You suspect that you may have an underactive thyroid gland.  Your doctor does a simple TSH thyroid blood test.  The result is within normal range.  You are informed that your thyroid is normal and that a hypothyroid diagnosis has been ruled out.  Yet, you have symptoms typical of a low thyroid.  What do you do when your doctor suggests that it may be depression and offers an anti-depressant or advises you to do more exercise, eat and sleep better,lose weight,  and stop worrying?

     A hypothyroid patient typically experiences fatigue, a lack of stamina, a need to rest following any effort, and depressed mood.  Physically it is not unusal to have cold hands and feet, swelling in the extremities, coarse drying of the skin, thining of the hair, fragile fingernails and toenails, muscle pain with activity, and fullness in the neck.  Mentally there can be less sharp mental acuity, decreased memory, even brain fog, and low grade cognitive dysfunction.  Younger women can experience missed periods and fail to achieve an easy pregnancy and are subject to harsher menstruation pain and bleeding. On physical exam, the doctor’s use of the reflex hammer will demonstrate a weakened Achille’s tendon reflex as well as an oral temperature measurement well below 98.6F.  A greater degree of swelling is seen in the more severe case with “myedema” present not just in the extremities but trunk and face.  Loss of eyebrow hair is not unusual.  Woman are more prone to experience episodes of breast soreness.  Hypothyroidism can be underlying depression even when other physical symptoms are not present.

     A patient experiencing a number of the aforementioned symptoms has a high likelihood of having hypothyroidism and the normal TSH should not rule out the diagnosis.  Other thyroid blood tests deserve to be tested including the “free” (unbound) T3 and free T4 as well thyroid antibody studies.  Although most phsicians do not offer urine testing of thyroid hormones, a 24-hour urine measurement sometimes reveals hypothyroidism when the blood test is normal.  If all tests come out normal but the symptoms and signs appear to fit the diagnosis of hypothyroidism, the doctor could treat with low-dose thyroid to determine if there would be symptomatic improvement.  Such treatment can be monitored with further testing.  

     Thyroid treatment need not be a prescription of synthetic thyroid hormones such as Synthroid (levothyroxine) and Cytomel (lio-thyronine).  Natural thyroid hormone replacement such as Naturethroid or Armour thyroid can be employed.  Additionally some patients respond well to the use of so-called “glandular” thyroid manufactured from animal thyroid glands but lacking hormone.  Additionally thyroid treatment may benefit from the use of amino acid treatment such as with tyrosine and phenylalanine.  The thyroid is also dependent on adequate iodine which may need supplementation.  Trace minerals including selenium, zinc, and copper supplementation may also be beneficial.  For sensitive patients homeopathic thyroid support may be necessary.