Early Detection And Treatment May Prevent More Severe Disease

When it comes to diagnosing thyroid dysfunction, there's much more than meets the eye. Studies show that as many as 90% of patients with positive test results for thyroid dysfunction are missed by primary care physicians who rely only on standard testing which consists on testing only TSH and T4, and not based on symptoms of thyroid dysfunction.

"…clinical acumen alone lacks sensitivity and specificity in detecting previously undiagnosed thyroid dysfunction," points out Dr. Jim R. Stokigt of the Monash University Department of Medicine in Australia in a recent review article.

Because thyroid dysfunction is not easily gauged by clinical symptoms alone, proper testing is important, he observes. The 1998 guidelines from the American College of Physicians recommends routine testing for thyroid stimulating hormone (THS) levels in all women over 50 when they present for medical care. The American Thyroid Association recommends that all adults have TSH tested at age 35 and monitored every five years thereafter.

Certain groups at higher risk can benefit from more aggressive evaluation. "Testing of thyroid function may soon become standard practice in women who intend to become pregnant, or as early as possible in pregnancy, based on recent evidence of significant intellectual impairment in the offspring of women who were even mildly hypothyroid early in pregnancy," Dr. Stokigt writes.

Subclinical hypothyoidism is a very early, subtle stage of the disease process that occurs when levels of TSH begin to creep upward, before thyroid hormone levels are actually abnormal. This is often the initial sign of thyroid dysfunction, one that can precede clinical symptoms and overt disease by many years.

Based on TSH testing of over 25,000 men and women, the Colorado Thyroid Disease Prevalence Study determined that nearly 10% of randomly screened individuals showed signs of subclinical hypothyroidism - with the rate doubling in the higher age groups.

A positive test result for thyroid peroxidase antibody (TPOAb) can also be an important early warning signal of emerging dysfunction. "This antibody has a better positive predictive value than measurement of serum TSH in identifying an increased risk of postpartum thyroid dysfunction," Dr. Stokigt observes.

"TPOAb positivity has also been shown to be associated with increased susceptibility to depression in perimenopausal women by an effect independent of thyroid function and menopausal status."

While having either high TSH or positive TPOAb raises the risk of progressing to overt hypothyroidism by eight-fold, having both of these risk markers considerably ups the ante. A person with both early warning markers may have an astounding 40-fold increased risk of developing overt hypothyroidism, according to one study.

Thus, the case for more rigorous testing of at-risk groups is bolstered by several lines of evidence. Proponents point out that untreated thyroid dysfunction, even at the mild, subclinical stage, is associated with increased risk of developing a wide array of related health problems-including heart disease, osteoporosis, depression, and adverse fetal development. Besides preventing more serious disease, identifying and treating subclinical dysfunction appears to improve nonspecific symptoms in many patients, suggest results from several small double-blind trials.

For one, as indicated in the review article, markers such as TPOAb can indicate clinical risk independent of TSH levels. "Addressing these specific imbalances, which may be related to aging, gut or bacterial imbalances, or adrenal dysfunction, allows the physician to develop more finely honed, customized treatments," Dr. Furlong points out. Second, as the review emphasizes, many markers act synergistically.

The Comprehensive Thyroid Assessment provides the complete evaluation needed to accurately assess early, preclinical stages as well overt thyroid dysfunction and to thoroughly monitor treatment interventions in patients.

Thyroid dysfunctions are related not only to the primary thyroid gland, but also to a range of secondary metabolic challenges associated with unhealthy aging, stress, and nutritional insufficiencies, all of which reduce the efficiency of the HPT axis and control of intermediary and cellular physiology by thyroid hormones. Furthermore, high levels of cortisol (an adrenal hormone produced by excessive stress) along with high levels of inflammatory cytokines, have been associated with depressed levels of the active thyroid hormone T3, expecially in fibromyalgia patients.

Stress increases the levels of glucagon, lowers levels of T3, and elevates levels of rT3, producing the outcome of secondary borderline hypothyroidism

The Adrenal Stress Profile measures levels of adrenal hormones. This is a salavary assay of cortisol and DHEA, imbalances of which are associated with ailments ranging from obesity and menstrual disorders to immune deficiency and increased risk of cardiovascular disease to thyroid dysfunction.

Changing amounts of DHEA and cortisol over an individual's lifetime may signal important alterations in adrenal function that can profoundly affect his/her energy levels, emotional state, disease resistance, and general sense of well-being. That's because adrenal hormones exert a profound influence on the body's carbohydrate, protein, and lipid metabolism, immune response, thyroid function, cardiovascular health, and overall resistance to stress.

Nutritional Intervention

A variety of specific nutritional, phychosocial, and environmental modulators influence the HPT (hypothalmus, pituitary, thyroid axis) function and may, therefore, be worth evaluating prior to pharmacological intervention therapy with thyroid hormone replacement. Proper testing will help to evaluate the situation so an appropriate course of action my be taken.

Source: Stockigt JR. Case finding and screening strategies for thyroid dysfunction. Clinica Chimica Acta 2002;315:111-124.

Call to set up a nutritional consultation so that tests can be performed and a comprehensive strategy of lifestyle, dietary modification and nutrient supplementation can be implemented to aid you in reversing this disorder.

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Dr. Rispoli, Ph.D., L Ac. has had a clinical practice for over 20 years. Her programs work because she is so thorough in testing and providing a nutritional approach. Remember that the body can heal itself if given the proper nutrients.

The information herein is not intended as diagnosis, treatment or a cure. Should you have a medical condition please seek the advice of your medical doctor.