Frequently Asked Questions

Thyroid and Hormones

The thyroid gland and what can go wrong when it is low


Here are examples of what the thyroid will cause when it is low

What does the thyroid look like when it is low in function?


What should I do if I suspect that my thyroid is low?

What is Hashimoto’s disease?

Who is a candidate for thyroid replacement?

What are the symptoms and signs of low thyroid?

What are the general replacement practices of most doctors?


Why do doctors not use T3?

What is Dr. Paoletti’s approach to thyroid replacement?

What are the side effects of thyroid replacement?

What can I expect when my thyroid is corrected?




The thyroid gland and what can go wrong when it is low:
The thyroid gland is an import endocrine gland at the base of the neck. The thyroid is responsible for the metabolic rate of the body. Many consider it the master gland of the body. Without it, none of the other hormones functions well. It is important to the function of all of the systems of the body.
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Here are examples of what the thyroid will cause when it is low:
When the thyroid is low, the nervous system does not function well, your thinking is unclear, and the hearing becomes poor. The skin becomes dry and rashes occur. Your sinuses become more inflamed and because of the constant drip into your lungs may cause recurrent bronchitis. The gastrointestinal system depends on the thyroid gland and will not function well without it. Constipation soon develops and with it, gas develops. From the constant pushing, hemorrhoids and bleeding soon follow. The cardiac system is also dependent on the thyroid. Too low of thyroid will leave you with a very slow heart beat. If the deficiency of thyroid is allowed to continue, you will even develop irregular beats in severe cases. Swelling of the lower extremities, (your legs) will occur especially in the front of your lower leg bones – called pretibial edema, usually accompanied by a rash in this region. One’s reflexes and movements become slower due to the nervous effects of the low hormone. The fatigue is severe and sleep and rest become essential all of the time. Depression often arrives with the onset of the problem or becomes worse if it already exists. The production of blood by the body is affected and one develops anemia – a low blood count. The ability of the blood to clot can also be affected in severe cases. The liver also will be inhibited from performing its function well. Often we see a yellowing with low thyroid, which is a manifestation of a build up of bilirubin - a waste product of red blood cells in the blood when they disintegrate. Ones ability to hold onto to sodium, a vital mineral is also lost when the thyroid is low. This leads to weakness with standing and a whole host of other metabolic problems – particularly in the brain where a foggy sense of lack of focus is apparent. Problems with the menstrual cycle occur in great frequency with low thyroid either too many or too few. Periods are also very painful and heavy when they occur. Finally the cholesterol will be elevated with low thyroid contributing to plaque and atherosclerosis.

Most of the symptoms that are mentioned above are the extreme cases of low thyroid. I mention them only to illustrate the importance of recognizing a truly low thyroid condition before some serious condition such as an arrhythmia – a fast irregular beating of the heart can occur. Usually only those who ignore the problem or struggle to treat a true thyroid deficiency in a non-medical fashion can possibly develop these problems.

I remember a case when I was taking care of an older woman whom everyone had expected to die soon because of a dangerous arrhythmia (a life threatening irregular heart beat) that was resistant to any treatment or medication. I was told that all of the tests had been done on the woman. It was felt that she would not leave the hospital alive. When I, a new intern, arrived on the ward, I asked permission to run a complete evaluation on the patient. When I did so, I discovered that her sodium were very low. I ran a thyroid screen and discovered that she was almost devoid of thyroid! When we replaced – gave her the thyroid hormones artificially – that she was missing she recovered immediately. Her cardiac function returned and the life threatening arrhythmias disappeared. The embarrassed but grateful cardiac team sent her home in less than two weeks.
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What does the thyroid look like when it is low in function?
When it is low in its function, the thyroid often enlarges and you can sometimes see it or even feel it when you swallow. Occasionally some individuals can tell that they have an enlarged thyroid from comparing old photos. In the absence of weight gain, an enlargement of the neck indicates a thyroid problem.
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What should I do if I suspect that my thyroid is low?
Doctors usually replace thyroid when its function is low since it is destructive to allow one to be low for long periods. The thyroid can be considered as one of the most important glands of the body. When it is not functioning, properly none of the other hormones works properly (see above). If you suspect that you have a low thyroid or have been diagnosed with one, it is beneficial to consider replacement – the taking of medication that is identical to the thyroid hormone that the body makes – to replace the deficiency.
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What is Hashimoto’s disease?
The most common form of low thyroid is Hashimoto’s disease, a disease where thyroid antibodies, proteins that attack the body’s healthy thyroid tissue, are present. When present, they slowly destroy parts of the thyroid and cause it to loose function. Even when your thyroid function is normal at the laboratory, the brain may have to send much more of a messenger, thyroid-stimulating hormone (TSH), from the brain in order for the thyroid to work well at all. When this happens, individuals often feel the strain of this disorder long before the lab values become what most doctors consider clinically abnormal. This is why when you test your hormones; the whole answer cannot simply come from looking at the paper results. The real decision of whether someone needs replacement depends on how someone feels.

Graves’ disease is the opposite of the Hashimoto’s disease. With this disease, you will have high thyroid hormone level. Symptoms of this disorder frequently are rapid speech, fast heartbeats, excess body sweating, and high persistent anxiety - even paranoia. If you have or suspect you have this condition, it could be or become life threatening and you should seek help immediately. Replacement is not for you!

