Hypothyroidism and Hyperparathyroidism

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

Hypothyroid syndromes include both clinical and subclinical types. The term clinical refers to a classic clinical disease presentation, but developing thyroid imbalances of a subclinical nature are now recognized as more prevalent, and present a variety of milder symptoms that reduce vitality, contribute to infertility, and present serious future health risks. Early treatment of subclinical hypothyroid conditions is highly recommended, and Complementary and Integrative Medicine (CIM/TCM) provides an ideal holistic approach that is supported by an ever increasing amount of scientific study. Regaining the healthy homeostasis and euthyroid function should be the goal in all subclinical hypothyroid states, and if possible, in clinical hypothyroidism as well. Understanding these conditions is the first step in achieving this goal, and hopefully this long article and research links will help you deal with this difficult health problem.

While both presentations, clinical and subclinical, involve underproduction of thyroid hormones, clinical cases, indicating a defined symptomatic disease, involve alarmingly low levels of circulating thyroid hormones, while subclinical hypothyroidism may present as mild deficiencies or fluctuating thyroid hormone levels. The laboratory tests in subclinical hypothyroidism usually show high TSH (thyroid stimulating hormone secreted by the pituitary and stimulated by the hypothalamus glands in the brain) but normal freeT3 (active thyroid hormone not bound to a protein carrier) and freeT4 (inactive prohormone) in the circulating blood in subclinical syndromes. This indicates that most of these subclinical syndromes involve a central problem related to the adrenal-hypothalamic axis, or neurohormonal function and regulation. Sometimes problems at the peripheral receptors may present as normal TSH and T4, but deficient T3 and excess reverse T3. This indicates that many of these conditions involve a metabolic problem inhibiting conversion of T4 prohormone to active T3, a process that involves enzymatic iodine transfer.

Because the circulating thyroid hormone levels are relatively normal in subclinical hypothyroidism there is little risk in utilizing a course of safe treatments with Complementary and Integrative Medicine (CIM/TCM) to try to resolve the symptoms and improve endocrine health. Obviously, just relying on the use of synthetic T4 (levothyroxine or synthroid) is not the complete answer. Restoration of the thyroid function, and the whole thyroid system, often requires restoration of various aspects of the health, especially the endocrine, or neurohormonal, balance, and acupuncture, herbal and nutrient medicine provides an ideal therapeutic protocol for restoration of homeostatic balance and holistic metabolic concerns. Many different goals can be achieved with TCM therapies. Some understanding of this complex physiological thyroid system and its problems is important in therapy, both for the acupuncturist (TCM physician) and the patient, and this article provides some useful clinical information. Patients may choose to utilize CIM/TCM a little, or delve deeper for more complete restorative medicine. Holistic medicine in chronic systemic disease involves an array of choices, and the informed proactive patient must make these choices.

Clinical hypothyroid conditions present more of a risk to the patient, as well as more severe clinical symptoms. Thyroid hormones play a vital role in regulating metabolic rate and tissue maintenance. Lowered metabolic rates present a variety of symptoms that decrease health and vitality, and cardiovascular risk is increased with poor tissue maintenance, as well as the reduction in erythrocyte glutathione, a key antioxidant and cell detoxifier (see a separate article on Glutathione Regulation and the Importance of Maintaining Balance on this website). Since the endocrine system is a hormonal feedback system, any hormonal or neurohormonal imbalance may affect the entire system and contribute to other hormonal imbalances, and a variety of hormonal pathologies are seen in clinical hypothyroidism over time. For example, osteoporosis and infertility are two problems of hormonal imbalance that are highly associated with hypothyroidism. Most cases of subclinical hypothyroidism gradually worsen, and usually go unnoticed until this condition is suspected as the cause of another health problem, or because chronic anxiety, depression, and fatigue become a persistent problem. Gradual inexplicable weight gain may also herald a diagnosis of subclinical hypothyroidism. Subclinical hypothyroidism is rarely diagnosed until other related health problems occur, unfortunately. If we did screen and detect subclinical hypothyroidism early in its course, and integrated CIM/TCM with standard care by the M.D., many of these cases would not progress to a clinical hypothyroid state, and many comorbid health problems could be avoided. Clearly, if the thyroid gland itself is still producing a normal range of thyroid hormones the use of synthetic thyroid T4 prohormone could trigger a deficient production from the endocrine gland over time, creating a clinical presentation.

