When I walk into an exam room, the first thing I do is shake my patient’s hand. I do this both for the social connection, but even more importantly, to feel the temperature of the hand. If they are feeling run-down, I listen to the patient’s complaints and then ask further about cold hands and feet, fatigue, dry skin, constipa- tion, difficulty losing weight, fluid retention, depression, memory loss, anxiety, insomnia, joint aches, muscle aches and hair loss. All of these are symptoms of less than optimal thyroid function.
If you aren’t feeling energetic, the chances are you are not enjoying life to its fullest, but you don’t have to accept this situation.
The thyroid is a butterfly-shaped gland that is located in the front of the neck. Although malnutrition and illnesses of various kinds can harm its function, the most common cause is increased cortisol due to stress. To counter this malaise, thy- roid supplements can be prescribed.
Thyroid supplements come in two forms, T4 (the storage or precursor form) and T3 (the active form of thyroid). How- ever, the most popular medicines used for low thyroid (Synthroid, Levoxyl and Levothyroxine) are all synthetic T4 hormones, yet there is not a single T4 receptor in the entire body.
T4 must be converted to T3 in the body, but during stress, the body cannot convert T4 to T3. Rather, due to cortisol (from stress), the T4 converts to reverse T3— the mirror image of free T3, which attaches to the cells in the body without creating biologic activity—preventing the active T3 from attaching to the receptors and giving a metabolic effect. Thankfully, there is a blood test for reverse T3, if we need more proof that we are stressed.
Elevated blood glucose levels (a pre- diabetic condition) can cause a lack of thyroid hormone. Also, deficiencies in vitamins and minerals including iodine, zinc and selenium can affect the thyroid (Europe Journal of Endocrinology 2002, April; 146 (4): 559-66).
Believe it or not, reverse T3 served a very necessary function to our ancestors. During times of famine, our bodies respond by converting T4 into reverse T3, which causes decreased energy and metabolism (burning calories more slowly) as a survival mechanism. However, nowadays, when we are under stress, we are usually still eating three meals a day while our bodies are attempting to preserve fat and lower our metabolism.
So how do we achieve less reverse T3? The main way is to eliminate physical and mental stress. Next is to treat iodine, selenium and zinc deficiencies. Finally, if we are unable to decrease the reverse T3, we need to have bio-identical thyroid supplements. Sadly, many of us are chronically under stress and could possibly need thyroid supplements for optimal health.
The standard lab test that most doctors use for determining thyroid function is to check TSH (thyroid stimulating hormone), which rises when inadequate thyroid is available. Anti-aging physicians have always said that an optimal TSH is less than 1.0, while the laboratory I use gives a “normal range” for THS of .4 to 4.5. I also check for free T4 and free T3. Free T3 is the best indicator of someone’s thyroid function. Remember, T4 is a pro-hormone and T3 is the actual active hormone, and TSH is the response of the brain to T3 and T4. If this sounds confusing, let me simplify it for you. How does one know if what is normal to one person is normal to another? How do you feel? Do you feel vibrant and energetic, or not?
Let’s talk now about lab tests. A TSH should be ordered, but what TSH is optimal? The answer is .1 to 1.0. At that level, we have lots of energy, the brain is functioning optimally, we have less body fat, we have less lipids (cholesterol and triglycerides) and we have lower blood sugar. At this thyroid level, there are no adverse effects: bone loss, rapid heart rate, or other undesirable effects. What is the difference between TSH of 0.4 and 4.0? The answer: 12.13 lbs.! (Journal of Clinical Endocrinology Metabolism 2005 Jul; 90 (7):4019-24). Free T3 should always be measured as well. “Normal” is between 2.3 to 4.3. However, optimal is 3.5 to 4.3.
I normally get up at 5:30 a.m. every morning to take my dogs out for a hike, and I like to be asleep by 10:30 p.m. However, I was recently having difficulty staying awake beyond 8:00 p.m. Worse, I found myself driving to work while sipping coffee instead of riding my motor- cycle on most days. I took my free T3 level and it turned out to be 2.9; within the normal range. But then I realized that what the anti-aging experts say is correct; I may have been “normal” but I was certainly not feeling optimal. I put myself on a low dose of Armour Thyroid and once again, I am able to stay awake until 10:30 p.m., I sleep better and my quality of life is better.
During times of stress or suspected low thyroid, one should also get a reverse T3 reading. The normal for this is 90 to 350, with the optimal being less than 200.
I do not base any of my treatment on T4 readings, as there are too many factors affecting the conversion of the storage form to the active form.
What nutrients are needed in order for your body to make thyroid hormone? According to the RDA, 150 mcg of iodine per day is needed to stay alive. However, much higher doses are actually necessary for optimal thyroid function. Iodized salt provides about 400 mcg per teaspoon and iodine is also available in seafood, dietary supplements or Lugol’s Solution (The Original Internist, 12(3):105-108, 2005). Adequate amounts of vitamin D also contribute to the body’s manufacture of thyroid hormone (please see “The Unknown Hormone” in Sept. 2011). Trace amounts of selenium and zinc are also necessary.
Now, let’s talk about treatment. In the Journal of Clinical Endocrinology Metabolism 2011 August 24, it states that the treatment of T3 alone (versus both T3 and T4) improved weight loss, resulted in better lipid levels, and had no adverse effect on cardiovascular function or insulin sensitivity. The only problem with treating T3 only is the short half-life of T3; the thyroid pill would have to be taken two to three times a day. The preferred method for myself and multiple other doctors is Armour Thyroid, which is 80% T4 and 20% T3—close to what the body actually makes, which is 90% T4 and 10% T3. If you don’t have insurance coverage for this agent, a compounding pharmacist can make bio-identical thyroid inexpensively.
Read this article carefully, and do not settle for feeling mediocre. Once you get lab tests, keep copies for your files and compare tests during various stages of your life, making note of how you are feeling during those times, taking the multiple factors I stated above into account.
If you have any questions, give me a call at 949.916.3600.
John G. Alevizos, D.O.