Not Your Mother’s Thyroid Disease

Frequently, patients present having been previously diagnosed with hypothyroidism (low thyroid). Most times, patients are currently being treated with medication but are looking for relief of symptoms and not just satisfying some numerical benchmark outlined by their physician. There appears to be a disconnect between treating the numbers and treating the patient when it comes to thyroid disease. After all, what is the point of cumbersome testing or taking daily medication if not for the promise of feeling well?

Much discussion typically surrounds the use of T3 (to use vs not to use and the form in which it is used). Many times, discussion also centers around what tests are appropriate and best represents each patients clinical situation. It seems, there are as many different ways to test and treat hypothyroidism as there are practitioners. Furthermore, many practitioners tend to order only the tests they were taught to order during their training. Many times this restricts the investigation to TSH and free T4. This approach may be adequate for many “run of the mill” cases of hypothyroidism. But, if your therapy is not progressing to afford you the best quality of life possible with optimal thyroid hormone levels, further investigation may be required to get a full assessment of your malady.

There are several factors to keep in mind when considering the best treatment for hypothyroidism:
Although patients may have an adequate TSH level with treatment with Levothyroxine (T4), this does not insure adequate conversion of T4 to T3 (the much more active hormone form).
If you are on T4 or T3 and are not getting the anticipated response, it may be worthwhile to get a RT3 (reverse T3) level. This is an inactive alternate isomer form of T3 which can “clog up” the thyroid hormone feedback system, thus actually worsening the clinical picture despite what would seem appropriate medication doses. Many persons with adrenal dysfunction or iron/ferritin deficiency have the propensity to make RT3.
Excessive caffeine and alcohol can worsen the dietary intake of iron, Vitamin B-12, Vitamin C. Limiting these in excess may help to meet the necessary dietary requirements.
Excessive physical stressors such as recovering from surgery, prolonged illness, sleep deprivation, or emotional stress for prolonged periods can cause excess or low levels of cortisol production from the adrenals. These changes in adrenal function can increase the production of RT3 and decrease conversion of T4 to active T3.

If your current thyroid therapy does not seem to be working, it may be worth discussing the effect of RT3 and/or the use of T3 in addition to your current regimen.

In Health,

Dr. Gary F. Joseph

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