I had the pleasure of speaking with Lisa Hunt, D.O., an integrative physician at Holtorf Medical Group (www.holtorfmed.com) in El Segundo, CA a short while ago. I polled my audience and your top thyroid-related questions are answered here by Dr. Hunt. Dr. Hunt is a board-certified integrative physician and has extensive experience in thyroid health, hormone replacement, immune dysfunction and chronic conditions.
A lot of people don’t spend much time thinking about whether their thyroid gland is functioning sufficiently, but having your thyroid hormones at optimal levels plays a key role in how your body regulates metabolism, growth and development, mood, and sleep. In fact, every cell in your body needs thyroid hormone to perform well.
That said, many thyroid patients report that it has taken years to get a diagnosis, or they struggle to find adequate care to manage their condition.
Simply put, thyroid patients are in desperate need to find doctors who test with a full thyroid panel, know optimal ranges for best results, provide individualized treatment options, and listen to symptoms with lab testing as a guide.
With my mission to help thyroid patients learn more about their condition and to help them find excellent care, I was fortunate to interview thyroid and hormone expert Lisa Hunt, D.O., of Holtorf Medical Group.
Dr. Hunt specializes in anti-aging treatment, thyroid hormone replacement, menopause/andropause therapy (including bioidentical hormone replacement), chronic fatigue syndrome, fibromyalgia, Lyme disease, strengthening the immune system, neurotransmitter analysis/replacement, and nutritional support guidance.
Dr. Hunt is board certified in both Family Medicine and Holistic and Integrative Medicine, and she brings over 20 years of experience as both a family physician and medical director. Her approach to treating thyroid disease is based on her decades of experience, open mind and experience with a variety of unique thyroid cases, and listening to patient concerns.
In this recent interview, Dr. Hunt answers my audience’s most pressing questions, and shares her approach on thyroid disease and how she has helped patients in her practice.
[Dr. Hunt]: When testing thyroid function, many doctors only test the levels of Thyroid-Stimulating Hormone (TSH). Although TSH is considered the “gold standard” test by many endocrinologists, there is no consensus on the appropriate reference range for this test.
Some endocrinologists consider any number within the reference range (it’s around .40 to 4.0 mlU/L at many U.S. labs) “normal,” and others feel that TSH must be as high as 10 mlU/L.
Therefore, the TSH test is not only unreliable due to the lack of consensus as to what the results indicate, but also because TSH is a limited analysis of thyroid function.
More specifically, this “gold standard” test neither considers Free T4 and Free T3 — the actual circulating thyroid hormones, nor the antibodies that detect autoimmune thyroid disease (such as Hashimoto’s thyroiditis).
As a result, you may have sub-normal levels of T4 and T3 (meaning, bodily systems are not receiving enough thyroid hormone), and/or antibodies that show that your thyroid gland is in self-destruct mode. Yet, if your TSH is within the reference range, the endocrinologist may say your thyroid function is “normal.”
Moreover, it is more uncommon for endocrinologists to screen for a patient’s levels of Reverse T3 (RT3). As the mirror image of T3, RT3 is responsible for keeping active thyroid hormone levels balanced and is important for overall thyroid function.
Additionally, stress, diet, inflammation, and/or chronic illness can negatively impact the conversion of the T4 thyroid hormone into T3, which can result in severe symptoms of hypothyroidism that would not be detected by a TSH test.
Thus, in order to receive an accurate picture of your thyroid health, it is best to have a full panel screening of your thyroid hormones.
I typically test the following labs in a patient’s thyroid panel while taking careful consideration into symptoms and what levels may be optimal for the individual:
[Dr. Hunt]: If your labs show a high Reverse T3 level, you may be converting most of your T4 into Reverse T3. This is problematic due to the fact that RT3 will bind to T3 receptors, but it has no bioactivity. As a result, high RT3 levels can lead to hypothyroid symptoms, despite the other thyroid hormones being in the “normal range”.
Potential causes of high RT3 include chronic dieting/starvation, nutrient deficiencies, kidney disease, adrenal dysfunction, chronic infection, and stress.
Unfortunately, due to the previously described issue of the prevalence of TSH-only testing to diagnose thyroid health (ie. not a full thyroid panel), RT3 tests are not commonly ordered.
The blood test for RT3 is controversial because there is a lack of consensus on how to interpret the results or treat the patient. Fortunately, there is an increasing amount of interest among practitioners to understand and determine the role of RT3 in thyroid disease and severe medical illnesses.
In regard to treatment, one method of addressing high RT3 is to prescribe a sustained release of T3 for two to three months.
The goal is for the negative feedback to the pituitary gland from the sustained release T3 to slow down the production of T4, which can result in a decrease in the production of RT3. Symptoms will improve with lower levels of RT3 because T3 will be able to bind unopposed to receptors.
[Dr. Hunt]: Despite popular belief, there is no one effective standard treatment for thyroid disease.
In fact, one of the most important things to understand as both a practitioner and as a patient is that each case is different and every person has individualized needs.
1.) Synthetic T4: Levothyroxine, Synthroid, and Levoxyl are some of the most common medications prescribed for hypothyroidism. Such synthetic forms of T4 are administered in hopes of normalizing patients’ thyroid hormone levels based on the assumption that the body will correctly convert T4 into T3.However, if T4 remains unconverted or is over-converted into Reverse T3, their health will not improve.
