Dr. Rebeccah Shalev,

Naturopathic Medical Doctor

Do you feel cold all the time? Or even just cold in your hands and feet? Hypothyroidism can be one of the most common causes of both. Other typical symptoms of low thyroid hormone are fatigue, brain fog, weight gain, depression, hair loss, thinning outer eyebrows, dry skin and constipation.

Many people go undiagnosed (or under treated) with hypothyroidism for a number of reasons. Most important is the reliance by most doctors on TSH (Thyroid Stimulating Hormone) alone to diagnose and monitor hypothyroidism. TSH is not actually a thyroid hormone -- it’s a pituitary hormone. I like to describe it as a measure of how loudly the pituitary gland is yelling at the thyroid gland to make more thyroid hormone, and many things can affect it’s level. Menopause, taking thyroid medication that contains T3 (such as natural dessicated thyroid), and pituitary dysfunction can all falsely lower the TSH number, making someone appear to be in the normal range when they are actually hypothyroid.

Another common cause of hypothyroidism also lies outside the thyroid gland and may not affect the TSH test. In response to the production of TSH by the pituitary, the thyroid gland produces T4, which is actually still a precursor hormone. It must then be converted to T3, and this happens in every cell of the body (but primarily in the liver). T3 is the active end product of thyroid hormone, and it’s this hormone that most determines your SYMPTOMS of hypothyroidism. Estrogen can interfere with the activation of T4 into T3, which helps to explain why this problem appears more frequently in women than men. Other factors that can also block this crucial conversion are inflammation, insulin resistance, high stress hormones, liver dysfunction, and various nutrient deficiencies. Many women who have a normal TSH level are still suffering from symptoms of hypothyroidism because of suboptimal conversion of T4 to T3.

How do we tease out these cases of hidden hypothyroidism?

Step one is to run thorough lab tests. I like to start with not just TSH, but also Free T4, Free T3 and Reverse T3. This gives me a good idea of not just IF there is a problem, but WHERE it’s coming from. I also like to screen for thyroid antibodies so we can see if your immune system is attacking your thyroid gland. The good news is that if you have insurance, these labs are usually all covered and if you don’t have insurance, they are relatively inexpensive to pay for out of pocket.

Step two is to begin individualized treatment. Based on the lab results that come back, I start some people on thyroid replacement hormone right away. This can mean Natural Dessicated Thyroid (like Armour or Naturethroid), pharmaceuticals (like Levothyroxine and/or Liothyronine), or compounded medications (in any combination of T4 and/or T3 we want to have made for you). In other cases, sometimes the labs show me that the problem is based in an autoimmune attack on the thyroid, a sluggish pituitary gland, or something blocking the T4 to T3 conversion. If we can address the root cause of the imbalance in YOUR body, sometimes we can reverse the problem at its source and you may never need to go on thyroid meds at all!

Dr. Rebeccah Shalev specializes in a whole-body approach to hormonal balancing. In addition to treating conditions such as menopause, PMS and PCOS, she rocks at hypothyroidism and insulin resistance! Using Naturopathic and Functional Medicine, she can help find the root cause(s), and help you to correct the imbalance. She uses advanced labwork, herbs, homeopathy, dietary and lifestyle counseling, detoxification, bio-identical hormone replacement (BHRT), glandular support (e.g., Natural Dessicated Thyroid), and/or pharmaceutical interventions, and can tailor her approach to your preferences. She is currently accepting new patients at Labrys Healthcare Circle. Call 510-859-8460 for appointments with Dr. Shalev.