On June 7, 2014, endocrinologists will gather in Los Angeles, CA for a one-day symposium focusing on various thyroid-related issues. One of the sessions is titled: "Challenges in Thyroid Hormone Therapy: Why Does It Seem So Complicated?"
On the one hand, it’s promising to think that a group of prominent endocrinologists are joining together to discuss this important issue. The endocrinology community, after all, is not typically known for acknowledging — much less being curious about — the complexities of thyroid hormone treatment. The tendency is usually to prescribe Synthroid, Levoxyl or another brand name or generic form of levothyroxine, and then write off any unresolved symptoms as unrelated to the thyroid problem, as a consequence of poor lifestyle choices, or even, as a somatoform disorder, also known as a psychosomatic disease.
But for two decades, thyroid patients, advocates, and an increasing number of physicians — many of them holistic or integrative — have already been hard at work identifying and successfully identifying effective solutions to the challenges of thyroid hormone therapy. To some extent, it’s complicated because the endocrinology world makes it so.
The Limitations of the TSH Test
Thyroid hormone therapy is complicated when the Thyroid Stimulating Hormone (TSH) level — only one test among many — is relied on to the exclusion of other test results, symptoms, history, and clinical examination. It is also complicated when the endocrinology community can’t even come to agreement regarding the official reference range for the TSH test – the test they often refer to as the “gold standard.” Yet studies show that elevated TSH levels — even within the normal range — are a factor in fertility, and in miscarriage risk. Research shows that subclinical hypothyroidism – as evidenced by high-normal/borderline TSH levels – can contribute to a host of health challenges, including cardiovascular disease, depression, infertility, and obesity, among others.
Failure to Test for And Address Thyroid Antibodies
Thyroid hormone therapy is complicated when one cause of hypothyroidism — autoimmune Hashimoto’s disease — is all but ignored by the endocrinology community. In the U.S., one cause of hypothyroidism is Hashimoto’s disease — the autoimmune disease where antibodies attack the thyroid gland, and eventually slow it down and make it hypothyroid. Symptoms can start long before the slowdown is reflected by the TSH test. Yet many endocrinologists do not include a Thyroid Peroxidase Antibodies (TPO) test as part of a thyroid workup, again, preferring to rely only on the TSH test result. At the same time, studies show that treatment of euthyroid (normal TSH level) Hashimoto’s disease may help lower antibodies, and prevent progression to overt hypothyroidism. And cutting-edge research has shown that selenium supplementation, low dose naltrexone, and dietary changes — such as a gluten-free diet — may lower antibodies, reduce inflammation, and help resolve symptoms in some patients.
Failure to Test Free T3 and Treat with T3
Thyroid hormone therapy is complicated when the active thyroid hormone T3, is not measured, and when deficiencies in this key hormone are not addressed. The thyroid produces, among others, two key hormones, T4 and T3. T4 is a storage hormone, and its function is to be converted into T3, the active hormone that delivers oxygen and energy to cells, tissues, glands and organs. You can have a TSH in the “normal reference range” and yet still have low-normal or below-normal Free T3 levels, indicating that you do not have enough active thyroid hormone in your bloodstream, sometimes referred to as a conversion disorder. Despite studies showing that patients prefer combination treatments that include both T4 and T3, many in the endocrinology community refuse to test for Free T3, and will not prescribe any medications that include T3. (Cytomel and generic liothyronine are synthetic T3, and natural desiccated thyroid drugs like Nature-throid and Armour contain natural forms of T4 and T3.)
Failure to Test and Address Reverse T3
Thyroid hormone therapy is complicated when an important impediment – Reverse T3 – is not measured, and when elevations in Reverse T3 are not addressed. Reverse T3 is produced from T4 as a result of nutritional deficiencies, chronic stress, and other factors. It is an inactive, useless form of T3, but it can also block the body’s ability to properly utilize the active T3 in the bloodstream. Conventional endocrinology does now acknowledge the role of Reverse T3, and because resolving elevated Reverse T3 often involves use of medications that include T3, patients often reach a dead end on this issue.
Overreliance on Levothyroxine
Thyroid hormone therapy is complicated when you exclude other options, and offer only one drug treatment. For the endocrinology community, that drug is levothyroxine — synthetic T4. Known by the brand names Synthroid, Levoxyl, Tirosint, and generically as levothyroxine, it is the treatment of choice for most endocrinologists. But again, studies have shown that patients have better relief of symptoms and quality of life when they are prescribed a T4/T3 combination drug. These findings — even though published in reputable medical journals — are often dismissed as “bad science” by the endocrinology world.
These are just a few of the issues that make thyroid hormone treatment so complicated for endocrinologists – and a key reason why more and more thyroid patients are turning to integrative, holistic and complementary physicians for effective thyroid diagnosis and treatment.