Are you one of the 30 million women or 15 million men that have a chronic medical problem that’s both under-diagnosed and under-treated?
Are you suffering from vague symptoms that you think are a normal part of aging?
Written by Mark Hyman, MD
Maybe you feel sluggish in the morning
or have a problem with your memory or trouble concentrating or focusing on tasks
or maybe you have dry skin
or fluid retention
or maybe your sex drive is not what it used to be
or maybe your hands and feet are cold all the time.
Maybe your hair is thinning
or your voice is a little hoarse.
Maybe your fingernails are thick and cracking.
Maybe your cholesterol is high.
Maybe you have trouble losing weight or maybe you’ve gained weight.
Maybe you’re suffering from depression or anxiety.
Maybe you have really bad PMS or you’re suffering from infertility.
You may even have muscle cramps, muscle pain or weakness.
Most of these symptoms would not lead you to go to the emergency room but do significantly affect the quality of your life. And most of us accept them as a normal part of our lives without really questioning them. Occasionally you might go see your doctor who shrugs them off. He or she is an expert in acute illness but often fails miserably when it comes to addressing the subtle changes in your body that affect the quality of your life.
Low sex drive is not necessarily a disease nor is a little dry skin or constipation or being tired. These are not diseases according to conventional thinking but, for you, these are significant problems.
I am talking about a condition that goes undiagnosed in HALF of the 45 million Americans that have it. It’s called hypothyroidism.
What is hypothyroidism?
This is a condition where your overall metabolic gas pedal has slowed down because the master gland that controls it, the thyroid gland, is not functioning at full speed (or even completely missing in the case of thyroidectomy, radioactive iodine or congenital hypothyroidism).
If your thyroid slows down or you don’t have a thyroid gland, every other organ and system in your body slows down – your brain, your heart, your gut, your muscles.
Thyroid hormone is like a master switch that turns on the genes that keep every cell of the body running.
Now this is one of those gray areas in medicine, but doctors tend to think in black and white. It’s not that you either have it or you don’t. You’re pregnant or you’re not. You can’t be just a little bit pregnant. But you can be just a little bit hypothyroid and it can have a dramatic effect on the quality of your life. That’s why millions of people are untreated and thyroid is such a hot potato in medicine.
This problem is further compounded by the view in conventional medicine that you can diagnose hypothyroidism ONLY through one lab test called TSH (thyroid stimulating hormone) and that you only qualify for treatment if your blood level is over 5. This unfortunately leaves a whole group of people with what we call subclinical hypothyroidism. It’s called that because doctors have a hard time diagnosing it.
Subclinical hypothyroidism may show up for you with many low grade symptoms such as fatigue, trouble losing weight, depression, or constipation. It often shows up on blood tests that most doctors never do. So you may not have the full textbook case of hypothyroidism but you might feel badly most of the time and no one can figure out why.
The key is that there is a way to treat hypothyroidism for those with subtle symptoms and make those who are diagnosed and treated with only partially effective treatments like Synthroid or Levoxyl feel even better.
The problems is that having a low thyroid function doesn’t just make you a little tired, it can lead to more serious problems including heart attacks and diabetes.
It takes being a medical detective
I see this all the time in my medical practice with patients coming in with vague complaints that alone may not seem that significant but when you put them all together create a significant story. In fact I remember the story of one patient who was 73 years old. This woman came to see me because she had been to see her doctor with complaints of fatigue, sluggishness, poor memory, mild depression, dry skin, constipation, some fluid retention, and her doctor said, “Well what do you expect? You’re 73 and this is what 73 is supposed to feel like.” But I do not believe that’s true.
I believe that most symptoms of aging that we see are really symptoms of abnormal aging or dysfunction that are related to these imbalances in our core body systems. I find that I have to be a medical detective to find clues, no one else is looking at, and put together the story of why a person is suffering that makes sense.
In this 73 year old patient, I tested for a number of different things and found that she had a sluggish thyroid. She did not quite meet all the criteria of conventional medicine for hypothyroidism but she had Hashimoto’s thyroiditis (which is an autoimmune disease where the immune system attacks your own thyroid gland) that led to her thyroid functioning poorly. Simply by replacing her missing thyroid hormone, giving her some nutritional support, and implementing some simple lifestyle changes, she went from feeling old to feeling alert and energetic and youthful and all of her symptoms cleared up.
