by Kent Holtorf, MD
ThyroidChange Contributor and Medical Director of Holtorf Medical Group
Those who are feeling sluggish, have difficulty thinking clearly, and seem to be incapable of losing unwanted weight may be suffering from hypothyroidism. This common thyroid disorder is not only difficult to diagnose but also challenging to treat.
Sadly, many hypothyroid patients are receiving suboptimal care in the form of T4-only treatments.
Effectively treating thyroid disease in any form requires patient-specific optimization of many different systems throughout the body. Unfortunately, much of the medical community incorrectly believes that hypothyroidism can be resolved with a standardized one-size-fits-all approach.
This has caused many patients to suffer from continued symptoms of hypothyroidism despite receiving treatment for their condition. This issue can only be resolved through increased understanding of hypothyroidism and greater awareness of the flaws inherent to standard T4-only treatments.
It accomplishes this by producing various hormones with the most notable being:
- Thyroxine (T4): the storage form of thyroid hormone that can be converted to T3
- Triiodothyronine (T3): the active form of thyroid hormone that accelerates bodily activity
- Reverse triiodothyronine (RT3): the opposite or mirrored form of T3 that helps regulate the effect of T3
Hypothyroidism is a common disorder described as a decline in thyroid activity that results in a decrease of thyroid hormone.
Poor thyroid function contributes to a slowing of numerous systems throughout the body and is typically accompanied by symptoms such as fatigue, depression, aches and pains, infertility, hair loss, and cognitive difficulties.
Hypothyroidism may be caused by a number of issues including genetic conditions, nutritional deficiencies, hormonal dysfunctions, illnesses, and more.
Experts estimate that anywhere between 10 to 40 percent of Americans suffer from undiagnosed hypothyroidism. Sadly, many of these individuals do not improve even if they receive treatment for their condition. This is most often due to reliance on ineffective T4-only approaches.
Perhaps the main reason that T4-only therapies have become the standard treatment for hypothyroidism is an over-reliance on TSH for assessing thyroid function.
Thyroid Stimulating Hormone (TSH) is the hormone responsible for triggering thyroid hormone production. Unfortunately, doctors continue to wrongfully assume that “normal” TSH levels equate to proper thyroid function and hormone values.
However, testing TSH only provides information on how well the body is communicating and not if its thyroid needs are being fulfilled. A full thyroid panel will give a much better picture of your overall thyroid status. You can order your own through LetsGetChecked.
Improving T4 levels with medication like levothyroxine can bring TSH values into the “normal” range but that does not necessarily mean thyroid is working properly.
Sadly, because of the misplaced trust in TSH values, many doctors believe that T4 medications are the only intervention needed to resolve hypothyroidism.
Because of this, hypothyroid patients frequently continue to experience symptoms of hypothyroidism despite undergoing treatment and receiving reassurance from their doctor that their condition has improved.
However, common components of hypothyroidism including conversion issues, transportation problems, and autoimmune disorders significantly reduce the efficacy of T4 treatments.
1. Conversion Issues
To maintain healthy bodily function, T4 must be converted into T3. Disruption or limitation of the conversion process results in a T3 deficit and ultimately hypothyroidism.
If a patient’s condition is caused by poor T4 to T3 conversion, the standard treatment practice of supplying the body with additional T4 provides little benefit. In fact, the addition of T4 can actually make the condition worse.
Two common causes or poor thyroid hormone conversion are chronic stress and adrenal dysfunction. If the body remains in a heightened state of stress and/or adrenal activation, conversion of T4 to T3 decreases while conversion of T4 to RT3 increases.
Therefore, in this type of situation, treatment with T4-only therapies tend to exacerbate the issue. Worse still, patients with conversion issues often exhibit “normal” TSH levels, which can lead to an incorrect diagnosis.
2. Transportation Problems
In order to influence bodily function, thyroid hormone must be delivered to the appropriate cells and tissues. There are multiple factors that may impede thyroid hormone transport including:
- Health conditions such as insulin resistance, hyperlipidemia, and diabetes
- Mood disorders including depression, anxiety, and bipolar disorder
- Chronic conditions like fibromyalgia, chronic fatigue syndrome, and leaky gut
- Neurodegenerative disorders such as Parkinson’s and Alzheimer’s
T4-only treatments do not improve hypothyroidism caused by poor hormone transportation. If the body’s ability to deliver thyroid hormone is inhibited, additional T4 will simply remain unused, which increases the risk hormone imbalances.
3. Autoimmune Disease
One of the leading causes of hypothyroidism is an autoimmune disorder known as Hashimoto’s thyroiditis. The condition causes an individual’s own immune system to attack their thyroid resulting in reduced thyroid activity.
Autoimmune thyroid disorders are notoriously difficult to diagnose and treat. It is often the case that Hashimoto’s patients being treated with T4-only medications experience minimal and at most, a temporary improvement of their condition.
In order to effectively treat hypothyroidism caused by autoimmune dysfunction, a more thorough multi-system approach must be taken. Doing so allows for individualized optimization of the multiple systems and factors involved.
It is often the case that factors of hypothyroidism such as poor conversion, limited hormone transport, and autoimmune disease are present in patients, which dramatically reduces the efficacy of T4-only medications.
Only through thorough understanding of hypothyroidism and its underlying causes can the problems of T4-only treatments be avoided and one’s condition improved.
For assistance in finding a good thyroid doctor, please visit our Find a Doctor page.
To order a thyroid panel beyond just TSH, visit LetsGetChecked. They have a user-friendly app and easy, home-kit finger prick system. Plus, it's affordable! Use code "ThyroidChange" for 20% off.
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2.Kent Holtorf, MD. “Thyroid Hormone Transport into Cellular Tissue.” Journal Compilation, AARM, DOI 10.14200/jrm.2014.3.0104
3.Kent Holtorf, MD. “Understanding Local Control of Thyroid Hormones: (Deiodinases Function and Activity).” https://www.nahypothyroidism.org/deiodinases/
4.Kent Holtorf, MD. “Diagnosis of Hypothyroidism: Are we getting what we want from TSH testing?” https://www.nahypothyroidism.org/how-accurate-is-tsh-testing/
5.Kent Holtorf, MD. “Why Doesn’t My Endocrinologist Know All of This?” https://www.nahypothyroidism.org/why-doesnt-my-doctor-know-all-of-this/
6.Kent Holtorf, MD. “Tissue and pituitary levels of T3 with T4 only preparations.” https://www.holtorfmed.com/download/thyroid-fatigue-and-weight-loss/Tissue_Levels_of_T3_with_T4_Only_Preparations.pdf
7.Fraser, W D et al. “Are biochemical tests of thyroid function of any value in monitoring patients receiving thyroxine replacement?” British medical journal (Clinical research ed.) vol. 293,6550 (1986): 808-10.
8.Kent Holtorf, MD. “Standard thyroid tests lack the accuracy to determine the proper dose of thyroid replacement.” https://www.holtorfmed.com/download/thyroid-fatigue-and-weight-loss/Standard_Thyroid_Tests_and_Proper_Thyroid_Dose.pdf