ThyroidDeficiencyStrikesOneinSixHypothyroidismisthemostcommonofallthehormonediseases,yetmostpeoplewhohaveitareunaware.Thetestforthisdeficiencyissimpleandalmostpainless,andthetreatmentiseffective,safe,andinexpensive.Leftunattended,asubtlemalfunctioncouldmeanheartdiseaseandanearlierdeath.Withonlyaslightdecreaseinthyroidhormoneactivitytherearenosymptomshowever,becausethisglandaffectsthefunctionofalmosteverytissueinthebody,severedeficiencycancausecomawithmultisystemfailure.

Hypothyroidismcanbetheresultofiodinedeficiency,medications,surgery,andradiation,butthemostcommoncauseinWesternpopulationsisapersonsownimmunesystemattackinghisownthyroidgland.Theinflammatoryprocessisknownasautoimmunethyroiditis(alsocalledHashimotosthyroiditisafterthedoctorwhofirstdescribedtheconditionin1912).Theresults:515%ofthegeneralpopulation,andasmanyas20%ofwomen,middleagedandolder,haveanoticeablelossofthyroidfunction.Thecauseisconsideredtobeunknown,butaswithotherautoimmunediseases(type1diabetes,rheumatoidarthritis,multiplesclerosis,etc.),therichWesterndietisthelikelysource.(Theimmunesystemistrickedbyanimalproteinsthatpeopleconsumetoattacktheirpancreas,joints,brain,thyroidandothertissuesbyaprocessknownasmolecularmimicry.)

DiagnosisbyaSimpleBloodTest

Hypothyroidismmaybesuspectedwhenpeoplecomplainoffatigue,weightgain,depression,slowmentalprocessing,muscleweakness,constipation,and/orfeelingcold.However,thesearesymptomscommonlyseenwithotherconditions,includinggenerallypoorhealth.Becausethepresentationissononspecific,anyonewhodoesnotfeelwellshouldautomaticallyhavetheirthyroidstatuschecked.

Hypothyroidismisdiagnosedbymeasuringahormoneproducedbythepituitarygland,calledthyroidstimulatinghormone(TSH).Asthenameimplies,thishormonestimulatesthethyroidtosynthesizemorehormonesandwhenthethyroidglandfailstorespondasdirected,thenmorestimulatinghormoneisreleasedinanattempttocorrectthedeficiency.ThusanelevationofTSHmeanshypothyroidism.NormalTSHlevelsaregenerallyconsideredbetween0.4and4.0mU/L.Someauthoritiesrecommendloweringtheupperlimitsofnormalto2.5mU/L,becauselevelshigherthanthiscouldmeanmoreheartdisease.1a

Beforecommittingsomeonetoalifetimeofthyroidreplacementtherapy(pills),theTSHlevelshouldberepeatedafterall,thelaboratoryinstrumentscouldhavebeenincorrectlycalibratedthatdayoryourspecimencouldhavebeenmixedupwithsomeoneelses.

TreatmentofHypothyroidism

Formostotherwisehealthyadultswithhypothyroidism,theinitialdoseofthyroidreplacementshouldbeanamountequivalentto0.125mgdailyoflevothyroxine.Lowerstartingdosesmaybenecessaryforpeoplewithseverecoronaryarterydisease.TSHlevelsshouldbemonitoredevery4to6weeksandappropriateadjustmentsindosemadebasedonresults.Usingtheresultsfrombloodtests,ItrytokeeptheTSHlevelsofmypatientsbetween0.5and2.0mU/L.1aOncethecorrectdoseisdetermined,thentheTSHlevelshouldbecheckedannually,unlessthepatientshealthsuggestsotherwise.Eventhoughtreatmentmayseemsimple,aboutonefifthofpatientsreceivetoolittleandonefifthreceivetoomuchreplacementwiththyroidmedication.

CommonSupplements

(Costof90pillswithapotencyequalto0.125mglevothyroxine)

ArmourThyroidisanextractmadefromdriedpigthyroidglands($21.99)

Thyrolarissyntheticproductcombiningtriiodothyronine(T3)andlevothyroxine(T4)($64.99)

Synthroidisthemostpopularbrandofsyntheticlevothyroxine(82%ofthemarket)($39.97)

Levoxylisagenericbrandofsyntheticlevothyroxine($27.97)

Levothroidisagenericbrandofsyntheticlevothyroxine(26.97)

Unithroidisagenericbrandofsyntheticlevothyroxine($24.99)

Cytomelissynthetictriiodothyronine(rarelyusedalonetotreathypothyroidism)

GenericbrandsoflevothyroxineandSynthroidallworkequallywell.1

ShouldMildHypothyroidismBeTreated?