I had another patient who was a young 28 year old woman who was chronically constipated and thought this was part of normal life to go to the bathroom every 3 or 4 days. She also felt tired in the morning and had trouble staying up at night to socialize with her friends and being an active 23 year old woman. She thought this was a normal constitutional problem and was stuck living like that. No one had diagnosed the fact that she had a sluggish thyroid. As soon as I nutritionally supported her and eliminated the food allergens she had, particularly gluten which creates inflammation which interferes with thyroid function, then she felt better. Her constipation resolved, she was energetic in the morning, she didn’t need coffee anymore to stay alert, she was able to stay up later at night without any fatigue or limitations.
Another young woman came to see me that had over 30% body fat and was unable to change her body no matter what she did. She ate perfectly, she exercised with a trainer every day, and her body wouldn’t budge. She also had a slightly depressed mood and other vague symptoms. I treated her with a low dose of Armour thyroid, which is natural thyroid hormone replacement medication, and she not only lost 20 pounds and improved her body composition but all her other symptoms went away.
This problem affects men, women, and children of all ages. It’s unfortunately common because of all the stressors in our environment, including toxins like heavy metals and pesticides, and nutritional deficiencies, all of which interfere with our thyroid function.
It is critical to understand that our thyroid is not just linked to our energy and the other symptoms that I described, but is the master metabolism hormone that controls the function and activity of almost every other organ in your body. When it slows down, everything slows down.
The good news is that there are clear ways to diagnose the problem as well as to treat it through a comprehensive approach using functional medicine.
A different approach to thyroid treatment
The first step is to find out if you have any of the chronic symptoms of hypothyroidism or any of the diseases associated with hypothyroidism. You have to ask yourself if you have any of the following symptoms:
___ fatigue
___ poor concentration or memory
___ low grade depression
___ dry skin
___ hoarse voice
___ coarse, thin hair
___ cold hands and fee
___ low body temperature
___ low pulse
___ muscle pain or weakness
___ low sex drive
___ weight gain
___ fluid retention
___ high cholesterol
Once I’ve asked my patients about all these symptoms I do a physical exam for clues to a low functioning thyroid:
___ low body temperature
___ fluid retention
___ thick tongue
___ swollen feet
___ swollen eyelids
___ enlarged thyroid gland
___ excessive ear wax
___ dry mouth
___ coarse skin
___ low blood pressure
___ decreased tendon reflexes
___ hair loss
___ loss of outer third of eyebrows
These are all useful physical signs of hypothyroidism that I can look for and I can put them together with the symptoms into a story of what is causing the problem.
Once I’ve done that and considered all the potential causes of low thyroid function like toxins, allergens, stress, and nutritional deficiencies, the next thing I do is the right blood testing. Most doctors just do TSH, which unfortunately is not a full picture of the thyroid. The newer guidelines of the American College of Endocrinology consider anyone with a TSH level over 3 as having hypothyroidism. Most doctors think that only a TSH above 5 or 10 is worth treating. Unfortunately this leaves millions suffering unnecessarily. There are also other important thyroid lab tests.
___ Free T4
___ Free T3
___ Thyroid Peroxidase Antibodies (TPOAb)
___ Thyroglobulin Antibodies (TgAb)
I also look for associated problems including gluten intolerance, food allergies, heavy metals, stress, as well as vitamin D, selenium, vitamin A, zinc, and omega 3 fat deficiencies.
And then I design a nutritional, lifestyle, and supplement regimen as well as a thyroid hormone replacement plan as a patients needs to regain their health and address this hidden epidemic of unnecessary suffering.
Once you’ve confirmed that a sluggish thyroid is contributing to your symptoms, the good news is that there are many things you can do to improve your thyroid problem.
About Mark Hyman, MD
Dr. Mark Hyman is a practicing family physician and ten-time #1 New York Timesbestselling author. He is the Director of the Cleveland Clinic Center for Functional Medicine. He is also the founder and medical director of The UltraWellness Center (in Lenox, MA), chairman of the board of the Institute for Functional Medicine, a medical editor of The Huffington Post, and was a regular medical contributor on many television shows including CBS This Morning, Today Show, Good Morning America, CNN, and The View, Katie and The Dr Oz Show. He is the winner of the Linus Pauling Award, The Nantucket Project Award, and was inducted in the Books for Better Life Hall of Fame.
