Wellness Letter: Medical News

April's Story — Is Her Thyroid to Blame?
By Jannet Huang, MD, FRCPC, FACE

April has been feeling very lethargic and has noticed more hair in her comb after her shower lately. She just doesn’t feel like doing much of anything, even things she used to think were fun. She is worried that her thyroid is low, but her doctor told her everything was fine at her last check-up a year ago. April has been feeling so slow that it is becoming increasingly more difficult to exercise. She tells people that she has gained weight because her metabolism changed. The reality is she stopped going to the gym, to tired and too self-conscious about her body to go. She keeps telling herself she would start doing the yoga tapes that she bought months ago, but that just hasn’t happened yet. If only she wasn’t so exhausted all the time! Even though she’s sleeping more than 10 hours a day, she wakes up tired and achy and unmotivated…

April is certainly not alone in her predicament of lethargy, weight gain and hair loss. Quite a few women experience similar symptoms and long to find answers. Even though all of the symptoms listed here can be due to an underactive thyroid (hypothyroidism), these symptoms are nonspecific and can be caused by a number of different issues in her endocrine system. It is simple to blame the thyroid, but for most women like April, taking thyroid hormone supplementation by itself does not relieve all the symptoms. The whole person approach at The Center for Optimal Health is just the right approach to assist April in restoring her health and vitality.

At The Center for Optimal Health, April will benefit from the expertise of an integrative medicine team to thoroughly evaluate her whole person. When she meets with our Endocrine Nurse Practitioner Sue Kim-Saechao, she will get lots of time and personal attention. Her concerns will be carefully listened to. I will join April and Sue to discuss her issues and make plans together for investigations. In April’s case, there are a few points Sue and I will explore:

• Iron deficiency is a common cause of hair loss and lethargy as well as cold intolerance, even dizziness in women. Ferritin level is one of the lab tests that is used to evaluate the iron stores. Low ferritin levels may compromise optimal thyroid function as well.
  
  
• Anti-thyroid antibodies represent an important test to detect the autoimmune condition – Hashimoto’s thyroiditis.
  
  
• The laboratory normal range for thyroid function screening test TSH (Thyroid Stimulating Hormone) is too wide. When a person’s TSH is higher than 3, they are more likely to develop overt hypothyroidism.
  
  
• Sleep apnea and restless legs syndrome are fairly common causes of daytime fatigue. She may need to be referred to a sleep lab for an evaluation.
  
  
• Keep in mind that stress and sleep deprivation can lead to fatigue and abdominal weight gain. Stress can also lead to hair loss! An evaluation by Dr. Stephanie Buehler, Center health psychologist, may help determine how April copes with stress. April can learn guided imagery, biofeedback, relaxation, and other techniques.
  
  
• Insulin resistance leads to abdominal weight gain. Many women with insulin resistance experience reactive hypoglycemia which can lead to lethargy and “brain fog”. The Center dietitian can help adjust April’s diet.
  
  
• Hormonal causes should be considered: Perimenopause can be associated with abdominal weight gain as well as hair loss. Excess male hormones (androgens) can be the culprit for hair loss (and excess facial / body hair). Only careful laboratory evaluation of April’s hormonal levels can reveal if she might benefit from hormonal therapy.

These are just a few of the issues (among the many) we consider when we work with April to attempt to resolve her symptoms so that her quality of life can be restored. For many women like April, there is not really one single problem that explains everything. By optimizing several aspects that are out of balance, we achieve the best results. In our interaction with April, we continue to emphasize that her symptoms need to be addressed with a holistic approach: nutrition, exercise, stress reduction, adequate sleep, evidence-based vitamin/herbal supplementation and appropriate medications. This is exactly the reason based upon which our integrative team was created at the Center.

—April 2006

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