Diagnosis & Treatment
Diagnosis and treatment of thyroid disorders have long since been approached in a clinically inaccurate and ultimately limited fashion. Traditionally, thyroid stimulating hormone (TSH) has been used as the definitive test for thyroid function.
When clinically appropriate, measuring TSH helps manage autoimmune thyroid conditions such as Hashimoto’s Thyroiditis and Grave’s Disease. However, if TSH is “normal”, then thyroid conditions are often “ruled out” and further investigations are not performed no matter how symptomatic you may be.
If your TSH is elevated, as is common in overt hypothyroidism, then free thyroxine (T4) will be measured. If free T4 is low, a synthetic T4 medication, often Synthroid, is tried in conventional medical practices. While this testing method works for some patients, it is inadequate for others. Biologically, T4 is significantly less active than the other thyroid hormone, triiodothyronine (T3).
Additionally, conventional “normal” ranges for T3 and T4 vary from lab to lab and are generally not agreed upon. This means that you may or may not be diagnosed with a thyroid condition based on the specific lab that your doctor uses. Using this schema, more than 60% of low-functioning thyroid conditions go undiagnosed!
Signs & Symptoms
Signs and symptoms of low thyroid include fatigue, weight gain, dry skin, hair loss, constipation, low mood, blood sugar mismanagement, “running” cold, and many more. We believe that signs and symptoms of disease are just as important as lab numbers, especially when using TSH alone to assess thyroid function. Having "normal" numbers with low thyroid signs and symptoms is known as Euthyroid Sick Syndrome and is often missed by doctors. Also, every hormone, including thyroid hormones T3 and T4, is highly bound to plasma proteins and has both a “free” and “bound” form. In fact, T4 is 99.5% bound to Thyroid Binding Globulin (TBG), more so in pregnancy and if using contraceptive pills. Often, a total T4 (mainly bound) rather than a free T4 (bioactive) is used to assess thyroid function and to measure treatment efficacy. As you can see, there are many ways in which a low thyroid condition can be missed and therefore mistreated.
How are we different?
- Use TSH only when clinically relevant, NOT as general screening
- Test for free T4 AND free T3, not bound hormone
- Treat low thyroid with BOTH T4 and T3 replacement
- Use consistent, optimized ranges
- Treat the Patient for symptom resolution, NOT purely the numbers