Unexplained Fatigue: Could your Thyroid have the Answer?

Low thyroid function is said to affect ten times more women than men but the correct treatment can boost energy and health

Thyroid hormone is produced from a tiny gland that curves across the windpipe just below the Adam’s apple; its job is to keep the body’s various functions working at the right pace. Too much and everything goes too fast – you lose weight, can’t sleep and your heart races; too little and your system slows down – fatigue, dry skin and constipation.

Too little (hypothyroidism) is the most common; production can be affected by all sorts of things – an autoimmune response, for example, or other factors such as prolonged stress or intake of certain drugs which can damage your thyroid. Patient groups like Thyroid-UK – set up in 1999 to fight for better treatment for this condition – claim pollutants and even a lack of fruit and vegetables can also reduce your thyroid gland’s output. The official NHS line, which Dr Skinner, author of Diagnosis and Management of Hypothyroidism disregarded, is that if the level of a marker for thyroid levels in your blood is within the ‘normal’ range, then you aren’t hypothyroid and you shouldn’t get a hormone supplement.

Dr Skinner’s approach was to treat the individual patient, not a blood test. “I’d run the regular test and some more besides,” he says. “But if the patient had all the symptoms that you get with low thyroid, then I’d prescribe a low dose supplement and gradually increase it. If their symptoms improved, that was a pretty good sign that their body needed more than the normal range.” In fact, whether you are found to be inside or outside the normal range can depend on where the test is being done.

The difference between the UK and the USA is particularly striking. In the UK, the healthy range for the most commonly used test – known as TSH (thyroid stimulating hormone) – is between 0.5 and 5, although many experts will refuse to treat a patient until the level reaches 10 (the job of TSH is to make the thyroid produce more, so when it is high it means the thyroid is in trouble). Yet four years ago, the American Association of Clinical Endocrinologists recommended that: “Doctors consider treatment for patients who test outside a TSH range of 0.3 to 3”. How many more patients that would mean should be officially treated in the UK isn’t known. But the Association commented that it would make 20% of the USA hypothyroid.

Thyroid expert Dr Leonard Wartofsky from the Department of Medicine at Washington Hospital Centre in the US thinks an upper level of 3 may even be too high. “According to the latest thinking, the upper level should be about 2.5,” he says. “My UK colleagues say there’s no evidence that treating below 10 is beneficial but I’d say it was mixed; studies showing benefit are coming in. We certainly see dramatic improvements in patients treated within reference levels here.” So there is certainly hot academic debate going on about just what counts as a healthy thyroid level. In fact, as Lynn Mynott of Thyroid-UK points out: “The Department of Health guidelines say that ‘blood tests are useful but should not be used in isolation’. In other words, you need to take symptoms into account as well.” So the first thing to do if you are worried about your thyroid levels and have had them tested by the doctor, is not to accept vague phrases about their being ‘high’ or ‘low’ but instead ask for actual numbers and ask what the testing lab considers a normal range.

If possible, get a copy of the actual report. If it shows that your TSH level is above 2.4 to 3.0 and you are told that this is normal, point out that the American Association of Clinical Endocrinologist (AACE) now recommends treating when TSH goes above 3.0. A more detailed test can be run by Genova Diagnostics. The lab’s Total Thyroid Screen includes tests for TSH, anti-thyroid antibodies and the two kinds of thyroxine (your thyroid hormone) called T4 and T3. T4 is converted into T3, the active form of thyroxine. For details, contact Genova at 020 8336 7750 or visit www.iwdl.net.

Sometimes you can have a normal T4 but a low T3, which means your ability to convert T4 into T3 is impaired and you feel tired as a result. If this is the case, follow my nutritional guidelines below. If your TSH is high, but your thyroxine levels (T4 and T3) are normal, one possibility is that you have too much oestrogen, which competes with thyroxine at hormone receptor sites. In other words, your body is able to make thyroxine, but the message isn’t getting through. Having a lot of dairy products can promote excess oestrogen, so reduce or exclude dairy but do increase nuts or seeds to make sure you get enough calcium.

