5 reasons conventional doctors can’t fix your thyroid

5 reasons doctors can't fix your thyroid

Why did I create Hypothyroid Mom?

I have spent countless hours over the last 5 years pouring over published studies on hypothyroidism. I have scoured the Internet every day searching for the very best thyroid experts and doctors. I have answered email after email and social media comments and posts from people struggling with hypothyroidism at all hours of the day and night. I have devoted my life to this blog that I created called Hypothyroid Mom. And you may wonder. Why?

Rage.

Yes I said rage.

On a cold, snowy day in New York City on January 20, 2009, I lay on a medical exam table on what would be one of the worst days of my life. I had miscarried at 12 weeks and was being prepared for a D&C, a surgical procedure to remove my baby. A technician had just taken an ultrasound and walked out of the room to reconfirm to the medical staff that my fetus had no heartbeat. I sprang off my bed and ran to the image on the screen. I felt my body shake and my fists clench as I stared at the image of my unborn child. From a place deep in my soul came a wail, “What happened to my child?”

I had unnecessarily lost my unborn baby all because my doctors had not read the Endocrine Society guidelines for pregnancy. Yes. Seriously. A TSH of less than 2.5 in the first trimester was clearly stated in the 2007 guidelines and mine was close to a whopping 10.0 with raging symptoms.

Why had I trusted my conventional doctors to have the answers?

Why had I not done my own research and been my own advocate?

Why had I not told my doctors to go to hell when they insisted that my symptoms were all in my head?

I should have fought like a ferocious lion for my child.

And I have to live with that regret for the rest of my life.

I will tell others.

I promised myself as I lay on that medical exam table.

I will let the world know.

I promised.

And Hypothyroid Mom was born.

I was determined to get to the bottom of this. I wouldn’t rest until I got myself well again and all my Hypothyroid Mom followers with me.

I searched high and low for thyroid experts when I first created Hypothyroid Mom in 2012. At that time there weren’t as many health experts and doctors writing about thyroid as there are today. I had to really search for the best information and I struck gold when I landed on this man.

Chris Kresser.

I hope he knows how many people he has helped. Including me.

I recently had a chance to connect with Chris and ask him some of my lingering thyroid questions. I know there is much written about thyroid but I wanted to dig deep into some of the issues that are not usually covered.

Written by Chris Kresser, M.S., L.Ac

1. The upper limit of the laboratory reference range for TSH is TOO high

Thyroid-stimulating hormone is the hormone that’s secreted by the pituitary gland, and its job is to tell the thyroid gland how much thyroid hormone to produce. The pituitary is kind of like the control tower that monitors thyroid hormone levels in the blood, and if they’re low, what it will do is produce higher amounts of TSH, or thyroid-stimulating hormone. On the other hand, if thyroid hormone levels are high in the bloodstream due to hyperthyroidism or maybe doses of thyroid medication that are too high, you’ll see TSH drop because the pituitary is naturally trying to limit the amount of thyroid hormone that’s produced by the thyroid gland.

Anytime you go to most conventional medicine physicians, and even if you just look at your lab results, you’re going to see that most commonly the reference range for TSH goes up to an acceptable limit of about 4.5.

How was the limit of 4.5 initially established?

The initial study was on the NHANES cohort, the Nurses’ Health Study. A lot of research has been done on that group, and not only did they not exclude people with undiagnosed hypothyroidism, they didn’t even exclude people with diagnosed hypothyroidism, which just seems crazy. So they took a whole bunch of people and they measured their TSH, but they included people with known and then undiagnosed hypothyroidism, which would skew the range much higher than it should be otherwise.

Then more recently, in the last 10 or 15 years, they’ve done studies where they excluded anyone with diagnosed hypothyroidism, which is just basic, but then they also used different methods of screening for hypothyroidism that didn’t involve TSH to determine whether people had undiagnosed hypothyroidism, and if they did, they excluded those people as well. And they basically found that a normal TSH for people that don’t have any thyroid problems is somewhere between 0.5 and maybe 2.2 or 2.5, depending on the study that you look at. As you can see, that’s very, very different than 4.5 being the upper end of the limit.

 Lab markers are a snapshot in time, and you never want to rely exclusively on lab markers without assessing the entire clinical picture. And that’s especially true if we see people with thyroid symptoms or symptoms that could be attributed to poor thyroid function.

2. T4 to T3 conversion problems are NOT thyroid problems

T4 is 94% of what the thyroid gland produces in terms of thyroid hormones. Then that T4 has to get converted into T3, because T4 is not very active metabolically. T3 is the thyroid hormone that really activates the cellular receptors and does everything the thyroid hormone is supposed to do. So the thyroid gland produces most of the T4, and then elsewhere—not in the thyroid gland, but elsewhere around the body like the liver and the gut—that T4 gets converted into T3, which is the active form.

