What is Hypothyroidism?
Hypothyroidism refers to an underproduction of thyroid hormones by the thyroid gland. The production of thyroid hormones is controlled indirectly by hormones released by the pituitary gland, which act on the thyroid itself. Approximately 4.6% of Americans have hypothyroidism, and approximately 60% of those with a thyroid condition are unaware of it. Hypothyroidism is more common in women and in people over the age of 50.
What Causes Hypothyroidism?
There are many causes of hypothyroidism. Hashimoto’s thyroiditis is an autoimmune disease in which the immune system attacks the thyroid gland resulting in hypothyroidism. There are also subtypes of Hashimoto’s thyroiditis (e.g., subacute lymphocytic thyroiditis) that can lead to hypothyroidism. Hypothyroidism can be the result of radio- or surgical ablation of the thyroid, which is used to treat thyroid cancer. Hypothyroidism can also be caused by diseases of the hypothalamus or pituitary, by some medications, by severe iodine deficiency, and by specific nutrient deficiencies.
What are the Symptoms of Hypothyroidism?
Symptoms of hypothyroidism are fatigue, weight gain, depression, intolerance to cold, excessive sleepiness, inability to concentrate, dry skin, constipation, muscle cramps, elevated cholesterol levels, diffuse aches and pains, and swelling of the legs. Severe hypothyroidism is associated with reduced heart rate, puffiness of the eyes, reduced body temperature, heart failure, and even coma.
How is Hypothyroidism Diagnosed?
Most of our patients that have had their thyroid hormone levels measured say “the doctor said that it was normal”. The issue with this is two-fold. First, normal and optimal are two different things. TSH (thyroid stimulating hormone) is the most common screening marker but has an enormous physiological range. The “normal” TSH range is from .5 to 5.2 mIU/L; that’s like saying you can wear a size 1 or 5 shoe and be comfortable. Second, the TSH level indicates how the pituitary “perceives” thyroid function, but provides no information about whether the thyroid hormones, T3 and T4, are being made in appropriate amounts or if they are being properly utilized by the body. To understand thyroid function, along with a thorough physical exam, all thyroid hormones, including TSH, free T3, free T4, must be measured as well as antibodies to the thyroid. This is necessary to screen for autoimmune thyroid conditions that can exist even when TSH levels are optimal. Finally, thyroid hormone levels must be assessed in the context of symptoms to address thyroid imbalance.
Hypothyroidism and subclinical hypothyroidism can be treated in a variety ways. We have herbal options for those who are not interested in bioidentical thyroid hormones, and, in some cases, thyroid medications are also appropriate. Treatment options vary based on whether or not there is an autoimmune etiology associated with the hypothyroidism. Accompanying any thyroid treatment is the optimization of nutrients and diet to ensure the body has what it needs to correct the hypothyroidism. Nutrient optimization typically allows patients to take less thyroid medication and use less supplementation. Additionally, it is a common misconception that once thyroid medication is prescribed, the patient must stay on the medication indefinitely. We have successfully taken patients off of thyroid medication after improved nutrition has corrected their thyroid imbalance.