This paper is longer than usual. In it I provide a very detailed analysis of hypothyroidism in Lyme. Be patient as you read it. The “what to do part” is at the end. But to understand my recommendations you need to understand why most physicians approaches to thyroid illness do not work in Lyme. Most of this article is from a paper I provided to my medical board trying to educate them about thyroid illness in Lyme disease. I show that:
- current hypothyroid guidelines most doctors follow do not work in Lyme disease;
- people with Lyme have peripheral thyroid disorder which is not found using TSH and T4 testing alone;
- thyroid symptoms matter and often are more reliable in Lyme disease than testing to determine if one has low thyroid;
- even a person with normal thyroid testing can have low thyroid based on his or her own unique “normal” thyroid levels;
- comprehensive thyroid testing should include TSH, free T4, free T3, reverse T3, and TPO antibodies;
- for most dessicated or armour thyroid is the best medicine;
- low dose naltrexone (LDN) is very helpful for a type of low thyroid called Hashimoto’s;
- selenium, zinc, Vitamin D and non-toxic levels of iodine help.
If you want your physician to diagnoses and treat your low thyroid in Lyme disease as I propose here, print off this article and provide it to your physician. It contains a large number of references which physicians like when using new treatments like I propose here.
Hypothyroidism is the clinical and biochemical consequence of low thyroid hormones and their effects on the tissues and organ systems. (1) It has numerous symptoms including changes in voice, dry skin, coarse hair, cold sensitivity, fatigue, muscle cramps, constipation, depression, slow thinking, poor memory, and changes in menses. (2,3) There are a number of signs including delayed ankle tendon reflexes, increased weight, and dry skin. (2,3) Laboratory abnormalities may include elevated thyroid stimulating hormone (TSH), low T4 and T3 thyroid measured as T4, free T4 (fT4), T3, free T3 (fT3), increased reverse T3 (rT3) and low fT3/fT4. (1,2,4)
In this paper I review current guidelines for the diagnosis and treatment of hypothyroidism. While the existence of these guidelines suggest some consensus regarding how to diagnose and treat this illness, there remains a large degree of controversy, and therefore, room for clinical judgment. There is a body of science and clinical experience that suggest the one size fits all population-based approach of relying just on TSH levels and free T4 levels along with using only T4 replacement therapy for a number of people is inadequate. In this paper I review the science and propose a different approach for my practice. This calls for treating people for a condition known as peripheral hypothyroidism.
Current Hypothyroid Guidelines
In 2012 The American Association of Clinical Endocrinologists and the American Thyroid Association (AACE/ATA Guidelines) published clinical practice guidelines for hypothyroidism in adults. (4) These guidelines conclude: