Hypothyroidism and Functional Medicine

This recent NY times article refers to a study showing that ‘thyroid disease is over diagnosed and over treated.’ The study used blood levels of TSH (thyroid stimulating hormone) for diagnostic criteria and prescribed Synthroid (synthetic T4) for those in the abnormal range. A number of clinical signs and symptoms associated with hypothyroidism were followed and were not shown to change even as the TSH came back down into normal limits. The conclusion was that TSH is not a good indication of thyroid health and these clinical signs and symptoms do not seem to respond to synthetic T4.The problems with this study are a good indication of the pitfalls of modern medicine. I see patients with hypothyroid symptoms, like morning fatigue, constipation, dry hair, skin and nails, cold intolerance and trouble losing weight in spite of exercise, all the time. Patients may show up with plantar fasciitis or other degenerative conditions of the musculoskeletal system due to the edema in the soft tissue that is a clinical sign of hypothyroidism. This is classically referred to as a “woody edema” because it takes a few seconds of pressure to sink into the skin then leaves a heavy impression. This is due to protein in the extracellular space that draws the fluid in but adds viscosity to the fluid. This has a different appearance than swelling of the lower extremity due to heart failure or venous insufficiency.

Using a combination of lab tests, patient history taking and physical exam it is apparent whether a patient is hypo, hyper or eu (normal) thryoid. The lab analysis needs to include free T4 and free T3 in order to know whether a patient is converting from T4 to T3, which is the more biologically active, but shorter lived, thyroid hormone. There are many reasons why you can have a normal TSH and still be hypothyroid, including inability to convert T4 to T3, increased reverse T3 (binds to the same receptor but has no effect), and thyroid receptor resistance (much like insulin resistance seen in diabetes).

The problem with this study is that there is more to hypothyroidism than hypothyroidism. In many cases, the underlying cause of hypothyroidism is adrenal fatigue and the underlying causes of adrenal fatigue are multi-factorial. This includes a multitude of systemic stressors such as sleep apnea, food sensitivities, hypo and hyper-glycemia, overuse of stimulants, chronic infections, nutritional deficiencies, other hormonal imbalances due to andro or menopause, insomnia, chronic pain and its causes, over training syndrome, and exposure to environmental toxins. This is where conventional medicine gets lost. It is a lot of keep track of but it is what is actually happening. This is why Functional Medicine is essential for understanding hormone pathology and why conventional Endocrinologists (hormone specialists) are missing the boat in many cases.

There are correlations in the musculoskeletal world with Orthopedic surgeons and Pain managements specialists who burn nerves, steroid away inflammation and cut through connective tissue to surgically remove damaged tissue. These solutions are equally myopic in their diagnosis and treatment in many (but not all) cases. The field of regenerative medicine is about knowing the diagnosis but also knowing the diagnosis behind the diagnosis. Maybe it is because I grew up playing chess, but you never win when you only think one move ahead. You need to be thinking three moves ahead. Good medicine, preventative medicine, works like this whether it is managing hormones or healing meniscal tears and back pain.

The take away by the NY Times reporter was that perhaps the clinical signs and symptoms are just a sign of ennui (weariness from lack of excitement) due to our current cultural and political atmosphere. That sounds like a diagnosis from the New York times journalist, not a doctor. And it doesn’t solve the problems caused by untreated hypothyroidism and its underlying causes.

If you have hypothyroidism or any of the above mentioned signs and symptoms that may be undiagnosed hypothyroidism, search for a functional medicine doctor in your area to evaluate the underlying causes of your hypothyroidism. In some cases, using a different medicine such as Nature-throid or a compounded T4/T3 combination product may be more effective at relieving clinical signs and symptoms. When we treat the underlying causes it is possible to get off of the medicine altogether, which in conventional medicine is viewed as a required life long chronic medication. If you are in the area, book an appointment with me at the San Francisco Institute for Integrative and Regenerative Medicine to get a thorough evaluation of your overall heath.