustained release); compound T₄/T₃ (individualized), thyroid protomorphogen (dessicated organ), or a combination of any of the above

7. Assess symptoms after using the medications and identify other patterns and causes of remaining symptoms

8. Treat all identified underlying causes of thyroid problem (for example, adrenal dysfunction, liver dysfunction, auto-immune disease, life-style patterns, nutritional deficiencies and excesses, etc.)

9. Re-assess needs for hormonal medication in light of treatment of underlying causes

10.   Taper hormonal medication as indicated

 

If you have questions about the treatment of hypothyroidism, please call the clinic at 503-230-8973. 

 

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