Thyroid Disorders

thyroid disorderThe thyroid is a critical gland situated in the base of the throat. It produces several thyroid hormones that regulate every cell’s metabolism, energy, temperature regulation, and growth. The thyroid is responsible for speeding up and slowing down cells. This can result in people searching for help with terms like underactive thyroid NZ or hypothyroidism NZ (over productive thyroid).
The consequences of deficiency or excess can range from minor ‘missed’ thyroid symptoms to catastrophic life-threatening illness, including the following:

• Lack of energy
• Sensitivity to the cold
• Dry and coarse skin
• Frizzy hair and hair fall
• Difficulties losing weight
• Puffy appearance
• Difficulty concentrating
• Body aches
• Enlargement of the thyroid

The list goes on, but some signs and symptoms of thyroid disorders are subtle and can slowly take place. In some cases, the symptoms are easily missed as the patient and their family or friends become used to the changes and never think something is wrong. This is common in thyroid and in many other gradual hormone deficiencies. Here is what Hypothyroid Mom says about the 300+ symptoms that are possible! Well worth a check.

Most cases are relatively easy to diagnose, have abnormal thyroid blood tests and will do well on standard prescription thyroid hormone medications.

There are also other signs and symptoms of thyroid problems that are not so typical, especially in women:

  • Lab tests may be in the so-called ‘normal range’, but the patient may still be very unwell with underactive thyroid symptoms suggestive still of hypothyroid problems.
  • Tests are in the very low yet ‘normal’ range, but the patient is told to get tested again ‘in another year’ to see if the results would be more out of range.
  • The patient is on thyroid medication, the tests are all in-range, but the patient has not regained health.
  • The patient increases the amount or strength of the medication, but is still very unwell. This is the time a totally different approach, or a different brand or system of thyroid medication.
  • The patient has high antibodies, which indicates an autoimmune inflammation. This is termed Hashimoto’s Disease. Can we treat the underlying condition that has lead to the failing thyroid gland? Maybe.
  • Nothing works- all forms of thyroid (T4 even T3) is still not getting her well. There may be an answer.

 What types of Thyroid Diseases are there?

  1. Hypothyroidism (under-active thyroid) – common causes:
    1. Viral Thyroiditis
    2. Auto-immune Thyroiditis (Hashimotos)
    3. Goitre – iodine deficiency
    4. After surgical removal of thyroid gland
  2. Hyperthyroidism  (over-active thyroid) – termed Thyrotoxicosis
    1. Active hormone producing nodules
    2. Cancer
    3. Graves Disease – an autoimmune process.
    4. Too much thyroid medication
    5. very rarely from excess iodine – various sources

Most of this page will be about the common Hypothyroidism or ‘under-active thyroid’

Take the Thyroid questionnaire to see how you score. Most cases are relatively easy to diagnose, have abnormal thyroid blood tests and will do well on standard prescription thyroid hormone medications.

Thyroid Details

2000px-Thyroid_systemOur brain monitors all functions. If more Thyroxine is required, it signals to the hypothalamus (major control centre) which secretes a hormone TRH to tell the pituitary to send TSH into the bloodstream which reaches the Thyroid and causes production of several Thyroid hormones especially T4.

However T4 is quite inactive until it reaches the tissues, loses one iodine (it has 4) and becomes T3, the very active and now fully functioning Thyroid hormone. As the levels of T3 and T4 build up the brain senses this and slows TSH release. Its all fine tuning. Its important to know that the pituitary itself needs T3 as well to function!

So by measuring TSH, T4 and T3 we can assess whether the THYROID gland is making enough hormones in response to the brain sensing levels in the blood stream. HOWEVER – blood levels do not reflect at all what is happening in the tissues – in fact different tissues of the body for example heart cells, brain cells, muscle cells may have different requirements and whereas one body system may be getting by another may not.

An individual’s symptoms do not always match the blood result. The final functionality of the thyroid   system depends on how well the T3 accesses the cell receptor sites within each cell. And how many receptors are available. Many things from gene expression, toxins, endocrine disrupters other hormones etc can decrease or increase cell responsiveness. Relatively normal blood levels can occur with significant dysfunction and symptoms. So you can understand why simply measuring the TSH is so basic and whilst may be quite suitable for many, for others it is hopelessly inadequate. I will provide references for this observation.

Thyroid Function Tests

  • TSH
  • T4
  • T3
  • rT3
  • Antibodies – TPO, TGA
  • rT3/T3 ratio
  • Iodine Loading test
  • Halides (Fluoride, Chlorine, Bromine – may affect Iodine)

 

Routine lab blood tests measure TSH first, and if abnormal T4 but rarely T3. Lets first revise the Thyroid Hm Flowphysiology of the thyroid gland  – a 101 lesson. Click the figure to enlarge. Its important to understand. So why not measure all three hormones? Because of financial constraints and ‘accepted practice guidelines’, health authorities control what doctors are allowed to test for and so only TSH is used as a screening and treatment monitoring test. Most of the time that gets by as long as the doctor also remembers to check thoroughly the patients symptoms looking for clues of deficiency. You CANNOT rely on just the TSH in many cases !

