Hypothyroidism is an extremely common type of hormone deficiency that affects as many as 35% of women and 10% of men. Commonly known as an “underactive thyroid”, it occurs when the thyroid gland, located in the lower part of the neck, does not produce enough thyroid hormone. Thyroid hormone is extremely important because it is the fuel that gives each and every cell in the human body the energy to perform its own unique biologic function. When the body does not produce enough thyroid hormone, its cells do not have the energy to function properly, causing a person to experience symptoms that adversely affect their health and quality of life.

Although there are eight thyroid blood tests available that may aid in the diagnosis of Hypothyroidism, many symptomatic patients are not diagnosed and are denied treatment. This happens because most doctors rely entirely on the result of a single thyroid blood test, the TSH level (Thyroid Stimulating Hormone), to diagnose Hypothyroidism. Because of this, as many as 40% of symptomatic patients who actually have Hypothyroidism go undiagnosed and untreated.

Dr. Melnick’s vast experience in treating people with Hypothyroidism has taught him that the real key to the accurate diagnosis and successful treatment of hypothyroidism is a person’s symptoms. By taking the time to listen to patients’ symptoms, the diagnosis of Hypothyroidism is clear in 95% of cases. Although Dr. Melnick orders comprehensive thyroid blood testing and a thyroid sonogram on all new patients, he mainly uses the results to understand the root cause of a person’s thyroid condition.

Similarly, Dr. Melnick believes that a person’s symptomatic response to thyroid medication, rather than the thyroid hormone levels in the blood, is the key to restoring health and a good quality of life to people with Hypothyroidism. Dr. Melnick treats patients with natural prescription thyroid medications by gradually increasing the dose every three to four weeks, until their symptoms are relieved. Because thyroid hormone functions inside the body’s cells, the levels of thyroid hormones in the bloodstream do not necessarily mean that the amount of thyroid hormone that has entered the cells is adequate for the cells to function normally. Although there may be normal levels in the blood, people may still have the symptoms of hypothyroidism. The only way to have a sense of the level of thyroid hormone inside the cell is by a patient’s symptoms. When there is inadequate thyroid hormone inside the cell, cells do not function normally and people experience symptoms of hypothyroidism. When the level of thyroid is adequate, symptoms disappear.

Dr. Melnick is unique because he practices “high tech’ medicine yet, at the same time, is an experienced “old school” doctor who enjoys spending time with his patients. He truly values the doctor-patient relationship, which is something that rarely exists today in hospital based medical practices. If you are experiencing any of the symptoms found below, it may be beneficial to be evaluated by a specialist like Dr. Melnick.

Dr. Melnick Publishes Article on His “Old Fashioned” Approach to Hypothyroidism »

Common Symptoms of Hypothyroidism

Hypothyroidism can cause a wide variety of symptoms. While every patient is different, symptoms of hypothyroidism may include the following:

  • Fatigue
  • Difficulty in getting out of bed in the morning
  • Afternoon energy crash/ needing to take daytime naps
  • Brain Fog
  • Hair loss
  • Difficulty in concentrating/ ADD
  • Poor memory
  • Low motivation
  • Depression
  • Cold extremities
  • Weight gain or difficulty losing weight
  • Slow speech
  • Hair loss
  • Premature graying of the hair
  • Low body temperature/ always cold/ sleeping with socks
  • Cracked heels and dry feet
  • High cholesterol
  • Ringing of the ears
  • Constipation
  • Anxiety and/or panic attacks
  • Slow pulse/low blood pressure
  • Decreased tendon reflexes
  • Droopy eyelids
  • Puffy and swollen face
  • Sparse, coarse, and dry hair
  • Coarse, dry, and thickened skin
  • Carpal tunnel syndrome
  • Hands tingling or numbness
  • Muscle cramps
  • Orange-colored soles and palms
  • Sides of eyebrows thin or fall out
  • Increased menstrual flow in women
  • Infertility and miscarriages

Diagnosing Hypothyroidism

As part of the initial evaluation, Dr. Melnick orders a comprehensive battery of nine thyroid blood tests. Dr. Melnick’s staff will email a laboratory requisition so that blood testing is done at a convenient local lab. Fasting is not necessary prior to thyroid blood testing. However, for people already taking thyroid medication, the time interval between taking thyroid medication and the blood draw is very important. The timing of the blood draw will be indicated on your lab requisition.

For ease in obtaining the results of your blood test, it is best to use a national clinical laboratory such as Quest Labs. Dr. Melnick has a direct online connection with Quest which makes your results readily available to him. It is also advantageous to open a patient portal which provides online access to your blood test results, which is most helpful when Dr. Melnick discusses your blood tests with you.

A thyroid sonogram may also be recommended as a diagnostic test for hypothyroidism. In many cases of hypothyroidism, a sonogram may show the thyroid gland to be enlarged or have nodules, both of which are indicators of hypothyroidism. Thyroid gland inflammation, such as found in cases of Hashimoto’s can also be seen in some cases. Dr. Melnick’s staff will email you a requisition for the test, which is performed in a radiology office.