Usually, we only know for sure if this subclinical condition exists by testing for levels of hypothalamic pituitary thyroid stimulating hormone (TSH), which should be tested along with a full thyroid panel, including the active unbound thyroid hormones in circulation, freeT3 and freeT4, SHBG (sex hormone binding globulin), TPO (thyroid peroxidase antibody), and levels of the adrenal hormones cortisol, DHEAS, and testosterone. I repeat this basic testing protocol because today, most institutional doctors are not testing for these various hormone parameters, opting instead to test only the TSH, and cheating the patient out of a full and comprehensive diagnosis and analysis of their problem. This change in testing guidelines only came about after many Medical Doctors expressed concern that a large number of subclinical cases of hypothyroidism were not being treated with the safest and most effective strategy, utilizing Complementary Medicine (CIM/TCM). By limiting the testing to TSH alone, the question of what type of hypothyroidism the patient is experiencing is eliminated. Testing for active hormone metabolites in saliva and veinous blood stick samples may be a more accurate and revealing test than simple test of circulating blood levels today as testing methods have improved in this realm, and studies clearly show that a number of factors may affect the circulating level of TSH. What the patient must be aware of is the fact that to successfully treat their hypothyroidism, a clear diagnosis is important to guide therapy. While standard medicine takes a more cynical approach, that their only therapy is synthetic T4 hormone, or levothyroxine/synthroid, and so we don't need to make a clear differential diagnosis, many patients are now aware that there are many treatment options that can be integrated successfully into the therapeutic protocol, from Complementary Medicine, and a clear diagnosis is vitally important. Intelligent patients will take a more proactive approach and insist on a thorough and accurate diagnosis and discussion of all the treatment options.

In clinical hypothyroidism, thyroid hormones should be prescribed if the underlying condition cannot be resolved within a relatively short time frame. Since there are many potential causative factors in hypothyroid pathology, a holistic and thorough approach is needed with resolution of the underlying health problems. Synthetic thyroid hormone is almost always prescribed in standard medicine, but natural bio-identical hormones are finally gaining favor again, with the use of dessicated thyroid T3 showing much promise. This is an extract of animal thyroid hormone that is compatible with the human metabolism, and produces a bioidentical effect, with less side effects. One must search to find the M.D. with the knowledge to use this type of therapy, as most M.D.s are still guided by the wishes of the big pharmaceuticals to prescribe the more expensive patented synthetic medication, and use of natural T3, or a combination of T3 and T4, requires more attention and monitoring. Nevertheless, there are a growing number of M.D. endocrine specialists that are utilizing natural thyroid bioidentical hormone therapy, and work with an integrated approach that utilizes Complementary Medicine even when treating a more serious clinical hypothyroid condition.

Even with a clinical hypothyroidism, the degree of function in the thyroid system is important to long-term outcomes and quality of life. In 2006, and in follow-up printed in 2014, a large Mayo Clinic study showed that for patients taking a higher dosage of synthetic T4, or levothyroxine, greater than 125 mcg per day, these patients on followup after one year did not have a normal TSH in over 73 percent of cases, whereas patients taking less than 125 mcg continued to have a TSH in the normal range in over 90 percent of cases. Not only does this show that patients taking a higher dose need to have more monitoring and adjusting of the medication dose, but that there is a potential for improved health and less risk of hyperthyroidism and adverse effects if the patient could maintain an endocrine function that allowed for a low dosage of T4 levothyroxine. To see this study, just click here: http://www.ncbi.nlm.nih.gov/pubmed/24333203 . Complementary and Integrative Medicine (CIM/TCM) helps to restore hormonal balance, improve inflammatory regulation, and correct metabolic disorder that is at the heart of the thyroid dysfunction. Even if a natural euthyroid state cannot be restored completely, there is a potential for an improved hormonal homeostasis and decreased need for the pharmaceutical treatment, with adjusted dosage in relation to monitoring. As always, the first step is to get a thorough testing and differential diagnosis. Distinguishing the underlying causes and ruling out more threatening problems, such as cancer and nodular thyroid conditions, is important, and distinguishing the problems in the central axis, the thyroid glands themselves, and/or the peripheral thyroid metabolism is very important in designing the right individualized integrated treatment protocol.

Poor thyroid function is often related to a broad endocrine imbalance, develops gradually, and presents as a subclinical, or less threatening disorder. Complementary and Integrative Medicine (CIM/CM) offers an array of therapies, including acupuncture stimulation, herbal medicine, and nutrient medicine, that is backed by scientific study and is individually tailored to help restore thyroid and endocrine health. Such therapy may also help prevent thyroid dysfunction. Scientific studies that support these valuable integrative therapies may be accessed in the section of this article entitled Additional Information and Links to Scientific Studies.

