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Help for Hypothyroid / Myxedema / Natural Thyroid 101Hypothyroidism Type 2:
A New Way of Looking at an Old Problem
by Nenah Sylver
(Please go to the site in order to see the photos.)
The Basics of an Epidemic
What do chronic pain, diabetes, heart disease, menstrual difficulties, and sleep apnea have in common? As physician Mark Starr points out in his extensively researched book, Hypothyroidism Type 2: The Epidemic, there's an excellent chance that this apparently disparate collection of disorders – among literally dozens, if not hundreds – indicate abnormally low thyroid function.
The thyroid is a butterfly-shaped endocrine gland located at the throat that produces numerous related hormones: thyroxin (also known as T4), liothyronine (also known as T3), T2, and T1. T4, the most well known of all the thyroid hormones, heats the body and speeds metabolism (of fats, proteins, and carbohydrates) and heart rate. T3, the most active form of thyroid hormone, also heats the body and speeds metabolism and heart rate. At best, T4 is only about one-quarter as potent as T3, and in any case, most is converted into the more active T3 by the liver, kidneys, and other body cells. T2 stimulates metabolism, while one animal study showed that T1 cools the body and slows the heart. Together, all four of these related hormones probably act synergistically in ways that are not yet fully understood.
Thyroid underactivity, commonly called hypothyroidism, was first reported in London in 1875. According to many reliable sources, including doctors Broda Barnes, David Derry, Jacques Hertoghe, and James Howenstine, at least one-third to one-half of the US population suffers from slight to severe hypothyroidism.
In his book, Starr explains the differences between Types 1 and 2:
• With Type 1 Hypothyroidism, the thyroid does not produce sufficient amounts of hormone to maintain "normal" blood levels of hormones, which in turn will maintain normal blood levels of thyroid-stimulating hormone (TSH) produced by the pituitary. (I will say more about TSH a little later.)
• With Type 2 Hypothyroidism, the thyroid gland produces "normal" amounts of hormone, but the cells are unable to utilize the hormone properly. Some experts call this thyroid hormone resistance (which may be regarded as similar to insulin resistance).
Laboratory tests showing inadequate bloodstream levels of thyroid hormone make it easy to diagnose Type 1 hypothyroidism. However, lab tests fail to detect Type 2 hypothyroidism, because despite adequate bloodstream hormone levels, the cells are unable to accept and utilize that hormone (for a variety of reasons, which I'll address in a moment). Since the main problem lies with the cells that are actually utilizing the hormone, a different approach needs to be taken when testing for – and to a certain extent, when treating – Type 2 hypothyroidism.
Since many more people suffer from Type 2 than Type 1 hypothyroidism, and because Type 2 is widely misunderstood and misdiagnosed, this article will focus on Type 2: its manifestations, the best way to diagnose it (it's not with lab tests), and its treatment. For this article, I have drawn heavily from Mark Starr's book, Hypothyroidism Type 2: The Epidemic.
Dr. Starr became interested in the subject for both personal and professional reasons. More than a dozen years ago, he embarked on a quest to heal his own chronic pain, fatigue, and allergies after receiving no relief from the majority of physicians with whom he consulted. Professionally, while treating thousands of people who suffered chronic pain alongside a wide range of disorders, he discovered a pattern. The underlying cause or contributing factor to their pain was low thyroid function. Dr. Starr's book is the result of over a decade's worth of intensive research and writing about the history, problems, politics, personnel, literature, case studies, and treatment related to hypothyroidism. I had the opportunity to visit Starr's new clinic, which is near my home, so at the end of this article, I will also give a brief description of his practice.
Endless Disease Conditions
Most people (correctly) regard the thyroid as responsible for proper metabolism. However, this gland plays a major role in hundreds of bodily functions. Here is just a sample of the many symptoms and conditions that can be caused, indirectly or directly, by an under-functioning thyroid gland:
• Appetite disruption (heightened or diminished)
• Autoimmune conditions, including allergies, lupus, and rheumatoid arthritis
• Blood sugar disorders, such as diabetes, hypoglycemia, or a combination of the two
• Cancers, all kinds
• Cardiovascular abnormalities, including high cholesterol, poor circulation, heart palpitations, hypertension (high blood pressure), and hypotension (low blood pressure)
• Dental problems, including chronic gum infections, receding gums, and TMJ or Temporomandibular Joint dysfunction (clenching of the teeth, leading to chronic inflammation and pain in the temporomandibular joint)
• Fatigue and lethargy
• Gastrointestinal disorders, including irritable bowel syndrome, and impaired digestion leading to constipation and nutritional disorders
• Heart conditions, including coronary artery disease from accelerated atherosclerosis (hardening of the arteries), arrhythmia (irregular heartbeat), abnormal blood pressure (either too high or too low), diminished cardiac output, weakness of the heart muscle, and congestive heart failure
• Hoarseness of voice, difficulty in swallowing, swollen enlarged tongue, and sleep apnea
• Immune response malfunction, leading to increased infections (including Candida albicans) in all parts of the body
• Mental and emotional problems, including difficulty in cognition, and anxiety, depression, memory loss, manic depression, psychosis, and schizophrenia
• Metabolism malfunctions, leading to weight gain (usually) or weight loss (occasionally)
• Muscular disturbances, including ataxia (lack of coordination), carpal tunnel syndrome, fibromyalgia, and weakness
• Neurological impairment, including but not limited to ear conditions (deafness, tinnitus, and vertigo), headaches and migraines, Multiple Sclerosis, and paresthesia (numbness and "pins and needles" in nerves)
• Pain in joints and muscles, including arthritis and fibromyalgia
• Perspiration reduction
• Reproductive disorders, including birth defects, cysts in breasts and ovaries, endometriosis, infertility, and menstrual disturbances
• Respiratory conditions, including asthma, emphysema, pneumonia, and chronic sinus infections
• Skin disorders, including acne, alopecia (hair loss), boils, dryness, eczema, hives, and psoriasis
• Sleepiness and sleep apnea.
• Slowed movement and speech
• Structural weaknesses/deformities and impaired ability to repair damaged tissues, manifesting in brittle nails, brittle or scant hair (including baldness), degenerating bones (osteoporosis), malformed bones (scoliosis), and thinning and loss of eyebrows, notably the outer third
• Temperature regulation malfunction: intolerance to heat, and excessive coldness, particularly in extremities.
• Urinary tract problems, such as urinary infections and especially kidney failure from shrunken, scarred kidneys
Why So Many Conditions?
