Hashimotos And Graves
Hashimoto's and Graves are really two sides of the same coin. Both are autoimmune with the primary attack on the thyroid gland; both cause misery. Graves is always a hyperthyroid result and Hashimoto's mainly hypo with bouts of hyper.
For a doctor to rely on TSH alone or TSH with T4 and T3 alone in diagnosing and monitoring thyroid treatment is just mismanagement. TSH levels can vary greatly from day-to-day making it completely unreliable for treatment plan assessment; and this variation in TSH levels can happen without any treatment whatsoever.
So, in people with Hashimoto's, their TSH will go up and down, up and down, up and down, unrelated to any treatment because when the immune cells are attacking the thyroid, there's the release of thyroid hormones in their bloodstream and that release of thyroid hormones into the bloodstream then suppresses their TSH. So, depending on which day you test the patient, they may look like they have a normal thyroid.
This is how improper testing leaves a patient misdiagnosed, mismanaged, and just plain miserable! YOU have to take responsibility for your own health and find a doctor who will work with you until the answers are discovered. There is always a cause to an effect, always a reason for a symptom; there is always a reason 'why', you just haven't yet found someone to help you figure it out.
Angela's Story
Angela, a seventeen year old senior in high school has suffered her share of teenaged teasing. She started gaining weight in sixth grade and no matter what she has done to stop the process, the pounds have been adding up. Her mother and she have been in Weight Watchers 3 times, she's tried Jenny Craig, joined a gym and even joined the school's cross-country team, all leaving her discouraged, exhausted, and shamed. She has learned to live with her problem and excels in mathematics. She hopes to be a teacher some day. Angela's parents are divorced and her mother partly blames her failed marriage on her daughter's weight problems. She has taken Angela to the medical doctor but the simple and incomplete blood tests performed were "normal" and more shame was piled onto the heap of a stressed physiology.
Midway through her senior year, Angela's mother was referred to a functional medicine doctor who ran a more complete thyroid panel, including TSH, T4, T3, reverseT3, T3 uptake, and thyroid antibodies. Suspecting an Autoimmune thyroid from the symptoms alone, the doctor also ordered a fecal parasitological test and stool and gene testing for soy, gluten, egg, casein, and yeast. The testing was expensive but the doctor seemed confident and Angela and her mother were ecstatic just to find someone who would take a thorough assessment of her situation.
It's cases like this where I tell my patients that we HOPE something in the tests come back positive. We need to know what is going on in order to treat the patient. Discovery, the preparation before the battle, is the secret to winning the battle. While I was in college and professional school, I 'earned a living' painting houses over the summer. I'd walk door-to-door in the older neighborhoods of the sleepy, rural, river town I grew up in and asked homeowners if they needed any painting done. I was never short of work; one hundred year old houses are in constant need of repair. I learned quickly that to do the job right did not mean I needed to just slap some paint on the chipping lapboard. There were at least a dozen coats of color over that four inch siding and preparation for a new coat would be the biggest battle. It was the preparation that was the hardest work. Scraping aged paint down to smooth wood bloodied my knuckles and cramped my fingers. It didn't take more than one under-bid job to realize that the preparation was going to take much longer than anticipated and cost me more than time.
I learned much from my summers of painting that equates to treating autoimmune conditions. Preparation is more than half the battle - you have to spend the time and money to discover the cause of the disorder. Dig until you find the gold!
Luckily for Angela, she found a doctor who never gave up. Her thyroid antibody test came back negative, which would indicate to most doctors that she was NOT autoimmune. But he knew that if she was autoimmune, Th1 dominant, her hyper-firing Th1 system would be suppressing the Th2 antibody production - she still may be a Hashimoto's patient, the digging didn't stop. Specific cytokine testing was ordered while they waited for the results of the stool antigen and gene tests. Sure enough, Th1 cytokines were elevated and a CD4:CD8 ratio was imbalanced; Angela is suffering from an autoimmune disease! That week the stool testing results came back and at least one antigen was identified - Angela was autoimmune gluten! She carried two gluten genes and they were both expressed (turned-on).
Finally some answers. A detailed plan of elimination, detoxification, and Th1/Th2 immune regulation could be undergone. Angela's doctor (and new best friend) made sure that further testing to determine the effect on other tissue was done so he could support every down-regulated system to give her the most comprehensive support possible and the greatest chance of success.
Angela and her mother had similar questions, concerns, and frustrations regarding their problem that we see from most patients: "Why didn't my doctor test for this?" "Why wouldn't anyone else believe me?" Believe me when I say that we've even had patients take their test results back to their primary care doctors to be told that they are crazy and the problem is all in their head. I've seen doctors even have the gall to write them a prescription for Prozac on the spot. What is wrong with these people!? It's like a painter slapping another coat of paint over chipping wood - it will look good at a distance but just another example of shoddy work.
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