Patient Mysteries:
ARE YOU THYROID DEFICIENT? Part 2
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Written by Dr. William N. Clearfield, D.O.
n Part 1 we reviewed two case studies illustrating common clinical presentations of thyroid disease, the anatomy and physiology of the thyroid gland, symptoms of low thyroid output and causes of thyroid disease. In Part 2 we will review the diagnosis and offer treatment modalities for varying types of thyroid maladies including medications, supplements and dietary advice. Diagnosing thyroid deficiency is a hot topic. Battle lines were drawn several years ago when patients, obviously hypothyroid, were told they were “normal” because a single test, the TSH, was inside a “normal” 2 standard deviations or 95% of a cross section healthy adults range. “The serum thyrotropin (TSH) is the single best screening test for primary thyroid dysfunction for the vast majority of outpatient clinical situations. The standard treatment is replacement with levothyroxine. The decision to treat sub clinical hypothyroidism when the serum thyrotropin is less than 10 mIU/L should be tailored to the individual patient.”1 10! Even the most generous standard lab has an upper reference range of 4.5 mIU/L. This reference range, one size fits all, cookbook medicine approach, leaves millions of clearly hypothyroid patients, un- and under-diagnosed and un- and under-treated. Left alone, hypothyroidism can progress to enlarged
Healthy Beginnings • September 2015
hearts, heart failure, brain fog, infertility and miscarriage. The risk of elevated blood pressure, Hashimoto’s Disease, and depression in relation to the thyroid can be seen with a TSH reading as low as 1.9. At 2.0, elevated markers for cardiac and carotid (c-Reactive Protein and Homocysteine) disease are evident. When the TSH is 3.3 or greater severe forms of depression, increased body mass index, and blood sugar abnormalities are common.2 These are all within the confines of a “normal” thyroid. The sweet spot, the place where our patients function at their very best, are happiest, and have the best cognitive function, best lipid profiles, no cardiac irregularities, or bone loss is really 0.1 and 1.0 mIU/L.3 Thyroid hormones, once released, travel in the blood stream either bound to a protein or in free form. T3 is the functioning thyroid molecule. Only the free form is available to produce the desired hormonal effect. Knowing the amount of circulating thyroid hormone
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