Are you tired of feeling tired all the time ? – why it could be your thyroid.

daffodilsWelcome to my March Newsletter

March usually brings breezes loud and shrill but I’m writing this newsletter looking out onto a very warm spring day, after spending the morning on the beach! Those awful months of January and February are now firmly behind us and although March can be unsettled weather wise we have much to look forward to.. the clocks go forward (hoorah!) this month and even though we lose an hour of sleep we have 210 extra hours of sunlight and that has got to be a bonus!

Before we bounce in summer I know some of you are struggling (or know someone struggling) with fatigue and odd vague symptoms so this months newsletter is on the thyroid gland. I’m seeing an abundance of people having been undiagnosed or diagnosed with hypothyroidism. Let me explain that comment in more detail later. This gland is vital to our overall health and can cause problems in all of us, men and women and at any age. When its not working properly the list of symptoms can be daunting. Last year I saw a 25 yr old woman, her parents and siblings were all hypothyroid. She had all the symptoms as well but her blood test was borderline. It took another six months for a positive test to show. By that time she was well into the symptoms of fatigue, puffy eyes and feeling the cold. If this sounds like you, a family member or friend, read on….

Why is the thyroid gland important?

The thyroid gland lies in front of the neck between the voice box and the skin. The entire gland weighs less than an ounce. Despite its small size its an extremely important organ which controls our metabolism and is responsible for the normal working of every cell in the body. It achieves this by making the hormones thyroxine (T4), and triiodothyronine (T3) and secreting them into the bloodstream. In healthy people the amounts of T3 and T4 in the blood are maintained within narrow limits by TSH which is secreted by the anterior pituitary gland. If your GP suspects that you may have an under active thyroid they will send you for a blood test. High levels of TSH mean you have an under active thyroid. You will then need to take thyroxine, and your blood will need to be monitored as its not easy getting the right amount – it’s certainly not a one size fits all situation.

The typical (but not necessarily accurate) type of person to get this condition is female, overweight and over forty. However that is too specific. I’ve seen many underweight people who have under active thyroids in their late 20’s and 30’s. If you are having trouble losing weight, feel the cold a lot and feel tired, its worth asking your GP for a test. I have listed most of the symptoms below, but the list is far longer and the symptoms can be strange and vague e.g. the fatigue has been described as “feeling drugged”. Unfortunately the thyroid blood test is notoriously unreliable as the thyroid secretions change, so you might need several tests to get a positive result. If your blood tests come out positive your GP will usually leave it a month or two and do another one just to make sure. You are measuring your TSH level and often you can be borderline and then normal several months later. There is a strong hereditary link to this condition – all my family have hypothyroidism and at the moment my results are borderline.

Woman trying to sleepWhat are the symptoms of an under active thyroid?

* Cold hands and feet * Tendency to feel the cold * Fatigue, especially in the morning* Depression * Dry Skin * Headaches * Constipation * Loss of hair * Aching in the joints * Muscle cramps in the feet at night * Swollen eyelids (especially in the morning) * Swelling of hands and feet * Heavy periods * Loss of libido * Brittle nails * Difficulty swallowing * Elevated cholesterol * Hoarseness *Low blood pressure * Inability to concentrate * Poor memory* Slow heartbeat (bradycardia) * Weight gain.

How is it diagnosed?

The conventional approach to diagnosing hypothyroidism revolves around the measurement of thyroid blood tests, primarily the TSH test. If the TSH is elevated, the pituitary gland is sensing a low thyroid hormone level in the body and TSH is being secreted in order to stimulate the thyroid gland to produce more thyroid hormone. If the TSH is normal many doctors believe that automatically rules out a hypothyroid state. The reference ranges are:

TSH normal range 0.4 – 4.5 mIU/L
TSH Hypothyroid > 4.5mIU/L

So what’s the problem with the TSH test?

There are several schools of thought regarding the validity of the TSH – this is just one of those. The TSH blood test has been the gold standard in conventional medicine for over 30 years. When TSH values fall above this range i.e. >4.5 mIU/L a diagnosis of hypothyroidism is given. When this reference range was established it included approximately 95% of the population. Therefore 5% of the population fell outside this range and therefore could be classified as having a thyroid disorder. In the Colorado Thyroid Study researchers believed that the true incidence of hypothyroidism was higher than 5%. Dr AP Weetman, professor of medicine wrote in the BMJ:

Even within the reference range of 0.5 – 4.5 mIU/L a high thyroid stimulating hormone concentration ie > 2 mIU/L was associated with an increase risk of future hypothyroidism. The simplest explanation is that thyroid disease is so common that many people predisposed to thyroid disease are included in laboratory references which raises the question whether thyroid replacement is adequate in patients with thyroid stimulating hormone levels > 2 mIU/L. The high frequency of overt and subclinical hypothyroidism observed raises another contentious issue – namely whether screening for hypothyroidism is worthwhile”.

