Citing the observations of the American Association of Clinical Endocrinologists, Dr. Daris Kharrazian points out that the majority of people with low thyroid function suffer from autoimmune thyroiditis or Hashimoto’s thyroiditis. When thyroid is prescribed to lower the TSH lab values, it does nothing to check the destruction of the thyroid gland by the immune system. In Why Do I Still Have Thyroid Symptoms, Dr. Kharrazian describes six distinct patterns of hypothyroidism:

1. Primary hypothyroidism exists with a true dysfunction of the thyroid gland. An elevated TSH can identify this pattern and supplementing thyroid will provide relief.
2. Secondary hypothyroidism will be caused by pituitary gland dysfunction. Watch for a TSH less than 1.8 and T4 less than 6. The causes include a very active stress response from the adrenals, postpartum depression and inappropriate use of thyroid hormone. The tissue eventually becomes resistant to the thyroid hormone and the pituitary/thyroid loop permanently lost.
3. Thyroid under conversion can be identified by low T3 and free T3 with normal T4 and TSH. This may be caused by high cortisol levels and chronic infection and inflammation of the cell membranes.
4. Thyroid over conversion of T4 to T3 with a corresponding low thyroid hormone binding globulin causes too much cell stimulation by T3 with eventual cell resistance. This occurs with insulin resistance in women, and thyroid symptoms resolve with improvement of the insulin resistance.
5. Thyroid-binding globulin excess is stimulated by birth control pills or excess estrogen replacement and binds up too much thyroid to no longer be available to the cells.
6. Thyroid cell resistance with normal thyroid and pituitary function may occur with high cortisol and high homocysteine. Addressing the adrenal function may resolve the resistance.

When autoimmunity is the issue, the treatment should be directed toward the immune system. Hashimoto’s is identified with testing for thyroid peroxidase antibodies. Thyroid peroxidase is responsible for thyroid hormone production. Thyrogloblulin antibodies may also be elevated.  The thyroid gland also uses thyroglobulin in the production of thyroid hormones. In the case of Graves’ disease, there are antibodies to thyroid-stimulating hormone (TSH).

Dr. Kharrazian suggests that testing be done for immune system markers. It is possible that a person be out of balance with either TH-1 (T-helper cells) or TH-2. For TH-1, cytokines such as interleukin 2, interleukin 12, tumor necrosis factor alpha and interferon are tested. The TH-2 indicators are interleukins 4,13,10. Based on these results, if a person is either TH-1 or TH-2 dominant, then the treatment is directed to supporting the less dominant area to bring the immune system back to balance. He recommends numerous nutritional interventions that may be done to restore balance.

Why Do I Still Have Thyroid Symptoms? is packed with information, research, and a refreshing look at ways to unscramble the barriers to relieving people of their hypothyroid symptoms.