I recently saw a show on TV called “Doctor Who”. It was a season finale and it had all of the most beloved Doctors in it. I had a few questions about the show that I wanted answered and I didn’t know where to turn. This is why I turned to Doctor Detective. Bryan Walsh will say hello and help you solve your investigations, right on safermom.com.
Doctor Detective is the first medical mystery show on television. Each week, Dr. Rebecca Winters, a board-certified emergency medicine physician and board-certified forensic medical examiner, investigates a real-life medical mystery. Each episode features Dr. Winters going to the scene of a crime or disaster, interviewing witnesses, documenting the scene, and performing an autopsy or blood draw on the victim, all while searching for clues. The cases are fascinating and the truth is always stranger than fiction.
I met Bryan Walsh when he was an intern at The Huffington Post. I had been covering crime for the site for several years, and he had just started as a crime reporter. I loved his enthusiasm and his willingness to ask me questions, which was refreshing on a crime beat where so many reporters are reluctant to talk to their sources. I asked him to do a story on me, which he did and wrote a fantastic profile on me. Later, he came to my blog to guest-blog, and I asked him to write the intro to this post.
In this week’s case study, we meet a lady who, despite a healthy diet and exercise regimen, is unable to lose weight. The problem is that her low thyroid symptoms aren’t detected by a standard test panel. We utilize a more thorough thyroid examination to diagnose her issue and get her on the path to recovery.
Eat less calories and exercise more. It’s a fantastic prescription for boosting health and body composition in general. It does not, however, always work.
Even with a great workout routine and a well-balanced diet, some individuals have strange symptoms and complaints, especially considering how much effort they put into their fitness and health.
We know there are just a few specialists on the world to turn to when we encounter customers who have issues that exercise and diet — not to mention their own physicians — can’t seem to cure. Bryan Walsh is one of them.
Dr. Walsh has a keen intellect, a fitness background, a naturopathic medical degree, and a long list of extra training and certifications. His wife, too, is a naturopath. (We’re willing to wager that his children are the healthiest on the world.)
Dr. Walsh transforms from a mild-mannered father and husband into a forensic physiologist when difficult situations occur. He takes out his microscope and examines blood, saliva, urine, lifestyle – anything it takes to solve the medical puzzle.
We leapt at the opportunity to collaborate with Dr. Walsh on a regular case study segment. You’ll learn how a skilled practitioner thinks by following along with these interesting examples. You’ll also learn how to take better care of yourself.
We meet a lady today who is concerned about her weight and energy levels. Discover how Dr. Detective investigates the issue of the “invisiblely low thyroid.”
The thyroid hormone is essential for weight management. The thyroid is important in regulating the body’s metabolic “idling speed” in general. When the thyroid is underactive (hypothyroidism), the body’s processes slow down, almost as if it were a cold engine.
Low thyroid symptoms include:
- Having trouble losing weight or gaining weight
- chilly fingers and toes
- Mild sadness, “brain fog,” irritability, or just “the blahs” are all symptoms of depression.
- constipation and slow digestion
- reduced libido and sex hormone production (in women, this can include disrupted menstrual cycles)
- Hair and nails that are dry and brittle
- muscular tiredness, weakness, and cramps; sluggish workout recovery
Although some individuals have these symptoms, lab testing indicate that their thyroid function is normal.
However, as today’s example shows, most lab tests do not provide a comprehensive picture of thyroid hormone levels. And a lot of what we’ve learned about thyroid hormone has to be rethought.
The customer
Amanda, a cheerful 50-year-old, came to our office seeking assistance with her recent weight increase. She’d not only failed to lose weight despite following a regular PN-style diet and exercise regimen, but she’d gained approximately 1 pound each month for the previous 9 months.
Amanda was not overweight at 5’9″ and 149 pounds, but her lack of results pointed to underlying physiological abnormalities, despite her great diet and exercise regimen.
It’s time for Dr. Detective to get down to business.
Symptoms and indications of the client
Amanda was a bright, articulate, and honest lady who didn’t have any specific symptoms other than unexplained weight increase. A little probing, though, yielded a few additional hints:
| Symptoms / Signs | My views on the subject – possible problems |
|---|---|
| Weight increase that isn’t explained, chilly hands/feet, and moderate sadness (sometimes known as “the blues”) | Thyroid hormone abnormalities, as well as sex hormone imbalances, are both common. |
| Desires salt | An adrenal hormone imbalance is a possibility. |
| I’m having trouble sleeping. | Adrenal hormone abnormalities and blood sugar imbalances are also conceivable. |
These symptoms were intriguing, but they were too broad to offer solutions on their own. So, as usual, we began with a healthy blood chemistry.
