Tag Archives: subclinical hypothyroidism

Fatigue? Weight Gain? Depression? Maybe it’s your thyroid.

Low thyroid function is very common.  It is especially common in women.  And your doctor may not diagnose you with it because of one simple mistake.

The thyroid controls how quickly the body uses energy, makes proteins, and controls how sensitive the body should be to other hormones.  It is exceptionally important.  Without thyroid function one cannot survive.

The thyroid is located in the neck just below the Adam’s Apple.  The average person should not be able to feel it.  It may become enlarged if you have low thyroid function.  In that case, one would be able to feel it and it may even be visible in the neck.

The thyroid is controlled by the pituitary gland in the brain.  The pituitary secretes a hormone called thyroid stimulating hormone or TSH.  TSH tells the thyroid to secrete its hormones.  These hormones are called T3 and T4.  When these hormones are secreted they make their way back to the pituitary via the blood stream and this tells the pituitary to stop secreting TSH.  This is known as a negative feedback loop.

 

The pituitary secretes TSH which tells the thyroid to secrete its hormone. This hormone then tells the pituitary to stop secreting TSH.

An under active thyroid is known as hypothyroidism.  The symptoms are varied and include the following:

  • Poor muscle tone (muscle hypotonia)
  • Fatigue
  • Cold intolerance, increased sensitivity to cold
  • Constipation
  • Depression
  • Muscle cramps and joint pain
  • Goiter
  • Thin, brittle fingernails
  • Coarse hair
  • Paleness
  • Decreased sweating
  • Dry, itchy skin
  • Weight gain and water retention
  • Bradycardia (low heart rate – fewer than sixty beats per minute)

The most common symptoms I see in practice of low thyroid function are the inability to lose weight and fatigue.  Depression is common as well but that can have many causes.

How is the thyroid tested?

The thyroid is tested with a blood test.  TSH is generally considered the gold standard to asses thyroid function.  A high TSH indicates that the pituitary gland is working too hard to get the thyroid gland to produce its hormone.  This means one has hypothyroidism.

I’ve had my TSH tested and it’s normal but I have all the symptoms

This is very common.  Unfortunately most doctors do not assess the thyroid completely.  There are many other parameters to check besides TSH.  Remember TSH is a brain hormone and while it can be valuable it is not the whole picture on the thyroid.

Let’s start with the controversy over the reference levels that most U.S. labs (and therefore doctors) use for a normal TSH.  Generally speaking, they use a reference range of 0.5-5.0.  If your TSH falls in that range then you are considered healthy, even if you have all of the hypothyroid symptoms.  This can be frustrating for many patients.  That reference range that most doctors rely on is far too broad and outdated.  Unfortunately, medicine is very slow to adapt.  This puts the patient at the disadvantage.  A more appropriate reference range for TSH is 0.3-3.0.  This is a much smaller range and would appropriately diagnose many more people with hypothyroidism.

So, if your doctor uses the old range of 0.5-5.0 and your TSH tested at 4.0 your doctor will tell you that your thyroid is doing just fine and will not treat you.  If he were to use the most updated range set forth by the American Academy of Clinical Endocrinologist in 2003 you would be appropriately diagnosed as hypothyroid and be treated accordingly.

What else can be tested?

Remember, TSH is just one parameter to be tested.  You can also test for the actual thyroid hormones themselves.  When testing for T3 and T4 there are two things to remember.  You must test the free and total T3/T4.  What’s the difference?

Total T3 and T4 takes into account the total hormone you have.  This includes biologically active and inactive forms.  The total hormone you have might be normal, but the free hormone might be low.

The free fraction of the hormones can often be low despite a normal total hormone reading.  The free hormone is what is actually available to your body to use.  It is unbound and biologically active.  Think of it like your cash flow.  A person might be worth a lot of money with real estate holdings and investments but if they don’t have any actual cash they can’t purchase anything.  If you have a low free hormone you will have symptoms of hypothyroidism.  However, if it’s not tested it might be missed.

You should also have the anti-thyroid antibodies tested.  These are antibodies that some people make their thyroid.  The body’s immune system mistakes the thyroid for an invader and begins to attack it.  High antibodies alone are enough to cause the symptoms of low thyroid function despite all other parameters being normal.

The bottom line is if you think you might have low thyroid function, don’t rely on just the TSH to tell you.  Have the full workup done.  That includes:

TSH, free and total T3 and T4 and the anti-thyroid antibodies.

And don’t forget; don’t rely on the outdated TSH scale.  Use the smaller more appropriate scale.

Getting an appropriate diagnosis is important and if you use these tips there shouldn’t be any more confusion for you.

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4 Simple Ways To Help You Lose Weight

One of the major health issues facing Americans today is obesity.  As a matter of fact more than two thirds of Americans are overweight or obese.  In my clinic we see lots of people who simply want to lose weight and get healthy.  While every case is a little different there are several things that you can do that will greatly improve your chances of losing weight and certainly get you feeling better.  Below I’ve listed somethings that are critically important in our program for people to get fit and most importantly, stay there.

