Every year I'm hoping medicine will catch up, that health care providers all over the country will get the news "YOU NEED TO CHANGE THE WAY YOU DIAGNOSE AND TREAT HYPOTHYROID!" It's December and this year isn't looking good. So I want to take some time to talk about the basics, so that you in turn can know what to discuss with your doctor, PA, or NP.
Let's talk thyroid signs and symptoms and you see if these sound familiar: fatigue, dry skin, depression, brain fog, brittle nails, hair loss, constipation, decreased sex drive, always being cold, weight gain or difficulty losing weight, thinning at the edges of your eyebrows, brain fog (did you catch that?). The incidence of hypothyroid also goes up post-pregnancy.
Ok, this can get a little dense but do your best to get through it. There are 3 major players in thyroid function: TSH, free T3 and free T4. Thyroid stimulating hormone (TSH) sends out the message for need of some T3 and free T4. It is like the gas pedal, the harder we push on the pedal the harder the car is going to work, and the higher the number of TSH will be. When the thyroid received TSH it begins releasing hormones. The majority of what is released from the thyroid is T4, which unfortunately doesn't do us a lot good until it's converted into T3, which a small percentage is. Once finally reaching T3 things can go 2 ways: either free T3 (yay) or reverse T3 (boo). Free T3 is the active form of thyroid and is what carries the effect of our thyroid throughout our bodies (the MOST important). You can think of reverse T3 as free T3 competition. It can bind to the same receptor site taking up the parking spot (why not continue this car analogy?) of our beloved T3. Reverse T3 is often high when our body is under stress or significant inflammation which means we get even less free T3 activity. So what our body really uses is the T3, but this is the least monitored out of the 3. I have no idea how that ending up happening. Often, the only thing being checked is the patient's TSH. Complicating things further is the fact that the "normal range" most used by providers, are grossly inadequate for all three of these hormones, but most dramatically TSH-making even the potential initiation of a hypothyroid diagnosis extraordinarily sparse. In practice, I simply use the TSH value to tell me how hard the thyroid is working to get the output of the patient's T3 and T4. Besides, it's not uncommon for it to be low if a patient is on thyroid medication. This renders it even more useless and problematic, as it is often still the only thing checked for patients being treated. Oh TSH, the problems you cause us.
*There are some other labs that can be useful but we will save for a later post.*
Let me recant my hypothyroid experience at my primary care doctor's office a few years ago. Bear in mind I had been on thyroid medication for years and am obviously familiar with with the symptomology associated with hypothyroid on both a professional and personal level. It went something like this:
Me: "I am having symptoms of x, y, z (really more like a-z), I think I need to increase my thyroid med."
Doctor: "Let's get some lab work."
Me: "Ok."
Lab work returns.
Doctor: "Oh it looks like we need to decrease your thyroid medicine."
Me: "WHAT? (almost jumping across table) Can I see that? (almost ripping it out of his hands) Oh, well you only the checked the TSH.
Doctor: "Ya..."
Me: "You can't decrease my thyroid medication based on this, this isn't even the right lab work. If you want to order my Free T3 and Free T4 then we can talk, if you'll still want to decrease my thyroid meds after that I will have someone else manage my thyroid."
I returned a week or two later.
Doctor: "Your free T3 and free T4 look ok but your TSH is still too low and I think we need to decrease your meds. Oh and by the way, I looked up the labs to run and I was right-TSH."
Needless to say, I went elsewhere. On my thyroid screening questionnaire I filled out at my intake, I checked off each every single thyroid symptom. Every single one. The doctor looked at the same lab results as the previous doctor and thought my free T3 looked low and it was not wonder I was having so many problems.. I have a hard time admitting this to people but for two months leading up to that appointment I was almost bed bound. I literally went to work every day, got off in the afternoon and went to bed by 3pm until the next morning. I remember telling my husband in the car at one point that I think he may need to just take me to the hospital, that I was just too tired and I just didn't feel like I could push myself any more.
That second doctor gave me my life back. He thinks I'm silly when I tell him but he gave me my life back because it's something so simple. The coolest thing is that sometimes I get to give people their life back. They come to me for depression but they don't need an antidepressant at all-they simply have a thyroid problem their doctor missed by only checking their TSH.
Some good internet resources for information pertaining to thyroid are the websites of Stop the Thyroid Madness and that of Dr. Amy Myers out of Austin, Texas.