Mostdoctorsbelievethatslightdecreasesinthyroidhormoneproduction,seenbyanincreaseinTSHlevelintotherangeof2.5mU/Lto10mU/L,shouldbeleftuntreated.2However,Iholdaminorityopiniononthisissueandoftenrecommendtreatmentfortheselaboratoryresultsforseveralreasons.ManypeoplewithamildelevationofTSHgoontodevelopdefinitehypothyroidismearlysupplementationwillpreventthemfrombecomingclinicallyhypothyroid,ifandwhentheirconditionprogresses.Treatmentofmilddeficiencyhasbeenshowntorelievetroublesomesymptoms,likefatigueandmuscledysfunction,andimprovementalperformance.3,4

However,themostimportantreasonthatItreatmildelevationsofTSHistoreducetheriskoffuturecoronaryartery(heart)disease.PeoplewithelevatedTSHlevelshavehighercholesterollevelsandtreatmentwiththyroidhormonesupplementswilllowertheirtotalandLDLcholesterollevels.3,4ThiselevationofcholesterolassociatedwithaslightlyhigherTSHleveltranslatesintoanincreasedriskofheartdiseaseduetoblockedcoronaryarteries.5Treatmenthasbeenfoundtoreducethickeningsinthewallsofthearteriesaconditionassociatedwithahigherriskofheartattacksandstrokes.6Mildhypothyroidismisassociatedwithanincreasedriskofcongestiveheartfailureamongolderadults.7Finally,theoverallriskofdeathmaybeincreasedbyamilddecreaseinthyroidactivityasreflectedinaslightelevationofTSH.5

Islevothyroxinealonesufficienttreatment?

IthasbeenclaimedthatpatientswithhypothyroidismshowgreaterimprovementsinmoodandbrainfunctioniftheyreceivetreatmentwithArmourthyroidratherthanSynthroid(levothyroxine).8Thisconclusionisbasedona1999studypublishedintheNewEnglandJournalofMedicinethatactuallytestedasyntheticmixtureoflevothyroxine(T4)andtriiodothyronine(T3),ratherthepigderivedArmourpreparation.9Thestudyshowedsomeofthemeasuresformentalperformance,moodandphysicalstatuswereimprovedinpeopletakingthecombinationofbothformsofthyroidhormone,ratherthanthesinglehormone,levothyroxine.Sucharevelationcausedquiteastirinthemedicalcommunitybecausedoctorsaretraditionallytaughtthatusinglevothyroxinealoneisthebestwaytotreathypothyroidism.

Inresponse,severalstudieswereperformedtotrytoverifythesefindings.ContrarytotheNewEnglandJournalofMedicinestudy,eachofthenewerstudiesfailedtofindanimprovementinmoodormentalperformancewiththecombinationoversinglehormonetherapy.1a,1015OnestudyreportedahigherriskofoverdosingpatientscausinghyperthyroidismaccompaniedbyfeelingsofimpairedwellbeingduetothefastactingT3mixedinwiththepreparation.11Consideringalloftheresearchtodate,levothyroxine(thesinglehormone)aloneshouldremainthetreatmentofchoiceforreplacementtherapyofhypothyroidism.14(Thereissomepharmaceuticalindustrymoneyfundingthisconclusion,soasalways,Ireservemyrighttochangemyopinionondrugtherapy.)

SomeofthereasonsforcautionarebecauseofitsquickonsetandshortdurationofactionT3cancauserapidandirregularheartbeatsandbedifficulttomonitor.AlloftheT3werequireisnaturallyproducedinourbodyfromT4thetissuesslowlyandsafelymakeametabolicconversionofsomeoftheT4toT3.

AnimalExtractsMayNotBeSafe

ManypatientsIseeexpressadesirefornaturaltherapies.Therefore,itshouldbenosurprisetohearthattheywanttoavoidtakingsyntheticthyroid(levothyroxine)andinsteadrequestanaturalpreparation,liketheArmourbrand.Extractsmadefromtheglandsofanimalscontainseveralformsofthethyroidmolecule,includingT3andT4andsomedoctorsconsiderthisanadvantage,whilemostresearchdoesnotsupportthisviewpoint.

Theoriginaltreatmentofhypothyroidismdevelopedbackin1891wasmadefromextractsfromthethyroidglandsofsheep.Sincethenthedesiccatedglandsofotheranimals,includingcowsandpigs,havebeenused.Theprocessofmakingthismedicationbeginswithremovingtheanimalsthyroidgland,thendryingit,andfinallygrindingitintoapowder.BecauseofvariationsinconcentrationsofactivehormonesintheanimalsglandulartissuesthepotencyofthepreparationscanvarygreatlypeoplehavedevelopedserioussideeffectsfromnaturalthyroidproductsthatcontainedgreaterthanexpectedamountsofT3.Becauseoftheforeignanimaltissuesusednaturalthyroidsupplementscanalsocauseallergictypereactions,especiallyinpeopleknowntobeallergictoanimalproteins.

