Saul Marcus, ND
New York City
Naturopathic Doctor

Hypothyroidism Guide Page 1

These pages originally written in 2010 for my first website. I have posted them here for educational purposes. For general information on how natural health can help with thyroid conditions please follow this link to the main hypothyroidism page.

1. Hypothyrodism Guide

This guide will detail the diagnosis and holistic treatment of hypothyroidism and hyperthyroidism. For a more concise list of natural treatments and supplements for hypothyroidism you can follow this link.

Holistic means treating the whole body, and not just a single part. Thyroid disease often begins some place else other than the thyroid gland. Too much focus on “treating hypothyroidism” can lead to accumulation of general information, which although valuable, is nonetheless not always helpful at treating the individual.

The question is not how to treat hypothyroidism per se. It is rather; how to treat the individual who presents with hypothyroidism as part of a larger clinical picture.

I have attempted to be concise. However, thyroid disease is by its nature complex. In order to make this guide useful I included detail beyond what you would find on health tip web sites.

This guide is not:

A series of health tips. You can those all over the Internet.
Selling some miracle cure thyroid supplement.
Selling a specific protocol that will work for everyone.

What this guide is:

A detailed review of the causes and treatment of hypothyroidism and hyperthyroidism, based up my education as a naturopathic doctor, professional seminars attended, and experience working with thyroid patients.

Hypothyroidism and Hyperthyroidism Symptoms

The thyroid is a gland in the neck whose main job is to produce thyroid hormone. Thyroid hormone stimulates cellular activity and metabolic rate. The metabolic rate is how much energy each cell produces. Too little thyroid hormone (hypothyroidism) causes symptoms of having too little energy. Too much thyroid hormone (hyperthyroidism) will causes symptoms of elevated metabolic rate.

Lab testing for thyroid disorders is not an exact science. Reference ranges for is considered “normal” are far to large. Both symptoms and labs need to be considered.

Thyroid Disease symptoms

The following are not comprehensive lists of all symptoms, just some of the most common ones.

Symptoms of Hypothyroidism:

Fatigue, lethargy
Weight gain
Dry, coarse skin
Cold intolerance
Swelling of hands, legs and face
Chronic infections
Postnasal drip(especially in the back of the throat)
Weakness
Muscle cramps
Arthralgia(joint pain)
High cholesterol
Constipation
Abnormal blood sugar
Parasthesia (sensation of tingling or numbness, feeling “pins and needles”) [1]

Symptoms of Hyperthyroidism:

Heat intolerance
Sweating
Increased appetite but weight loss
Fast heart rate (tachycardia)
Heart palpitations
Nervousness
Muscle weakness
Tired, but unable to sleep
Protrusion of the eyeballs (exopthalmos) [2]

2. Thyroid Stimulating Hormone (TSH)

What is TSH?

Thyroid stimulating hormone (TSH) is produced by the pituitary gland at the bottom of the brain. Its job is to tell the thyroid how much thyroid hormone to make. [3]

TSH levels

Normally, if you have too little thyroid hormone, the pituitary will make more TSH, to tell the thyroid to make more hormone. Therefore, high TSH indicates low levels of thyroid hormone (hypothyroidism). [4]

Likewise, if you have too much thyroid hormone, the pituitary will make less TSH, to tell the thyroid to make less hormone. Therefore, Low TSH can indicate high levels of thyroid hormone (hyperthyroidism). [5]

The following chart shows how TSH levels change when there is a disease of the thyroid gland.

Thyroid function	Pituitary	Thyroid gland
Normal	Produces enough TSH to stimulate thyroid gland, but not too much	Produces proper amount of thyroid hormone
Hypothyroidism (low thyroid hormone)	Makes more TSH to tell the thyroid to make more thyroid hormone.	Due to thyroid disease, the thyroid gland cannot respond to increased TSH and still makes too little thyroid hormone.
Hyperthyroidism (high thyroid hormone)	There is already too much thyroid hormone, so the pituitary makes very little TSH.	Due to thyroid disease, the thyroid makes excessive amounts of thyroid hormone despite less stimulation from the pituitary gland and TSH.

