How to Diagnose Hypothyroidism

Dr. Maupin and Brett Newcomb discuss how to how to diagnose hypothyroidism

Many doctors in their early training and in medical school were taught that if they gave thyroid medicine to their patients the patients would be more likely to have heart attacks and or arrhythmias. Some of them do not know that this thinking is outmoded and that thyroid should be replaced at optimal (or functional) levels and not just at minimum doses.

Low doses of thyroid medicine will work to shut down the patient’s thyroid, not to facilitate the functioning at optimal levels. It is also problematic when doctors only look at the lab sheet to determine if the problem is solved, they tend not to ask the patient about symptom relief. The lab results will say things are “normal” but the patient may well still be suffering from low levels of thyroid.

Doctors should look at and interview their patients, instead of just using a lab test to manage thyroid replacement. This is getting more difficult because doctors have less time face to face with their patients — reading labs is faster than talking with them. Doctors need to observe and ask the patient about their symptoms:

• Are cold all the time?
• Is their hair thinning on the top of the head?
• Are they losing their lateral eyebrows?
• Are they exhausted all the time?
• Do they suffer from water retention?
• Is their skin dry?
• Do they report their mouth is dry and cottony?
• Are they constipated a lot?

You can’t just look at the lab values! You have to talk to the patient.

People who live in the midwestern United States can suffer from an iodine deficiency which increases the tendency to develop goiters. Iodine deficiency also affects functioning of the thyroid. Iodine needs to be replaced if it is not present in the diet. We need to eat foods like kale, spinach and kelp or take an iodine supplement. It is important because without iodine, the thyroid won’t work. Without a working thyroid, women can’t get pregnant and they can’t regulate their body temperature and all the previously mentioned symptoms begin to occur.

Sometimes, if a doctor looks, they will see that the patients tongue is swollen and has the “ruffled potato chip” indentations because the teeth are cutting into the tongue. This is a visible sign of thyroid deficiency. The normal-range used on lab charts are not enough to go by, and the “normal” listed is based on healthy young men, not women. A normal for women has been established, but the lab sheets do not use it, so a physician cannot go by lab values alone in making a diagnosis of hypothyroidism.