THYROID 101 T
he past couple of months we have studied normal thyroid regulation and treatment and why the TSH test may not be the best for indentifying all cases of hypothyroidism. This month I am going to be discussing an integrative approach to diagnosing hypothyroidism, which involves three things:
• Listening to the patient and their symptoms • Examining the patient, looking for specific physical exam findings • Ordering and interpreting more comprehensive thyroid blood testing
I will be explaining each of these steps in more detail but if
you are struggling with symptoms, I want you to follow along and complete the questionnaires. In doing so, you can use this article to help identify whether or not hypothyroidism may be a problem for you.
Step 1. Listen to the patient. Listening to the patient is by far the most useful part of the patient encounter. I like to start all of my new patient visits with the open ended statement, “Tell me your story.” This gives all of my patients the opportunity to express what they have been dealing with in their own words. During this time I listen care- fully for clues that would suggest a thyroid problem. I then follow up with other questions to get a clear picture of the symptoms that they are dealing with. The following questionnaire is a com- mon list of symptoms associated with hypothyroidism. It doesn’t cover the all of the symptoms, but is quite useful in figuring out if hypothyroidism may be an issue.
Thyroid Symptoms Do you feel fatigued?
Is it difficult to lose weight or are you gaining weight? Do you often feel cold? Do you have less than 1 bowel movement a day? Do you have cold hands or feet? Do you have foggy thinking or difficulty concentrating? Do you have stiff joints, plantar fasciitis or carpal tunnel? Do you notice a lot of hair loss, especially in the shower? Do you feel depressed, restless, moody, sad? Do you have a difficult time waking up in the morning? Are you prone to getting sick? Do you have decreased sex drive?
Score 1 point for each "Yes" answer. If you scored greater than or equal to 3, then you may have hypothyroidism. The higher the number the greater the likelihood. Total Score: _____
Step 2. Examine the patient A thorough physical exam is critically important in helping
to identify patients with hypothyroidism. There are specific physical exam findings that often present when a person suffers
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"Wiggy" Saunders, MD Integrative Approach to Diagnosis
from hypothyroidism. You can do your best to examine yourself and see if you identify with the findings:
Physical Exam Findings
Is your temperature < 98.6 degrees? Is hair dry or brittle? If you pull on your hair do multiple strands come out? Loss of lateral eyebrows?
Is there build up of skin in the ear canals? Is there puffiness or bags beneath your eyes? Is your tongue enlarged or does it have indentions on the sides? Are your lips, hands or feet dry and cracked? Do you notice excess skin or tissue in the front of your neck? Is your thyroid enlarged or do you feel nodules? Is your pulse rate less than 65 beats per minutes? Are your fingernails weak and brittle? Do your lower legs indent when pushed on? Is there swelling of the lower legs?
Score 1 point for each "Yes" answer. If you scored greater than or equal to 3, then you may have hypothyroidism. The higher the number the greater the likelihood. Total Score:_____
A thorough history and physical exam are probably the most important indicators in identifying hypothyroidism. If you com- pleted the questionnaires and the results indicate a strong likeli- hood of having a thyroid problem, as part of an integrative ap- proach, confirmation of these findings with blood testing is recommended.
What tests are really needed to assess thyroid functioning? Previously, I explained why the TSH test cannot definitively identify suboptimal thyroid function. In order to best assess what is really going on in the body I like to look at more comprehen- sive blood testing. These additional tests give a better idea of what is going on at the cellular level (where symptoms develop) and if there is an autoimmune component (like Hashimoto’s) involved. The tests that I recommend include: • TSH • Free T3 (Free Triiodothyronine) • Reverse T3 • Anti-Thyroglobulin antibodies • Anti-Thyroid Peroxidase antibodies.
Next month, I will be discussing the difference between “normal” levels and “optimal” levels for thyroid tests.
Dr. Weston "Wiggy" Saunders is an Integrative and Functional Medicine Physician at Robinhood Integrative Health in Winston- Salem. Please call 336-768-3335 for an appointment. Facebook:
facebook.com/DrWiggy. See ad on page 14.
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