With all the mainstream emphasis on blood tests, the issue of thyroid dysfunction diagnosis has become a highly controversial one. Much of this controversy has swirled around Dr Barry Peatfield, who has been treating thyroid patients holistically for a long time. He had his licence suspended by the GMC in 2001 for this approach and has since resigned and now runs a complementary therapy clinic – The Peatfield Clinic for Metabolic Health (01883 623125). Dr Peatfield diagnoses low thyroid on the basis of symptoms as well as a detailed physical examination. He frequently asks patients to use the Barnes temperature test, which involves taking your temperature first thing before rising on five consecutive mornings (for women, in the first half of their cycle). If it falls below 97.8F/36.6C, it can be a sign of hypothyroidism. While regular doctors dismiss it as unreliable, Dr Peatfield claims it is supported by good evidence and that it gives a more accurate picture of the state of your system than the snapshot provided by a blood test.

Synthetic Thyroxine or Armour Thyroid?

If your doctor is prepared to treat you, you will almost certainly be offered thyroxine, a synthetic version of T4 which the body then turns into the useable form T3. A test for just T4 can be misleading because if your problem is that T4 is not being properly converted into T3, it won’t be spotted – you will have plenty of T4 and may still feel terrible. Some people don’t respond well to doses of T4 so a few doctors are prepared to offer an older form of treatment known as Armour Thyroid USP. This is a dried extract of pig thyroid which was used regularly on the NHS until over 30 years ago.

Mainstream doctors will say that T4 is more consistent in quality and lacks risks associated with treating with animal extract. But its supporters claim that chemically, Armour Thyroid is more like the human hormone and that some patients do very well on it. It is no longer licensed in the UK but can be obtained from the USA and doctors can issue a private prescription for it. Just how many people could benefit from thyroid hormones, even though official guidelines say they should not get it, is unknown. Women are ten times more likely to be affected than men. One lower UK estimate says that low thyroid could affect a million women, more than have diabetes.

Nutritional Support for Your Thyroid

From a nutritional perspective, the two most common causes of an underactive thyroid are ‘endocrine burn-out’, which I’ll come to in a minute, or an auto-immune condition where your body produces anti-bodies that attack the thyroid. This second factor can be identified by testing for what are called ‘anti-thyroid antibodies’. If you test positive there’s a good chance you may have an unidentified food allergy. What appears to happen, in some cases, is that your immune system reacts against a food protein (the most common being wheat, milk and, for some people, soya) and cross-reacts against thyroid tissue. So the next step is to test yourself with a IgG food intolerance test.

Thyroid hormones are made from the amino acid tyrosine, which is converted into thyroxine, then into T3, by enzymes that depend on zinc, selenium and iodine. B vitamins are also important. So, I’d start with taking a high strength multivitamin that contains iodine, zinc (at least 10mg) and selenium. You could try adding extra zinc (up to 20mg a day in total) or extra selenium (up to a maximum of 200mcg in total). Kelp is also a good source of iodine, as is seafood. You need about 1000mg of tyrosine (some need twice this), taken on an empty stomach. Some supplements provide this with adaptogenic herbs such as the ginsengs. Most of all, put yourself on a strict low-GL diet, eating lots of fresh fruit, vegetables and wholefoods, and minimise stress and stimulants (caffeine and nicotine). You may also want to supplement 200mcg of chromium since this often helps lift low energy and low mood. All these steps can help to reverse endocrine burn-out. But if none of this works, I’d recommend exploring the possibility that you have an underactive thyroid and may benefit from a low dose of thyroxine. With the right nutritional support the chances are you won’t need very much to feel a lot better. The best place to find a list of sympathetic doctors is through one of these two patient support groups:

• Thyroid Patient Advocacy-UK (www.tpa-uk.org.uk)
• Thyroid UK (www.thyroiduk.org)