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Hypothyroidism, The Hidden Epidemic

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Who should read this?

Anyone who

• Has had a feeling that he/she is hypothyroid but has "normal" thyroid blood tests
• Has hypothyroid symptoms (see them in the Diagnosis section below) and normal blood tests
• Is being treated for hypothyroidism and is not satisfied with the results; i.e., has not gotten major symptom relief, particularly improvement in brain and emotional functioning.
• Is being treated with thyroxin (T4, Synthroid and others) but not with sustained release liothyronine (T3)
• Is being treated with Cytomel
• Would like to know if he/she is participating in the hidden epidemic of hypothyroidism
• Would like to take more responsibility for his/her health and decrease dependency on the disease care system and prescription drugs.
• Would like to use one safe, inexpensive treatment with a natural (bioidentical) hormones that can resolve multiple symptoms which, if treated separately, could cost thousands or tens of thousands of dollars and perhaps put one's life in danger from adverse drug reactions.

Henry David Thoreau wrote: "For every person hewing to the root of the tree of evil there are a hundred hacking at its branches." In my youth I worked in a landscape nursery and have personal knowledge of the difference in outcome when the branches are pruned and when the root is cut. When I became a physician I decided to approach the tree of disease by being a root hewer and not a branch hacker. I have never regretted that decision although it has made me an outsider in conventional medicine.

In practical terms, hewing to the root means finding one thing which, if corrected, will improve several symptoms and if possible, many symptoms. Hypothyroidism is one of the conditions which, when corrected, will do this. You can see what I mean by looking at the symptom list in the Diagnosis section of this article.

Not only is hypothyroidism the root of many symptoms but it is amongst us as a hidden epidemic. It is hidden because most physicians believe the TSH (Thyroid Stimulating Hormone) blood test, which more and more physicians are discovering is grossly unreliable for diagnosing hypothyroidism. Ridha Ahrem, M.D. and author of The Thyroid Solution, was a professor of endocrinology and for five years editor of The Thyroidology Journal. He wrote that for years he believed the TSH and when it was normal and the patient wasn't, he considered the patient inadequate. After years of futile searching for the cause of the inadequacy, he eventually discovered that it was not the patient but the test that was inadequate. He then began to treat the patient and not the lab test. The results were very gratifying to him and to his patients. In a section below, you can read how I do this.

Genevieve's experience with Synthroid

About a year after the birth of her third child, Genevieve developed increasingly dry skin and hair, weight gain and severe fatigue to the extent that it was a struggle to care for the newborn even with full time help who did most of the house work. Blood testing showed hypothyroidism. Her physician prescribed Synthroid, a trade name for l-thyroxin, aka T4. She had some relief of severe fatigue but became increasingly anxious, agitated, and dizzy as the dose was increased because her fatigue was not sufficiently relieved. Her heart pounded, she had excessive sweating, and it became difficult to walk. She was so dizzy that she spent most of the day in bed. One day she noticed my copy of The Merck Manual and began to read about Synthroid. She had all the symptoms, of Synthroid toxicity meaning that she was overdosed on Synthroid. At that point she consulted another physician who knew that most people need both T3 and T4 to correct hypothyroidism. He stopped Synthroid and prescribed Armour thyroid containing both T3 and T4. Within a week her symptoms were almost gone and her energy and mental clarity were returning. She has continued on T3 and T4 for forty years and has no more hypothyroid symptoms except for a few times when she reduced the dose to see if she could feel and function well on less thyroid. She found every time that she couldn't.

Genevieve's case is typical of that of millions of women whose hypothyroidism is inadequately treated with Synthroid and other brands of l-thyroxin. Big Pharma has been successful in leading doctors to believe the misinformation or disinformation that l-thyroxin alone is the best treatment for hypothyroidism. For information about the Big Pharma conspiracy to mislead doctors about many drugs, see Overdosed America, by John Abramson, M.D., a clinical professor of medicine at Harvard University Medical School. For the science behind the need for both T3 and T4 in the treatment of hypothyroidism, see The Thyroid Solution, by Ridha Arem, M.D., professor of endocrinology and past editor of The Thyroidology Journal. Both books are available from Amazon.com.