Doctors often depend solely on TSH to diagnose and treat hypothyroidism. Other labs tests and clinical observation are often ignored. The medical establishment’s over reliance on TSH causes under diagnosis of hypothyroidism. [6]

Why we can’t use TSH as the only measure of thyroid function:

The reference range for TSH is too large.

According to The National Institutes of Health’s (NIH) web site, normal TSH reference range is 0.4 – 4.0. The NIH article goes on to say:

Those without signs or symptoms of an under active thyroid who have a TSH value over 2.0 mIU/L but normal T4 levels may develop hypothyroidism in the future. This is called subclinical hypothyroidism (mildly under active thyroid) or early-stage hypothyroidism. Anyone with a TSH value above this level should be followed very closely by a doctor.”[7]

While it is good to see more mainstream sources recognizing the insufficiency of relying solely on TSH reference ranges, the above recommendations are still lacking.

There is nothing in the above about prevention. Instead they recommend monitoiring TSH.

Monitoring disease progression is not prevention. It’s sort of like putting up a dozen cameras around a dangerous intersection so the next accident can be caught on tape. True prevention stops the disease from happening. People need to do more than just wait until their TSH becomes bad enough for thyroid drugs.

3. Blood tests for hypothyroidism and hyperthyroidism

The thyroid hormone family

There are numerous thyroid hormones. Symptoms of hypothyroidism may be related to imbalance in these different hormones. This makes proper lab testing for hypothyroidism much more complex than only looking at TSH. [8]

There are two main forms of thyroid hormone, T4 (thyroxine) and T3 (triiodothyronine). T3 is the stronger active form. T4 is not totally inactive, but is much weaker compared to T3.

The thyroid gland makes some T3, but mostly T4. T4 has to be converted to T3 outside the thyroid.

Not all T4 is converted into T3. Most is actually converted into reverse T3. Reverse T3 is molecularly the same as T3, but it’s shaped in a different way so it’s inactive.

Additionally, thyroid hormone is carried in the blood bound to protein (thyroid binding globulin). Bound thyroid hormone is inactive. A blood test for total T4 measures all T4. A free T4 blood test shows just how much is free to be active. There is always more bound hormone than free. [9]

If too much thyroid hormone is bound (and therefore inactive) this may cause or exacerbate symptoms of hypothyroidism. [10]

So the three steps necessary to get active thyroid hormone is production, conversion into t3 and freeing it from binding protein.

Thyroid function lab tests:

Thyroid Stimulating Hormone (TSH) – Typical reference range: 0.4 – 4.0 mIU/L

TSH is made by the pituitary gland to tell the thyroid how much hormone to make. Although there is no absolute consensus on what the reference range should be, typically 1.5 to 2.5 is most optimal.

Hypothyroidism can have both a high or low TSH pattern:

High TSH (consider above 2.5) and hypothyroidism symptoms indicate either autoimmune disease or iodine deficiency.
Low TSH (consider under 1.5) and hypothyroidism symptoms indicate poor TSH stimulation from pituitary gland. [11]

Thyroxine (Total T4), Free Thyroxine (Free T4) and Free T3

Total T4 measures both the free and bound T4. A free T4 test measures only the free T4. Free T3 is a measurement of free T3 in the blood. Unlike TSH, these tests are a direct measurement of thyroid hormones. [12]

Low T3 could potentially indicate a problem with thyroid hormone conversion that may not be seen by just testing T4. [13]

Reverse T3

Revere T3 may be high (although it can possibly be normal) on lab tests if someone is converting too much T4 to T3. [14]

T3 uptake

This test helps to see how much thyroid hormone is bound (and therefore inactive) to the protein, thyroid binding globulin (TBG). Low T3 uptake can indicate hypothyroidism, and high T3 uptake can indicate hyperthyroidism. [15]

Thyroid antibody tests

Autoimmune disease is when your bodies own immune system attacks and destroys your own cells. In autoimmune thyroid disease (also called Hashimoto’s thyroiditis) the immune system attacks and destroys the thyroid.

Anti thyroid peroxidase (anti-TPO), and anti thyroglobulin measure antibodies against the thyroid gland. If either are elevated this indicates an autoimmune attack on the thyroid gland.

