If you're feeling bad and your thyroid isn't working

I have discussed the issues of inaccurately assessing thyroid function by using the archaic methods of measuring only TSH. Some physicians will also measure the T4, but very few will measure the T4 and T3 levels. Some endocrinologists have the audacity to say it doesn’t really matter and all of the T4 is converted to T3, the only active form of the thyroid hormone. Because of this intellectual arrogance, too many patients are suffering from the classic low thyroid state manifested by inability to lose weight, or to gain weight, afternoon exhaustion, dry hair and skin, cold intolerance and fatigue. Every day I see patients who have been improperly diagnosed as having normal thyroid function, when in fact they truly suffer from a low thyroid state. I recently saw a very nice lady in my office that epitomizes the inability of conventional medicine to accurately diagnose patients with low thyroid function, when in fact they are really suffering from classic hypothyroidism. The patient is a 44 year old woman, who over the last few years has developed increasing issues with weight gain, despite working out in the gym and exercising 5-6 days a week. She states that she eats very little, living on portions fit for a bird, but continues to gain weight or at least not lose weight. She was carefully evaluated by her gynecologist, who referred her to a local endocrinologist specializing in thyroid problems. She was seen once by the endocrinologist and later by a nurse practitioner and started on only synthroid or T4. She continued to worsen, struggling with extremely low energy levels, almost incapacitating her with exhaustion in the late afternoon. She had “lab tests” completed and her synthroid was increased without any improvement. She was told by the thyroid specialist that she was doing great, but she was still exhausted, gaining weight and cold all the time, wearing a sweatshirt to go grocery shopping in her local Publix supermarket in the middle of the summer. Her job was suffering from her overwhelming exhaustion and her stress levels grew exponentially. She felt horrible.
A friend of hers sent her to me to be evaluated for thyroid issues and we checked lab values of TSH, T4, and T3. The lab values were so classic for a condition coined by one of my patients: “A failure of conventional medicine.” Her TSH level was. 853, a level deemed absolutely normal by 80% of the physicians assessing thyroid function and who refuse to listen to a patient’s symptoms, and heed their signs. This single assessment would have resulted in most physicians telling her that she had “normal” thyroid function. The next level we looked at was the T4. The free form of T4 may also be evaluated as well, but the total T4 of 11.1 (normal range 4.5-12) was obtained, and again the patient would have been told that her thyroid was working great, and that her weight gain was undoubtedly from eating too much and not exercising enough. But she worked out 6 days a week and ate almost nothing. Finally we checked the T3, the level I believe is the most important of all the labs tested, as it is the only active form of the thyroid hormone that interacts with our body, improving our metabolism. The level was 82( range 83-200) Many thyroid “experts” insist that all T4 is converted to T3, and that is absolutely not true. Stress is the biggest offender for blocking the activation of the thyroid hormone, and drugs like beta-blocker for blood pressure and heart issues, and statins for reducing cholesterol markedly reduce the conversion of T4 to T3. What do you think? Does all the T4 go to T3? The T4 is in the 90% percentile of normal and the T3 is below normal! Wonder why she felt so rotten. Her thyroid function was very low, and the only way to figure it out is to test the T3 and to LISTEN to the patient. It’s time we as physicians wake up and disregard these antiquated guidelines established by specialists in the pockets of the pharmaceutical companies. Demand to be listened to by your doctor and don’t let him/her disregard your symptoms! Ask to have your thyroid corrected with a T4/T3 combination (like Armour), and not just T4.