How is it possible that the malfunction of one tiny gland can influence so many other functions that do not seem related to each other? Consider the most obvious effect of an underactive thyroid: reduced cell metabolism of proteins, fats, and carbohydrates. This not only means inefficient transport of nutrients into the cell membrane, but also inefficient transport of wastes out. As holistic practitioners well know, inadequate nourishment and the buildup of toxins (regardless of the cause) can exacerbate or outright cause virtually all conditions that we call "disease." The more toxins engorge the cells, the more one becomes susceptible to infections and degenerative conditions. As it turns out, the mitochondria – microscopic energy-burning units of the cell responsible for about 90% of the energy production that our cells, tissues, and organs require for metabolism – are intimately affected by thyroid dysfunction. Starr writes:
Thyroid hormones are responsible for our metabolism. When thyroid hormones are given to animals, trillions of mitochondria increase in size and number. The total membrane surface of the mitochondria increases almost directly in proportion to the increased metabolic rate of the whole animal. My medical school textbook, The Textbook of Medical Physiology, states: "It seems almost to be an obvious deduction that the principal function of thyroxin [thyroid hormone] might be simply to increase the number and activity of mitochondria."
The beneficial symbiotic relationship between mitochondria and thyroid hormone works both ways. Adequate levels of thyroid hormone not only increase mitochondria number and function, but as Starr points out, "mitochondrial mutations appear to be largely responsible for the metabolic defects at the cellular level, which result in a hypothyroid-like condition…. Defects in mitochondria, as well as synthetic toxins, impair thyroid hormone metabolism at the cellular level." Not surprisingly, symptoms of mitochondrial disease are the same as symptoms of hypothyroidism.
There are scores of environmental toxins that interfere with every aspect of thyroid metabolism and cause the mitochondria to malfunction. These include petroleum and petroleum byproducts; pesticides, herbicides and fungicides; heavy metals, among them mercury, arsenic, lead, aluminum, barium, and cadmium; organic solvents, including benzene, toluene, trichloroethylene, and dichloromethane; and numerous other synthetic chemicals. Fat-soluble toxins lodge in the fat cells that lie beneath the skin and surround internal organs. Women, whose bodies contain more fat than men's, hold proportionately more toxins in their systems and thus, one might assume, suffer from hypothyroidism in much greater numbers than do men. Statistics show this to be true.
Faulty thyroid receptors on the cell membranes as well as mitochondrial mutations can cause a hypothyroid condition. "Defective thyroid receptors," Starr writes, "may prevent a sufficient supply of hormones that are circulating in our blood from reaching the mitochondria and other crucial sites such as the nucleus of the cell. The nucleus is where the thyroid hormones activate genes and stimulate protein synthesis, among a host of other tasks" [emphasis added]. This explains why so many people with underactive thyroids have brittle nails and hair, and even bone defects. If the body cannot utilize amino acids to create new, properly formed tissue, the cells will be imperfect and cause structural abnormalities.
Myxedema, which is the retention of mucin, can also occur when the tissues do not properly process and utilize thyroid hormone. (Myx is the Greek word for "mucin," and edema means "swelling.") Mucin is a compound comprised of sugars bound to a protein and in modest amounts is a constituent of connective tissue. (Connective tissue lines blood vessels, comprises nerve sheaths, is part of the fascial envelope surrounding muscles, and is in organs and glands, in the gastrointestinal and urinary tracts, and in the mucous membrane lining of the respiratory tract, including the sinuses.) By nature, jelly-like mucin absorbs water. When present in normal amounts, mucin is not a problem. But in excess, the hydrophilic (water-loving) mucin can cause serious problems wherever it accumulates in the connective tissue. Over half of the hypothyroid population (55%-60%) has abnormally high amounts of mucin, which accumulate more with age. In fact, the medical term for "hypothyroidism" used to be myxedema.
You can see how an underactive thyroid can be responsible for so many debilitating and apparently disparate health problems. Just a small sample includes heart disease, digestive disorders, liver malfunction, lupus, muscular pain, neurological impairment, sinusitis, and sleep apnea (caused by a swelling of the trachea and larynx). Also worth noting are Temporomandibular Joint (TMJ) problems. These often accompany hypothyroidism due to slow contraction and relaxation of the muscles. Muscle spasms are common in hypothyroidism, as are arthritic changes and joint effusions (an abnormal buildup of joint fluid).
Inadequate thyroid hormone at the cellular level also negatively impacts other glands. "Without the crucial influence of thyroid hormones," Starr emphasizes, "proper maturation and function of the other hormone glands is not possible." To compensate for the weakness and low metabolism caused by inadequate thyroid hormone, other parts of the body overwork, including the adrenals and the sympathetic nervous system. This may cause the subject to temporarily experience a rapid heartbeat and/or feel hyperactive, jittery, and restless – until exhaustion sets in from the unnatural attempts to compensate for low thyroid hormone levels. More often, though, the majority of sufferers simply feel fatigued and weak most of the time.
As you review the previous list of health conditions directly caused or heavily influenced by hypothyroidism, keep in mind the phrases poor utilization of thyroid hormone by the tissues, excess mucin, and inadequate function of other glands. Just these three descriptions can explain almost all of those symptom pictures.
Flawed Lab Tests
The biggest error in hypothyroid diagnosis is the medical profession's excessive reliance on laboratory tests only, to the exclusion of the subjects' symptoms. When hypothyroidism was first detected in the 1800s, physicians listened to the people who actually had the disorder and based their treatments on what they observed and on what their patients told them. There are many physical signs of hypothyroidism, among them puffy face and lips, hair loss, dry puffy skin, abnormally slow movements and speech, hoarse voice, and intolerance to cold. (Not only does the person subjectively feel chilly, but the hands and feet feel cold to another person's touch.) Mark Starr writes that in the early twentieth century,
…the ultimate test of whether or not a patient was hypothyroid was the patient's response to a trial of thyroid hormones. Confirmation depended upon improvement or resolution of their symptoms. . . . [But] the list of thyroid blood tests grew until there were scores of available tests. Unfortunately, they failed to improve the ability to detect Type 2 hypothyroidism.
Today, the overwhelming majority of doctors are taught to check only the patients' blood tests if they suspect hypothyroidism. If the tests are normal, the search begins for other possible causes of their problems. The vast majority of patients with hypothyroidism have normal thyroid blood tests, because the tests do not detect Type 2 hypothyroidism. Countless new syndromes, both mental and physical, have been adopted in [futile] attempts to explain the myriad symptoms related to hypothyroidism [emphasis added].
How ironic – though one must admit, not surprising! – that with the mechanization of medicine, along with its reductionist laboratory tests and synthesized pharmaceuticals, the person's own experiences and symptoms became secondary to the practitioner's theories. In the words of Starr, medical professionals have become "blinded by their devotion to the laboratory tests." Drawing on the groundbreaking (and commonsense) work of pioneer physicians – including Broda Barnes, Eugene Cohen, Jacques Hertoghe, Hermann Zondek, Hans Kraus, and Lawrence Sonkin (the latter two with whom he studied) – Starr analyzes in depth some common misconceptions about thyroid testing. The most commonly used blood test, which is based on the theory of the TSH-thyroid hormone feedback loop, contains a simple but major flaw. Since somany doctors rely on this test to make an accurate diagnosis, it's worth addressing.
