Hypothyroidism is one of the most commonly-treated conditions. Patients can be of any age and can have hypothyroidism from many causes. Its symptoms can be subtle, making hypothyroidism one of the most commonly misdiagnosed conditions.

What are the symptoms of hypothyroidism?

The symptoms of hypothyroidism are complex and can mimic other diseases. Use the checklist below to see if you may have hypothyroidism.

	Symptoms		Symptoms
	Fatigue		Constipation
	Joint pains		Cold intolerance
	Muscle aches and cramps		Weight gain
	Fibromyalgia		Dry skin with little perspiration
	Memory loss		Eyelid swelling
	Mental slowness		Neck fullness
	Difficulty concentrating		Lump in throat
	Cold hands and feet		Sensitive to flu and viral colds
	Overall cold feeling		Loss of outer third of eyebrows
	Depression		Hoarse voice
	Hair loss		Weakness
	Dry hair		Lethargy
	Heavy menstrual bleeding		Poor concentration
	Eczema/hives/acne		Dry eyes
	Low blood sugar		Infertility
	Headaches or migraines		Low sex drive
	Blurry vision		Ringing in ears
	Lack of hunger		Shortness of breath
	Slow wound healing		Swollen legs
	High cholesterol		Dizziness
	Slow heartbeat		Poor heart function
	High blood pressure		Heavy menstrual bleeding
	Low blood pressure		Difficulty losing weight

Who is at the greatest risk for hypothyroidism?

While hypothyroidism can happen to anyone, some risk factors exist for the development of the disease. If you fall within one or more risk factors, it may be important to have your thyroid gland tested:

	Risks for Low Thyroid		Risks for Low thyroid
	Female gender.		Age over sixty.
	Family history of low thyroid.		History of pituitary disease.
	History of thyroid lump or biopsy.		History of fibromyalgia.
	Smoking history.		Recent pregnancy
	Family history of autoimmune disease.		History of absent, heavy or few menstrual periods.
	History of Lithium Use.		History of infertility.
	History of head or neck radiation.		Strong miscarriage history.
	History of thyroid cancer.		History of obesity.

How do you test for a low thyroid condition?

Providers of conventional medicine often order a TSH test, which is a blood test for the hormone TSH that is released by the pituitary gland in response to a need for thyroid hormones. As you’ll see later, the TSH test alone doesn’t really pick up all of the possible causes of a low thyroid condition. At the Center, we use the Short Thyroid Profile (STP), which measures the saliva for its levels of Free T4 and Free T3 (the thyroid hormones), anti-TPO antibodies and TSH. Measuring these hormones offers a much greater accuracy in detecting the presence of thyroid disease. The Free T3, in particular, measures the amount of active hormone in the cells of your body and is very effective at showing an individual’s thyroid function.

Blood Testing and Functional Ranges

Testing for a low thyroid condition in conventional medicine basically only involves a TSH evaluation. The TSH range considered to be normal depends on whether or not your healthcare provider understands the “functional ranges” for the TSH. The functional range is a better assessment of how normal the thyroid is functioning. In addition, if your provider is using the conventional ranges, he or she may not know that the American College of Pathologists changed the upper limit of TSH from 5.0 to 3.0. Even after three years, many of the laboratories have not yet changed their interpretation of the rule change.

Thyroid Stimulating Hormone: Conventional and Functional Changes

High Thyroid Conditions

Grave's Disease
Toxic Goiter
Thyrotoxicosis
Toxic multinodular goiter
Postpartum thyroiditis

Low Thyroid Conditions

Thyroid failure
Faulty pituitary
Hashimoto's
Myxedema
Toxins
Medicines

Below is an example of what you’d receive if you did a salivary STP test and had it run through the Diagnostechs Lab:

STP	Saliva Thyroid Study
Free TSH	Thyroid Stimulating hormone 41 Normal	Borderline low: 20-25 nIU/ml Normal: 26-85 nIU/ml Borderline high: 86-120
FreeT4	L thyroxine <0.1 Low	Normal 0.17-0.42nIU/dL
FreeT3	Triiodothyronine 0.15 Low	Borderline Low: 0.21-0.27 p/ml Normal: 0.28-1.10 pg/ml
Anti TPO	Thyroid microsomal Aby, SIgA Negative	Normal: Negative

The individual represented in the test above suffers from a low thyroid condition, even though the TSH is technically normal.

What are some diseases of hypothyroidism?

Hypothyroidism can come from many different sources—from failure of the pituitary gland to failure of the body to convert T4 to active Free T3. Below is a listing of the various types of hypothyroid conditions:

