Are you tired of feeling tired?
This question is completely on target. It is not uncommon to encounter individuals that do not feel at their best, they lack the energy to carry on with their daily lives and literally, they need to force themselves to get through their day.
Having an optimal level of hormones is paramount to have a good level of energy.
Thyroid Dysfunctions
We live in a “toxic soup” (polluted drinking water, polluted air, food loaded with pesticides and other toxicants, and more). This impairs the overall function of our body. Thyroid dysfunctions are prevalent.
The thyroid gland is a small gland in the lower area of the neck but critical for the body to function well.
When your thyroid gland is not working well, you will commonly feel tired. Here is a list of symptoms and findings that suggest your thyroid gland is not working properly.
1- The person suspects having thyroid problems but the doctor tells the patient that the blood tests are normal
2- The person was diagnosed as having thyroid problems, treatment was implemented but symptoms did not get better, and yet the doctor tells the patient that everything is now okay, as the blood tests have become normal.
If you identify with one of these situations, keep reading.
Due to the many toxicants that affect us, for many people, glands are unable to produce a healthy level of hormones. Laboratories “adapt” to this new situation by moving the ranges of the blood parameters down (lower) so, the “normal” is redefined (see Problems with usual thyroid testing). Being sick, in this unthinkable but real circumstance becomes the new normal. Yes, the patient may have symptoms but given that the levels are now considered normal, something else must be the cause: stress? overwork? depression, so maybe antidepressants are indicated?
Diagnosis of thyroid dysfunctions should be inferred by the clinical presentation (which requires an interaction between the patient and the practitioner). Laboratory testing should be used only to confirm the clinical suspicion.
Here is a list of symptoms
- Feeling tired
- Poor energy
- Cold intolerance or cold sensitivity
- Cold hands and/or feet
- Need to wear socks to sleep (winter only or all year round)
- Difficulty falling asleep
- Waking up feeling tired
- Feeling sleepy during daytime
- Difficulty concentrating
- Problems with memory
- Anxiety
- Depression or bluish mood
- Muscle pain and cramps
- Joint pain
- Waking up feeling tired
- Feeling of brain fog
- Hair loss
- Dry skin
- Brittle nails
- Constipation (regular transit implies daily bowel movements without difficulty)
- Menstrual irregularities, painful periods
- Difficulty getting pregnant or history of miscarriage
- Having gained weight easily in the border of the tongue
- Difficulty losing weight
- Headaches
- Fluid retention
- Recurrent colds
Findings
- Enlarged tongue with teeth indentations
- Enlarged thyroid gland
- Swollen ankles
- Hair loss
- Thinning of the lateral aspect of the eye brows
- Low basal body temperature (Temperature less than 97/8 F upon waking up)
- Elevated cholesterol and triglycerides
If you have several of the above symptoms with some of the findings, it is highly likely your thyroid gland is not working efficiently
Hypothyroidism (“low Thyroid”) is a common problem that is commonly missed
When the levels of thyroid hormones are low, the condition is called hypothyroidism (hypo = low). Very frequently, the patient with clear symptoms of hypothyroidism has normal blood tests. For this reason, the patient with these complaints is often dismissed (“Everything is normal”, “The blood tests are normal” or “It’s all in your head” are common explanations given to these patients). If you feel you have this problem but no treatment was ever offered to you, or you were treated but have not improved, you are not alone. There is a huge number of people in the general population with unrecognized, untreated, or unsuccessfully treated thyroid conditions.
When the “normal” blood tests are evaluated more in depth, subtle abnormalities are frequently found. The blood levels may be normal, but not optimal.
To understand why thyroid dysfunctions are so often misdiagnosed it is helpful to have a minimal understanding of the physiology of the thyroid gland (the mechanism of how the gland works) and it is also useful to understand why the thyroid tests frequently fail to help diagnosing the condition.
If you are interested in learning more about how the gland works, click here, and if you want to learn more about blood tests for thyroid dysfunction, click here. Here you will find our usual panel for the evaluation of thyroid dysfunctions
Physiology of the thyroid gland
The thyroid gland mostly produces a hormone called Thyroxine. It is known as T4 because it carries 4 atoms of Iodine. This hormone is inactive. Once it is transported into the cells (where the thyroid hormones will exert their function), the inactive T4 is transformed into an active hormone called Thyronine. This activation is accomplished by removing one of the Iodine atoms, so Thyronine is called T3.
