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January is thyroid health awareness month. Hypothyroidism, or low thyroid, is a common condition, affecting almost 5 in every 100 Americans. Underdiagnosis is a problem and may as much as double that number. Part of the reason so many cases go undiagnosed is that the symptoms of hypothyroidism can be variable. Symptoms may include fatigue, brain fog, headaches, hair loss, dry skin, heart palpitations, weight gain, feeling cold, constipation, anxiety and menstrual irregularities.

Symptoms alone are not enough to diagnose hypothyroidism, but a blood test usually confirms our suspicions. Thyroid stimulating hormone, TSH for short, is the usual test run for checking thyroid. For screening asymptomatic patients, this is often sufficient. TSH is an indirect measure of thyroid function. This hormone is released by the pituitary gland to tell the thyroid to produce and secrete thyroid hormones and it’s levels rise and fall in response to thyroid hormone levels. I describe it as a see-saw – if your thyroid hormone levels go up, TSH goes down and vice versa. But TSH is also affected by other hormones, like the stress hormone cortisol, so TSH testing alone might not give you the whole picture. 

In my experience, if you are symptomatic, it’s better to run a complete panel including thyroid hormones, T4 and T3. Measuring these hormones directly ensures that we catch more individuals experiencing hypothyroidism. In addition, it may help to provide clues about a functional problem with hormone conversion. T3 is considered the “active” form of thyroid hormone and less of this is secreted directly from the thyroid gland. T4 is the inactive form, but is usually easily converted to T3 by the body. The levels of T3 and T4 can point to issues of conversion which can often be addressed with targeted nutritional supplements that aid the process. If the levels of T4 and T3 are low, we can also consider supplementing with thyroid hormone to correct this imbalance.

And finally, I would be remiss in any conversation about hypothyroidism not to mention the most common cause of hypothyroid in our country, Hashimoto’s thyroiditis. Hashimoto’s is an autoimmune condition in which your body’s own immune system damages the thyroid gland, commonly resulting in hypothyroidism. I find that many of my patients with Hashimoto’s either have not been previously tested for this underlying condition or have been advised that there is nothing to be done and that the condition will continue to damage their thyroid. I’ve seen naturopathic treatments reduce Hashimoto’s markers to normal levels and result in improvements in symptoms. 

If you have symptoms as listed above, please discuss them with your PCP and consider getting a blood test. If you need additional support, I’m here to help.  

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