Thyroid
and Hormones
The thyroid gland and what can go wrong when it is low
Here are examples of what the thyroid will cause when it is low
What does the thyroid look like when it is low in function?
What should I do if I suspect that my thyroid is low?
What is Hashimoto’s disease?
Who is a candidate for thyroid replacement?
What are the symptoms and signs of low thyroid?
What are the general replacement practices of most doctors?
Why do doctors not use T3?
What is Dr. Paoletti’s approach to thyroid
replacement?
What are the side effects of thyroid replacement?
What can I expect when my thyroid is corrected?
The thyroid gland and what can
go wrong when it is low:
The thyroid gland is an import endocrine gland at the
base of the neck. The thyroid is responsible for the metabolic
rate of the body. Many consider it the master gland of the body.
Without it, none of the other hormones functions well. It is
important to the function of all of the systems of the body.
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Here
are examples of what the thyroid will cause when it is low:
When the thyroid is low, the nervous system does not function
well, your thinking is unclear, and the hearing becomes poor.
The skin becomes dry and rashes occur. Your sinuses become more
inflamed and because of the constant drip into your lungs may
cause recurrent bronchitis. The gastrointestinal system depends
on the thyroid gland and will not function well without it. Constipation
soon develops and with it, gas develops. From the constant pushing,
hemorrhoids and bleeding soon follow. The cardiac system is also
dependent on the thyroid. Too low of thyroid will leave you with
a very slow heart beat. If the deficiency of thyroid is allowed
to continue, you will even develop irregular beats in severe
cases. Swelling of the lower extremities, (your legs) will occur
especially in the front of your lower leg bones – called
pretibial edema, usually accompanied by a rash in this region.
One’s reflexes and movements become slower due to the nervous
effects of the low hormone. The fatigue is severe and sleep and
rest become essential all of the time. Depression often arrives
with the onset of the problem or becomes worse if it already
exists. The production of blood by the body is affected and one
develops anemia – a low blood count. The ability of the
blood to clot can also be affected in severe cases. The liver
also will be inhibited from performing its function well. Often
we see a yellowing with low thyroid, which is a manifestation
of a build up of bilirubin - a waste product of red blood cells
in the blood when they disintegrate. Ones ability to hold onto
to sodium, a vital mineral is also lost when the thyroid is low.
This leads to weakness with standing and a whole host of other
metabolic problems – particularly in the brain where a
foggy sense of lack of focus is apparent. Problems with the menstrual
cycle occur in great frequency with low thyroid either too many
or too few. Periods are also very painful and heavy when they
occur. Finally the cholesterol will be elevated with low thyroid
contributing to plaque and atherosclerosis.
Most of the symptoms that are mentioned above are the extreme
cases of low thyroid. I mention them only to illustrate the importance
of recognizing a truly low thyroid condition before some serious
condition such as an arrhythmia – a fast irregular beating
of the heart can occur. Usually only those who ignore the problem
or struggle to treat a true thyroid deficiency in a non-medical
fashion can possibly develop these problems.
I remember a case when I was taking care of an older woman whom
everyone had expected to die soon because of a dangerous arrhythmia
(a life threatening irregular heart beat) that was resistant
to any treatment or medication. I was told that all of the tests
had been done on the woman. It was felt that she would not leave
the hospital alive. When I, a new intern, arrived on the ward,
I asked permission to run a complete evaluation on the patient.
When I did so, I discovered that her sodium were very low. I
ran a thyroid screen and discovered that she was almost devoid
of thyroid! When we replaced – gave her the thyroid hormones
artificially – that she was missing she recovered immediately.
Her cardiac function returned and the life threatening arrhythmias
disappeared. The embarrassed but grateful cardiac team sent her
home in less than two weeks.
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What does the thyroid look like when it is low in function?
When it is low in its function, the thyroid often enlarges
and you can sometimes see it or even feel it when you swallow.
Occasionally
some individuals can tell that they have an enlarged thyroid
from comparing old photos. In the absence of weight gain, an
enlargement of the neck indicates a thyroid problem.
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What should I do if I suspect that my thyroid is low?
Doctors usually replace thyroid when its function is low
since it is destructive to allow one to be low for long periods.
The thyroid can be considered as one
of the most important glands of the body. When it is not functioning, properly
none of the other hormones works properly (see above). If you suspect that
you have a low thyroid or have been diagnosed with one, it
is beneficial to consider
replacement – the taking of medication that is identical to the thyroid
hormone that the body makes – to replace the deficiency.
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What is Hashimoto’s disease?
The most common form of low thyroid is Hashimoto’s disease, a disease where
thyroid antibodies, proteins that attack the body’s healthy thyroid
tissue, are present. When present, they slowly destroy parts of the thyroid
and cause
it to loose function. Even when your thyroid function is normal at the laboratory,
the brain may have to send much more of a messenger, thyroid-stimulating
hormone (TSH), from the brain in order for the thyroid to work well at all.
When this
happens, individuals often feel the strain of this disorder long before the
lab values become what most doctors consider clinically abnormal. This is
why when
you test your hormones; the whole answer cannot simply come from looking
at the paper results. The real decision of whether someone needs replacement
depends
on how someone feels.
Graves’ disease is the opposite of the Hashimoto’s disease. With
this disease, you will have high thyroid hormone level. Symptoms of this
disorder frequently are rapid speech, fast heartbeats, excess body sweating,
and high
persistent anxiety - even paranoia. If you have or suspect you have this
condition, it could be or become life threatening and you should seek help
immediately.
