When your blood is drawn could affect TSH level and hypothyroidism diagnosis

If you check your thyroid levels in the afternoon with a blood draw, results may come back normal even though you’re hypothyroid, according to a new study. Checking your TSH in the morning can give you more accurate results.

Like other hormones in the body, thyroid-stimulating hormone (TSH) follows a daily rhythm and is not consistent throughout the day. Researchers in the study evaluated untreated patients with subclinical hypothyroidism along with patients taking a T4 hormone. They tested the participants’ TSH before 8 a.m. and again between 2 and 4 p.m.

In both groups TSH dropped substantially during the afternoon test, which would have led to hypothyroidism not being diagnosed in about 50 percent of the untreated participants.

Their TSH was 5.83 mU/L in the morning and 3.79 mIU/L in the afternoon. In the group being treated with thyroid medication TSH was 3.27 mIU/L in the morning and 2.18 mIU/L in the afternoon.

A 2004 study also showed that late morning, non-fasting TSH dropped 26 percent compared to early morning, fasting TSH.

Timing of TSH test adds new ammunition to thyroid range controversy

The researchers concluded that the timing of your blood draw plays an important role in how to decipher the results of your thyroid panel.

Unfortunately, even with an early morning blood draw, many hypothyroid patients still slip through the cracks because most doctors use ranges that are too wide.

It’s still very common for doctors to diagnose hypothyroidism using a TSH range of 0.5 to 5.0 mIU/L even though the American Association of Clinical Endocrinologists recommended years ago the range should be 0.3 to 3.0 mIU/L.

Functional medicine uses narrower ranges and more markers to identify hypothyroidism

In functional medicine we use an even narrower range of 1.8 to 3 mIU/L. We also know in functional medicine that looking at TSH alone can miss hypothyroidism.

For some, TSH may be normal but other thyroid markers are off. That’s why it’s important to order a thyroid panel that looks at a more complete thyroid picture, which can include total and free T4 and T3, reverse T3, free thyroxine index (FTI), T3 uptake, and thyroid binding globulins. Many conditions can cause poor thyroid function, including inflammation, hormonal imbalances, and chronic stress. Evaluating other thyroid markers gives insight into these imbalances.

Always screen for autoimmune Hashimoto’s hypothyroidism

In addition to these markers, anyone with hypothyroid symptoms should be screened for Hashimoto’s, an autoimmune disease that attacks and destroys the thyroid gland. Hashimoto’s accounts for about 90 percent of hypothyroid cases in the United States. You screen for Hashimoto’s by checking TPO and TGB antibodies.

Although thyroid medications may be necessary to maintain thyroid function, they do not address the immune system’s relentless attack against the thyroid gland. Not managing Hashimoto’s increases the risk of developing other autoimmune diseases. These can include pernicious anemia, rheumatoid arthritis, vitiligo, and Type I diabetes.

Ask my office how to properly evaluate your thyroid symptoms and lab markers for appropriate thyroid management.

 

Baywatch beauty brings Hashimoto’s hypothyroidism out of the closet

Talk to a group of women with Hashimoto’s hypothyroidism, and they’ll likely all share the same frustrating story. Frequently dismissed, misdiagnosed, or ignored by doctors, Hashimoto’s hypothyroidism is finally getting the recognition it deserves thanks to former Baywatch beauty and Playboy cover girl Gena Nolin.

Struggling with Hashimoto's on the Baywatch set

Nolin struggled through marathon days on the set of Baywatch in a tiny red tank while battling symptoms of Hashimoto’s: fatigue, depression, hair loss, and weight gain. According to one interview, she gained weight despite exercising and eating very little—a salad or a can of tuna a day—and her hair became dry and brittle. Exhausted and starving, she pushed on with the help of antidepressants.

Symptoms worsened after her first two pregnancies. Doctors simply pegged her problems on postpartum depression, and prescribed her antidepressants. After her third pregnancy she suffered from arrhythmia, or irregular heartbeats, a common symptom of Hashimoto’s. She visited a couple of doctors before one finally diagnosed her with Hashimoto’s hypothyroidism, explaining the mysterious symptoms she had been battling since the age of 18. After experimenting with different thyroid hormones, she was almost symptom-free after just three days of finding the right one.

