DiseasesThe thyroid and fatigue — can your results still be misleading when they’re within the normal range?
- Henryk Różański — Choroba Hashimoto, czyli przewlekłe autoimmunologiczne zapalenie tarczycy, część 1.
- Henryk Różański — Fitoterapia choroby Hashimoto, cz. II
- Jerzy Jaśkowski — Niedoczynność tarczycy
- Jan Jaśkowski — Jak nie dać się złej aurze i przygnębieniu? — Moja Apteczka
- T4 + T3 combination therapy: any progress? · Endocrine 2019
- Orthomolecular Medicine News Service — Free Access to Nutrition Therapy Videos
- Orthomolecular Medicine News Service — The Need for Iodine Supplementation
- Orthomolecular Medicine News Service — The ICV Axis: A Practical, Clinically Actionable Breakthrough for BHRT and Metabolic Medicine
Henryk Różański notes that in the early stages of Hashimoto’s, FT3 and FT4 may be normal, while hypothyroidism may develop later.
- Fatigue and weakness can occur early in the disease, when temporary hyperthyroidism is possible.
- Jerzy Jaśkowski believes that rigid reference ranges do not account for differences between people.
- If hypothyroidism is suspected, he recommends correcting deficiencies and then checking TSH, FT3 and FT4 again.
What the authors write
Henryk Różański
In early Hashimoto’s, FT3 and FT4 levels may be normal, while hypothyroidism may develop later.
„FT3 and FT4 levels in serum are low or normal. An ultrasound characteristically shows hypoechogenicity of the thyroid tissue. Inflammatory infiltrates in the thyroid contain plasma cells and lymphocytes. Lymphoid follicles with large germinal centers form. The follicular epithelium of the thyroid gland atrophies or undergoes oncocytic transformation. The nuclei of oncocytes can look like those of malignant tumor cells. In the early stage of the disease, thyroid function is normal and may even show signs of hyperthyroidism (Hashitoxicosis). Hypothyroidism develops only after many months or years.”Zmniejszone lub prawidłowe jest stężenie FT3 i FT4 w surowicy. W obrazie USG charakterystyczna jest hipoechogeniczność miąższu. W naciekach zapalnych tarczycy stwierdza się plazmocyty i limfocyty. Powstają grudki chłonne z dużymi ośrodkami namnażania. Pojawia się zanik lub przemiana onkocytarna nabłonka pęcherzyków gruczołu tarczowego. Jądra onkocytów dają obraz (imitację) komórek nowotworu złośliwego. We wczesnym okresie choroby czynność tarczycy jest prawidłowa, a nawet przejawia nadczynność (Hashitoxicosis). Dopiero po wielu miesiącach lub latach rozwija się niedoczynność.
Henryk Różański
Fatigue and weakness can occur at the onset of Hashimoto’s, when temporary hyperthyroidism is possible.
„Because thyroid overactivity may occur initially during Hashimoto’s disease, the following symptoms may appear for a time: nervousness, fatigue, weakness, increased sweating, intolerance of high ambient temperatures, tremor, increased motor activity, palpitations, increased appetite, weight change (usually weight loss at first), menstrual cycle disorders, tachycardia (rapid heartbeat) and heart rhythm disorders, high blood pressure, and muscle weakness.”Ze względu na możliwą początkową nadczynność tarczycy w przebiegu choroby Hashimoto przez pewien czas mogą wystąpić następujące objawy: nerwowość, zmęczenie, osłabienie, zwiększone pocenie się, nietolerancja wysokiej temperatury otoczenia, drżenie, nadaktywność ruchowa, kołatanie serca, zwiększenie apetytu, zmiana masy ciała (na początku zwykle utrata masy ciała), zaburzenia cyklu miesiączkowego, tachykardia (częstoskurcz) i zaburzenia rytmu serca , nadciśnienie tętnicze, osłabienie mięśni.
