Sensible-Alternative Naturopathic Clinic

New Guidelines for Thyroid Test

Eight years ago, the American National Academy of Clinical Biochemistry narrowed the window of normal for thyroid stimulating hormone (TSH) from 0.5-5 to 0.2-2.5mIU/L.  Similar revisions by the American Association of Clinical Endocrinologists (AACE) meant that 13 million people previously considered to be normal, could now become officially diagnosed with under-active thyroid.  ⁽¹⁾

If you suspect low thyroid function, but have had "normal" blood tests, you and your doctor may want to take a second look. A TSH of greater than 2.5 is not normal.

You should also consider the fact that TSH is lower if the blood test is taken later in the day, and if you were not fasting. ⁽²⁾ Your TSH reading may be artificially low if you are deficient in cortisol, an adrenal hormone.

Another very important test for thyroid is the blood test for thyroid antibodies. Thyroid antibodies can cause symptoms even when TSH is normal. In particular, they have been shown to have a role in fertility and miscarriage. ^(3,4)

Untreated thyroid disease leads to heart disease, muscle weakness, poor mental function, and an increased risk for cancer. Some experts believe that it may be responsible for 40% of unexplained cases of fatigue, depression, weight gain and infertility ⁽⁵⁾.

Common Causes of Thyroid problems

Why is thyroid disease so common?  Like many other hormone imbalances, under-active thyroid is due, in part, to our modern lifestyle.  Causes include:

• Autoimmune thyroiditis (Hashimoto's) is the most common reason for under-active thyroid. In this condition, the immune system attacks the thyroid gland, and it also as interferes with the action of thyroid hormone in the body. Thyroid hormone tablets are not adequate treatment. The immune problem must also be addressed. Thyroid autoimmunity affects 1 in 4 women. It is the result of environmental toxins and widespread vitamin D deficiency. It is also caused by wheat gluten, which has been shown to be a trigger for Hashimoto's⁽⁶⁾ (See Autoimmune article.)
• Selenium deficiency (a serious problem in Australia due to low soil levels).  Selenium is necessary for the conversion of T4 to T3.  (Incomplete conversion results in high levels of reverse T3, an inactive hormone.) Selenium has also been shown to reduce autoimmunity against the thyroid (ie. to treat the underlying cause of Hashimoto's thyroid disease.) ⁽⁷⁾
• Oestrogen dominance caused by stress and pollution (see Sensible News 27).  Oestrogen suppresses thyroid function.
• Environmental toxins affecting the thyroid gland, such as mercury ⁽⁸⁾, bromine, chlorine, fluoride, PCBs and others. According to new research presented at the American Thyroid Association meeting, "environmental factors account for about 30% of the risk for autoimmune thyroid disease". ⁽⁹⁾ Of concern are certain pharmaceutical medications, cigarette smoking, stress, selenium deficiency, pesticides, polychlorinated biphenyls (PCBs), and bisphenol A (BPA).
• Adrenal insufficiency. A deficiency in the adrenal hormones DHEA or cortisol is a common underlying issue in thyroid disorders. If it is not corrected, patients may find that they cannot tolerate thyroid replacement treatment. Cortisol deficiency may suppress TSH.
• Iodine deficiency. Deficiency is very common in Australia. Get your iodine level checked with a urine test, and then use a proper iodine supplement, not kelp. Kelp is not effective because it also contains bromine which inhibits thyroid function. Hashimoto's patients should use iodine with caution, as large doses may aggravate your condition. That said, if an iodine deficiency has been established with a urine test, then a small dose of iodine is certainly indicated, even in Hashimoto's patients. Iodine is not the solution for every thyroid problem, but a deficiency should be corrected. If not for the thyroid alone, then for the other tissues, such as brain, breasts and uterus, that require iodine. If the iodine deficiency is not corrected, then the body will harvest iodine from the thyroid hormone medication.

How do you know if you have a thyroid problem?

Symptoms of under-active thyroid include: fluid retention, hair loss, yellow skin on the palms, sensitivity to heat or cold, fatigue, poor mental function, slowed heart rate, irregular periods, very dry skin, constipation, high cholesterol, and more.

What tests might you need?

If thyroid disease is suspected, blood tests should not be limited to TSH.  Other useful tests include thyroid antibodies, free T3, free T4 and reverse T3. Also DHEAS, serum vitamin D and urinary iodine.

Thyroid resistance syndrome (elevated reverse T3)

After 12 or more months on conventional thyroid treatment, T4 resistance can develop. The syndrome occurs when T4 is not adequately converted to its active form: T3. The conversion is easily disrupted, because it occurs in the liver, and requires many nutritional cofactors. Instead of being converted to T3, a large amount of T4 is converted to reverse T3, which is inactive thyroid hormone The high level of reverse T3 causes symptoms of under-active thyroid, despite a normal blood test for TSH, T3 and T4.

