If you’ve been reading this blog for a while, you might be surprised by the title of this post. I’ve been critical of pharmaceutical approaches in the past, and in general, I recommend avoiding the use of medication whenever possible.
However, I have no problem with pharmaceuticals if:
- they work,
- they do more good than harm, and;
- there are no non-drug alternatives with the same effect.
It turns out that thyroid medication meets these criteria in cases of hypothyroidism with chronically elevated TSH. Elevated TSH indicates that the body is not producing enough thyroid hormone to meet metabolic needs. And thyroid hormone is so important to the proper function of the body that the benefits of replacing it far outweigh any potential side effects of the medication.
Remember that every cell in the body has receptor sites for thyroid hormone. Thyroid hormones are responsible for the most basic and fundamental aspect of physiology: the basal metabolic rate. Since the basal metabolic rate affects every system of the body, low thyroid hormone causes a global decline in cellular function.
Here’s a list of things that can go wrong when thyroid hormones are low. It’s not complete, but it should give you some idea of how important the thyroid is to proper function.
- Decreased energy production and metabolism in all cells of the body
- Decreased bone quality and increase in fractures
- Elevated cholesterol
- Impaired phase II detoxification
- Decreased stomach acid production
- Constipation, intestinal dysbiosis, malabsorption
- Intestinal inflammation
- Blood sugar imbalances
- Gallstone formation
- Vascular and arterial plaquing
- Neurodegeneration, cognitive problems, depression
- Weight gain
- Hair loss
- Dry skin
- Cold hands and feet
- Infertility and reproductive dysfunction
- Weakened immune system
I could go on, but I think you get the point. If your thyroid hormones are low, you can’t be healthy. Period.
90% of people with hypothyroidism in the U.S. have Hashimoto’s disease. Hashimoto’s is an autoimmune condition that causes destruction of the thyroid gland over time. As this destruction progresses, the thyroid gland becomes less and less able to produce enough hormones to meet metabolic needs. This is reflected in an increase in thyroid-stimulating hormone (TSH).
Persistently elevated TSH is a sign that the body needs more thyroid hormone than it can produce on its own. This is one clear sign that it’s time for replacement medication. But it isn’t the only one. Some people with TSH in the normal lab range still find that they benefit from replacement.
Note that I’m not saying everyone with hypothyroid symptoms should be on medication. In a previous post, I discussed 5 different patterns of low thyroid function that present with normal TSH levels. These include underconversion of T4 to T3, problems with thyroid binding proteins, pituitary dysfunction and thyroid receptor-site resistance. In these cases, the problem isn’t with the thyroid gland itself or its ability to produce enough hormones, but is either “upstream” (in the case of pituitary dysfunction) or “downstream” (in the case of conversion problems, binding protein issues or resistance.) For these patterns, replacement hormones are often unnecessary.
There are many in my profession (natural healthcare) that vehemently oppose the use of medication under any circumstances. I think that’s foolish. I’m more concerned about the dangers of Big Pharma than most. But that doesn’t mean we should ignore the important role drugs play in treating certain conditions.
In fact, my philosophy on healthcare can be simply stated as: whatever works best and causes the least harm. It’ not often that a drug fits the bill. But in the case of hypothyroidism with elevated TSH, I believe replacement medication is a necessary part of a larger strategy that includes balancing blood sugar, adrenals and the immune system and fixing the gut.
In the next post I’ll discuss the many different considerations when choosing a thyroid medication.
- Three reasons why your thyroid medication isn’t working Has your thyroid medication stopped working? Are you always asking your doctor to raise the...
- 3 steps to choosing the right thyroid hormone When it comes to choosing the right thyroid hormone, there's no "one size fits all...
- 5 thyroid patterns that won’t show up on standard lab tests If you have hypothyroid symptoms, but your lab tests are normal, you may have one...
- The thyroid-gut connection You can't have a healthy gut without a healthy thyroid, and you can't have a...
- Thyroid, blood sugar & metabolic syndrome Healthy thyroid function depends on keeping blood sugar in a normal range, and keeping blood...
