Patient Safety: Stop Dismissing Thyroid Disease
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Patient Safety: Stop Dismissing Thyroid Disease

Understanding Thyroid Disease

Many who suffer from thyroid disease are both unaware of the presence of a disorder and the impact that it can have on one’s body. Frequent reports of feeling fatigued, having difficulty thinking clearly, and the presence of other chronic conditions such as diabetes or depression are signifiers that one may have a thyroid condition.

With an estimated 27 million adults in the U.S. suffering from thyroid disorders and up to 40% of the population experiencing suboptimal thyroid function, it is critical we understand thyroid health and the proper means of treatment.

Introduction to Thyroid Function

Understanding the basics of thyroid function is important when discussing thyroid health. There are four hormones of primary concern regarding thyroid function:

  • Thyroxine (T4) – the inactive or storage form of thyroid hormone
  • Triiodothyronine (T3) – the active form of thyroid hormone
  • Reverse T3 – the hormone that helps regulate T3 levels
  • Thyroid Stimulating Hormone (TSH) – the hormone that communicates the need for thyroid hormone and helps regulate production/release

When the body experiences low levels of T4 and T3, TSH is released to inform the thyroid that it needs to produce additional hormones. When in proper balance, T4, T3, and Reverse T3, keep the body’s metabolic processes working as intended. This influences weight control, temperature regulation, growth, and other important functions. The most common form of thyroid dysfunction is an underactive thyroid, known as hypothyroidism, which can lead to the following symptoms:

When one is suffering from a thyroid disorder the critical thyroid hormones mentioned above can fall out of balance. There are many things that influence thyroid function and it is important to be aware of their presence.

Overlooked Conditions

Unfortunately, various important factors are regularly ignored by many medical practitioners. The following thyroid conditions are often overlooked or discounted to the patient’s detriment.

Reduced Production:

Physiological and emotional stress play an important role in thyroid hormone balance. If someone is experiencing these stressors, due to chronic illness such as diabetes, depression, fibromyalgia and many others, they may experience a significant drop in thyroid hormones throughout the body. Because many physicians do not investigate beyond standard TSH testing, reduced thyroidal function and suboptimal hormone levels can go unnoticed.

Improper Conversion:

One may present “normal” T4 and TSH levels while experiencing a T3 deficit due to poor conversion. Because T4 must be converted into T3 before it can be utilized properly, any kind of inhibition of this process can induce symptoms related to thyroid dysfunction. Furthermore, one may experience excessive conversion of T4 into Reverse T3, further inhibiting the efficacy of what little T3 is available. Because conversion can be inhibited by numerous common conditions it is critical that physicians ensure that one properly converts T4 into T3 before deciding on a treatment method.

Poor Transport and Receptivity:

Transfer and reception of thyroid hormones in the appropriate systems may also be impacted. Although one may be producing the appropriate amount of T4, T3, and Reverse T3, if it is not correctly utilized, one can experience severe thyroid-related symptoms. Additionally, this condition will not be recognized by current widespread standards of testing.

There are numerous chronic conditions that promote development of the problems noted above. If you experience any of the following conditions, you are at greater risk of thyroid dysfunction:

  • Fibromyalgia
  • Depression
  • Obesity
  • Chronic Fatigue Syndrome
  • Mitochondrial dysfunction
  • Neurodegenerative disease
  • Insulin resistance and/or diabetes
  • Chronic inflammatory conditions
  • Chronic dieting

Inadequate Testing

Perhaps the main reason an estimated 13 million cases of thyroid dysfunction go undiagnosed every year is that medical professionals rely on old and/or flawed testing methods.

TSH levels alone are the most widely utilized means of testing for thyroid dysfunction. But, when it is the sole testing method it is woefully inaccurate. Many who complain of thyroid related symptoms often present “normal” TSH. In part this is because TSH does not correlate with tissue thyroid levels throughout the body and only measures how well the needs of the body are being communicated to the pituitary. It does not signify if those needs are being met. This standard of testing misses 80% of patients suffering from low levels of thyroid hormones.

Most physicians are not able to maintain the most current data or read contemporary medical journals due to time restrictions or a simple unwillingness to change their practice. Because of this, they rely on consensus statements produced by medical societies such as the Endocrine Society or the American Thyroid Association. Unfortunately, multiple studies have shown that reliance on these types of statements regularly result in poor care and treatment. It is consensus statements that have spread the belief that TSH testing is the only test needed to properly diagnose a thyroid condition.

Inconsistency among blood tests is also a common failure in thyroid testing. Labs frequently use outdated or improper ranges when analyzing blood tests for thyroid conditions. Pathological ranges are used to assess one’s thyroid health, which only recognizes a problem if one’s levels fall drastically outside of the average seen at that testing facility. These ranges are often broad but even small shifts in thyroid hormones can cause one’s health to decline. This means that even if one begins to feel terrible but their tests fall within the expansive “normal” range many practitioners will declare them healthy. Furthermore, depending on the lab, the same patient may be noted as having reduced, increased, or perfectly healthy thyroid levels. Inconsistency such as this can lead to severe mistreatment and misdiagnosis of patients.

T4-Only Versus Combination Therapies

Although T4 treatments in the form of Synthroid, Levoxyl, and Levothyroxine, are the most common approaches to managing one’s thyroid condition they are likely not the best. Utilizing T4 replacement therapy alone can elevate one’s TSH and T4 levels to the “normal” range while not resolving T3 and Reverse T3 issues. This may give physicians a false impression that one’s thyroid is functioning correctly.

If one increases T4 production or availability while they have a conversion issue, it can make their condition worse. For example, if the body is overly converting T4 into Reverse T3 then adding more fuel is not going to resolve a T3 deficiency. Instead, it makes it worse. Furthermore, because TSH levels are not correlated to this kind of issue, one’s physician may think that their treatment is working as intended while the patient suffers.

Those with thyroid conditions, specifically T4 conversion dysfunction, have been shown to greatly benefit from combination thyroid replacement therapy. By utilizing treatments that include both T4 and T3, especially time-released T3, the body is more capable of achieving correct thyroid hormone ratios. By providing the correct value of T3, the body is less inclined to produce T4 that could be inhibiting T3’s impact if it is being overly converted into Reverse T3. Continuously supplying the body with T4 through standard treatment does not resolve issues of conversion, transport, or receptivity.

Don’t Settle for Suboptimal

Being vigilant and well-informed of the problems surrounding thyroid diagnosis and treatment will help protect you from poor care and inadequate treatment. If you are consistently exemplifying symptoms of a thyroid condition but your physician refuses to pursue comprehensive testing that includes at least T4, T3, Reverse T3, and TSH, then it may be time to seek a new medical practitioner. By utilizing the information given in this article you can help improve your own quality of care and be better positioned to resolve thyroid dysfunction.

Patient Safety: Stop Dismissing Thyroid Disease was last modified: February 23rd, 2017 by Holtorf Medical Group

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