AM I HYPOTHYROID EVEN THOUGH MY LAB TESTS ARE NORMAL?

Having treated hundreds of patients with symptoms of hypothyroidism, I can say with assurance that many cases where the TSH test was within what is considered to be normal range benefited remarkably from empirical use of the thyroid medicines, usually a desiccated thyroid preparation known as Armour Thyroid™ or Nature-Throid™. Indeed, if we accepted the TSH test as the only indicator of the need for thyroid, countless patients in our clinic (and in clinics throughout the United States) would be suffering needlessly.

Despite normal basic laboratory tests for hypothyroidism (i.e., the TSH test), many of our patients are indeed “sub-clinically hypothyroid.” Another way of putting this is that they have “sub-laboratory” hypothyroidism, a term coined by Alan Gaby, M.D. in his excellent review article entitled “Sub-laboratory” Hypothyroidism and the Empirical use of Armour Thyroid ™in 2004 (Alte
Med Rev 2004:9(2): 157-179). Here Gaby documented the research in this area, explaining with great clarity how it is possible to be hypothyroid despite normal lab tests, citing important studies, and reviewing the evidence for benefits, safety and a rational methodology for treatment.

Possible explanations for the disconnect between clinic and laboratory include a syndrome known as “tissue resistance to thyroid” (TRTH), defects in the conversion of T4 to the biologically active metabolite T3, possible mutations of thyroid hormone receptors in the brain, genetic variations in the deiodinase enzymes that convert T4 to T3, and the possible inhibition of peripheral thyroid hormone receptors by various environmental toxins, metabolites or byproducts of intestinal flora.

Countless patients present to physicians every day with symptoms of hypothyroidism, including chronic fatigue, constipation, coldness, immune system problems, unexplainable weight gain, problems with hair and nails, and a host of other symptoms. Lab testing yields normal values in the TSH and other basic tests, and despite their protestations, patients are refused thyroid treatment and offered no significant treatment.

Often enough, these patients show up at the door of Pearl Natural Health, and we proceed to evaluate their problems fully and, when indicated, empirically treat with thyroid hormones. We will do this, despite conventionally normal lab tests, always monitoring carefully with laboratory every step of the way. More often than not, when appropriately prescribed, symptoms of hypothyroidism are improved or eliminated, and thyroid function tests remain within normal limits.

While we do extensive laboratory testing, beyond simply the TSH and Free thyroxin test, to include other markers that identify a sub-clinical hypothyroidism (such as thyroid antibody tests, free T3, and reverse T3 tests), we have certainly come to rely more on clinical symptoms for a diagnosis of hypothyroidism, backed up by some trending in laboratory toward a clinical hypothyroidism. Even the American Association of Clinical Endocrinologists argued back in 2004 that the upper limit of TSH be changed from 5.0 to 3.04 mU/L which should raise further questions about the validity of the TSH tests as the chief diagnostic parameter for the prescription of thyroid.

If you suspect that you are hypothyroid, despite normal labs tests, consider a full evaluation at Pearl Natural Health for “Sub-Clinical “ or “Sub-laboratory” hypothyroidism.

Dr.Gary Weiner can be contacted at pearl@pearlnaturalhealth.com