Often times I find doctors try to over complicate the thyroid, maybe in attempts to impress patients with their knowledge. However, most hypothyroidism can be simplified down to 2 general types. They are functional and autoimmune.
Autoimmune is by far the most common and it is also known as Hashimoto’s or Hashimoto’s thyroiditis. I have written an entire section on autoimmunity so we will get more detailed on that later. For now its important to know a few things.
When you have Hashimoto’s or an autoimmune thyroid problem, you are experiencing damage to your thyroid gland that is in part irreversible. The longer this process continues the more of your thyroid gland becomes damaged and this damage generally cannot be undone. While you are experiencing this damage to your thyroid other parts of your body may be at risk for damage, but more on that in the Hashimoto’s section.
Medications may not stop this damage from occurring but rather make you feel better as this process damages your thyroid gland. So the cause may not be addressed by medication, consider this example. Let’s image that one day you come home and none of the lights or electricity works. What would you do? Try to find the source of the problem, right? Blown fuse, unpaid bill, downed power line, etc… Well giving thyroid hormone to someone with hypothyroidism is like putting battery powered lights in a house with broken electricity. Using battery powered lights is not a bad short term strategy, but is far from ideal long term.
Functional problems, also know as Euthyroid Sick Syndrome, are slightly different. In this situation your thyroid gland is not being damaged but your thyroid is either not making enough thyroid hormone or your thyroid hormone is not being used in your body properly; this usually because your T4 is not being converted into T3 or because your T3 is being blocked by rT3. Think of this situation as the electricity works, but all your bulbs have burnt out. You still wouldn’t want to use those battery powered lights as a fix, would you?
Sometimes people with a functional problem will be given thyroid medication or sometimes they will be told “it’s all in their head”. However, the cause of the problem will not be addressed by medications. Again I want to make sure to say that medications may be needed in some cases, but medications should never be used without also investigating what is causing the problem in the first place.
These problems can also occur together, meaning you can have a combination of an autoimmune problem and a functional problem. The good news is we know what causes these problems. Additionally, lab testing is available to identify what type of problem you have and more importantly testing is available to determine what is causing your problem so that we can then fix it. In our next section we will discuss the causes.