T4: Inactive, a pre hormone
T3: active, the thyroid hormone
All glands function with self-regulating mechanisms: The Pituitary gland (in the brain) produces hormones that stimulate the other glands in the body. In this case, the Pituitary gland produces the Thyroid Stimulating Hormone or TSH to stimulate the Thyroid gland to produce thyroid hormones.
When the brain senses that the levels of hormones (T4 or T3) go down, it produces more TSH. TSH will stimulate the thyroid gland to produce more thyroid hormones, which in turn will lead to a decrease in the production of TSH.
This feed-back loop, when working properly, keeps a steady level of hormonal production. When everything works “fine”, measuring TSH will give an overall idea of how the thyroid gland is working. If the level of the TSH is in range, one assumes everything is fine.
The 2 key points expressed above are “when everything is fine” and “one assumes”. For more information, read “Problems with usual thyroid testing”
Problems with usual thyroid testing
Many people with symptoms that clearly suggest a thyroid dysfunction are told that they are fine, that the problem is not the thyroid, as the blood test is normal.
Tests commonly used to determine the presence of thyroid conditions, and why not all of them are useful.
- The test most commonly used is the level of the Thyroid Stimulating Hormone or TSH. If TSH is normal it is assumed that everything is alright.
- The range of the TSH hormone is huge. It goes from 0.45 IU/mL to 4.5 IU/mL. That is a range of 10 times between the lower and the upper values, which is not common in Nature. The American Association of Clinical Endocrinologists (AACE) suggests that the upper limit of the TSH reference range be lowered to 2.5 IU/mL.
“Range” is a statistical concept applied to a population. When we say that a value has a range that goes from “x” to “y”, means that 95% of the population studied will fall inside that range. Each individual patient may function better at different levels of the range.
- TSH levels vary throughout the day by up to approximately 50% of mean values, so such changes do not necessarily reflect a problem.
https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext.
The determination of thyroid function requires a clinical evaluation of the symptoms: If symptoms are present, the patient has a problem regardless of the blood value. The patient will function best when symptoms are nonexistent. Measuring blood levels when symptoms are not present can help establish the blood values this particular patient needs to function properly. - Not taken into consideration by most health practitioners is the fact that we are living in a “toxic soup” (polluted drinking water, polluted air, food loaded with pesticides and other toxicants, and more). The effect of these multiple and prevalent toxicants is that the mechanisms of our body are frequently impaired. In this case, a clearly low or relatively low hormonal value can co-exist with a low or relatively low value of the stimulating hormone, which strongly suggests that both, in this case the Thyroid gland and the Pituitary gland are dysfunctional. If one assumes that “everything is fine” and only measures for TSH, finding a normal TSH value will lead to the conclusion that the Thyroid gland is normal which is not the case if the person has a multitude of symptoms.
In this case, a low or relatively low TSH will coexist with low or relatively low thyroid hormones. This suggests that the regulatory mechanism above described, is not working well as the Pituitary gland does not respond to the suboptimal thyroid hormone values (both glands are dysfunctional).
Not being aware of the possibility of both glands being dysfunctional at the same time will lead to the wrong assumption that a person with thyroid-related symptoms but with normal or low TSH values has no thyroid problems.
- The range of the TSH hormone is huge. It goes from 0.45 IU/mL to 4.5 IU/mL. That is a range of 10 times between the lower and the upper values, which is not common in Nature. The American Association of Clinical Endocrinologists (AACE) suggests that the upper limit of the TSH reference range be lowered to 2.5 IU/mL.
- Some doctors measure for TSH and T4. Measuring only TSH and T4 does not give a complete view of the thyroid function. T4 is inactive. The transformation into the active T3 occurs mostly in the tissues where the thyroid hormone will work.
The most common problem is that the conversion of T4 into T3 is not sufficient. Measuring for T4 without also measuring T3 will not reveal this problem.
The conversion of T4 into T3, to produce the active thyroid hormone, is under the regulation of an enzyme that removes one atom of Iodine from T4. If this enzyme does not work well, good levels of T4 can coexist with low or relatively low (sub-optimal) levels of T3.
If both hormones are not measured at the same time this information is not acquired. This is an extremely common situation.