Onepotentialproblemthathasreceivednoseriousinvestigationistheriskofcontractinginfectionfromconsumingglandulartissuesinpillform.Muchworkhasbeendoneshowinganimalbornemicrobescanbespreadtopeoplebyeatinganimalsasfood16,17andthereiseveryreasontobelievethesamecanoccurwhendriedanimaltissuessoldasmedicationsare

consumed.Cancer,includingleukemia,virusesandAIDSlikevirusesarecommonlyfoundincowsandpigs.18,19Thesevirusesareknowntoinfectpeople.20Couldthesesupplementsbeanunintendedmediaforthespreadofprionbasedbraindiseases,likemadcowdisease?Therearemanyreasonstobelievethatthisisarealrisk.21,22

ThedeadlyH5N1strainofbirdfluhasrecentlybeenfoundinpigpopulations.23Historymayberepeatingitself.Thedeadlyhumaninfluenzavirusof1918thatkilledmorethan20millionpeopleworldwidewasamutationofaswinefluvirusthatevolvedfromAmericanpigsandwasspreadaroundtheworldbyUStroops.24

Sincetherehasbeenessentiallynoeffortbythelivestockindustryinmost(butnotall)countriestocleanuptheiranimals,hundredsofdifferentkindsofinfectiousmicrobesarebeingconsumedbybillionsofpeople.Therefore,toprotectyourselfandfamilythereiseverygoodreasontonoteattheseanimalsandtheirbyproducts,includingglandularextracts,likenaturalthyroidextract.(FormoreinformationseemyFebruary2004newsletterarticle:WidespreadInfectionwithLeukemiaVirusfromMeatandMilk.)

OverdosingBySelfmedicatingandtheNaturalDoctor

InmypracticeIoftenseepatientswhoaretakinganoverdoseofthyroidmedication.Theymaybeselfmedicatinginhopesoffeelingmoreenergeticorlosingweighteffortlessly.Anotherrealpossibilityistheirdoctor,oftenreferredtoasalternative,holistic,and/orcomplementary,prescribesasupraphysiologicdosetotreatvariousailments,suchaschronicfatiguesyndromeorarthritis.

Inactualpractice,peoplealmostneverrequiremorethan0.2mgoflevothyroxine(equaltoabout2grainsofthyroidextract).Inadditiontofailingtoresolvehealthandweightproblems,toomuchthyroidcanresultinbonelossandheartarrhythmias.25,26

AChangeinDietWillNotCorrectHypothyroidism

OncethethyroidtissueisdestroyeditwillnotregrowandIknowofnowaytostimulatetheremainingglandtoworkharder.Manypeopleaskifavoidingcruciferousvegetablefoodsortakingextraiodinewillcuretheirthyroidcondition.Compoundsinplantfoods,likecabbage,cauliflower,Brusselssprouts,milletandsoyhaveantithyroideffects.Thesefoodsarereferredtoasgoitrogenicfoodsbecausetheoreticallytheycanleadtoaconditionoflowthyroidwithanassociatedglandenlargement,calledagoiter.Supplementationwithiodinecompletelyreversesthegoitrogenicinfluenceofanyvegetables.(Incidentally,thesesamefoodshavecompoundsthatprotectagainstthyroidcancer.27)

Thereisnoharmintryingtoimproveyourthyroidfunctionbyavoidingcruciferousvegetables,soyandmillet,and/oraddingmoreiodine(likefromseavegetables)toyourdiet,butmyexperiencehasbeenthatthiseffortwillmakenodifference.Letmeknowifyoufindotherwise.

Simple,Safe,EffectiveMedicalCare

Partoftheroutineevaluationofallofmypatientsisacheckoftheirthyroidstatus.IftheirTSHlevelsareabove3mU/L(aftertwoseparatetests),thenIconsiderrecommendingsupplementationwithlevothyroxine.IleanmoretowardstreatmentthehighertheTSHlevel(themoreseverethehypothyroidism).Also,iftheyhaveahigherriskforheartdisease,thenIammoreinclinedtorecommendtreatment.

EventhoughIhavenotfoundthebenefitstobegreat,Iamsometimespersuadedtotreatwhenweightlossorfatigueisthepatientsconcern,andtheyalsohaveaslightlyabnormalTSHlevel.Othertimes,whenthedecisiontotreataslightlyabnormalTSHlevelsisnotstraightforward,Imaysuggestasixmonthtrialonthyroidandlookforsubjective(feelingsofwellbeing)andobjective(lowercholesterol)improvements.

