A Few Things I Wish More Doctors Knew About Thyroid Treatment

Hello everyone,

Today I want to tell you a few more things I wish more doctors knew about thyroid. These “pearls”, so to speak, are bits of the knowledge I use in my practice to help people get better results from their thyroid treatment.

A big thing I wish more doctors knew about thyroid is that the “normal ranges” that are reported from the lab for thyroid hormone tests are way too wide. They were probably calculated by including a good number of people who were ”normal” but didn’t even realize they had thyroid symptoms. There’s a fairly tight range that I consider “ideal” level for Free T4 and for Free T3, which are the two thyroid hormones you need in order to feel well. And they need to be in balance, and in those ideal ranges or you probably won’t feel well. We already talked in the previous post about TSH (the brain chemical that drives your thyroid to make hormones), and how it can be high, low, or in between and you can still have not enough or not the right balance of thyroid hormones to feel well. The only way to know is to test both FreeT3 and FreeT4. There are other tests that are also crucial to have balanced thyroid function but they are a topic for a whole other blog post.

Another thing is, doctors have been taught in the past that thyroid levels don’t fluctuate much. But this is not true for people taking thyroid medications. Because the pills are free hormones and not stored in the thyroid gland, these blood levels can fluctuate greatly through the day and night, particularly if you take thyroid medicine once a day as most doctors recommend. They will be really high starting about an hour after you take your medications, to really low right before you take it. Doctors call this cycle a peak and trough. And you might feel fine at a certain point in that cycle, but bad the rest of the time, because of how much the levels fluctuate.

If you go to the lab each time at different or random times throughout the day, your numbers may look too high or too low due to where you are on that cycle. This may cause your doctor to change your dose, even when you are feeling OK, or tell you everything’s fine, even when you are not. If this is you, try two things: 

1. Break your thyroid pill in half and take half in the morning and a half in the afternoon, exactly twelve hours apart, and at exactly the same times each day. This helps even out the highs and lows in the blood levels, which makes most people feel much better.
   
   
2. Always get your lab drawn at exactly the same time of day, every time you do it. This may cause some inconvenience, but it is so helpful. Also, if you forgot a dose of medicine at any time in the 3 days prior to the lab draw, put it off until you have it right. In my clinic, I ask patients to always get the lab draw done exactly halfway between the morning and afternoon doses, generally about 1 pm for most people. If things still don’t feel right after doing this, then you need to get evaluated by someone who is really knowledgeable about thyroid management.

 
And finally, let’s talk about extreme or prolonged stress - elevated ACTH (the brain chemical that signals your body to make more stress hormones), suppresses TSH and therefore suppresses thyroid function (it’s like your body is going into hibernation.) This is because your body can’t tell the difference between a calorie-restricted diet and actual starvation, or between being stressed out because of a stressful job or home life,  from an extreme illness or injury where it needs to conserve energy or die. Which, if you aren’t actually sick or injured or starving, makes it even harder to manage your life, because it adds chronic exhaustion to the list of things causing you to be stressed out. 

There are more ways that chronic stress harms or dysregulates thyroid function as well. Some of them are beyond the scope of a blog post but suffice to say if you’re having symptoms of low thyroid and stress, it is likely that your thyroid is not working well even if your labs look pretty good. There ARE things that can be done to fix this, that we can address in a future post.

If you’re a physician reading this and want to know even more, check out the course I sponsor on Integrative Endocrinology techniques that can help some of your most difficult patients with thyroid, adrenal, and other endocrine abnormalities. https://www.allergyaccessmd.com, and look for the courses tab. There are also some links there to other free resources that I recommend.

I'm Dr. Dana Gibbs, encouraging you to take charge of your hormonal health. For more tips and updates, sign up for my newsletter at https://www.danagibbsmd.com/email-list-form. If you're in North Texas and struggling with thyroid or chronic fatigue issues, visit https://www.danagibbsmd.com/cim-medical for a new patient evaluation.