During training, we are taught that the standard treatment for an elevated TSH is Synthroid, or levothyroxine. This hormone is also known as T4. Often, the standard of care for hypothyroidism is replacement with T4 and yearly monitoring with lab testing of TSH and T4 levels. There are multiple problems with this approach.
To begin with, when a patient is showing signs of hypothyroidism, these signs can also indicate chronic infections, like mono or EBV, chronic candida in the gut, or chronic lyme disease. Low iron levels and adrenal dysfunction can also present with hypothyroid like symptoms – fatigue, low sex drive, hair loss, dry skin, irregular periods, depression, poor digestion, the list goes on.
When we rely on TSH and total T4 only as our lab markers, we may end up with a free T3 (the unbound version of T3) that is too high and/or an elevated reverse T3, which indicates something termed “pooling” of the thyroid hormone. Since TSH is made by the hypothalamus, it is not a direct measurement of how well the thyroid is making hormone, or of how well our patients’ bodies are utilizing their medication.
When we treat with Synthroid alone, we miss the opportunity to mimic the body’s healthy thyroid function. The thyroid typically produces T4, T3, T2, T1, T0 and Calcitonin. Although it is not clear about the roles of T0, T1, and T2, we do know that patients who are treated with only T4 often develop osteoporosis, continue to have signs of depression, and have mild continuous symptoms of low energy, low libido, and “foggy” mental capacity. We have found that treating patients with combination products, like Nature-throid, WP thyroid or compounded desiccated thyroid provides all of these components – Calcitonin, T0, T1, T2, T3, and T4. Armour thyroid is another option – it contains T3 and T4.
Since T3 is the active form of the thyroid hormone, most patients need to take T3 to have full resolution of symptoms. Now, our bodies can turn T4 into T3, however this process depends on the absorption of the thyroid hormone in a peroxide environment. Those patients with low stomach acid or taking anti-reflux medication will not appropriately absorb and subsequently convert T4.
In addition, the conversion of T4 to (the active hormone) T3 occurs in the liver. Although liver function can look normal on typical screening labs, many of us have slowed down our liver’s natural detoxification with over the counter medications and alcohol over the years. Eating cruciferous vegetables as well as taking herbs like milk thistle can help with liver function and in turn aid in the conversion of T4 to T3.
Another, very important aspect of treating low thyroid is how the adrenal glands, as well as the hippocampus are affecting the TSH number. Stress raises the TSH, therefore patients need a full evaluation of their adrenal function before replacing the thyroid hormone, as low cortisol levels should be addressed first.
Finally, we now understand that autoimmune thyroid disease often begins with leaky gut syndrome. Therefore, we always need to check for thyroid antibodies. Patients with one autoimmune disease are very likely to get a second autoimmune disease and they need information on gut healing to prevent future disease, as well as control or even reverse the current issue.
For many of us, healing leaky gut means avoiding environmental toxins and eating a clean, elimination type diet for a month or so, and then keeping a close log of symptoms as we introduce foods that have a potential to cause openings in the gut lining, or intestinal inflammation. When we continue to eat foods that are passing through the gut wall without being properly broken down, the immune system attacks these foods as foreign, and unfortunately the longer this goes on, the immune system turns on its own organs and begins to attack them as foreign as well. With autoimmune thyroid disease, (Hashimoto’s or Graves) the immune system has turned on the thyroid. So, you can see how simple replacement with T4 not only does not protect the patient from future problems, it also does not get to the root cause of the thyroid and possibly immune dysfunction.
There are more avenues to explore – such as low dose naltrexone for the immune system and adaptogens, like holy basil, to help your adrenal glands function properly. I recommend the following books to all patients with thyroid issues: Stop the Thyroid Madness (first and second editions) by Janie A. Bowthorpe and Hashimoto’s Protocol by Isabella Wentz.
Come on in to be seen for a new patient intake, where we will spend 90 minutes getting to know you, looking over your records, doing a full exam, and together forming a plan for your wellness.
Kate Godly