The most common blood test for hypothyroidism depends on the following assumptions. The body tissues transmit their need for thyroid hormones to the hypothalamus in the brain, which sends a signal to the pituitary gland. In turn, the pituitary secretes thyroid stimulating hormone (TSH), which signals the thyroid gland to secrete more hormones. These hormones are then carried by the bloodstream to the tissues. The action of the thyroid hormones on the tissues reduces the tissue signals to the brain for more thyroid hormones, and the pituitary stops secreting TSH.
The problem with this scenario is that most of the time, the mitochondria in toxic and defective cells are unable to convey to the brain their need for thyroid hormone, even if it's urgently required. In fact, according to numerous studies, people whose mitochondria tested abnormal nonetheless had normal thyroid hormone levels in their blood. Modern thyroid blood tests, Starr reminds us, do not detect Type 2 hypothyroidism "because thyroid hormone levels [in the bloodstream] may be normal, but they are not high enough to stimulate the . . . defective mitochondria into normal activity" [emphasis added]. Nor are the blood thyroid hormone levels high enough to induce the resistant receptor sites on the cells to start accepting hormone. Any part of the cell can be involved in the failure to process and utilize thyroid hormone. "There is no scientific evidence," Starr bluntly states, after providing a detailed review of the literature, "to support the doctors' claim that the TSH test detects hypothyroidism in the vast majority of patients. The validity of the TSH [tests] has been [solely] established by word of mouth and [only] purportedly by the [flawed] studies I have presented." Unfortunately, few medical personnel appear to have read the literature upon which the presumed validity of the TSH test was based – or have read it with a careful enough analytic eye.
The Need to Observe Clinical Symptoms
I have already mentioned the clinical observation of numerous signs, such as puffy face and lips, thinning or lack of hair, the missing third of the outside of the eyebrows, swollen skin, lack of alertness, slowed speech, hoarseness, and cold extremities. And, of course, there's the common weight gain and tendency toward chronic infections.
There is also another very simple hypothyroid indicator that was developed by Broda Barnes, MD, PhD (he died in 1988). Barnes told his clients to take their armpit temperature before rising every day, usually over a period of weeks. If the temperature averaged lower than 97.8º F, the person was considered hypothyroid. Starr points out that the basal temperature test for hypothyroidism is "not infallible" – for example, someone might be hypothyroid but have a near-normal basal temperature, suggesting that the higher-than-expected temperature readings may be due to chronic inflammation in the lungs or elsewhere. Nevertheless, Barnes's temperature test is still an effective and accurate diagnostic tool in most instances.
Again, I refer the reader back to the extensive list at the beginning of this article. By now, it should be clear that hypothyroidism is fairly easy to detect, once you know what to look for. One more thing: a prominent research study in the Journal of Clinical Endocrinology found that some people with severe biochemical hypothyroidism exhibited only mild clinical signs, whereas others with minor biochemical changes exhibited severe clinical signs.
These are the last "before" and "after" pictures concerning hypothyroidism treatment that Dr. Starr has seen in any endocrinology textbook. With all of the subjects, the only thyroid hormone treatment
Top left: Woman with abdominal fluid (ascites) before dessicated thyroid therapy.
Top right: The same woman, no longer with ascites, after three months of desiccated thyroid hormone therapy.
Middle left: Person wioth enlarged heart before desiccated thyroid therapy.
Middle right: The same person with a successful resolution of congestive heart failure - a normalized heart - after three months of desiccated thyroid hormone therapy.
Bottom left: Person with enlarged and inflamed colon before desiccated thyroid therapy.
Bottom right: The same person, now with a normal colon, after three months of desiccated thyroid hormone therapy.
Before and after
Source: Lisser, H., and Escamilla, R.F.. Atlas of Clinical Endocrinology: Including Text of Diagnosis and Treatment. C.V. Mosby Company, 1957. Reprinted with permission.
Treatment for Type 2 Hypothyroidism
1. Replacement Hormone
Whether the person's thyroid gland is not producing enough hormone or the cells are unable (for whatever reason) to process what the gland is producing, the treatment is the same: replacement hormone. From the perspective of conventional medical training, flooding the system with thyroid hormone, in amounts greater than what laboratory blood tests might indicate are useful or prudent, may seem questionable. But consider the highly dysfunctional state of the mitochondria and/or cell receptors. If you saturate the tissues with enough hormone, for a long enough period, even malfunctioning mitochondria and stubborn receptor sites will start processing and utilizing the hormone. Once the body begins to function correctly, it has the potential to self-correct. Then, conceivably, the hormone dosage can be reduced. This points to the need for careful monitoring of people with Type 2 hypothyroidism. It's easy to assess a body that is starting to heal, Starr maintains. "The increased basal temperature that results from administering desiccated thyroid is a direct result of enhanced mitochondrial activity."
What type of pharmaceuticals work best? Up until the 1960s, people suffering from hypothyroidism were given desiccated thyroid derived from pigs. This means the entire dried gland and its contents – all four forms of thyroid hormone, RNA, DNA, and other co-factors. But by the 1970s, isolated thyroxin (T4) was introduced as the "gold standard" of thyroid medications. By definition, thyroxin is only a portion of the thyroid hormone complex. Since it does not contain the synergistic effects of the entire glandular material, not surprisingly, it proved less effective clinically than the desiccated thyroid.
One such study on the superiority of desiccated thyroid over thyroxin was conducted in Belgium and was published in 2001 by endocrinologist Jacques Hertoghe and his colleagues in the Journal of Nutritional and Environmental Medicine. Subjects showed marked improvement when they began taking desiccated thyroid instead of only T4. The hallmark symptoms of low thyroid – constipation, headache, joint and muscle pain, muscle cramps, depression, cold intolerance, and fatigue – were reduced by 70% after they switched from T4 to desiccated thyroid. "Symptoms of the patients already taking T4," notes Starr, reviewing the study, "did not differ from those of the group of untreated patients" [emphasis added].
Occasionally, Dr. Starr has found, some people require compounded T3 or T4 only or combinations of the two, because they are either allergic to, or unable to tolerate, desiccated thyroid. Or, they don't want to take the desiccated pork product for religious reasons. Whatever replacement hormone product is used, it's crucial that the client be monitored on a regular basis. This includes self-monitoring. The doctor must be willing to work closely with the client as well. And the client must be willing and able to detect physiological changes that indicate too little or too much hormone and regularly report to the doctor.
Significantly, as one's metabolism becomes more efficient, perspiration will increase, allowing for the elimination of more toxins. As more toxins are eliminated, the better the cells – including the mitochondria and hormone receptor sites – will function. This suggests that mitochondrial defects can be corrected, given enough time, patience, and dedication. (See below.)
