Question: I have had a lot of symptoms such as thinning hair, dry skin, weight gain without changing my habits, constipation, night sweats and low body temperature.
When I searched this online, hypothyroidism came up a lot, so I went to my doctor and my TSH was 4.2, which he said was normal. I hear of naturopaths treating thyroid even if blood work is normal. Can you comment on this?
Answer: The screening test for thyroid is a measure of thyroid stimulating hormone (TSH), which is secreted by the pituitary gland in the brain. The current range is 0.35-4.2.
TSH rising is the brain’s way of asking the thyroid gland to increase its production of T4 and T3 — your less active and more active forms of thyroid hormones. This method of testing is used to assess primary hypothyroidism, meaning the thyroid itself is underperforming, and it is not a brain messaging issue.
Most NDs and many MDs would agree that being in this range alone, is not enough to absolutely rule out inadequate thyroid hormone, in the serum or tissue, as a cause of hypothyroid related symptoms. In my experience, patients feel best at a TSH below 2.0.
Many scientific sources, including the American Association of Clinical Endocrinologists, have made recommendations that the TSH range be narrowed because too many people can have sub-clinical hypothyroidism in the upper half of the range. The third National Health and Nutrition Examination Survey (NHANES III) screened 17,353 subjects from 1988 to 1994 and excluded those with diseases or factors known to affect thyroid function. In the resultant “normal” population of 13,344 subjects, 95 per cent had TSH levels that fell between 0.3 and 2.5 mIU/L. In other words, healthier people had lower TSH levels.
So, if an individual presents with hypothyroid like symptoms, they have low body temperature and their TSH is above 2.5, then I would first consider supportive nutrients. Iodine, tyrosine, vitamin A, selenium, zinc and iron have different supporting roles, including thyroid hormone production, conversion of T4 to more active T3 and thyroid hormone receptor function.
The hormone we measure in the blood only has an action when it successfully makes it into your tissue via hormone receptors, so it is important to rule out factors that interfere with this uptake.
I prefer to lower TSH to the lower end of normal range and monitor signs and symptoms to see what symptoms improve, while avoiding overstimulation. If ND supervised nutrient supplementation is not adequate to do this, then a low dose of Health Canada approved Erfa dessicated thyroid would be suggested. Currently, Erfa thyroid needs to be prescribed by an MD, but an ND is often the person recommending this discussion. In B.C., NDs have prescribing rights for basic medications, including bioidentical hormones, and Ontario has passed legislation that grants NDs limited prescribing rights as well. NDs in other Canadian provinces hope to also be able to practice to their full scope in the future.
Thyroid medication can potentially decrease or eliminate the need for many other types of medications such as antidepressants, statins, hypotensive drugs, sleeping pills, antibiotics and diabetic meds. Thyroid hormones have a relationship to other hormones such as estradiol, progesterone, testosterone, cortisol and insulin. So, puberty, fertility, menopause, stress and diabetes can be affected by thyroid hormone levels and vice versa. Fine-tuning thyroid function is a powerful place to start because it affects every body system.
Kali Simmonds, ND, is a doctor of naturopathic medicine who practises in Charlottetown. The information provided is not intended to diagnose or substitute the advice of your healthcare professional. Please consult with your healthcare provider before making any changes.
She welcomes questions for this column, which is published the first Tuesday of the month in The Guardian. She can be reached by mail at 34 Queen St., Charlottetown, C1A 4A3 or by email at firstname.lastname@example.org.