I Think It’s My Thyroid
“I think it’s my thyroid!”
I hear those words in my practice multiple times on a daily basis. The constellation of symptoms attributable to a dysfunctional thyroid could fill this page. Fatigue and weight gain are the two most common that come up with my patients, and are often the reasons treatment is sought out in the first place. Others, such as constipation, dry skin and/or eyes, feeling cold all the time, and hair thinning, are often elucidated after more intense questioning. Many more subtle symptoms are less often recognized by patients prior to testing and treatment – poor concentration, difficulty with memory, feeling like one is “in a mental fog”, trouble sleeping, and trouble waking up in the morning are just a few. Once treatment is initiated, many symptoms improve almost immediately.
Patients often come to me having been placed on an antidepressant for their symptoms. They feel many of the symptoms of depression, and are often diagnosed as such since, in their words, “all their tests were normal”. The thyroid may be the problem here, even when thyroid tests are in the normal ranges. This is what is referred to as “Subclinical Hypothyroidism”. Unfortunately, it can be easily missed if the tests are interpreted incorrectly, resulting in the addition of medications which can have a whole bunch of unnecessary side effects.
The thyroid gland is a small structure located in the front of the neck. In response to a hormone released by the pituitary gland (in the brain) called “thyroid stimulating hormone” (TSH), the thyroid then produces several hormones, which then travel through the bloodstream to the rest of the body. Those hormones go to cells throughout the body, and act on those cells to control metabolic activity (think energy production). Based on this extremely simplified explanation of the thyroid system, it stands to reason that if any part of this system isn’t working well (the pituitary gland, the thyroid gland, or the cells responding to thyroid hormone), symptoms of a thyroid problem will be present.
Testing for thyroid dysfunction is relatively straightforward. We can test the levels of thyroid hormones in the blood and determine if there is a problem. Most doctors are trained to recognize thyroid tests that are “abnormal”. And if they’re not, the lab will tell them when the number is “out of range”.
The first problem is really with our definitions of what is “healthy” for patients. Traditionally, doctors (and by extension, their patients) will consider any result within the “normal range” to be healthy. I can’t even count how many times I’ve heard the following from my patients –
“My numbers are normal, but I still don’t feel well.”
They have normal testing (according to the lab), yet still have all the symptoms of low thyroid. Why does that happen?
It’s all in how you look at it
Interpretation of thyroid tests is important. What many doctors forget is the simple fact that we are not treating the laboratory results, we are treating the patient – you. If you aren’t feeling well, it doesn’t really matter that the labs are normal. So, what is the real problem?
What I look for – and what all doctors should be looking for – is a result that is “optimal”. Optimal is exactly as it sounds – it means that your level is the best result for you. Often, with the thyroid, that means having thyroid hormone levels toward the upper limit of what the lab considers normal. Having a fixed range of normal (which is rather wide for most labs) means that there will be some people with levels almost twice as high as others, yet both are considered normal.
One of the major problems with having such a wide range of normal values is this – we don’t suddenly go from a perfectly functioning thyroid to a poorly functioning one. There is usually (except in the case of surgical removal of the thyroid) a gradual decline in thyroid function over time. So, that person who starts with an optimal level may slowly decline over time to a level toward the low end of “normal”. When that happens, symptoms may be present – all before the level drops into the “abnormal” range. So, a doctor who is taking the laboratory’s interpretation at face value may miss the fact that thyroid function is getting worse.
The Art of Medicine
There is no question that technically speaking, the practice of medicine has made great strides over the last few generations. Advancements in the state of medical knowledge – particularly in the areas of emergency care, diagnostic tools, laboratory evaluations, and treatments – have made it possible to prevent, diagnose, treat, and cure a great many diseases. However, one of the key components to healthcare, which we’ve lost along the way, is the art of medicine. I’ve known many now retired physicians, who practiced before a time when advanced testing was available. Almost all of them were able to talk to a patient, examine them, and have a very good idea of what the problem was – all without a single test. Many disorders, including thyroid disease, were treated based on symptoms, not lab values (because they weren’t readily available).
In my training, we were taught that when it comes to the thyroid, we should rely almost exclusively on laboratory tests. If you presented with the symptoms of a dysfunctional thyroid, we checked lab tests. If they were normal, well, then it just can’t be the thyroid.
There is a wealth of data now debunking that myth. Too many other factors are at play to rely solely on lab values.
It’s A Balancing Act
I mentioned in the beginning of this article that there are several steps involved in order for the thyroid to work well:
- The brain needs to release a hormone to tell the thyroid what to do.
- The thyroid needs to be able to recognize what that hormone is telling it to do.
- The thyroid needs to be able to comply with the instructions (i.e., make more thyroid hormone).
- The thyroid hormones need to go through the bloodstream to the cells and tissues that need it.
- The cells need to be able to recognize what the thyroid hormones are telling it to do.
- The cells then need to be able to comply with those instructions.
We can only directly test a couple of those steps with readily available tools. There are many factors affecting every step of that process – some we can test, others we can’t. A few examples:
- Adequate blood flow – to the brain, so the thyroid stimulating hormone can be produced; to the thyroid, so that hormone can get there; to the cells, so thyroid hormones can actually work. This is true for any cell to respond to any hormone.
- Nutritional factors affect how well the thyroid makes thyroid hormones, as well as how the cells respond to the hormones. For example, a vital component of thyroid hormone is iodine – if our diets are low in this nutrient, the thyroid will be compromised.
- The immune system needs to be functioning well, so the thyroid isn’t “under attack”. Autoimmune disease – where the immune system makes antibodies which harm the thyroid – is the most common cause of poor thyroid function in the developed world.
- Other organs need to be working well – the adrenal glands have a tremendous effect on thyroid function. (But that’s a topic for a whole new article!)
These are just a few examples. The bottom line is this – if we rely on lab tests alone to diagnose a problem with the thyroid, we are essentially ignoring these other factors. This is where the art of medicine comes in. Your doctor needs to be able to say “Hey! Your blood tests are normal, but you still have symptoms. I think it still could be something to do with your thyroid.” There is more than just a directly measurable value at play.
So, if you have symptoms of a thyroid problem, it’s important to be evaluated by a doctor who understands that you are more than just a collection of lab test results. Call today for a complete evaluation!