January is\u00a0Thyroid Awareness Month,\u00a0which calls attention to the various health problems connected to the thyroid.\u00a0Most of us have heard about the thyroid gland, but may not realize its importance\u00a0and\u00a0associated symptoms.\u00a0 This month\u00a0is dedicated to talking about thyroid illnesses\u2013 and why it’s often misdiagnosed!<\/p>\n
By sharing information about thyroid diseases, we hope to\u00a0educate our patients and encourage them to visit us for a simple blood test to determine if treatment is\u00a0needed. \u00a0Without further ado, here is Seaside’s founder,\u00a0Dr. Yazdani with her thoughts on the mystery of the thyroid.<\/p>\n
THE THYROID ENIGMA\u00a0<\/strong><\/p>\n Sitting in a lecture hall at USC’s Thyroid Symposium shortly before the pandemic when lecture halls existed, I’ll never forget the glance shared between the doctor in the next chair over and I when we heard the speaker say, “You don\u2019t need to treat TSH unless it\u2019s above 8.”\u00a0 Then the following speaker presented data from a double-blind randomized controlled study, the gold standard in medical sciences,\u00a0confirmed that TSH readings don\u2019t correlate\u00a0with a person\u2019s clinical hypothyroid symptoms.\u00a0 Another mind-blowing fact we couldn\u2019t wrap our heads around when all along we\u2019ve been treating thyroid disorders based on clinical symptoms and TSH values. It was this moment that solidified for me, the ever present enigma of the thyroid.<\/p>\n It should be way more simple, this walnut weighted, butterfly shaped endocrine organ that nestles low on the cricoid cartilage of the neck and only spews out 3 hormones, T3, T4 and calcitonin using a handful of elements such as iodine, selenium and tyrosine. \u00a0 While the thyroid seems straightforward, its complexity likely stems from its reliance on tissues to decide the degree to\u00a0which thyroid hormones are processed at the organ level, as well as thyroid’s\u00a0intricate involvement with the hypothalamus-pituitary axis.\u00a0 More often than we\u2019d like to believe, this mysterious organ evades the smartest clinician\u2019s judgement leaving us\u00a0perplexed, wondering\u00a0like that\u00a0instance in the lecture hall, “When will we ever figure you out?”\u00a0<\/em><\/p>\n Here’s a brief synopsis of what we do know about the thyroid:<\/b><\/p>\n Thyroid hormones thyroxine (T4) and triiodothyronine (T3) are essentially a cluster of iodine molecules woven around the amino acid tyrosine. \u00a0 Almost all but a small percentage of circulating hormone is tightly bound by storage proteins.\u00a0 Only when they reach their sites of action do the hormones unbind and get to work on gene expression.\u00a0 Thyroid hormone receptors have a higher affinity to T3 than T4, and it\u2019s the targeted organs and tissues that convert T4 with deiodinase family of enzymes, to the more potent activator T3 by deiodination (removing iodine particle).\u00a0 This allows the tissues to decide how much activation is needed in real time.\u00a0 And it’s also the site of regulation by many factors such as other hormones, caloric intake, inflammation, drugs\/toxins, etc.\u00a0\u00a0The liver and kidney are the major converters of T4 to T3, therefore kidney and liver dysfunction also play a critical role in thyroid homeostasis.\u00a0 Organs turn off thyroid activity by converting T3 to its inactive form, reverse T3.<\/p>\n <\/p>\n Thyroid hormone’s affect on metabolism:\u00a0<\/b><\/p>\n In the heart, thyroid hormones increase heart rate and cardiac output. In the lung, it increases oxygenation. \u00a0\u00a0In various tissues, thyroid hormones increase gene expression of Na+\/K+ ATPase to increase oxygen consumption, respiration rate and body temperature all leading to increase basal metabolic rate.<\/p>\n Thyroid hormones melt fat, burn carbohydrates and breakdown proteins. \u00a0In children, thyroid hormones work with growth hormones to stimulate bone growth and stimulate brain maturation.<\/p>\n Calcitonin, helps regulate calcium metabolism in the body.<\/p>\n <\/p>\n Control of\u00a0thyroid secretion:\u00a0<\/b><\/p>\n The brain controls the thyroid gland by releasing thyrotropin-releasing hormone (TRH) which stimulates release of thyroid-stimulating hormone (TSH) from the pituitary gland, that then triggers increased production of T4.\u00a0 This axis tightly controls itself by a negative feedback loop where T4\/T3 suppress TRH and TSH.