Why thyroid problems and their symptoms should be examined by health professionals

Tiredness, hair loss and weight gain could be pointers to an underactive thyroid gland, but other, unrelated causes need to be ruled out first and use of medication needs to be carefully monitored

PUBLISHED : Monday, 27 March, 2017, 6:17am
UPDATED : Monday, 27 March, 2017, 5:35pm

Feeling tired all the time? Putting on weight? Losing hair? You might have an underactive thyroid. Proper testing and medication could set you straight, but there could be other issues at play.

First, a few basic things to understand about the thyroid: its function is to take iodine, which is found in many foods, and convert it into the thyroid hormones thyroxine (T4) and triiodothyronine (T3).

Thyroid cells are the only cells in the body that can absorb iodine. These cells combine iodine and the amino acid tyrosine to make T3 and T4. This T3 and T4 are then released into the bloodstream and are responsible for controlling metabolism.

“Most of the time patients have non-specific complaints: fatigue, hair loss, weight gain, occasionally constipation. Dry skin sometimes,” says Dr Charlene Kulenkampf from Dr Lauren Bramley & Partners in Hong Kong’s Central district.

The first step is a blood test to determine the levels of thyroid hormones. When you produce too much of the hormones, the condition is known as hyperthyroidism. This is relatively rare. Hypothyroidism, when the body doesn’t produce enough of the hormones, is much more common and will be the concern of this story.

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Hashimoto’s disease – a condition in which the immune system attacks the thyroid – often leads to hypothyroidism and is one of the most common causes of the condition. If someone tests positive for Hashimoto’s, Dr Nichola Salmond at the Optimal Family Health medical practice, also in Central district, says she puts them on thyroid replacement therapy. She looks closely at the borderline cases, which fall just within the boundary of what is deemed “normal”.

“I treat the person rather than the blood level. If someone comes in with typical thyroid symptoms, but they are borderline, then in some cases I will treat them [with thyroid medication] and see if it helps their symptoms,” says Salmond.

Kulenkampf also looks closely at the borderline cases and suggests that doctors who stick to the standard reference levels overlook a lot of people. If someone is borderline, she begins by ruling out other issues before turning to thyroid medication. She checks iodine levels, nutrition and tests to see if they have been exposed to heavy metals.

“We are suggesting a gluten-free diet for those with Hashimoto’s and have seen a good response. I have some borderline patients who have dealt with it through diet,” says Kulenkampf.

Most doctors will check T4 levels, but the majority of doctors in Hong Kong don’t test for T3. The body needs T4 to make T3, but having T4 isn’t enough to guarantee there will be enough T3; there could be a problem with the conversion.

“For some reason most doctors in Hong Kong don’t really believe in T3 – the US is much more open to it. We can test genetically to see if you are a good T4 converter,” says Kulenkampf.

The genetic test is new to Hong Kong and is run through a new lab in Cyberport.

“I like to use Erfa, which is made from pig’s thyroid,” says Salmond.

For those starting thyroid medication it’s important to begin with a low dosage and check the body’s response. Too much thyroid medication can cause serious side effects.

“Overtreating can lead to heart palpitations, osteoporosis and anxiety,” says Salmond.

Other symptoms of overmedicating include weight loss, diarrhoea and trouble falling asleep. While none of these are life threatening in the short term, in the long term they could be.

“Most people inform us if there is high weight loss and they are feeling symptoms such as anxiety. You don’t want your heart running at that rate long-term as it could lead to heart issues,” says Kulenkampf.

Naturopath Benita Perch, of the Integrated Medicine Institute in Central district, believes many people are overmedicated and some don’t immediately come forward to request a change in treatment or dosage because they like the fact the weight is falling off so easily.

“Almost ... 60 per cent of the time people are given thyroid medication when they don’t actually need it. I see it all the time because it’s an easy fix,” says Perch.

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She says she’s seen many cases of women who put on weight because of hypothyroidism, and while thyroid medication seems like the perfect solution it’s not always the answer for everyone.

“It will speed the metabolism up and you will lose weight, but it’s a short-term fix and eventually the body will get used to the thyroid hormone and need more. For a lot of women they want that quick fix, but within a year they will need to increase the dosage,” says Perch.

She is quick to make clear that thyroid medication for those who need it is essential and a good thing; her bugbear is when it is prescribed when a change of diet – for example cutting out gluten – would have a positive effect, but take a little longer.

“You’ve got to work out what’s going on with the thyroid; there are so many other options. And if you are on thyroid medication and you don’t want to keep going up and up in dose when there are other options,” she says.

After testing for thyroid stimulating hormones, she looks at nutrition and gluten intolerance and checks for an imbalance in the gut, whether it be an overgrowth or a parasite that has triggered an inflammation that may have caused an auto-immune condition. Stress is also a big factor.

“Stress can play a huge part, so we make sure people are on B vitamins. And we may introduce herbs – ashwagandha [also known as Indian ginseng and one of the most powerful herbs in Ayurvedic healing] can really help with the thyroid and adrenal glands,” says Perch.

She says she has managed to get quite a few people off their thyroid medications, but that it is generally easier if they have been on them for no more than a few years.

“If you take thyroid medication, then eventually the thyroid starts to not function,” says Perch.

She begins such treatment by asking to see a patient’s first blood test, before they began taking medication.

“I’ve seen women who are osteopenial, the early stage of osteoporosis, from the medication. People should stop to think about it – in their 50s they might end up with issues they didn’t expect,” she says.

The bottom line is if you think you might have a thyroid issue, get checked out by a doctor you trust. And if you are on thyroid medication, keep an eye out for signs that you might be overmedicated, as that could lead to health problems further down the line.

“If someone has been hypothyroid and they start losing a massive amount of weight I always check their pulse rate and ask whether they have trouble getting to sleep or if they feel wired or anxious,” says Salmond.