Some of the most significant stressors of mitochondria are heavy metals. Mercury is particularly insidious, as it's everywhere in our environment and affects the system in devastating ways. It can also be difficult to eliminate. Intravenous chelation therapy has proven effective, but is expensive and time-consuming. Less expensive but effective alternatives include the oral ingestion of broken cell wall chlorella, liquid zeolite, alpha lipoic acid, and certain amino acids in the correct proportions, often in combin ation with each other.
The fact that a good portion of the T4 to T3 conversion takes place in the liver also points to the need for a good detox liver protocol, as this organ is primary in converting systemic and environmental poisons into less noxious, more easily excretable substances. An overall excellent – and easy – means of detoxifying is sweating. Sweating reduces the waste removal burden on the kidneys, liver, and eliminative organs. Numerous studies have shown vastly decreased levels of mercury and other toxins after even only a few weeks of regular sauna therapy. In fact, subjects have been known to blacken their towels with the metals excreted through the skin during sweating. My book, The Holistic Handbook of Sauna Therapy, discusses sauna protocols in depth: the mechanism of sweating; the three types of heat, including details on far infrared; what types of heating elements and sauna building materials are best for people with particular sensitivities and needs; how to take a sauna and avoid heatstroke; which medical conditions can be relieved by sweating; when one should not use the sauna at all; and when one may use the sauna with medical supervision; pregnant women and children in the sauna; and specific detox protocols.
Be aware that sauna therapy can achieve opposite effects with regard to medication. On the one hand, some medication may be sweated out of the system. On the other hand, the elimination of toxins increases the metabolic efficiency of the cells, which means that in many cases a drug is more efficiently absorbed into the cell – and therefore will be needed in reduced amounts. Whatever detox protocol you use, it needs to be consistent. Sometimes it can take longer than desired to eliminate toxins from deep inside the tissues.
3. Nutritional Support
Iodine is essential for proper thyroid function. Potassium iodide is absorbed directly by the thyroid gland, whereas iodine tends to be more heavily concentrated in the breasts, reproductive organs, and respiratory tract (including the sinuses). Both forms of iodine are necessary for optimal functioning. Some types of seaweed added to the diet, such as dulse, provide large quantities of iodine.
To assist in the conversion of T4 to T3, supplementation with selenium, zinc, and vitamins E and B6 are usually indicated. Manganese, known to protect the thyroid and liver, is sometimes called the "anti-pear nutrient," so named because it helps eliminate the faulty weight distribution pattern common with hypothyroid people. Thyroid hormone increases the enzyme levels in the body. Since vitamins are essential constituents of both enzymes and co-enzymes, increased thyroid hormone levels require a higher intake of vitamins.
4. Glandular Support
Adrenal and thyroid function are intricately related. Sometimes, hypothyroid subjects are unable to tolerate even sub-therapeutic amounts of thyroid hormone due to adrenal fatigue. (In their attempt to raise the energy of the body and compensate for the under-activity of the thyroid gland, the adrenals have overworked and are now exhausted.) Therefore, support for the adrenals, other glands, and even the hypothalamus may be indicated during or even before beginning thyroid hormone therapy.
Dr. Mark Starr's Clinic
In early 2008, Dr. Mark Starr left his established and thriving pain clinic in Atlanta, Georgia, to relocate to Phoenix, Arizona. In his spacious, comfortable, and conveniently located Paradise Valley office, Starr continues to practice his specialty: the elimination of pain and the treatment of hypothyroidism, usually with desiccated thyroid hormone. (Some people are allergic to pork, are vegans, or have religious objections to pork, so they take the compounded pharmaceuticals.) Starr also specializes in sports injuries, using FDA-approved and FDA-cleared electromedical devices that include a state-of-the-art laser and the Tennant Biomodulator®.
As an author in the holistic health field who specializes in electromedicine, I was very impressed with the range of therapies available in Dr. Starr's clinic. I was also impressed with Starr's knowledge, obvious passion, caring, and dedication to helping people regain their health. Having dealt with his own hypothyroid issues and been obliged to dig for answers that at the time were not readily available, Dr. Starr makes an excellent advocate for those seeking competent medical treatment.
Dr. Mark Starr's extensively researched book, Hypothyroidism Type 2: The Epidemic, is essential reading for both professionals and laypersons. The book cites long-term studies, involving thousands of subjects, showing that hypothyroidism is rampant. Starr's book also explains how Type 2 hypothyroidism develops and describes the best treatments for it. Physicians in all specialties who want to augment the efficacy of their care should read Dr. Starr's book. The many photographs in the book of hypothyroid people, before and after treatment with thyroid hormone, reinforce the differences between hypothyroidism and normalcy in an unmistakable and striking way. Anyone who looks at these "before" photographs is bound to recognize someone they know – someone who could have been helped to overcome a debilitating condition, if only they or their doctors knew about it.
Unfortunately, hypothyroidism is often the last possibility considered for those who are unwell. Since thyroid hormones are intricately related to virtually every bodily function, hypothyroidism can cause or exacerbate an almost unlimited number of conditions that initially might not seem related to each other. This points to the importance of applying an integrative approach to how the body functions, instead of perceiving various conditions as discrete "diseases."
Laboratory tests for hypothyroidism miss the vast majority of sufferers. The most commonly performed, "gold standard" tests do not reveal what is occurring at the cellular level. If the cells are unable to utilize and process thyroid hormone, even with normal bloodstream thyroid hormone levels, the person has hypothyroidism – in this case, Type 2, which is pervasive in a large percentage of the population and unrecognized by mainstream medicine.
The client's history and clinical exam are the best diagnostic tools for hypothyroidism: in fact, they are the basis of good medicine. If the person's clinical picture improves when he or she takes thyroid hormone, then he or she is hypothyroid! This simple concept can be difficult for some professionals to grasp, especially if they insist on ignoring their clients' symptoms at the expense of erroneous theories. As Dr. Thomas Boc remarks: "There are countless thousands of people who are in failing health because their doctors are not listening to what the patient is trying to tell them about their illnesses. They [the doctors] have been trained to rely on blood tests more than on the history and examination of the patient."
Desiccated thyroid is more effective than T4 (levothyroxin) for treating hypothyroidism. Prominent studies prove that heavy metals, especially mercury, interfere with thyroid hormone uptake and utilization. Therefore, detoxification protocols such as chelation and sauna therapy are indispensable. So is proper nutrition, including supplementation with iodine and other minerals like selenium, without which thyroid hormone cannot be utilized and converted into a form useable by the tissues. As the body eliminates toxins and nutrient absorption is improved, the thyroid hormone dose may need to be decreased. Thus, care must be taken to monitor the client's responses.
