Too many patients come into my office struggling with weight loss. They exercise 5 times a week or more, have a very healthy diet and, they don’t over-consume calories, yet their weight won’t budge. These patients claim that if they just look at cheesecake they gain 5 lbs. My usual response to these patients is that they are either not being totally honest about their lifestyle and diet or, they have a problem with their metabolism.
I have always said that maintaining a healthy weight should not be that difficult and when it is, there is something going on beyond too many calories and not enough exercise. This is when I usually start asking about Thyroid function. Many patients simply state that they have been checked and they are fine. This begins a line of questioning around the tests done and the results. Others state that they have just been told to exercise more and eat less. While increasing activity and consuming fewer calories is sound advice, it is not helpful to the patient that is basically living on lettuce!
To investigate thyroid function, the standard medical practice is to test TSH (Thyroid stimulating hormone). TSH is secreted from the pituitary in response to circulating levels of Thyroxin (T4) in the blood. When T4 levels drop, more TSH is released to stimulate T4 release from the thyroid gland. When T4 levels are adequate then TSH levels fall. So the standard thinking is that if TSH levels are in normal range, then the thyroid gland must be functioning well and releasing enough T4. This is absolutely correct. The problem is that metabolism does not stop with adequate thyroxin levels. T4 is released by the thyroid gland, but then has to be enzymatically converted into Triiodothyronine (T3). T3 has a stronger influence on metabolism than T4. If T3 is inadequate, or if too much reverse T3 (rT3) is made, then symptoms of hypothyroid will persist.
When patients with difficulty losing weight, cold intolerance, fatigue, low mood, low libido, dry skin, brittle hair, constipation, foggy brain come to see us, we recommend a full thyroid panel. To treat symptoms of low thyroid function properly, we have to know what is being produced by the thyroid gland, and how the body is using it. A basic Thyroid panel may be enough to determine what is going on, but there are more complicated cases where I will recommend blood work as well as urine thyroid testing. Comparing thyroid hormones in the blood to what is in the urine will let us know what is happening at the cellular level.
Thyroid hormone production and utilization is effected by many factors including nutrition, stress, illness, heavy metals, halides, inflammation, and medications. Diagnosing and treating a thyroid condition can be very simple and basic, but in my experience, it is generally under diagnosed and not adequately treated. Patients who truly struggle with weight loss may require further investigation than the standard medical system offers. We are fortunate, as Naturopathic Doctor, to be able to have a deeper understanding of metabolism and thyroid testing and to be able to offer customized treatment options to our patients.