When your blood is drawn could affect TSH level and hypothyroidism diagnosis

tsh-hypothyroidism-hashimotos-afternoon

If you check your thyroid levels in the afternoon with a blood draw, results may come back normal even though you’re hypothyroid, according to a new study. Checking your TSH in the morning can give you more accurate results.

Like other hormones in the body, thyroid-stimulating hormone (TSH) follows a daily rhythm and is not consistent throughout the day. Researchers in the study evaluated untreated patients with subclinical hypothyroidism along with patients taking a T4 hormone. They tested the participants’ TSH before 8 a.m. and again between 2 and 4 p.m.

In both groups TSH dropped substantially during the afternoon test, which would have led to hypothyroidism not being diagnosed in about 50 percent of the untreated participants.

Their TSH was 5.83 mU/L in the morning and 3.79 mIU/L in the afternoon. In the group being treated with thyroid medication TSH was 3.27 mIU/L in the morning and 2.18 mIU/L in the afternoon.

2004 study also showed that late morning, non-fasting TSH dropped 26 percent compared to early morning, fasting TSH.

Timing of TSH test adds new ammunition to thyroid range controversy

The researchers concluded that the timing of your blood draw plays an important role in how to decipher the results of your thyroid panel.

Unfortunately, even with an early morning blood draw, many hypothyroid patients still slip through the cracks because most doctors use ranges that are too wide.

It’s still very common for doctors to diagnose hypothyroidism using a TSH range of 0.5 to 5.0 mIU/L even though the American Association of Clinical Endocrinologists recommended years ago the range should be 0.3 to 3.0 mIU/L.

Functional medicine uses narrower ranges and more markers to identify hypothyroidism

In functional medicine we use an even narrower range of 1.8 to 3 mIU/L. We also know in functional medicine that looking at TSH alone can miss hypothyroidism.

For some, TSH may be normal but other thyroid markers are off. That’s why it’s important to order a thyroid panel that looks at a more complete thyroid picture, which can include total and free T4 and T3, reverse T3, free thyroxine index (FTI), T3 uptake, and thyroid binding globulins. Many conditions can cause poor thyroid function, including inflammation, hormonal imbalances, and chronic stress. Evaluating other thyroid markers gives insight into these imbalances.

Always screen for autoimmune Hashimoto’s hypothyroidism

In addition to these markers, anyone with hypothyroid symptoms should be screened for Hashimoto’s, an autoimmune disease that attacks and destroys the thyroid gland. Hashimoto’s accounts for about 90 percent of hypothyroid cases in the United States. You screen for Hashimoto’s by checking TPO and TGB antibodies.

Although thyroid medications may be necessary to maintain thyroid function, they do not address the immune system’s relentless attack against the thyroid gland. Not managing Hashimoto’s increases the risk of developing other autoimmune diseases. These can include pernicious anemia, rheumatoid arthritis, vitiligo, and Type I diabetes.

Ask my office how to properly evaluate your thyroid symptoms and lab markers for appropriate thyroid management.

 

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Baywatch beauty brings Hashimoto’s hypothyroidism out of the closet

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Talk to a group of women with Hashimoto’s hypothyroidism, and they’ll likely all share the same frustrating story. Frequently dismissed, misdiagnosed, or ignored by doctors, Hashimoto’s hypothyroidism is finally getting the recognition it deserves thanks to former Baywatch beauty and Playboy cover girl Gena Nolin.

Struggling with Hashimoto’s on the Baywatch set

Nolin struggled through marathon days on the set of Baywatch in a tiny red tank while battling symptoms of Hashimoto’s: fatigue, depression, hair loss, and weight gain. According to one interview, she gained weight despite exercising and eating very little—a salad or a can of tuna a day—and her hair became dry and brittle. Exhausted and starving, she pushed on with the help of antidepressants.

Symptoms worsened after her first two pregnancies. Doctors simply pegged her problems on postpartum depression, and prescribed her antidepressants. After her third pregnancy she suffered from arrhythmia, or irregular heartbeats, a common symptom of Hashimoto’s. She visited a couple of doctors before one finally diagnosed her with Hashimoto’s hypothyroidism, explaining the mysterious symptoms she had been battling since the age of 18. After experimenting with different thyroid hormones, she was almost symptom-free after just three days of finding the right one.

Nolin stands apart as a hypothyroid celebrity

What separates Nolin from other celebrities with hypothyroidism—Oprah Winfrey, Kelly Osbourne, Kim Cattrall, Jillian Michaels, and Mary-Louise Parker—is that Nolin uses her notoriety to speak up for the millions of Americans with hypothyroidism who are misdiagnosed or mismanaged by the health care system.

Nolin also recognizes and promotes the fact that for 90 percent of Americans, hypothyroidism is caused by an autoimmune disease, Hashimoto’s, which attacks and destroys the thyroid gland (explained in the book Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal? by Datis Kharrazian, DHSc, DC, MNeuroSci.) Nolin advocates a gluten-free diet and other natural thyroid strategies outlined in Dr. Kharrazian’s book.