It's critical that health practitioners learn how to diagnose and treat Type 2 hypothyroidism. The ability to work with this condition indicates a caring, open-minded, and competent professional who is free from rigid and antiquated notions that do not reflect the lives, suffering, or medical conditions of real people. Clients fortunate enough to obtain proper treatment for hypothyroidism enjoy a vastly improved quality of life – physically, mentally, emotionally, and spiritually.
Proper Thyroid Supplementation
Prevents Heart Attacks
[In 1948], the National Heart Institute began the Framingham Study, officially named "The Heart Disease Epidemiology Study." The objective: to determine why heart attacks were rapidly reaching epidemic proportions.
Over 5,000 adult residents of Framingham, Massachusetts volunteered to participate in the long-term medical study. The group underwent thorough physical exams. All were free of heart disease initially. Participants were examined at two-year intervals. People who later suffered heart attacks helped determine the so-called “risk factors” that became associated with the illness. Risk factors included high blood pressure, elevated cholesterol, increasing age, and having a family history of heart attacks. Men were found to be at higher risk of heart attacks than women.
In 1950…Dr. [Broda] Barnes began a long-term study to determine if proper treatment of hypothyroidism would prevent heart attacks…. Dr. Barnes intended for his study to parallel the Framingham Study…. [His] research included 1,569 patients who received treatment for their hypothyroidism. A minimum of two years of thyroid therapy was required to be included in the study…. An individual patient’s symptoms, response to the hormones, and basal temperatures determined their dosage of thyroid hormones….
The Framingham Study would have predicted that 72 of Dr. Barnes’s patients should have suffered heart attacks. Only four occurred…. Dr. Barnes purposely did not attempt to control cholesterol, smoking, exercise, or other variables among his study group. He wanted the only variable between his patients and those from the Framingham Study to be the use of thyroid hormones….
Over 90% of predicted heart attacks from the Framingham Study were prevented…. Dr. Barnes predicted that our massive effort to control heart attacks would fail, unless we recognized and properly treated hypothyroidism.
– Mark Starr, MD(H)
Hypothyroidism Type 2: The Epidemic (2007), 34-35
Mark Starr book
To contact Dr. Starr:
Mark Starr, MD(H)
21st Century Pain & Sports Medicine
10565 North Tatum Boulevard, B115
Paradise Valley, Arizona 85253
Thyroid - Check It YourselfThyroid
Tyrosine: Tyrosine is an amino acid. Both Tyrosine and Iodine are necessary for the body to manufacture thyroid hormone. Tyrosine is found in quality protein formulas. Iodine can be purchased separately.
Iodine: As far as known to medical science today, the need for iodine in the diet is only for the production of thyroid hormones. Therefore, only a very small amount of iodine is needed in the diet.
Multi-Vitamins: High quality multi-vitamin / mineral formulas are needed to add the necessary "co-factors" needed for enzymatic pathways. Organic chemistry studies (a requirement for medical school students), demonstrates that all enzymatic, energy, and virtually all biological pathways in the human body, need many nutrients, or co-factors, to properly complete each pathway. Shortages of needed nutrients results in dysfunction of the organs for which those pathways could not be completed properly.
Protein: To assure a complete array of all the amino acids, all the essential and non-essential, careful consideration must be made as to the quality of the protein consumed. The protein chosen should also provide maximum protein bioavailability. To achieve these qualities: First: the whey used for the protein must be from cows that were not fed any hormones! Second: The whey must only be processed under very low temperatures! Excessive heat denatures (damages) the amino acids.
For best health, it is also very advisable to combine your daily protein consumption with several, daily servings of both fruits and vegetables. Also, include a full spectrum of Omega 3, 6, and 9 essential fatty acids. Adding these two groups, the fruits / vegetables, and the fatty acids, in addition to daily protein supplementation, will provide you with the best possible nutritional foundation for sound health.
The thyroid gland in located in the lower front portion of your neck. It is responsible making thyroid hormones. Thyroid hormones help regulate metabolism and energy. An under active thyroid gland is called hypothyroidism and manifests as a sluggish and overweight individual. Hyperthyroidism is just the opposite. The thyroid gland manufactures too much thyroid hormone and manifests as an individual that is to hyperactive, skinny, sweaty, etc.
Tyrosine is an amino acid. Both Tyrosine and Iodine are necessary for the body to manufacture thyroid hormone. Tyrosine is found in quality protein formulas.
Thyroid research over the past forty years has clearly shown a direct relationship between heart attacks and thyroid deficiency, according to Dr. Broda Barnes who wrote the book “Hypothyroidism The Unsuspected Illness.” The true culprit causing the increase in heart attacks is not necessarily how much cholesterol is consumed, but how the cholesterol is assimilated in the body. Studies have shown that low thyroid levels causes a glue-like substance called mucin to accumulate causing a cascade of biochemical changes leading to a degeneration of the arteries. Other studies have shown that the removal of the thyroid gland soon leads to atherosclerosis. Researchers have discovered that mucin can even develop in children who have insufficient thyroid function. They found out that as long as thyroid hormone is administered, the tissue would be normal. But if thyroid therapy was stopped, mucin rose rapidly. If thyroid therapy was begun again, the mucin content returned to normal. Therefore, one of the many preventive measures that can be done to prevent the possibility of heart attacks is to ensure the proper amount of thyroid is in the body. Research has shown that thyroid deficiency causes hardening of the arteries. Thyroid therapy helps reverse this and also reduces the risk of heart attacks. In his book, Dr. Barnes states that 40% of Americans suffer from an inadequate supply of thyroid hormone, an ingredient vital to health in the human body. Dr. Barnes noted that hypothyroidism often goes undiagnosed because blood thyroid values are usually inaccurate. He recommends a simple test, called the “Basal Temperature Test,” which the patent can perform at home. The temperature test should be done upon awakening in the morning, but before leaving your bed. How to take the basal temperature test for determining low thyroid: 1) If you are a male or a non-menstruating female, take an oral mercury thermometer (which has been shaken down and placed at the bedside the previous evening) and place it in your armpit for 10 minutes immediately upon awakening while lying quietly in bed. Repeat the test three days in a row. Normal temperature is 97.8 to 98.2 degrees. If your temperature is low, your thyroid gland is probably under active. 2) If you are a female who menstruates, do the above test on the second and third day of your period in the same manner. 3) If you have a very young child and are unable to take his armpit temperature, you can take the rectal temperature for 2 minutes. Normal would be 1 degree higher than the above, which is 98.8 to 99.2 degrees. 4) Record the results and bring this record to your physician.
Dr. Barnes has shown that many infections (especially those of the respiratory tract such as pneumonia, tonsillitis, sore throats, middle ear infections and sinusitis) can be reduced when the body has the proper amounts of thyroid. He has also shown that cold hands and feet of the hypothyroid patient signify poor circulation to the skin, which results in a susceptibility to skin infections. There are very few people with skin diseases of any kind who would not benefit by thyroid.