In 1995, experts in thyroid disease from the University of Nebraska Medical Center conducted The Colorado Thyroid Disease Prevalence Study, where a cross-section of the public, namely 25,862 participants in a statewide health fair in Colorado, were assessed for symptoms, TSH levels, fT4 thyroid hormone levels, and lipid levels. The prevalence of elevated TSH levels in this population was 9.5 percent, indicating that nearly one in ten Americans may have a subclinical hypothyroid disorder, and the prevalence of a low TSH level was 2.2 percent, indicating a subclinical hyperthyroid condition. Among the patients already being treated and taking a thyroid medication, forty percent had an abnormal TSH level, indicating that standard treatment was insufficient to restore the endocrine health. Clearly, a more comprehensive and holistic treatment strategy is needed. More than twenty years after this landmark study, standard medicine still has not adopted the needed changes. The study also noted that elevations of TSH corresponded to changes in lipid levels that may affect cardiovascular health, and most cases of abnormal TSH did not produce symptoms that were alarming to the individual. Individual symptoms associated with thyroid disease were not a reliable indicator of disease, and often a number of symptoms were necessary to warrant the investigation of thyroid disease.

Numerous large population studies have been conducted since this landmark 1995 study, confirming a very high percentage of the populations with abnormal TSH levels. There has been little agreement worldwide on the implications, or even the definitions of differentiated thyroid disorders based on normal and abnormal TSH levels. The range of normal TSH is still controversial, and although studies show differences in the asymptomatic TSH levels with aging, the range of normal TSH has not been adjusted. A 2004 large study of the population in France (Valeix P et al: Annals of Endocrinology (Paris) 2004 Dec;65(6):477-86) found that among a representative population of 11,256 men and women, with patients previously diagnosed with thyroid disease excluded, that TSH levels of less than 0.4, indicating a subclinical hyperthyroid imbalance, were found in 7 percent of men, 5.3 percent of women aged 35-44, and 4.4 percent of women aged 45-60. The prevalence of subclinical hypothyroid imbalance as noted by a TSH of 4 - 9.9 was 11.1 percent of women aged 45-60, 7.2 percent of women aged 35-44, and 4 percent of men, with an additional finding of nearly 1 percent of the population with a TSH greater than 10 mU/I, among the general population not diagnosed with a thyroid disease or imbalance. These 2004 studies conclude that it is still unclear whether this high percentage of the undiagnosed public is experiencing a biochemical imbalance or dysfunction, or a traditional thyroid disease. The French study concluded that a significant percentage of patients with abnormal TSH were affected by iodine deficiencies or other environmental factors (see study links in the Additional Information section at the end of this article). Clearly, the prevalence of thyroid dysfunction is high in the populations of the United States and Europe. Preventive measures, such as an easy urine blot test for iodine level assessment, are now available, but rarely utilized. We see from these large population studies in the last decades that many millions are affected by thyroid system imbalance, with many related to iodine insufficiency, and that even with synthetic t4 prescribed, a high percentage of patients do not have the situation controlled, and are not really treating the whole disease and preventing future health problems adequately.

Today, most medical doctors in the United States only test the TSH, or thyroid stimulating hormone of the hypothalamus and pituitary. TSH (thyroid stimulating hormone), though, has a large diurnal variance, with normally low concentration during the day, and it increases during the evening by approximately 75 percent. In addition, pulsatile fluctuations in the TSH concentration occur throughout the day and night. Quality of sleep has been shown to affect the TSH levels as well. These pulsatile and diurnal fluctuations, and the potential of individual variance, as well as other health factors affecting the TSH level, make utilization of TSH levels alone to diagnose and treat thyroid disorders problematic. In addition, a number of medications, environmental factors, behavioral habits and stress syndromes are proven to affect this TSH level. Despite this knowledge, standard medical practice in the United States stubbornly tests only the TSH level today, ignoring the requirement of a more accurate and complete diagnostic workup. The only reason for limiting diagnostic testing to TSH alone is in response to the growing demand for more individualized treatment for the types of hypothyroid disease, which would include Complementary and Integrative Medicine (CIM), as standard medicine relies solely on synthetic T4, or levothyroxine, for all types of hypothyroidism. Basing diagnosis and treatment on a TSH level alone appears to be a cynical and reactionary approach. This treatment often comes with the recommendation to continue with synthetic hormone replacement for the rest of your life, and is sometimes prescribed inappropriately for subclinical cases. An attempt to first restore euthyroid, or normal thyroid, function is sensible. Getting past these general practices to an improved treatment of thyroid disorders will take a change of attitude, and this is not happening very fast.

