Over the last few years, there has been an increased awareness of thyroid conditions, specifically hypothyroidism. The proper thyroid evaluation has become somewhat controversial as well. For decades, a simple TSH (Thyroid Stimulating Hormone) test has been the conventional test of choice in screening most thyroid related issues.
However, an ideal thyroid evaluation is so much more than just the typical TSH blood test. The TSH reference range is 0.45 – 4.5 uIU/mL depending on the lab. This range is quite large and many people can exhibit hypothyroid related symptoms, but their TSH is within normal range.
Common Hypothyroid Symptoms:
Other tests for thyroid function include both Free T4 and Free T3. The hormone Thyroxine (T4), which is released by the thyroid gland is an inactive hormone. The body will convert T4 into T3, which mainly occurs in the liver. The free T3 is the active form of thyroid so it is very important to include this blood test for proper evaluation.
It is important to point out, that approximately 70% of all hypothyroid cases are of the Hashimoto’s Thyroiditis type, which is an autoimmune condition where the immune system is attacking the thyroid. With Hashimoto’s you want to work on the autoimmune component, which means beyond just medication.
The antibodies involved in Hashimoto’s hypothyroid are the Thyroid Peroxidase Antibody (TPO) and and the Thyroglobulin Antibody (TGab). It is important to test these antibodies in any thyroid patient to differentiate if they have Hashimoto’s or generalized hypothyroid. Often some patients have elevated antibodies but have normal values of TSH, Free T3, Free T4.
Thyroid Testing:
There are many different types of medications for hypothyroidism. Conventionally, the typical medications prescribed are Synthroid, Levothyroxine or Levoxyl. It is very common for many patients on Synthroid, Levothyroxine or Levoxyl to have a reduced TSH but also still experience hypothyroid related symptoms.
In most cases, we like to use medications with a combination of both T4 and T3. Conventionally, Cytomel is a T3 drug that is often prescribed, but it is an instant release and many patients do not tolerate this medication. A better option is Compounded Thyroid, which is usually a Sustained Release (SR) combination of T4 and T3. In addition, there is Armour and Nature-Throid, which are both porcine based medications that also included T4 and T3. There is no one-size-fits-all in hypothyroid treatment.
The thyroid and adrenal glands are connected and when one is low the other is compromised. Patients with adrenal fatigue sometimes cannot tolerate thyroid medication until you treat the adrenal dysfunction, making it important to work on the adrenals when you are being treated for hypothyroid.
Hypothyroidism also includes patients that have had their thyroid removed due to thyroid cancer. These patients do very well on compounded T3/T4 thyroid therapy.
Many doctors that practice “functional medicine” will be able to treat your thyroid condition more individually, looking more into functional blood testing for Free T3 and Free T4 as well as treating other systems of the endocrine system.
If you have questions, please feel free to leave a comment below, you can contact us directly.
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