Major Revision of Hypothyroid Diagnosis Guidelines

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March 01, 2003 | 44,232 views

Although thyroid disease is easy to diagnose and treat, half of the cases in America remain undiagnosed. Minor thyroid abnormalities may go unnoticed, but data suggests that many people with low-level thyroid problems could improve with treatment.

In an effort to improve diagnosis of thyroid disease, the American Association of Clinical Endocrinologists (AACE) has released new guidelines that narrow the range for acceptable thyroid function.

Doctors typically base diagnosis of thyroid disease on the "normal" range for the thyroid stimulating hormone (TSH) test. While the previous normal range was between 0.5 and 5.0, the new guidelines narrow the range for acceptable thyroid function to between 0.3 and 3.04.

Under the new guidelines, as many as 27 million people may have abnormal thyroid function--more than double the number of people thought to have abnormal thyroid function under the old guidelines. These estimates would make thyroid disease more common in North America than diabetes.

Women are at an increased risk for thyroid disease, as they are five to eight times more likely than men to be diagnosed. The elderly are also at an increased risk--by the age of 60 years, as many as 17 percent of women and nine percent of men have an underactive thyroid. Thyroid disease is also linked to other autoimmune diseases, including certain types of diabetes, arthritis and anemia.

The thyroid gland produces hormones that influence essentially every organ, tissue and cell in the body. Thyroid disease, if left untreated, can lead to elevated cholesterol levels and heart disease, infertility, muscle weakness, osteoporosis and, in extreme cases, coma or death.

Hypothyroidism (underactive thyroid) affects some 80 percent of patients with thyroid disease. Symptoms of hypothyroidism include fatigue, forgetfulness, depression, constipation, and changes in weight and appetite.

Experts hope that the new guidelines will give physicians the information they need to diagnose mild thyroid disease before it leads to serious health consequences such as elevated cholesterol, heart disease, osteoporosis, infertility and depression. February 20, 2003

American Association of Clinical Endocrinologist January, 2003

If you have been a regular reader of this site you will already know that the normal reference ranges for thyroid that have been used in the past were not correct.

More than two years ago I posted my revision of the thyroid guidelines that placed the upper limit of TSH at 3.0.

This is one of the benefits you will continue to receive by reading this newsletter--you will receive the most current health information, usually several years before it is widely accepted by the traditional medical community.

It is wonderful that more people will be properly diagnosed, but once diagnosed they will be faced with the dilemma of how to be treated. Nearly every traditional medical doctor will use synthetic thyroid to treat the symptoms of low thyroid (see table below).

Unfortunately, this will not help the bulk of people who are suffering with these symptoms. This is largely related to the fact that most people can’t effectively convert the pure T4 in the synthetic thyroid preparations to T3.

However, nearly all traditional medical doctors believe otherwise despite strong evidence to the contrary. If your doctor will not discuss your request for natural thyroid, this is a major clue that you will need to find another doctor who understands the truth about thyroid hormone replacement.

While natural thyroid hormone (typically Armour thyroid) is better for most people, some individuals clearly do better on the synthetic versions. Typically, the longer you have been on synthetic hormones, especially if it has been three years or longer, the more difficult it is to successfully switch to Armour thyroid. This is because the body becomes used to the synthetic version and learns to adjust and compensate for it.

However, the key issue here, especially for those who are in the new "marginal" hypothyroid range of 3 to 5, is whether any thyroid hormone is needed at all.

My typical approach is to avoid the use of all thyroid hormones in newly diagnosed patients. It is quite easy to start someone on thyroid hormones and relieve their symptoms (see table below). However, once a person remains on thyroid hormone for a number of years, there is a great tendency for their thyroid to become progressively less functional and eventually stop producing any functional hormones.

Starting a person on thyroid hormones could condemn them to taking thyroid hormone for the rest of their life, and this is something I am very reluctant to do.

So my initial strategy is to start patients on selenium and iodine to provide the raw materials for their thyroid gland to work better.

We also start everyone on an improved diet that is metabolically typed and optimized for them.

I also look at emotional issues as in my experience often when the thyroid stops working properly it is to compensate for dysfunction from the adrenal gland. The adrenals are typically challenged due to unresolved emotional stresses.

I have long ago abandoned the use of adrenal hormone testing, as I have never found it, or adrenal hormone supplementation, to be very helpful in addressing the underlying causes of the adrenal impairment.

The majority of the time the adrenal impairment was related to unresolved stress issues that frequently resulted in sleep impairments. So I would send the person to see one of our six therapists for treatments (frequently EFT treatments) to help resolve the adrenal dysfunction.

Fortunately, most of the people responded quite nicely and were able to recover their thyroid function and normal thyroid tests without the use of thyroid hormones.

However, sometimes this is just not possible, and when that is the case it is quite rare if natural hormones like Armour thyroid don’t provide outstanding improvement.

Symptoms of Low Thyroid
Fatigue (most common)
Skin can become dry, cold, rough and scaly
Hair becomes coarse, brittle and grows slowly or may fall out excessively
Sensitivity to cold with feelings of being chilly in rooms of normal temperature
Difficult for a person to sweat and their perspiration may be decreased or even absent even during heavy exercise and hot weather
Constipation that is resistant to magnesium supplementation and other mild laxatives is also common
Difficulty in losing weight despite rigid adherence to a low-grain diet, especially in women
Depression and muscle weakness

Many thanks to Mary Shomon for providing the details of this story and for providing such an outstanding resource for thyroid patients with her Web site. I highly recommend her book, Living Well With Autoimmune Disease, and if you haven’t read my review of this book I encourage you to do so.

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