The concerns people have about thyroid issues and requests for prescriptions for desiccated thyroid extract has necessitated the need for this article. We have come across patients not only in our clinics but also in different chat rooms, wondering where and how and when to start  desiccated  thyroid extract. All these patients believe that desiccated thyroid extract is the miracle medicine; that it is the real solution to their symptoms and it can be prescribed as soon as they know that they have thyroid symptoms, and of course that OHIP (provincial health insurance) should pay for the costs.

THYROID ISSUES ARE LIKE A PUZZEL

We do agree with all that has been said. It is good news that an increasing number of people are becoming aware of the significance of a natural approach to their health issues. After all, ‘natural’ is the time old, time tested, safest and simplest approach to any health issue.

Actually, desiccated thyroid extract was the first ever replacement therapy given for low thyroid function. Obtained from bovine thyroids, it was natural, safe, effective and available for decades until pharmaceutical companies invented synthetic T4. Doctors were overwhelmed by persuasion from the pharmaceuticals and the idea of a single dose and a single monitoring tool. The question is: Is there really a single thyroid hormone and a single monitoring tool for all  thyroid issues?

Here, we try to resolve some of these misconceptions and issues one by one.

MISCONCEPTION  ONE:

T4 IS THE ONLY HORMONE PRODUCED BY THE THYROID GLAND:

T4 is the medication routinely prescribed by your doctor to treat your thyroid deficiency. However, T4 is not the only hormone produced by the thyroid gland. Depending upon how many iodine molecules a hormone has, the thyroid produces T4, T3, T2, and T1. T4 is an inactive form and it cannot bind to the thyroid receptors which are present on the surface of every cell in your body. If your body does not have the ability to convert T4 to T3, the routine prescription medication is useless for you.

MISCONCEPTION TWO:

TSH IS THE ONLY MONITORING TOOL FOR THYROID FUNCTION:

There is not only one monitoring tool for thyroid function. TSH (thyroid stimulating hormone) is used to rule out thyroid deficiency or excess. However, thyroid assessment needs not only TSH, but also T4, T3, and even reverse T3 (rT3) to be monitored. Rarely you may also require a scan or biopsy. Without doing appropriate tests for your situation, we may not be able to treat your thyroid problem successfully.

MISCONCEPTION THREE:

T4 IS THE ONLY TREATMENT FOR THYROID:

T4, which is routinely prescribed to treat thyroid deficiency, is not the only treatment for low thyroid function. If your body cannot convert T4 to T3, then T4 is useless for you. In fact, at times your T4 level may be higher than normal, yet you still have all the symptoms of thyroid dysfunction. Sometimes your doctor may give you increasingly higher doses of T4 without making any difference to your symptoms. Such patients need further tests and workup before another treatment can be initiated.

MISCONCEPTION FOUR:

T3 IS THE ALTERNATIVE TREATMENT:

T3 may be the alternative type of treatment. However, if the thyroid receptors are already occupied and blocked, then T3 may also not work effectively.

MISCONCEPTION FIVE:

T3 BINDS TO THE THYROID RECEPTORS:

This is true. However, T3 and reverse T3 both can bind to the thyroid receptors. In fact, reverse T3 may take preference over T3 when it comes to binding the receptor. Reverse T3 is also an inactive form of thyroid hormone. So if you have high levels of reverse T3, then the situation is even more complicated. We need to find out why your reverse T3 is high.

MISCONCEPTION SIX:

T3 IS EFFECTIVE WHEN T3 LEVELS ARE FOUND TO BE LOW:

This may be true. In some cases, however, T3 levels are found to be high and still there is no response to treatment. This is because the blood test routinely done to measure T3 does not discriminate between T3 and reverse T3. You may not respond to T3 replacement if most of your T3 is actually reverse T3. This makes thyroid replacement therapy more complicated.

MISCONCEPTION SEVEN:

TYPICAL THYROID SYMPTOMS ARE ONLY DUE TO THYROID DEFICIENCY:

In complicated situations with high rT3, other glands need to be monitored. They affect thyroid function. We may need to treat other glands (adrenal glands for example) even before treating thyroid deficiency.

MISCONCEPTION EIGHT:

DESICCATED THYROID EXTRACT COULD BE PRESCRIBED WHENEVER A PATIENT HAS TYPICAL THYROID DEFICIENCY SYMPTOMS:

If you have never been on any kind of thyroid replacement therapy or you are a good responder, then desiccated thyroid extract may be initiated right away. However, if you are one of the resistant or non-responding patients or have other underlying causes for your symptoms, then you will need to go through certain tests and evaluation before substituting your therapy.

MISCONCEPTION NINE:

PROVINCIAL HEALTH INSURANCE COVERS EVERYTHING :

The doctors who practice an integrative approach to treatment do so because of their professional quest to treat the complicated health issues of today to the complete satisfaction of their patients. They see how frustrated patients can be when their symptoms are often not relieved with conventional medicine alone, and they have been equally as frustrated with limited testing and time resources. These doctors believe that you need an understanding of what is happening to you, and how and why it is happening. This takes time, patience, interest, extra staff and extra tests. Provincial insurance does not cover these extra costs, so the doctors opt out of provincial insurance so that they may carry out proper assessment, testing, and treatment. This is why integrative doctors are not covered, although some insurance carriers are now reimbursing patients for some of the costs.

We hope that this article has helped to clear up some of the confusion that some people may have about the complicated issues of thyroid function and treatment. Please feel free to drop us an email or give us a call at the clinic if you have any questions or concerns.

Amtul Q. Farhat