Treating Hypothyroidism

Most doctors automatically prescribe synthetic thyroid hormone medications, such as Synthroid or Levothyroxine, to patients with hypothyroidism. However, 40% of patients do not experience relief from their symptoms with these medications. For this reason, Dr. Melnick prefers to treat his patients with a natural thyroid prescription medication generically known as NDT (Natural Dessicated Thyroid). It is made from the thyroid glands of pigs, which contain the identical thyroid hormones that are produced by the human thyroid gland. Armour Thyroid, which now has a generic identical twin sister, NP Thyroid, has been “grandfathered” for the treatment of hypothyroidism many years ago by the FDA because of its long history of safe and effective usage. If it did not have de facto FDA approval, it would have been removed from pharmacies’ shelves soon after 1972 when the FDA enacted legislation that all new drugs had to submit studies demonstrating safety and effectiveness before being approved for sale in pharmacies.

Dr. Melnick has prescribed Natural Dessicated Thyroid since he began his practice over 40 years ago. From his clinical observations, as well as his own personal experience taking natural thyroid medication, Dr. Melnick believes that the results of treatment with natural thyroid medications are far superior to those seen with the synthetic medications that are commonly used today. Ninety to ninety five percent of people suffering with the symptoms of hypothyroidism will experience relief when they are taking adequate amounts of natural thyroid medications, whereas studies show that only 60% of patients experience symptomatic relief when treated with synthetic thyroid T4 only medications. For the small percentage of people that do not experience adequate symptomatic relief from treatment with NDT, Dr. Melnick uses a pure T3 protocol which helps all but 1% of the NDT non-responders.

Although blood test results are useful in determining the root cause of hypothyroidism, people seeking treatment for hypothyroidism should be aware that the optimal dose of natural thyroid medication cannot be determined by a person’s blood work results. Since the early days of the commercial production of NDT in the 1920’s and long before the advent of thyroid hormone blood tests, the optimal dose of thyroid medication was determined by the clinical evaluation of the patient’s symptomatic response to a gradual increase in NDT dosage at 3-4 week intervals. When the patient’s symptoms have resolved, the dose that the patient was taking at that time was continued. If a patient experiences a subsequent change in symptoms, their dosage is adjusted either downwards or upwards, depending on the nature of their symptoms. The “old school” clinical approach, based upon a patient’s clinical symptoms, is the key to the successful treatment of hypothyroidism.

The main reason that levels of thyroid hormones in the blood do not accurately reflect the adequacy of thyroid function is that thyroid hormones function biologically inside of the cells of the body. The amount of biologically active thyroid hormones, T3 and T4, circulating in the blood do not necessarily correlate with the amount of thyroid hormones that are able to enter into the cells of the body. T3 is the most biologically potent form of thyroid hormone, which is produced from T4, which is a weak thyroid hormone whose major function is to be a source of T3. What happens when thyroid hormones enter a cell involves a very complex series of events, involving hormone receptors, DNA, messenger RNA and mitochondria, all of which come together to ultimately power cells to adequately perform their assigned biologic functions. When cells do not have adequate amounts of intracellular T3, people experience some of the 200 possible symptoms caused by low thyroid, since there are many different cell types function. Since each and every cell in the body is dependent on adequate amounts of thyroid hormone to function normally, it becomes obvious that

By taking the time to listen to the patient’s symptomatic response to their medication, combined with clinical judgment produced by years of experience treating people with hypothyroidism, is far superior to using blood test results, especially the levels of TSH, to determine a person’s optimal dose of thyroid medication. Actually, the “old fashioned” clinical approach, based on a person’s clinical symptoms, was the way that hypothyroidism was successfully treated for 50 years prior to the advent of hormonal blood testing in the late 1960’s. Ironically, the use of the TSH levels in both the diagnosis and treatment of hypothyroidism has harmed many individuals with hypothyroidism because many truly hypothyroid individuals actually have low TSH level

If a healthcare provider attempts to determine to achieve optimal NDT dosage so that the levels of TSH, T3 and T4 fall within the “normal” laboratory reference ranges, a person suffering with the symptoms of hypothyroidism will not get better. It is the amount of T3, the active thyroid hormone, that gets into the cell that provides symptomatic relief to a patient. Since there is no way to measure the level of intracellular T3, presence of symptoms is the only reliable indicator of the status of thyroid function. Therefore, in the case of hypothyroidism, treating according to blood test results is not the correct way to determine thyroid hormone dose.

Dr. Melnick’s method will gradually increase the dose of thyroid medication depending upon improvement in symptoms. It can take up 12 to 16 weeks to find the ideal dosage to alleviate symptoms and lead to a better quality of life. During this time, Dr. Melnick will speak with a patient every 3-4 weeks to check in on their symptoms and adjust dosages as needed.

His preference for the treatment of hypothyroidism with natural desiccated thyroid (NDT) medications, such as Armour or NP Thyroid, is confirmed by studies which have clearly shown that patients have superior symptomatic relief when treated with NDT medication as compared to treatment with synthetic thyroid medications, such as Synthroid. The secret of NDT medication is that it already contains T3, the most potent thyroid hormone, that actually relieves the symptoms caused by an underactive thyroid gland. Since the root cause of the symptoms of hypothyroidism is the inability to adequately convert T4, a weak thyroid hormone that is the active hormone found in Synthroid, into T3, the potent form of thyroid hormone, 40% people continue to have no symptomatic relief when treated with synthetic thyroid medications. Furthermore, just like the human thyroid gland and unlike synthetic thyroid medications, NDT contains Thyrocalcitonin, a hormone that causes the formation of new bone. NDT is an effective preventative and restorative therapy for women with hypothyroidism who have osteopenia and osteoporosis. Changing to NDT medication should be considered in all menopausal women being treated with synthetic thyroid medications, especially if they are not taking post menopausal hormonal therapy. 

Learn more about Treating Hypothyroidism with Telemedicine »

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