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Jeanne W. Shiffman, MD, DABFP
The Thyroid A Functional Medicine Approach
Steinmetz Integrative & Functional Medicine Center

The Thyroid A Functional Medicine Approach

Many people think they have symptoms of an inefficient thyroid but are told that the labs are normal or, are taking thyroid medicines, but are not feeling better. Thyroid hormones can affect the whole body, leading to many different symptoms. It is best when looking at the thyroid to take a functional medicine approach.

According to the Institute for Functional Medicine, “Functional medicine addresses the causes of chronic diseaseFunctional medicine emphasizes the therapeutic partnershipand encourages moments of deep insight that contribute to more comprehensive answers to stubborn, complex medical problems.”

First a thorough history from each new patient should be reviewed. Is there a family history of thyroid disease? What are the symptoms? Could these be from something else and not the thyroid? Were there exposures earlier in life that affected the thyroid? What is their diet? After questioning, a physical exam will be conducted to look and feel for any problems, including feeling the thyroid gland itself.

While asking about what symptoms are important, it is also important to do lab studies. The most common thyroid lab test measures the thyroid stimulating hormone (TSH). This is from the pituitary gland in the brain and it sends a signal to the thyroid to make hormones. The second most common test measures the thyroid hormone T4. It is also important to check hormone T3, to see if enough T4 is being converted into T3. Many people do not properly convert and feel better when T3 is added to their medication regimen.

Sometimes it is helpful to look at reverse T3 and thyroid antibodies. Some T4 gets converted to reverse T3; when too much gets converted, reverse T3 acts like a brake on the system. People can also make antibodies against their thyroid and this can happen even when the TSH and thyroid hormone levels are normal.

The presence of thyroid antibodies indicates an autoimmune disease. Often this can be linked to food sensitivities. In addition to making changes in diet, we can also perform specialized lab tests to help uncover sensitivities. Heavy metal exposure, such as lead, can also damage the thyroid and be tested for.

It is wise to get an ultrasound if the patient is taking thyroid medication or if the gland feels enlarged during a physical exam. The ultrasound will see if there are any nodules or signs of cancer. There is no radiation in an ultrasound test.

The thyroid can be nourished with vitamins and minerals, such as selenium. Even low vitamin D levels affect thyroid hormone levels. Iodine is important for the thyroid and it is easy to measure your iodine levels to see if you are deficient.

For those that need medicines for low thyroid, there are synthetics and desiccated, or pig based, preparations. The synthetics are bio-identical T4 and T3. The desiccated medicines are T3/T4 combos. It is a journey with your doctor using how you feel and lab testing to find the best thyroid medicine for you.

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