ThyroidsupplementationisoneoftheveryfewtreatmentsIcommonlyprescribe.(SeemyNovember2004newsletterforamorecompletelistofMcDougallusedmedications.)Formypatientswithadamagedthyroidgland,correctinghypothyroidismwiththerightamountoflevothyroxinecanbeaninexpensivemedicalmiraclewithoutsideeffects.

References:

1a:SpencerCA.DemersLM.LMPG:LaboratorySupportfortheDiagnosisandMonitoringofThyroidDisease(PublishedGuidelines):http://www.nacb.org/lmpg/thyroid/3c_thyroid.doc

1)DongBJ,HauckWW,GambertoglioJG,GeeL,WhiteJR,BubpJL,GreenspanFS.Bioequivalenceofgenericandbrandnamelevothyroxineproductsinthetreatmentofhypothyroidism.JAMA.1997Apr16277(15):120513.

2)CrapoLM.Subclinicalhypothyroidismandcardiovasculardisease.ArchInternMed.2005Nov28165(21):24512.

3)RobertsCG,LadensonPW.Hypothyroidism.Lancet.2004Mar6363(9411):793803.

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NagatakiS,EguchiK.Riskforischemicheartdiseaseandallcausemortalityinsubclinicalhypothyroidism.JClinEndocrinolMetab.2004Jul89(7):336570.

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7)RodondiN,NewmanAB,VittinghoffE,deRekeneireN,SatterfieldS,HarrisTB,BauerDC.Subclinicalhypothyroidismandtheriskofheartfailure,othercardiovascularevents,anddeath.ArchInternMed.2005Nov28165(21):24606.

8)UseArmourthyroidratherthanSynthroid:http://www.mercola.com/1999/archive/armour_thyroid.htm

9)BuneviciusR,KazanaviciusG,ZalinkeviciusR,PrangeAJJr.Effectsofthyroxineascomparedwiththyroxineplustriiodothyronineinpatientswithhypothyroidism.NEnglJMed.1999Feb11340(6):4249.

10)EscobarMorrealeHF,BotellaCarreteroJI,GomezBuenoM,GalanJM,BarriosV,SanchoJ.Thyroidhormonereplacementtherapyinprimaryhypothyroidism:arandomizedtrialcomparingLthyroxineplusliothyroninewithLthyroxinealone.AnnInternMed.2005Mar15142(6):41224.(Mercksponsored).

11)SiegmundW,SpiekerK,WeikeAI,GiessmannT,ModessC,DabersT,KirschG,SangerE,EngelG,HammAO,NauckM,MengW.Replacementtherapywithlevothyroxineplustriiodothyronine(bioavailablemolarratio14:1)isnotsuperiortothyroxinealonetoimprovewellbeingandcognitiveperformanceinhypothyroidism.ClinEndocrinol(Oxf).2004Jun60(6):7507.(Nosponsorlisted)

12)ClydePW,HarariAE,GetkaEJ,ShakirKM.Combinedlevothyroxineplusliothyroninecomparedwithlevothyroxinealoneinprimaryhypothyroidism:arandomizedcontrolledtrial.JAMA.2003Dec10290(22):29528.(Sponsor,NationalNavalMedicalCenter)

13)SawkaAM,GersteinHC,MarriottMJ,MacQueenGM,JoffeRT.Doesacombinationregimenofthyroxine(T4)and3,5,3'triiodothyronineimprovedepressivesymptomsbetterthanT4aloneinpatientswithhypothyroidism?Resultsofadoubleblind,randomized,controlledtrial.JClinEndocrinolMetab.2003Oct88(10):45515.(SponsoredbyAventis)

14)EscobarMorrealeHF,BotellaCarreteroJI,EscobardelReyF,MorrealedeEscobarG.REVIEW:Treatmentofhypothyroidismwithcombinationsoflevothyroxineplusliothyronine.JClinEndocrinolMetab.2005Aug90(8):494654(SponsoredbyUniversityGrants)

15)WalshJP,ShielsL,LimEM,BhagatCI,WardLC,StuckeyBG,DhaliwalSS,ChewGT,BhagatMC,CussonsAJ.Combinedthyroxine/liothyroninetreatmentdoesnotimprovewellbeing,qualityoflife,orcognitivefunctioncomparedtothyroxinealone:arandomizedcontrolledtrialinpatientswithprimaryhypothyroidism.JClinEndocrinolMetab.2003Oct88(10):454350.(SponsoredbySirCharlesGairdnerHospitalResearchFoundation)

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