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 MILD HYPOTHYROIDISM – the missed diagnosis?

 (The International Journal of Alternative and Complementary Medicine – June 1998) (amended and updated)

 For more than 25 years, I have had a particular interest in the diagnosis and treatment of functional hypoglycaemia (low blood sugar) and other causes of chronic fatigue. Having written three books on hypoglycaemia (published in 1981, 1995 and 2003), it was inevitable that patients have since consulted me with symptoms of both hypoglycaemia and chronic fatigue.
 When hypoglycaemia is suspected, I usually request a six hour glucose tolerance test with either a hair mineral analysis or a serum mineral profile Occasionally an adrenal stress index is also requested.

 These patients usually present with a typical symptom profile, which can be summarised as follows:

 O mental and physical lethargy
 O young patients’ often underweight, middle-aged and elderly patients usually overweight,
 O anxiety and/or depression
 O symptoms always worse on rising and better towards the end of the day
 O coldness of hands and feet
 O variable joint and muscle pain particularly in the lower back, neck and shoulders
 O poor memory and concentration
 O symptom-improvement after eating and worsening with missed meals

 Although these are symptoms typical of functional hypoglycaemia – they are also very similar to the symptoms of hypothyroidism. This coincidence may partly explain why approximately 40 per cent of my patients who present with suspected hypoglycaemia, show a normal six hour G.T.T. result when tested.

 With this in mind, I now routinely request a thyroid profile blood screen, with all patients who present the following symptoms:

 O fatigue
 O low basal temperature
 O poor memory and concentration
 O unexplained weight gain (over 40 years of age)
 O unexplained weight-loss (under 40 years of age)

 Significantly, many of these patients have been previously reassured that their thyroids are quite normal.

 With 80 per cent of my patients, the Thyroid Stimulating Hormone (TSH) and Free T4 (Thyroxine) results fall within the normal ranges. However, the free T4 is frequently at the lower end of the range, that is, 10-13pmol/L.