Hypothyroidism: Pitfalls of the conventional approach

If you’re like countless clients who come to see me, you’re sick and tired of feeling sick and tired, and know there must be a better solution to managing your thyroid condition. Your doctor diagnosed you with hypothyroidism and started you on thyroid medication, but you don’t seem to feel much better? Or maybe you felt better for a few weeks, but now you’re feeling back to your old sluggish self again? You go to your doctor and are told that your thyroid numbers look normal but you know something is still very wrong? I can’t tell you how many times I see these concerns in my practice!

First, let me explain the basics of the thyroid. The pituitary, a gland near the brain, releases TSH (thyroid stimulating hormone) which is essentially a message telling the thyroid to produce T4 (thyroxine). T4 can then go down 2 pathways. Either it is converted to T3 (triiodothyronine), which is the active form of the thyroid hormone, or it’s converted to RT3 (reverse T3) which is essentially the brakes on the metabolism. (3) RT3 is produced in higher quantities in response to stress, inflammation or infection in the body, and it’s primary purpose is to conserve energy for emergency use. The primary driver of metabolism in the body is the unbound form of T3, termed free T3, so obviously we want to have optimal levels of this hormone to maintain a healthy weight, heart, brain and digestive function.

Unfortunately, the conventional way of evaluating and managing hypothyroidism falls short for so many people and for so many reasons:

1. Typically, your PCP would simply check a TSH or thyroid stimulating hormone. While the TSH can provide clues to un underactive thyroid, it tells us nothing about how much of the active thyroid is available, the free T3. For example, a person can have a TSH in the “normal” range, but still have very low circulating levels of free T3, indicating there is either not enough T4 to convert to T3, the T4 is being converted to RT3 (the brakes), or there is simply a roadblock in the T4 conversion to T3. This is often why clients come to me complaining of thyroid symptoms even though they have been told their thyroid levels look “normal”.
2. The “normal” range of TSH is typically somewhere in the range of 0.5 to 4.8. Normal reference ranges vary from lab to lab and each lab sets their own ranges. This presents a problem in and of itself for obvious reasons. Additionally, “normal” reference ranges do not mean “optimal” ranges. In other words, a person could have a TSH of 3.5 which would be inside the normal range for that particular lab, but still be very symptomatic given that a TSH of 3.5 is significantly outside of “optimal” range. In a conventional setting that person would be told “everything looks normal” and sent on their way.
3. Thyroid antibodies TPO and anti-TG are almost never screened for in the conventional setting. These antibodies give us important clues as to the cause of the hypothyroid condition, specifically autoimmunity or Hashimoto’s disease. It’s important to know if this is the case, as Hashimoto’s is a much more complex condition and it’s vital to look for the root cause of the autoimmunity. Antibodies can be present for 5-10 years before there is enough thyroid destruction to cause hypothyroidism, so it’s important to screen for antibodies to prevent ongoing destruction.
4. The mainstay for treatment of hypothyroidism is to give T4 or levothyroxine. (1) This presents a problem for those patients who have problems converting the T4 to T3. This is often seen in nutrient deficiencies such as selenium and zinc, gut disorders, drug interactions, or in those with genetic variants in the DIO2 enzyme, which is responsible for making the T4 to T3 conversion.(2) Clients often come to see me feeling terrible on levothyroxine, and we discover very low levels of free T3 on lab work. In this case I either place them on a combination T4/T3 therapy or simply add T3 alone and their symptoms response is incredible!

If you feel like your symptoms have been dismissed and are tired of the one-size-fits-all approach to testing and treating your thyroid dysfunction, it’s important to find a certified functional medicine practitioner who can do a thorough workup and create a customized treatment plan based on your specific needs.

1. ncbi.nlm.nih.gov/pmc/articles/PMC4267409/
2. https://eje.bioscientifica.com/view/journals/eje/178/6/EJE-17-0947.xml
3. https://www.ncbi.nlm.nih.gov/books/NBK519536/