An Epidemic?

A weak or malfunctioning thyroid gland can have a devastating effect on the whole body, mind and quality of life. We are in a thyroid disease epidemic with levels at all time highs in this decade. An estimated 20 million Americans have thyroid disorders, but more than half still remain undiagnosed. Approximately one out of every eight women will develop a thyroid disorder in her lifetime. Women are more likely to suffer from a thyroid condition and since thyroid functions less effectively with age, the elderly population is also more at risk. By age 60 as many as 17 percent of women will have an under active thyroid. Anytime hormones fluctuate is also a trigger for the thyroid to lose its homeostasis, important markers being puberty, pregnancy, and menopause. An understanding of the thyroid, its functions and the implications and reasons for the epidemic that is occurring is key to understanding how to properly find balance and treat it.

About the Thyroid

The thyroid gland, located in the neck, is one of the largest endocrine glands. Its often referred to as the master gland because it controls so many vital functions in our body. It controls the metabolism and how quickly the body uses energy and controls how sensitive the body is to other hormones. It has a huge influence in the immune system and its impact is felt cascading through all our organ systems from the brain and nervous system to the heart, lungs, kidneys, liver, digestive system and reproductive glands. It affects fat metabolism, regulates fatty acids, reduces cholesterol, impacts protein synthesis, increases oxygen use, regulates temperature, and is a key player in bone growth. In fact the thyroid makes thyroid hormones that enter every cell in the body. 

The thyroid secretes two hormones: thyroxine (T4)  and triiodothyronine (T3). The building blocks of these hormones come from iodine (the 3 and 4 in T3 and T4 represent the number of iodine atoms attached) and the amino acid tyrosine. The thyroid also secretes another hormone called Calcitonin which helps regulate blood calcium levels.

The complexity of thyroid hormones and its feedback loops causes a lot of room for misunderstanding and lack of understanding. It all begins in the hypothalamus in the brain wherethyrotroponin-releasing hormone (TRH) is released to stimulate the anterior pituitary gland, in the brain also, to secrete a hormone called thyroid stimulating hormone (TSH). As the TSH increases it signals the thyroid gland to produce T4 and T3 hormones. Once the thyroid has secreted adequate levels of these hormones into the bloodstream, TSH levels are inhibited in a negative feedback loop. So in other words, if your TSH is high its usually a sign of hypothyroidism and if your TSH is low, its usually indicative of hyperthyroidism. This is exactly where the problems arise as the current western medical model relies solely on that premise to test for thyroid disorders. 

Current Thyroid testing and diagnosis in our current medical system

Does this sound familiar? You feel something is off. You are always tired, have gained a lot of weight that cant be explained, cant sleep, feel cold, difficulty concentrating, hair loss, dry skin, slowed digestion of food, depression, infertility, low blood sugar, constipation. You go to the doctor to get checked out. The doctor runs a blood test to test your TSH and it comes back within normal ranges. If you insist that you don’t feel well and that something is wrong your doctor may tell you its all in your head and prescribe some antidepressants to help with that. Well you are not alone. Many medical doctors and HMO’s like Kaiser have a strict policy to only test the TSH unless abnormal and then do further blood tests. Lets look at the problems with that:

 1. The TSH is just one of the pieces of the puzzle that the determines the thyroid health and as we saw earlier there are many feedback loops involved. TSH values also fluctuate during the day being lowest in the morning so that can skew the results. 

2. The (old) standard reference ranges for TSH are 0.5 – 5.5.  However as of January 2003 the American Association of Clinical Endocrinologists (AACE) released a press release stating that they ”encourage doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.04. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now.”     These old ranges have been designed to catch the 2% in the upper and lower limits to prevent pathology and were not designed and set for optimal health. Functional medicine takes this a step further and moved the optimal TSH ranges narrower to 1.8-3.0. Furthermore, The National Academy of Clinical Biochemistry in 2002 propose that the upper limit of TSH be lowered even lower to 2.0 as their findings suggest that subjects with a TSH above 2.0 will develop hypothyroidism within 20 years.(source) 

3. If the TSH blood test comes back high, then the doctor will generally prescribe synthetic thyroid hormone (levothyroxine, synthroid, etc). However in many cases the patients symptoms are unaffected by the medication and even though they retest and the blood tests are now within normal ranges, all that was accomplished was the doctor treating the blood test not the patient. 

4. External factors can influence the release of TRH and TSH. These include exposure to extreme cold, which is accompanied by increased hormonal secretion, and emotional stress, which sometimes increases and other times decreases hormonal secretion.

4. The iodine-thyroid connection: many hypothyroidism cases are treated by giving synthetic thyroid hormone yet the doctors fail to look beyond to look at the root of the disorder. Since iodine is the building block of the thyroid hormone, a lack in iodine in the body can cause hypothyroidism. Once patients are tested for iodine sufficiency and supplementation begins, many have found the need to decrease or even eliminate their need for their medication. 

Clinical Hypothyroidism

Clinical hypothyroidism refers to the disease presentation of the thyroid which has serious health risks. Subclinical hypothyroidism on the other hand is akin to the gasoline light coming on in your dashboard as you are driving your car. The car is now at risk of stopping in the middle of the road within 30 miles and the car isn’t running as efficiently as when the gasoline is full. Because subclinical hypothyroidism isn’t diagnosed by most medical doctors it presents a risk for serious future health risks. 

Subclinical hypothyroidism presents with a variety of milder symptoms that reduce vitality, contribute to infertility and affect the body and mind alike. Because the symptoms are milder and its not life threatening yet, Chinese and natural medicine are highly effective at correcting the imbalance through their holistic approach. 

The blood tests in subclinical hypothyroidism usually show a high TSH but normal freeT3 and freeT4. Sometimes problems present themselves as deficient T3 and excess revere T3 but normal TSH and T4.

The endocrine system is a hormonal feedback system in which any imbalance in one part of the system may affect the entire system and thereby creating other hormonal imbalances. For example, infertility, adrenal insufficiency, osteoporosis are some consequences of untreated clinical hypothyroidism. 

Because the symptoms canvary and are so vast, a proper differential diagnosis is important. This involves testing the levels of TSH along with a full thyroid panel, including freeT3, freeT4, and in cases of suspected Hashimotos thyroditis also TPOAb, TGAb, T3uptake, and rT3. In addition to the thyroid evaluation its also important to test the adrenal cortisol, DHEA, and testosterone levels. 

Symptoms and signs of Sub-Clinical Hypothyroidism

Problems with cognition and memory,
Episodes of heart palpitations, 
Difficulty in losing weight,
Elevated cholesterol


Symptoms and signs of Clinical Hypothyroidism

These include the subclinical hypothyroidism symptoms plus: 

Cold intolerance or chills, 
Decreased ability to sweat, 
Cool, coarse, dry skin, 
Facial puffiness, 
Edema around the eyes, 
Sluggish movements, 
Weight gain, 
Constipation & decreased bowel movements, 
Numbness & tingling(parasthesias), 
Voice hoarseness, 
Hearing loss, 
Dry thinning hair, hair loss, especially outer 1/3rd of eyebrows, 
Diminished ankle reflex, 
Heavy menstrual periods (metrorrhagia),
Lowered basal body temperature is also a prevalent sign and can easily be monitored by a patient at home.