Hypothyroidism can wreak havoc in your daily life with symptoms that are as persistent as they are frustrating. From relentless fatigue and unexpected weight gain to brain fog, these symptoms often creep in slowly, making them hard to pinpoint. This article is a little technical, but being informed is key if you’re dealing with hypothyroidism (underactive thyroid).
Clients taking thyroid medication often contact me for help with weight loss because, while the medication normalizes thyroid production, it doesn’t automatically lead to weight loss (thyroid hormones aren’t weight loss drugs). You’ve likely done some research and reviewed your blood results, but let’s go over the basics again. Rest assured, I can definitely help you lose weight, even with thyroid challenges.
Thyroid Hormone Function
The main effects of thyroid hormones are to:
- Increase the metabolic rate, which boosts energy production and expenditure.
- Increase protein synthesis stimulating growth and repair of tissues
- Stimulate heart function by increasing the heart rate and cardiac output
- Promote heat production in the body helping to maintain body temperature
- Enhance the nervous system activity and mood
Symptoms of Inadequate Thyroid Hormone
When the thyroid gland doesn’t produce enough thyroid hormones, the symptoms can be vague but may vary in severity and develop gradually over time:
Hypothalamus and the Pituitary Gland
Hormones are chemicals that carry messages in the blood between different parts of the body. They control many important processes and having too much or too little of a hormone can cause problems. It’s crucial to keep hormone levels balanced to maintain health. The hypothalamus and pituitary gland in the brain help control most of the body’s hormones.
Hypothalamus *releases hormones that stimulate the pituitary gland and the pituitary gland **releases hormones in response. The hypothalamus therefore controls the pituitary gland.
Thyroid Gland
The thyroid gland, located at the front of your neck, produces two important hormones: T3 and T4. T4 is the precursor hormone that gets converted into T3 in your tissues, and it’s T3 that has the more powerful impact on your body.
Dr. Mark Hyman refers to the thyroid as the ‘canary in the coal mine’ because it’s extremely sensitive to environmental toxins, stressors in our diet, and even gluten.
While both hormones are crucial, T3 is the active form that influences things like metabolism and energy levels. T4 has a much longer half-life (about 7 days) compared to T3, which only lasts about a day. This longer half-life of T4 helps keep your thyroid hormone levels stable, ensuring your body has a steady supply of thyroid hormones to work with.
Thyroid Hormone Production
The thyroid gland has small structures called follicles, where thyroid hormones are made. Iodine, which is crucial for this process, enters these follicles in the form of iodide. Inside, an enzyme changes iodide to iodine, which is needed to produce thyroid hormones. A protein called thyroglobulin helps iodine attach and form the hormones T3 and T4, which are then released into the bloodstream to help regulate metabolism.
Iodine Deficiency and Autoimmune Disorders
Iodine deficiency can lead to hypothyroidism and cause a goitre (swelling of the thyroid). In autoimmune diseases, the immune system mistakenly attacks healthy thyroid cells, and antibodies target proteins like thyroglobulin or thyroid peroxidase. For example, Hashimoto’s Thyroiditis leads to an underactive thyroid (hypothyroidism), while Graves’ Disease causes an overactive thyroid (hyperthyroidism).
Understanding Blood Results
To help understand your thyroid blood tests, here’s a quick breakdown:
| T3 & T4 | TSH | |
| Primary Hypothyroidism | Low | High |
| Secondary Hypothyroidism | Low | Low |
| Subclinical Hypothyroidism | T4 is normal | High |
| Primary Hyperthyroidism | High | Low |
| Secondary Hyperthyroidism | High | High |
Hypothyroidism and hyperthyroidism cover a wide range of conditions, from primary gland dysfunction to more complex issues within the regulatory systems (such as the pituitary or hypothalamus). Each type has unique causes, lab profiles, and treatment approaches. For hormone-related concerns, an endocrinologist is the best specialist to consult.
T3, T4 and TSH Levels
A TSH level within the normal range (0.4-2.5mU/l) excludes any significant malfunction of your thyroid gland. If the TSH level is just above the upper range of normal (above 2.5mU/L), it is possible you may develop hypothyroidism in the future.
A normal level of T3 (triiodothyronine) in adults is 79–165 nanograms per decilitre (ng/dL). However, normal ranges may vary between laboratories and are age-specific for children under 20. Low levels of T3 can make it difficult to lose weight.
A normal level of total T4 (thyroxine) in adults is between 5.0 and 12.0 μg/dL. However, many factors can affect T4 levels, including sex hormones, medications, and liver disease.
What Is Typically Prescribed for Hypothyroidism?
Levothyroxine is a generic medication that is available under different brand names, including Euthyrox. It is also a synthetic form of thyroxine (T4) and is commonly prescribed for the treatment of hypothyroidism. Levothyroxine is considered a generic equivalent to Euthyrox as it contains the same active ingredient.
Some healthcare providers recommend taking T3 (triiodothyronine) in addition to T4 for the treatment of hypothyroidism (that is, two separate pills). Liothyronine, known by the brand name Cytomel and Triostat, is the synthetic form of T3.
Research shows that as of 2023 the second most prescribed medication in the US was Levothyroxine, which remains a cornerstone of treatment globally. Specific data for South Africa is scarce.
Challenges of Thyroid Medication: Pricing, Research, and Treatment Realities
The pricing of thyroid medication seems to be increasing at an alarming rate, despite ongoing efforts by governments to hold pharmaceutical companies accountable for overcharging.
Alongside this, there’s a significant lack of reliable research on thyroid hormone therapy, making it difficult for doctors and patients to trust the available data. The quality of studies is often inconsistent, with small sample sizes and flawed results, which leaves many questions unanswered.
Another issue is that patients often feel stuck on medication indefinitely, even if it doesn’t improve their symptoms, under the misconception that thyroid medication is for life. The truth is, with medical guidance, it’s possible to stop or adjust treatment
Additionally, proper use of levothyroxine, which should be taken on an empty stomach and well before meals, is crucial. Mismanagement of this medication or taking it alongside certain supplements like iron or calcium, can lead to over- or under-treatment.
Conclusion
In summary, managing hypothyroidism or hyperthyroidism requires careful attention to both diagnosis and treatment. It’s important to reassess your condition, track progress, and provide feedback to your doctor. Blood tests may need to be repeated to avoid overtreatment and keep thyroid hormones balanced. While your endocrinologist manages your diagnosis and treatment, understanding your body and condition is essential.
If you’re frustrated with weight gain, I’m here to help! While your endocrinologist handles your thyroid care, I’ll support you with behavioural weight management and coaching. Together, we’ll address the root causes and create sustainable strategies for lasting results. Let’s work together to regain control of your thyroid health and help you feel your best.
Please note: This is research for information only and must not be taken as medical advice.