Before you all get too excited, I did say this was one school of thought, but I do know quite a few GP’s who feel the same and feel restricted in what they can do when the test is borderline or the patients symptoms are severe. Over 30 years ago Dr Barnes wrote about the inadequacies of solely relying upon blood tests in: Hypothyroidism The Unsuspected Illness. Dr Barnes agreed that lab testing could not be the sole judge of whether there is hypothyroidism present or not. He wrote “all commonly used lab tests for thyroid function leave much to be desired. They are useful in some but not all cases, and they are no substitute for a good physicians knowledge of what thyroid deficiency can bring about and his expert clinical impression of what it may be doing in the case of an individual patient”.

There is great controversy in conventional medicine about what the normal TSH range should be set. There are many doctors and organizations who believe the upper limit of the TSH range should be lowered from 4.5 – 3.0 mIU/L. This small change may result in a doubling of the numbers of individuals diagnosed as hypothyroid. Some people may do better at a TSH of 1.0 while another may do better on 3.0. It is also important to check more than just the TSH test. T3 and T4 levels are also important. Its common to see patients who have normal T4 and TSH levels and low T3 and may therefore have the symptoms of hypothyroidism. Many people do not convert T4 to T3 and might well be hypothyroid even though the TSH falls within the normal range.

Don’t get me wrong, blood tests are important but for some conditions, we could wonder how relevant they are. So many people have clear blood tests but are still symptomatic (and this goes beyond hypothyroidism) and if its not “in their heads”, which it often isn’t then there is something else going on.

Factors that may cause inability to convert T4 to T3

Nutrient deficiencies : * Chromium * Copper * Iodine * Iron * Selenium * Zinc * Vitamin A * Vitamin B2 * Vitamin B6 * Vitamin B12. Medications: * Beta Blockers * Birth control pills * Oestrogen * Lithium * Steroids. Diet: * Soy * Cruciferous vegetables. Other: * Aging * Alcohol * Diabetes * Obesity * Stress* Surgery.

What to do next?

If you have the above symptoms and/or have a family history of hypothyroidism, go and get your TSH tested. If there is a family history, ask for T3, T4 and thyroid antibodies as well. If the test comes back borderline, discuss this with your GP in more detail and ask for another test in a few months time. In the meantime concentrate on your diet (see below) and get as much exercise as you can. Make sure you are not deficient in any of the above vitamins and minerals and get expert personalised help if you are still having problem – this can be with a nutritionist.

Diet tips for hypothyroidism

If you thought diet had nothing to do with an underactive thyroid think again: The key is adopting a diet that is rich in whole foods, including plenty of vegetables, fruits, lean meats and whole grains like brown rice, quinoa or barley instead of wheat based products. These foods typically nourish the body and provide plenty of natural vitamins and minerals.

Avoid excess sugar and refined foods. Too much sugar can cause weight gain, but especially in someone with hypothyroidism. Typically, eating too much sugar results in the body creating too much insulin. This means your body is not able to use its own fat for energy, so any carbohydrates and other molecules you eat are stored as fat, so you find it hard to shift excess weight.

Someone with hypothyroidism is much more likely to end up exhausted, fatigued and hungry for longer-periods of time when they are not eating correctly. So eat several small meals during the day instead of three larger ones. This helps maintain a steady level of energy and provides the body with a steady source of constant fuel and also helps to improve metabolism.

If you are not doing so already, begin a moderate exercise regime to boost your metabolism.

An under active thyroid may increase your risk of a heart attack, so take nutritional steps to make sure your heart is healthy. Keep an eye on your cholesterol – raised cholesterol levels can be a sign of hypothyroidism rather than an unhealthy diet and lifestyle.

image002MA17662467-0002Foods that support thyroid health

1. Seafood, like sushi and seaweed, which contain iodine to support the thyroid gland. But also fish for its essential fatty acids content (Omega 3’s) that assist with weight loss, reducing inflammation, and the production of hormones.

2. Green tea, which can help support the metabolism.

4. Lean meats and fish which contain tyrosine, thought to help boost thyroid hormone production.

5. Foods rich in selenium, a mineral that supports the thyroid and immune system for those suffering Hashimoto’s disease (an auto-immune based thyroid condition). These include brazil nuts and salmon.

6. Eat in moderation (as they can suppress the thyroid function): Broccoli, Brussels sprouts, cabbage, kale, mustard, greens, peaches, pears, radishes, spinach and turnips.

7. Eat zinc rich foods such as almonds, tofu, chicken, turkey and pumpkin seeds. iStock_trout

If you are putting on the pounds due to an underactive thyroid, it can be a tough call to lose the weight – if you would like some personalised help with this then do contact me on 01323 737814.

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