Over 27 million Americans suffer from underactive thyroid symptoms in the U.S. A majority of those affected are women. Still this condition remains to be very mismanaged and mistreated. Typically when a patient goes to the hospital exhibiting hypothyroid symptoms (fatigue, cold hands and feet, weight gain, hair loss,etc), the first thing that happens after a consultation is the ordering of blood work. The blood work will contain a thyroid panel.
That thyroid panel typically consists of four measured blood markers, but the gold standard that is analyzed is “TSH” or Thyroid Stimulating Hormone. If that number is high or low based on the laboratory ranges (and that’s a whole other topic on itself, the relevance of lab ranges vs. functional ranges), hormone replacement therapy is prescribed. The goal of hormone replacement therapy is to adjust medication to get TSH to show up normal on the blood test. So it’s all based on the TSH value and getting that TSH value back into that 0.5-5.5 mU/L range.
But what if this is accomplished and you are still having all the same underactive thyroid symptoms?
Unfortunately this happens a lot, and here’s why. TSH is just a small glimpse of the overall picture regarding thyroid metabolism. There is an entire river of feedback loops, pathways and systems to underactive thyroid function. Treating based on TSH value is looking at just one small stretch of that river. TSH being elevated could be the byproduct of the hypothalamus or pituitary not functioning properly, upstream from the thyroid. It could be a problem in the liver or intestines, affecting the conversion of T4 to T3. What if that patient was on antibiotics? This would kill the healthy intestinal bacteria responsible for that conversion. If the problem is downstream from the thyroid, then feedback loops go right back to the hypothalamus at the beginning of the pathway.
What if it actually is true primary hypothyroidism and the thyroid is the culprit? If that’s the case, then that thyroid hormone replacement may help you, but only in that case. The point is to get a second opinion and question your doctor before going through invasive treatments and procedures like hormone replacement, radiation, surgery, etc. There are great references and info sources to learn more about low thyroid function. The more you know about thyroid health, the better questions you will be able to ask and the more searching for answers you will be able to do. This will help you get to the bottom of your underactive thyroid symptoms.