Interview with a Thyroid Expert
Dr. Nancy Evans
N.D
N.D
Thanks again for agreeing to take the time out of your busy schedule to answer my interview questions for my blog. Your expertise is so important to educate people around the world about Thyroid problems. Not only I’ll reach English readers in the US, but my blog is translated into Spanish.
For my audience that doesn’t have too much information about the Thyroid gland, I’d like to ask you the following questions:
For my audience that doesn’t have too much information about the Thyroid gland, I’d like to ask you the following questions:
1. Can a patient have a normal range of TSH and still have symptoms of Hypothyroidism?
Typically with overt hypothyroid patients, the TSH is a relevant test to diagnose hypothyroidism. However, the “normal range” includes 95% of the population, and most doctors will only treat those that are truly out of range. High/normal TSH values usually indicate clinical hypothyroidism. More importantly, however, the values of Free T4, Free T3, Reverse T3, and thyroid antibodies must also be evaluated to accurately diagnose a patient with hypothyroidism.
2. Is it important to be tested for Free T4, Free T3, and RT3, and why?
Free T4, Free T3, and Reverse T3 will accurately indicate the amount of thyroid hormone that is actually circulating in the bloodstream. TSH is only an indirect marker, indicating the indirect signaling of the pituitary to the thyroid gland. Metaphorically, TSH is like staring at the smoke alarm, while free T4 and free T3 actually indicate whether there is actual fire and smoke. Reverse T3 will indicate whether T4 is adequately converting to T3 or not, and able to get into the cells.
3. Do you consider it important to take T3 medicine for patients that have problems with converting from their T4 to Free T3, or have high RT3 levels? If so, can you explain a little bit as to why?
T4 is the bound thyroid hormone, while T3 is the free, available thyroid hormone. Many patients do fine of T4 (Levothyroxine, Synthroid) and convert is adequate to T3. However, many patients take T4 only, but still feel symptomatic, because they have not converted the bound hormone (T4) into the active hormone (T3). Our human bodies produce about a 4:1 ratio of T4:T3, so many patients need that same sort of ratio in order (adding in T3 to their treatment) to resolve their symptoms.
4. Can you explain please, what role RT3 plays in evaluating the thyroid’s function according to your experience? And how do you treat patients with high RT3 levels?
T4 converts to T3 or RT3. RT3 is the completely inactive thyroid hormone, like having a foot on the brakes. Often patients are given T4-only medication, and even at higher dosages, feel no improvement. In these cases, the RT3 is often quite high, indicating the need for less T4, and more T3 to appropriately treat their condition. Before we conclude, I want to briefly discuss a few health questions. I’m hoping my readers can make lifestyle changes that can positively affect their thyroid health with some of your answers.
5. Are chemicals, pesticides, hormones in food, deficiency of iodine, vitamins, and minerals negative factors to having and maintaining a healthy thyroid? Is there any validity to the importance of eating Organic?
No matter what disease state we’re talking about, everyone must address and optimize their diet. Proper nutrition with adequate nutrients found in organic, clean, grass-fed meats, vegetables, and whole foods is necessary for optimal health in everyone. Any health protocol must address diet if any improvement is desired.
6. Lastly, are there any final comments you would like to give my readers who might be suffering thyroid issues?
It is important that all patients seek out a medical practitioner who listens to their symptoms and is willing to address and change the protocol until the patient feels well. All doctors should be on the side of the patient, prioritizing clinical outcomes over lab values. I have no explanation for why any doctor would not be wanting to prioritize the health of their patients! Last Thoughts: I want to share with you a metaphor I use: The thyroid is only an instrument in a full orchestra where the rest of the instruments are the other organs, glands, and hormones in the body. If some of them are not working properly, we are not going to make beautiful music.