The exams and evaluations
We usually begin with a simple blood chemistry test, but since Amanda was experiencing so many low thyroid symptoms, we decided to add a more comprehensive thyroid panel to our regular panel.
The results of the tests
Panel of blood chemistry
Amanda’s blood chemistry revealed a number physiological abnormalities, but the following were particularly relevant to her unexplained weight gain:
| Marker | Result | Reference Range in the Laboratory | Thoughts |
|---|---|---|---|
| Phosphatase alkaline | 35 IU/L | 25-100 | Low levels of zinc and/or vitamin C may indicate a deficit. |
| Cholesterol Total | 140 mg/dL | 100-199 | Inflammation, liver dysfunction, and dietary inadequacy are all possibilities. |
| HDL cholesterol (high-density lipoprotein) | 81 mg/dL | >39 | Inflammation is a possibility if the level is borderline high. |
| Triglycerides | 44 mg/dL | 0-149 | Low – inflammation is a possibility, as is a nutritional deficit. |
| TSH | 1.46 milligrams per deciliter | 0.45-4.5 | Normal |
| T4 is a four-letter word (thyroxine) | 7.6 ug/dL | 4.5-12.0 | Normal |
| Hemoglobin | 11.9 g/dL | 11.5-15.0 | Anemia is a possibility if your blood count is very low. |
| Ferritin | 14 ng/mL | 13-150 | Low iron reserves; heavy menses; parasites; nutritional inadequacy; additional blood loss; borderline low |
| 25-hydroxyvitamin D | 39.3 nanograms per milliliter | 32-100 | Low-to-mid range |
Amanda had a number of borderline indicators, suggesting underlying physiological problems (e.g. inflammation), but none of her markers, including the two thyroid markers on this panel, TSH (thyroid-stimulating hormone) and T4, provided insight into the unanticipated weight increase.
- TSH instructs the thyroid to increase or decrease output. TSH levels that are excessively high indicate that the thyroid isn’t receiving the signal and that TSH is increasing to compensate. When TSH is normal, as it was in Amanda’s instance, it may indicate that the issue is “downstream,” in the thyroid itself, rather than in the pituitary, which secretes TSH.
- T4, or thyroxine, is the thyroid hormone that is more plentiful but less strong. It’s transformed to T3, which is more active. If T4 is normal but T3 is low, it means T4 isn’t being converted correctly.
TSH and T4 were both normal, according to the first panel. The second, more in-depth thyroid panel, on the other hand, offered more information.
| Marker | Result | Reference Range in the Laboratory | Thoughts |
|---|---|---|---|
| T4, free | 1.27 micrograms per deciliter | .82-1.77 | Normal |
| T3 total (triiodothyronine) | 80 ng/dL | 71-180 | Underconversion is on the bottom end of the scale. |
| Free T3 | 2.3 pg/mL | 2.0-4.4 | Underconversion is on the bottom end of the scale. |
Amanda’s T4 is a four-letter word (thyroxine) was within normal limits, but her T3 (triiodothyronine), the active type of thyroid hormone, was on the low side.
As a result, her thyroid gland seemed to be generating sufficient quantities of T4.
Patients may still experience all of the low thyroid symptoms, including the unexplained weight gain, sadness, and chilly hands and feet described by Amanda, if T4 is not converted to the more active T3.
Alternative medicine practitioners are often taught that the enzyme that converts T4 to T3 – 5’deiodinase – is a selenium-dependent enzyme, meaning that it requires selenium to function correctly. Heavy metals, oxidative stress and lipid peroxidation, inflammation, and increased cortisol are some of the additional reasons of poor conversion.
What was going on with Amanda in particular? It’s time to go back to work on the case.
The treatment plan
We chose to supplement Amanda’s system with more selenium and antioxidants since she was potentially deficient in key minerals including zinc, iron, and vitamin C, as well as showing symptoms of inflammation.
Diet is the first step.
Amanda was put on an elimination diet to assist with her potential inflammation.
Thyroid conversion support is the second step.
Second, we started her on a medication called Thyro-CNV by Apex Energetics, which contains components like selenium, zinc, vitamin C, n-acetyl tyrosine, and guggul gum extract to promote thyroid hormone conversion. She took two capsules twice a day.
Antioxidant/anti-inflammatory assistance is the third step.
We recommended Amanda take one capsule of broccoli seed extract, curcumin, green tea leaf extract, and resveratrol (Nrf2 Activator by Xymogen) twice a day to decrease inflammation.