<\/p>\n The labs:<\/b><\/p>\n The laboratory tests that detect thyroid status are TSH, as well as T4 and T3 in unbound form.\u00a0 There are also total T4, total T3, reverse T3 and a host of autoantibodies we use to diagnose dysfunction.<\/p>\n Factors that affect conversion of thyroid hormone to active form or accelerate conversion to reverse T3:<\/b><\/p>\n Stress, age, smoking, inflammation, trauma, fasting, vitamin D deficiency, iodine deficiency or excess, selenium deficiency, prolonged shift work, cirrhosis, kidney disease, drugs, and infection.\u00a0 Environmental toxins such as PCB\u2019s in plastic or flame retardants containing bromide may also negatively impact thyroid function.<\/p>\n The Symptoms:\u00a0<\/b><\/p>\n When the TSH is high and free T4 is low, this suggests low thyroid state, or hypothyroidism (common form Hashimoto\u2019s)<\/b>.<\/p>\n Think slow and cold – cold hands and feet<\/p>\n Slow gut transit – constipation<\/p>\n Slow metabolic rate – weight gain<\/p>\n Slow brain function – depression and fatigue<\/p>\n Slow clearance of complex molecules from skin – edema and hair loss.<\/p>\n When TSH is low and free T4 is high, this indicates hyperthyroidism (common form is Grave\u2019s Disease)<\/b><\/p>\n Think fast and warm – sweaty palms and jitteriness<\/p>\n Rapid heart rate<\/p>\n Rapid metabolism – weight loss<\/p>\n Rapid gut transit – diarrhea<\/p>\n Above is a very basic view of pathology arising from the thyroid.\u00a0 Rarely, is it ever this straightforward.\u00a0 For example, in the case of hypothyroidism, we\u2019ve held fast to the notion of a one size fits all approach with supplementation of T4 alone.\u00a0 We\u2019re learning now about polymorphisms in expression of deiodinase enzyme activity that prevents affected individuals from converting T4 to its active form T3, and that these patients would benefit from a T4\/T3 combination regimen.\u00a0 We have learned that TSH has a diurnal secretion, challenging interpretation in patients with severe sleep disorders or night shift workers.<\/p>\n We have seen from elaborate trials on thousands of patients, that symptoms of hypothyroidism have little correlation with actual TSH lab values.\u00a0 Even TSH lab itself has come under scrutiny for its unreliability, not to mention how endocrinologists can\u2019t seem to agree on a standardized approach to lab monitoring of patients on thyroid hormone.\u00a0 Some use TSH without T4 or T3, some use TSH with free T4 but not T3, and some look at total T3 but not free.<\/p>\n To add to the confusion, we have the Almighty\u00a0search engines that\u00a0offer patients an array of misinformation that attribute\u00a0their\u00a0fatigue, weight gain or mental fog to low thyroid hormone, and\u00a0encourage them to demand thyroid supplementation from their provider even when labs are within normal range.\u00a0The fringes of medicine specialties have catapulted this phenomenon with coining terms such as relative TSH abnormalities, and prescribing thyroid hormones and excess iodine to many of their followers.\u00a0 I once came across a self-claimed health guru who developed a habit of prescribing massive amounts of active T3 hormone, having patients take it every 6 hours to prevent the crash that naturally would ensue from high intake.\u00a0 And more recently, I encountered a patient who was thrown into a transient state of menopause by excessive administration of iodine on the advice of her health coach. \u00a0 With all its feedback loops and layers of protection against chaos, the thyroid gland is extremely vulnerable to changes in the environment and stressors within the body.\u00a0 Not knowing how to interpret test results in the context of a patient\u2019s clinical status can lead to disastrous outcomes.<\/p>\n Meanwhile,\u00a0the commanding organizations such as\u00a0American Thyroid Association and European Thyroid Association advise against treatment of hypothyroidism until TSH levels are above 10 mIU\/L, unless there are overt clinical symptoms.\u00a0 In complete opposition to their guidelines,\u00a0primary care providers by in large are initiating\u00a0hormone replacement when TSH levels fall outside of normal reference range which is closer to\u00a04-4.5 mIU\/L, because we rarely see patients without corresponding symptoms when TSH approaches\u00a04 mIU\/L, let alone 10.