Thyroid Deficiency

The thyroid gland is the biggest gland in the neck. It is situated in the  front of the neck, just below your Adam’s apple, on either side of the  neck, and partly wraps around the trachea (wind pipe). The sole function  of the thyroid is to make thyroid hormone. This hormone has an effect  on nearly all tissues of the body where it increases cellular activity.  The function of the thyroid therefore is to regulate the body's  metabolism. The thyroid gland receives much of its instruction  from the pituitary gland, a small gland located at the base of brain.  The pituitary gland secretes Thyroid Stimulating Hormone (TSH). TSH, as  its name implies, stimulates the thyroid gland to start producing  thyroid hormone. When the thyroid gland starts to slow down or become  underactive, it doesn’t produce as much thyroid hormone. When the  pituitary senses the thyroid hormone levels are too low, the pituitary  produces more TSH as part of a chemical messenger sending a message to  the thyroid gland to ask for more thyroid hormone production. Understand  that TSH is not an active hormone, it’s a chemical messenger. That’s  all. We see TSH levels rise to abnormal levels as we see thyroid hormone  levels fall as part of a negative feedback loop. TSH blood  levels are commonly measured as a way to screen for thyroid  abnormalities. The normal range for most labs is 0.5 – 5.5. The higher  the number, the greater the indication of an underactive thyroid. At  Chadds Ford Wellness, we prefer to see people in the “optimum” range,  under 2.0The main hormone produced by the thyroid gland is T4,  also known as levothyroxine. It is a molecule that contains 4 iodine  units (hence the “T4”). The T4 gets secreted by the thyroid gland and  enters the blood stream. Once it reaches the body, T4 gets converted to  T3 (tri-iodothyronine) by cleaving off 1 iodine unit. (A small amount of  T3 is also produced directly in the body.) T3 is 4-5 times more active  or powerful than T4 and is the real, active thyroid hormone that has its  action on all of our cells in our  body. If  the thyroid gland is underactive (hypothyroidism), insufficient amounts  of T4 are produced, resulting in too little T3. On the other hand, your  body may also not adequately convert T4 to T3, in spite of adequate T4  levels. This is seen more commonly with a poorly functioning adrenal  gland as often seen with patients who are under more than normal  physical or psychological stress or even some disease states like  anemia.

  • Types of Hypothyroidism
    Primary Hypothyroidism: Thyroid gland failure indicated by elevated TSH and eventually low free T4 and T3
    Secondary Hypothyroidism: Pituitary failure indicated by low free T4 and low-normal TSH
    Tertiary Hypothyroidism: Hypothalamic failure indicated by low thyrotropin-releasing hormone (TRH)
    Non-thyroidal Hypothyroidism: Poor conversion of T4 to T3 indicated by low T3 levels
    Cellular Hypofunction or Hormone Resistance: Resistance to thyroid hormone (TH) diagnosed by elevated free T3 and T4 levels in the absence of TSH suppression
    Subclinical Hypothyroidism: Low thyroid symptoms with approximately normal lab results included high-normal TSH and low-normal free T3 and T4
  • Monitoring Thyroid Levels
    There  are several blood tests to measure besides the TSH. Knowing that the  active hormone from the Thyroid gland is T3, one would expect we would  train doctors to look carefully at this hormone level. Unfortunately we  don’t. The assumption is that T4 is always changed to T3 outside of the  thyroid gland and that is simply not the case in reality. At Chadds Ford  Wellness, we find the most useful tests to order are both the Free T3  and Free T4 levels. These tests measure the amount of T3 and T4 hormone  that is “free” in the blood and available to be used by the cells in the  body. For optimal benefit the literature supports raising Free T3  levels to the higher end of the normal range of about 4 pg/ml (the  normal range is 2.3-4.2).
  • Thyroid blood tests should be repeated in about 4 to 6 weeks after either starting treatment or changing doses.
  • Thyroid Level Ranges
  • Normal 0.5 – 4.3
  • Optimal ≤ 2
  • Free T3
  • Normal 2.9 – 4.6
  • Optimal 4 - 4.2
  • Free T4
  • Normal 0.9 – 1.4
  • Optimal > 1.0
  • Reverse T3
  • Normal 9.2 – 24.1
  • Free T3/Reverse T3 Ratio
  • Normal > 20
  • Autoimmune Antibodies
  • Antithyroglobulin antibodies (AgAb)​ < 4 IU/mL​
  • Thyroperoxidase antibodies (TPOAb)​ < 35 IU/mL
  • Thyroid Replacement Therapy
    The  most common thyroid medication used for treating hypothyroidism include  Synthroid® and Levoxyl®, which are brand names for levothyroxine (T4).  The problem with a T4 only approach to treatment is it will leave many  patients with persistent symptoms of hypothyroid disease because of the  lack of conversion of T4 to T3. At the Wellness Center we prescribe  mostly Armour Thyroid hormone to avoid this common scenario. The beauty  of Armour Thyroid® is that it has both T4 and T3 in the exact amounts  that the human thyroid produces under a normal healthy state and is  therefore, bioidentical. A synthetic form is also available known as  Thyrolar®.
  • Nutrients to Support Thyroid Function
    Phosphatidyl  Serine with no complex (300-1000 mg daily): This supplement is taken at  bedtime and helps to lower high cortisol levels. PS is prevalent in  your immune cells, muscle tissue, and brain cells and benefits brain  improvement, cell repair, and immune system function.
