Wisdom Wednesday: Thyroid Disease

The American College of Endocrinology (ACE) is the educational and scientific arm of the American Association of Clinical Endocrinologists (AACE). ACE has begun an awareness program designed to increase dialogue between patients, their physicians, and pharmacists. This program is available to the public at www.thyroidawareness.com. If you want more information after reading this blog, please visit their web site.

AACE president Dr. R. Mack Harrell, who is a thyroid specialist, stated “Thyroid hormone is the leading prescription drug in our country, and there are a lot of misconceptions about what thyroid disease is and what the thyroid does.”

The thyroid manufactures thyroid hormone from cholesterol and four molecules of iodine. This product is called T4. T4 is then released into the blood stream where it does nothing. T4 is the stable form of thyroid hormone. When your metabolism needs a boost, one of the iodine molecules is stripped from T4 creating T3. This is the active form of the hormone and stimulates general metabolism. Your ability to get out of bed in the morning and start your day is dependent on T3.

Eighty percent of T3 is created in the liver; the remaining twenty percent is formed in the kidneys. However, T4 to T3 conversion is under the control of the adrenals. Healthy thyroid hormone levels are dependent on the thyroid, liver, kidneys and adrenals. The function of all these glands and organs is controlled by the pituitary gland.



The pituitary gland produces TSH (thyroid stimulating hormone). Measurement of TSH levels is the gold standard for evaluating thyroid function. The medical norms for this test are 0.40 – 4.50, an extremely wide range. When the TSH is elevated, it indicates hypothyroidism. When it is low, it indicates hyperthyroidism or more commonly, over medication.

The AACE recommends the healthy range to be 1.0 – 2.0. Although many endocrinologists follow this recommendation, most physicians fail to take note of a TSH blood test that is outside this healthy norm, but within the broader range of normal. This has created significant issues in managing medication for hypothyroidism as many patients are either over or under medicated.

Another issue is what medication to use. Synthroid (levothyroxine) is standardized T4. However, Armor thyroid is a mix of T4 and T3. There is a raging controversy within the medical profession on whether to prescribe T4 or a combination of T3 and T4. The official stand of the AACE is that a very small percentage of patients will do better with some T3, but the vast majority of patients should remain on T4. Unfortunately, there is a lot of variation in both T3 and T4 activity between Synthroid and the generic substitutes.

I believe most patients feel better faster with the T3 as it is the active form of the hormone. Taking it by-passes the liver, kidneys, and adrenals. Virtually all patients have some impairment of both liver and adrenal function. Toxins in our environment tax the liver and the stress of everyday life takes a toll on the adrenals. Although patients feel the change quickly with T3 medication, its suppression of the endocrine system is much more systemic than T4.

Finally, there is the issue of Hashimoto’s Thyroiditis. It is estimated that a third of patients diagnosed with hypothyroidism actually suffer from Hashimoto’s, an autoimmune disease. I think that estimate is low and is really closer to half of the diagnosed population. The testing, thyroid auto-antibodies and a TPO (thyroid peroxidase) are seldom run as there is no medical treatment outside prescribing T3 or T4.

The Bottom Line:
If you have been diagnosed with hypothyroidism or suspect you have an issue, have a full thyroid profile including the auto-antibodies and TPO. If you agree to medication, stay consistent with both the brand and dosage. Closely monitor your TSH levels. However, there are natural alternatives that can even address Hashimoto’s Thyroiditis. Please consider investigating your natural alternatives.