Patients typically confuse thyroid disorders with vitamin deficiencies. For those that have a real, underlying thyroid condition, they also often underestimate the impact of their vitamins on thyroid medications (they can interfere with the medications). A personalized vitamin survey can help determine the right blend of vitamins for a specific profile and can provide warnings about common interactions like thyroid medications. However, any proficient personalized vitamin assessment should be discussed with your primary care physician, who can help determine with an examination whether there could be an actual underlying thyroid issue and not simply vitamin deficiencies.
How do we assess our thyroid status? A simple blood test will do the trick. It is our practice to screen all patients over thirty annually for thyroid disorders. Some younger patients should have occasional screening as well, especially if there is a family history of thyroid disease as it tends to run in families. There is an association between thyroid disorders and other autoimmune conditions, such as IBD, type 1 diabetes, and rheumatoid arthritis, among others. The most useful blood test for looking at thyroid function is the thyroid-stimulating hormone (or TSH) test. It determines the blood level of the TSH hormone that the brain sends out to regulate the thyroid. If the brain senses too little circulating hormone, the TSH goes up. If it senses too much, this number goes down. For this reason, deciding if someone’s thyroid is over- or underactive is a bit counterintuitive— a low TSH means the thyroid is overactive (hyperthyroid), while a high TSH means it is underactive (hypothyroid). An underactive thyroid is by far the more common finding. Other levels, such as T4 and T3, can be used in conjunction with the TSH. Conditions typically causing under- and overactive thyroids are Hashimoto’s thyroiditis and Graves’ disease, respectively. These are both autoimmune conditions, which involve various antibodies attacking the thyroid gland.
If your thyroid is in fact underactive, it is generally simple to treat. We typically use synthetic thyroid (such as levothyroxine), which is a close approximate to the T4 your body makes. It is essential when taking levothyroxine to take it in the prescribed way, since it must be absorbed properly and uniformly each day; otherwise regulating thyroid levels will be difficult. T4 replacement can actually be taken any time of day as long as you are consistent about the time and way in which you take it. Thyroid hormone should be taken on an empty stomach, and you should wait thirty minutes before eating. You should also not take any vitamins (particularly those that contain iron or calcium) within three hours of taking the thyroid hormone, as they can interfere with its absorption. Same for antacids and cholesterol- lowering medications. These vitamins and medications should be avoided for three hours before and after taking the medication. Finding the right time to take your levothyroxine can be a challenge, but taking it consistently as part of a regular routine is important to get consistent absorption and blood levels.
Thyroid levels can be reassessed five to six weeks after starting thyroid replacement or changing a dose. It takes this long to see an accurate rise or fall in TSH. Remember, this is the brain’s response to how much hormone it senses. Your brain takes a while to figure things out. For this reason, changes in thyroid hormone can only be assessed and adjusted after five to six weeks of treatment. This also speaks to the slow-acting nature of levothyroxine. It is metabolized slowly and has a long half-life. Therefore, its effects are felt not in minutes or hours but rather in days or weeks. You must be patient to feel its effects, but it is certainly worth it to restore your metabolism to its natural state.
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