Although some preschool children suffering from hypothyroidism, may have a somewhat dull and apathetic appearance and be less active than normal youngsters, a few may be very nervous, hyperactive and unusually aggressive. Emotional problems and learning disabilities are frequent and a low thyroid child may cry for no apparent reason and object vigorously to any restrictions. Temper tantrums are common and are probably related to undue fatigue. These children may sleep longer than other youngsters of their age, be a slow starter in the morning, have a short attention span, and compulsively go from one activity to another. Infections are common. Since some of these problems often have multiple causes, children frequently require treatment for allergies, environmental sensitivities, nutritional deficiencies, and parasites, as well as thyroid therapy. There are many, many symptoms of low thyroid with the most common complaint being fatigue that no amount of sleep seems to help. People who suffer from this overall feeling of chronic sluggishness tend to get depressed. They frequently lose hope resigning themselves to a life of low level functioning. Many allegedly "depressed" patients resume normal lifestyle enriched with exercise and brighter outlook within weeks after being placed on natural thyroid medication.
DISCLAIMER This information is provided for Educational Purposes Only and has NOT been designed to diagnose, treat or cure any health conditions. Please consult a qualified Health Care Professional with Nutritional Training to diagnose your health conditions and avoid self-diagnosis. The U.S. Food and Drug Administration have not evaluated statements about these health topics or any suggested product compositions.
Iodine and Hashimoto's ThyroiditisIodine and Hashimoto's Thyroiditis
Natural Thyroid 101Natural Thyroid 101
# Why is this page specifically on natural desiccated thyroid? Because unlike T4-only meds like Synthroid, Levoxyl, levothyroxine, Eltroxin, etc…desiccated thyroid gives you exactly what your own thyroid would be giving you: T4, T3, T2, T1 and calcitonin. Patients around the world have found it to be a far better treatment, removes lingering symptoms, improves your immune system, gives you your life back, stops the attack of Hashimotos disease if you dose it high enough, and is also far better if you’ve ever had thyroid cancer.
# What are the brands of desiccated natural thyroid? The brand name “Armour” is the most well known of the Natural Desiccated Porcine Thyroid meds and oldest on the market–since early in the 20th century. Unfortunately, Armour was reformulated in 2009 and patients are reporting a return of their old hypo symptoms, stress on their adrenals, as well as new symptoms like heart palps. All or some of the latter occur fairly immediately, or within a few months, say many patients on the new Armour. But there are also good brands called pigs Naturethroid and Westhroid, both produced by RLC Labs. Additionally, some patients are using a natural desiccated thyroid called Thyroid-S or “Thiroyd” from Thailand with excellent results, as well as Erfa’s Thyroid from Canada. Australia uses compounded desiccated thyroid powder and there are many compounding pharmacies around the world. All desiccated thyroid comes from pig thyroid, and all most use thyroid desiccated powder which meets the stringent guidelines of the US Pharmacopeia. To see ingredients of all, go here.
# What are the units of measure per tablet/capsule? With the main brands, such as Naturethroid, Westhroid, Armour etc, each tablet/capsule is measured in milligrams (mg.). The typical tablet is 60 mg or 65 mg, which is called one grain. So, a 1/2 grain tablet is 30/32.5 mg. A 2 grain tablet is 120 mg/130. A 3 grain tablet is 180/195 mgs. A 4 grain tablet is 240/260 mg. A 5 grain tablet is 300/325 mg.
# What’s in desiccated natural thyroid? Natural Desiccated Porcine Thyroid, also just called Natural Thyroid or Desiccated Thyroid, contains the same hormones that your own thyroid would produce–T4, T3, T2, T1 and calcitonin–and is why patients have found it to work so well. T4 is the storage hormone; T3 is the active, energy-giving hormone, and both are found in a 80/20 ratio in each 60 mg of desiccated thyroid. The T2, T1 and calcitonin is not measured, but it’s there, according to Forest Labs, the makers of Armour. Since porcine thyroid tends to have more T3 proportionately than human thyroids (80/20 as compared to the human 93/7), some patients add a small amount of T4, but only after they find their optimal dose of dessicated thyroid–the dose which removes all symptoms and gets the free T3 towards the upper part of the range. Many do fine on porcine thyroid alone, though.
# Are there any non-prescription desiccated thyroid products? One more well-known over-the-counter (OTC) natural thyroid is called Nutri Meds which is available in either porcine or bovine desiccated thyroid. You may find other fine OTC products on the shelf of your local health food store. But…these products are not regulated, and the potency appears to be much less than prescription desiccated thyroid, so you may have to take much more for the same effect…and hope that the consistency will be similar from bottle to bottle.
# How do patients dose with natural desiccated thyroid? Thyroid patients and their doctors have found it wise to start on a smaller dose of desiccated thyroid than they will ultimately need, such as 1 grain (60 mg.). Why? Because the body may need to adjust to getting direct T3 again, and there may be other issues which can crop up, such as sluggish adrenals or low Ferritin. Those who start on natural desiccated thyroid have discovered that it can be wise to RAISE within two weeks or less to prevent hypothyroid symptoms from returning due to the internal feedback loop in your body, which can happen if you stay on a low dose too long before raising.
# Do I simply swallow it? Yes, you can swallow it and do great. Before Armour was reformulated and distributed in the new form in 2009, patients found it easy to do it sublingually i.e. you place the tablet under your tongue, or between your gums and inner cheek. Granted, Forest Labs did not make Armour to be sublingual, but it worked! Now, it’s more difficult, and those who want to continue with sublingual administration, especially with brands that may work better for you like Naturethroid,, have to cut the tablet up quite small and add a tiny amount of sugar. When swallowing desiccated thyroid, it will be important to avoid iron, estrogen and calcium supplements at the same time, since all bind the thyroid hormones to some degree.
# Do I take it once a day? To the contrary, most patients have found it beneficial to divide their dose to at least twice a day, if not more, in order to spread the energy-giving affect of T3. Desiccated thyroid contains direct T3, which is short-lived, and which peaks about 2 hours after you take it. An example is taking 2/3 or your natural desiccated thyroid in the morning, and the other 1/3 in the early afternoon. Or, for example, if you were on 3 1/2 grains, you might do 2 grains in the morning, one grain around noon, and the half grain by 2-3 pm. Some folks dose 4-5 times a day, especially in the presence of low cortisol. A few even do it once in the morning, and find that to be very effective. But the latter can stress your adrenals, or can result in fatigue later in the day. And remember: your own thyroid gives you what you need throughout the day instead of one dump; thus, multi-dosing is a way to replicate that.