Step 4: Use iron as a support
Iron supplementation may trigger a lot of inflammation. So, even though Amanda’s ferritin was borderline low, we decided to attempt increasing her iron levels via food rather than supplements because of the potential inflammatory processes going on in her body. We urged her to eat more green leafy vegetables and supplemented her diet with two teaspoons of blackstrap molasses each day.
The end result
We re-ran Amanda’s thyroid panel thirty days later:
| Marker | Result | Reference Range in the Laboratory | Thoughts |
|---|---|---|---|
| TSH | 1.29 milligrams per deciliter | 0.45-4.5 | Normal |
| T4 is a four-letter word (thyroxine) | 7.2 ug/dL | 4.5-12.0 | Normal |
| T4, free | 1.19 nanograms per deciliter | .82-1.77 | Normal |
| T3 total (triiodothyronine) | 59 ng/dL | 71-180 | Low |
| Free T3 | 1.9 pg/mL | 2.0-4.4 | Low |
Yikes. Amanda’s thyroid conversion was going in the exact opposite way we intended it to. It’s back to square one!
Th1 and Th2 are two types of cells.
Clinicians often refer to the immune system’s two “arms,” Th1 and Th2. More information about this may be found here.
Compounds that are usually thought to be antioxidants may activate the Th2 arm of the immune system, which can have beneficial benefits in certain people. They may, however, exacerbate the problem in individuals with already dysregulated immune systems! This seemed to be what had occurred with Amanda.
To address this issue, we opted to forego antioxidant assistance for the time being and instead focus on nutritionally supporting her immune system’s other arm, the Th1 side.
For 30 days, we instructed Amanda to take echinacea, andrographis, medicinal mushrooms, and astragalus, among other Th1-stimulating botanicals.
These were her follow-up findings two months later.
| Marker | Result | Reference Range in the Laboratory | Thoughts |
|---|---|---|---|
| TSH | 1.37 milligrams per deciliter | 0.45-4.5 | Normal |
| T4 (thyroxine) | 6.5 ug/dL | 4.5-12.0 | Normal |
| T4, free | 1.07 nanograms per deciliter | .82-1.77 | Normal |
| T3 total (triiodothyronine) | 77 ng/dL | 71-180 | Low-to-mid range |
| Free T3 | 2.2 pg/mL | 2.0-4.4 | Low-to-mid range |
Amanda’s T3 markers improved somewhat from the previous test, but she still seemed to be underconverting T4 to T3.
Hmmmm. This was going to be a more difficult case than we had anticipated!
We had a discussion with Amanda at this point. I’m certain that with enough lab testing and searching for answers, we could have figured out why she wasn’t converting T4 to T3 as efficiently as she could. Amanda, on the other hand, contacted us because she was worried about gaining weight. As a result, we offered her an option.
- Option one was to keep performing lab testing and experimenting with various dietary regimens to figure out what was causing her underconversion.
- Option two was to take her test findings to a sympathetic endocrinologist in the hopes of being prescribed thyroid hormone replacement therapy.
Amanda selected the second choice, going on medication, in order to reduce weight as quickly as possible.
Amanda experienced more energy and a better mood after just one week of thyroid hormone therapy. Within a month, she had begun to lose weight.
Summary
So, what can we learn from Amanda’s experience?
- For a variety of reasons, people struggle to lose weight. Thyroid issues are one of the possibilities. Consider an underlying issue like as a hormone imbalance if you’re doing everything “right,” being honest and consistent with your good PN habits, and yet not seeing results (or worse, gaining weight while feeling awful).
- Thyroid issues aren’t as straightforward as many people think. Even if the thyroid gland is functioning properly, low thyroid hormone symptoms will persist if inactive T4 is not converted to active T3. While many alternative practitioners attribute low T4 to T3 conversion to a lack of selenium, there are a number of other factors that may cause poor T4 to T3 conversion. They are sometimes simple to see, and sometimes they aren’t.
- When evaluating thyroid function, most traditional physicians simply look at TSH and total T4. However, a more comprehensive thyroid panel is required to determine if there are any problems with thyroid hormone physiology. TSH, total T4, total T3, free T4, free T3, and T3 uptake are all included in a full panel. Request a full panel if you’re having low thyroid symptoms and a standard thyroid panel hasn’t shown anything odd.
- Start with less intrusive treatments like dietary changes or nutritional assistance if possible. However, you should not rule out the use of traditional medication. If you’re dealing with a difficult issue, you may require all hands on deck to handle it.
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