Thyroid is a very important metabolic hormone. The levels of this hormone tend to slowly decline after the age of 40, but can certainly decline earlier due to excess stress, nutritional deficiencies, or if one’s own immune system develops antibodies to their thyroid. As well, many processed foods (bread, pasta, sports drinks) contain bromine which displaces iodine and can lead to decreased thyroid activity.
Symptoms of thyroid deficiency include low energy, lack of mental clarity, low mood, weight gain, cold extremities, dry skin and hair, constipation, and the loss of the outer third of the eyebrows. If untreated it can lead to chronic fatigue, congestive heart failure, osteoporosis, and dementia.
Certain other conditions can lead to thyroid excess (including taking too much thyroid replacement!) which leads to tremors, anxiety, palpitations, and excessive weight loss.
Some specific nutrients important for thyroid function include iodine, tyrosine, selenium, zinc, B12, ferritin, and Vitamin D.
Testing for thyroid function is a bit problematic as we tend toward over-reliance on the TSH, or Thyroid Stimulating Hormone. The normal range in BC is very broad, ranging from 0.1 to 5.0. (The upper limit in Washington State is 3.0). TSH will go up if the thyroid is underperforming, as it is designed to stimulate the thyroid into producing more hormone when needed. I like to aim for a TSH below 2.0 for optimal performance, as I certainly see plenty of patients who have clinical symptoms of hypothyroidism with levels of TSH between 2 and 5. If in doubt, we can ask for a level of Free T4 and Free T3. The T4 comes directly from the thyroid gland, but then gets converted to the much more active (hence more important) form called T3. This test is not usually covered by MSP but the test is very affordable at approximately $25. The normal range of T4 is 11 to 23, so in patients with hypothyroid symptoms I aim for the upper half (over 16). Normal levels of T3 are between 3.5 and 6.5, so I aim for over 5. I would refrain from replacing thyroid hormone if the T3 level was already over 5. In borderline cases, thyroid restoration may be needed for a period of time and as nutrition and stress levels improve, thyroid hormone can sometimes be discontinued. Healthy adrenal function is particularly important for the conversion of T4 into T3.
I usually recommend a product containing both T3 and T4, although some people will do very well on Synthroid or Eltroxin, which contain just T4. Thyroid replacement should be taken first thing in the morning on an empty stomach, 30 minutes before eating. One tip is to keep your thyroid medicine on your bedside table with a glass of water, and take it as soon as you open your eyes. In those with antibodies against their thyroid (known as Hashimoto’s Thyroiditis) we tend to avoid glandular supplements such as Armour Desiccated Thyroid, as it is an immune stimulant. Instead, we might ask the compounding pharmacy to prepare a blend of T4 and T3 in a sustained-release capsule. Expect to see improvement within 2-3 weeks. Watch out for anxiety, tremors, and palpitations, which could be an indication of over-dose.
If you have further questions about your thyroid, or about hormone replacement in general, be sure to speak with your doctor about appropriate testing and replacement options.
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Dr. Grant Pagdin MD
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