Article from www.sensible-alternative.com.au

Underactive Thyroid

New Guidelines for Thyroid Test

The "New Guidelines" were first announced in early 2003. Five years on, pathology reports continue to use an outdated reference range for TSH.

Over five 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 become officially diagnosed with underactive 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 you were not fasting. ⁽²⁾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 elevated cholesterol levels, 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 it so common? Like many other hormone imbalances discussed in Sensible News, low thyroid is due, in part, to our modern lifestyle. Causes include:

Autoimmune thyroiditis (Hashimoto's) is the most common reason for underactive 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 Sensible News 20 for more information about autoimmune conditions.)
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.) ⁽⁶⁾
Ostrogen dominance caused by stress and pollution (see Sensible News 27). Oestrogen suppresses thyroid function.
Contamination of the thyroid gland by mercury ⁽⁷⁾, bromine, chlorine,fluoride and other toxins.
Adrenal stress depleting thyroid function
Iodine deficiency. Deficiency is very common in Australia. Get your iodine level checked with a urine test, and then use an iodine tablet, not kelp. Kelp will not work because it also contains bromine which inhibits thyroid function.

How do you know if you have a thyroid problem?

Common symptoms of underactive thyroid include: variable fluid retention, yellow skin, sensitivity to heat or cold, fatigue, poor mental function, slowed heart rate, irregular periods, very dry skin, constipation, high cholesterol, irregular periods and more.

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

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.

Treatment

If the condition is autoimmune, the best natural treatment is a treatment for the immune system:

Avoid wheat.
Use immune-modulating supplements such as pancreatic enzymes, vitamin D and Rehmannia
Correct oestrogen dominance. (Starting progesterone may require a decrease in dose of any pre-existing thyroid medication.)
Detoxify mercury and other toxins. (Testing for excessive mercury is available at Sensible-Alternative.
Supplement selenium.

Other Naturopathic treatment:

Homoeopathic thyroid hormone
Iodine (not kelp)
Tyrosine
Vitamin B6
Coconut milk
Exercise
Withania
Coleus

A hormone supplement 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 (thyroxin) alone. Thyroxin 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, vitamin B6 and other co-factors are required.)

Two alternative prescriptions are available:

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.
Thyroid Extract (desiccated thyroid) is popular with some natural practitioners. Thyroid Extract should NOT be used for Hashimoto's, however, because it can aggravate the autoimmune process. Thyroid extract is available by prescription from compounding chemists.

Thyroid hormone should not be used without professional advice.

Appointments at Sensible-Alternative

For professional advice regarding thyroid issues, please call to make an appointment...

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

email:

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) 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

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

(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.