Recently I was given a T-shirt with the words "It's Not Your Thyroid" printed on the front. It was a joke from one of my nurse practitioner students that I have taught in the past. I was slightly hesitant to post a picture of it, concerned that my friends and/or patients may not understand it. I did share it on my personal and business FB page, however; because, truthfully, I think it's funny. I also figured that the people who know me will understand what it means and that those who don't might spark conversation. I was right on both counts. Unfortunately, however, another doctor, a former resident phyisician in my program, posted it on his own page with disparaging remarks. I refrained from defending myself on his page because I don't put much credence in his opinion of my practice, and I knew my thoughts here would be better appreciated.
I was accused of not taking my patients seriously and for making fun of their thyroid concerns. I'm glad to know that a T-shirt can make this other physician judge me when he hasn't seen me or been around my practice in nearly 7 years. That's one of the problems with this country, that everybody feels the need to judge and place labels on people without really knowing them. But, I digress. I don't worry about what he thinks about me because I know that I do my best to take care of my patients and their concerns. So, let's talk about what that shirt means.
One of the top five chief complaints I get from patients is fatigue. Everybody's tired and everybody has read something online. Rarely does somebody come in to the office without having done their "scientific" Google research or read a blog. And, yes, nearly everybody wants their thyroid checked. Let's talk about why.
The thyroid is a small gland in the neck that assists the body's cell in metabolism and affects the function of virtually every organ in the body by secreting specific hormones. It works by stimulation of the pituitary gland in the brain. In fact, when a TSH is tested in lab work, this is a measurement of a hormone from the pituitary gland and NOT the thyroid. In turn, the pituitary gland doesn't work without the hypothalamus, another gland in the brain. I like a description I stole from another website to liken all of this production in terms of a heater, a thermostat, and a person controlling the thermostat. The thyroid is the heater that puts out the heat. The pituitary is the thermostat that senses the heat and turns on and off depending on how much heat is needed. The hypothalamus is the person who controls the thermostat, telling the pituitary gland at what level the thyroid should be set.
The measurements that are used are also various. The most commonly known, thyroid-stimulating hormone (TSH) is often the one we check the most because the many components of the thyroid have not been shown to be as sensitive to changes as the TSH. You'll hear lot of talk about T3, T4, and mutliple other levels, but the science has not shown human studies to be as sensitive to these measurements as they are to TSH. In fact, many of the T3 that is produced occurs inside of other cells from the conversation of T4 so 80% of it is actually produced outside of the thyroid gland. Because of this, measuring T3 does not really give us a full picture of the thyroid gland that some people would like to think. I'd be happy to discuss any of this further at an upcoming visit if you'd like. This brings me to the next point.
If you're confused at this point, it's ok. It's a complex system, which is why I do, in fact, take it seriously. I also take fatigue seriously. Americans are more tired now than ever before, but they're also more deconditioned and have the worst diets. When somebody comes in to discuss their fatigue, the fact is that I can usually point out a multitude of other causes rather than just blaming this complex gland. I usually ask three basic questions: 1) How much water are you drinking? 2) How much exercise are you getting? 3) How much sleep are you getting?
Typically the answers to these questions are less than ideal. When discussing the diet I often get the comment, "I don't eat that much." While that may be true, it also may be true that you aren't eating enough, or that what you are eating isn't the right stuff. I also get, "I drink plenty of water." Do you really? Measure it some time and see how many days you are truly getting at least 64 oz daily. I also hear this: "I'm very active." I get it, you're up and down, moving around all day long. Listen, if that's all it took for us to be fit, many more of us would be in great condition. True exercise takes effort, much more than most of us give in any given day. Or, this one: "My body doesn't require that much sleep." Oh really? You and God have discussed this and determined that what's needed by everybody else isn't needed by you?
What else could be causing your fatigue? Anemia, sleep apnea, stress, depression, multiple vitamin deficiencies, poor diet, auto-immune disorders, hormone imbalances, cardiovascular disease and many other things. All I'm trying to say is that the poor thyroid gland gets a bad rap. Everybody wants something to be wrong with it even more than they want to make significant changes to any of these other components of their lives. If you really want to know what's causing your fatigue, let's sit down and really talk, truly be honest with all of the other possibilities. Sure, we'll do some bloodwork but don't be surprised if it comes back normal. Then, let's evaluate your sleep, your diet, your exercise and anything else that might be going on and see if we can get to the real root of the problem. Thyroid disease is not something you want; and, it's treatment is absolutely not a miracle cure for fatigue or weight loss. It's a true disorder that has life-long consequences and potential complications.
While you may think you know me by reading a T-shirt that I own, I definitely don't think I know you until we've spent more than a few visits evaluating your life. You can't just assume every person with fatigue has a thyroid disorder. I wish it was that simple all of the time; but, the fact remains that good medicine is more than just throwing pills at a gland that may or may not be dysfunctional. There are 4 tenets of Osteopathic medicine that I truly believe.
The body is a unit; the person is a unit of body, mind, and spirit.
The body is capable of self-regulation, self-healing, and health maintenance.
Structure and function are reciprocally interrelated.
Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function
Look for my next shirt to say, "You don't need antibiotics." (See a previous blog post.)