Countless people suffer months or years with hypothyroid conditions that could have been easily reversed with proper diagnoses. It is estimated that 13 million cases of thyroid dysfunction go undiagnosed each year, and inadequate thyroid testing is a big factor.
What is happening here? Many doctors rely only on TSH marker to diagnose and manage thyroid disease; however, this is just one of the four needed markers to establish a correct interpretation and analysis of your thyroid status. Moreover, many doctors use the lab ranges (referred to as “pathological” or disease ranges) that come with the test results, instead of functional ranges, which have been carefully researched and formulated as parameters of good thyroid health.
The lab ranges are simply the averages of all the people who have had blood work analyzed by that lab in the last year. They are so called “normal” or “healthy” places to be but are actually statistical averages. Different labs can and do have different reference ranges. It is common to have a test result come back “normal” from one lab and “out of range” for another lab. In truth, if your lab values are within the set reference range, you are within the “average,” and not necessarily healthy.
Each lab director sets the reference range for each particular test based upon a percentage of people who have taken the test. Essentially, laboratories are relying upon a bell curve to determine each reference range. The standard in medicine is to establish the mean and then set two deviations, one above and one below the mean. These reference ranges will continue to get wider and wider, as patients get sicker and sicker.
Like all endocrine glands, the thyroid does not exist independently of other glands. The thyroid is a part of the HPT axis (hypothalamus, pituitary, thyroid) and as such is under the influence of several hormones and feedback loops. Additionally, the thyroid is intrinsically linked to the adrenal glands and can be greatly affected by the body’s responses to stress.
As an example of this, it is well established that increased levels of glucocorticoid hormones such as cortisol, can inhibit TSH release by the anterior pituitary, as well as the conversion of T4 into T3, which takes place in the liver.
What Are the Necessary Markers to Correctly Assess Thyroid Function and Thyroid Testing?
Many endocrinologists consider measuring TSH levels to be the “gold standard,” but other markers are as important to be carefully analyzed, like Free T4, and Free T3 — the actual circulating thyroid hormones — or antibodies like TPO (thyroid peroxidase antibodies) to detect autoimmune thyroid disease. If you don’t test these markers also, you can run the risk of having sub-normal levels of T4 and T3, and/or antibodies that show that your thyroid gland is in self-destruct mode. Frustrating as it may sound, if TSH is within the “reference range,” the endocrinologist may say your thyroid functions “normal.”
TSH (Thyroid Stimulation Hormone) is the most common and sensitive marker of thyroid function. It is a hormone released by the pituitary gland and directly signals to the thyroid gland to produce T4 (thyroxine). TSH secretion is stimulated by the hypothalamic hormone TRH (thyroid releasing hormone). Negative feedback mechanisms within the HPT axis (hypothalamic/pituitary/thyroid) further regulate TSH secretions. An elevation in TSH is one indicator of decreased thyroid activity.TSH increases when T4 drops and decreases when T4 rises.
TSH levels above 2.5 are considered to be suspicious for subclinical hypothyroidism by many integrative physicians.
Free T4 (Free Thyroxine) is used to measure the amount of free (active) T4 in the blood. It is high with hyperthyroidism and low with hypothyroidism. The Free T4 test measures the available amount of the T4 storage hormone available to be converted into T3, the active thyroid hormone.
While the reference range at many labs runs from .8 to 2.8 ng/dL, integrative physicians have found that most patients feel best when their level falls into the top half of the range, at a level of 1.3 or higher.
Free T3 (Free Triiodothyroxine) measures free T3 hormone and is the best marker for measuring active thyroid hormones available to thyroid receptor sites. Free T3 measures are more clinically relevant than Total T3 measures. Decreased FT3 measures are one indicator of low thyroid activity.
While the reference range at many labs runs from 2.3 to 4.2 pg/mL, integrative physicians have found that most patients feel best when their level falls into the top half of the range, at a level of 3.2 or higher, and in many cases, at 3.7 or higher.
Reverse T3 is a measure of the amount of T4 that is converted into a biologically inactive form of the T3 hormone. Integrative physicians have found that elevated levels of Reverse T3 may suggest that thyroid hormone is not properly converted from T4 into T3, for use by the cells, and may result in hypothyroidism symptoms despite otherwise “normal” levels of Free T4, Free T3 and/or TSH.
A combination of the serum levels of TSH, free T3, free T4, reverse T3, and if necessary anti-TPO antibody, antithyroglobulin antibody and SHBG should be used in combination with clinical assessments and measurements to most accurately determine the overall thyroid status in a patient.
Forgoing treatment based on a normal TSH without further assessment will result in the misdiagnosis of a large number of hypothyroid patients that may greatly benefit with treatment. Simply relying on TSH to determine the thyroid status of a patient demonstrates a lack of understanding of thyroid physiology and is not evidence based medicine.
Our experts at Holtorf Medical Group can guide you through thyroid testing. Contact us to learn more.
This is a very simple but effective test, which will help individuals determine how their thyroid is functioning without the need for blood tests.
