Frat Party Becomes Zen Thyroid
By Sara Gottfried, MD & Stephanie Daniel, MS4
1. Blood Spot TSH: If your symptoms don’t match your labs, consider blood spot testing. Stephanie, my co-author and 4th year medical student, worked with Dr Richard Shames, MD, who commented that TSH is a fragile pituitary thyroid, unable to face up to the harsh reality of rough handling and waiting around in a lab. TSH degrades hourly in a tube of blood, whereas a dried spot of blood is stable for weeks to months. Degraded TSH in blood is arguably less reliably a match to your symptoms than blood spot TSH. Get yours at CanaryClub.org. If you’ve had a good experience with other blood spot tests, leave us a comment!
2. Resistance to Meds: Cells in your bod can be resistant to thyroid hormone. Two reasons: lack of adequate co-factors (iodine, copper, vitamin D as mentioned in last week’s post) or allergy (mediated by antibodies). Folks with resistance require high doses of thyroid medication to feel good. One sign of this is thyroid patients who increase their thyroid antibodies over time – this is harder to treat thread dysfunction and we want to optimize not just to labs, but to symptoms too.
3. Don’t shy away prematurely from low TSH. Many patients (and well-meaning doctors) feel TSH should be 0.3 to 2.5, or if you’re at Kaiser, 0.5-5.0. Hypothyroidism patients get started on a partial dose of thyroid medication, and their TSH drops from 5 to 2.0. Problem is many of these folks are still having symptoms such as fatigue, weight gain, hair loss, constipation. Their doc stops at that dose because of an unwarranted fear that you’ll go all hyperthyroid on them. Recall that hyperthyroid is diagnosed at TSH < 0.004. Hello, Dr-Fear-of-Hyperthyroid? Keep goin’, Babies!
4. Poor Lady’s T3. If you’re stuck with crap insurance like many of us, and your doc won’t order a free T3 because of expense – opt for a total T3. As you know, T3 is the form of active thyroid hormone. Total T3 normal range at most labs is 80-200 ng/dL, but our goal is 140-200.
5. Exam Exam Exam. When looking for signs of too much or too little medication, does your doctor examine you? While it may not always be necessary, it can help clarify whats happenin’ when labs and symptoms don’t jive. Examples: if you are not on enough thyroid medication, your Achilles tendon reflex may be slow (delayed return). Or you may have swelling around the eyes and ankles. Or your tongue may be enlarged (evidence of this is teeth indentations from resting teeth on tongue when mouth closed). Or hair loss in outer third of eyebrow. Or pokey heart rate. Too much medication manifests as tremor, fast heart rate and quick reflexes.
for Integrative Medicine
Sara Gottfried, MD
300 Lakeside Dr, Suite 202
Oakland, CA 94612
Tags: blood spot TSH, exams, frat party becomes zen thyroid by dr sara gottfried and stephanie daniel ms4, managing low TSH, poor lady's T3 test, resistance to meds, thyroid patient issues, thyroid related symptoms