Q: My sister was diagnosed with hypothyroidism last year and she is feeling so much better on her thyroid medicine. I have many of the same symptoms, fatigue, weight gain, hair loss, though when I go to my doctor she says my thyroid tests look fine. Is there a better way to test for low thyroid?
A: Certainly, there are better ways to get to the diagnosis of Hypothyroidism (low thyroid) than just looking at blood tests. You find yourself probably suffering from hypothyroidism at a time when conventional medicine insists that your laboratory values must be abnormal to receive treatment. This wasn’t always so. Fifty years ago physicians did not have blood tests that reliably helped in the diagnosis of hypothyroidism. In lieu of blood test they took a careful history looking for the cardinal signs of low thyroid: sluggish energy, chilly core temperature, constipation, hair loss, dry skin, depression, weight gain, achey muscles, insomnia, recurrent infections, loss of periods, irregular periods, family history of thyroid disease, osteoporosis, or gluten allergy for starters. Then physicians would do a physical exam looking for other clues of low thyroid state. Especially they would look at the ankles for a puffy swelling that does not resolve while sleeping called myxedema. They also carefully looked at ankle reflex as when it is slow this can be a sign of low thyroid. Most of this way of making the diagnosis of hypothyroidism is lost. We physicians have research that shows that patients who develop hypothyroidism have symptoms well before their labs are abnormal. We know that there is no perfect test. That tests are supposed to help us confirm a clinical suspicion. Sadly however, we rely completely on labs to diagnose hypothyroidism.
Now, some lab tests are better than others. Certainly most people will have some signs of low thyroid in their labs if they get a free T3 and a free T4 in addition to the usual Thyroid Stimulating Hormone(TSH). Urine and salivary tests are not especially helpful for making the diagnosis. Nor is basal body temperatures as some people run chilly constitutionally. That is they are chilly by nature.
If these labs are borderline and you have several other signs of low thyroid, you deserve a carefully monitored trial of thyroid medicine. If you have heart problems especially problems with your heat rhythm, hypertension, diabetes, kidney disease, insomnia, anxiety, or are at high risk for heart problems then you’ll need to work carefully with your doctor. Even though you can get iodine and even some thyroid glandulars that have animal sourced thyroid over the counter do not attempt to treat yourself! You must really work with a good thyroid physician, one well versed in clinical hypothyroidism, not just laboratory hypothyroidism. May I suggest a more mature physician? Some naturopaths and a few chiropractors have experience with clinical hypothyroidism. If you already have a good relationship with one you may ask them to petition your M.D. physician to try a low dose of a thyroid medicine.
Note that not all patients respond to the commonly available type of thyroid medicine, T4. T4 is also know as Synthroid, Levothyroxine, Levothroid, or Levoxyl. While these T4 products are bio-Identical (look just like your own T4), some 15% of hypothyroid patients do not respond well to them. These patients usually do better with brand name Porcine thyroid called Armour Thyroid. So do not discourage if you don’t do well on a T4 product, you may do quite well on Armour thyroid.
Note that if you are diagnosed with hypothyroidism you’ll need to be screened for other disorders that you are at risk for: osteoporosis (get a bone density scan), low vitamin D (a blood test), and gluten allergy (see enterolab.com). You will of course need follow your thyroid labs also. Though thyroid labs are not perfect they can be very helpful in adjusting your dose to insure you do not get too much thyroid medicine.
Nexus July/August 2013