How to Take the Test
• Place a thermometer at your bedside.
• Immediately upon waking, keeping movement to a minimum, reach for the thermometer, and place under the armpit until temperature reading is completed. (If you forget to do it first thing and get out of bed, don’t take your temperature that morning, as it will be an incorrect reading.)
• Create a record of your body temperature.
• Repeat this test, always under the same arm, and record the information for 4-7 mornings.
It has been medically established that normal values for underarm temperatures are in the range of 97.8-98.2 degrees Fahrenheit. A temperature below 97.8 indicates Hypothyroidism and above 98.2 indicates Hyperthyroidism
*This test is not perfect, and should be seen as a starting point only. Underlying adrenal or pituitary issues can effect body temperature and skew the range indicating a thyroid disorder.
Want More Tests Done?
Order your own lab panels and take them to your doctor. Ask for Free T3, Free T4, TSH, Thyroid Antibodies and Reverse T3. http://www.canaryclub.org
Content for this section is from Naturopathic Physician Dr. Cheryl Kasdorf. If you would like to learn more about her work and other important thyroid-related medical issues, visit http://drcherylkasdorf.com/
Natural Thyroid Medications
If you have been diagnosed with low thyroid function, or hypothyroidism, you and your doctor have a number of medications to choose from. As a Naturopathic Physician, my focus is to choose the medication that fits your needs, to individualize your prescription so that you are adequately treated and your symptoms are relieved.
If you have researched thyroid disease and treatments, no doubt you have come across widely different approaches and convincing arguments for each. I will not go into those here. I encourage you to actively participate in your medical decisions, and encourage a balanced approach. Getting into an adversarial relationship is not productive, and a mix of openness and skepticism will most likely bring you to your most appropriate treatment. One authoritative and balanced resource I recommend is The Complete Idiot’s Guide to Thyroid Disease, by Dr. Alan Christianson and Hy Bender.
The purpose of this article is to discuss natural thyroid medications to bring distilled information to your open skeptical mind.
Natural vs Synthetic
Natural thyroid medications are prescription medications made from the thyroid glands of pigs. You might find it called
• Desiccated thyroid
• Glandular thyroid
• Natural Desiccated Thyroid
It is the only thyroid medication that contains all four thyroid hormones that our bodies make: T4, T3, T2, and T1. In addition, its iodine, thyroglobulin protein and glandular tissue content have useful functions in the body.
Trade names of this Natural Desiccated Thyroid include:
• Acella – NP Thyroid
• Armour thyroid
• WP Thyroid
In addition, compounding pharmacies may use whole desiccated thyroid porcine glandular in their individualized prescriptions.
Most mainstream doctors prescribe a thyroid medication that is synthesized from chemicals in a lab and contains the hormone T4 only. This is available in both trade name brands and generic forms. Synthroid is in the top 10 most commonly prescribed medications. Common forms include:
In addition, synthesized T3 hormone is available by prescription as well as compounded. The brand name is Cytomel and the generic form is known as liothyronine.
Women’s International Pharmacy has compiled a chart of thyroid hormone therapy options which make it easy to evaluate. It contains additional useful information and may be accessed here: thyroid_hormone_therapy_options.
Advantages of Natural Desiccated Thyroid
• A natural mix of all 4 thyroid hormones T4, T3, T2, T1
• T4 is the predominant thyroid hormone produced by our thyroid glands, but it is minimally active until converted to T3
• A small amount of the metabolically active T3 helps people who don’t effectively convert their T4 into T3
• Contains thyroglobulin protein which slows the breakdown of T3, the active hormone so that it will keep you going all day without having to dose again during the day
• T2 has been found to play a role in metabolism and fat burning
• The glandulars in the NDT can help strengthen and rebuild you own thyroid gland, provided you still have it
• Also one grain NDT contains 120 micrograms of iodine. The adult RDA is 150 mcg, with the WHO (World Health Organization) recommending 220 mcg for pregnant women.
• Relatively low price – pigs thyroid glands are sold at a low cost to manufacturers
• No one can patent a pig thyroid gland, so name brands are already at generic prices
Disadvantages of Natural Desiccated Thyroid
• Comes from a pig, which is objectionable to vegetarians, Orthodox Jews and other religious groups, and others who find it distasteful
• A smaller range of dosages available than the synthetic, so sometimes a combination of pills must be used to get in-between dosages
• At times, there has been a “shortage” of natural raw materials, limiting its availability.
• Many mainstream doctors will flat-out refuse to prescribe it.
Issues which are debatable as advantages / disadvantages
The human thyroid gland makes a ratio of T4 to T3 of approximately 10 to 1. The pig gland in NDT contains a ratio of 5 to 1. This makes an excess proportion of T3. Some patients can use this higher proportion if they have trouble converting T4 to T3. In addition, there is some evidence that in cells, the proportion of T4 to T3 is closer to the 5 to 1.
The first thyroid hormone supplements came from animal glandular tissue. At that time, the potency was determined by measuring its iodine content, because that was the best technology could do.