Subclinical hypothyroid conditions reflect a broad imbalance in hormonal health that onsets gradually and without significant symptoms, thereby going unnoticed. They are often accompanied by a subclinical, or asymptomatic, hyperparathyroidism, and other hormonal imbalances. When the condition is discovered, it is usually because of routine laboratory testing, or because of generalized complaints of unusual fatigue and low energy. There is mildly increased risk of cardiovascular disease over time with subclinical hypothyroidism, and the patient should address this unhealthy state to avoid stroke and heart attack. Many patients seek a simple treatment and opt for a single pill, while others wish to treat the condition by restoring hormonal health with Complementary Medicine. This latter group finds that improved health is worth the time and effort required with the holistic approach. Since there is usually no immediate health threat, these patients have time to explore and understand the various array of improvements in health that are needed to restore thyroid function.

Women with subclinical hypothyroid conditions present with increased risk of cardiovascular disease, and over a 10-year period of time, increased mortality from heart attack, especially with aging, and with concurrent underlying cardiovascular risk, diabetic states, and autoimmune disorders. Heart attacks and cardiovascular disease is now recognized as one of the leading causes of death for women, and restoration of the homeostatic health and function of the thyroid system is very important in preventive medicine. Men did not show this increased risk of cardiovascular mortality associated with thyroid disease in studies, indicating that female hormonal imbalances were an important factor in associated health risks, and attention to the entire female hormonal balance is thus important to decrease future health risks. The most prevalent type of hypothyroidism for women is called Hashimoto's, a complex autoimmune disorder that may turn from a hyperthyroid state to a chronic hypothyroid state. Hashimoto's disease is also called lymphocytic thyroiditis, or autoimmune thyroiditis, and involves infiltration of lymphocytes (white blood cells such as T and B cells) into the thyroid gland follicles.

Estimates of the prevalence of Hashimoto's hypothyroid syndrome in women, compared to incidence for men, range from 2 to 1, to 20 to 1, female versus male. Often, other autoimmune disorders eventually occur in women with Hashimoto's hypothyroidism, such as Vitiligo, Sjogren's, and Lupus, as well as pernicious anemia, and these risks should be addressed in therapy as well. A full laboratory assessment should examine active metabolites of the sexual steroid hormones as well as the thyroid hormones, thyroid antibodies, cortisol levels, and even Vitamin D3 prohormone. The exact connection between the hypothyroid state and increased cardiovascular risk is still not known, although FSH has been shown to have a direct effect on the heart tissues and arterial linings over time. It could be that the same factors that lead to a subclinical hypothyroid condition also lead to an unhealthy cardiovascular state in women, though. The lesson to be learned is that the patient with these conditions needs to improve their overall health and take a more holistic approach to treatment. A more comprehensive treatment strategy is needed to prevent the disease from progressing to these other disease states, and Complementary and Integrative Medicine (CIM/TCM), in the form of a knowledgeable Licensed Acupuncturist and herbalist, is an excellent choice to integrate into your treatment team.

