• Introduction
• Causes of Hypothyroidism
• Symptoms of Hypothyroidism
• Diagnosis of Hypothyroidism
• Treatment of Hypothyroidism

Introduction:

Hypothyroidism is a condition in which the body lacks sufficient thyroid hormone. Since the main purpose of thyroid hormone is to "run the body's metabolism", it is understandable that people with this condition will have symptoms associated with a slow metabolism. Over five million Americans have this common medical condition. In fact, as many as ten percent of women may have some degree of thyroid hormone deficiency. Hypothyroidism is more common than you would believe...and, millions of women and men are currently hypothyroid and don't know it.

Causes of Hypothyroidism:

• It is a result of previous (or currently ongoing) inflammation of the thyroid gland which leaves a large percentage of the cells of the thyroid damaged (or dead) and incapable of producing sufficient hormone. The most common cause of thyroid gland failure is called autoimmune thyroiditis (also called Hashimoto's thyroiditis), a form of thyroid inflammation caused by the patient's own immune system.
• Medical Treatments.
• Hyperthyroidism is an excess of thyroid hormones. The commonest cause is autoimmune (Graves’ disease) characterized by the presence of antibodies directed against the thyroid-stimulating hormone (TSH) receptor, and causing a toxic diffuse goitre.
• Toxic multinodular goitre
• Toxic nodule (adenoma)
• Drug-induced hyperthyroidism (amiodarone)
• Excessive ingestion of levothyroxine (thyroxine) 
• High levels of human chorionic gonadotrophin (HCG) as this is similar to TSH, and can stimulate the thyroid gland (and suppress TSH
• Pituitary adenoma secreting excess TSH 

Symptoms of Hypothyroidism

• Fatigue
• Weakness
• Weight gain or increased difficulty losing weight
• Coarse, dry hair
• Dry, rough pale skin
• Hair loss
• Cold intolerance (can't tolerate the cold like those around you)
• Muscle cramps and frequent muscle aches
• Constipation
• Depression
• Irritability
• Memory loss
• Abnormal menstrual cycles
• Decreased libido
• Changes in vision, photophobia, eye irritation, and diplopia (with Graves’ ophthalmopathy)
• Dyspnoea, palpitations
• Emotional lability, insomnia, irritability, nervousness
• Exercise intolerance
• Frequent bowel movements or diarrhoea
• Heat intolerance, increased sweating 
• Increased appetite, weight loss
• Infertility, oligomenorrhoea
• Agitation
• Atrial fibrillation, heart failure, resting tachycardia
• Conjunctival oedema, lid lag, and proptosis (with Graves’ ophthalmopathy)
• Dependent oedema
• Pretibial myxoedema
• Proximal myopathy
• Thyroid enlargement
• Tremor
• Warm, moist hands

Diagnosis of Hypothyroidism: 

The big myth that persists regarding thyroid diagnosis is that an elevated TSH level is always required before a diagnosis of hypothyroidism can be made. Normally, the pituitary gland will secrete TSH in response to a low thyroid hormone level. Thus an elevated TSH level would typically suggest an underactive thyroid. 

The traditional tests of thyroid function, the T4 (or total T4), T3-uptake, FTI, 'T7', total T3, and T3-by-RIA tests should be abandoned because they are unreliable as gauges of thyroid function. The most common traditional way to diagnose hypothyroidism is with a TSH that is elevated beyond the normal reference range. For most labs, this is about 4.0 to 4.5. This is thought to reflect the pituitary's sensing of inadequate thyroid hormone levels in the blood which would be consistent with hypothyroidism. There is no question that this will diagnose hypothyroidism, but it is far too insensitive a measure, and the vast majority of patients who have hypothyroidism will be missed.

The clinical symptoms of hypothyroidism are many. Perhaps the most common is fatigue. The skin can become dry, cold, rough and scaly. The hair becomes coarse, brittle and grows slowly or may fall out excessively. There is a sensitivity to cold with feelings of being chilly in rooms of normal temperature. It is 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 another common symptom. Difficulty in losing weight despite rigid adherence to a low grain diet seems to be a common finding especially in women. Depression and muscle weakness are other common symptoms.

Most patients continue to have classic hypothyroid symptoms because excessive reliance is placed on the TSH. This test is a highly accurate measure of TSH but not of the height of thyroid hormone levels.

The basic problem that traditional medicine has with diagnosing hypothyroidism is the so called "normal range" of TSH is far too high: Many patients with TSH's of greater than 1.5 (not 4.5) have classic symptoms and signs of hypothyroidism.

The alternative to monitor thyroid disease is to use the Free T3 and Free T4 and TSH levels and interpret them with new reference ranges. If one measures the Free T3 and Free T4 levels the only accurate measure of the actual active thyroid hormone levels in the blood, as well as the TSH, one will find out how often a low normal TSH does NOT exclude hypothyroidism. It is relatively common to find the Free T4 and Free T3 hormone levels below normal when TSH is in its normal range, even in the low end of its normal range. When patients with these lab values are treated, one typically finds tremendous improvement in the patient, and a reduction of the classic hypothyroid symptoms.

There are a significant number of individuals who have a TSH below 1.5 but their Free T3 (and possibly the Free T4 as well) will be below normal. These are cases of secondary or tertiary hypothyroidism, so, TSH alone is not an accurate test of all forms of hypothyroidism, only primary hypothyroidism.

This revised method of diagnosing and treating hypothyroidism seems superior to the temperature regulation method promoted by Broda Barnes and many natural medicine physicians

Treatment of Hypothyroidism:

The easiest and most effective treatment is simply taking a thyroid hormone pill (Levothyroxine) once a day, preferably in the morning. This medication is a pure synthetic form of T4 which is made in a laboratory to be an exact replacement for the T4 that the human thyroid gland normally secretes. It comes in multiple strengths, which means that an appropriate dosage can almost always be found for each patient. The dosage should be re-evaluated and possibly adjusted monthly until the proper level is established. The dose should then be re-evaluated at least annually. If you are on this medication, make sure your physician knows it so he/she can check the levels at least yearly.

Occasionally the correct dosage is a bit difficult to pin-point and therefore you may need an exam and blood tests more frequently. Also, some patients just don't do well on some thyroid medications and will be quite happy on another. For these reasons you should not be shy in discussing with your doctor your blood hormone tests, symptoms, how you feel, and the type of medicine you are taking. The goal is to make you feel better, make your body last longer, slow the risk of heart disease and osteoporosis...in addition to making your blood levels normal! Sometimes that's easy, when its not, you need a physician who is willing to spend the time with you that you deserve while you explore different dosages other types of medications (or alternative diagnoses).

The most common starting dose for patients with hypothyroidism is Armour thyroid, 90 mg which is cut in half with a razor blade and half is taken after breakfast and the other half after dinner. Taking it after meals also helps to reduce volatility of the blood-level of T3. If the patient has any problem breaking or cutting the pill, they should purchase a pill-cutter at the pharmacy. The TSH, Free T3 and Free T4 are then repeated in one month and the dose is adjusted.

In order to optimize the hormone replacement, the Free T3 and Free T4 should be above the median but below the upper end of the laboratory normal reference range. The goal for healthy young adults would be to have numbers close to the upper part of the range, and for cardiace and/or elderly patients, the numbers should be in the middle of its range. The Free T3 and Free T4 levels should be checked every month and the hormone therapy readjusted until the FT3 and FT4 levels are in the therapeutic range described. A small number of large, overweight, thyroid-resistant women may need 6-8 grains of Armour Thyroid or the equivalent of thyroxine per day (counting 0.1mg of T4 as 1 grain of Armour Thyroid).