In 1955, Synthroid first came to the market. In an aggressive marketing campaign, it was promoted as new and modern and the desiccated thyroid was portrayed as old fashioned and inconsistent from batch to batch. Then there was a report in a major medical journal of one patient who was severely under-treated due to the inconsistency of the natural desiccated thyroid. This sealed the fate of NDT in some physician’s minds and showed the shining advantage of the money-maker Synthroid.
All thyroid hormone medication manufacturers must follow the guidelines of the United States Pharmacopeia (USP), a highly respected authority which sets the standards. With the advent of new technologies in the mid-1980’s, natural desiccated thyroid manufacturers could now measure the actual amounts of T3 and T4 in their pills. So now there is absolutely no difference in standardization between synthetic and natural forms of thyroid, as long as the manufacturers are adhering to the standards.
In fact, the USP standard allows a 10% variation in T4 and 10% variation in T3 in the manufacture of thyroid medications. This can account for some of the brand variations. And look at the history of recalls on medications due to mistakes: synthroid has had several and so has Armour.
RLC labs stands out from all the other manufacturers in that their in-house policy is to only allow less than or equal to 2% variation in the T3 and T4. RLC labs tablet natural desiccated thyroid into
• WP Thyroid
And they have had no recalls.
Natural Desiccated Thyroid and Autoimmune Thyroid
It is thought in some circles that Natural Desiccated Thyroid will aggravate patients with Hashimoto’s autoimmune thyroid condition. The thinking is that there is an immune attack on the enzyme thyroperoxidase and the protein thyroglobulin when it is released from the NDT, perpetuating the autoimmune attack.
Wow, this could be huge and sounds viable in theory. I have had a few patients who did not respond well to NDT, but I was not able to determine if it aggravated an autoimmune attack or if there was some filler ingredient they did not tolerate.
A literature review has not shown any evidence of the theory, though. In fact, one citation showed NDT was actually beneficial because it induced tolerance, calming the immune attack, instead of aggravating the condition.
What distinguishes NDT medications – The Issue of Fillers
Why can’t medication manufacturers just put the thyroid in a pill and leave it at that?
Why are there fillers?
Thyroid hormone is so very potent that the body only makes about 94-110 micrograms T4 and 10-22 micrograms T3 daily.
To appreciate how little this is, a milligram is less than a grain of salt, so 100 micrograms of T4 is one-tenth of that and 10 micrograms of T3 is one-onehundredth of that!
So if a thyroid medication has 38 micrograms of T4, you can appreciate how tiny an amount that is. That is why there are fillers.
Now, at first the manufacturers used cornstarch and other problematic fillers. Some people still have undesirable reactions to the fillers. Current commonly used one include:
- Microcrystalline Cellulose (synthetically derived fiber base utilized to provide volume and bulk)
- Dicalcium Phosphate (derived from a mined ore utilized as a binder to hold all the ingredients together during tableting)
- Colloidal Silicon Dioxide (derived from a mined ore utilized as a natural desiccant to ward off moisture and humidity)
- Sodium Starch Glycolate (synthetically derived starch molecule utilized for proper disintegration of the tablet in the stomach)
- Magnesium Stearate (derived from a vegetable source utilized as a lubricating agent so the tablet doesn’t stick to the molds)
- Hydroxypropyl Methylcellulose (derived from a plant cellulose base utilized to provide bulk and density to the tablet for proper compression – also part of a clear coating solution)
- Polysorbate 80 (an inactive water soluable emulsifying agent blends the ingredients to prevents separation, derived from a vegetable source utilized as a binder to hold all the ingredients together during compression)
- Carnauba Wax (derived from the pores of the leaves of the Brazilian wax palm tree utilized to provide a complete seal in the final stage in tablet coating)
- Polyethylene Glycol (PEG) (Synthetically derived, water-soluble, waxy solid, utilized with Hydroxypropyl Methylcellulose as part of the clear coating solution.)
- Lactose Monohydrate (present in traceable amount as part of Thyroid USP diluent for the NDT powder)
Is there an alternative? Yes. Now, RLC labs is producing a “Pure” form of its WesThroid called WP Thyroid (formerly called Westhroid-P)which only has two natural inactive ingredients:
1. inulin from chicory root (a natural fiber)
2. medium chain triglycerides from coconut (easily absorbable fats)
It is interesting to note that the formulations of the WesThroid and NaturThroid have been identical for years. They continue to make both because of name recognition.
It turned out that they were more easily able to gain an alteration of the WesThroid so that is this new product. Effective August 2013, RLC labs changed the name of the product form Westhroid-P to WP thyroid to minimize confusion between the existing Westhroid and Westhroid-P. I have it available in my office. Ask if you would like to try it instead of NatureThroid.
Naturopathic Physician Dr. Cheryl Kasdorf is a doctor who listens and has answers with a natural approach that works. She is known as the go-to person to get back your get-up-and-go when it is gone, gone, gone. Get your FREE gift “Dr. Kasdorf’s Health Secrets for Feeling & Looking Great” at drcherylkasdorf.com