In recent years we have finally seen an acknowledgement that subclinical hypothyroid states are often induced by medications. A 2010 report by experts at the University of Colorado School of Medicine showed that a number of common medications are proven to either suppress TSH or lead to increased TSH and hypothyroidism. Glucocorticoids, dopamine agonists, statin drugs, retinoids and rexinoids are known to suppress TSH levels either at the hypothalamus pituitary complex or the thyroid glands themselves. Glucocorticoids are now a broad array of steroid drugs, with the most well known being prednisone and cortisone shots, but a wide variety of diseases are now treated with these medications. Dopamine agonists (receptor agonists) are now a broad class of drugs, the most well known L-Dopa prescribed for Parkinson's disease, but now many types are prescribed for a variety of neurological and psychological conditions, such as Restless Leg Syndrome. Statin drugs are of course prescribed for cholesterol excess. Retinoids and rexinoids are prescribed mainly for skin disorders and eye disease, but rexinoids are a new class of hormone receptor agonists used in cancer therapy. Anti-seizure medications (phenytoin), NSAIDS, blood thinners (warfarin), metabolic agents such as metformin, immune medications such as Interferon, and lithium prescribed for bipolar disorder are all common medications that may alter the thyroid system, either directly or competing for metabolism and blood proteins that bind and carry. In assessing chronic hypothyroidism and hyperparathyroidism, these medication causes must be considered, and since many medications are now found to negatively affect thyroid metabolism when used concurrently with synthetic T4, or levothyroxine, this too must be a consideration. To see this report from the University of Colorado School of Medicine, click here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784889/ . Studies have also found that relatively short periods of elevated TSH may induce hyperparathyroidism, as sell as chronic kidney dysfunction, and even agents that affect the metabolism and hormonal regulation of growth factors. Diagnosis and assessment of these disorders can become complex, but it is not helpful to jump to conclusions and dumb this down to generalized assumptions and a one-size-fits-all approach. It appears sensible to try to restore euthryoid function when possible with Complementary and Integrative Medicine, rather than live with these risks of drug-drug contraindications and long-term comorbidities.

Symptoms and Signs of Hypothyroid Pathology

Subclinical hypothyroidism, like clinical hypothyroidism, is seen predominantly in women, with onset between the ages of 30 and 60, and may now be seen in at least 7-10 percent of the population. Symptom presentation often shows anxiety, depression, problems with cognition and memory, episodes of heart palpitations, difficulty in losing weight and elevated total cholesterol, although absence of these symptoms does not rule out hypothyroid states. Hormonal imbalances are prevalent in subclinical hypothyroid states. For instance, 5 percent of women after birthing acquire a temporary thyroid inflammatory disorder that usually first presents as hyperthyroidism and then often turns to hypothyroidism. A substantial number of these postpartum hypothyroid cases will become permanent without proper care. Clinical hypothyroidism symptoms include fatigue, cold intolerance and chill, decreased ability to sweat, cool, dry skin, facial puffiness and sluggish movements. There is often a slowing of intellectual abilities and heavy menstrual bleeding, sometimes prolonged, called metrorrhagia.

Signs and symptoms of hypothyroid syndrome that are significantly more prevalent than in the normal thyroid population include dry skin, intolerance to cold, abnormal sweating, weight gain, coarse skin, puffiness, constipation, decreased bowel movements, numbness and tingling (paresthesia as peripheral neuropathy), cool skin, cold feet, hoarseness, hearing loss, dry thinning hair, and diminished ankle reflex. Of course, absence of one or more of these symptoms and signs does not mean that you do not have a hypothyroid condition, and each individual may present with a different array of these possible symptoms. Lowered basal body temperature is also a prevalent sign, and this can be easily monitored by the patient by purchasing an electronic thermometer and charting the basal body temperature upon waking each day. A complete diagnostic assessment is important when these common signs and symptoms occur, and if a subclinical hypothyroid syndrome is suspected, measures taken to reverse this dysfunction. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) presents and array of therapeutic protocols that can be individually tailored into a combined holistic treatment. Short courses of frequent acupuncture combined with a more prolonged step-by-step restorative course of herbal and nutrient medicine can restore balance to the thyroid system in most women.

Studies have shown that a majority of patients with chronic hypothyroidism have symptoms of muscle dysfunction (myopathy), revealed in tests with an elevated blood level of creatine kinase (CK), which correlates with the severity of the hypothyroidism. Up to 80 percent of patients will show clinical evidence of this myopathy, sometimes within weeks of onset, and other times much later in the course of the disease. The muscle symptoms include pain, slowed ankle reflexes, muscle weakness, and muscle cramps, and often wax and wain in intensity. A feeling of sluggish muscle movements, and mild episodic swelling may occur. The range of severity is great, with many patients experiencing mild symptoms that hinder exercise, and most often affect the pelvic and shoulder girdle. In a small percentage of patients, these symptoms may become severe, with rhabdomyolysis (accumulation of protein fragments that degenerate the muscles) and kidney dysfunction, diaphragm dysfunction, and breathing difficulty. Most often, pain during and after exercise, and vague symptoms of weakness or clumsiness in the thighs and upper arms are experienced. Often, even patients taking synthetic T4 (levothyroxine of synthroid) still experience these symptoms. Thyroid dysfunction is often linked to mitochondrial dysfunction and problems with regulation of the calcium metabolism. Acidity in muscle tissue and delayed glycogen breakdown in exercising muscles have been noted. All of these problems may be helped with integration of Complementary Medicine, and restoration of normal thyroid function rather than full dependence on synthetic thyroid hormone T4 will achieve better overall health. Hypothyroid myopathy will resolve when an euthyroid state is restored.

