Hypothyroidism More Common than Previously Recognized--an Opinion
April 24, 2003—As many as 13 million Americans have undiagnosed hypothyroidism (underactive thyroid), according to a report issued by the American Association of Clinical Endocrinologists (AACE) (www.aace.com/pub/tam2003/press.php). New diagnostic guidelines issued by AACE will make it easier to identify the condition and treat it effectively. As a result, many people who have been suffering from symptoms of hypothyroidism will finally receive appropriate treatment and experience relief.
The thyroid is a gland located in the neck, just below the Adam's apple. It produces hormones that play a crucial role in the body's metabolism. Hypothyroidism can result in a wide array of symptoms, including fatigue, depression, cold hands and feet, dry skin, fluid retention, hair loss, menstrual irregularities, infertility, and elevated serum cholesterol. If left untreated, hypothyroidism can increase the risk of developing heart disease. Hypothyroidism is treated by supplementing with one or more of the hormones normally produced by the thyroid gland.
The standard diagnostic test for hypothyroidism is to measure the blood level of thyroid-stimulating hormone (TSH), a hormone produced by the pituitary gland that sends a signal to the thyroid gland to produce more thyroid hormone. When the amount of thyroid hormone circulating in the body is sufficient, the TSH level in the blood remains relatively low; however, if the body is not receiving enough thyroid hormone, the TSH level rises. For many years, doctors diagnosed hypothyroidism when the TSH level was greater than 5.0. According to the new guidelines, treatment with thyroid hormone should be considered whenever the TSH level is above 3.0. As many people have a TSH level between 3.0 and 5.0, the adoption of the new guidelines will result in more people being diagnosed with hypothyroidism.
Despite this loosening of the diagnostic criteria for hypothyroidism, I believe that many cases of the disease will still be missed. My experience, and that of a growing minority of physicians, is that blood tests are not always sensitive enough to identify hypothyroidism. In some cases, the combination of symptoms, physical-examination findings, and subnormal body temperature may be sufficient to consider initiating a careful trial of thyroid-hormone therapy.
During a 17-year period, I have treated more than 1,000 people with thyroid hormone, even though their blood tests for hypothyroidism were normal. In many of these cases, thyroid hormone was the only treatment that helped them, after they had consulted unsuccessfully with many different doctors. Symptoms and conditions that improved included chronic fatigue, depression, infertility, menstrual irregularities, hair loss, joint pains, water retention, and intolerance to cold weather. These people probably had what might be called tissue resistance to thyroid hormone, meaning that the level of thyroid hormone in their body was normal but their response to the hormone was inefficient.
At least three physicians have written books supporting the concept that clinical hypothyroidism occurs commonly in people with normal blood tests. Although the number of physicians who agree with this point of view now numbers in the thousands, the majority of doctors are unconvinced, and the issue remains controversial. The new AACE guidelines may not be the final word on how best to diagnose hypothyroidism, but they are certainly a step in the right direction.
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Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.
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