The Thyroid Dilemma
By Madhuri Cawley, P.A.-C., M.A.



To prescribe or not to prescribe, that is the dilemma! It “shouldn’t” be such a quandary, but western medicine has complicated a rather straightforward issue. Part of the problem is in the confusion about what tests should be used to diagnose thyroid dysfunction; another is about what substance and dose of thyroid to use for treatment; and the third issue is about underlying causes of thyroid ill-health as with other metabolic processes that have gone awry.

Hypothyroidism is one of the most misdiagnosed, under-diagnosed or ignored health conditions. Most traditional information taught in medical schools about thyroid testing is inaccurate or incomplete. Ordinarily, a single blood lab test is ordered — the TSH level (Thyroid Stimulating Hormone). This hormone is made by the pituitary gland to stimulate the thyroid to produce thyroid hormones. In a healthy-working thyroid gland, there is a biochemical feedback loop that slacks off on the production of TSH if there are enough thyroid hormones present. Doctors mistakenly think that if the TSH is normal the thyroid is normal. This is too simple and not valid. This test needs to be looked at, but not without others.

The next test “typically” ordered is a Total Thyroxine level. Thyroxine is T4; the primary thyroid hormones are T4 and T3, Triiodothyronine. Total thyroxine tells us what is available in the system but not necessarily what amount is usable. To know that, the Free T4 or unbound, usable Thyroxine would need to be examined. T4 is usually the most prevalent, and converts normally to T3.

When that conversion process is not working well or at all, T3 needs to be supplemented. Doctors don’t agree on this, however when people who need T3 get it supplementally, they feel much better. Because either the need for T3 or the conversion process is underplayed or misunderstood, a test for T3 is usually not ordered. The T3 Uptake is the typical test ordered to measure T3, although this does not tell how much is usable. To get this information, the Free T3 must be ordered. Sometimes T7 is ordered, which is useless. It only indicates how much total thyroid is available and gives no specific information.

The TSH, Free T4 and Free T3 are the minimally-required tests. Anything less, is not adequate. Endocrinologists who have a better understanding of the biochemical process of thyroid production and usage will often order these tests. Some people have more complicated thyroid issues and to specifically check for these, one must get thyroid antibody tests, Anti-thyroglobulin (Anti-TG) and Anti-thyroperoxidase (Anti-TPO) Antibodies. These will reveal if there is an autoimmune thyroid condition, Hashimoto’s (hypo) or Graves’ (hyper) condition.

There are other tests which can be done: eg. level of TRH, Thyrotropin Releasing Hormone, which is produced in the hypothalamus to stimulate TSH in the pituitary. This does not need to be checked routinely unless one suspects a hypothalamic thyroid problem, a rarer occurrence. r-T3, or Reverse T3, looks at a specific conversion problem. Usually a high amount of r-T3 implies the body is producing an inactive form of T3 in peripheral places in the body like the liver, which points out the need for T3 supplementation. Elevated Prolactin levels can indicate a pituitary tumor which may be implicated in altered thyroid hormone production.

There is also validity to knowing information about a person’s body temperatures, especially the resting or basal temperature. To do this, place a thermometer under your arm for 10 minutes on 3 consecutive days, done first thing in the morning before arising. If using a digital thermometer, it won’t take 10 minutes. If you are female and still having menstrual cycles, check the temperatures on days 2, 3 and 4 of the cycle. Record your findings. Normal is between 97.8 F and 98.2 F.
All nodules should be evaluated by ultrasound or other scanning devices and biopsy done when suspected as malignant. Any hyperthyroid condition with nodules is suspect.

Now that the really technical testing has been addressed, some information about types of thyroid will be reviewed. Traditionally, Synthroid, Levothyroxine or some form of these which are T4 only, is given. They can contain talc, sugar and dyes along with other fillers. They do not address the need for T3. If there is a conversion problem of T4 making T3, giving more T4 will not make more T3.

All along “conversion” has been mentioned. As mentioned before, the thyroid gland produces mostly T4 and T3. T3 is the stronger acting of the two, but is produced by T4. The T3 breaks down to T2 and T1, although not much is known about these. If a Whole Thyroid is taken, one gets the benefit of T2 and T1. Some people need this and some do not. Mostly, these are inactive forms of thyroid.

Armour, a whole thyroid prescription product, contains T4 and T3 in specific proportions. Unfortunately, Armour contains dextrose and mineral oil. There are other better forms of whole thyroid, such as Naturthroid and Biothroid which have the same proportions of T4 and T3. e.g. 1 gr. = T4 38 mcg. and T3 9 mcg.