Diagnosis of Hypothyroidism

Since the TSH and other thyroid blood tests are grossly unreliable, how can hypothyroidism be diagnosed? In my practice it is diagnosed by four items:

• the history
• physical findings
• low basal body temperature
• Favorable response to a therapeutic trial on both T3 and T4.

History: Onset is often after severe emotional and/or physical stress, especially childbirth or menopause. Autoimmune disease and toxic chemical exposures are often associated with hypothyroidism. People of certain ethnic origins, such as Native Americans, Scotts, Irish, and Russian are particularly susceptible. Family history is important since there is a genetic linkage.

Symptoms: The brain, being the most energy hungry organ in the body, takes the first hit. The first symptoms are often depression, anxiety, irritability, insomnia, brain fog, memory impairment, and mood swings. There is likely to be inappropriate fatigue, muscle aches and pains, cold intolerance, dry skin and hair, brittle nails, constipation, and frequent infections, particularly sinus. For a more complete symptom list, see the section on Hypothyroid Diagnosis below.

Physical findings including basal temperature. (Detailed directions for doing the basal temperature test are in the Hypothyroid Diagnosis section.)

Favorable response to a therapeutic trial on T4 and T3. If you get on your correct dose of thyroid and your symptoms go away or get much better, you were hypothyroid no matter what your lab work showed. This completes the four-step diagnostic process which I have found most reliable and satisfactory.

Treatment:

Desiccated thyroid. Reliable brands are Armour Thyroid and NatureThroid. Do not use Synthroid or any of the other T4 products. Start with ½ grain (30 mg) daily and gradually increase under medical supervision until symptoms stop or temperature normalizes or you get signs of excessive thyroid stimulation, whichever comes first.

Cost depends on dose and doses vary widely. An average dose would be one grain twice a day although many people get along fine on less. At the average dose a month's treatment would cost about $15. That makes it the best prescription value I know, considering both the low cost and the huge benefit that can come from it. Armour thyroid 1 grain (60mg) costs about $20 per 100 tablets. NatureThroid is slightly less but harder to find.

Duration of treatment. You will need to continue to take thyroid only so long as you wish to feel and function your best! Most people need to take thyroid indefinitely but a few may not. As we grow older we may not need as much, so every few months it's a good idea to decrease the dose and see if you feel and function as well. If so, continue on the lower dose but be alert for symptoms to start creeping back so slowly that you may not notice until the bad old days are here again. Of course, all thyroid treatment should be under the supervision of a physician knowledgeable about T3/T4 therapy.

Supplements: Always take a high potency multivitamin-mineral supplement, such as Essential Nutrients. Your thyroid system won't work right without enough iron and selenium. Essential Nutrients will supply the selenium. Women who have menses will need supplemental iron.

An iodine supplement is needed because iodine deficient men have increased risk of prostate cancer and women have an increased risk of breast cancer when taking thyroid. Adequate iodine cancels the increased risk. A good iodine supplement is Iodoral 1 tablet (12.5mg) daily.

Thyroid Glandulars is thyroid tissue from which almost all the hormones have been removed. I have never known them to correct hypothyroidism.

Diet: I sometimes see recommendations to avoid cabbage and soy products because they inhibit thyroid function. I advise my patients to continue to enjoy these wholesome foods and if necessary we will just increase the dose of thyroid slightly to offset any food related inhibition.

