Fatigue, Thyroid Function and Hypothyroidism

Hypothyroidism is a serious condition found in people with and without food allergies. However, people with food allergies, particularly those with celiac disease (a gluten allergy), frequently suffer from hypothyroidism. 
Hypothyroidism causes fatigue and weight gain as well as other problems, and is often overlooked and misdiagnosed due to complexities in thyroid testing and symptoms which may overlap or contradict the symptoms of food allergies. These issues are discussed in this article. 

What Is the Thyroid Gland?
What Are the Symptoms of Hypothyroidism?
How Is Hypothyroidism Typically Diagnosed?
Why Does Hypothyroidism Frequently Go Undiagnosed?
What Is the Current Standard for Determining Hypothyroidism?
Autoimmune Hypothyroidism and Hashimoto's Thyroiditis
What Thyroid Tests Should Be Run?
How Is Hypothyroidism Treated?
Hypothyroid Case Studies

What Is the Thyroid Gland?
The thyroid gland sits in the neck in front of and on both sides of the trachea and secretes thyroid hormones. These hormones regulate metabolism and thus affect many aspects of health. 

What Are the Symptoms of Hypothyroidism? 
Lack of adequate thyroid hormone production may result in one or more of the following symptoms: fatigue, weight gain, constipation, cold extremities, inability to focus, forgetfulness, dry skin and depression. 

How Is Hypothyroidism Typically Diagnosed? 
Most physicians measure thyroid function not by testing thyroid hormones, but by testing levels of TSH. TSH stands for Thyroid Stimulating Hormone. TSH is produced by the pituitary gland and stimulates the thyroid gland to produce thyroid hormones. 
As thyroid hormone production drops, TSH levels are supposed to automatically increase to compensate for low thyroid hormone levels. Therefore a higher than normal TSH level indicates a hypothyroid condition. 

Why Does Hypothyroidism Frequently Go Undiagnosed? 
Unfortunately, TSH doesn’t always respond correctly to low thyroid hormone levels. If the actual thyroid hormones themselves (called T4 and T3) are not checked, hypothyroidism can be missed. I’ve seen several cases of hypothyroidism with low thyroid hormone production and a normal TSH level. 
Also, most physicians are using old data and a normal reference range that is too large when determining whether or not the TSH level is normal. This means that many people are being told that they have a normal thyroid when, according to the latest scientific standards, they are actually hypothyroid. 

What Is the Current Standard for Determining Hypothyroidism?
The American Association of Clinical Endocrinologists recommends that the normal reference range for TSH be reduced by nearly half, down to 0.50-2.50. The old range is 0.50-5.00. (The higher the number, the more hypothyroid you are.) This means that thousands of people are being misdiagnosed and are actually hypothyroid. Unfortunately, most physicians have been slow in adopting these new standards and many people continue to be misdiagnosed.

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Autoimmune Hypothyroidism and Hashimoto's Thyroiditis 
Many hypothyroid conditions are caused by an autoimmune reaction that attacks the thyroid gland. One of the most important of these is called Hashimoto’s Thyroiditis. 

What Thyroid Tests Should Be Run?
An initial evaluation of thyroid function must include not only TSH, but thyroid hormones as well. Whenever there is a diagnosis of hypothyroidism, or when the TSH level fluctuates, it is also important that autoimmune thyroid antibodies be measured. This is especially true for people with food allergies, since there is a higher association of autoimmune hypothyroidism in these people. 

How Is Hypothyroidism Treated?
Once the problem is properly diagnosed it is relatively simple to correct with thyroid hormone replacement. However, it is important to have thyroid levels monitored regularly to make sure that the prescribed dosage is correct. This is particularly true in people with autoimmune thyroid conditions and those with newly diagnosed food allergies, as their thyroid levels are susceptible to frequent swings.

If you are concerned about the possibility of having hypothyroidism or are wondering about the interpretation of previous lab results, please call my office at 206-264-1111 to schedule an appointment for a thorough evaluation of your thyroid function.

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Hypothyroid Case Studies
Case #1: 30 year old woman with complaints of fatigue, weight gain and forgetfulness. These had become progressively worse over the last 2 years. Patient was previously told that her thyroid was normal. Retesting demonstrated that she was in fact suffering from hypothyroidism. Treatment with thyroid hormone completely solved her energy shortage resulting in weight loss and much better cognitive function. 

Case #2: 40 year old man with fatigue, weight gain and constipation. This patient complained of feeling very sluggish. Testing showed that he had a hypothyroid condition. Treatment with thyroid hormones quickly turned around his fatigue, resolved the constipation and made it possible for him to lose weight. 

Case #3: 51 year old woman (M.M.) diagnosed with hypothyroidism 2 years ago and recently diagnosed with celiac disease. TSH testing showed fluctuating thyroid levels for over 2 years, resulting in repeated changes in dosage of thyroid medication. More recent testing demonstrated high autoimmune thyroid antibodies, explaining the fluctuations in thyroid levels. This patient continued to experience abdominal pain, nausea and weight loss until the celiac disease was diagnosed. Avoidance of gluten may stabilize thyroid problem. 

Case #4: 35 year old man (N.P.) diagnosed with celiac disease approximately 2.5 years ago. He was very tired and had trouble focusing and remembering. He was also approximately 50 pounds overweight. Lab tests revealed significant hypothyroidism and very high thyroid antibodies. Thyroid medication has quickly begun to restore this patients energy and clarity of thought and he is doing much better. 

Case #5: 70 year old woman (M.K.) diagnosed with hypothyroidism 4 yrs. ago. Finally diagnosed with celiac disease in 2003. She continued to experience many problems, (including fatigue, weight loss, and diarrhea) until both problems were diagnosed and properly treated. 

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