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My TSH is 1.04 Normal range is .32 – 4.00 in canada
Free T3 is 2.6 normal is 3.1-6.2
Free T4 is 13 normal is 9-19
Am I hypo? I have anxiety, constipation, digestive issues, dry skin, insomnia and other symptoms. Please help doctor says I am fine.
So what happens when you have a patient who’s thyroid labs (the 4 mentioned) are sometimes high & sometimes low? I had a very large left goiter removed in 2008 & been suffering ever since. Nobody will prescribe thyroid medication because it works sometimes, but I have heat & cold intolerance, have low & high blood pressure, get fevers & low body temperatures, cannot loose weight even when though I can’t eat for days. I’m really scared because I have all the other hypothyroid symptoms with occasional bouts of hyperthyroidism, no andwers, & it causes so much physical & emotional stress. Oh and now my right thyroid is enlarged. Do doctors ever prescribe synthroid to stop goiter growth? Should I find another endocrinologist?
I became hypothyroidic following radio active iodine treatment in 2010. I lost 4 of the 5.5stone I’d gained and kept it off for almost four years. Now I’m struggling again along with most of the symptoms named in your post. I’m actually beginning to feel quite ill. Living in the UK, my GP tells me I cannot increase my levothyroxine as my rating is at the top of the government advocated reference range. I thought of requesting a T3 assessment, but even if I’m not converting the thyroxine efficiently, our NHS UK does not prescribe T3. I’m at a loss what to do to help myself.
Hi Lynne,
I suggest you go to see Dr Barry Peatfield in Crawley, UK. I had similar issues to you as I had radio active iodine treatment in 2009 and found that I couldn’t metabolise levothyroxine so felt ill for years. I am now taking NDT (since last year) which suits me much better, although I’m not quite there yet. One of my GPs very kindly prescribed me T3 for some time which was better than T4 but still not entirely suitable in the long term. If you google Dr Peatfield, you can get his phone number and also read his book.
So what do we do if we can’t see this doctor? I’ve tried so many doctors and none will listen! I just am told I need to exercise more and that exercising more would help with my extreme fatigue and inability to lose weight. I did a bootcamp exercise class and have done every diet/lifestyle change possible. Nothing helps! I’m feeling very hopeless and scared I will always just be fat and tired, no matter what I do.
Online directory for naturopath doctors
https://www.naturopathic.org/AF_MemberDirectory.asp?version=2
Hope this helps
Thank you!
I’ve had my thyroid checked for different times I have every single one of the symptoms except for half blood pressure and they keep on telling me I do not have a thyroid problem that my thyroids OK but my thyroid swollen they wanted to stick a needle in my throat and I told him no because they wouldn’t knock me out to do it they wanted me to stay awake and just number through needles freaked me out so I wouldn’t it’s been about four years ago maybe I need help what do I do
There’s a couple mistakes in my post sorry I was talking the text and didn’t check before I shared it so it doesn’t really make sense my thyroid has been checked four times and they wanted to just numb my throat because it was swollen but it was functioning just fine they said makes no sense at all
I have sluggish thyroid and take nature-throid. I am very lucky in that my sister is a nurse-practitioner specializing in women’s health. She tests me for vitamin and hormone levels and over about 4 years, my labs have significantly improved. She also does hormone pellet implants from bioTE (capsules placed under the skin that slowly dissolve over 3 months or so). I recommend searching for a practitioner that uses the pellets. They seem to do way more testing for vitamin/hormone levels including thyroid problems, with more training in this area. Hope this helps! FYI my sister practices in Texas a couple of hours drive East of Dallas, Bogata Health Clinic.
You’re speaking directly to me! My doctor sees me every three months, wherein I continue to gain weight and exhibit other symptoms in spite of a very clean, low-gluten, whole foods diet and an active exercise regimen. She tests my labs, which always turn out okay, then tells me to further restrict my diet, giving me the side-eye and suggesting that I’m secretly night-snacking. It’s insulting to be so distrusted, and to have a doctor so unwilling to advocate for me.
A question for those with similar problems: how did you get around this? How did you find a doctor willing to help you?