What we often see is people who have either normal or low normal T4, and then they have low T3. What that indicates actually is that the thyroid gland may be functioning okay, but the conversion of T4 to T3 that’s happening all around the body is not working well. That’s a really important thing to understand. T4 to T3 conversion problems are not thyroid problems. They’re not problems with the thyroid gland. They’re problems that are caused elsewhere in the body that affect the thyroid system. They affect the cell’s ability to receive T3 thyroid hormone. They’ll manifest in hypothyroid symptoms, but they’re not actually a problem with the thyroid gland. It’s crucial to understand that, because it completely informs how we address T4 to T3 conversion problems.

For example, giving the patient a whole bunch more T4 medication is probably not a great idea in that situation, because the T4 is not being converted into T3. But that’s the standard treatment for a lot of thyroid problems, is just to give Synthroid or levothyroxine, which is a T4-based medication.

So what’s going wrong in this situation? It’s usually three primary causes: inflammation, poor gut health, and very low-carb diets.

3. Sensitivities to thyroid medication are OVERLOOKED

Another common question that is hotly debated is whether bio-identical or synthetic hormones are best. The answer is: “It depends.” In general I think bio-identical hormones are the best choice. A frequently perpetuated myth (in Synthroid marketing, for example) is that the dosages and ratio of T4:T3 in Armour aren’t consistent. Studies have shown this to be false. Armour contains a consistent dose of 38 mcg T4 and 9 mcg T3 in a ratio of 4.22:1.

However, in some cases patients do feel better with synthetic hormones. One reason for this is that a small subset of people with Hashimoto’s produce antibodies not only to their thyroid tissue (TPO and TG), but also to their own thyroid hormones (T4 and T3). These patients do worse with bio-identical sources because they increased the source of the autoimmune attack.

Another important consideration in choosing the right hormone is the fillers contained in each medication. Many popular thyroid medications contain common allergens such as cornstarch, lactose and even gluten. Most hypothyroid patients have sensitivities to gluten, and many of them also react to corn and dairy (which contains lactose).

Synthroid, which is one of the most popular medications prescribed for hypothyroidism, has both cornstarch and lactose as a filler. Cytomel, which is a popular synthetic T3 hormone, has modified food starch – which contains gluten – as a filler.

Even the natural porcine products like Armour suffer from issues with fillers. In 2008, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler. This may explain the explosion of reports by patients on internet forums and in doctor’s offices that the new form of Armour was either “miraculous” or “horrible”. Those that had sensitivities to dextrose were reacting less to the new form, and experiencing better results, while those that had sensitivities to methylcellulose were reacting more, and experiencing worse results.

The best choice in these situations is to ask your doctor to have a compounding pharmacy fill the prescription using fillers you aren’t sensitive to. Unfortunately, insurance companies sometimes refuse to cover this.

4. Studies show that 90% of people with hypothyroidism are producing antibodies to thyroid tissue

90% of people with hypothyroidism are producing antibodies to thyroid tissue. This causes the immune system to attack and destroy the thyroid, which over time causes a decline in thyroid hormone levels.This autoimmune form of hypothyroidism is called Hashimoto’s disease.

Most doctors know that the majority of hypothyroidism is an autoimmune disease. But most patients don’t. The reason doctors don’t tell their patients is simple: it doesn’t affect their treatment plan. Conventional medicine doesn’t have effective treatments for autoimmune disease.

The standard of care for a Hashimoto’s patient is to simply wait until the immune system has destroyed enough thyroid tissue to classify them as hypothyroid, and then give them thyroid hormone replacement. If they start to exhibit other symptoms commonly associated with their condition, like depression or insulin resistance, they’ll get additional drugs for those problems.

The obvious shortcoming of this approach is that it doesn’t address the underlying cause of the problem, which is the immune system attacking the thyroid gland.

What the vast majority of hypothyroidism patients need to understand is that they don’t have a problem with their thyroid, they have a problem with their immune system attacking the thyroid. This is crucial to understand, because when the immune system is out of control, it’s not only the thyroid that will be affected.

Hashimoto’s often manifests as a “polyendocrine autoimmune pattern”. This means that in addition to having antibodies to thyroid tissue, it’s not uncommon for Hashimoto’s patients to have antibodies to other tissues or enzymes as well. The most common are transglutaminase (Celiac disease), the cerebellum (neurological disorders), intrinsic factor (pernicious anemia), glutamic acid decarboxylase (anxiety/panic attacks and late onset type 1 diabetes).

5. Antibody tests are NOT reliable in diagnosing Hashimoto’s

The first-line test you do for Hashimoto’s, typically what I do, is antibodies. By antibodies, I mean thyroperoxidase and thyroglobulin antibodies, these are the two antibodies that tend to be elevated in Hashimoto’s. Thyroperoxidase is elevated a lot more often than thyroglobulin.

I know some practitioners will say anything above zero is abnormal, but I don’t actually think that’s true. A small amount of antibody production is actually not pathological or abnormal. I do use the lab range. If it’s getting close to the top of the lab range, I will definitely be paying attention, because the cutoffs are always somewhat arbitrary. They’re based on research and prospective studies, and I’ve seen some prospective studies that suggest to me that the lab range should be, perhaps, a little bit lower than it is.

