What Controversy Surrounds Hypothyroidism Treatment?

Unfortunately, there are many physicians that still believe that they can rely on the TSH (Thyroid Stimulating Hormone) test alone to determine if someone has hypothyroidism. They rely on the lab results, and if you fall within the “norm,” then you must not have hypothyroidism, despite having many of the symptoms of this common condition. However, advocates of further testing state that TSH levels do not indicate what circulating thyroid hormones are actually doing in your body. Therefore, the TSH test does not provide the complete picture. Another thing to remember is that normal does not always mean optimal. That is a very important distinction to make!

Some doctors will also (or only) test your T4 levels. However, it often stops there. Advocates of further testing point out that even if your TSH lab result comes back “normal,” it does not necessarily mean that your body has enough of it. In addition, if your T4 levels are “normal” according to lab results, it does not mean that your body is converting it to T3 (to be used by your tissues) appropriately. In contrast, the assumption by the endocrinology community has been that there is nothing that goes wrong with the T4 to T3 conversion process in people’s bodies.

But hypothyroidism is easy to treat, right?

Many physicians have been taught that treatment of hypothyroidism is pretty standard, and easy to treat. You do one or two bloods tests. The lab results indicate whether that patient is hypothyroid. Easy, right? False.

If you speak to many patients with diagnosed hypothyrodism, they will tell you that despite treatment with thyroxine (T4) medications alone, they still do not feel completely normal. In fact, it is estimated that only 50% of people receive proper treatment. In other words, treating hypothyroidism is not as simple to treat as some practitioners may lead you to believe.

There are also patients who cannot get the diagnosis of hypothyroidism, despite feeling tired and cold all the time. The fatigue interferes with their daily functioning, and still they continue to live with undiagnosed hypothyroidism.

Are things changing?

There are more physicians who are beginning to move away from relying on the TSH and/or the T4 as the be-all and end-all of diagnosing this common condition. Some are also beginning to realize the importance of adding T3 hormone as an adjunct to T4 hormone treatment. Others also support the use of natural, dessicated thyroid in treatment.

Fortunately, more studies are being conducted into the effectiveness of T4/T3 combination therapy, and using less of a one-size-fits-all approach.

As well, more are starting to recognize that a full set of tests have to be done (TSH, Total T4, Free T4, Total T3, Free T3, Reverse T3, Thyroid Antibodies), and even if all of these test come back normal, the patient may still respond to treatment for hypothyroidism as normal may not be optimal for that patient.

So if you are not getting the answers you want from your physician, what should you do?

Find someone who will listen. You are the one who does not feel well.

If TSH and T4 tests are not detecting hypothyroidism, other tests to be considered include the Total T3 test, Free T3 test, Reverse T3 test, and Thyroid Antibodies test.

The Free T3 is an important test as it indicates if your body is converting T4 into the T3 it needs to help regulate the body. However, it is not routinely done by all physicians.

As mentioned earlier, it has long been thought by many in the medical community that there is no such thing as the inability of the body to have difficulty converting T4 into T3. So even if your TSH is normal, advocates of T3 testing state that symptoms of hypothyroid can be confirmed by the this test. This is then where the addition of T3 to the medical treatment can be beneficial.

Reverse T3 is another test to determine if your body is actually converting T4 into usable T3, or if it is actually converting it from T4 into the unusable form of Reverse T3.

Thyroid Antibodies can be tested for. Their presence can indicate that your body is attacking its own thyroid (called an autoimmune disease). Your TSH blood test (likely the most common test done to test for hypothyroidism) may prove normal, but the presence of thyroid antibodies may be enough for your doctor to consider treating you for your thyroid condition.

Another important consideration is that different labs use different values. Therefore, rather than look at lab values, and what the lab considers normal, you want to work with a doctor who works with you to determine what is a normal level for YOU. It is important to realize that normal thyroid lab values have decreased in range over the years, and even if your lab results come back normal, you still could have hypothyroidism.

There are some natural ways to support your thyroid, and ensure it functions optimally. You may want to find a doctor that practices functional medicine. A functional medical doctor can assist you with natural ways of treating the root cause of illness, rather than just treating the symptoms with medication. If you or someone you know may have a thyroid condition, call 770-731-9410 and schedule an appointment with Dr. Sean Savedoff.

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