I have a sister who is a nurse practitioner. She specializes in women’s health, so I am very lucky. I recommend looking for a practitioner who uses bioTE hormone pellets. (Pellets placed under the skin that dissolve over about three months) She does a lot of hormone/vitamin/thyroid testing and is much more proactive in this area. She’s in Texas, but you should be able to get a list of practitioners from the bioTE website. Hope this helps!
Online directory for naturopath doctors
https://www.naturopathic.org/AF_MemberDirectory.asp?version=2
Hope this helps
“Once you’ve confirmed that a sluggish thyroid is contributing to your symptoms, the good news is that there are many things you can do to improve your thyroid problem.” I hope to read more about these things. Let’s face it, we aren’t getting answers from the medical field & most don’t ever get an opportunity see a competent doctor.
I wish there was a retreat somewhere where we can all go where there are all kinds of treatment options available to try all kinds of weight loss programs to try all kinds of things to learn that’ll help so we can go in the way we are but come out stronger more able to control our weight and more able to control the things around us accept the things that we can’t and the wisdom to know the difference
Great Idea! I wonder if Hypothyroidmom would consider doing this, or if they already do?
I need help… my TSH is at 36 due to a compounding pharmacist giving me the wrong medication. I’m now taking 39.5 micrograms of Tirosint per day, the only medication I can currently take. I need to take more thyroid medication but my body for some reason is blocking my taking any more medication. If I take 1 more microgram a week, I get extreme hyper symptoms. It’s physiological. I’m on high doses of blood pressure medication and beta-blockers. I had my thyroid removed many years ago. Five doctors have tested everything and can’t come up with an answer. Top doctors in San Diego and Los Angeles tell me that if I can’t get more medication in me there is strong possibility I could die.
To make things worse, in October 2017 I was diagnosed with lung cancer and need surgery but with my TSH number so high doctors have said I would not wake up after the surgery.
Has anyone had a problem like this and has found an answer.
I still have my thyroid, but we still have some oddly familiar symptoms. I was on 1.25 mcg of levothroid, then manufacturer shut down, and I’m highly allergic to Synthroid. Started taking Nature-throid, Tirosint, and many others. For years my blood pressure kept climbing past 160/90, and I always felt horrible. I started having episodes where my BP would go to 240/130, sometimes more. Medication for BP made me horribly sick, but had to take it. I lowered my dosage of thyroid (which I felt was causing too much cortisol from the adrenal glands). After years of struggle and then not being able to go out of the house, I finally understood thru incredible amt. of research that cortisol (adrenaline) was the cause of the extreme BP, Xanax works well for this because it lowers cortisol. For some time I had to experiment because I couldn’t keep my BP down, and had to use all kinds of calming supplements and drugs. Recently, I took Xanax (1/2 of a .25 mg tab twice a day), along with clonidine (1/2 of a 0.1 mg twice a day at 7AM & 2PM , and a beta blocker (atenolol (1/2 of a 25 mg tab)(caution, this combo in larger doses has been deemed difficult, but because my dosages are so low now, it has worked out fine for me and is OK’d by doctor. I also discovered that if I took olive leaf extract, 4-6 capsules (by Seagate), I could do without the Xanax. Olive leaf extract is an herb that is far different from drug Xanax, except that it also lowers BP, and is also antimicrobial, antifungal, antibiotical, with virtually NO side effects! I now take clonidine, atenolol, and olive leaf extract, along with melatonin at night. I have celiac disorder (very common with thyroid disorder, make sure you check that out), cannot eat wheat, any dairy except grass fed butter, no grains WHATSOEVER and many other things. This journey so far has taken me 10 years with some very scary times, don’t give up! If you had overactive thyroid (yours was natural, mine was medication induced), your adrenal glands are probably so worn out, they wreak havoc. Recognize that if you start taking supplements for your adrenal glands, some things might increase your BP, so get that under control first. Find an integrative, functional doctor, don’t rely completely on tests, rely on what your body is telling you. I still have pretty severe fibromyalgia and more weight, swelling, and bad fatigue, but my BP is usually in the normal range now. I have to build up my thyroid, tests show that medication shrank it, but I don’t have Hashimoto’s or anything else. I was given meds in error many years ago. Maybe you don’t need so much thyroid if you can get your BP down, without huge amounts of antihypertensives. Keep on going, you will find the answers, as will I! It makes sense to me that your adrenal glands are struggling, no longer under control and are pumping out too much adrenaline, thus the high BP. By the way, Olive leaf extract will help you with the cancer, too, as will other herbs. Hope this helps!