Horror Stories:

Sometimes my patients who are doing very well on thyroid supplementation and have a TSH below the reference range are told by another physician that they are

• overdosed on thyroid and they must decrease the dose or risk
• destruction of their thyroid gland
• osteoporosis
• enlarged heart and congestive heart failure
• death

This puts the patient in quite a quandary. Why would another physician tell them this if it isn't true? If it is true, why would I prescribe something that puts them in deadly danger? The answer to the first question is important and complex, too much so to attempt here. You can find part of it in Overdosed America, by John Abramson, M.D. The rest of the answer, at least according to my perception, I intend to post on this site on a page I'll probably call, "Protecting Yourself and Your Loved Ones in a Broken Health Care System."

I have tried from the beginning to prepare my patients for this by explaining that I do not believe the TSH is accurate and reliable for diagnosing or treating hypothyroidism but most conventional physicians believe it is. I adjust thyroid dose according to the way my patient is feeling, functioning, and the basal temperature. I ask the new patient to read Hypothyroidism, Type 2 by Mark Starr, M.D. for the science supporting the way we treat the condition. Most patients do not do this, but when we have the discussion following the horror stories, they remember that I asked them.

I tell them that I have used the Barnes Method of treating hypothyroidism for 25 years and have never seen these horrors happen. When I first heard about them I ordered chest x-rays every year to look for heart enlargement and bone densitometry every two or three years for osteoporosis. When neither condition appeared after several years of low TSH, I decided that the increased cancer risk from the x-rays was more dangerous that the alleged side effects so I stopped ordering the studies. I was reassured that some patients with low TSH actually increased their bone density over time.

Why would physicians say that disasters will occur that in fact never did in my 25 years of experience? I think there are several reasons:

• It is easier to believe the TSH than to diagnose on the basis of history, symptoms, physical findings, the basal temperature, and the patient's response to treatment.
• Doctors are under intense time pressure and will naturally prefer a diagnostic test that takes seconds to interpret over one that takes minutes, sometimes many minutes.
• Medical schools teach that the TSH is reliable.
• The studies from which the horror stories were derived were poorly done and misleading. They included patients who had gone from hyperthyroidism to hypothyroidism. In hyperthyroidism the thyroid levels are much higher than I ever prescribe and may actually produce the severe and dangerous symptoms and conditions described above.

The thyroid-adrenal connection
What if the patient does not improve or gets worse on the therapeutic trial? This usually means there is adrenal weakness. Some of my and patients do not respond well to thyroid, no matter how much they need it, until their adrenal function is evaluated and supported with adrenal hormones if they are insufficient. Patients who have felt worse on the therapeutic trial usually do splendidly on thyroid once they have correct adrenal support. I intend to post a section on Low Adrenal Reserve in the Conditions section. Until then you can get the information you need from The Safe Uses of Cortisol, by William McK. Jeffries.

Signs of excessive thyroid: tremor, nervousness, restlessness, feeling over stimulated, insomnia, rapid and/or irregular pulse, excessive sweating, diarrhea, rapid weight loss, weakness

Why Synthroid and Cytomel often won't work

Synthroid and other brands of T4 (thyroxin) contain only T4. T4 is a weak hero for upregulating metabolism. The theory is that the body will convert enough T4 into T3 for the brain and the rest of the body to function optimally. For many people, this does not happen; therefore, the brain and the rest of the body do not get enough energy to function well. T3 is four times as effective as T4 for increasing metabolism and it is an important neurohormone as well. Some people feel an increase in energy on T4 but the brain fog, depression, and other brain symptoms do not clear. T3 is necessary for optimum brain function.

Cytomel is an instant release form of T3. In small doses it sometimes works but has the disadvantage of delivering T3 in spurts which tend to throw the body out of balance. The body is accustomed to having a steady and continuous supply of T3 as T4 is converted into T3. When the T3 comes in spurts it often causes heart symptoms such as chest pain and rapid or irregular pulse. These can be frightening.

One solution to the Cytomel problem is to use a sustained release T3 which mimics the slow, steady conversion of T4 to T3. Sustained release T3 is available on prescription from compounding pharmacies.