On occasion, individuals experience extremely low thyroid levels and yet do not have thyroid antibodies. Under normal circumstances, this is usually from some acute or chronic illness and can be addressed with supplements and dietary changes. Soy, as well as other foods when present in excessive amounts, is capable of causing a low thyroid and often stopping the offending substance will correct the problem. When no apparent reason can be discovered for the low thyroid, and it is persistent and debilitating, replacement can be a consideration.
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Who is a candidate for thyroid replacement?
Anyone who demonstrates symptoms of low thyroid and has Hashimoto’s should consider replacement. Thyroid is a natural hormone and is a relatively small protein that we can now make in the identical form that the body creates. Its replacement is not associated with side effects unless the replacement is excessive. That is why the levels must be checked often, especially initially to assure that the levels are accurate.
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What are the symptoms and signs of low thyroid?
Low thyroid symptoms and signs include cold hands and feet, chronic fatigue, poor exercise tolerance, mental slowness, slow speech, constipation, the wearing of warm clothes when others do not, general aches and pains, hair loss, dry skin, chronic sinus problems, recurrent bronchitis and even depression. Other signs that the low thyroid state exist are the enlarged thyroid, dark circles under the eyes, puffy eyes, slow pulse, slow speech, and elevated cholesterol. Finally, a history of irregular, heavy, or extremely painful menses is often caused by a sub clinical low thyroid - a condition of thyroid disease, which is accompanied by just borderline levels of thyroid hormone.
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What are the general replacement practices of most doctors?
Many women while on thyroid treatment receive the wrong hormone replacement. They lack balance, the correct hormone balance, and continue to experience the symptoms of low thyroid – fatigue, dry skin, constipation, memory loss, mental slowness. Paradoxically, they often feel edgy and low at the same time. This is because most doctors only replace the thyroid hormones with levothyronine(T4) (Synthroid, Levoxyl, or generic levothyroxine). Ignored is the other natural hormone, triiodothyronine (T3), which often is the only hormone that can provide you with relief from your hypothyroid symptoms. It really is the actual ACTIVE thyroid hormone in the body.
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Why do doctors not use T3?
In nature, T4 often is converted into T3 so doctors feel that it is not necessary to replace both hormones. However, in nature, many people’s bodies cannot convert these hormones. Often conditions such as depression, medications, certain foods, lack of sleep, or just genetics prevent this normal conversion. This results in a deficiency of active thyroid (T3). These individuals then experience the symptoms of hypothyroidism even in the presence of their replacement T4. This is why they can be on adequate levels of Synthroid for instance and fail to feel better.
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What is Dr. Paoletti’s approach to thyroid replacement?
Dr. Paoletti, will take the time to sit down with you and review all of your history, your previous labs, your current symptoms, your medicines and supplements, and your current desires. If you exhibit signs and symptoms of low thyroid, Dr. Paoletti, will retest you at her labs to establish if you are abnormal. Dr. Paoletti takes special care to test your hormones in a way that will show any imbalances that can arise. She uses a lab that she has carefully screened for accuracy and sends only certain tests the Free T4, the Free T3 and the TSH levels. All three must be in the proper balance before one can feel normally energetic again.

Following your history, the doctor will examine you for signs of thyroid deficiency. Many of the signs have nothing to do with the thyroid itself. In women, cycle irregularities can indicate this problem as do skin and hair problems. Dr. Paoletti also examines you to determine if you may be exhibiting signs of low thyroid.

Following the history, review of labs, and exam, Dr. Paoletti will again sit down with you and review the findings, and discuss the mutually agreed-upon plan. This usually includes, starting on thyroid medication and returning in about two to four weeks to check blood levels of your new hormones. The timing of this will depend on whether you have been on medication before, your current levels and the degree of discomfort that you are experiencing.

If you have not had a thyroid scan (an ultrasound study to see the contents of the thyroid) to rule out the presence of nodules, one will be ordered. It is important to order this because the occasional presence of thyroid disease can cause thyroid nodules – masses – that are either precancerous or cancerous. This study will detect this so that you are sure that you have nothing else to worry about except just replacing the thyroid.
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What are the side effects of thyroid replacement?
Since thyroid hormone as it is available now on the market is the exact replica of the thyroid found in the body. If it is replaced with the proper dosage, there should be no side effects. Problems arise when it is replaced either inadequately or in excess. When this is the case you will experience the dangerous side effects mentioned in the first part of this section. To avoid this, levels of thyroid hormone should be monitored very carefully, especially initially. Often the alteration of other hormones such as estrogen, the birth control pill, or other hormones can change the concentrations, thus again close monitoring is important.
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What can I expect when my thyroid is corrected?

When the thyroid hormones are replaced correctly, the symptoms of low thyroid, which are described above disappear. You will find that you have you old energy back and in particular, the chronic sinus problems that often bother women with the low thyroid will disappear. If heavy, painful periods have been your experience, they too will most likely be reduced also. Cholesterol levels improve and your mental acuity will sharpen as will your memory. Lastly, on occasion, depression that is either caused or exacerbated by the thyroid problem eases or now responds to antidepressant medication, which previously may have not worked at all.
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