Thyroid Issues – Medical & Alternative Perspectives The Women's Wellness Series April 26, 2010 Richard J. Clofine, D.O.

Thyroid Gland Physical & Energy AnatomyThyroid Physiology and Function

Thyroid Control Pituitary Gland (TSH)Hypothalamus (TRH – thyrotropin releasing hormone)

Thyroid Stimulating Hormone (TSH)T4 (thyroxine)T3 (triiodothyronine)rT3 (reverse T3)Thyroid Binding Globulin(blood transport protein)IodineThyroid Antibodies

Hypothyroidism (low thyroid function)

Risk Factors (family history, personal history, treatment for hyperthyroidism (radioactive iodine, surgery, antithyroid drugs), thyroid cancer surgery, pituitary tumors, other autoimmune or endocrine disease, Epstein Barr Virus / Mononucleosis, aging, pregnancy, menopause, smoking & cessation, drugs (lithium), excess iodine supplementation, excess goitrogenic foods.

Symptoms (NOTE: these symptoms are more often from poor lifestyle, not thyroid disease.)(>50% of people experience these – may depend on severity)

weakness, fatigue & lethargy; cold intolerance; dry skin, decreased sweating & hair loss; inability to concentrate & memory loss; constipation; weight gain; dyspnea; peripheral parasthesias.

(<50% of people experience these – may depend on severity) depression; anorexia ; muscle cramps, muscle and joint pain; infertility; menorhagia (heavy irregular period bleeding); anovulation (failure to ovulate); carpal tunnel syndrome; decreased hearing.

"Medical/Clinical" Hypothyroid Disease – 3% of general populationAbnormal thyroid lab is present... this is the conventional medical diagnosis

Severity varies (mild, moderate, severe)Medical Causes (Hashimoto’s Autoimmune Thyroiditis, Graves Disease (end stage) & associated

autoimmune diseases, Dietary Iodine Deficiency & Goiter (enlarged thyroid gland), Myxedema (very dangerous; untreated severe hypothyroidism)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Lotus GynEcology 47 Commerce Drive, #1A, Blairsville, GA 30512 WWW.LOTUSGYN.COM 706-835-1045

"Subclinical" Hypothyroid Disease Normal thyroid lab present but thyroid symptoms persist ... this is an alternative medical diagnosis not accepted by conventional medicine

Many Different Perspectives (Broda Barnes, Wilson’s Syndrome, Metabolic treatment of chronic fatigue (http://www.drlowe.com/), XXXXXX

Hyperthyroidism (too much thyroid hormone) Hyperthyroid symptoms (weight loss, frequent defecation, disturbed sleep and irritability, anxiety,

bulging eyes (exopthalmos, worse in smokers), ovulation and menstrual irregularity • Graves Disease• Medication Excess (too much thyroid meds causes hyperthyroidism)

Thyroid NodulesThyroid Cancer

Thyroid Evaluation • Caregiver Relationship (who should you see for evaluation?)• Symptoms & Signs of disease• Temperature - Normal axillary body temp is between 97.4 and 98.2 degrees Fahrenheit. Temperatures

below that are suggestive of low thyroid. Lab EvaluationWhen Thyroid function is LOW, the TSH is ELEVATED.When Thyroid function is HIGH, the TSH is DECREASED

T4/T3 TSH T4 T3Normal Thyroid NORMAL

Range NORMAL0.4-4.5 mIU/L

(most Holistic Physicians use 0.4 – 3 mIU/L)

NORMALT4 = 5.6-13.7 mcg/dlFreeT4 = 0.8-1.5 ng/dl

NORMALT3= 87-180 ng/dlFreeT3 = 230-420 pg/dl

Hypothyroid (primary)

LOW HIGH Mild Moderate Severe

Low Low

Hyperthyroid HIGH LOW

Thyroid Antibodies (anti-peroxidase, anti-thyroglobulin)

Iodine Testing – Use caution with Iodine supplementationBecause deficiency causes hypothyroidism doesn't mean excess cures it!(patch test, iodine loading test)

Thyroid MedicationProper use balances thyroid function

• Levothyroxine (synthetic stereoisomer of T4 with longer ½ life = QD dosing)◦ Synthroid, Unithroid, Levoxyl, generic