Importantly blood tests can sometimes be misleading. They can be in the low normal range, yet the patient still be unwell from thyroid problems. Normal ranges are a GUIDE ONLY. There is much debate about hormone resistance to thyroid hormones requiring some people to require extra dosing than others just to feel normal. In doing so their blood tests may get up in the high or even over the ‘normal’ range. It may be similar to the resistance increasing numbers have to the insulin hormone. I believe hormone ‘resistance’ is widespread to perhaps many hormone systems for many reasons perhaps including xeno-chemical interference.

Research many people are deficient in iodine (present in sea-salt and marine foods). Various techniques of measuring iodine are used – even wiping iodine on the skin and seeing how long it takes to absorb! I cant vouch for the validity of such practice, it might be. Blood and urine tests are not suitable. Best is the Iodine loading test which we can arrange for you.

A full questionnaire, examination and body temperature charting, as well as blood work should be done. If in doubt still and pending comprehensive assessment of all other hormones, other causes; a ‘trial of therapy’ may be warranted to assess the benefit of improving the hormone status. Such a trial is the only way to assess the situation in the end.

cave girl 2You will note in the diagram, the hormone called rT3 – reverse T3 – it appears to be a hormone also derived from T4 but has a blocking effect in the cell. Perhaps it counter balances effects of the T3 – even slowing down the metabolism when the organism, ie person, is under a lot of stress. Harks back to early human times – trauma, huge distress and rT3 makes the cave person retreat from the danger/injury and recover back in the cave a while. Forced rest.

As with all hormone treatments, it is mandatory to be under a doctor’s care who understands the biochemistry and physiology of hormones.

Why low thyroid function

This depends on where the fault lies – examples:

  • Deficiency of nutrients, vitamins or other hormones
    • Zinc, B1, B6, Stomach acid, Vit A, Vit E
    • Tyrosine, Iodine, Selenium, Vanadium, Vit B12, Vit C
    • Progesterone
  • Disease of thyroid itself – Autoimmune disorder called Hashimoto’s thyroiditis
  • Effects of drug side-effects and environmental pollutants, PCB’s, thiocyanates, perchlorates etc
  • Burnout following over-activity – thyroiditis
  • Pituitary failure
  • Hypothalamic malfunction
  • Thyroid hormone blocking – rT3 possibility – other anti-thyroid hormone resistance causes
  • Excess diet ‘goitrogens’ from brassica foods.
  • Thyroid receptor site resistance – genetic or environmental causes such as chlorine, bromine, fluorine (the Halide group interfere with iodine) and perhaps heavy metals Pb, Hg, As, Cd.

Treatment Strategies

Treatment

Thyroid Treatment for Underactivity (Hypothyroidism)

Dr. Reeder will discuss and select appropriate options for treating hypothyroidism depending on full evaluation and test results.

Optimising thyroid function MUST be done under supervision by your clinical response, blood testing and temperature monitoring.

Having medical symptoms of an under active thyroid, supported by blood testing (refer to information on this page), the conventional accepted approach is to prescribe L Thyroxine (T4). This will in most instances correct the problem of insufficient T4 production – for whatever reason.
However, the small group of patients we are addressing, in spite of  ‘normal’ blood tests, remain unwell and have not recovered from their thyroid symptoms sufficiently. It is a dilemma for the patient as well as doctor because the test TSH, is ‘normal’. Therefore ‘…its not your thyroid‘.

This raises questions:

  1. Is the TSH absolutely reliable in all cases? Some medical literature says no. Even labs may agree.
  2. Should we carefully increase treatment until the patient normalises health as a priority? In other words treat the patient first and TSH second. Seems correct.
  3. But is there harm if the TSH falls below the standard lab reference range yet the patient is now well? This is the heart of the debate. Read on>
  4. Which thyroid treatment is the right one? Whichever safely restores the patient’s health to their best. Most often its standard L T4 medication. Some who dont respond will do so very well on standardised dessicated thyroid (DTE). Few can only regain health on various ratios of T4 and T3 treatment – even T3 alone in some instances. More on this elsewhere.
  5. Is there any difference between standard L Thyroxine (T4 only) and ‘natural thyroid’ better termed Dessicated Thyroid Extract (DTE) ? Absolutely. L T4 is just that and DTE is a porcine glandular extract lab processed and standardised to contain T4, T3, T2 etc. Also its not a funded prescription.
  6. Is there a danger when TSH is low? Lets discuss this. Please follow the link>>>

More information coming on this topic.