Some people need more T3 than T4, or no T4. Cytomel has been used traditionally but it contains sucrose and talc. Thyrolar contains a higher ratio of T3 to T4 but it contains dyes and other synthetic fillers. I recommend the use of Whole Natural Thyroid products, Biothroid or Naturthroid. Biothroid is presently not available, hopefully temporarily. I am using Naturthroid until Biothroid comes back onto the market.

For those who need a different proportion of T4 and T3, or either of these by itself, I use pure compounded thyroid which is bio-available and bioidentical to what the thyroid produces. These contain fillers of lactose or cellulose only. Wilson’s Syndrome is a condition where the thyroid makes enough T4 but doesn’t convert to T3.

Sometimes a small amount of T4 makes enough T3, and T4 alone is needed. I use the pure compounded T4 rather than commercial pharmaceuticals. Lastly, some people need some of the whole thyroid and additional T4 or T3. Using compounded thyroid has the benefit of being able to quantify exact doses. When taking thyroid, it is important to have testing done periodically to stay on target with doses needed.

The most common symptoms of hypothyroidism include: fatigue, depression, difficulty concentrating, insomnia, difficulty waking up in the morning, cold hands and/or feet, intolerance to cold, hoarseness, constipation, loss of hair, fluid retention (swelling), dry skin, other skin conditions including acne, poor resistance to infection, frequent sinus infections, allergies, high or low cholesterol, PMS, loss of menstrual periods, painful or irregular periods, excessive bleeding, infertility (male or female), fibrocystic breasts, ovarian cysts, decreased sweating or no sweating, sudden weight gain, and the list goes on and on.

Symptoms of hyperthyroidism include: nervousness, irritability, rapid heart rate, palpitations, bulging eyes, heat intolerance, weight loss, thinning of hair, diarrhea, loss of menses or decreased flow, swelling in the front of the lower legs, tremor, weakness, increased reflex reaction, dry mouth, excessive sweating, insomnia or shortened sleep cycles. Be aware that other hormonal or chemical imbalances can cause these same symptoms, either in conjunction with the thyroid imbalance or alone.

The minerals Iodine and Selenium play a very important role in thyroid functioning. They require a certain balance. Too much of one or the other can worsen thyroid conditions. Goiter is an enlarged thyroid resulting from too little iodine. If Selenium deficiency also exists, an even larger goiter can be present. If Selenium is low and Iodine is high, the thyroid can become hyperactive. Graves’ thyroiditis can then lead to Hashimoto’s and they can exist together, particularly when these minerals are imbalanced in this way.

Adrenal glands play a role in thyroid imbalance. They are responsible for many important biochemical and biological functions such as sleep, weight balance, healthy cardiac functioning, stress management, fight or flight reactions, immunity and sex hormone production, among others. With too much stress for too long, the adrenals become depleted and this directly affects the thyroid. One can recognize this in chronic fatigue and fibromyalgia conditions, for example.

Stressors include: poor diet (eg. high in sugar, caffeine, alcohol); physical, emotional, mental and/or spiritual traumas; and toxic exposures. Some women do not re-balance hormonally and chemically after pregnancy, and they develop adrenal and thyroid problems. They may have had them less obviously prior to their pregnancies.

People who need thyroid supplementation and take it, “get their life back” as many have told me, since some of their other health problems clear up. I have found that people with cancer almost always have low thyroid. In all the chronic conditions I work with, I always check thyroid function. Two frequently asked questions are: 1) “Will I need to be on thyroid for the rest of my life?” 2) “Will taking thyroid suppress my own thyroid function?”  

The answers are not what you might suspect. I have seen people require smaller doses after cleansing and healing toxicity and other stress situations. Some people stop thyroid after many years and do OK. Maybe it is because they have changed to less stressful lifestyles.

Constant stress and toxicity exposure produce some biochemical changes which affect all the metabolic pathways and create altered glucose regulation, immune dysfunction (as discussed), abnormal pain regulation, neurological imbalances, impaired mineral and vitamin absorption, impaired sex hormone production and usage, etc. This is a topic all its own. However, as clearing takes place, health improves. Most people probably do need thyroid indefinitely, but the purest forms and appropriate dosing do not harm the body.

Too much thyroid can suppress a partially functioning thyroid gland leading to hyperthyroidism and/or cause problems such as increased heart rate and irregular rhythms which can become life-threatening if unchecked. If this occurs, one should always consult with their prescribing practitioner immediately. Typically reducing the dose or stopping it for a few days will reverse the symptoms.

Madhuri Cawley, P.A.-C., M.A., has been serving women and men for over 29 years through her natural medical practice, specializing in thyroid and other natural, bioidentical hormones. She offers individual consultations and holds group seminars. Her treatment involves comprehensively balancing the whole person by diagnosing underlying causes of symptoms and illness. Phone (760) 295-5392 or you may e-mail her at   Also visit her website at

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