Thyroid Disorders | Robert Lang, MD

Depression… Chronic Fatigue… Weight Gain… Hair Loss… Low Sex Drive…

“Are You Thyroid Deficient?”

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Hope... that’s what my patients are looking for.

The hope that someone will finally tell them what’s wrong – and what they can do to help heal their shopping bag full of complaints and conditions.

  • Weight gain, no matter how strict a diet is tried.
  • Constant fatigue, morning, noon and night. Even with 8 hours or more of sleep.
  • Depression, coming out of nowhere. It’s like looking at a rainbow, and suddenly seeing only grey.
  • Brain fog, that no amount of coffee or souped-up caffeine drinks can dissipate.

Then there are the host of other symptoms…constipation, always feeling cold, memory loss, low libido, abnormal cholesterol, vanishing eyebrows, hair loss, coarse hair, anxiety, dry skin, brittle nails, muscle cramps or aches, and hoarseness.

These patients I’m seeing are at the end of their rope. Almost to a one, they’ve already been to multiple physicians and specialists. They’ve had test after test, and each time the results – and the diagnosis - are the same.

“Your tests all say everything is normal. We can’t find anything physically wrong with you.”

Then comes the clincher… the catch-all their doctors use when they have no clue what the answer is:

“It’s all in your head. I’ll write you a prescription for a mild anti-depressant.”

Which is probably the last thing these patients need! The anti-depressants only make matters worse, since these people aren’t clinically depressed. They’re suffering – and no one can tell them why.

Medical Complaints On The Rise

Here’s the bad news: All the conditions I mentioned earlier have been steadily increasing over the years. Where maybe I would get one or two patients a week with these symptoms, it’s now a steady stream of both men and women trying to find out what’s wrong with them.

I’m their last resort. They often bring me test results from other doctors, as if to prove they’ve been trying everything they can. They’re convinced they have some strange, untraceable disease, and are steeling themselves for the worst.

But now the good news... most of these cases are in fact easily treatable.

All the above symptoms, the lethargy, the lack of sex drive, the weight gain, the depression… the host of debilitating conditions, all of them can stem from an under active thyroid, or hypothyroidism in medical talk.

I look at their charts, then order a specific test for thyroid function. I’m already pretty sure what I’ll find. Their thyroid is barely functioning.

Why “Normal” Is Anything But...

There’s a dirty little secret most doctors don’t discuss with their patients.

When medical tests are done, anything within a wide range of results is considered normal. Your thyroid could be limping along at 20% efficiency, yet for the tests, that’s fine. Since the tests say you’re OK, the doctor just repeats what he reads off the charts.

Well, the simple fact of the matter is this - those results aren’t normal. Your body is deficient, and you have all the classic symptoms to prove it. You know in your heart you don’t need a doctor who merely reads reports and treats from lab tests, you need a physician who actually listens to and treats people - just like you.


Diagnosing thyroid disorder is based mainly on symptoms and the blood levels of your thyroid hormones is used for confirmation. Neither the symptoms nor the blood tests are 100% accurate for diagnosing a low or high thyroid condition.

Used together however, we can diagnose with about 98% accuracy. New research has shown that many more people have Hypothyroidism (low thyroid) than previously believed.

High/Low Thyroid Levels
Symptoms of LOW thyroid levels: Symptoms of HIGH thyroid levels:
Fatigue Nervousness
Depression Irritability
Forgetfulness Weakness
Dry coarse hair Hair loss
Hair loss Difficulty sleeping
Puffy eyes Rapid or pounding heart beat
Aching joints Increased sweating
Enlarged thyroid gland Heat intolerance
Slow heart beat Weight loss (increased appetite)
Cold intolerance Frequent bowel movements
Constipation Diarrhea
Brittle nails Warm moist palms
Heavy and/or irregular periods Shaking fingers (tremor)
Decreased appetite Scant periods
High blood pressure Enlarged thyroid
High cholesterol

Note: When there are symptoms from both columns, there is usually a low thyroid and an adrenal problem. You would fit into this category if you are both tired and "wired."

As recently as 50 years ago, it was a known scientific “fact” that you could take as much thyroid hormone as you needed to overcome symptoms. Because thyroid hormone is a “natural hormone” it was believed to be safe at any dose and there were no research studies disapproving this. It wasn’t until the 1980’s that research revealed high doses of thyroid hormone caused osteoporosis.

Almost overnight thyroid hormone became “dangerous” and the pendulum swung in the opposite direction. There were still no good tests for measuring thyroid blood levels, and fear of treatment became dogma. When reliable tests finally became available, many people with untreated hypothyroidism were still being included in the “normal” range.

To further complicate things, some people are more sensitive to thyroid hormone. However, if the lab tests come back “normal” and they have no symptoms, thyroid treatment doesn’t even enter the picture.

This further taints the “normal range” making mild hypothyroidism look “normal” when it really isn’t. When these people are accurately tested, the “normal” range becomes much narrower than what is currently reported.

Many people with the symptoms listed above do not get diagnosed and properly treated because their health care provider isn’t familiar with the new research and how to interpret the latest laboratory tests.

Interpreting Thyroid Tests

First, it is frequently stated that thyroid tests are not accurate.

That was definitely the case as recently as 30 years ago. However, this is no longer true, at least for the TSH test (thyroid-stimulating hormone blood test). Anyone claiming this test isn’t accurate simply does not understand how to interpret the results.

The only time the TSH may not be helpful is when it’s done on a patient with a pituitary disorder, which is not a common experience. The irony is that the reason some practitioners believe the TSH test isn’t accurate is because many people with mild hypothyroidism are being reported in the normal range.

