Article: Janie's Thyroid Story

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Article: Janie's Thyroid Story
Janie's Story

Fatigue? Thinning hair? Weight gain?

I have been complaining to doctors for years of extreme fatigue, always feeling cold, and thinning hair. My complaints largely fell on deaf ears. Since these are the typical symptoms of hypothyroidism (low thyroid), the doctor would always test my thyroid--usually a TSH test--which always fell in the normal range.

Finally, I found a wonderful new doctor. She explained that the TSH test, while SOMETIMES a good indicator, many times is deceiving. Women can actually have low thyroid and still have a normal TSH level. When TSH is normal but symptoms still indicate low thyroid, it's also important to test the actual thyroid hormone levels--T3 and T4. When she tested mine, they were both low and my T3 was extremely low. She began treating me with Armour Thyroid. Armour is a natural thyroid hormone that contains both T3 and T4.

It has done wonders for me. I have more energy than I've had in years, I've lost 15 pounds (so far!), and my hair is starting to fill in again. I'm still colder than normal, but then my dosage still needs some tweaking.

I read everything I could and found out some interesting things. There is a tremendous amount of hypothyroidism going largely undiagnosed because doctors are still mainly relying on the incomplete picture of the TSH test. Furthermore, women using estrogen are more susceptible to thyroid problems. That probably explains why so many sisters in the Hormone Jungle have problems.

If you are suffering from typical symptoms (fatigue, weight gain, thinning hair, cold feet and hands or the inability to get warm, constipation, weight gain, or a decreased sex drive), see your doctor. Better yet find a doctor experienced in treating thyroid problems. And here are some questions you should ask your doctor:

1. What do all those "things" (TSH, T3, T4, etc.) that show up on the usual test report mean?

2. I've read that free T3 and free T4 should be tested. Should you be testing mine?

3. What should the normal ranges of these tests be?

4. If the numbers are not in the normal ranges, what do we do to get them to be normal?

5. Will you treat my symptoms if my numbers are inside the normal ranges?

These can be loaded questions and will give you the doctor's philosophy about a "normal" TSH. Does he also test for the thyroid hormones T3 and T4 if the TSH is normal? Does he believe diagnosing thyroid is a combination of lab reports and how you feel? Some doctors are known for being "numbers" people. They manage by the numbers, and not by the symptoms, which can often create the "you're in the normal range, so you're fine" response that many of us hear when we complain that we still don't feel well.

OK - one last word (Sorry, I can't help myself when I'm passionate about something!) some women (like me) seem to have a problem making the conversion from T4 to T3. That is why many women seem to do better on a T3/T4 drug like the natural Armour. Doctors still seem unwilling to prescribe it, however, thinking it is old fashioned. They prefer the synthetic T4 only drug (Synthroid) even though a recent study shows most women feel better on a T3/T4 drug.(14)

Also for us women that seem to have some trouble converting T4 to T3, according to Mary Shomon's site, we do need to add selenium to our supplements. Selenium aids in the conversion of T4 to T3. You can actually get enough selenium in 2 brazil nuts--which I eat every day. (Luckily I really like them--now if I can just find them shelled, I would be a real happy camper!!).

Best Wishes

Janie

Here's a little background on thyroid (or Trish's two cents)

I've got low thyroid too, so Janie's story is close to my heart. Thyroid replacement makes so much difference if you need it. It really is amazing after a few weeks how much better you feel.

Janie and I think that the best information on the web is at Mary Shomon's thyroid site at http://thyroid.about.com/mbody.htm

But here's the basics:

The thyroid is a gland in your neck that produces hormones controlled by the pituitary gland. The pituitary sends out Thyroid Stimulating Hormone (TSH) to tell the thyroid gland to make thyroxine or thyroid hormone, which affects heart rate, body heat, hair and skin growth, mood swings, menstrual periods, memory, and energy level (that's why you get the symptoms that Janie described when you get too little of it).

