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Bioidentical Hormone Replacement: Can Include Thyroid Treatments

Apr 26, 2012 09:37AM ● By Josie Tenore, M.D.

The human body contains endocrine glands that produce many hormones other than the famous testosterone and estrogen, and the most notable of these is also the largest: the thyroid gland. This butterfly-shaped organ sits at the base of the throat and is responsible for many functions, including manufacturing protein, deciding how quickly the body uses energy and regulating other hormones.

The thyroid is one of the most highly misunderstood glands, and millions of people in the United States, most of them women, suffer from thyroid disease. Decoding its functions is proving to be controversial. For example, during all phases of a woman’s life, from puberty to menopause, she may experience multiple symptoms that have traditionally been attributed to depression. But now we are seeing that there may be other explanations for these symptoms, including improper functioning of the thyroid gland. Dr. Russell Joffe, of the North Shore-Long Island Jewish Health System, states, “In the early 20th century, the best descriptions of clinical depression were actually in textbooks on thyroid disease, not psychiatric textbooks.”

Symptoms of Thyroid Problems

Symptoms of an improperly functioning thyroid may include cold hands, thinning hair, dry skin, fatigue, weight gain or loss, slow or rapid heart rate, depressed mood and a general feeling of malaise.

What You Should Know

When thyroid disease is suspected, many doctors commonly order an inexpensive thyroid stimulating hormone (TSH) blood test. When your results are abnormal (either high or low), a remedy is prescribed to balance the thyroid. The problem is that when the test is normal, you may still have problems with your thyroid gland that go undiagnosed.

Here is where it gets tricky, because a standard hormone test may not tell the full story. The thyroid gland manufactures a number of different hormones, the principal one being thyroxine, or T4. Your brain uses this hormone to tell the hypothalamus gland either to release or shut down its production of TSH. When your thyroid gland is underperforming, the hypothalamus secretes more TSH, the level goes up and the test comes back as abnormal. If the thyroid is hyperactive, the hypothalamus is told to stop working and the level of TSH will be lower than expected, also indicating an abnormal result.

However, the rest of your body needs a different version of thyroid hormone: triiodothyronine, or T3, which is converted from T4 by an enzymatic reaction. When this doesn’t occur properly, levels of T3 become low and your body will develop symptoms of an underactive thyroid, even though the levels test normal. If TSH tests normal, but you still have symptoms, ask your doctor or lab to measure your “free T3” levels, and then find a health practitioner that understands how to properly interpret the blood test.

What You Can Expect

If T3 proves to be low, you should be prescribed either a bioidentical T3 hormone alone or in combination with T4. You will be advised to take the medication daily, on an empty stomach, and not eat for 30 minutes afterward. Some women feel much better within a few days, but usually it takes longer for symptoms to improve. After several weeks, your blood tests will be repeated and the dose of replacement hormone you need determined on the basis of symptom relief, heart rate and blood pressure levels, and the actual blood test.

Dr. Josie Tenore, M.D., MSc, is the owner of FreshSkin, in Highland Park, specializing in hormone replacement therapies for men and women and aesthetic medicine. For more information, call 847-681-8821 or visit