Replacement is not for you!
On occasion, individuals experience extremely low thyroid levels and yet
do not have thyroid antibodies. Under normal circumstances, this is usually
from
some
acute or chronic illness and can be addressed with supplements and dietary
changes. Soy, as well as other foods when present in excessive amounts, is
capable of
causing a low thyroid and often stopping the offending substance will correct
the problem. When no apparent reason can be discovered for the low thyroid,
and it is persistent and debilitating, replacement can be a consideration.
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Who
is
a candidate for thyroid replacement?
Anyone who demonstrates symptoms of low thyroid and has Hashimoto’s
should consider replacement. Thyroid is a natural hormone and is a relatively
small
protein that we can now make in the identical form that the body creates.
Its replacement is not associated with side effects unless the replacement
is excessive.
That is why the levels must be checked often, especially initially to assure
that the levels are accurate.
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What are the symptoms and signs of low thyroid?
Low thyroid symptoms and signs include cold hands and feet, chronic fatigue,
poor exercise tolerance, mental slowness, slow speech, constipation, the
wearing of warm clothes when others do not, general aches and pains, hair
loss, dry
skin, chronic sinus problems, recurrent bronchitis and even depression. Other
signs
that the low thyroid state exist are the enlarged thyroid, dark circles under
the eyes, puffy eyes, slow pulse, slow speech, and elevated cholesterol.
Finally, a history of irregular, heavy, or extremely painful menses is often
caused
by a sub clinical low thyroid - a condition of thyroid disease, which is
accompanied by just borderline levels of thyroid hormone.
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What are
the general replacement practices of most doctors?
Many women
while on thyroid treatment receive the wrong hormone replacement.
They lack balance, the correct hormone balance, and continue
to experience the symptoms of low thyroid – fatigue, dry
skin, constipation, memory loss, mental slowness. Paradoxically,
they often feel edgy and low at the same time. This is because
most doctors only replace the thyroid hormones with levothyronine(T4)
(Synthroid, Levoxyl, or generic levothyroxine). Ignored is the
other natural hormone, triiodothyronine (T3), which often is
the only hormone that can provide you with relief from your hypothyroid
symptoms. It really is the actual ACTIVE thyroid hormone in the
body.
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Why do doctors not use T3?
In nature, T4 often is converted into T3 so doctors feel that
it is not necessary to replace both hormones. However, in nature,
many people’s bodies cannot convert these hormones. Often
conditions such as depression, medications, certain foods, lack
of sleep, or just genetics prevent this normal conversion. This
results in a deficiency of active thyroid (T3). These individuals
then experience the symptoms of hypothyroidism even in the presence
of their replacement T4. This is why they can be on adequate
levels of Synthroid for instance and fail to feel better.
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What is Dr. Paoletti’s approach to thyroid replacement?
Dr. Paoletti, will take the time to sit down with you and review
all of your history, your previous labs, your current symptoms,
your medicines and supplements, and your current desires. If
you exhibit signs and symptoms of low thyroid, Dr. Paoletti,
will retest you at her labs to establish if you are abnormal.
Dr. Paoletti takes special care to test your hormones in a way
that will show any imbalances that can arise. She uses a lab
that she has carefully screened for accuracy and sends only certain
tests the Free T4, the Free T3 and the TSH levels. All three
must be in the proper balance before one can feel normally energetic
again.
Following your history, the doctor will examine you for signs
of thyroid deficiency. Many of the signs have nothing to do with
the thyroid itself. In women, cycle irregularities can indicate
this problem as do skin and hair problems. Dr. Paoletti also
examines you to determine if you may be exhibiting signs of low
thyroid.
Following the history, review of labs, and exam, Dr. Paoletti
will again sit down with you and review the findings, and discuss
the mutually agreed-upon plan. This usually includes, starting
on thyroid medication and returning in about two to four weeks
to check blood levels of your new hormones. The timing of this
will depend on whether you have been on medication before, your
current levels and the degree of discomfort that you are experiencing.
If you have not had a thyroid scan (an ultrasound study to see
the contents of the thyroid) to rule out the presence of nodules,
one will be ordered. It is important to order this because the
occasional presence of thyroid disease can cause thyroid nodules – masses – that
are either precancerous or cancerous. This study will detect
this so that you are sure that you have nothing else to worry
about except just replacing the thyroid.
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What are the side effects
of thyroid replacement?
Since thyroid hormone as it is available now on the market is
the exact replica of the thyroid found in the body. If it is
replaced with the proper dosage, there should be no side effects.
Problems arise when it is replaced either inadequately or in
excess. When this is the case you will experience the dangerous
side effects mentioned in the first part of this section. To
avoid this, levels of thyroid hormone should be monitored very
carefully, especially initially. Often the alteration of other
hormones such as estrogen, the birth control pill, or other hormones
can change the concentrations, thus again close monitoring is
important.
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What can I expect when my thyroid is corrected?
When
the thyroid hormones are replaced correctly, the symptoms of
low thyroid, which are described above disappear. You will find
that you have you old energy back and in particular, the chronic
sinus problems that often bother women with the low thyroid will
disappear. If heavy, painful periods have been your experience,
they too will most likely be reduced also. Cholesterol levels
improve and your mental acuity will sharpen as will your memory.
Lastly, on occasion, depression that is either caused or exacerbated
by the thyroid problem eases or now responds to antidepressant
medication, which previously may have not worked at all.
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