Henryk Różański
Elevated thyroid antibodies alone are not enough to make a diagnosis; a characteristic ultrasound appearance or impaired thyroid function is also needed.
„An increase in thyroid antibody levels alone does not automatically mean that a disease has been diagnosed. At least one of the other two criteria must also be met: a characteristic ultrasound appearance (for example, heterogeneous and reduced echogenicity) and/or impaired thyroid function (elevated TSH).”Samo zwiększenie stężenia przeciwciał przeciwtarczycowych nie oznacza automatycznie rozpoznania choroby. Powinno być spełnione przynajmniej jedno z 2 pozostałych kryteriów: charakterystyczny obraz USG (np. niejednorodna i obniżona echogeniczność) i/lub zaburzenia czynności tarczycy (zwiększone stężenie TSH).
Jerzy Jaśkowski
Jerzy Jaśkowski recommends correcting deficiencies if hypothyroidism is suspected, then checking TSH, FT3 and FT4 again.
„If hypothyroidism is suspected, deficiencies should first be corrected. Then check whether TSH, FT3 and FT4 are within the correct ranges after supplementation. If some deficiencies remain but are minor—around 20%, for example—it is also best to leave things alone and give the body a chance; it may be able to recover on its own.”Przy podejrzeniu niedoczynności tarczycy w pierwszym rzędzie trzeba uzupełnić niedobory, a potem sprawdzić, czy po tym uzupełnieniu normy TSH, FT3 i FT4 będą poprawne. Jeśli niedobory się utrzymają, ale będą już niewielkie – rzędu np. 20%, to też należy to zostawić w spokoju i dać szansę organizmowi – może sam się wybroni.
Jerzy Jaśkowski
Jerzy Jaśkowski believes that rigid reference ranges do not account for differences between people.
„If it is around 20%, that too should be left alone, giving the body a chance—it may be able to recover on its own. Please remember that reference ranges are always established for a normal hematocrit, which is about 42. The ranges are set rigidly, even though we are all different.”20%, to też należy to zostawić w spokoju i dać szansę organizmowi – może sam się wybroni. Proszę pamiętać o tym, że norma jest zawsze opracowywana do prawidłowego hematokrytu, który wynosi ok. 42. Ramy podaje się na sztywno, a przecież jesteśmy różni.
Jerzy Jaśkowski
Jerzy Jaśkowski warns against treating only minor deviations from the normal range and points to the need to check for deficiencies.
„In other words, giving supplements for minor deviations is a mistake, but it is also an excellent way to drain patients’ pockets.
If the same symptoms occur with the deficiencies listed above, why aren’t tests done—for example, to check iodine levels?”Innymi słowy, przy minimalnych odchyleniach podawanie preparatów to błąd, ale też doskonały drenaż kieszeni pacjentów.
Jeżeli wiadomo, że te same objawy występują przy wyżej wymienionych niedoborach to dlaczego nie wykonuje się badań np. poziomu jodu?
Jan Jaśkowski
For apathy, low energy, or sleep problems, Jan Jaśkowski recommends checking TSH, FT3 and FT4.
„The thyroid plays a key role in metabolism. People with hypothyroidism are much more likely to struggle with depression. So when symptoms such as apathy, low energy, or sleep problems occur, it is worth checking thyroid hormone levels (TSH, FT3, FT4).”Kluczową rolę w metabolizmie odgrywa tarczyca. Osoby z niedoczynnością tarczycy znacznie częściej zmagają się z depresją. Dlatego przy objawach takich jak apatia, spadek energii czy problemy ze snem, warto zbadać poziom hormonów tarczycy (TSH, FT3, FT4).
Research from PubMed · Europe PMC
We selected 1 studies with the best, positive results. This is a selection, not a full review of all research.
Total number of studies on this topic in PubMed: 232.
The review indicates that normal TSH does not always mean normal thyroid function in the tissues, and fatigue may persist despite a normal result; the cause, however, remains uncertain.
