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Thyroid Therapy

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Thyroid Therapy

Thyroid dysfunction was recognized more than 100 years ago. A lack of thyroid hormone (hypothyroidism) is more common than an excess condition (hyperthyroidism).

Symptoms of Hypothyroidism include but are not limited to:

  • Morning fatigue
  • Daytime fatigue/somnolence
  • Depression
  • Cognitive impairment (difficulty in thinking clearly)
  • Cold intolerance
  • Constipation
  • Memory impairment
  • Menstrual disorders
  • Musculoskeletal pain
  • Fluid retention
  • Hair thinning

The standard laboratory tests for diagnosing thyroid dysfunction are:

  • Thyroid stimulating hormone, (TSH)
  • Free T4; the pre-hormone made in the thyroid
  • Free T3; the active hormone converted from T4 in the thyroid and in peripheral tissues
  • Thyroid binding globulin; the transport protein that carries thyroid hormone in the blood
  • Thyroid antibodies; these are proteins that are markers for autoimmune inflammation of the thyroid known as thyroiditis. This is a condition that can lead to hypothyroidism.

The non-conventional methods for diagnosing hypothyroidism include:

Basal Body Temperature: There are two schools of thought as regards basal body temperature. The traditional school of thought developed by Dr. Broda Barnes advises taking the temperatures first thing in the morning. The newer school of thought advises taking the temperature at intervals during the day. I often ask patients to do it both ways.
Dr. Broda Barnes method:

  1. Obtain a basal thermometer. It is important to use a mercury thermometer and not a digital thermometer.  Shake it down and put it by your bedside when you go to sleep.
  2. Upon awakening and before arising place the thermometer in your axilla (armpit) for 10 minutes. Do this for five days in a row.
  3. In women, the temperature should be taken starting on the second day of menstruation. In mid cycle there is a typical rise in temperature with ovulation. In post-menopausal women and men the time of the month does not matter.
  4. A normal temperature is considered to be between 97.8-98.2 degrees Fahrenheit. Temperatures below this range may suggest under activity of the thyroid.

Dr. Bruce Rind’s Method:

  • Use a basal thermometer. It is important to use a specialized digital thermometer. This type of thermometer is available at the RiverHill Wellness Center.
  • The temperature is taken under the tongue not in the axilla. The temperature is taken three times per day for 3 consecutive days.
  • The first temperature is taken 3 hours after arising.
  • The second temperature is taken three hours after the first temperature.
  • The third temperature is taken three hours after the second temperature. Do a daily average of the three temperatures taken.
  • Menstruating women should avoid taking the temperatures in mid cycle when they are ovulating.

Body temperature as a means of diagnosing under activity of the thyroid is controversial. It should be used in the context of a patient history, physical exam and laboratory testing.

A second method for looking at thyroid function that is out side main stream medical practice is The 24 Hour Urine Collection for Free T3 and Free T4.  This is the test favored by the Belgian endocrinologist Dr. Thierry Hertoghe. He argues that a 24-hour collection gives a more accurate picture of the persons’ thyroid hormone production than a spot serum measurement.

Remember, testing combined with history and physical exam is needed to make a diagnosis.

There are several issues regarding treatment of functional hypothyroidism.

  • We need to establish whether there is an adequate production of T4 from the thyroid gland.
  • We need to establish whether T4 (the pro-hormone) is being converted to T3 (the active hormone) in the thyroid and in the peripheral tissues.
  • We need to establish whether there is tissue resistance to adequate amounts of thyroid hormone. This last idea is mostly speculation. Many physicians suspect that there can be thyroid hormone resistance just as there can be insulin resistance (a pre diabetic state).