Imagine if Oprah Winfrey helped hypothyroid sufferers

Imagine if Oprah Winfrey had access to the same knowledge and information when publicly discussing her thyroid condition—she could have helped millions of sufferers and advanced thyroid care in this country. Faced with patient demand, doctors would have been forced to increase their knowledge and education to offer genuine help to their patients.

Nolin reaches out for those with Hashimoto’s hypothyroidism

Online thyroid communities have warmly embraced Nolin. Her Facebook page Thyroid Sexy has almost 13,000 likes, and she posts frequently and communicates with her followers. Her post I am Hashimoto’s Disease—A letter for patients, family and friends, garnered a huge response for readers.

Nolin is the first internationally known celebrity who has made it a personal mission to bring positive awareness to thyroid disease. She is co-authoring a book about her journey and Hashimoto’s hypothyroidism with thyroid author Mary Shomon. Shomon is the author of the About.com Thyroid Disease blog, and the author of several best-selling thyroid books.

Hashimoto’s hypothyroidism can lead to more autoimmune disease

Hashimoto's-hypothyroidism-autoimmuneFailing to manage your Hashimoto’s hypothyroidism condition could lead to future autoimmune diseases. A recent study revealed that roughly one in six patients with Hashimoto’s has another autoimmune disease, most commonly:

  • atrophic gastritis, a condition in which the lining of the stomach is constantly inflamed
  • vitiligo
  • celiac disease
  • antiphospholipids syndrome, which may cause blood clots, miscarriages, or stillbirths, and
  • multiple sclerosis.

Hashimoto’s is an autoimmune disease that attacks and damages the thyroid gland, causing symptoms of hypothyroidism that include weight gain, cold hands and feet, depression, fatigue, and hair loss. In the United States, about 90 percent of hypothyroidism cases are due to Hashimoto’s.

Of the more than 1,500 patients with autoimmune thyroiditis (Hashimoto’s) who were included in the study, 16 percent were found to have an additional autoimmune disease. These patients also exhibited poor absorption of T4, chronic unexplained anemia, and recurring pregnancy losses. Thyroid hormone medication, which is the conventional treatment, may compensate for a damaged thyroid, but it does not address the underlying autoimmune condition.

Managing your Hashimoto’s hypothyroidism can prevent other autoimmune diseases

Hashimoto’s is more an autoimmune condition than a thyroid condition and must be managed accordingly. Autoimmune diseases such as Hashimoto’s hypothyroidism are evidence of an immune system that has become so imbalanced it attacks the very tissue it was designed to protect. Fortunately, research in recent years has provided us with tools we can use clinically to help restore balance and thus tame the autoimmune attacks.

Ditch the gluten

The first and perhaps most important step is removing gluten from the diet. Gluten causes a strong immune reaction in many people, and studies show a link between gluten and numerous autoimmune diseases, including Hashimoto’s. When someone with an undiagnosed gluten intolerance eats gluten regularly, it puts the immune system on constant red alert. This causes chronic inflammation and can trigger the onset of an autoimmune disease.

The autoimmune diet

Most people with an active autoimmune disease also suffer from intestinal permeability, or leaky gut, a condition in which the gut walls become damaged and overly porous. This allows undigested foods, bacteria, and other pathogens into the bloodstream, where they trigger more inflammation.

Managing an inflamed and leaky gut is foundational to taming an autoimmune disease. One of the first steps to repairing leaky gut is to temporarily follow an autoimmune diet, which eliminates foods that commonly provoke an immune reaction. Many people with Hashimoto’s hypothyroidism find they must also eliminate other foods, such as dairy or corn, in addition to gluten. In my office, we supplement this diet with select nutritional and herbal compounds that help restore the gut lining.

Sometimes these tools alone are enough to substantially reduce autoimmune flare-ups.

Going beyond the autoimmune diet may be necessary

Other times, more intensive therapy is required. This can include unwinding long-established cycles of inflammation, restoring immune balance, and/or determining whether a bacterial or viral infection, an environmental toxin, or something else is provoking the autoimmune attacks.

If you would like help addressing Hashimoto’s hypothyroidism and preventing future autoimmune diseases, please contact my office.

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Hypothyroidism during pregnancy more common than thought

pregnancy hypothyroidism Hashimoto's

A new study shows hypothyroidism during pregnancy may be more common that previously thought, thanks to new clinical guidelines for evaluating thyroid stimulating hormone (TSH). The study revealed hypothyroidism in one in six pregnant women, a 10 percent increase after using a narrower TSH range.

The new guideline for normal TSH is now 0.3 to 3.0, narrower than the former guideline of 0.5 to 5.0. In functional medicine we use a range of 1.8 to 3.0.

Gestational hypothyroidism poses a number of risks, including miscarriage, hypertension, gestational diabetes, low-birth weight, and risk for lower IQ in the baby.

Hashimoto’s hypothyroidism screening important during pregnancy

This study illustrates the importance of screening for hypothyroidism during pregnancy. Only about a quarter of the more than 500,000 women in the study were tested for TSH, meaning many more may have gone through pregnancy with an undiagnosed thyroid condition.

