How Does Thyroid Disease Work?

There is no question that an abnormal thyroid can lead to weight gain. The thyroid gland, located at the front of the neck, affects nearly every body system including metabolism. When too little thyroid is produced, metabolic rate slows, leading to weight gain in many people affected by the condition.

However, most overweight people have a normal functioning thyroid gland. We routinely check thyroid levels to ensure it is working but find that, as other studies suggest, fewer than 5% of overweight people have an unrecognized thyroid disorder. Also, those who have gained weight as a consequence of an abnormal thyroid are discouraged to learn that “fixing” the thyroid through medication does not reverse the weight gain.

At the Lindora clinics we include thyroid tests in a patient’s standard lab. These are reliable, well-accepted screening tests.

The American Association of Clinical Endocrinologists and The American College of Endocrinology, the two largest organizations of physicians and researchers in the U.S. dedicated to the treatment of hypothyroidism, do not recognize saliva, tongue scraping, or axillary temperature tests as indicative of thyroid disease.

There are four important questions to ask about this:

1. Why don’t traditional doctors use these alternative tests but insist on sticking to TSH as the gold standard?

Answer: Doctors who either refuse to use these alternative tests or just do not give someone a diagnosis of hypothyroidism are often labelled “bad doctors” by disgruntled patients, presumably because they were not bright enough to make an accurate diagnosis or were too stodgy to adopt “new” diagnostic procedures that nearly always give a positive diagnosis.

But there is a very good reason that they continue to rely on TSH–it simply is the “best” test. Best can be defined as a combination of most sensitive (those who have a positive test actually have the condition) and most specific (those who have a negative test actually do not have the condition). There simply have been no studies showing validity of the alternative tests. In fact, these tests have extremely LOW sensitivity, giving the impression that many more people have the condition than actually do (known as “false positives”). Among physicians, there is a real interest in discovering an effective, inexpensive, and quick test like any of the above. TSH testing is expensive (about $50 each, compared to $8 for a complete panel).

2. Why, then, do alternative practitioners rely on the alternative tests?

Answer: Alternative practitioners have a lot to gain personally by using a test with a high false positive rate. They can pull people into their treatment regimen by creating a condition that doesn’t really exist. They can sell them stuff–books, nutriceuticals, or remedies.

3. Don’t people usually feel better after taking thyroid?

Answer: Yes, most people (especially women) do feel better after taking supplemental thyroid. In the 50’s and 60’s, thyroid was among the most commonly dispensed medications in weight loss clinics (it continues to be in Mexico and other countries). It can increase metabolism and increase weight loss. But feeling better does not always equal becoming healthier.

4. So, if it doesn’t do any harm, why not prescribe thyroid to those with normal TSH levels?

Answer: First, supplemental thyroid can do harm. Studies have shown that, when thyroid is taken by people with normal thyroid function, weight loss is due to muscle loss more than fat loss. Also, a feedback loop to the thyroid decreases it’s own natural production.

Thyroid is rarely a significant cause of weight gain. More disappointing is the minimal effect on weight loss once thyroid medicine is begun. One study showed an average weight loss of just 8% of the excess weight after taking thyroid medicine; this means a person who’s gained 100 lbs. would lose just 8 of those 100 after the thyroid is under control.

So look at everything else in your life that you can control -diet, exercise, stress -while continuing to work with your doctor on finding the correct thyroid medicine and dose for you.