The problem with thyroid antibodies is, like almost any lab test that you can mention, they’re not 100% reliable as a way of diagnosing Hashimoto’s. For example, in a study of 100 South Asian Indian people that had Hashimoto’s confirmed by histological analysis—meaning actually looking at the tissue and seeing for sure that they have Hashimoto’s—about 89% had TPO antibodies and 65% had thyroglobulin antibodies. That means that 11% of people with Hashimoto’s would have been missed if you were only looking at TPO antibodies, and a full 35% of patients with Hashimoto’s would have been missed if you were only looking at thyroglobulin antibodies. What we can say from these numbers is that anywhere between 11% and maybe 30% of patients, if you run TPO and thyroglobulin antibodies that have negative results on an antibody test, may still have Hashimoto’s, even if you run that antibody test multiple times. So that’s really important for clinicians to understand, because I’ve seen a lot of patients who’ve been to the doctor a few times before they came to see me. They said, “No, I don’t have Hashimoto’s. I had an antibody test, and it was negative.” Well, you can’t really conclusively rule it out just from an antibody test or two.

I always recommend that people do two to three tests over time at least, to see if we can catch it. And I have seen that with patients, where they’ve come and they’ve had one or two negative tests. I test them a third or fourth time, and we catch the antibodies elevated on the third or fourth time.”

About Chris Kresser

Chris Kresser is a globally recognized leader in the fields of Paleo nutrition, and functional and integrative medicine. He is the creator of ChrisKresser.com, one of the top natural health sites in the world. Chris’ book Unconventional Medicine: Join the Revolution to Reinvent Healthcare, Reverse Chronic Disease, and Create a Practice You Love will change the way doctors practice medicine and the way chronic disease patients like those of us with hypothyroidism advocate for ourselves.

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About Dana Trentini

Dana Trentini M.A., Ed.M., founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.

Comments

  1. My daughter was diagnosed with hypothyroidism at age 12. I had taken her in three times and doctors refused to do lab work. I took her back when she was so tired, she couldn’t even climb the stairs to her room. I demanded a blood test. They discovered the hypothyroidism and sent us with an RX of levothyroxin, and repeated blood tests every three months until her levels “normalized.” I am new to this. I feel like it’s a guessing game on how she feels day to day and is now having a ton of stomach issues that led us to an endoscopy, showing inflammation in her stomach (not celiacs – they tested). I am wondering if the medicine could cause this? I wish there were a more natural option for her. Anybody have any advice? Her skin gets red patches and she misses so much school with the stomach issues. So frustrating! Any help is appreciated!

    • Hello, I feel like you just described what I went through as a child. I was constantly in trouble at school for falling asleep at my desk until my mom demanded a blood test. My levels were so high I was hospitalized.
      I am 55 now and struggled all my life with this. I have full-blown Hashimoto’s disease and all I get from my doctors said is “well most hypothyroid sufferers end up with Hashimoto’s. There’s really nothing you can do but take your Synthroid “. My hair is extremely thin and even when I am on a 1000 cal diet I cannot seem to lose weight. I recently read up on how to treat auto immune disease and have started staying away from lectins, glutens, soy, and foods that might contain these items that animals might have eaten such as dairy. I find I feel a little better and I sure wish I would’ve known this back when I was 12 years old. Start looking for a doctor to treat her for an auto immune disorder and you will probably do much more good for her in the long run.

    • Jennifer K Blanchard says

      I have been taking Armour Thyroid for 10 years and while I still have some bouts with tiredness I don’t have nearly the side affects I read about other people having on the synthetic thyroid. You have to tell the Dr. you want Armour because they will NOT write it if you don’t tell them to. My Dr. still tries to make me switch every year and I refuse.

  2. I have high tsh is started at a level of 26. I was put on synthroid and it went down to 4 but then spiked to 39. I am on 200mcg of synthroid and my tsh level is still high.
    I am infertile and after several doctors I can not get my level to go down.
    Any advice ?

    • Make sure when they check her thyroid they do a T3 AND T4 NOT JUST A TSH. I HAD AN AREA ON MY SKIN WHETE THE SKIN WAS HURTING AND I MEAN REALLY HURTING . I USE JOSIE MARAN ARGON OIL ALSO AT QVC.COM. IT DOESNOT HAVE ALCHOHOL IN IT AND IT REALLY WORKS YOU USE EVERY DAY ALL OVER YOUR BODY FOR 2 WEEKS AND THEN EVERY OTHER DAY. QVC.COM HAS BETTER PRICES. IT IS VERY IMPORTANT THEY DO A T3 ANDT4. MY SON IN LAWS BLOOD WORK WAS FINE THEY ONLY DID A TSH HE THIUGHT HE HAD PNEUMONIA WENT TO ER FOR XRAY. LONG STORY SHORT HE WENT TO CLEVELAND CLINIC BECAUSE THEY WEREN’T SURE WHAT KIND OF CANCER HE HAD. HE HAD STAGE 4 MEDULLARY THYRIOD CANCER A TUMOR ON HIS LL LUNG AND IT WAS REMOVED THEY REMOVED HIS LYMPH NOTES ON LEFT SIDE. TODAY HE HAS BEEN CANCER FREE 4 YEARS.

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