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Thyroid Issues, hypothyroidism

Patrick Massey MD, PhD ALT-MED Medical and Physical Therapy
Elk Grove Village IL and serving the Chicago area

Fatigue, weight gain, hair loss and decreases in memory are, for many people, attributed to symptoms of aging. However, these symptoms may be the result of an underactive thyroid gland or hypothyroidism.

According to one professional endocrinology society, the way most doctors test thyroid function may not be as sensitive at detecting hypothyroidism as commonly believed. This means that there are millions of people who experience symptoms of hypothyroidism, yet are told that their thyroid is functioning fine.

The thyroid gland controls, to a great extent, the body's metabolism through the production of thyroid hormones, primarily triiodothyronine (T3) and thyroxine (T4). An underactive thyroid may not produce enough T3 or T4 to meet the demands and stresses of daily living. This condition is often under-diagnosed because the symptoms can appear slowly over time. Symptoms can include anxiety, difficulty losing weight, hair loss, mood changes, menstrual changes, severe fatigue, sallow (yellow) skin and difficulty with memory.

There are well established and accurate tests for thyroid function, but the interpretation of the test results is the key to diagnosing an underactive thyroid. The commonly used reference ranges may be too wide and probably miss many people with an underactive thyroid.  Iin 2003, the American Association of Clinical Endocrinologists recommended a much narrower range of 0.3 to 3.0 micrograms per deciliter.

Using the more exact reference ranges for thyroid function, almost 20 percent of the population (60 million people) would be diagnosed with an underactive thyroid gland.

An underactive thyroid can increase the risk of Alzheimer's disease, heart disease and even osteoporosis. There are a number of medications used for the treatment of hypothyroidism including T4, T3 and combinations of T3 and T4.

Modest iodine supplementation may also help, but is rarely a cure. Be wary of supplements used to keep the thyroid “healthy.”  They usually are made from powdered animal thyroid gland and may contain substantial amounts of T4 and T3. They are not standardized and may cause more problems than they solve.

There are a number of thyroid medications available to patients.

T4 is thyroid hormone with 4 iodine atoms attached  (Synthroid, generic – levothyroxine). T4 is the most commonly used thyroid medication. It has a long half life because it is biochemically inactive until the body converts it into the active form of thyroid hormone T3: so it acts like a sustained-release form of T3.

T3 is thyroid hormone with 3 iodine atoms attached (Cytomel, generic –liothyronine). T3 is the active form of thyroid hormone. Physicians rarely prescribe it because of its short half life…needs to be taken several times per day.

Combined T3/T4 : Most common medication is Armour thyroid, FDA approved, standardized amounts of T3 and T4 and first introduced in the late 1800’s for the treatment of hypothyroidism. There are a number of other T3/T4 combination medications available…not just Armour…and may have a slightly different ratios of T3 and T4. Compounding pharmacies can make T3/T4 medications individualized to the needs of the patient.

***I strongly do not recommend thyroid gland - based supplements. The levels of thyroid hormone are not standardized and results are quite variable. High dose iodine has no role in treating hypothyroidism. It can be toxic***

Many physicians only prescribe T4 and, truth be told, T4 works just fine for most patients. However, in my experience, about 20 - 30% of patients who need thyroid medication simply do not do well on T4 alone. For a variety of reasons, they may not convert T4 into T3 very well or they simply need extra T3. The majority of these patients will do well on a T3/T4 combination medication.

For most medical conditions, a number of medications are available because no one medication works for everyone.
For hypothyroidism, only one medication (T4) is recommended and this is wrong. People are different and good options are available.

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Tuesday June 18, 2024