Medical doctors often do not run these because regardless of result they will prescribe thyroid hormone according to TSH. However, from a holistic perspective, antibody tests help show the cause of hypothyroidism and thus guide treatment.

Thyroid stimulating immunoglobulin (TSI)

This antibody mimics the actions of TSH and stimulates the thyroid to make too much thyroid hormone. High amounts of TSI are associated with Graves disease and hyperthyroidism. In Graves disease all 3 antibodies should be tested.

Other tests for hypothyroidism:

Basal Body temperature

This test for thyroid function was popularized by Broda Barnes and his book “Hypothyroidism: The Unsuspected Illness.” Since thyroid hormone is largely responsible for body temperature, it follows that measuring body temperature may indicate hypothyroidism. Often people with low body temperatures have hypothyroidism symptoms, despite normal thyroid blood tests.

Directions:

Place thermometer by your bed before going to sleep.
Upon waking, place the thermometer under the armpit for a full 10 minutes (oral temperature can be taken instead).
Stay as still as possible. Rest with the eyes closed.
Record temperature for at least 3 days (some sources will say up to 10 days). Menstruating women should do the test on the second, third and fourth day of their period. [16]

Average body temperature should be between 98.0°F and 98.6°F. [17]

Lateral 1/3 of eyebrows

People with hypothyroidism often lose the outer third of their eyebrows.

Achilles heel reflex

Most people know that there is a reflex point just below the knee. When a doctor hits this point with a reflex hammer, it causes the leg to involuntarily move.

We have another reflex point on the Achilles’ tendon. This is the strong ligament on back of the leg, where the leg meets the foot. Hitting the Achilles’s tendon with a reflex hammer should cause the foot to jerk. This is known as the Achilles heel reflex.

People with hypothyroidism often have a diminished Achilles reflex and this is a simple way to indicate possible hypothyroidism.

Just testing TSH is not enough

It is essential to run appropriate thyroid tests. There is no consensus among holistic practitioners which tests are best to run. However expanded panels will usually include, TSH, free and/or total T4, and free T3 as bare minimum. Individual patient circumstances may warrant testing more thyroid labs.

It is also important for each patient to get a copy of their labs and review them personally. Just because a doctor says your labs are all “normal” that doesn’t mean nothing is wrong. Official reference ranges are too large; so all labs should be reviewed with scrutiny.

4. Conventional versus natural treatments for hypothyroidism

The following are treatment plans different doctors may take with the same hypothyroidism patient.

Doctor 1: Does nothing unless TSH is over 4.0.

Doctors often do not treat hypothyroidism unless TSH is over 4.0 (or out of reference range). [19]

Patients are often told nothing is wrong with (just because TSH is not high enough) despite having many symptoms of hypothyroidism.

Frequent retesting of TSH may be ordered as part of “watchful waiting.” Thyroid medications are only prescribed when things look bad enough on lab tests. Never mind that for some time the patient may have been feeling bad enough despite what the labs said.

When thyroid medication finally is prescribed, it is typically the form of Synthroid or thyroxine.

Doctor 2: treats according to symptoms, not labs

Some doctors who are more knowledgeable about hypothyroidism will prescribe medications based upon symptoms and not lab tests.

However, this approach has problems as well.

Replacing thyroid hormone does nothing to treat the original causes of hypothyroidism.
There are natural treatments which may be able to reverse the hypothyroidism. Some hypothyroid patients may unnecessarily be put on thyroid medication for life.
Not everyone with symptoms necessarily needs thyroid hormone medication. This is especially true for those with low-normal TSH. In fact, giving thyroid hormone can make some people feel worse.

Often these doctors will use natural forms of thyroid hormone such as Naturethroid and Armour. Cytomel (a T3 medication) or T3/T4 blends from a compounding pharmacist may also be prescribed.

Doctor 3: Medication when needed, but also works on underlining cause.

Some people do need thyroid medication. But prescription should be based upon overall assessment of the individual and given when the body is unable to make enough thyroid hormone on its own. Whenever possible, work should be done to find the cause of hypothyroidism and reverse it when possible.

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