\u00a0 The disconnect is profound placing the burden of proof among the societies to defend their guidelines and challenge the medical and non-medical’s community\u2019s will to treat.<\/p>\n In my opinion,\u00a0thyroid hormone in small doses generally does make us feel better, at least temporarily but long term may not be beneficial when true disease doesn\u2019t exist. We offer micro-dosing\u00a0in weight loss medicine to drive metabolism in our favor.\u00a0 I also treat elevated TSH bordering abnormal in a symptomatic patient with iodine, selenium and zinc, and at times with thyroid medication.\u00a0 In pregnant patients or pre pregnancy planning, we treat subclinical hypothyroidism, because low thyroid state in early fetal development leads to detrimental outcomes.<\/p>\n The important step in managing a thyroid patient is close monitoring of symptoms and labs after supplementation and taking into consideration lifestyle, diet and interaction with other drugs.<\/p>\n A humble disposition to thyroid\u2019s curveballs is really the only steadfast approach I\u2019ve held on to over the years in the management of my patients with thyroid illness.\u00a0 I look forward to the bountiful\u00a0research and expanding science in the field of thyroid illness, to further our limited understanding of this simply complex and marvelous organ.<\/p>\n In good health and wellbeing,<\/em><\/p>\n Yazdani, MD<\/p>\n <\/p>\n “Curious about thyroid disease? Give us a call today to schedule an appointment.” <\/strong><\/p>\n – Nasimeh Yazdani, M.D.<\/strong><\/p>\n <\/p>\n References\u00a0<\/strong><\/p>\n American Thyroid Association<\/p>\n European Thyroid Association<\/p>\n UPTODATE<\/p>\n Salman Razvi,et al.\u00a0 Results in the Diagnosis and Thyroid Dysfunction, Journal of Thyroid Research, VOL 2019<\/p>\n Challenges in Interpreting Thyroid Stimulating Hormone Results in the Diagnosis of Thyroid Dysfunction<\/p>\n Salman Razvi<\/b>,1<\/sup> Sindeep Bhana,2<\/sup> and Sanaa Mrabeti3<\/sup><\/p>\n Physiology, Thyroid Hormone<\/b><\/p>\n Shahid MA1<\/sup><\/b><\/a>, Ashraf MA2<\/sup><\/b><\/a>, Sharma S3<\/sup><\/b><\/a><\/p>\n Variation in the biochemical response to\u00a0l-thyroxine therapy and relationship with peripheral thyroid hormone conversion efficiency\u00a0<\/span>in\u00a0Endocrine Connections<\/a> Eur Thyroid J 2013;2:215\u2013228\u00a0\u00a0ETA Guideline: Management of Subclinical Hypothyroidism Simon H.S. Pearce a, b Georg Brabant c Leonidas H. Duntas d Fabio Monzani e Robin P. Peeters f Salman Razvi a, g Jean-Louis Wemeau<\/p>\n","protected":false},"excerpt":{"rendered":" January is\u00a0Thyroid Awareness Month,\u00a0which calls attention to the various health problems connected to the thyroid.\u00a0Most of us have heard about the thyroid gland, but may not realize its importance\u00a0and\u00a0associated symptoms.\u00a0 This month\u00a0is dedicated to talking about thyroid illnesses\u2013 and why it’s often misdiagnosed! By sharing information about thyroid diseases, we hope to\u00a0educate our patients and […]<\/p>\n","protected":false},"author":1,"featured_media":25780,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"none","_seopress_titles_title":"The Thyroid Enigma - Find Symptoms & Treatment Here!","_seopress_titles_desc":"In this article, you can read a detailed analysis of the Thyroid Enigma. Discover symptoms & treatments of the Thyroid Enigma at Seaside Medical Practice.","_seopress_robots_index":"","_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-18312","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/posts\/18312","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/comments?post=18312"}],"version-history":[{"count":1,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/posts\/18312\/revisions"}],"predecessor-version":[{"id":25782,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/posts\/18312\/revisions\/25782"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/media\/25780"}],"wp:attachment":[{"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/media?parent=18312"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/categories?post=18312"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.seasidemedicalpractice.com\/dev\/wp-json\/wp\/v2\/tags?post=18312"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nJohn E M Midgley<\/a>,\u00a0Rolf Larisch<\/a>1<\/a>,\u00a0Johannes W Dietrich<\/a>1<\/a>, and\u00a0Rudolf Hoermann<\/a>1<\/a>
\nVolume\/Issue:\u00a0<\/b>Volume 4: Issue 4<\/a>
\nPage Range:\u00a0196\u2013205<\/p>\n