Impaired conversion of T4 to T3 can also be caused by the elevation of the stress hormone cortisol. Elevated reverse T3 can persist even once cortisol is normalised.

Do you have Low Blood Pressure?

Many women with Low Blood Pressure Syndrome also have autoimmune thyroid disease.

Your thyroid could be the CAUSE of your elevated cholesterol

If you are like 90% of Americans, you are probably unaware of this link. According to a survey conducted by the American Association of Clinical Endocrinologists, fewer than half of people diagnosed with high cholesterol had had their thyroid checked, and 90% of survey participants were unaware of the thyroid's impact on cholesterol. Thyroid hormone is necessary for the healthy metabolism of cholesterol.

Treatment

If the condition is autoimmune, you need to correct immune function. See Lara's article on autoimmune disease.

Effective strategies for addressing the autoimmune aspect of Thyroid disease include:

• Avoid wheat.
• Correct vitamin D deficiency
• Improve gut flora
• Reduce stress
• Correct underlying adrenal issue, such as DHEA or cortisol imbalance.
• Correct oestrogen dominance. Consider using Natural progesterone.
• Detoxify mercury and other toxins. (Testing for mercury toxicity is available at Sensible-Alternative Clinic).
• Supplement selenium to lower thyroid antibodies. Also helps with conversion of T4 to T3.
• Herbal medicine Bupleurum, Turmeric, Rehmannia and others.

Other Naturopathic treatments for thyroid.

• Herbal medicines Withania or Coleus to increase production of thyroid hromone. (See Best Herbs for Women article.)
• Iodine (not kelp). Use with caution in Hashimoto's disease.
• Amino acid tyrosine which is the building block for thyroid hormone.
• Vitamin B6 and Vitamin A to improve function of the thyroid gland.
• Selenium and zinc to ensure conversion of T4 to T3.
• Coconut milk/ coconut oil provides medium chain fatty acids to normalise gut flora and stimulate metabolic rate.
• Exercise
• Sleep

Thyroid hormone supplements

Supplementation with thyroid hormone is the standard medical treatment for underactive thyroid.  Some hormone medication, however, is better than others.  This is because many people to not respond well to T4 (thyroxine) alone.  Thyroxine does normalise blood tests, but it cannot relieve low thyroid symptoms until is has been converted it to T3, the active hormone.  Failure to make this conversion is common.  (Selenium, zinc vitamin B6 and other co-factors are required.)

Two alternative prescriptions are available:

1. T3 (Tertroxin or the much preferred, but more expensive, slow-release T3) used together with T4 long term or by itself for a short term correction.
2. Thyroid Extract (desiccated thyroid, Armour thyroid) is popular. It can be a good choice for non-autoimmune thyroid problems, or for Hashimoto's if the antibodies are not too high. High thyroid antibodies may be aggravated by thyroid extract. Thyroid extract is available by prescription from compounding chemists.

Appointments at Sensible-Alternative

For professional advice regarding thyroid issues, and to get your thyroid tested properly, please contact us for an appointment...

Sensible-Alternative Hormone Clinic
Suite 1, Berry Rd Medical Centre
1A Berry Rd, St Leonards NSW.
phone: 02 9438 3448.

References

(1) AACE Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism, Endocrine Practice, Vol.  8, No.  6, Nov/Dec 2002.

(2) Scobbo RR et al. TSH variability in normal individuals: the influence of time of sample collection. W V Med J. 2004;100:138-142

(3)Stagnaro-Green A et al.. A prospective study of lymphocyte-initiated immunosuppression in normal pregnancy: evidence of a T-cell etiology for postpartum thyroid dysfunction. J Clin Endocrinol Metab 1992;74:645-653.

(4)Bussen, S et al. Increased prevalence of thyroid antibodies in euthyroid women with a history of recurrent in-vitro fertilization failure. Human Reproduction. 2000. 15(3): 545-548

(5) Barnes, Broda.  Hypothyroidism: The Unsuspected Illness. 1976

(6) Sategna-Guidetti C et al. Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. Am J Gastroenterol. 200. ;96(3):751-7.

(7) Mazokopakis EE, et. al. Effects of 12 Months Treatment with l-Selenomethionine on Serum Anti-TPO Levels in Patients with Hashimoto's Thyroiditis. Thyroid. 2007 Aug;17(7):609-12

(8) Barregard L, Lindtedt G, Shutz A, et al.  Endocrine function in mercury exposed chloralkali owkers.  Occup Environ Med 1994, 51 (8)536-540

(9) Medscape Medical News from the American Thyroid Association (ATA) Spring 2010 Meeting. Presented May 15, 2010.