Sensible-Alternative Naturopathic Clinic

New Guidelines for Thyroid Test

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. (For an appointment with our Naturopathic Doctor, click here.)

Ten years ago, the American National Academy of Clinical Biochemistry narrowed the reference range for thyroid stimulating hormone (TSH) from 0.5-5.0 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⁾

You should also consider the fact that TSH is lower if the blood test is taken later in the day, and if you ate before the test. ⁽²⁾ Other factors can cause an inaccurate TSH reading, such as a deficiency in the adrenal hormone cortisol.

The most 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)

Thyroid antibodies cause symptoms even when thyroid reading is normal

"...it raises the possibility that optimal doses of thyroid hormone will not completely ameliorate all symptoms" - Dr Emerson (editor of journal Thyroid)

New research has shown that Hashimoto's patients with high thyroid antibodies report more symptoms than patients with low thyroid antibodies, even if their thyroid function test is normal. In other words, thyroid replacement is not enough to ameliorate symptoms of autoimmune thyroid disease. ⁽⁵⁾

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 ⁽⁶⁾.

Standard thyroid medication is not enough

New research confirms that T3 is helpful for thyroid patients. In a double-blind crossover study (considered the gold standard for medical research), Danish researchers found that the addition of T3 to conventional thyroxine (T4) treatment significantly improved patients' quality of life, and relieved depression. Study participants improved in mood, vitality, sensitivity, social functioning and general health. There were no side effects and the blood marker TSH was kept stable. ⁽⁷⁾

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⁽⁸⁾ (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.) ⁽⁹⁾
• Oestrogen dominance caused by stress and pollution.  Oestrogen suppresses thyroid function.
• Environmental toxins affecting the thyroid gland, such as mercury ⁽¹⁰⁾, 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". ⁽¹¹⁾ 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. Read about Low Blood Pressure Syndrome for more information on adrenal insufficiency.
• 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.
• Iron deficiency

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 some 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 react with anxiety and heart palpitations when you take thyroid medication?

The most common explanation for this an underlying problem with adrenal insufficiency (cortisol and DHEA deficiency). Corrent the adrenal problem, and then you should be able to tolerate thyroid medication.

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.
• Correct an iron deficiency.
• 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 disease, please make an appointment with one of our Naturopaths.

Locations in Crowsnest Pass, Canada and Sydney, Australia.

1) Dr Lara Grinevitch - Crowsnest Pass, Canada

Lara sees patients on Mondays.

Click here to email Lara

Text message or leave a voicemail on Lara's cell:  1 587 880 4436

Phone Crowsnest Clinic: 1 403 563 3334. (Clinic phone is attended Tuesday-Friday)

2) Biljana Koga or Deborah Gibson - Sydney, Australia

Two Sydney locations: Chatswood - Cronulla

Sydney phone number: 02 8011 1994

To email our Sydney head office: click here.

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) Ott, Johannes et al. Hashimoto's Thyroiditis Affects Symptom Load and Quality of Life Unrelated to Hypothyroidism: A Prospective Case-Control Study in
Women Undergoing Thyroidectomy for Benign Goiter.Thyroid, 2011; 21 (2): 161 DOI: 10.1089/thy.2010.0191

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

(7) van Leeuwen FE, Klip H, Mooij TM, et al. Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort. Hum Reprod. 2011 Oct 26. PMID: 22031719

(8) 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.

(9) 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

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

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