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I left off in the last article of this series answering the often asked question “ why, based on my blood tests, does my doctor say my thyroid is normal, yet I feel lousy and have all the symptoms of low thyroid?” In “the old days” doctors diagnosed based on the clinical picture, spending quality time and listening to the patient, then from the history and exam , and pertinent tests, a conclusion was made and appropriate medicines and advice were dispensed. A “doc by number” reads lab results and diagnosis and treats accordingly. Alternative/holistic doctors correlate signs and symptoms, basal body temperature and blood tests in diagnosing thyroid conditions. I discussed some reasons why the “gold standard” of thyroid blood tests is TSH and why that is inadequate as a determining factor for a diagnosis. I will mention other valuable blood tests that help more clearly define hypothyroidism. In doing so, I am stressing again that solely relying on TSH testing will miss many hypothyroid cases.

To review the connection between iodine and thyroid hormones, the thyroid gland produces hormones, T1, T2, T3, and T4. This stands for the amount of iodine molecules present respectively. Of these T3 is the active thyroid hormone that gets inside the cells and affects the metabolism of the whole body. TSH is more reflective of T4 levels. Many patients will have normal T4 and normal TSH but low T3 levels. Therefore, a comprehensive thyroid lab profile would include T3, free T3, reverse T3 (rT3), as well as T4, free T4 and TSH. Dr. Jonathan Wright , M.D. and his staff of doctors at his clinic find that elevated rT3 shows a reason for body signs and symptoms of weak thyroid much more often than other thyroid lab tests combined. They further concluded based on clinical observation of dozens of patients that an elevated rT3 almost always correlates with elevated levels of toxic metals, such as lead, cadmium, mercury, arsenic, nickel and others. Also, many people for a wide variety of reasons that I will delineate, do not adequately convert T4 to T3. In these “poor converter” patients the T4 levels are often maintained and so the TSH levels will be normal. Yet the active T3 hormone will be suppressed.

After listing a host of reasons why people may be “poor converters” of T4 to T3 I am then going to establish why the conventional medicine of choice for treating hypothyroidism is a synthetic T4 product called Synthroid, which often fails to properly correct the sluggish thyroid issue. A primary factor causing this “poor conversion” state is low iodine levels. Other nutritional deficiencies such as selenium, iron, zinc, and B vitamins as well may contribute to poor conversion. Certain medications such as beta-blockers, lithium, chemotherapy, radiation, anemia meds, cytokines, birth control and hormone replacement may cause poor conversion of T4 to T3. Too much alcohol, soy products and cruciferous vegetables as well are contra-indicated. Toxic metals such as lead, fluoride and mercury as well as other toxic substances found in pesticides are a possible cause. Even “stress”(weak adrenals) can cause poor conversion of T4 to T3. Again, and this is very important to understand, the TSH test is very sensitive to T4. If the T4 levels go up the TSH will fall. So patients with high TSH are treated with T4 (synthroid.) However, and this is critical, if the body is unable to convert T4 to the active more important T3 the patient will still be suffering from all the symptoms of hypothyroidism! This is a primary answer to the question raised by thousands of patients who are told their thyroid is ok based on the TSH and T4 blood results, and who still feel lousy. Many of these patients are then told by their conventional doctor to seek psychiatric help! Dr. Kenneth Blanchard, an endocrinologist, states: “what doctors are always told is that TSH test always gives a yes or no answer. In fact, I think this is fundamentally wrong. The pituitary TSH is controlled, not just by how much T4 and T3 are in circulation, but by how much T4 is converted into T3.”

The next issue I will discuss is also an area of thyroid conditions that is often missed by conventional doctors. Dr. David Brownstein, a leading authority on thyroid, sites research done by Dr. John Lowe. Dr. Lowe confirmed observations of thyroid hormone resistance in 3 placebo-controlled, double blind crossover studies. For varied reasons, including genetics, the cells of the body that require thyroid hormones become unreceptive or unresponsive to the hormone. So even if there is an adequate supply of thyroid hormone symptoms of hypothyroidism will be experienced. The physician’s job is to find ways to make the cells less resistant, such as detoxify programs and identifying medications that may be the cause. As is many cases, a trial of normal or higher than normal doses of thyroid hormone is required to produce the desired effects on the body. This is a prime example where merely following blood results will be misleading. A patient might have blood tests indicating hyper-thyroidism(too much thyroid hormone) , but when evaluated do not exhibit any signs of overactive thyroid. In other words, holistic doctors are more interested in how much better the patient is doing than in correcting blood results. To reiterate, lab tests alone will miss many cases of hypothyroidism. Remember, no test tells what thyroid hormone is doing at the cellular level. A holistic approach will consider many parameters including simply how the patient feels, along with basal body temperature and the comprehensive blood tests mentioned above.

In the next segment of this series on Thyroid and iodine we will review auto-immune thyroid conditions and their treatment. Stay tuned!