TSH shouldn’t be the only marker ordered. Pregnant women should also test other thyroid markers, such as T4 and T3, as well as TPO and TGB antibodies. The antibody tests determine whether the hypothyroidism stems from an autoimmune disease called Hashimoto’s, which attacks and destroys thyroid gland tissue.

Studies show about 90 percent of hypothyroidism cases in the United States are due to autoimmune Hashimoto’s hypothyroidism. Thyroid hormone medication alone does not effectively manage Hashimoto’s. Instead, appropriate thyroid care involves managing the immune system.

Hashimoto’s hypothyroidism risk to baby’s health

Although it’s always important to manage an autoimmune disease, it’s especially vital during pregnancy. Autoimmune Hashimoto’s hypothyroidism is a sign that the pregnant woman’s immune system is out of balance. It also signals a high probability of intestinal permeability, or leaky gut (which allows undigested foods and pathogens to escape into the bloodstream, where they trigger an immune reaction). People with Hashimoto’s commonly have food intolerances, particularly to gluten, and high levels of the stress hormone cortisol.

These are health conditions that can affect the fetus. Studies show that infants born to mothers with high cortisol are at higher risk of developing allergies. An intolerance to gluten or other foods can be passed on to the infant, as can immune imbalances, which can raise the risk of such disorders as asthma, eczema, and allergies.

Hypothyroidism is a red flag that the body is out of balance and that the health of the child may be compromised.

Addressing Hashimoto’s hypothyroidism during pregnancy

It’s very important to screen for hypothyroidism and Hashimoto’s during pregnancy. It’s even better to screen for it before conception.

If lab tests identify hypothyroidism, optimal health of the mother and the baby depends on restoring thyroid activity.

While thyroid hormones may be necessary, a pregnant woman also should address the underlying cause of the hypothyroidism. We can do this through lab testing, an autoimmune diet, and nutritional support appropriate for pregnancy.

Detecting hypothyroidism early can help ensure a healthier pregnancy, a healthier child, a reduced risk of postpartum depression, and more energy for the mother during the demanding post-partum period.

Heart disease is an inflammation disease

You could eat a “heart-healthy” diet, exercise regularly, and maintain a healthy weight and still be at risk for heart disease.

heart disease inflammation hypothyroidism gluten

Why? Because the root cause of heart disease is inflammation, and managing inflammation goes beyond standard prevention advice.

The whole grain diet, inflammation, and heart disease

Are you following popular guidelines by eating a whole grain diet? Opting for whole wheat bread may seem like a healthy choice; however research suggests that as many as one in five people have a gluten sensitivity.

For the gluten-intolerant person, even whole wheat products cause inflammation, increasing the risk of heart disease. In fact, more and more people are discovering that they can significantly reduce inflammation by eliminating grains all together.

Other foods—such as dairy or eggs—may also cause sensitivities and increase inflammation. An anti-inflammatory diet can help ferret out which foods increase inflammation.

Whole grains and blood sugar

A grain-based diet may also be too high in carbohydrates for some, causing blood sugar to swing dramatically between extreme highs and lows. This leads to a drop in energy, sugar and/or caffeine cravings, sleep issues, and most importantly, inflammation. High-carbohydrate diets—even those high in fibrous whole grains and legumes—can prove too inflammatory for some people. Leafy, colorful vegetables and mildly sweet fruits (such as berries) are a better choice.

Gut health and heart disease

Other causes of inflammation include: an overgrowth of harmful bacteria in the gut, poor function of the digestive organs, and gastric irritation. All play a role in increasing the risk of heart disease.

Studies suggest that the overgrowth of one strain of gastric bacteria in particular—“H. pylori”—increases the risk of heart disease. Caused by insufficient acidity in the stomach, the usually symptomless H. pylori is responsible for peptic ulcers—a condition estimated to affect many Americans.

How inflammation increases the risk of heart disease

Inflammation creates lesions on arterial walls, thus contributing to the formation of plaque within the arteries—a process known as “atherosclerosis.”  In order to quickly repair the lesions, the body “patches” them up with cholesterol. Although an effective short-term fix, this eventually leads to the creation of artery-clogging plaque, and drives up the risk of a heart attack.

Hypothyroidism and heart disease

Whenever I see high cholesterol in a patient, I immediately screen for hypothyroidism. Hypothyroidism increases triglycerides, cholesterol, and “bad” LDL cholesterol.

Most people in the U.S. with hypothyroidism have it as a result of Hashimoto’s disease—an autoimmune disease that attacks and destroys the thyroid gland. An unmanaged autoimmune condition is another factor that can lead to chronic inflammation, increasing the risk of heart disease.

The source of inflammation is different for everyone

You can see why reducing inflammation is “at the heart” of reducing your risk of heart disease, and why statin drugs do not address the root cause for most people. The source of inflammation can vary for each individual, but typically it involves evaluating one’s diet, immune health, and digestive function.

This explains why I look at more than just cholesterol when evaluating the risk of heart disease. I examine other markers on a blood chemistry panel, including fasting blood sugar, homocysteine, C-reactive protein, immune markers, and thyroid values.