In the Spring of last year, the Wall Street Journal columnist Melinda Beck struck a chord with many patients suffering from common thyroid disease symptoms. Under diagnosed and requiring quality time with the patient to properly diagnose, many patients with thyroid disease are under treated or even untreated.  Patients are fighting for validation of symptoms and treatments that are more effective.

The butterfly shaped gland in the center of the neck is responsible for over 200 functions in the body. It is considered the master gland of metabolism. How well the thyroid is functioning is inter-related with every system in the body. A thyroid that is not functioning optimally can be the cause of an array of symptoms that can easily be overlooked or mis-diagnosed. If providers aren’t listening to patients and performing a thorough assessment of thyroid function, patients may come away with “band aids” for their symptoms, frustrated, and with no real solutions.

Beck’s article titled, “Doctors Hear Patients’ Calls for New Approaches to Hypothyroidism” outlined a protocol for effectively diagnosing thyroid problems where the patient’s symptoms are the primary focus. A lab assessment includes a thorough assessment of more than just one hormone (TSH) that impacts thyroid function.

Spending quality time with the patient is the key to identifying symptoms that could be related to thyroid dysfunction. Notable symptoms include:

– Low energy (unable to make it through the day, waking not feeling rested)

– Extreme/overwhelming fatigue

– Unexplained weight gain or the inability to lose weight

– Mood issues (mood swings, anxiety, or depression)

– Menstrual irregularities (heavy, painful period or infrequent periods)

– Infertility

– Headaches (tension, cluster, and/or migraine)

– Muscle/joint pain (may be persistent or intermittent)

– Poor temperature regulation (always cold or always hot)

– Skin issues (dry, acne)

– Hair issues (thinning hair, hair loss, facial hair)

– GI issues (constipation, diarrhea, abdominal cramping, reflux)

– Mind issues (brain fog, poor concentration, or poor memory)

– Neck swelling, snoring, or hoarse voice

– Immune issues (inability to fight off illness and infection)

 

What’s the problem?

“Doctors and patients have been at each other’s throats for decades over how to treat a little gland in the neck—and patients may be gaining ground,” wrote columnist Melinda Beck.

Dr. Edmund Rhett describes why you cannot rely solely on a single form of treatment for hypothyroidism such as T4-only treatment like Levothyroxine or Synthroid, which is most commonly the standard of care.

“The brain produces a hormone TSH that tells the thyroid to make T4, an inactive (storage) thyroid hormone. T4 should convert to T3 which is the active thyroid hormone that works at the cellular level throughout the body controlling the over 200 functions the thyroid plays a role in. When you are only treating the thyroid with T4, it is like you are providing a car with only crude oil when what you really need is gasoline to make the car run. Treatment with only T4 is frequently insufficient because due to genetic and lifestyle factors, age, and chronic illness, the body’s ability to convert T4 to T3 becomes less efficient as well as cells are less efficient at uptaking and using T3.”,explains Dr. Edmund Rhett.

The goal of treatment is to provide the body with an appropriate level of T3 resulting in an optimally functioning thyroid and resolution of symptoms. Although the thyroid is a very complex and dynamic organ that is influenced by other factors that must be included as a part of a thorough thyroid work up. In addition to assessing TSH, Free T4 and Free T3, another inactive hormone, Reverse T3,  present when there is underlying systemic inflammation, can be an important part of adequately treating the thyroid. Also, thyroid dysfunction can be autoimmune in nature (Grave’s Disease or Hashimoto’s Thyroiditis) and therefore thyroid antibodies should be evaluated when assessing the thyroid.

 

A Better Thyroid Treatment Protocol

Rhett Women’s Center believes in a 360 approach to patients suffering from thyroid dysfunction. This approach begins with a comprehensive provider consultation. Your provider will begin by reviewing symptoms, ordering appropriate laboratory tests, and will then offer a full range of treatment options as the first step toward feeling better, faster.

“We use thorough lab testing and do not rely fully on the ‘normal’ range values as the sole guide for initiating treatment.  We find that combining the patient’s symptoms with lab values and lifestyle factors to determine the treatment plan to be a far more effective practice that results in healing for the patient,” says Dr. Rhett.

It’s estimated that as many as 25 million Americans have a thyroid problem, and half of them have no idea that they do. Hypothyroidism, or an under-active thyroid, accounts for 90% of all thyroid imbalances.

“I was so tired. It never seemed to go away. I kept gaining weight no matter how much I went to the gym or starved myself. My doctor kept telling me to exercise and gave me a prescription for antidepressants. I felt shuffled out the door. And the symptoms just got worse,” shares a middle aged patient. “A friend told me about Rhett Women’s Center. I came in and talked to Dr. Rhett, received a full blood panel and developed an individualized plan to attack the root cause of my fatigue, weight gain and foggy brain. That was last year. I feel like myself again. I have energy now. I feel and look better, too.”

Dr. Bianco of the American Thyroid Association (ATA) in the WSJ article credits patients for advocating for themselves and telling doctors they really don’t feel “fine”.  Bianco says, the ATA, “…has refocused the research to search for answers for such patients.”

“Hypothyroidism is often under diagnosed because most doctors spend only a few minutes talking with patients. Thyroid symptoms require more time and knowledge of the patient. We know that listening to the patient gives us the information we need to assess and appropriately treat thyroid dysfunction. It helps to have a practice that concentrates solely on gynecology to do this. Women need to focus on and make an invest in their own health,” says Dr. Rhett.

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A quick reference guide to improve thyroid function:

• Schedule quality time with a provider who is trained to treat thyroid disease.
• Get good lab tests including TSH, Free T4, Free T3, Reverse T3 and thyroid antibodies
• Invest in pharmaceutical grade supplements such as a high-quality fish oil, Vitamin D, Probiotic and a multivitamin as your foundation
• Evaluate hormone levels
• Address diet/nutrition–many thyroid treatments include a significant commitment to nutrition that may include liver detox and a focus on gut health, ex. The Microbiome Diet
• Exercise (cardio and strength)
• Decrease stress (yoga, meditation, prayer)
• Ensure adequate sleep