Nolin stands apart as a hypothyroid celebrity

What separates Nolin from other celebrities with hypothyroidism—Oprah Winfrey, Kelly Osbourne, Kim Cattrall, Jillian Michaels, and Mary-Louise Parker—is that Nolin uses her notoriety to speak up for the millions of Americans with hypothyroidism who are misdiagnosed or mismanaged by the health care system.

Nolin also recognizes and promotes the fact that for 90 percent of Americans, hypothyroidism is caused by an autoimmune disease, Hashimoto’s, which attacks and destroys the thyroid gland (explained in the book Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? by Datis Kharrazian, DHSc, DC, MNeuroSci.) Nolin advocates a gluten-free diet and other natural thyroid strategies outlined in Dr. Kharrazian’s book.

Imagine if Oprah Winfrey helped hypothyroid sufferers

Imagine if Oprah Winfrey had access to the same knowledge and information when publicly discussing her thyroid condition—she could have helped millions of sufferers and advanced thyroid care in this country. Faced with patient demand, doctors would have been forced to increase their knowledge and education to offer genuine help to their patients.

Nolin reaches out for those with Hashimoto's hypothyroidism

Online thyroid communities have warmly embraced Nolin. Her Facebook page Thyroid Sexy has almost 13,000 likes, and she posts frequently and communicates with her followers. Her post I am Hashimoto’s Disease—A letter for patients, family and friends, garnered a huge response for readers.

Nolin is the first internationally known celebrity who has made it a personal mission to bring positive awareness to thyroid disease. She is co-authoring a book about her journey and Hashimoto’s hypothyroidism with thyroid author Mary Shomon. Shomon is the author of the About.com Thyroid Disease blog, and the author of several best-selling thyroid books.

Hashimoto's hypothyroidism can lead to more autoimmune disease

Failing to manage your Hashimoto’s hypothyroidism condition could lead to future autoimmune diseases. A recent study revealed that roughly one in six patients with Hashimoto’s has another autoimmune disease, most commonly:

• atrophic gastritis, a condition in which the lining of the stomach is constantly inflamed
• vitiligo
• celiac disease
• antiphospholipids syndrome, which may cause blood clots, miscarriages, or stillbirths, and
• multiple sclerosis.

Hashimoto’s is an autoimmune disease that attacks and damages the thyroid gland, causing symptoms of hypothyroidism that include weight gain, cold hands and feet, depression, fatigue, and hair loss. In the United States, about 90 percent of hypothyroidism cases are due to Hashimoto’s.

Of the more than 1,500 patients with autoimmune thyroiditis (Hashimoto’s) who were included in the study, 16 percent were found to have an additional autoimmune disease. These patients also exhibited poor absorption of T4, chronic unexplained anemia, and recurring pregnancy losses. Thyroid hormone medication, which is the conventional treatment, may compensate for a damaged thyroid, but it does not address the underlying autoimmune condition.

Managing your Hashimoto’s hypothyroidism can prevent other autoimmune diseases

Hashimoto’s is more an autoimmune condition than a thyroid condition and must be managed accordingly. Autoimmune diseases such as Hashimoto’s hypothyroidism are evidence of an immune system that has become so imbalanced it attacks the very tissue it was designed to protect. Fortunately, research in recent years has provided us with tools we can use clinically to help restore balance and thus tame the autoimmune attacks.

Ditch the gluten

The first and perhaps most important step is removing gluten from the diet. Gluten causes a strong immune reaction in many people, and studies show a link between gluten and numerous autoimmune diseases, including Hashimoto’s. When someone with an undiagnosed gluten intolerance eats gluten regularly, it puts the immune system on constant red alert. This causes chronic inflammation and can trigger the onset of an autoimmune disease.

The autoimmune diet

Most people with an active autoimmune disease also suffer from intestinal permeability, or leaky gut, a condition in which the gut walls become damaged and overly porous. This allows undigested foods, bacteria, and other pathogens into the bloodstream, where they trigger more inflammation.

Managing an inflamed and leaky gut is foundational to taming an autoimmune disease. One of the first steps to repairing leaky gut is to temporarily follow an autoimmune diet, which eliminates foods that commonly provoke an immune reaction. Many people with Hashimoto’s hypothyroidism find they must also eliminate other foods, such as dairy or corn, in addition to gluten. In my office, we supplement this diet with select nutritional and herbal compounds that help restore the gut lining.