1. Increase Your Activity Level With Exercise

This one seems like a no brainer, but when I talk to people about exercise I find that they don’t really understand what is necessary for them to actually see results.  I always ask people what they do for exercise.  For women, one of the standard answers is, “I have a young child at home and that gets me plenty of exercise.”  For men, a standard answer is, “My job is very physical so I don’t need to exercise.”  Other general answers patients give me for the dreaded exercise question include, “I walk to dog every day,” or “I like to garden on the weekend,” or “I don’t have time to exercise.”

Now, I can certainly appreciate that taking care of a young child can be fatiguing.  I can also understand that a physical job like construction is taxing.  I also know that walking the dog and gardening might seem like exercise, but if we examine these a little closer we will see that they do not qualify as exercise unfortunately.

Taking care of a young child and a job in construction are something that must be done every day (or almost every day).  At one point both of those might have burned you enough calories to qualify as an increase in your activity level.  However, after doing these things over and over again, your body figures out a way to to expend the least amount of energy possible while still performing those tasks.  This means that they no longer qualify as “exercise.”  Take this example.  If you went to the gym and you wanted to start getting in shape you might start by running on the treadmill.  You might start my running just a single mile.  Over time this single mile would no longer be difficult for you and would no longer qualify as exercise or produce the results you are looking for.  The same principle applies to your daily activities.

So to see the results you want, you must include exercise into your activities.  You don’t need to exercise every single day but at least several times per week.  Patients often tell me there is no time in their day for this.  The fix for this is simply that you must make the time.  No magic solutions for that one.

The exercises that I like people to include are weight training with high intensity interval training for cardiovascular health.  Weight training has many benefits.  It raises the amount of calorie you burn when you are at rest, it improves strength which reduces injury and it helps keep bones healthy and strong.  The high intensity interval training is cardiovascular work mostly using your body weight for resistance.  Often times this work is no more than a single 8-10 minute session after a weight training session.  The benefits are well studied and the shorter duration work out is equivalent to much longer workouts that are purely cardiovascular in nature.

2. Improve Your Diet

Again, this one sounds so simple, yet when done incorrectly will lead to poor results.  I always recommend that people reduce carbohydrate in their diet.  For a jump start I generally recommend that people get no more than 20-40 grams of carbohydrate per day.  For a little perspective on that, a single slice of whole wheat bread has about 15 grams of carbohydrate in it.  I also recommend that they get ketone strips from the local pharmacy.

Ketones are a by product of fat metabolism.  When you are exclusively burning fat for energy (as opposed to sugar) ketones will be excreted into your urine.  You may test this with ketone strips.  Simply pass them through a stream of urine several times per day and compare the color coded strip with the reference chart of the bottle.  You will want to see a trace to small amount of ketones.  This ensures that you are burning your body stores of fat for energy.

A diet low in carbohydrate will also help you gain control of a hormone called insulin.  People who have diets high in carbohydrate over produce insulin.  This is problematic because insulin is a storage hormone.  It causes your body to store energy in the form of fat.  Obviously if you produce too much of this hormone you will tend to store fat very easily.  Insulin is released in response to carbohydrate in your diet.  Reduce the carbohydrate and you reduce your fat storing hormone!

As a side note, continually over producing insulin will lead to diabetes and all the health complications associated with it.  Do not take insulin over production lightly.

3. Take Fat Burning Supplements

Many supplements tout their ability to lose weight for you.  No supplement will lose the weight for you.  To do that you will have to do the first two steps above.  There are, however, supplements that will help you lose weight.

One great example is something called carnitine.  It is available from many sources.  It works because carnitine is necessary for the body’s cells to transfer fat into the mitochondria.  This mitochondria is the power house of each cell.  It is what produces energy so the cell can keep up with it’s daily activities.  In order for it to burn fat it needs carnitine.  It is simple to take and is available in capsule form.  It is also very safe, unlike many other weight loss supplements.

Y0u may also benefit from taking supplements to stabilize blood sugar and reduce insulin production.  These are available through reputable supplement companies and I would urge you to see a doctor that specializes in functional medicine to find these types of supplements.

4. Check Your Thyroid

The thyroid can be thought of as the thermostat on the metabolism.  If it is under active your metabolism will be under active as well.  This means you will tend to gain weight very easily among other symptoms like lethargy, insomnia and general low energy.  Checking the thyroid is simple to do through a blood test.  I routinely check my patients on it.

There are several things to look for.  Many times physicians will order something called a TSH or thyroid stimulating hormone.  TSH is a brain hormone that tells the thyroid to secrete it’s hormone.  TSH is inversely proportional to thyroid function.  That means that the higher the TSH the lower your actual thyroid function is.  The reference ranges for most labs for TSH are 0.30-5.0.  This range is far too large.  A more appropriate range is actually 0.3-3.0.  In my practice if a patient’s TSH is above 2 I like to treat them and help them optimize thyroid function.  Other things that need to be checked are the actual thyroid hormones called T3 and T4.  Sometimes those are low, but the TSH is normal.  If the only test ordered is a TSH you might miss the fact that your thyroid is under active.  I also like to see something called the thyroid antibodies.  Sometimes people have antibodies to their own thyroid which reduces its effectiveness.

This list is by no means all inclusive.  It does, however, provide you and insight into the first few steps that go through my mind when someone asks for my advice in helping them lose weight.  We have been very successful in helping people get fit and achieve their weight loss goals.  It is not something that can be done for you, but the reward for achieving your goals is a great one.

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Filed under Diet