Factors that may lead to Functional Hypothyroidism include:

  1. Nutritional Deficiencies
    Deficiencies in vitamins; A, B2, E
    Deficiencies in trace minerals; iodine, iron, copper, zinc, selenium
    Deficiencies in essential fatty acids (this is my speculation)
    Protein/calorie malnutrition
    Deficiencies in metabolic intermediates; NADH
  2. Metabolic Abnormalities may lead to poor conversion of T4 to T3. The dominant metabolic abnormality that can do this is insulin resistance. Insulin resistance and its treatment can be reviewed in the functional basis of health and healing section.
  3. Hormonal deficiencies may impair the conversion of T4 to T3. This is  
    observed when the DHEA level is low. DHEA can be low for many reasons including aging, stress and insulin resistance. There may be a functional adrenal insufficiency. This can account for a failure of the basal body temperature to respond to thyroid supplementation.
  4. Excess ingestion of certain foods may inhibit thyroid hormone production;  
    cauliflower, soy products, high protein diets and excessive iodine ingestion
  5. Medications can inhibit thyroid production, reduce conversion of T3 to T4 and produce a relative resistance to thyroid hormone. This list includes but is not limited to lithium, beta-blockers, anti-thyroid medications, antidepressants, antiseizure medications, anticoagulants, antiarrythmic agents and anti-inflammatory drugs.
  6. 6. Certain herbal products can inhibit thyroid function; Lithospermum, Lycopus, Melissa and some flavonoids.
  7. Toxic agents that can adversely affect thyroid function include alcohol, tobacco, cadmium, mercury, cyanides, thiocyanates, phenols, coal derived pollutants, carbontetracholride, pesticides, herbicides and organochlorines.
  8. Chronic diseases involving other organs; liver, kidney, GI, cardiovascular,
         immune system, rheumatologic and neoplastic.

This list is daunting but consideration of these issues may be important in dealing with a person with a refractory problem.

Thyroid Hormone Treatment Strategies:

The conventional medicine approach uses a synthetic T4. For many people this is perfectly adequate.

The advocates of the Dr. Broda Barnes method think that the animal glandular extract is a better form of replacement. They argue that the products in the extract provide a balanced supplementation that is more like our own natural glandular production. Many people feel better, (more energetic) with this form of supplementation. There is no objective evidence in the medical literature that one form is better than another.

There was an approach advocated by Dr. Denis Wilson.  He argued that the problem is the over production of a product called reverse T3. Excess reverse T3 blocks the thyroid receptors and inhibits production of regular T3. He used escalating doses of slow-release T3 to shut down the persons own thyroid production and to reduce and halt the production of reverse T3. He then tapers the slow-release T3 and allows the persons own thyroid production to take over. His approach is intriguing. It has been beneficial for many patients. It has made other patients very ill. Its safety is not well established. It is unproven by any scientific observational process. It is difficult for patients to adhere to the regimen. It is not a technique I recommend.

There are a group of clinicians who have observed that patients with the problem of “low metabolism” have a dominant symptom of fatigue and general low energy. They have difficulty accomplishing the daily activities of their lives. There are many possible causes for this phenomenon including chronic infections, intoxications, chronic stress, endocrine disorders and other chronic diseases. The belief is that these underlying problems can create thyroid and or adrenal dysfunction or insufficiency. These clinicians have observed differences in patient history, physical exam and laboratory testing based on whether the individual has a problem that is predominately thyroid, adrenal or mixed. Most importantly, they have observed that patients with functional adrenal insufficiency do not respond to thyroid hormone either clinically or in terms of an improvement of their basal body temperature. This has led him to a therapeutic process that addresses this sub group of patients. I believe his approach may have merit.

Therapy must be individualized. Monitoring on a regular basis is essential. Many patients do very well with T4 (levothyroxine). Others need a combination of T4 plus T3 (cytomel or Nature Thyroid). Others do well with the glandular extract (thyroid extract by Armour).

Functional thyroid hormone therapy should be done with consideration of the interaction with other endocrine function such as adrenal function (Cortisone and DHEA) and pituitary function (growth hormone). Please review these issues in the other chapters of this section.