Hidden Health Threat Looks Like Normal Aging… But Isn’t

A good friend has been feeling sluggish and depressed lately, and to make matters worse, she’s slowly gaining weight. Since she’s approaching 50, she attributes all this to getting older — but I suggested she see her doctor for a check-up since thyroid disease can also be associated with these symptoms. In fact, experts estimate that more than 27 million Americans, half of whom don’t know it and 80% of whom are women, suffer from thyroid disease. It’s a diagnosis that many physicians miss — in part because they don’t listen closely to what patients are saying. I sat down with some experts on thyroid and hormone disorders in order to learn what to look out for (including the not-so-obvious symptoms), what you need to bring to the attention of your doctor and also how to balance your thyroid naturally.

The fact that risk for thyroid disease increases as you get older doesn’t make it any easier to spot, as it can cause a variety of puzzling symptoms that many patients and even doctors mistake for signs of normal aging or other diseases. It’s treatable, but left unchecked, thyroid disease can have serious health consequences including high cholesterol, abnormal heart rhythms, bone loss, and with severe untreated disease, even coma.


For the latest news on thyroid disease, I spoke with Ken Blanchard, MD, PhD, a board-certified endocrinologist in private practice and coauthor of What Your Doctor May Not Tell You About Hypothyroidism. He told me the thyroid is like a delicately tuned instrument. “Thyroid rhythms change over time with our bodies’ metabolic needs,” he explained. “Our bodies and environments are in constant flux, and it’s the thyroid’s job to be exquisitely sensitive to changes in the body’s internal and external environment.”

A variety of influences can cause your thyroid to produce either too much thyroid hormone (hyperthyroidism, which is fairly rare), causing trembling hands, irritability, heat intolerance, sleep difficulty, abnormal heart rhythms and weight loss… or too little (hypothyroidism) causing sluggishness, depression, intolerance to cold, dry, coarse skin and hair, constipation and weight gain. In women, hypothyroidism can also cause heavy or irregular menstrual periods. Interestingly, fatigue is a common symptom of both hyper- and hypothyroidism.


Thyroid disease, particularly hypothyroidism, has been on the rise in recent years. Dr. Blanchard suggests that environmental toxins may inhibit production of thyroid hormone, noting that dental x-rays (where the thyroid is improperly shielded) and toxic chemicals are possible culprits. Also, age itself can be a factor, he says: “As our metabolic and immune systems slow down, we’re more prone to infection and immune disease, both of which can manifest as hypothyroidism.”

The vast majority of hypothyroidism cases are caused by Hashimoto’s thyroiditis, a condition more likely to affect women, in which the immune system attacks the thyroid gland. According to Dr. Blanchard, women’s vulnerability to hypothyroidism is consistent with their vulnerability to autoimmune diseases in general. “Three-fourths of autoimmune diseases such as lupus and rheumatoid arthritis strike women,” said Dr. Blanchard. “This has led experts to believe that female hormones may play a role in hypothyroidism.”


Mainstream medical doctors typically diagnose thyroid disease with a test that measures thyroid-stimulating hormone (TSH). If thyroid hormone levels are high (hyperthyroidism) and serum TSH is low, standard treatment involves drug therapy or surgery. Another treatment for hyperthyroidism, usually tried before surgery, is radioactive iodine thyroid ablation. If the test reveals a low level of thyroid hormone (hypothyroidism), usually with high serum TSH, treatment usually involves a synthetic of thyroid hormone thyroxine T4 called levothyroxine (Synthroid).

However, many patients with classic hypothyroidism symptoms have a TSH level within a normal range, and leave their doctor’s office without a diagnosis or treatment. In Dr. Blanchard’s view, this is the problem with the conventional approach — it’s an insufficient diagnostic tool, leading to “countless undiagnosed cases and unnecessary suffering,” he says. Dr. Blanchard relies instead on symptoms and patient history.

This “functional approach” to diagnosing and treating hypothyroidism uses the TSH test as one of several possible markers for the disease, considering the treatment with thyroid hormones as a way to confirm presence of disease. For a typical hypothyroid patient, such as a woman in her 40s with a list of symptoms consistent with hypothyroidism and TSH level in the normal range, Dr. Blanchard tries what he calls an “intelligent therapeutic trial” of T4 and T3, the latter being a hormone rarely used by physicians. “A notable improvement on the thyroid treatment confirms that the patient is, in fact, functionally hypothyroid,” he explained. He says it is not unusual to see an excellent response to this treatment by patients with classic symptoms of hypothyroidism, yet normal TSH measures. “Thyroid hormone replacement is very complicated and has to be done on a one-to-one basis,” said Dr. Blanchard. “After years of judicious trial and error, I’ve seen thousands of patients respond well to an individualized, physiologic balance of T4 and T3 that restores a healthy balance of thyroid hormones.”


As you know, I believe naturopathic medicine contributes a different perspective, so I asked Daily Health News contributing medical editor Andrew L. Rubman, ND, for his opinion. “Thyroid disease is rarely a simple problem with one cause,” he said. “It’s complex and needs to be treated as part of an overall physical assessment.”

Dr. Rubman says it’s a good idea to have your naturopathic physician collaborate with your medical doctor to find treatment approaches beyond medication. He emphasizes the importance of supporting the thyroid naturally with a healthy lifestyle, good nutrition, regular exercise and stress management to decrease the odds that disease will develop, noting that factors such as insufficient dietary iodine may confound the problem. Though body temperature was once thought to be a reliable measure of thyroid function, this has largely been discredited, says Dr. Rubman.


Other strategies to help protect your thyroid health include:

Get regular thyroid screenings. According to the American Thyroid Association, if you are 35 or older, you should have your thyroid tested at least every five years.

Learn about your family history for thyroid disease. Thyroid disease, such as Hashimoto’s thyroiditis, is often hereditary. If a family member has thyroid disease, you are at increased risk.

Take charge of your own care. If you suspect you may have thyroid disease, find an open-minded doctor to talk to, someone who is willing to look beyond the TSH test and take your symptoms seriously. Choose a physician who focuses on you as an individual. Don’t just give up if your TSH results are normal yet you still suspect thyroid disease. Urge your doctor to look further, or consult a board-certified endocrinologist or naturopathic physician with a specialty in endocrinology. You can use The Hormone Foundation (www.endo-society.org/apps/FindAnEndo2/) as a resource to find an endocrinologist.

Minimize environmental toxins. Eat as many fruits and vegetables as possible. Reduce consumption of animal fats in dairy products, processed foods, meats and poultry, as they tend to harbor toxic chemicals. Buy organic foods whenever you can.

Reduce stress through relaxation and exercise. As always, these are the cornerstones of physical and mental health.

Eat right. Good eating habits, adequate digestion and regular dietary sources of the building blocks of both thyroid hormones — the mineral iodine and the amino acid tyrosine — can only help. Sources of iodine include seaweed, shellfish (shrimp, clams, oysters) and iodized salt. Tyrosine, a non-essential amino acid, is produced from foods including soy, chicken, turkey, fish, peanuts, almonds, avocados, bananas, lima beans and pumpkin seeds.