HYPOTHYROIDISM PATIENT INFORMATION SHEET
Congratulations on your new diagnosis of hypothyroidism! I know that may sound like an odd cause for congratulations, but for most of you this diagnosis may be a relief and may open up a new world of treatments that should help resolve many of the symptoms you’ve been suffering with for a very long time.
How did we arrive at this diagnosis? If you show symptoms of hypothyroidism then I use the stricter ACCE (American College of Clinical Endocrinologists) and NACB (National Academy of Biochemistry) guidelines of a TSH range of either 0.3-3.0 or 0.4-2.5, combined with the results of T3/T4/antibody tests, and certain physical examination findings. (Many labs use a broader range that misses the diagnosis for a lot of hypothyroid people, so we don’t use those outdated guidelines.) Based on some combination of your lab results and your symptoms or physical exam findings you meet the criteria for hypothyroidism. If your antibody tests were negative but should be repeated every year or so in case of autoimmune thyroid disease (Hashimoto’s.), which can wax and wane and is sometimes hard to pick up on a test. But honestly most cases of hypothyroidism in this country are autoimmune, so we tend to assume they are even if the tests didn’t pick it up. This means you’re likely to have better thyroid function if you follow a diet that decreases inflammation and autoimmune response in your diet.
What should I change in my diet? I recommend a daily iodine and selenium supplement for all of my thyroid patients, and for most people the amounts found in NOW or Longevity Nutrients brand multivitamins are sufficient. Take them once a day with food, at a separate time from your thyroid pill because some of the multivitamins can block its absorption. Cruciferous veggies are fine as long as they are at least partially cooked most of the time. Avoid gluten, as it has been closely linked with poor thyroid function. There are lots of “anti-inflammatory” or “autoimmune” cookbooks available online or at your library. They basically revolve around avoiding foods that tend to trigger inflammation, like gluten/dairy/sugar/white grains/etc, and make up for them with LOTS of fresh veggies. healthy fats, and a variety of protein sources. Whole 9, Abel James, Amy Myers MD, and Super Easy Paleo are all good sites to check out. Sign up for their mailing lists for at least a few months so you can learn as much as you can (and usually get some free e-books for signing up!), but don’t feel pressured to spend any money, and you can opt out of the lists at any time if the email surge becomes overwhelming. These are all legitimate sites that I have vetted ahead of time – you won’t find any scams or fads there.
Which meds will I take? There are a wide range of thyroid replacement meds to choose from. I usually start patients on T4 and add a small amount of T3 if the T4 isn’t helping symptoms within a month. A certain percentage of patients do better on natural thyroid, which we can switch to at any time based on symptoms or patient preference. Insurance sometimes doesn’t cover natural thyroid as well as it covers the synthetic thyroid. I don’t want to bias you completely against synthetic thyroid, because there are plenty of patients out there who feel great on them. But if you’re not one of them we will switch you quickly to whatever version works for you. The process of finding the right thyroid medication can sometimes take may months, but eventually we hit on the right combination.
Do I need lab monitoring to see how if my meds are working? Once we have made the diagnosis and started thyroid replacement, labs no longer give us accurate information, even if thyroid meds are skipped for a few days before the test. So many providers, including myself, choose instead to monitor dosage mostly based on the patient’s signs and symptoms, with occasional lab tests as needed. The most important thing to look out for is over-replacement, which causes symptoms of hyperthyroid and can be very dangerous. Your provider will monitor your heart rate, temperature, and blood pressure, and other signs of hyperthyroid such as bulging eyes, shaking, jerky movements, etc. You will need to report any of these symptoms, along with any rapid heart rate, increased sweating, or palpitations. There are many international medical providers in third world countries who successfully manage thyroid dosages based on signs ans symptoms alone, because they don’t have access to labs, and they have published many studies that have validated using signs and symptoms as a safe and effective way to manage thyroid dosages.
Where do I go for more info? Mayoclinic and UpToDate for patients are good medical sites with basic mainstream thyroid info. Amy Myers MD devotes most of her practice to using functional medicine to help heal thyroid disease, and I highly recommend all of her articles and educational programs. Two good blogs that tend to have well-researched information about thyroid issues are www.hypothyroidmom.com and www.stopthethyroidmadness.com. Some patients find these blogs to be a good source of information and support, but please don’t make any changes to your treatment regimen without consulting with your provider first.
Please call your provider to schedule a consult if you have any additional questions about your new diagnosis: 206.734.4981