# How do I know when I’m on enough? Before labs were developed, doctors treated patients with a thyroid disorder by symptoms….and successfully. Patients and many wise doctors have found this an ideal way to treat—by symptoms. One important symptom is your temperature. Temps reflect metabolism, and metabolism is controlled by your thyroid. Find a mercury or liquid oral thermometer, which is more accurate than most digitals. Generally, you want your morning temp (before rising) to be 97.8 to 98.2, and your afternoon temp to be around 98.6. You may find your temperatures correcting before you find your optimal dose. Unfortunately, doctors are trained to put a HUGE reliance on labs over symptoms. But labs only tell PART of the story. Patients have discovered that the free T3 can be the most informative. But you have to figure out where it is great for you, based on symptoms. When patients get their free T3 at the top, (or when all symptoms are eliminated) , they will often have a TSH far BELOW range, i.e. below one, and that does NOT necessarily mean you are hyper. Patients have found the TSH is less important once treatment is started, and just because one’s TSH can get lower than 1 while getting the free T3 up there, does NOT mean hyper has set in. Many doctors are uninformed about this, so be prepared, and pass along to your doctor what we have learned.
# Why is desiccated thyroid a better treatment? Desiccated thyroid is bar-none superior to T4-only meds treatment (Synthroid, Levoxyl, Eltroxin, Norton, etc) because it is natural (your body accepts ALL of it, unless you have an allergy to porcine), it contains both T4 (as the storage hormone) and T3 (the most active hormone and necessary for every cell in your body), as well as T2, T1 and calcitonin. T2 has an important role in metabolism. Calcitonin is the hormone which keeps the calcium in your bones, and certain doctors have noticed improvement in bone density with patients on natural thyroid.
# How do I find a doctor who understands desiccated thyroid? Patients regrettably find that many doctors are very ignorant about the efficacy and safety of natural desiccated thyroid. Be prepared. If you click on the highlighted “doctors” above, you’ll find recommendations on how to find a good doc. Consider calling the office to make sure this doc prescribes desiccated thyroid, checks the free’s, and pays attention to symptoms. If the doctor can’t do the latter, move on to another one! Another option is to visit a large pharmacy in your area and ask the pharmacist if anyone prescribes desiccated thyroid. And note that it is not uncommon to drive great distances to find a knowledgeable doctor.
# How high do I raise desiccated thyroid? As your doctor helps you raise your desiccated thyroid, a certain amount may give you better energy, but may not be quite enough to stop chronic low grade depression, for example. So another raise may be warranted. By observation, it appears that most hypothyroid patients end up in the 3-5 grains, with some lower, and some higher when they find their optimal dose.
# Are there other issues I need to correct? Often, there are other areas that need assistance when you are being treated with desiccated thyroid products. For one, many patients need to optimize their Ferritin level (storage iron), which is low in many thyroid patients. Low Ferritin can cause very similar symptoms as being hypothyroid, OR can cause you to have hyper-like symptoms when you try to raise desiccated thyroid. If upon starting desiccated thyroid, you have very strange symptoms, including anxiety, insomnia, shakiness, it’s a strong sign that you may need adrenal support. Cortisol is needed to distribute thyroid hormones to your cells, and if you are not making enough cortisol from sluggish adrenals, your blood will be high in thyroid hormones, producing the above symptoms. Adrenal support is used to give back to your body what your adrenals are not, which in turn allows the thyroid hormones to get to your cells. Unless you have hypopituitary, adrenal support is not meant to be for life for most, but to allow your adrenals to rest and recover. It is strongly recommended that you do a 24 hour adrenal saliva test–there are labs you can do them with here. 24 hour saliva tests give you far better information than the one time blood test that doctors will tend to recommend. You don’t need a STIM test, by the way, unless there is strong suspicion of Addisons or a pituitary problem. Work with your doctor on all this.
# Why do some patients take T3-only instead of desiccated thyroid? When your ferritin or B12 is too low, or your cortisol is too high or low, or other uncorrected issues are occurring, your body will tend to convert the T4 in desiccated thyroid to far more Reverse T3 (RT3) than you need. Excess RT3 clogs up cell receptors, preventing them from receiving optimal amounts of T3 in desiccated thyroid. You will also find yourself with excess T4 and toxic hyper-like symptoms of the excess. As a result, many patients feel the need to switch to T3-only. Cytomel is a popular brand prescribed by doctors. To find a good RT3 group, check the Talk to Others page. Chapter 12 in the STTM book is completely devoted to T3 and includes good information on RT3. Also check out the website on RT3 by patient Nick Foot.
# Are there any beneficial supplements that I can take with desiccated thyroid? Many patients take a Selenium tablet with their thyroid meds, which assists the T4 to T3 conversion. L-Tyrosine helps some patients, too. Zinc and Vit. C may play a role. Your need for B-vitamins will increase as you improve your energy levels. Some patients benefit from iodine supplementation. Optimizing your Vit. D levels can be important. Do research on the internet and also talk to your doctor.
# Any other tips? Many patients are keen to having an emergency backup of desiccated natural thyroid just for that–emergencies! Desiccated thyroid has a long shelf life, but you can also wrap it securely and place it in the freezer.
Hang in there!! Natural Desiccated Thyroid works!! And do what it takes to find a good doctor, or an open-minded doctor, who will work with you are a team.
Mistakes Patients Make (or their Doctors make for them!)Mistakes Patients Make (or their Doctors make for them!)
These are the most common mistakes patients, or their doctors, make when a switch has been made to desiccated natural thyroid like Naturethroid/Thyroid-S/Erfa, etc. and YOU can avoid them by being familiar with these reasons and making sure your doctor understands them, too. Can you find yourself below?
P.S. As of 2009, it may be mistake for you to be prescribed the brand name Armour. A slew of patients are reporting hypo symptoms returning on it, and other problems, since it was reformulated in early 2009. Many are switching to Naturethroid or Canadian Erfa. Talk to your doctor.
# STICKING WITH TOO LOW A DOSE. For a myriad of reasons, this happens often. Have one of these been true of you?
1) being held on a starting dose (such as one grain, less, or slightly more) longer than two weeks
2) being bound by the directives of a TSH-obsessed doctor
3) failing to get a raise of desiccated thyroid until the “next labwork”, which can be weeks and months away
4) following an inaccurate Synthroid-to-Armour conversion equivalence chart
5) being forced to lower a dose due to a high free T3 with continuing hypo symptoms, which is a sign of low cortisol, not too much desiccated thyroid, or
6) being afraid to go higher!
For example, a doctor has his patient make her way up to 1-2 grains, notices great improvements, but also has continuing problems. OR, a patient makes her way up to 2 grains and notices NO improvement. And it’s common to think that desiccated thyroid is not working! In reality, it may simply mean a patient isn’t on enough! By observation, many patients seem to need 3-5 grains before completely ridding themselves of symptoms, though some are lower and some higher. It can also be very wise to check adrenal function, since low cortisol can prevent thyroid hormones from making it to the cells….and you will still feel bad.
