Hypothyroidism

By Michael B.
Schachter, MD, FACAM

Introduction
One of the most under diagnosed and important conditions in the United States has been called the “unsuspected illness” and accounts for a great number of complaints in children, adolescents, and adults.  This condition is an underactive thyroid system.

What kinds of complaints characterize an underactive thyroid system?  Low energy and fatigue or tiredness, especially in the morning, is frequent in these patients. Difficulty losing weight, a sensation of coldness–especially of the hands and feet, depression, slowness of thought processes, headaches, swelling of the face or fluid retention in general, dry coarse skin, brittle nails, and chronic constipation are also common.  In women, menstrual problems–such as PMS and menstrual irregularities including heavy periods and fertility problems are further signs and symptoms.  People with an underactive thyroid may also have stiffness of joints, muscular cramps, shortness of breath on exertion, and chest pain.  Be aware that a person with a low functioning thyroid doesn’t have to have all of these symptoms; he may have only a few.

Where is the thyroid located in the body and what does it do?
The thyroid gland consists of two small lobes connected together.  It is located in the front of the neck, just below the voice box.  The thyroid gland is responsible for the speed of metabolic processes in the body and therefore affects every organ and organ system.  It is the metabolic stimulator, analogous to the accelerator of a car.  Normal growth requires normal thyroid functioning.  When the thyroid is not functioning properly, organs become infiltrated with metabolic wastes and all functions become sluggish.

When the thyroid gland is working properly, it uses the amino acid tyrosine and the element iodine to make the thyroid hormone called thyroxine or T4.  Thyroxine is called T4 because it contains 4 iodine atoms.  If a person is deprived of iodine in his diet, he develops an enlarged thyroid gland, called a goiter and symptoms of an underactive thyroid or hypothyroidism.  The other important thyroid hormone is triiodothyronine or T3, which has three iodine atoms.  T3 is actually the major active thyroid hormone, being much more active than T4.  T4 is produced within the thyroid gland and is later converted to the active T3 outside the thyroid gland in peripheral tissues.  Under certain conditions, such as stress, the thyroid gland may produce sufficient amounts of T4 to obtain normal thyroid blood tests, but its conversion to T3 may be inhibited, causing a relative insufficiency of active T3.  Under this circumstance, the patient will have hypothyroid symptoms in spite of normal thyroid blood tests.  As you will see, this fact results in many missed diagnoses of an underactive thyroid system.

Conventional Diagnosis
In the Introduction, I discussed the production of thyroxine (T4) in the thyroid gland and its conversion to T3 outside the thyroid gland in peripheral tissues.

A hormone from the pituitary gland, which is located at the base of the brain, controls the production and release of T4 from the thyroid gland.  This pituitary hormone is called thyroid-stimulating hormone or TSH.  When the level of T4 in the bloodstream is low, the pituitary increases TSH production and release, which in turn stimulates the thyroid gland to produce and release more T4.  The T4 then feeds back to the pituitary, reducing the secretion of TSH in a negative feedback loop.  When a person has difficulty making T4 due to iodine deficiency or for some other reason, one would expect to find an elevated TSH.  In this case, the pituitary’s TSH is trying to get the thyroid gland to produce more T4.  If both T4 and TSH are low, this may indicate a pituitary problem with a low TSH secretion resulting in the lower production and secretion of T4.

How is hypothyroidism diagnosed today by conventional medicine?  Unfortunately, the diagnosis by conventional physicians, including thyroid specialists called endocrinologists, is made almost exclusively from blood tests.  Generally, T4 and TSH are measured in the bloodstream.  Additionally, a protein that binds T4 is also measured.  From this protein and T4, the free, or unbound, T4 is calculated.  If a patient has a normal TSH and a normal free-T4, the conventional physician tells him that he does not have hypothyroidism, no matter how many signs and symptoms of hypothyroidism he has.  I believe that this mode of thinking is incorrect and that the thyroid blood tests miss many cases of hypothyroidism that would respond favorably to thyroid hormone treatment.

If most hypothyroid cases cannot be diagnosed by the usual blood tests, how can they be diagnosed?  Prior to the extensive use of blood tests, astute clinicians, who obtained careful medical histories, including family histories from the patient, and who performed a complete physical examination were able to diagnose hypothyroid states.  Later, basal metabolic rates were measured in patients using special equipment.  Then came the blood tests–the protein bound iodine or PBI, T4, TSH and even T3 by special radioactive studies.  Instead of using the blood tests as adjuncts to diagnosis, many physicians soon relied upon the tests exclusively.  To properly diagnose hypothyroidism, the clinician must go back to a careful medical history, physical examination, and measurement of the basal temperature of the body.

Complete Diagnosis
What in the medical history suggests the likelihood of hypothyroidism?  With regard to infancy and childhood, a high birth weight of over 8 lbs. suggests low thyroid.  During childhood, early or late teething, late walking or late talking suggests a low functioning thyroid in the child.  Also, frequent ear infections, colds, pneumonia, bronchitis, or other infections may be signs.  Problems in school including difficulty concentrating, abnormal fatigue–especially having difficulty getting up in the morning and poor athletic ability all suggest a low thyroid.  Keep in mind that a person with low thyroid functioning may have only a few of these characteristics.  You don’t have to find all of them to suspect a low thyroid.

During puberty, we see the same types of problems in school and with fatigue, which is often worse in the morning and gets a little better later in the day.  Often, adolescent girls suffer from menstrual irregularity, premenstrual syndrome, and painful periods.  Drug and alcohol abuse is common.

Throughout life, disorders associated with hypothyroidism include headaches, migraines, sinus infections, post-nasal drip, visual disturbances, frequent respiratory infections, difficulty swallowing, heart palpitations, indigestion, gas, flatulence, constipation, diarrhea, frequent bladder infections, infertility, reduced libido and sleep disturbances, with the person requiring 12 or more hours of sleep at times.  Other conditions include intolerance to cold and/or heat, poor circulation, Raynaud’s Syndrome, which involves the hands and feet turning white in response to cold, allergies, asthma, heart problems, benign and malignant tumors, cystic breasts and ovaries, fibroids, dry skin, acne, fluid retention, loss of memory, depression, mood swings, fears, and joint and muscle pain.

With regard to the family history, all of the above disorders can be checked in family members.  Particular emphasis should be placed on hypothyroid conditions in parents or siblings.  Also, a family history of tuberculosis suggests the possibility of low thyroid.

The physical examination often reveals the hair to be dry, brittle and thinning.  The outer third of the eyebrows is often missing.  One often finds swelling under the eyes.  The tongue is often thick and swollen.  The skin may be rough, dry and flaky and show evidence of acne.  The skin may also have a yellowish tinge due to high carotene in it.  Nails tend to be brittle and break easily.  The thyroid gland may be enlarged.  The patient is more often overweight, but may also be underweight.  Hands and feet are frequently cold to the touch.  Reflexes are either slow or absent.  The pulse rate is often slow even though the patient is not a well-trained athlete.

Click here to continue reading about Basal Body Temperature

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