Aim of the study: Guidelines on T4 + T3 combination therapy were published in 2012. This review investigates whether the issue is better understood 7 years later.
Results: One may try T4 + T3 combination treatment in selected patients as an experimental n = 1 study. The 2012 ETA guidelines are still valid for this purpose. More well-designed randomized clinical trials in selected patients are key in order to make progress. In the meantime the whole issue has become rather complicated by commercial and political overtones, as evident from skyrocketing prices of T3 tablets, aggressive pressure groups and motions in the House of Lords.
T4 + T3 combination therapy: any progress? · Endocrine 2019
Money for the studynot stated
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studydiscussion of other studies
“Not stated” does not mean nobody paid — the database does not always record it.
Perspectives and opinion materials
The content below presents the authors’ opinions, interpretations and hypotheses. It is not treated as equal to scientific studies and systematic reviews.
Orthomolecular Medicine News Service Opinion material
„A quick internet search for the causes of fatigue almost always brings up “low thyroid.” A trip to the doctor with this information in hand generally results in the following lab test: TSH (Thyroid Stimulating Hormone). All too often, to the surprise and disappointment of the patient, the word comes back: “Your thyroid is normal.” But is it? Ron Hunninghake and Dr.”A quick internet search for the causes of fatigue almost always brings up "low thyroid." A trip to the doctor with this information in hand generally results in the following lab test: TSH (Thyroid Stimulating Hormone). All too often, to the surprise and disappointment of the patient, the word comes back: "Your thyroid is normal." But is it? Ron Hunninghake and Dr.
Orthomolecular Medicine News Service Opinion material
„Iodine deficiency is associated with (2,3,4): fibrocystic breast disease leading to breast cancer, stomach cancer, goiter (enlarged thyroid), mental issues from reduced alertness, lowered IQ, autism to cretinism, lack of iodine for the fetus leads to cretinism, and in milder cases to autism and ADHD, slow metabolism, leading to tiredness, sluggishness, fatigue, apathy, depression and insomnia, inability to produce saliva, dry skin and lack of sweating, lack of optimal detoxification, especially of bromides, fluorides and heavy metals, sensitivity to temperature changes, cold hands and feet, muscle pain, fibrosis, fibromyalgia, erectile dysfunction…”Iodine deficiency is associated with (2,3,4): fibrocystic breast disease leading to breast cancer, stomach cancer, goiter (enlarged thyroid) mental issues from reduced alertness, lowered IQ, autism to cretinism, lack of iodine for the fetus leads to cretinism, and in milder cases to autism and ADHD slow metabolism, leading to tiredness, sluggishness, fatigue, apathy, depression and insomnia, inability to produce saliva, dry skin and lack of sweating, lack of optimal detoxification, especially of bromides, fluorides and heavy metals sensitivity to temperature changes, cold hands and feet, muscle pain, fibrosis, fibromyalgia, erectile dysfuncti…
Orthomolecular Medicine News Service Opinion material
„Step 3 - Restore Vitamin C as a Foundational Hormone-Modulating Molecule Vitamin C is required for: cortisol synthesis AND shutdown catecholamine balance mitochondrial ATP generation nitric oxide regulation glutathione regeneration insulin signaling ovarian/testicular redox function Low vitamin C clinically presents as: hot flashes insomnia emotional volatility insulin resistance estrogen/progesterone instability low testosterone response adrenal fatigue Vitamin C is the most overlooked hormonal stabilizer in integrative medicine.”Step 3 - Restore Vitamin C as a Foundational Hormone-Modulating Molecule Vitamin C is required for: cortisol synthesis AND shutdown catecholamine balance mitochondrial ATP generation nitric oxide regulation glutathione regeneration insulin signaling ovarian/testicular redox function Low vitamin C clinically presents as: hot flashes insomnia emotional volatility insulin resistance estrogen/progesterone instability low testosterone response adrenal fatigue Vitamin C is the most overlooked hormonal stabilizer in integrative medicine.
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