Basically, at menopause or after beginning any estrogen therapy, we all need to get tested for thyroid function. Menopause disguises the symptoms since the signs of menopause are so closely related to the symptoms of low thyroid. The real problem then goes untreated and that's not good.

Estrogen replacement, particularly estrogen in a pill, is also a problem, not because it causes the thyroid to go bad but because it shows there is a problem. A study just published in the New England Journal of Medicine found that women with healthy thyroids adjust to estrogen replacement and do fine. But women whose thyroids aren't functioning as well change from having a few symptoms that are ignorable to having a lot of symptoms and the bad effects of low thyroid. Estrogen boosts a chemical that ties up thyroid (Thyroid Hormone Binding Globulin); that's why you want the tests for "free" or "ready to use" thyroid that Janie talked about.

Androgens (testosterone, for instance) lower thyroid binding globulin so they decrease the amount of thyroid replacement we need. Testosterone replacement can actually give you the symptoms of too much thyroid.(1)

SYMPTOMS

Hypothyroidism (Low thyroid) Fatigue, exhaustion, feeling run down and sluggish, depression, unexplained or excessive weight gain, dry, coarse and/or itchy skin, dry, coarse and/or thinning hair, feeling cold, especially in the extremities, constipation, muscle cramps, hoarse or gravely voice, puffiness and swelling in the eyes and face, pains and aches in joints, hands and feet, carpal tunnel syndrome, mood changes, forgetfulness, snoring, long-lasting infections, tinnitus, dizzyness, light sensitive eyes (and the menstrual cycle is badly affected)

Hyperthyroidism (High thyroid) Nervousness, irritability, increased perspiration, thinning of your skin, fine brittle hair, muscular weakness especially involving the upper arms and thighs, shaky hands, racing heart, more frequent bowel movements, weight loss despite a good appetite, lighter flow, less frequent menstrual periods

SELENIUM AND WHY IT HELPS (plus ZINC and VITAMIN E)

The increase in thyroid problems these days may, at least in part, be related to the fact that we're getting less selenium.(12) Selenium is needed to make thyroid hormone, in particular, to make T3. When selenium is low, there are lower levels of T3 in the blood.(2, 5) Selenium is also needed to protect the thyroid gland so that it functions right.(4)

One thing that's noticeable in the studies I looked at is that they confirm Janie's experience. The selenium would be low, the T3 would be low, but the TSH was in the normal range. So that's why you need more than one kind of test!

If selenium is low (and the thyroid isn't working right), we can't fight off disease as well, (3, 10) we're more likely to have trouble with our moods, (3) and we're more likely to get arteriosclerosis because the arteries and veins get inflamed (3) and because our cholesterol goes out of whack.(11)

They think there can be even more serious consequences. When they studied people in dialysis whose kidneys aren't working right, they found that people who had low selenium and thus low T3 were more likely to die from multiorgan failure.(6) In a study of breast cancer patients, they found that both selenium and T3 was lower in the women with breast cancer.(7) Low selenium also is connected with low bone mineral density (bad for osteoporosis) and connected with thinning hair.(9)

So you see, selenium is a good thing in the Hormone Jungle.

Selenium needs natural vitamin E to work well.(13) Together, they really help with cholesterol--boosting HDL up and dropping the other types down. (11)

The problem with selenium is that too much is bad for you. It's hard to say how much you get from your diet because it depends on what kind of soil your food was raised on--and how can we tell that in the age of grocery stores? The U.S. government says that 400 mcg a day is safe. So, if you take supplements you want to stay way below that. Dr. Andrew Weil and the Natural Pharmacist site both recommend 200 mcg a day. As Janie says, you can get that from two Brazil nuts a day and then you're safe from worry about too much.

If you take anything that lowers stomach acid, you may need to think about taking even more or taking a kind that's easier to absorb: selenomethionine or high-selenium yeast (which contains selenomethionine). (13)

While I was looking around at what they knew about thyroid and selenium, I found that researchers think that the thyroid gland also needs zinc to work well. (4, 5) Since estrogen tends to use up zinc and create deficiencies, that might be another way that HRT and thyroid problems connect. Too little zinc lowers the levels of T3 and free T4 by 30%, (8) so it can make quite a difference.

THYROID TESTS

(for more information try Uthman, E. 1998. Interpretation of Lab Test Profiles. http://www.neosoft.com/~uthman/lab_test.html )

Here are some of the possible tests that your doctor might run.

TSH test (also called thyrotropin) If TSH is high, then your pituitary gland is sending out a lot of messenger signals. This shows that your thyroid is underactive (hypothyroid). It sends out a lot of messengers because it's not sensing enough T3 and T4 in the blood. TSH is useful for monitoring thyroid levels once you are under treatment, but other tests are needed to get a clear picture. The higher the number, the more more you need some thyroid replacement..

Total T4 (tetriiodotyrosine, 80% of thyroid hormone, controls metabolism) This measures the level of actual hormone in your blood. It measures both bound and free hormone, and it is more sensitive than the TSH test, showing changes sooner.

Free T4 index This measures the amount of thyroid hormone actually available for use in your cells. This is the one that Janie was talking about.

Total T3 (Triiodothyronine, 20% of thyroid hormone or thyroxine) This is the best test for hyperthyroidism (too much thyroid hormone).

Resin T3 Uptake This test is only useful with the Total T4 or Total T3 tests. It shows how much hormone is getting bound up as opposed to being produced. A high total T4 might be a result of too much hormone being produced or it might be the result of too much thyroid binding protein (like Thyroid Binding Globulin or TBG). If estrogen has increased the binding globulin, then the free hormone will be decreased and the resin T3 uptake will be decreased.

Antithyroid antibodies This tests for autoimmune diseases that affect the thyroid.

1. Arafah, Baha M. Increased need for thyroxine in women with hypothyroidism during estrogen therapy. The New England Journal of Medicine 344:1743-1749 Jun7, 2001

2. Jianhua, H., et al. 2000. Selenium influences growth via hormone status in broiler chickens. British Journal of Nutrition 84:727-732.

3. Rayman, M.P. 2000. The importance of selenium to human health. Lancet 356:233-241.

4. Arthur, J.R., and G. J. Beckett. 1999. thyroid function. British Medical Bulletin 55:658-668.

5. Ruz, M., et al. 1999. Single and multiple selenium-zinc-iodine deficiencies affect rat thyroid metabolism and ultrastructure. Journal of Nutrition 129:174-180.

6. Makropoulos, W. et al. 1997. Selenium deficiency and thyroid function in acute renal failure. Renal Failure 19:129-136.

7. Strain, J. J. et al. 1997. Thyroid hormones and selenium status in breast cancer. Nutrition and Cancer 27:48-52.

8. Kralik, A. et al. 1996. Influence of zinc and selenium deficiency on parameters relating to thyroid hormone metabolism. Hormone and Metabolic Research 28:223-226.

9. Sasaki, S. et al. 1994. Low-selenium diet, bone and articular cartilage in rats. Nutrition 10:538-543.

10. Arthur, J.R. 1991. The role of selenium in thyroid hormone metabolism. Canadian Journal of Physiology and Pharmacology 69:1648-1652.

11. Wojcicki, J. et al. 1991. Effect of selenium and vitamin E on the development of experimental atherosclerosis in rabbits. Atherosclerosis 87:9-16.

12. Arthur, JR, et al. 1990. The effects of selenium depletion and repletion on the metabolism of thyroid hormones in the rat. Journal of Inorganic Biochemistry 39:101-108.

13. "Selenium." The Natural Pharmacist. http://www.tnp.com/encyclopedia/substance/213/

14. Bunevicius, R. et al. 1999. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. New England Journal of Medicine 340:424-429. http://content.nejm.org/cgi/content/short/340/6/424

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.