The simplest and most economical way for most people to solve the T3/T4 problem is to use desiccated thyroid, which contains both T4 and T3 in the same proportion as they are made and released by the thyroid gland. This is why I usually prescribe Armour thyroid or NatureThroid.

What Causes Hypothyroidism?

• Environmental toxins, of which there are many and increasing all the time.
• Autoimmune disease
• Severe stress, physical and/or emotional
• There is a genetic predisposition
• Deficiencies in iodine, selenium, and/or iron
• Surgical removal or other trauma

Now, if you would like to begin your diagnostic process, here is a checklist you can use.

Hypothyroid Diagnosis: family history and symptoms

Family history
Who had thyroid disease or symptoms?

Your Symptoms and signs
Grade severity: 1 = mild, 2 = moderate, 3 = severe

Physical findings
Next, find your basal body temperature with the Barnes Basal Temperature Test Use a reliable glass and liquid metal thermometer, never a digital, which all seem to have been made on Fantasy Island. Accurate thermometers are available from www.wtsmed.com and Clayton Pharmacy in Clayton, Georgia. Ask the pharmacist for the one I recommend. Before you go to bed for the night, shake the thermometer down to 96 or below. Put it within easy reach when you wake up in the morning. On waking, before getting out of bed, put the thermometer in your armpit and leave it there for ten minutes. Women who have menses should do the test on the second, third, and fourth mornings of menstruation. Record readings for three mornings. Average the three readings. 97.8 - 98.2 is healthy, if there is no infection. 97.6 - 97.8 is borderline. Below 97.6 probably means hypothyroidism if there are signs and symptoms.

Other physical signs are:

Some of these you can notice for yourself; some your doctor will need to evaluate for you.

Lab studies. I would get some or all of these, depending on the situation.

Thyroid panel

• TSH
• Free T4
• Total T3
• Thyroid peroxidase and thyroglobulin antibodies

Comprehensive metabolic profile
Blood fats (cholesterol)
Homocysteine

Intervention. Here is the process I use with any patient I suspect had hypothyroidism.

1. Consider hypothyroidism
2. Remember that hypothyroidism can make other illnesses worse
3. Use history, including family, symptoms, and signs to support diagnosis.
4. Know that normal tests do not rule out hypothyroidism.
5. Determine that a therapeutic trial will be safe.
6. Discover the best dose, brand, and mix of Rx.
7. Determine if low adrenal function should be treated.
8. Get more improvement by balancing the reproductive system
9. Use vitamins, minerals, and amino acids.
10. Improve autoimmune conditions
11. Reach optimal recovery with empowered lifestyle, including appropriate diet, physical activity, good stress management, and supportive relationships.

So there you have it: you now know much about your thyroid system and how to find out if hypothyroidism is diminishing the quality of your life. If you believe it is, how can you find a doctor who uses this or a similar method of diagnosing and treating?

The following web sites have doctor finder pages: www.acam.org
www.wtsmed.com
www.armourthyroid.com

You are welcome to contact me.

Resources: there are several good books on hypothyroidism and some that are not so good. The best I know is Hypothyroidism, Type 2: The Epidemic, by Mark Starr, M.D. It's available from Amazon.com.

If you'd like to know how an academic endocrinologist discovered the T3 connection and why T4 alone so often doesn't work very well if at all: The Thyroid Solution, by Ridha Arem, M.D.

The classic book, which I discovered in desperation when my wife was incapacitated by Synthroid toxicity, is Hypothyroidism: The Unsuspected Illness, by Broda O. Barnes, M.D. We used the knowledge to enable Genevieve to recover her health and that knowledge has benefited hundreds, maybe thousands, of my patients since 1964. I was so impressed with the results of the Barnes Method that I gave a copy of the book to a bright young internist whom I thought would find it interesting and perhaps useful. I learned later that his dog not he, had devoured the book. After that, I wondered which of them knew more about diagnosing hypothyroidism.

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