A typical patient with thyroid deficiency: Hypothyroidism.
As a child, Steven had a tendency to put on weight. His parents tried to make him lose weight by doing sports and diet, but nothing really helped. He was a slow child; slow in thinking and problems with school. The teachers said he had ADD. As an adult, he gained weight and his face grew puffy especially in the morning. He was always on a diet and could not lose weight. His skin was rough and dry and he had a bad temper and felt depressed a good portion of the day.
What’s the problem? A low thyroid.
The role of thyroid hormone includes increasing blood flow, heart rate, heat production, metabolism and energy. Also, speed of thinking, intestinal mobility, thirst, raising the good cholesterol and immunity from various infections and cancer. Be aware that thyroid hormones beneficially decrease total and bad cholesterol, as well as decreased diastolic blood pressure and getting edema out of the cells. Factors that increase thyroid production include eating a high-calorie diet, fruits and vegetables. They can all increase thyroid function. Eating too much protein such as meat and poultry or eating a very little diet such as a low-calorie diet, fasting or malnutrition can considerably lower thyroid activity.
Most thyroid hormone levels gradually decline with age. There are two thyroid hormones: T4 and T3. T4 decreases approximately 10-20% from age 25 to 75, and T3 decreases by 25%.
Signs of low thyroid: The body appears to have a large chest and abdomen, but has smaller limbs and the patient may be obese and swollen. He is prone to ear, nose and throat infections and prone to weight gain and difficulty losing weight. There is edema or swelling all over. Energy is decreased with morning fatigue and fatigue when taking a rest. The patient typically feels better in the evening. There is intolerance to cold, especially cold hands and cold feet with white fingers in the winter, and intolerance to heat and inability to sweat in hot climates. The patient needs to wear supplementary warm clothes in all seasons. There may be migraines, hair loss, dry hair, brittle nails, slow growing nails, dry skin, arthritis, muscle and joint stiffness and low back pain. Memory is not good. There is poor attention, poor concentration and poor school performance.
The physical signs
of hypothyroidism include a puffy face, loss of outer third of the eyebrow, swollen eyelids, swollen lips and tongue. There are cold hands, brittle nails and slow growing nails. The calves show nonpitting edema and the feet are typically cold and swollen. There may also be flat feet. The skin is dry. The patient is tired most of the time.
I perform a battery of thyroid tests
to assess my patient. Blood tests include free T4, free T3, reverse T3, TSH and antibodies to T3 and T4, as well as antibodies to the thyroid gland itself. Of importance is the history from the patient. The patients, as discussed, are obese, depressed, cold and may exhibit high blood pressure and high cholesterol.
is using a natural thyroid called Armour, which has T4 as well as active T3. When indicated I use synthetic Synthroid
Another test that I also perform at times is a 24-hour urine to measure T3 and T4 over the whole day. I evaluate my patient frequently starting on a low dose and gradually raise the dose as needed. Then, blood tests are performed in order to make sure the patient is optimal.
Summary : I perform an extensive history and physical along with blood and urine testing to best treat my patients.