The problem isn’t with the test, it’s because the “normal range” is too large.

The TSH test is far more accurate because, unlike all other thyroid tests, it’s reported on a “log” scale, rather than a linear one. This log scale is 10 times more sensitive and 10 times easier to measure than the linear scale used for all other thyroid tests. Unfortunately, even many endocrinologists miss this fact.

Thyroid and Menopause

It’s estimated that by age 50 as many as one out of every five women has some degree of hypothyroidism. By age 60 it’s even higher. This low thyroid is often the ignored factor in women who are being treated for menopausal related symptoms.

Many women confuse hypothyroidism symptoms with menopause symptoms.

Fatigue, dry skin, weight gain, hair loss, constipation and "fuzzy thinking” or “brain fog" are common symptoms shared by both conditions. Thyroid antibody tests can sometimes be helpful in addition to TSH thyroid testing. Even if you have a "normal" test result, you should consider yourself a possible thyroid candidate if you have had ANY of the symptoms named above prior to menopause. Because low thyroid symptoms so closely mimics menopause, many patients (and their doctors) will dismiss hypothyroidism as a possible cause for their complaints.

Thyroid, Pregnancy and Infertility

Undiagnosed and untreated thyroid disease can be a cause for infertility or recurrent miscarriages. You need to know that in the past 30 years, I have seen many women with mild hypothyroidism who tested in the "normal" range become pregnant once low dose thyroid hormone was started.

If you are having difficulties in becoming pregnant, or have suffered a miscarriage there are several things you can do. Ask your doctor for both TSH (thyroid stimulating hormone) and thyroid antibodies laboratory tests.

Contrary to popular medical opinion, the T3 and T4 thyroid hormones are frequently reported as normal in mild hypothyroidism. Find out the actual numerical result for the TSH level from your doctor. It's important that you not accept "the result was normal" banter you’ll probably be given. You want the exact number.

Look at the TSH level. At most labs, they consider a normal range to be approximately 0.5 to 5.5. But as of 2003, 0.3 to 3.0 is considered the narrower normal range many experts are now using for diagnosis and thyroid management.

Some endocrinologists believe that a percentage of women may find it difficult to get pregnant - or maintain a pregnancy - at a TSH level above 2.0.

For some woman this is even too high. I have seen and treated women with long standing infertility with a TSH in the 1.0- 2.0 range who have become pregnant within 1-3 months on a dose of thyroid hormone that lowered their TSH to 0.3 -1.0.

If your TSH is "high – normal" or you have elevated thyroid antibodies, find a doctor or endocrinologist who has a good success rate working with thyroid related infertility. Ensure you are ovulating by using a fertility awareness method, and/or ovulation predictor.

Thyroid hormone is not only safe for the baby, it is necessary for normal brain development. Children born to mothers with untreated hypothyroidism have lower cognitive development than their peers.

Hair Loss And Dry Skin & Brittle Nails

“Could It Be My Thyroid?”

An under-active thyroid can create dry, coarse, itchy skin, hair loss and brittle nails. The well being of your skin, the largest organ we have, depends on the general health of your body. When hormones like those controlled by the thyroid are not working properly, it can have a noticeable effect on your skin.

A hypothyroid condition slows down your metabolism, which causes skin to become cold, dry and pale.

Hypothyroidism can contribute to aging and dry skin on your body – including your face - which in turn can cause winkles and creases.

These symptoms can occur especially in woman with subtle hypothyroidism. When tested they are usually told they are “normal” – which of course is not the case at all.

Thyroid and Weight Loss

“I May Be Overweight, But It’s Not My Fault!
It’s My Thyroids Fault… But Why?”

The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck, right below your Adam's Apple. The thyroid controls how quickly the body uses energy, makes proteins, and controls how sensitive the body should be to other hormones.

The thyroid gland does this by producing thyroid hormones. These hormones regulate the rate of metabolism and affect the growth and rate of many other internal systems.

The thyroid gland in turn is controlled by thyroid-stimulating hormone (TSH) produced by the pituitary. The most common thyroid gland problems consist of an overactive thyroid gland, referred to as hyperthyroidism, and an under active thyroid gland, known as hypothyroidism.

Many overweight people have some degree of hypothyroidism. By stabilizing the thyroid, weight loss often occurs as a very welcome side effect. Many studies show that thyroid hormone treatment can help accelerate weight loss – more so than can be achieved by dieting alone.

What Is The “Best” Prescription
Based Thyroid Treatment?

There are actually two types of thyroid hormone. Many people do extremely well with the hormone known as T4 (prescribed as Synthroid, Levoxyl or the generic levothyroxine). However, this T4 hormone must be activated by the body to be effective. When this conversion process is not working properly, a fixed dose combination of hormones, T4 and T3 (Armour Thyroid or Thyrolar) may be necessary to achieve full effect.

Alternatively, a separate T3 prescription (Cytomel or liothyronine) can be added to the T4. This allows for a more individualized treatment when the fixed dose doesn’t work. Your health care provider will work with you to find the safest and most effective treatment to alleviate your symptoms and improve your health and well being. Be careful of providers that say one preparation works for everyone. This is not a one size fits all problem.

Several adjustments may be required before a therapeutic level is reached.

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No amount of money in the world can substitute for good health. A healthy thyroid is crucial for a proper functioning body. Shouldn’t you do all you can to ensure a healthy, vibrant life is yours?

To a joyous life…

Robert Lang, M.D.

P.S. Just so that you know, I only recommend products from companies that either I or my wife have personally taken and tested. You can rest assured that when I say a product or supplement from a particular company works, it does just that.

Your health truly is my concern.

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