A comprehensive test of thyroid function should include not only the determination of TSH and T4, but also the levels of T3, another hormone called Reverse T3 (RT3) and also determining if there are antibodies directed against the thyroid gland (anti-thyroid antibodies). Unfortunately, not many doctors measure for T3 or for antibodies, almost none measure for RT3. This is the reason why so many people go undiagnosed and therefore remain untreated or mistreated as already explained.
Here is the complete panel ordered by Dr. Saporta to evaluate thyroid function
Measuring T3
At this time, the normal range of the hormone T3 free in blood is from 2.0 pg/mL to 4.2 pg/mL. (“Free” refers to the functionally available portion of the total amount of T3). Not so long ago, the lowest value for free T3 in blood was 2.4 pg/mL rather than 2.0 pg/mL.
Therefore, a patient with 2.4 pg/mL is now “normal”. The significance of this is that there is a huge amount of people that are therefore considered normal, when actually they are not.
In a counter-intuitive way, laboratories routinely adjust the values to what is being encountered in the community. In other words: if the pollution of the environment sickens our glands and makes them less functional, making it more difficult for the glands to produce a certain level of hormones, the labs will “adapt” to this new situation by moving the ranges further down (lower) so, the “normal” is redefined. Being sick, in this unthinkable but real circumstance becomes the new normal. Yes, the patient may have symptoms but given that the levels are now normal, something else must be the cause: stress? Overwork? Depression? Maybe antidepressants are indicated?
The reality is that any person with symptoms that suggest sub-optimal thyroid function and a level of FT3 of 3.0 pg/mL or less, is likely to benefit from a trial of supplementation. If administration of Thyroid hormones leads to symptoms resolution, the point is proven. If this intervention fails, something else should be looked for (example: assessment of function of the adrenal gland, patient’s diet and more).
Reverse T3 (RT3)
While many doctors think that RT3 is a hormone that does not work, RT3 plays an important role as a “brake” of the metabolism while T3 is the “driving force” of the metabolism. Stating that RT3 is not active is akin to stating that the brake-pedal of the car does not work as when we press it, the car does not move.
The higher the level of RT3, the more tired the person feels and the less energy is available to be used. When hibernating, bears develop a high level of RT3. The bear is not in a coma during hibernation, just in energy-saving mode. For a human that needs to be active, having an elevated level of RT3 implies feeling exhausted. The person would like to be in bed, but there are things to be done in daily life so the affected person needs to “force” himself/herself to do the daily chores.
Because a high level of RT3 goes with all the symptoms of low thyroid function but the levels of T4 and T3 may be normal, this condition is sometimes referred to as the Euthyroid Sick Syndrome. (“Eu” means normal). In other words: the person has symptoms of low thyroid function with normal levels of the (usual) thyroid hormones, meaning TSH and T4 (and potentially T3). If RT3 is not measured (most common occurrence) the clinician will never understand what is going on.
Anti-thyroid antibodies
Lastly, no panel for thyroid function would be complete without determination of antibodies against the thyroid gland. When our own body produces antibodies against some tissue or organ, the affected person is said to suffer from autoimmunity.
When the antibodies are directed against the thyroid gland, the person has an Autoimmune Thyroiditis. Grave’s disease and Hashimoto’s disease are examples of autoimmune thyroiditis. In Grave’s disease, the antibodies “pressure” the gland to liberate more hormones therefore producing an over function state known as hyperthyroidism. When the function is inhibited or eventually the gland becomes depleted, the more common condition of hypothyroidism develops. In this case, low, relatively low or even normal hormonal levels coexist with these auto-antibodies like the anti-thyroid peroxidase or TPO antibody.
Without entering into the complex topic of autoimmunity, the point is that a person with anti-thyroid antibodies will often complain of the symptoms of low thyroid function (hypothyroidism) and as explained above, all parameters measured in blood may be normal and still the patient be symptomatic. Patients with autoimmune thyroiditis will often benefit from a small dose of thyroid hormones. Unfortunately, most people with anti-thyroid antibodies are told to allow the disease to follow its course, and usually do not receive any treatment.
Determination of the presence of antithyroid antibodies should be part of the basic diagnostic routine, as this is an extremely prevalent condition.
Summary on laboratory testing
The diagnosis of thyroid disease should be suggested by the clinical presentation (the presence of symptoms) and not by the results of a laboratory test.
The blood test is more often than not normal, meaning the values fall in the established range. These normal values are commonly suboptimal meaning they fall towards the lower aspect of the range. In the specific case of free T3 this evaluation is compounded by the redefinition of the normal lower level of the range.