Dr. Chris Kresser is in Ca. I would go to him or one of the doctors in his practice
https://chriskresser.com/ccfmed/
Dee, have you tested reverse T3? Mine was very high. T4 meds do not work for me because my body converts T4 to RT3 rather than active T3. Once I got on T3 only, I began to feel half-human again. Best wishes for recovering from cancer!
So it is ok to take t3 only? I didn’t know that
Apparently it is Kim. I’m about 3 months in with T3 only, and I belong to several fb groups in which many take T3 only. Many add in NDT once RT3 issues are resolved.
Hi, Dee. I have a hard case, too, where I’m really sensitive to the thyroid-
replacement drugs….and I’m in the Los Angeles area & have also doctored
in the San Diego area, too, in the past. I’ve also tried Tirosint in the past
and was on it for a few years, but I had to give up on it because it was
really hard to take and was causing me extra symptoms I’d never had,
before. I’m now seeing a different doctor who is helping me try a different
medicine……..he is good about being flexible when I run into trouble,
which is a lot of the time! Have you seen Dr. Friedman in Los Angeles,
because that’s who’s trying to help me with this…..he sees a lot of hard cases.
I see him through the County health system, but he has a private practice,
too……..if you want more info, I guess reply to this and I will check back
The medicine I’m now taking is NP by Acella (Natural Porcine)…I’m still
learning how to work with it, but in some ways it’s easier than the Tirosint.
The doctor is trying to give me Magnesium Glycinate supplements (over
the counter) instead of beta-blockers or whatever…..I think the third brand
of them (Kal brand tablets, 400 mg a day) is finally starting to help with the
hyper-type symptoms these thyroid meds can give me, even when the dose is
actually too low. Good luck to you, and reply back to this, if you want. Starr D
all but one of the symptoms mentioned – I have. On top of that – I worked on Nuclear Missiles, highly toxic chemicals and spent decades working extremely high stress jobs. That said – the Kansas City Veteran’s Administration hospital not only IGNORES WOMEN and treats them like they DON’T belong there but also doesn’t have an inkling about any hormone but TESTOSTERONE. They offer a “ONE SIZE FITS ALL” Diet plan and bariatric surgery as the “solution” for any weight concern and has told me that other than that ans sybthriod (which I had a really bad reaction to) is the ONLY option and only that after many years of of asking. But then again I had a sleep test – got told to use a CPAP or DIE and didn’t see a Dr about it for 7 years – all the time being told that I had see one until I finally had a fit and demanded they check my records – So much gets swept under the rug there.
I still have so many of these symptoms after being on levothyroxine for years. What kind of doctor do I go to that will test all of these different aspects of the disease? My primary doc is great, but only tests me for my tsh. The endocrinologist I went to did the same. Help!
Insist that the endo run the thyroid antibody tests, as well as t4, t3, Vit d, b12, magnesium, zinc, cholesterol and routine blood tests. Mine gives me a hard time about always running the thyroid Antibody tests, but I insist on it. The reason is that I have altered my diet, gave up gluten and most dairy, eat more veggies and fruits and take supplements. I want proof of my own efforts are helping me to feel better. I lowered my thyroid antibodies by more than half by eliminating gluten. I do not take any thyroid or other meds despite the fact that my TSH was at 12 a while back. Following people like Dr. Hyman, Izabella went and Anthony Williams has helped me feel much better. You can do it too!
Nancy, would you PM me?
I have all symptoms of being hypo including a multi nodular goiter, and 2 siblings with thyroid disorders. My TSH is slowly rising and two years ago which was when my last bloods were done it was 3.7 but here in Britain you can’t be treated until your TSH is above 6. What do I do?
I am 67 and have been taking sythroid for years. I have all the symptoms you have takes about. My labs always show me on the low end of the scale. Is there a good learning book for me to read about my hypothroidism? Also is there a good book for me to read about glutin intolerence?
I am so sick of my doctor acting like my thyroid problem isn’t that big of a deal… It is at the root of almost all my problems…
Sounds like my Dr. “Your TSH is good ” that is i hear.
I am 66 and have hypo. My tsh is good but I am skinny, depressed and no energy. My doc also thinks everything is ok. It is not. I am not a text book hypo. Ir has ruined my health.