However, once a patient is complaining of symptoms of hypothyroidism, then you need to get a free T4 level along with the TSH. As far as free T3 levels are concerned, they usually aren't affected until hypothyroidism is extremely severe, so free T3 doesn't really have a role in the hypothyroid patient. It's a more relevant test for hyperthyroid patients.
As far as TSH goals are concerned, historically the normal range has been about 0. This can get pretty confusing. Even if we opt for the narrower window as our normal baseline so that asymptomatic people with TSHs above 3 are diagnosed with hypothyroidism , an improvement in outcomes should be shown before applying this universally..
Once a person is diagnosed with hypothyroidism, however, there is general agreement that keeping their TSH in a narrow therapeutic window about 0. Q: Many patients wonder if being overweight has something to do with their thyroid function. At what point is it appropriate to test their thyroid function?
A: The vast majority of obese patients do not have a definable endocrine abnormality. I usually check to see if the patient has any other symptoms of hypothyroidism other than weight gain before I order a TSH screening test.
Things like constipation or dry skin would raise my concern for hypothyroidism, though it's not unreasonable for primary care physicians to order screening TSH tests on patients who are gaining weight and specifically want their thyroid function tested.
Q: Tell me about the most popular alternative medicines for thyroid disease and the evidence, if there is any, for their use. A: First of all, the thyroid gland primarily makes T4, and just a little bit of T3.
T3 is the active thyroid hormone that controls metabolism, etc. Levothyroxine is primarily T4, so people have been theoretically interested in giving T3 directly as an alternative. There was a study in that showed some potential benefits of giving a combination of T4 Synthroid and T3 Cytomel agents.
However, a meta-analysis of 11 research studies showed that there was no evidence of benefit of combination T4 and T3 regimens. Armour Thyroid Forest Pharmaceuticals, Inc. However, the problem with Armour Thyroid is that the ratio of T4 to T3 thyroid hormone it contains can vary from batch to batch. I've had patients complain of palpitations and nervousness at times and studies reveal that blood levels of T3 can fluctuate substantially with T3-containing regimens in comparison with levels seen in patients with normal thyroid function or taking T4 preparations.
As far as a thyroid diet is concerned, we have no evidence that any particular diet specifically helps thyroid function. Of course, people need to consume sufficient quantities of iodine or else goiters can result. Q: Do you see a lot of patients who self-diagnose hypothyroidism through a Google search? A: Yes. The symptoms of hypothyroidism are often non-specific. Weight gain and fatigue are very prevalent in general.
I often find that people are trying to get by on six hours of sleep, eating poorly, and not exercising, and then they complain of fatigue and weight gain and want to ascribe it to a thyroid problem.
Dosage levels are increased or decreased depending on symptoms and results of blood tests. Medication will compensate for the weakened thyroid, eventually taking over when the thyroid ceases to function altogether.
For some, increasing their medication to compensate for reduced thyroid function happens over many years. Others go from no medicine to a full dose within six months.
I reassure my patients that we will work together to find a dose of medication that will hold things steady at some point. Mandagere: Some of my patients ask if mineral, vitamins or herbal supplements can be helpful. As an endocrinologist, I answer these questions based on my knowledge and experience with evidence-based studies and data. We also know that healthy living benefits our immune system, which in turn can lead to better thyroid function. I talk with my patients about general recommendations that include good quality sleep, regular exercise, and a lean and green diet that avoids process foods.
Mandagere: For my patients who are already being treated for hypothyroidism, I emphasize the importance of taking their medication in a consistent manner. This is where, with my passion for, and background in biochemistry and nutrition, things really get interesting in terms of problem-solving with my patients. We may find that their body is not absorbing the thyroid medication efficiently or that the metabolism of the medication has changed for one reason or another.
We talk about a proper dosing routine that includes taking their medication the same time every day on an empty stomach. We also discuss other prescriptions or supplements that might be impacting their thyroid medication. For instance, switching to Synthroid, the brand drug from the generic levothyroxine or levothroid has helped some patients.
This is because every time you purchase Synthroid at the pharmacy you get the exact same product. You know that the absorption and metabolism is very predictable. When you purchase the generic brand, however, the pharmacy may give you one generic batch one time and a different batch the next. The active drug is the same but the formulation — perhaps the coating on the pill — may be different and can affect absorption. I prefer prescribing Synthroid for my patients but, of course, the brand is more expensive so a lot people do opt for the generic and sometimes that means more monitoring and adjusting.
Kelly Mandagere joined Boulder Medical Center in after practicing for over 10 years as an endocrinologist in Louisville, Colo. During this time, the DC program focuses on diet, nutrition, and spinal manipulation, while the MD program emphasizes the study of pharmacology.
Complement to Your Thyroid Care. While your chiropractor may have been the one to diagnose your thyroid disease they can order laboratory tests and imaging studies, like a naturopath , once diagnosed, your chiropractor must refer you to a medical doctor for proper treatment—for instance, thyroid hormone replacement for hypothyroidism and either an anti-thyroid drug, surgery, or radioactive iodine ablation for hyperthyroidism.
Chiropractors can, however, provide supportive thyroid care, such as nutritional guidance or ways to ease musculoskeletal pain associated with the underlying thyroid disease like carpal tunnel syndrome or joint aches.
Chiropractors are legally prohibited from prescribing thyroid medication, which means that they cannot treat or cure thyroid conditions. Remain proactive in seeking out the right doctor-patient relationship. And keep a positive mindset, too. When you find that trusting, compassionate partnership, you will just know it. While not an exhaustive list, some situations include:. How to Find a Thyroid Doctor. You might also like Thyroid Awareness: January and Beyond.
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