Dear Dr. Roach: I was diagnosed with hypothyroidism many years ago and have since been put on Synthroid. Since I am extremely healthy other than this issue, is there any chance I can go off Synthroid ever? Are there any changes I can make on my own or holistically?
R.P.
Most cases of hypothyroidism that are diagnosed during adulthood are due to an autoimmune disease called Hashimoto’s thyroiditis. In this condition, the body attacks the thyroid gland, initially causing high thyroid levels, then leading to a slow decline in the thyroid level. This causes classic symptoms of fatigue, intolerance of cold, weight gain, dry skin, constipation, and many other nonspecific symptoms that can make the condition go unrecognized. Thyroid replacement, such as Synthroid, reverses all of these symptoms over time.
In most people with autoimmune hypothyroidism, the thyroid gland becomes fibrosed, and the gland simply cannot make thyroid hormone. In these cases, going off of the thyroid replacement is futile. The gland won’t start working again, and symptoms will return if you try.
In well-done clinical trials, a minority of people with low thyroid levels will be able to return to normal thyroid functioning with a slow taper of the thyroid replacement (about 1/3 in a recent review of available trials). Most thyroid experts recommend against this, but some physicians will have patients try it under careful supervision of both their symptoms and their thyroid blood tests.
A brand-new study found that deficiency in the mineral selenium worsens hypothyroidism, and selenium replacement can improve the thyroid hormone (TSH) level. Selenium deficiency is quite rare in North America and more common in Europe and Asia. But I don’t think selenium replacement will make it more likely for you to stop taking your thyroid replacement therapy.
“Holistically” means keeping all of the aspects of a person in mind: their physical, mental, spiritual, emotional and intellectual well-being. It’s how all caregivers should treat their patients.
Dear Dr. Roach: I have been reading books and articles on insulin resistance and metabolic syndrome. So, I have been trying to lose weight and get my insulin level down a bit. I also have fatty liver disease and your typical beer belly, but I don’t drink any liquor. My primary care doctor is kind of “old school” and is not inclined to focus on insulin level, yet I think insulin resistance is important. How do I navigate this?
D.D.
Metabolic syndrome has different definitions depending on the expert group, but it generally consists of two or three of the following factors: insulin resistance (defined by abnormal glucose levels); abnormal lipid levels (low HDL levels and high triglyceride counts); obesity (defined by waist size, not by BMI); and elevated blood pressure. All of these risk factors increase the risk of heart disease.
Measuring insulin levels is not typically done, except in clinical trials. The goal is to improve these parameters, and an improved diet and regular exercise are the keys to improving them. In some circumstances, medications may also be useful. Metformin, for example, reduces insulin levels, tends to help with weight loss, and has been proven to prevent or at least delay diabetes. Still, the key trial on diabetes prevention found that adherence with a good diet plan and regular exercise was even better than medication.
Fortunately, the key behaviors to reduce insulin levels are the same ones that will lead to overall improved risk factors, so I don’t think the advice you have been reading and the advice from your old-school doctor are really at odds.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
