Diagnosis of Hypothyroidism - Dr. Sarah Myhill

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Diagnosis of Hypothyroidism

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by Dr. Sarah Myhill
www.drmyhill.co.uk

Hypothyroidism is extremely common and very badly treated in this country. Its effects are insidious in onset and often mistaken for aging. It should be looked for in every patient with any unremitting symptom. I do thyroid function tests routinely in all my CFS patients.

Many of my patients come telling me that their thyroid gland has been checked and found to be normal. This just reflects how inadequate tests can be in picking up thyroid deficiency. Usually doctors simply check a TSH (thyroid stimulating hormone), which will only pick up primary thyroid gland failure. For many of my CFS patients the problem is secondary to pituitary failure and therefore the TSH will be normal. Too many doctors treat the laboratory, not the patient.

Symptoms of thyroid failure are:

weight gain
lethargy, inability to get fit
mental sluggishness (can progress to "myxoedema madness")
sensitivity to cold
heat intolerance
tendency to get recurrent infections
fluid retention
mood swings and depression
poor memory and concentration
hair loss - classically the outer third of the eyebrows
arthralgia (joint pain) and morning stiffness
skin problems and furunculosis (boils)
headaches
vertigo and deafness
hypoglycaemia (low blood sugar)
constipation
menstrual problems
pre-menstrual tension
digestive problems
infertility and loss of libido
feeling older than you are

Signs of hypothyroidism include:

puffy face and/or puffy eyes
cold hands and feet
dry skin, rashes, eczema and boils
enlargement of the tongue
hoarse voice or voice change
soft pulse or bradycardia
goitre (swelling at the base of the neck)
slowed Achilles tendon reflex
low basal body temperature (measure your body temperature first thing in the morning. If consistently below 36 degrees centigrade, suspect hypothyroidism).
and almost anything else!

Suspect hypothyroidism if blood tests show:

raised cholesterol (or abnormal fats)
macrocytosis - i.e. the red cells are too big
anaemia

Look for hypothyroidism with other diagnoses such as:

Chronic fatigue syndrome
Arteriosclerosis and heart disease
Cancer
Depression
Dementia
Muscle and joint pains

Furthermore, if one member of the family is affected, blood relatives are also at risk. I would screen for thyroid in all elderly patients.

Hypothyroidism must not be forgotten in children as a cause of failure to thrive or poor scholastic performance.

The test for hypothyroidism is to do a free T4, free T3 and TSH. This will pick up the majority of patients with thyroid problems. See tests of thyroid function.

Doctors Skinner, Peatfield and Lowe tell me that there is a small group of patients who have tissue resistance. This means that there is something wrong with the receptors so that they do not respond to normal doses of thyroxine. Therefore, they treat these patients with much higher doses of active T3 in order to make them feel well. So long as symptoms of thyrotoxicosis do not occur, I am told that this is a perfectly safe thing to do. However, I think it would be sensible to monitor ECGs and bone density to make sure one is not running into problems with long term toxicity. At present I do not have any patients that I treat with supraphysiological doses of hormones.

I diagnose hypothyroidism on the results of blood or saliva tests and confirmed by responses to a trial of thyroid harmony.

There are a few patients who do not feel well until their T4 is at the top of the normal range. So I find myself using thyroid hormones very often in fatigue syndromes.

Thyroid History is an excellent website with hundreds of experts from medical journals going back to the early 19th Century.

Also see www.thyroiduk.org

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