things, including the pituitary and its re- lease of TSH, the test becomes inaccurate.
The Solution:
It has become increasingly obvious to me that information on an integrative ap- proach to diagnosing hypothyroidism needs to be provided to a wider audience. It is my main objective as a physician to help alleviate the frustration of those still suffering In my opinion, an integrative ap-
proach is a more reliably comprehensive method of determining someone's thyroid status. The main difference is that tradi- tional medicine relies on one test, the TSH. Integrative medicine takes into account TSH results, AND patient symptoms, physical exam findings, and more com- prehensive thyroid testing. I want the multitude of patients out
there who have been told that their thyroid is “normal” because the TSH is within range, to know that they are not crazy. There is a reason that they feel the way they do and more often than not, it is be- cause of hypothyroidism.
What does it really mean to be hypothyroid? The American Academy of Clinical Endocrinologists is now recognizing that a TSH level greater than 3.0 uU/ml likely signifies hypothyroidism. However, many doctors are still using the old cut off of 5.0 uU/ml. While the lower TSH number is definitely going to catch many more cases of hypothyroidism, it will still leave many patients searching for answers. Unfortu- nately, diagnosing thyroid dysfunction can be much more difficult than ordering one blood test due to the complex interactions of multiple variables. My definition for being hypothyroid is: “when a patient has multiple symptoms and physical exam findings of hypothyroidism with subopti- mal thyroid hormone levels.” Let me break down my diagnosis a
little further:
• “Patient has multiple symptoms”: lis- tening to the patient express typical symptoms of hypothyroidism.
• “and physical exam findings”: on exam the patient has findings that correlate with hypothyroidism
• “suboptimal thyroid hormone levels”: I prefer the term suboptimal as opposed
Natural Triad Magazine
to abnormal. The truth here is that there is a big difference between being normal and being optimal. Lab values can be “normal” and fall within the reference range but they may still not be “optimal” and enough to complete their job for a particular individual.
In my clinical experience, I have no-
ticed that even when a patient’s lab results are “normal”, they may still feel terrible. It is not until we optimize their thyroid functioning, that they really start to feel better. This can happen because there is a continuum between health and disease and hypothyroidism is no exception. Traditional medicine often leans to-
ward a black and white mindset -- if a patient’s labs numbers fall within a certain range, they are categorized as either nor- mal (without disease) or with disease. In many instances, this can be true. A wom- an is either pregnant or not pregnant. However, it has its pitfalls when applied indiscriminately. Hypothyroid or Not. Yes or No. Black or White. It is not always that easy.
The continuum between health and
disease when it comes to hypothyroidism is a fine line and it is different for each person. It is this grey area that requires us doctors to use our diagnostic skills to figure out the best way to manage that patient. With these things in mind, I find it to
be of greater benefit to my patients to check medical history, physical exam find- ings, and confirm with blood work to identify suboptimal thyroid levels. This way I feel I can obtain a reasonably compre- hensive perspective on a complex set of interactions that occur throughout the body at the cellular level, rather than rely- ing on a single measurement of a pituitary hormone to provide all that information. TSH measurement has value but it is wise to remember that patients are people, and there is a wide range of variability in hu- man body response and function. We physicians, as care givers, will be more effective if we take into account their unique physiology, symptoms, and physi- cal exam findings to identify thyroid dys- function.
Dr. Weston "Wiggy" Saunders is an Inte- grative and Functional Medicine Physician at Robinhood Integrative Health in Win- ston-Salem. Please call 336-768-3335 for an appointment. Facebook:
com/DrWiggy. See ad on page 24.
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