As much as I try to teach patients about their health concerns, in the end, I always learn more from them, than they learn from me. Case in point: many years ago while flying home from a medical conference I happened to sit next to a particularly talkative woman. This always seems to happen when I need some serious shuteye. Once she found out that I was a doctor the flood gates opened and she divulged to me her entire medical history. I remember vividly how she suffered with severe fatigue, weight gain, and brain fog for many years. After seeing many doctors she was finally diagnosed with low thyroid (hypothyroid). She was put on medicine in the form of Synthroid (levothyroxine), and she did feel somewhat better. However, it wasn’t until she went to a different doctor who changed her over to Armour thyroid that she finally felt like her old energetic self again. Her energy returned, her brain fog cleared, and she began to lose weight.
As I listened to her story, I shook my head in the affirmative, as if I knew what she was talking about. After all, I was the doctor, not her. In actuality, I had never even heard of Armour thyroid. All through medical school, residency, and after many years of medical practice, Armour thyroid had never before come across my radar screen. However, here was a teaching moment, and once again, I was the student. Somehow she tweaked my interest enough so that I looked up Armour thyroid when I got home. I learned that it is a natural product containing a balanced blend of the thyroid hormones T3 and T4. This is in contrast to the form of thyroid prescribed by most doctors called Synthroid (generic= levothyroxine), which is a synthetic product containing only T4. I also learned that contrary to popular belief in traditional medical circles, women often feel better on a combination T3/T4 product such as Armour thyroid than on Synthroid. In fact, there was a well done study published in a prestigious medical journal called The Annals of Internal Medicine in which the authors compared the combination T3/T4 regimen (similar to Armour thyroid) with the standard T4 (Synthroid) regimen used by most doctors. They measured many parameters, including quality of life and patient preference. They found that 64% of women preferred the combination T3/T4 treatment, while only 7% preferred the solo T4 (Synthroid) treatment. These results mirror the trend I have seen in my own practice, in that many patients feel better on and prefer the Armour thyroid as compared to the Synthroid.
The problem of under-active thyroid is huge, affecting approximately 10 million women in America. According to the Thyroid Foundation of America, more than half of the patients with low thyroid in America are undiagnosed. Of those who are diagnosed, many are not receiving optimal treatment.
Thyroid affects just about every part of the body. The most common symptoms of low thyroid that I see in my office are fatigue (low energy) and the inability to lose weight. Other common symptoms include constipation, depression, brain fog, anxiety, dry skin, hair loss, low body temperature, low stamina, cold intolerance, cold hands and feet, low libido, generalized aches and pains, swelling, edema, puffiness, and brittle nails. Actual diseases that may be associated with low thyroid include hardening of the arteries, generalized inflammation, cardiovascular disease, abnormal lipid levels, abnormal menstrual periods, infertility, poor pregnancy outcomes, low mood, depression, fibromyalgia, chronic fatigue syndrome, and obesity.
The standard screening test most doctors use is called a Thyroid Stimulating Hormone or TSH test. I think that it is perfectly fine to use TSH alone to screen asymptomatic patients. However, if a patient presents with a clinical picture consistent with low thyroid, such as fatigue, I feel that a more thorough evaluation is warranted. If you dig a bit deeper by getting a complete thyroid panel including a Free T3 and Reverse T3, you often find that the root cause of the symptoms is an underactive thyroid gland, even with a normal TSH. I frequently find that in such cases when the thyroid function is optimized, the patient’s symptoms improve and they feel much better. In many patients, being “low normal” is not good enough. They often get excellent relief of their symptoms, when the labs are brought up to the mid or upper range of normal. This concept is called “thyroid optimization”.
Another underutilized screening and monitoring tool is the basal body temperature. The body’s temperature often correlates with the basic metabolic rate. This is the rate at which we burn calories while at rest. One of the most important regulators of basal body temperature is thyroid function. When a person’s temperature runs low, this may be a signal that the metabolism is slow, and that the thyroid function is suboptimal.
In summary, low thyroid is an important and sometimes insidious medical problem affecting millions of Americans, especially women. The symptoms may be many and varied. Low thyroid may be associated with many disease processes, and can have a profound effect on general health and quality of life. It often goes undiagnosed and under treated. If low thyroid is suspected, a careful symptom analysis and a thorough battery of tests are needed. If indicated, the thyroid function should then be optimized. A combination medication with T3 and T4 similar Armour thyroid should be considered as a viable treatment option.