Therefore, despite its increasing popularity as a treatment method, synthetic T4-only medication may not be the best option.Multiple studies have shown that T4-only formulations are not effective for optimizing or resolving thyroid disease.More specifically, a 1995 study published in the Journal of Clinical Investigation found that reaching optimal levels of TSH and T4 using T4-only formulations did not provide necessary T3 tissue levels. This resulted in the pituitary gland exhibiting proper T4 and TSH levels, but nearly all other tissues were deficient.Moreover, this study showed that patients who converted T4 to RT3 experienced a worsening of their symptoms with the use of T4-only medications. As a result, medicating with the addition of T3 may produce better results.
2.) Synthetic T3: In contrast, T3 formulations such as Cytomel are underutilized methods of treating thyroid disease.
Patients suffering from RT3 issues and poor thyroid function can benefit greatly from preparations containing T3 in addition to T4 (even if they present with normal levels of T4 and TSH).
Providing the body with appropriate amounts of T3 can reduce the need for additional T4.
In regard to Cytomel (liothyronine sodium) specifically, it is a synthetic formulation of thyroid hormone and acts significantly quicker than Levothyroxine and other T4 medications because the T3 provided by Cytomel does not need to be converted, and it can quickly influence metabolic function throughout the body.
3.) Natural Desiccated Thyroid: Unlike synthetic formulations, Natural Desiccated Thyroid (NDT) drugs are a prescription hormone treatment derived from natural sources. These formulations are frequently derived from animals (such as the dried thyroid gland of pigs or cows).
In fact, in the United States, NDT is exclusively formulated from pigs. NDT is also known as natural thyroid, porcine thyroid, or thyroid extract. There are multiple brands of NDT including Nature-Throid, Thyroid WP, Armour, and Acella.Unfortunately, many doctors still do not see this medication option as a valid or promising method of treatment. However, many patients may greatly benefit from switching from synthetic forms of thyroid hormone to natural formulations.
That said, every case is individual.
Part of the reason NDT can be more effective for some individuals is because it closely resembles human thyroid hormones, making it easier for the body to process.
Additionally, NDT is highly customizable allowing for unique formulations of T4, T3, T2, T1 and other thyroid hormones and nutrients to be easily incorporated into the same treatment.
It is also important to note that NDT is regulated by the FDA and undergoes a rigorous quality assurance testing.
4.) Compounded Medications: As far as compounded medications, many patients benefit from a combination of T4 and T3 compounded formulations. This is in part due to the fact that a quality compound eliminates the potential of including thyroid-inhibiting substances such as lactose and gluten, which are common in many medications.
Moreover, compounded medications give physicians the ability to customize the levels of T3 and T4 contained in their prescribed medication (because they are tailor-made). As a result, patients can require the specific quantities of hormones needed for their unique situation.
It is worth noting that patients who have not done well using T4-only formulations or NDT frequently benefit from a specified compound treatment.Given the variety and complexity of both thyroid health and thyroid medication, it is best to work with a trusted doctor to figure out your individual needs as every case is unique.
[Dr. Hunt]: Certain foods and drinks can negatively impact the thyroid. Below is a general outline of what we advise our patients:
Beneficial Food and Beverages
Take Caution With These Foods and Beverages
[Dr. Hunt]: Once you and your doctor feel that your thyroid hormones are near-optimal, is advisable to have a full thyroid panel performed every 6-12 months to see if your medication needs to be adjusted.
In the meantime, if you are still experiencing symptoms of hypothyroidism or general thyroid dysfunction, it may be due to ongoing fluctuations in thyroid hormone levels. This is a sign your medication dosage needs to be adjusted and you should have testing done every 6-8 weeks until optimal.It is important to note that certain factors may skew your thyroid test results, meaning the test may not indicate a true change in your condition. Being aware of factors that can influence your results can help you get the most accurate results as possible:
[Dr. Hunt]: While the most common causes of thyroid problems are autoimmune conditions, there are steps you can take to support your thyroid and its various functions. Below are general tips that can help patients resolve their symptoms.
[Dr. Hunt]: One of the main issues in thyroid healthcare is the “gold standard” of the TSH test.
The TSH test has proven itself inaccurate, and subsequent treatment (or lack thereof) based on this single test is ineffective.
A full thyroid panel should be the standard for the baseline test of thyroid health for anyone exhibiting symptoms. The thyroid is a complex organ and every case is unique, making a full panel completely essential for proper treatment.
In regard to healthcare in general, I am a strong believer in treating the whole-person, mind, and body, for optimal results.
Everything in the body is connected. With most general medicine, organs and bodily systems are treated separately as if they operate as stand-alone systems. This often leads to suboptimal results, and patients who are still symptomatic.
Because the thyroid is involved with so many body functions, and because countless people of the general population are suffering from an unresolved thyroid condition, thyroid disease is the best case example of how a lack of integrative, holistic treatment can be problematic.
In the video below, Dr. Hunt shares how her office utilizes in-depth testing for thyroid imbalances. If you would like more information about Dr. Lisa Hunt or Holtorf Medical Group, please visit their website. Their office is currently accepting new patients. They also provide regular phone/video appointments, depending on where you are located, for the convenience of out-of-town patients with one in-person appointment per year.
Lisa Hunt, D.O. is a functional medicine practitioner at Holtorf Medical Group in El Segundo, California. She is board certified in both Family Medicine and Holistic and Integrative Medicine, and she brings over 20 years of experience as a family physician and medical director. She specializes in anti-aging treatment, thyroid hormone replacement, menopause/andropause therapy (including bioidentical hormone replacement), chronic fatigue syndrome, fibromyalgia, neurotransmitter analysis/replacement, Lyme disease, immune system strengthening, and nutritional guidance.
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