The most common abnormality found is a normal or even healthy level of T4 (from the mid-point to the “right”) with a low or more commonly relatively low level of T3 (to the “left” of the mid-point). In this case, the two hormones are not in balance.
Other patterns of abnormality include the presence of an elevated RT3 and the presence of antithyroid antibodies. These can occur as the sole finding or as an association with what was described above.
Values of TSH higher than 2.5 IU/mL (upper limit of range: 4.5 IU/mL) should lead to suspicion that the person could be symptomatic. A symptomatic patient can have relatively low TSH values, even close to the lower end of the range (0.45 IU/mL). Trying to rely on the value of TSH to determine “normality” is often misleading.
Lastly, it is worthwhile to repeat the concept of the professors of prior generations: the diagnosis of a certain pathology should be inferred by the clinical presentation, which requires an interaction between the patient and the practitioner. Laboratory testing should be used only to confirm the clinical suspicion.
Our panel to evaluate thyroid conditions
- TSH
- Free T4
- Free T3
- Total T3
- Reverse T3
- Calculation of ratio of TT3/RT3
- Anti-thyroid antibodies
The physical exam in the patient with hypothyroid symptoms
Because of low metabolic rate, these patients often put on unwanted weight and have difficulty losing it (in other words, diets do not lead to weight loss). Still many patients with low thyroid function are very lean.
Hands and feet are often cold to touch. Ankles can be found to “look thick” due to fluid accumulation.
Eyebrows can become bare in the area of the eye-brow tail (Hertoghe’s sign).
The thyroid gland itself can be enlarged. This can be evidenced by palpation of the neck, sometimes it is even visible: there is a “bulge” in the lower neck. This condition is called goiter.
Treatment of thyroid conditions
Most doctors treat thyroid conditions by prescribing a medication called Levothyroxine (LVT). LVT is manufactured by pharmaceutical companies and has the structure of hormone T4.
Levothyroxine = T4
As explained before, if “everything is fine,” by administering LVT (T4) it will be expected that T4 will transform into T3, which is the active hormone. Therefore, when “everything is fine”, administration of T4 will lead into resolution of the symptoms that the patient has. In the usual scenario, a patient with elevated TSH will be treated with LVT.
Most common problem with usual treatment
The most common problem a patient has, is not the faulty production of T4, rather the conversion of T4 into T3.
In this case administering T4 to the patient will lead to normalization of TSH but not to resolution of the symptoms.
Therefore, people with elevated TSH will most likely receive LVT that commonly will not work well as explained above.
Relying only on TSH to establish the diagnosis will leave the huge number of symptomatic people with normal TSH undiagnosed and untreated.
Our Treatment
Recognizing that most patients have a problem with the conversion of T4 into T3, the most logical approach involves administration of T3
There are 2 ways to administer T3
- The most efficient one, with the best clinical results, is the administration of natural medications obtained from drying, pulverizing and making tablets from pork thyroid glands. These tablets contain T4 and T3 (very similar to the human ratio), but also other nutrients of the thyroid gland. More here.
- T3 is also produced by the pharmaceutical industries under the generic name of Liothyronine. Therefore, patients with dietary restrictions or reactivity to pork products can still be effectively managed with a combination of T4 and T3
The management of the increased reverse T3 and the management of the person with antibodies is complex and will not be included here but is routinely done at our office.
The use of Iodine (Lugol’s solution), and other supplements and nutrients is commonly used as adjuvant to the treatment
Using whole gland tissue can have actions similar to when administering a “glandular”.
Glandular therapies are supplements made from the glands, organs, or tissues of healthy animals with the purpose of maintaining the health or improving the function of that tissue or organ.
Whole gland thyroid medication was the first medication used for the management of thyroid conditions. Its use started in the early 1900’s.
Levothyroxine was first synthesized in 1949. Since then, natural thyroid medications fell into oblivion by the majority of doctors (many of whom do not even know that such an alternative is available). Natural thyroid medications are criticized by the mainstream medical community as lacking potency, or lacking consistency from batch to batch or having a limited shelf life. The potency of these natural medications is stable at least since 1985 in agreement with the U.S. Pharmacopeia content standards.
If you suspect you have an untreated thyroid condition, or you know you have such condition but you are not attaining results from your present management, call 908-352-6700 to arrange for a consultation about your thyroid condition.
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