Q: There seems to be a lot in the magazines about thyroid problems. How can I tell if I have a thyroid problem?

A: When a patient comes to the office for a physical exam, my first test is to tap on the tendon just below the kneecap to check that deep tendon reflex. If the reflex is sluggish (which means the lower leg doesn’t kick out), then I think to myself, hmmm, maybe this person has a thyroid problem.  If the patient admits to being tired, cold, constipated and having a hard time losing weight, I become more certain the thyroid could be under-functioning, also known as hypothyroid. The opposite state, hyperthyroid, also known as Graves’ disease, is much less common, and shows up with racing pulse, jittery or anxious feeling, loose stools, losing weight without dieting, disliking heat. I’ll always ask the cold, sluggish, constipated female patient about her menstrual function. If she says “heavy bleeding” then my diagnosis of hypothyroidism is nearly clinched. I’ll run lab work to confirm. Many doctors, and health-fair settings, will offer the TSH blood test to screen for hypothyroidism. This is marginally adequate. For one, the range of normal generally accepted for TSH is from 0.5 to 5.5. The higher the TSH goes, the less well the thyroid is working. I look for a TSH of 2 or less. I don’t wait for the TSH to get up to 5.5 to treat.

Hypothyroidism & Auto-immune Disease

Also, I want to know as soon as possible if this is an auto-immune thyroid disease, where your own immune system attacks the thyroid gland. To find out, I look with lab work for immune complexes against thyroid tissue, called Thyroid Peroxidase Antibodies (TPO). The TSH test alone doesn’t give information about antibodies to thyroid tissue. If TPO is positive, the diagnosis is Hashimoto’s Thyroiditis, possibly the most prevalent auto-immune disease in the US. (As an aside, fluoride was once used to treat Graves disease, and wide-spread fluoridation of our water supply may be a reason for the nearly epidemic hypothyroidism in this country.)

If your thyroid is under-functioning because of this auto-immune disease, not only does your thyroid gland need support, but you need to reduce inflammation and unnecessary immune reactions. The immune system kicks in when a foreign particle (virus, bad bacteria, bad fungus, indigestible food, etc.) enters the bloodstream. This immune response is a good thing, mostly, but not when you have an auto-immune disease. Because when you have an auto-immune disease, the immune system thinks parts of your own tissue is foreign — the thyroid gland in the case of Hashimoto’s, or the pancreas in diabetes, or protective sheath around your nerves in MS, or the fluid protecting the small joints in your hands in Rheumatoid arthritis. Therefore, if you have an auto-immune disease (and if your thyroid is under-functioning, it is likely you DO have Hashimoto’s), you must learn how to minimize provoking an immune response. You can’t avoid airborne viruses, nor avoid pathogens carried home by your children, or lurking on co-workers returning from travel. However, you can try to stay as healthy as possible with appropriate immune tonics, plenty of Vitamin C, plenty of clean water, adequate rest, and zero sugar.

Thyroid Malfunction & Diet

You can also, and this is important, avoid foods that your body doesn’t recognize as good nutrition for you, because if the digestive system can’t handle it, then the immune system will have to kick in. The immune system’s workhorses are the white blood cells, which dump packets of enzymes (lysosomes) onto foreign material in the bloodstream. The digestive system has similar enzymes, as well as saliva, stomach acid, bile and pancreatic juices, to digest food. However, some food doesn’t register as good nutrition in our bodies. We need to sort out for ourselves which foods are handled by the digestive system, and which are not — because it’s a waste of the immune system to use those specialized enzymes to digest food. The single most effective method of starting to determine which foods work and don’t work for your body is the blood-type system (see Eat Right for your Type by Dr. Peter D’Adamo). For example, blood-type O’s don’t do well with grains (especially not wheat) and need plenty of protein for optimal health. A’s don’t do well with red meat or dairy foods but do great with fish, a variety of grains, and plenty of vegetables. B’s need to avoid chicken, corn and soy products, but are the only blood-type that thrives on dairy products. Please check the book or website (ER4YT.com) for details. The bottom line: don’t eat food that will trigger an immune response. This is true even if you don’t have an auto-immune disease, because your immune currency is finite — you want to keep it in your savings account whenever possible. With just slightly reduced thyroid function, I advise patients to start therapy by increasing high iodine foods in their diet, such as fish (not farmed!) and sea vegetables. Not used to eating hijiki, dulse, kombu, or nori? Check them out! They are delicious soaked and put in any salad, or cooked into bean dishes. Speaking of bean dishes, soy products can BLOCK iodine uptake into the thyroid gland, and should be consumed sparingly by those with low thyroid function.

Treatments

If your thyroid problem is auto-immune,  but ask your doctor to find an appropriate  thyroid replacement (I prefer glandular products like Westthroid, Naturethroid, Armour Thyroid over synthetics like Synthroid, Cytomel, or Thyrolar.)  Armour, the original glandular therapy (first gleaned in the meat packing plants of Omaha Nebraska) is an old-fashioned medicine that offers combined T3/T4 (similar to the blend produced by a normally functioning thyroid gland) derived from dessicated beef or pig thyroid tissue, standardized to contain specific amounts of hormone. The thyroid hormones are simply a cluster of iodine molecules (3 iodine molecules make T3 — the active hormone — and 4 iodine molecules make T4 — the storage form).  In general, the combination of T3 plus T4 usually works better, and requires lower dosing, than T4 (levothyroxine) alone.  Rarely a patient will get spikes in thyroid antibodies (TPO) on the glandular products, but these are usually temporary and somewhat random.  The best way to reduce auto-antibodies is to control the thyroid deficit with appropriate support.