Thyroid Optimization to Promote Health and Well-Being

As part of our bioidentical hormone replacement therapy (BHRT) program, we optimize the levels of many hormones that have declined with age. Among the most important, thyroid homone, is “optimized” in either of the following 2 clinical scenarios.

  • Members with clinically symptomatic hypothyroidism despite “normal,” albeit sub-optimal, thyroid levels
  • Members with previously diagnosed hypothyroidism treated with synthetic T4 monotherapy (levothyroxine, Synthroid®, or Levoxyl®) who still feel poorly due to hypothyroid symptoms resulting from a lack of T4 / T3 combination therapy

Optimizing thyroid levels is critical to your health and well-being, because thyroid hormone exerts a meaningful effect on every cell and organ in our body. Symptomatic hypothyroidism can thus present in a variety of ways, including any of the following:

  • Poor sense of well-being
  • Diminished mood or depression
  • Low energy, fatigue or lethargy
  • Cognitive changes such as “foggy headedness,” forgetfulness, or feeling less “sharp”
  • Unanticipated weight gain or difficulty losing weight
  • Feeling cold
  • Constipation
  • Hair thinning, dry skin, or brittle nails
  • Diminished exercise performance
  • Abnormalities in cholesterol and triglycerides that lead to risk of cardiovascular disease
  • Menstrual irregularities

Treatment of symptomatic hypothyroidism to improve quality of life, weight, and health will not correct without addressing the thyroid deficiency. Why?

Because thyroid hormone is the principal metabolic quarterback in our bodies and a key aspect of your health, weight, and well-being. Thyroid levels, however, begin to decline in our mid-30’s, eventually reaching a level wherein people become symptomatically hypothyroid, even before becoming technically abnormal.

Why are people undertreated even though they’re symptomatic?

A couple reasons.

First, medicine tends not to treat “normal” levels until they become abnormal, even when they’re symptomatically suboptimal.

Second, many doctors measure thyroid stimulating hormone (TSH) from the pituitary gland as a measure of clinical hypothyroidism despite the fact that most of the time, particularly when dealing with “normal” ranges, TSH is not really helpful, because it doesn’t measure the clinical or metabolic magnitude of our thyroid levels.

“TSH is a good test to measure hypothyroidism. However, TSH is a poor measure of symptoms of metabolic severity. Therefore, it is the biological effect of thyroid hormone on the peripheral tissue, and not the TSH concentration, which reflects the clinical and metabolic effects.” British Medical Journal 2003 February; Vol. 326: 325-26

“Even though the TSH is in the normal range, patients continue to have persistent symptoms despite adequate replacement doses. These patients are symptomatic due to low T3 levels.” British Medical Journal 2003 February; Vol. 326:296-96

Insead of focusing on TSH (the pituitary gland) or T4 (an inactive, hormonal precursor), we prefer to focus on optimizing levels of the active form of thyroid, T3 (triidothyronine). Why? Because patients typically feel better and optimize their health risks when T3 levels are raised to the high end of normal for a young person.

“Low levels of free T3 in patients resulted in increased disability, depression, decreased cognition, energy, and increased mortality.” Journal of the American Medical Association 2004 December Vol. 292(2c): 500-04

“Low-normal thyroid levels result in increased cholesterol, increased heart disease, fatigue, low energy, depression, and memory loss. Thyroid replacement eliminates these risks. No study has shown any harm or adverse effect of treatment.” Consultant 2000 December: 2397-99

“Thyroid levels should be raised to the upper normal range for a young person. This results in optimal cognition, memory, and cerebral function.” Journal of Gerontology 1999 Vol. 54: 109-15

Combination therapy (with T3 and T4) provides superior benefit to T4 monotherapy, particularly when raising the active form of thyroid, T3, to the high end of normal for a young person.