  • Iodine  (1-12.5 mcg daily): In order to make thyroid hormone, the body must have  sufficient levels of iodine. Both low and excessively high levels of  iodine in the body have been associated with hypothyroidism. The amount  of iodine recommended for supplementation varies widely from patient to  patient. Thyroid levels should be monitored when supplementing with  iodine. If you have Hashimoto’s Thyroiditis you cannot take iodine  without very careful oversight.
  • Selenium (200-400 mcg daily):  This mineral aids in the activation of thyroid hormone and protects the  thyroid from high iodine levels, which can potentially destroy thyroid  gland cells. Low selenium levels have been associated with Hashimoto’s  disease.
  • Zinc (30-80 mcg daily): Zinc helps to convert T4 to T3  in patients who are T3 deficient. Too much zinc can suppress thyroid  function, cortisol, and copper levels. Avoid zinc if you have low  cortisol or copper levels.
  • Symptoms of Hypothyroidism:
  • Weight gain or increased difficulty losing weight
  • Coarse, dry hair
  • Dry, rough, pale skin
  • Hair loss
  • Cold intolerance
  • Muscle cramps and frequent muscle aches
  • Memory loss
  • Abnormal menstrual cycles
  • Decreased libido
  • *If the above symptoms are not treated the following conditions may develop.
  • Consequences of Hypothyroidism:
  • Gastrointestinal problems
  • Celiac Disease
  • Psychiatric disorder
  • Panic disorders
  • Cognitive decline
  • Decreased working memory
  • Decreased speed of cognitive processing
  • Cardiovascular disease
  • High blood pressure
  • High cholesterol
  • Hypothyroidism is the 2nd leading cause of hypercholesterolemia
  • Increased homocysteine levels, an independent risk factor for CVD
  • Elevated C-reactive protein indicating increased levels of inflammation
  • Metabolic Syndrome
  • Elevated triglyceride and blood glucose levels
  • Increased blood pressure
  • Excess body fat around the waist
  • Reproductive System Problems
  • Irregular menstrual cycle
  • Fatigue and Weakness
  • More common in elderly patients
  • Controversy
    Subclinical hypothyroidism
    Subclinical  hypothyroidism is diagnosed when patients exhibit low-normal lab  results including free T3 and free T4, and high-normal TSH (above 3.5)  but experience hypothyroid symptoms. Despite normal lab results,  symptoms actually improve with thyroid replacement. Conventional  endocrinologists refuse to treat patients with normal lab tests.  However, thyroid replacement can actually help symptoms such as fatigue,  depression, weight gain, dry skin, brittle nails, thin hair, memory,  concentration, constipation, and hyperlipidemia. Treating patients with  normal thyroid levels can potentially make patients hyperthyroid.  However, this is acceptable with careful oversight and as long as  patients remain asymptomatic. We make sure our patients are monitored  for side effects, such as bone loss, with periodic urine NTX tests, etc.  Here at the Wellness Center we believe in treating the patient, not the  lab test.
  • Use of Armour Thyroid in the Treatment of Hypothyroidism
    The  treatment of choice for hypothyroidism among endocrinologists is  synthetic thyroid hormone, otherwise known as Synthroid. Traditional  physicians are extremely against using desiccated thyroid, or Armour  Thyroid, claiming that its use is not scientifically based and calling  physicians who prescribe it “quacks.” However, desiccated thyroid has  been used safely for over a hundred years, is FDA approved, and is a  prescription drug. Synthetic thyroid has only been used since the 1950s.  The difference between the two drugs is that desiccated thyroid  consists of a combination of T4, T3, T2, T1, and calcitonin (although  not measured they are not removed) while synthetic thyroid is only made  up of T4 or levothyroxine. Therefore, desiccated thyroid replaces the  same hormones your thyroid would be giving you if it were healthy and  functioning normally. Desiccated thyroid is a cheaper, natural  alternative to synthetic thyroid replacement. The majority of patients  actually feel better on desiccated thyroid since synthetic thyroid often  leaves patients with lingering symptoms due to lack of conversion to  T3. Another reason many endocrinologists dislike the use of Armour is  that it has a short half-life. When necessary, twice a day dosing can  avoid this problem. In summary, we at Chadds Ford Wellness believe in  bioidentical, dessicated thyroid because we have found that it works, it  is safe to use, and has ample scientific evidence that it is safe to  use.
  • Type 4 Hypothyroidism (Non-Thyroidal Hypothyroidism)
    This  type of hypothyroidism occurs due to poor conversion of T4 to T3 in the  peripheral tissue. It is also referred to as Wilson’s Syndrome. This is  a controversial condition and is not recognized by the medical  community. It is hallmarked by normal free T4, low or low-normal free  T3, normal or high-normal TSH, and an abnormal reverse T3 level. This is  a very common finding in our patients. When given T4 only, or even  Armour thyroid, their T4 levels will increase to normal, but hypothyroid  symptoms will persist and free T3 levels will not return to optimal  range. The treatment is to figure out the cause, such as anemia or low  iron in storage form known as low ferritin levels. The most common cause  of Wilson’s Syndrome is an abnormally functioning adrenal gland due to  chronically high levels of physical or psychological stress, such as  chronic pain. Fixing a low or overactive adrenal gland is complex and  can take quite a bit of work, but once under control the thyroid gland  will usually function normally. As long as patients continue to  supplement their thyroid with bioidentical, dessicated thyroid their  hypothyroid symptoms will improve.