Sometimes these tools alone are enough to substantially reduce autoimmune flare-ups.

Going beyond the autoimmune diet may be necessary

Other times, more intensive therapy is required. This can include unwinding long-established cycles of inflammation, restoring immune balance, and/or determining whether a bacterial or viral infection, an environmental toxin, or something else is provoking the autoimmune attacks.

If you would like help addressing Hashimoto’s hypothyroidism and preventing future autoimmune diseases, please contact my office.

What’s wrong with my thyroid?

By Dr. Michael Ruscio

Why do so many people have symptoms of low thyroid function (aka hypothyroidism), yet their lab test are normal. You know something is wrong but your doctor says its all in your head. A study published in Alternative Medicine Review sheds some light on this subject.

Altern Med Rev. 2000 Aug;5(4):306-33.

The summary of this study reports there are a few, fairly common factors, that derange thyroid function but do so in such a way that will not be detectable on standard lab tests which test two markers called TSH and T4. Here are the highlights:

· First we have to understand the concept of activation of thyroid hormone

o Activation of thyroid hormone is when T4 is converted into T3. T3 is the active form of thyroid hormone.

o T3 is almost never tested by standard testing. This is important because even if you have normal T4 you can have abnormal T3. Further, if you have perfect T4 but abnormal T3, you will have symptoms of hypothyroidism.

§ Symptoms of hypothyroidism:

Fatigue High cholesterol

Weight gain Cold hands & feet

Depression Dry coarse skin & hai

Forgetfulness Always cold

· Inflammation decreased thyroid function

o A direct relationship was found between inflammation and decreased thyroid function. In fact, when healthy subjects were injected with inflammatory compounds (specifically IL-6) they developed symptoms of hypothyroidism.

o Don’t think inflammation is a big deal….30.7% of population (that’s 1 of 3 people) has abnormally high inflammatory marker according to a 2006 study.

§ Brain Behav Immun. 2006 Sep;20(5):498-504. Epub 2005 Dec 216330181.

· Toxic metals decrease thyroid hormone activation

o It is well know that people toxic with metals like lead or mercury have hypothyroid symptoms. In fact in another study it was shown that a key thyroid enzyme can decreased in function by 90% after exposure to toxic metals.

§ Heavy metal toxicity is also more common than you would think, people with silver fillings may be at risk for mercury exposure

§ Check out this video to see how silver fillings leech mercury http://www.youtube.com/watch?v=9ylnQ-T7oiA&feature=related

· Increased levels of liver toxicity (hepatic lipid peroxidation) cause hypothyroid symptoms

o As the toxic burden on the liver increased, less of the active form of thyroid hormone (T3) was made (less thyroid hormone was activated)

· Soy may be causing your hypothyroid symptoms

o Healthy subjects who consumed a high soy diet for 3 months developed symptoms of hypothyroidism, after returning to a normal diet their symptoms returned to normal

o Evan as little as 128mg of soy per day caused hypothyroid symptoms in one study performed on a group of women

· High levels of stress hormones also caused symptoms of hypothyroidism. This further reinforces what we have all noticed for decades, when some people are under high amount of stress they tend gain weight.

· Low calorie diets decreased thyroid function

o In men who reduced calories a meager 15% below needed intake showed an unfavorable shift in thyroid hormone levels.

§ How does this work? It’s a prehistoric survival mechanism. When food was scarce (or if you eat like food is scare) the body will slow down its metabolic rate to keep you alive. The slower your metabolism, the less fat you burn.

· A low very carbohydrate diet (less than 200g per day) maintained for too long can decrease thyroid function. This of this as dietary stress.

· This study also showed even if you eat a normal amount of calories but exercise to be in calorie deficit you decrease levels of active thyroid hormone (free T3 and increase reverse T3)

· Sleep deprivation caused a low metabolic state or hypothyroid symptoms.

What can you do?

· Control inflammation

· Rid your body of toxins and limit toxic exposure

· Avoid soy in the diet

· Don’t cut calories and keep your carbohydrates low but now too low, I recommend not exceeding 100 grams per day.

· Manage stress

· Selenium, Ashwaghanda, vitamin E, and gugulu

Visit our website www.IntegrativeHC.com for more information