The thyroid gland is responsible for regulating organ functions, metabolic rate and calcium use. It is a key component of the endocrine system, which is a feedback system of regulation in the body. For this reason, a holistic approach to improve overall endocrine function is important in treatment of hypothyroidism. Since hypothyroid dysfunction may be caused by problems in the pituitary or hypothalamus, which are affected by nervous disorders, chronic pain syndromes, and hormonal imbalances, these aspects of your health must also be addressed in therapy. Subclinical hypothyroid syndromes are linked to chronic fatigue syndromes (CFS/ME), chronic viral illnesses, metabolic syndrome (diabetes), insulin resistance, menopausal imbalances and menstrual disorders. Restoration of function should address the whole endocrine system to some extent in most cases. Since the thyroid also produces other hormones, such as calcitonin, which works synergistically with parathyroid hormone to balance calcium regulation in the body, correction of subclinical hypothyroid dysfunction will prevent a host of other health problems, including hyperparathyroidism. Calcium is the most highly regulated molecule in your body because it needs to be tightly controlled. Loss of calcium regulation is a serious health concern, since calcium is involved in many vital processes in your body. When symptoms of subclinical hypothyroidism are noted, it would be best to start treating early, and restore hormonal balance, before a host of serious related problems occur. Simple supplementation with calcium will not correct these problems, and eventually may do more harm than good.

Current Testing and Diagnosis of Hypothyroid disorders

Current testing and diagnosis of hypothyroid conditions has been inhibited by difficulties presented by insurance industry guidelines. Instead of a more thorough workup and specific diagnosis, most hospitals and clinics have curtailed the diagnostic workup, and often only the TSH (thyroid stimulating hormone) is now tested, or only TSH and the prohormone freeT4 (fT4). This is because the pharmaceutical industry has not produced significant therapy over the last 50 years, relying almost completely on chronic prescription of synthetic thyroid hormone for all conditions. As the scientific information has increased, the treatment and testing has decreased. This is not an acceptable situation for many physicians and patients. Many scientific experts and journal in the last decade have described this as a health catastrophe.

In 2003, a report published in the British Medical Journal (BMJ) stated: "The biological effects of thyroid hormones at the peripheral tissues- and not TSH concentrations- reflect the clinical severity of hypothyroidism. A judicious initiation of (thyroid hormone) treatment should be guided by clinical and metabolic presentation and thyroid hormone concentrations, and not by serum TSH concentrations (alone)." A more thorough initial thyroid testing includes levels of TSH, freeT4, freeT3 (triiodothyronine, the active form of thyroid hormone), TPO (thyroid peroxidase antibody), and active Vitamin D3 (25-OH cholecalciferol). Hormonal values that are important in the diagnosis once a thyroid hormone imbalance is noted include diurnal cortisol levels, testosterone, DHEA-S, SHBG (sex hormone binding globulin), estradiol, progesterone, and PGE2 ratio, as well as reverse T3 (rT3). If a metabolic disorder is suspected, testing for triglycerides, fasting insulin, hemoglobin A1c, and High Sensitivity C-Reactive Protein (hsCRP) may be important to the overall treatment strategy. If anemia or kidney deficiency is suspect, testing for serum ferritin and B12, and a 24-hour urine test is warranted.

Patients may want to chart a basal body temperature, as this is highly associated with subclinical hypothyroid state. An electronic thermometer may be utilized for convenience, but if a standard thermometer is used, be sure to keep it at the bedside and shake it down before going to sleep. The basal temperature should be taken in the underarm, or axilla, before you have been awake and moving around for 10 minutes. Menstruating women should take the temperature on the 2-4 days of the cycle. Normal axillary temperatures range from 97.8-98.2F, but this range may vary in the population. To be sure of your range, ask the staff at your medical clinic to provide you with past measurements.

The reasons these tests are not conducted have little to do with cost. Currently, a complete and accurate profile is available with active metabolite testing, using saliva and bloodstick samples collected by the patient, and the total cost of a complete panel out of pocket can be as low as $300. The reason that the current allopathic medical system has reduced testing is to discourage information that can be utilized in a Complementary Medicine approach. The patient now needs to demand thorough testing and seek an integrative approach if they want to utilize a sensible holistic regimen.