In contrast, replacement of T4 (Synthroid® or Levoxyl®) alone, the most commonly prescribed form of thyroid replacement, can leave patients with normal T4 and TSH levels and low normal T3 levels. Those low normal T3 levels leave the patient feeling clinically hypothyroid and lousy. High dose combination therapy with T4 and T3 typically produce symptomatic relief and noteworthy quality of life improvements.

“Combined T4 and T3 therapy resulted in symptoms, well-being and weight loss in comparison with straight T4 therapy. A decrease in weight resulted from using higher T3 levels.” Journal of Clinical Endocrinology and Metabolism 2005 May; 90(5): 2666-74

“Patients that took a combination of T4 and T3 experienced better mood, energy, concentration and memory and improved well-being. Patients on just T4 experienced no change.” New England Journal of Medicine 1999 February; 340:424-9

Optimization of T3 levels matter, however, not simply so people can increase their well-being, mood, energy, and cognition; or show improvements in hair and skin, weight, constipation, cold intolerance, or weight. Raising low T3 levels upward can improve health, too.

“Women with low-normal thyroid levels had a four fold increased risk of heart disease. The increased risk was equal to the risk of smoking and high cholesterol. Low normal thyroid hormones are a strong predictor of heart attack.” Annals of Internal Medicine 2000; 132: 270-78

“Low T3 levels are associated with increased heart disease and decreased cardiac function. Replacing T3 increases clinical performance and cardiac output. Adding T3 increases exercise tolerance and quality of life.” Cardiovascular Reviews and Reports 2002 23: 20-26

“Decreased T3 levels result in increased cholesterol and heart disease. Treating with T3 improves the lipid profile.” Preventive Cardiology 2001; 4: 179-82

“We have demonstrated that carotid intima-media thickness is independently associated with thyroid function within the normal reference range, which suggests an increased cardiovascular risk in subjects with low-normal thyroid function.” Atherosclerosis 2009: 204: 77-81

“Thyrotropin levels (T3), even those within the reference range, were linearly associated with Coronary Heart Disease morality in women. The results indicate that relatively low but clinically normal thyroid function may increase the risk of fatal Coronary Heart Disease.” Archives of Internal Medicine 2008 April 28; 168(8): 855-60

But wait a minute? Doesn’t high dose thyroid therapy and associated suppression of TSH lead to osteoporosis? No.

“Long-term high doses of thyroid had no adverse effect in causing osteoporosis or fractures.” Cortland Forum 2001 July: 85-90

“Even exceptionally high doses of thyroid do not cause osteoporosis or fractures.” Normal Metabolic Research 1995; November; 27(11): 503-7

“Long-term thyroid replacement with high doses has no significant effect in bone density or fractures.” Lancet 1992 July 4; 340(8810): 9-13

“In our study, we found significant association between low levels of T3, poor performance, and increased mortality.” Journal of the American Medical Association 2004 Vol 292 (21)

Might fibromyalgia symptoms be improved by high dose combination thyroid therapy? Yes.

“Fibromyalgia is frequently seen in hypothyroidism. There is now evidence to support that fibromyalgia may be due to thyroid hormone resistance (cellular hypo-function)..” Medical Hypotheses 2003 August; 21(2): 182-89

Discuss your hormone levels with a JumpstartMD Clinician to see whether you’re a good candidate for treatment, whether with thyroid optimization alone or with a broader “cocktail” of hormones that have declined with age.

Whatever your indication: decreased mood, energy, cognitive function, cold intolerance, constipation, unanticipated weight gain, difficulty losing weight, dry skin, hair thinning, or more, discuss your thyroid levels with your JumpstartMD Clinician. Discuss whether you would be a good candidate for combination thyroid therapy to improve your health, weight, and quality of life. If it appears you’re a good candidate for thyroid (and possibly other hormones, too), then discuss how to initiate such a treatment plan and schedule follow up labs. Results in hand, then arrange for a clinician visit to discuss whether you’ve improved your quality of life and how and whether you’ve yet achieved your therapeutic target and, if not, how to adjust further to get there.