Tags: hashimoto's, hormones, hypothyroidism, medication, thyroid
I’ve just recently been diagnosed as hypothyroid and very likely with Hashimoto’s (I tested positive for antibodies). My TSH was not very elevated – always hung around in the middle of the range but on a couple of tests went to the higher end of the range. Unfortunately I live in British Columbia where the range is very wide for TSH – .3 to 5.5. I finally found out about testing for Free T3 and Free T4 and that’s when the FT3 came back very slightly below the range. My FT4 is nothing to write home about either. I’ve since found out that TSH fluctuations are par for the course with Hashi’s, so it’s possible that I’ve had a TSH out of range in the past but just didn’t luck out enough to get tested that day.
I will tell everyone I know who is having symptoms of hypo to get all three (plus antibodies) tested and to not give up until they do. I’ve been very likely dealing with this since I was 12 and I got unexplained hives on my legs for 2 years and developed pompholyx on my hands, which persists seasonally to this day. Hives are often a sign that Hashi’s is developing. I’m 38 now and have suffered fatigue and weight gain, infertility and a bunch of other issues my whole adult life. I’m super happy to finally have a diagnosis but I know it’s just the beginning of things now. Thanks for your site, I’ve learned a ton since I stumbled across it!
Thanks so much for this series on thyroid issues. Your blog is one that I regularly follow as I try to learn all I can about allergies, asthma, and autoimmune disease. I just started a Paleo diet about 2 months ago, and while I feel great, I still need to be on medication for all three problems. In fact, I’ve been on Synthroid for 20 years, Allegra for about 4 years (just seasonally), and Advair for 8 months. While I’m very hopeful that someday I will be able to get off the allergy and asthma medications, I wonder whether it’s even possible to do without Synthroid. Do you have any experience with this? How long does it take for the body to heal?
I LOVE your work, but am not so keen on this article. A person can be extremely hypothyroid for YEARS or DECADES even, and the TSH will not rise. A better way to diagnose hypothyroidism is antibodies testing and FT4 and FT3 levels: http://nahypothyroidism.org/diagnosistreatment/ and http://www.stopthethyroidmadness.com/tsh-why-its-useless/
I know you have because I read all these great articles. Which is mainly why I am confused by your high TSH = thyroid meds stance. I have always had a ‘normal’ TSH, yet my antibodies were through the roof. I balance my blood sugar, am gluten free and low carb, and treat my adrenals. Yet I still am sick as a dog without my thyroid medicine. So, I really don’t get the emphasis on TSH in this post. It is a dangerous lab, which leaves people very ill for decades, as it takes so long to rise if the thyroid is not functioning correctly.
Can you do a small edit then? *wink*
P.S. I have loved this series.
I’m getting very checky here, but how about:
“It turns out that thyroid medication meets these criteria in cases of hypothyroidism with chronically elevated TSH, low free thyroid hormone levels or high antibodies. These markers indicate that the body is not producing enough thyroid hormone to meet metabolic needs. And thyroid hormone is so important to the proper function of the body that the benefits of replacing it far outweigh any potential side effects of the medication”.
I have spent a LOT of time on thyroid boards during the past two years. During that time I have seen many people come and go. Many will turn up desperately hoping that if their sex hormones optimise, their adrenals heal or they go off gluten, they will be ‘cured’. Experience has shown me however that this just does not happen. Optimising sex hormones often means people need less thyroid and going off gluten really makes a MASSIVE difference (I never got properly well until I went off gluten) but it is the rare person whose thyroid starts to function properly after they have taken these steps. Instead, they waste years trying to ‘heal’ and ‘cure’ themselves, when they could have had proper thyroid function restored instead.
I think eliminating gluten would PREVENT hypothyroidism. I also think optimising adrenal and sex hormone status could also play a preventative role. However, experience with people who have gotten well has shown me that once the antibodies get high enough and the frees low enough; the thyroid will rarely come back online. Even if it does, should a person really have to waste years of their life being miserable and waiting for it to do so?
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