Managing Hypothyroidism with Bioidentical Hormones

After the national outcry following the Good Housekeeping’s rather insulting and poorly researched article about thyroid dysfunction and hypothyroidism, Dr. Erika Schwartz, a leading expert in thyroid balance and Chief Medical Officer of RestoreMD talks about symptoms patients experience when suffering with hypothyroidism and how the condition can be properly diagnosed and treated by clinicians.  When diagnosed properly, thyroid dysfunction and hypothyroidism can be treated safely and effectively with the proper thyroid bioidentical hormone therapy.

What a sad state of affairs for the health of America's women. Thyroid disease -- undiagnosed and mismanaged -- is rampant.  In one extreme case a patient came to our offices after visiting ten other doctors. None of the doctors listened to her and refused to treat her symptoms, which affected her life and included: chronic fatigue, insomnia, perpetually feeling cold, weight gain, depression, hair loss and foggy thinking.  Each doctor after reviewing her blood work, and seeing normal TSH levels, refused to diagnose hypothyroidism and thus did not treat her.  No one checked her basal metabolic rate or her temperature that consistently were in the 1100 kcal and 96.5 range respectively. 

What is the function of the thyroid?

Thyroid hormone levels affect your metabolism, energy levels, attention, emotions and temperature.  Centrally located in the neck, between the brain and the rest of the body, the thyroid is our master gland directing metabolic and hormonal interaction throughout your body.

What is hypothyroidism?

Low Thyroid levels or Hypothyroidism is caused by thyroid underproduction of the thyroid main hormone thyroxine (T4) or the ability of the peripheral tissues to use the active form of thyroid (T3).  Any interference in the production of T4 can stop the normal conversion of T4 into its active form, triiodothyronine (T3) and lead to symptoms of hypothyroidism.

What are the symptoms?

Low thyroid levels may cause fatigue, insomnia, poor concentration, cold intolerance – always feeling cold, hair loss, depression, brittle nails, weight gain, heavy menstrual bleeding and multiple other symptoms.  Many physicians and patients blame these symptoms on aging, lack of exercise or stress and while these are contributing factors the main culprit may easily be thyroid hormone imbalance or hypothyroidism.

TSH testing for hypothyroidism

Some estimate between 20-60 percent of women experience some level of thyroid hormonal imbalance and the majority of these women are not treated and go under diagnosed with horrific impact on their lives.  Much of this is due to an outdated and controversial blood test called Thyroid Stimulating Hormone (TSH) that is still considered by too many physicians the only way to diagnose hypothyroidism.

The test was created and endorsed by the American Endocrine Society more than 50 years ago as the gold standard of hypothyroidism.  TSH ranges for diagnosing low thyroid function are inadequate and statistically too broad thus creating situations where clearly clinically hypothyroid people are considered to have “normal” range TSH results, thus missing an opportunity to help them feel better if thyroid therapy is instituted appropriately.

Essentially, the TSH test identifies how the pituitary gland in the brain perceives the level of circulating thyroid hormones in the blood. Low circulating thyroid levels cause the TSH to read high, yet factors such as low selenium, stress, high cortisol and estrogen levels may suppress TSH levels and allow thyroid symptoms to continue untreated.

What tests should doctors be performing?

Most doctors are trained to only test TSH levels of patients, and if these appear normal the doctor will not diagnose a thyroid problem regardless of symptoms.  More comprehensive testing including free T4, free T3 reverse T3, clinical picture, basal metabolic rate and body temperature, help provide a comprehensive picture of the thyroid function. 

Doctors must evolve beyond relying on the blood test results to make the correct diagnosis and actually listen to the patient. Since we are all unique individuals, what is normal TSH to one of us, may be quite high or low to another and we have no way of telling what is fact until we work with the whole patient in context.

This “new medicine” type of approach actually decreases the incidence of overlooked or ignored thyroid problems in this particular case.

Fact is that thyroid is a key ingredient to hormone balance and that besides using bioidentical hormones such as estradiol, progesterone, testosterone and supplements, diet and exercise, thyroid function must be addressed and treated as part of the whole picture from the very start if success is to be achieved.

Treatments for low thyroid

The treatments for low thyroid include a variety of medications that are only available by prescription only.  There are no thyroid medications that are available at the health food store or at your nutritionist’s office.

The following is a list of the available thyroid biodientical hormone medication, regardless of whether you get it from the pharmacy or the compounder:

• Cytomel- T3,
• Synthroid -T4,
• Levoxyl, Levothyroxine- T4,
• Liothyronine- T3,
• Compounded T3 and T4 in cream, drops and troches form,
• Compounded pork thyroid- The old Armour Thyroid combination of T3, T4 and T7.

While diagnosing low thyroid is not difficult if you have an open mind and the understanding, you can practically do it yourself, the proper treatment is not so simple and the outcome is based on how good you are at explaining how you feel and how experienced your doctor is at listening to you and integrating the proper treatment options for you.

My recommendations on treating thyroid problems

Once you figured out your thyroid is probably sluggish and may be causing you some of the problems that just don’t go away with the other treatments you are undertaking, do not take thyroid supplements. The only way to help a low functioning thyroid is with thyroid medication and it is all prescription medication.

The supplements I work with are designed to support your thyroid function by improving energy production at the cellular level, boost your immune system, decrease inflammation, which often causes the thyroid to slow down, and support hormone balance. But the supplements alone are not enough for a truly sluggish thyroid.

You need the proper thyroid bioidentical hormone medication and you must find a bioidentical hormone doctor to help you who is open and knowledgeable and willing to work with as many options as there are to find the proper combination of thyroid hormones that provide you the best balance. What the right medication for you is depends on your individual needs and you must work together with the doctor as partners to get you to the best thyroid hormone balance possible.

Finally, because the thyroid is not the only hormone that makes or breaks your wellbeing, keep in mind the thyroid is an important yet still just one piece of the puzzle that is your health. 

You need to address your other hormones with the use of bioidentical hormones, your diet needs to become a hormone friendly diet and your exercise regimen must help you get more energized and not more drained.

And keep in mind that the only thing you can be sure of is that your body will keep changing.  So become aware and flexible. When your body changes and the need for thyroid preparations and doses change, make sure your doctor knows you need to change the thyroid regimen you’re on.

To assess your symptoms and to learn more about how bioidentical hormones and the other safe and effective tools of Age Management medicine can lead to thyroid balance and well-being, contact a certified RestoreMD doctor in your area.

About Erika Schwartz M.D.

Erika Schwartz M.D. is the Chief Medical Officer of RestoreMD, the author of four bestselling books, a noted lecturer and TV personality.  She is one of the nation’s most widely recognized experts in the field of bioidentical hormones and is currently part of the new Life Changers Team appearing on EXTRA-TV.  Dr. Schwartz is the founder and owner of the Age Management Institute, New York.