Primary Hypothyroidism — This is when something, a toxin or medicine, for example, attacks and destroys the thyroid tissue. Most people can think of no obvious reason for having such a low thyroid condition. Without functioning thyroid tissue, very little T4 and T3 is produced. In this situation, an individual will demonstrate an elevated TSH because the pituitary gland is continually trying to signal the thyroid gland to turn out thyroid hormone. The earliest symptoms of this disease include fatigue, always being cold, having brittle, ridged nails or thinning hair.
Secondary Hypothyroidism — The thyroid gland can “fail” in a sense, not because there is anything wrong with the gland itself, but rather because the hypothalamus or pituitary gland are damaged and aren’t sending out any signals to make thyroid hormone. The thyroid gland is ready but doesn’t know the body needs any of its hormones.
Underconversion of T4 to T3 — The thyroid gland can be making sufficient amounts of T4 but since it is relatively inactive, its conversion to T3 is crucial. Problems with the adrenal gland or the liver, particularly, can affect this conversion and result in a functionally hypothyroid state even though T4 levels are normal. A condition known as Wilson’s Syndrome involves a persistent but reversible inability to convert T4 to T3 due to stress. It isn’t very common, however.
Hashimoto’s Thyroiditis — This is an autoimmune disease like Grave’s Disease that I talked about above. Your body’s immune system becomes disorganized or confused and starts to attack and destroy the thyroid gland; however, it has one crucial difference. Persons with Hashimoto’s Thyroiditis usually create anti-thyroid peroxidase antibodies (anti-TPO) that inflame the thyroid tissue just like Grave’s Disease and the result is the transformation of healthy tissue into fibrous or scar tissue that doesn’t make thyroid hormone at all. In the beginning stages of the disease there can be a temporary elevation of thyroid hormone because as the cells break down, they release the thyroid hormone into the blood stream that was stored in those cells. This disease affects only about 3-4% of people over 30. Interestingly, Hashimoto’s Thyroiditis and Grave’s Disease cluster with other diseases such as Diabetes mellitus type 1, lupus erythematosis and rheumatoid arthritis, all of which are autoimmune diseases.

When healthcare practitioners evaluate the thyroid function, it is always a good idea to check for the presence of anti-TPO antibodies. We’ll talk more about this when we discuss the various testing strategies for thyroid conditions.

The following drawing illustrates what can happen in Grave’s disease, Hashimoto’s Thyroiditis and other autoimmune diseases that involve the body making antibodies to itself:

Adrenal Causes of Hypothyroidism — This is likely a more common cause of sluggish thyroid activity than we think. Remember that the adrenal gland produces the stress hormones called cortisol and epinephrine (adrenaline) and it does so when you are under some kind of physical or emotional stress. Elevated levels of these stress hormones block the conversion of T4 which is relatively inactive to the active form of thyroid hormone, T3. This step occurs in the liver and requires zinc, selenium and the enzyme, 5’ deiodinase. Elevations or a decline in adrenal function can occur in emotional stressors, mental stressors, blood sugar dysregulation, sympathetic overflow, physical trauma, tissue damage, inflammation and pain. If this conversion is impaired, the thyroid gland and its hormonal ability are at a less optimal level function. The thyroid function is essentially shut down. This is sometimes called thyroid resistance.

Other causes of T4 to T3 Conversion Problems — The conversion of T4 to active T3 is vital. It also depends on the available amount of bodily selenium (a trace mineral). Without enough selenium, the thyroid hormone remains in its relatively inactive (T4) state. The conversion of T4 into the active T3 will be compromised,
Receptor status problemsIn order for the thyroid hormone to act, it must bind onto the receptor sites (docking ports) of the cells it wants to work with. Many substances, estrogen being one of them, bind to the receptor sites so that the thyroid hormones have no place to park or “dock” themselves. Many of these “endocrine disruptors” are environmental toxins such as plastics, heavy metals, solvents and toxins in our packaged food, air and water. Once again, the thyroid hormones are ready to do the job but nothing happens inside the cells because the receptors are being blocked by foreign toxins or endocrine disruptors.
Myxedema — This is technically not a new type of disease but is a state sometimes seen in very severe hypothyroidism. In the absence of thyroid function, a type of gel called mucopolysaccharide gel is deposited in the tissues of the face and legs. Water is absorbed into the gel and the individual with myxedema has a puffy face and swollen, edematous legs. Myxedema is a very serious condition. Its sufferers show marked slowing of mental capacity, extreme physical fatigue and unexplained weight gain.
Endemic colloidal goiter — This is a condition of hypothyroidism caused by a lack of dietary iodine. In the United States and in coastal areas around the world, there is no lack of iodine. In the coastal areas, iodine is consumed by eating seafood and certain shore-dwelling seaweeds, particularly bladderwrack. In the US, particularly the Great Lakes Region, the amount of iodine in the soil is extremely low. For this reason, the salt we buy in the store is iodized so that we get our iodine whenever we use salt. Most of the salt and minerals in our soil has already been leeched out. Some areas of central Europe, however, have no iodine supplementation normally and they can develop this condition. This is one of the hypothyroid conditions that cause an enlarged thyroid, also called a goiter.
Idiopathic nontoxic goiter — This is a catch-all term for an enlarged thyroid gland for which there is no provable cause. Researchers speculate that environmental or food substances are the cause of this disorder. Anyone with an enlarged lump in the front of their neck needs to consider that something like idiopathic nontoxic goiter is involved.
Thyroid Removal — If the thyroid has been removed due to cancer, nodules or hyperactivity, a severe lack of thyroid hormone would occur if the thyroid hormone isn’t immediately replaced. This almost always requires thyroid replacement although I like to think we should keep the adrenal glands, the digestive system and the rest of the body’s chemistry in balance in order to support the missing thyroid gland and the chemical reactions that occur with thyroid medication. If your doctor is using a T4 and T3 combination medication such as Armour Thyroid, your body will not have to convert as much Free T4 into Free T3. This is one less step that your body has to perform to create active T3 hormone. Remember, the conversion of Free T4 into Free T3 requires selenium. Using Armour Thyroid will allow you to replenish your selenium levels if they are already low. This is especially true in cases of thyroid cancer. It’s been suggested that selenium will inhibit the growth of some types of cancers. If your thyroid has been removed, physicians will often try to keep your TSH at a very low level so that the thyroid hormones do not stimulate the cancer to reoccur.
Lymphocytic Thyroiditis — This is a rare condition where the thyroid becomes inflamed by your body’s lymphocytes, a type of immune cell that, in this case, attacks the thyroid gland.