• Liothyronine (synthetic T3) – Cytomel• Levothyroxine + Liothyronine – Thyrolar• Compounded Porcine Thyroid

◦ Armour / Naturethroid / Westhroid (USP desiccated natural thyroid)◦ Porcine glandular

▪ (1 grain = 60 mg = 9 micrograms T3 + 38 micrograms T4▪ (T4/T3 ratio is 80/20 as compared to the human 93/7)

• Compounded T3 + T4 Capsules◦ Natural T3 + T4 in slow release capsule ◦ T3 clears the body rapidly, best taken twice a day, may cause less consistent levels

Alternative Thyroid TherapiesIt has been my practical experience that people with significant long term hypothyroidism usually need life long thyroid medication.

Supplements• Iodine

◦ diet and kelp (225 microgram per tablet kelp in one supplement). ◦ Soil is very iodine depleted in most areas today. ◦ Foods that contain iodine are yogurt, eggs, meat, fish and other seafood, radish, parsley, potatoes,

oatmeal and bananas.• Selenium

◦ Many people with hypothyroidism found to be selenium deficient.◦ Selenium is required to convert the T4 thyroid hormone to the active T3 form. ◦ Also a good antioxidant at 200 micrograms daily.

• Tyrosine ◦ amino acid source for thyroid hormone production, 500mg twice a day on an empty stomach

• Kelp = Bladderwrack◦ seaweed that is a rich source of iodine and has been used for weight loss and hypothyroidism. ◦ The low incidence of goiter in maritime people has been attributed to the iodine in kelp

◦ It also contains the minerals potassium, magnesium, calcium, iron, zinc, etc.

◦ kelp is thought to stimulate the thyroid gland increasing metabolism.

• Coconut Oil – Medium Chain Triglycerides

• DHEA (Some researchers believe that supplementation with DHEA might assist in stimulating thyroid production and alleviating symptoms)

HerbsThere are no herbs that contain thyroid hormone.Herbs can be helpful in supporting thyroid function.

• Adaptogens(help to adapt to stress)◦ Rhodiola (Rhodiola Rosea), Ginseng (Panax Ginseng), Holy Basil (Ocinum sanctum), Maca

(Lepidium meyenii), Ashwaganda (Withania Somifera), Cordyceps mushroom (C. Sinensis), Reishi mushroom (Ganoderma lucidum), Agaricus mushroom (A. glazei)

• Herbs used to support healthy thyroid function◦ Bayberry, black cohosh, goldenseal, Siberian ginseng, astragalus, saw palmetto berry, triphala,

ashwagandha, Guggulsterones from Guggle Tree (commiphora mukul), skullcap, maca.

Influence of Diet• Goitrogenic foods (foods that can cause thyroid enlargement = goiter)

◦ very excessive amounts raw over long period of time to cause a problem(brussel sprouts, rutabaga, turnips, kohlrabi, radishes,cauliflower, african cassava, millet, babassu, cabbage, kale, soy products)

• Pollutants◦ Chlorine, fluorine, and fluoride are chemically related to iodine, and compete with it

Healthy for Thyroid: • Consuming foods naturally high in B vitamins, such as whole grains, nuts,

and seeds, and iodine (fish, seaweed, vegetables and root vegies)

Energy Medicine (Energy Body, Fifth Chakra)

Traditional Chinese Medicine, Ayurvedic Medicine, Homeopathy

Bodywork, Exercise, Yoga, Movement Therapies

REFERENCES• http://thyroid.about.com/ (Mary Shomon) Living Well With Hypthyroidism• https://www.drbrownstein.com/home.asp Overcoming Thyroid Disorders• http://www.optimox.com/pics/Iodine/updates/UNIOD-02/UNIOD_02.htm• http://www.drlowe.com/ The Metabolic Treatment of Fibromyalgia• http://www.wrongdiagnosis.com/t/thyroid/prevalence.htm• Textbook of Primary Care Medicine, second edition. John Noble, M.D. (editor)• Coconut Oil & Medium Chain Triglycerides http://jn.nutrition.org/cgi/content/full/132/3/329

“Why Do I Still Have Thyroid Symptoms? When My Lab Tests are Normal”Datis Kharrazian, DHSc, DC, MS