For such a tiny organ, the thyroid gland holds the esteemed position of being the most important of the endocrine glands. The thyroid gland itself secretes two important hormones, T4 (thyroxine) and T3 (triiodothyronine). T1 and T2 are also secreted, but neither have any importance other than combining to form a small percentage of T3. Reverse T3 and T4 are chemically similar, but have no biological activity. The “reverse” designation simply refers to the chemical configuration because the molecules are a mirror image of the active molecules. The number after the “T” designates the number of iodine atoms that are present in that molecule. T4 is the primary hormone secreted by the thyroid as compared to T3. Most T3 results from the conversion of T4 in the liver, kidneys and other peripheral tissues. In a perfect world, the thyroid secretes the perfect amount of both hormones and exactly the right amount of T3 is converted from T4 in the peripheral tissues. The reality is that the world is not perfect and the incidence of low thyroid function (hypothyroidism) is much higher than most experts suspect. It is much more common than traditional medicine would have us believe and has actually has become an epidemic that wreaks havoc on the health of millions.

Hypothyroidism has many symptoms, but many doctors rely upon traditional testing that is inadequate and misleading at best. Doctors must and should look at the patient and consider the symptoms the patients have, but that most important basic aspect is often overlooked because of the improper way doctors have been trained to assess thyroid function. The most common symptom of low thyroid function is unexplained fatigue. Even with long periods of sleep, the hypothyroid person just never seems to have any energy. They wake up tired, stay tired throughout the day and go to bed tired. There are certainly other causes of fatigue, but hypothyroidism is at the top of the list. Other symptoms of hypothyroidism include:

Common Symptoms of Hypothyroidism

  • Weight Gain
  • Inability to lose weight
  • Dry skin
  • Constipation
  • Brittle nails
  • Mental “Fog”
  • Headaches
  • Memory impairment
  • Weak Heartbeat
  • Depression
  • Slow pulse
  • Difficulty concentrating
  • High blood pressure
  • Eczema
  • Easy bruising
  • Extreme Fatigue
  • Frequent colds or flu-like symptoms
  • Feeling of being cold
  • Multiple allergies
  • Cellulite
  • Loss of outer third of eyebrow
  • Dark circles under the eyes
  • Hair loss
  • Unexplained swelling
  • Difficulty swallowing
  • Swelling of the tongue
  • Impaired healing
  • Joint aches & pain (arthritis)
  • Muscle aches & pain (fibromyalgia)
  • Tingling/numbness
  • Accumulation of mucinous tissue under skin (myxedema)

It is unusual for a patient to complain of every symptom known to be associated with hypothyroidism, however, it is rather common for a patient to present with at least 6-8 of those listed above. No two patients are exactly alike and will present with different symptoms.

Regardless of the symptoms, most doctors order standard tests including the TSH (Thyroid Stimulating Hormone) test, free T4 and T3 uptake. The TSH test is supposedly the “gold standard” test to diagnose hypo or hyperthyroidism. It is also the test most doctors use to follow patients who are taking a thyroid supplement. A patient may have just enough energy to get out of the bed and drive to the doctor’s office because their thyroid function is so low, but if the TSH test is considered in the normal range, it’s as if the switch for common sense gets turned off with most doctors. Please understand that doctors do that not because they are bad people who don’t care, it’s simply a matter of having been trained improperly. A patient can have a low TSH test and still be in need of thyroid supplementation.

T4 is a thyroglobulin molecule that contains four atoms of iodine. Iodine is of major importance to the thyroid gland, but what many doctors do not understand is that iodine is important to the billions of other cells in the human body. T4 then undergoes a chemical change whereby one atom of iodine is removed resulting in the formation of T3, the major thyroid hormone. One would think that the molecule with more iodine is more important, but that is not the case! It is important to understand what I previously mentioned. T3 is four to five times more potent than T4 and it is the hormone that will determine whether or not a patient is hypothyroid. It is T3, in the free state, that is important! It is only the free portion of T3 that can bind to the specific T3 receptor site causing the cell to react and create energy. Free T4 also binds, but it is not nearly as important. The normal values listed by laboratories, for the free T3, are not what I have found to be the optimal values. To the contrary, the lower half of the “normal” range for free T3 is actually abnormal and consistent with a diagnosis of hypothyroidism. 

I have treated many patients who came to my office already taking the synthetic version of T4 (Synthroid, Unithroid or Levoxyl). I instruct all suspected hypothyroid patients to record their under arm (axillary) resting temperatures (before arising in the morning) and always obtain a free T3 laboratory study. In the vast majority of cases, their free T3 was extremely low (below optimal range) as were their resting axillary temperatures. For those already taking a synthetic T4 replacement, I typically change their thyroid replacement to desiccated thyroid and stop the synthetic variety of T4. I continue to monitor the free T3 and the body temperature. A very high percentage of those patients typically begin to show improvement during the very first week.

Thyroid Quick Facts

  • Thyroid is the most important endocrine gland
  • Thyroid hormone affects every cell in the body
  • Hypothyroidism has reached epidemic proportions
  • Hypothyroidism missed my most doctors
  • Hypothyroidism typically undertreated or not treated at all
  • Most doctors, regardless of specialty, use wrong laboratory tests to diagnose
  • T3 is the most important thyroid hormone and the free portion of utmost importance
  • T4 is the least important thyroid hormone
  • TSH very misleading laboratory test
  • Free T3 best laboratory value to consider but normal range too low
  • Normal not the same as optimal range for Free T3 (Doctor must know difference)
  • Most doctors do not treat properly
  • Desiccated (dried) thyroid preferable to synthetic versions of T4 (Synthroid, Levoxyl etc.)
  • Iodine should also be supplemented in most patients
  • Pulse rate should be monitored
  • Resting body temperature should be measured (best upon awakening)
  • Dosage of desiccated thyroid increased if symptoms recur regardless of laboratory values provided pulse rate stays in acceptable range
  • Symptoms very important in diagnosis
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