Last year, while sitting through a medical board review course for integrative medicine, an inexplicable feeling of fatigue washed over me. I had been sleeping well, yet still continuing to wake up exhausted. It was no small coincidence that the topic of discussion was the scientific evidence behind the integrative medicine approach to treating thyroid disease. You needn't have a medical background to know my symptoms were not normal. My hairdresser was watching my hair fall out by the handfuls for months, and she kept asking me about potential thyroid issues.
Have you also suffered from similar symptoms that could be related to thyroid disease? Subclinical thyroid disease and hypothyroidism are both more common in women than in men in the United States. I had gone to my primary care physician many times over the years complaining of symptoms. My thyroid stimulating hormone (TSH) levels always came back in the upper limit of normal range (around 10 mIU/L) so therefore no other tests were done. This is the problem. Often, to screen potential thyroid issues, physicians only check this one hormone level, which is created in the brain.
The serum TSH has a wide range of normal (from 4-10 IU/L), and your own TSH level's range of normal may be less than a calculated average for the entire population. According to the 2012 American Association of Clinical Endocrinology Guidelines, there are many reasons for a varying TSH level. Checking a serum TSH level is a screening test only, and not truly designed to diagnose a thyroid problem or monitor therapy. These guidelines recommend that if a patient is symptomatic, the additional two main thyroid hormones should also be checked: thyroxine (T4) and triidoothyronine (T3) or FT4 and FT3 levels.
This brings up the bigger question: Do we treat the patient or treat the lab? In medical training we are always taught to treat the patient, yet a women's subclinical thyroid symptoms can be brushed aside because the TSH levels fall into a broad category of normal. About one in 10 people with subclinical hypothyroidism may test positive for antithyroid antibodies. Elevated antibody levels occur in autoimmune thyroiditis, which may lead to a gradual loss of your thyroid gland function.
Research does not provide clear evidence to support treatment of every person who has subclinical hypothyroidism. Many doctors disagree whether this problem should even be treated. I wanted to be treated as a patient, not a lab result. This is why I decided to pursue treatment with an integrative medicine physician myself, and to no surprise found out I was that statistic: I had undiagnosed Hashimoto's thyroiditis.
Thomas Moraczewski, M.D., AFCOG is a board-certified gynecologist with additional fellowship training in hormone management from the American Academy of Anti-Aging Medicine, and he treats patients with hormone imbalances at the Center For Natural and Integrative Medicine in Orlando, Florida. "As an integrative medicine practitioner we look for root causes of hypothyroid disease. It's not enough to merely point out a low level at begin replacement hormone. We assess a patient's symptoms and rule out other hormones that can affect thyroid hormone production."
Nutrition plays a crucial role as well. In third world countries, the leading cause of low thyroid is iodine deficiency. "Though not as common in the Western world, we still see mild to severe iodine levels as measured in a simple urine test. Other important nutritional factors include zinc, vitamin D, ferritin, Vitamin A, and selenium," says Moraczewski.
How is working with a physician who specializes in integrative medicine or age-management medicine beneficial to treat potential thyroid disease? Wendy Warner, M.D., FACOG, ABIHM is a board-certified physician in gynecology and integrative holistic medicine. She is also the past president and a current active emeritus board member of the American Board of Integrative and Holistic Medicine.
"In treating patients, we don't just stop at giving them thyroid hormone replacement and some nutrients to support the thyroid. If the issue is autoimmune in nature (which it usually is), we also work to modulate the immune function in order to avoid further inflammatory damage to the thyroid gland," says Warner.
Integrative medicine physicians also focus on the patient as a whole, not just the one disease process they are diagnosed with. Dr. Warner explains, "Ultimately, working with a holistic practitioner is about seeing the patient for who they are as an individual. We put each treatment plan into the context of a person's life, a person's goals, and the person's spirit. Integrative medicine physicians keep in mind that it is the connection with our patient that will also help with the healing. We also teach our patients that their own mind-body connection will stimulate the innate healing response of which we are all capable."
When making the decision to treat subclinical hypothyroidism, you and your doctor will talk about the benefits of treatment. A physician who specializes in hormones such as a fellowship-trained endocrinologist, an integrative medicine physician, or a physician who has completed fellowship in age-management medicine will be able to assess your symptoms more thoroughly.
7 Signs That You May Have Undiagnosed Hypothyroidism:
Romila "Dr. Romie" Mushtaq, MD, ABIHM is a traditionally trained neurologist with expertise in the field of mind-body medicine. She is board certified in Integrative and Holistic Medicine. Dr. Romie helps clients connect to inner peace despite life's external chaos as a physician, professional speaker and certified life coach with her Mindful Living Program.