# BEING ON AN OPTIMAL DOSE and FEELING GREAT, BUT BEING LOWERED DUE TO THE TSH LAB RANGE Similar to #2 above, this is the person that made his/her way up to an optimal dose, or the dose that simply made them feel very good and removed symptoms, but having the dose lowered by a doctor who saw your suppressed TSH (i.e. below the range). This is doctor who thinks that ink spots on a piece of paper tell the truth more than your symptoms! When on an optimal dose of desiccated thyroid (or being very near), you WILL have a suppressed TSH without being hyper. Being lowered is a WRONG move.
# THINKING YOU ARE ON TOO MUCH BECAUSE OF HYPER-SYMPTOMS Yes, a doctor can guide you to go too high with desiccated thyroid and you’ll have hyper symptoms. You would then want to decrease your amount. But even more common is having hyper-like symptoms (anxiety, shakiness, fast heart rate, etc), especially on doses lower than 3 grains, because of underlying low-functioning adrenals (i.e. not enough cortisol), or even a low Ferritin—-each and/or both of which can be quite common in hypothyroid patients. So it can be wise to get both your Ferritin and cortisol levels checked. Ferritin is easily checked via a blood test, and if a patient is below 50, it can cause problems. As far as Cortisol levels, patients have found that the most accurate test is NOT a one-time blood test, but a 24 hour adrenal saliva test, which catches your levels during a 24 hour period. If money is an issue, try Discovery Steps One and Two on the Adrenal Info page on this site. Additionally, if you raise too quickly, or in too large a dose raise, your body can overreact, making you think you were on too much. The solution for patients has been to go back where they were, and go up in smaller increments, such as 1/4 grain.
# FAILING TO MULTI-DOSE Occasionally, some patients take their natural thyroid all at once in the morning and say they do fine. But, most individuals will notice much better results by multi-dosing. For example, a person on 3 1/2 grains might take 2 grains in the morning, one grain by noon or in the early afternoon, and 1/2 grain by mid-afternoon. Multi-dosing better imitates what your own thyroid would be doing, and gives you the direct T3 throughout the day when you most need it. Spreading out the Armour also prevents stress on your adrenals.
# SWALLOWING NATURAL THYROID WITH ESTROGEN, CALCIUM or IRON. Estrogen, calcium and iron bind some of the thyroid hormones and makes them unusable. So, it’s wise to avoid swallowing these at the same time you swallow your natural thyroid.
# STAYING ON A STARTING DOSE TOO LONG. The key to understanding this mistake is with the word “starting dose”. When first starting on any natural desiccated thyroid product, it can be wise to start on one grain or less, which is lower than you will ultimately need. Why? To help your body adjust to the direct T3. BUT, patients have found it UNWISE to stay on that low dose much longer than 2 weeks without raising. Why? Because hypothyroid symptoms can return with a VENGEANCE due to the feedback loop between the hypothalamus, pituitary and thyroid gland, i.e your hypothalamus gland senses the addition of desiccated thyroid (thinking the thyroid sent it), then sends a message to the pituitary gland, which in turn sends a message to the thyroid gland to stop producing, making you even more hypothyroid than you began.
# THINKING DESICCATED THYROID IS NOT WORKING WHEN SOMETHING ARISES. Desiccated thyroid contains direct T3, and the T3 can initially aggravate certain conditions. When this happens, doctors have had patients stop the increase of their desiccated thyroid, or decreased it to give the reaction time to go away. An example is Mitral Valve Prolapse–one patient noted that with each raise, she had palps. But they went away within the first 5 days after each raise. One gal got itchy when she got on desiccated thyroid, and was so determined to blame Armour that she got off, got back on Synthroid, and is STILL itchy.
# ADDING T4 or T3 to DESICCATED THYROID, OR EVEN TOO SOON! Most patients report that they do perfectly fine on desiccated thyroid alone, especially when they have taken the time to raise and find their optimal dose, which is often over 3 grains and has removed all hypothyroid symptoms. But some patients and their doctors feel the need to add either synthetic T4 or T3 to their natural thyroid dose to achieve a certain result . The challenge is in not adding it too soon, otherwise you miss out on the benefits of the T4, T3, T2, T1 and Calcitonin. Instead, if they had simply upped their desiccated thyroid more, they might have gotten the results they desired. Occasionally, a patient may suspect they have thyroid hormone resistance when 5-6 grains of desiccated thyroid is not doing the job. At this point, they add T3, or Cytomel, to their dose, to achieve results. Additionally, since most patients on an optimal dose of desiccated thyroid only achieve a mid-range T4, some are adding a small amount of T4 to raise the level.
# GOING UP WITH DOSAGES WAY TOO FAST. This was observed a few years ago: a doctor put his patient on desiccated thyroid. One grain, then 2 grains, 3 grains, 4 grains, 5 grains, then 6 grains. But the problem was that he did this within 4-5 weeks! OUCH. He started to find himself majorly overdosed with symptoms to match (high heart rate, sweating). He had to stop for a few weeks… then resume again at one grain and do it the right way. Namely, patients have noted that after they have been on a starting dose for a few weeks, they can start rising by 1/2 grain or so every 2-3 weeks. It’s all individual, and some may need lower amounts, but that seems to be the general amount to raise. They also note that when they get up to 2-3 grains, it’s time to hold each dose at least 4-6 weeks to allow the buildup of the T4, and to see it’s conversion to T3 results.
# PAYING TOO STRICT ATTENTION TO LABS. As mentioned above, thyroid patients have noticed that doctors tend to treat lab results rather than treat PATIENTS. Labs are interesting, and labs are good adjuncts to the full spectrum of dosing. BUT… SYMPTOMS are IMPORTANT. For example, patients have learned that even if there is a very suppressed TSH, and/or a high free T3, yet symptoms continue, it’s important to look at one’s adrenal function, since low cortisol can make the free T3 go high while symptoms continue.
# BELIEVING THAT DESICCATED THYROID IS “HARD TO REGULATE”. Totally and completely false. Patients have found nothing hard about desiccated thyroid. You simply raise it high enough to rid yourself of symptoms, which in turn gives you a free T3 towards the top of the range and a suppressed TSH. Believing that desiccated thyroid is hard to regulate is akin to believing that tricycles are hard to ride.
# THINKING THAT SYNTHETIC T4 ALONG WITH SYNTHETIC T3 (aka Cytomel), OR THE COMBO OF THE TWO (Thyrolar) IS JUST AS ADEQUATE AS NATURAL DESICCATED THYROID Adding synthetic T3 to your Synthroid, Levoyxl or other T4 brands is definitely a step up from being on T4 alone! We applaud that addition. But….to say it’s equal to being on desiccated thyroid t’ain’t so. Too many patients who have been on the synthetic combo, and switched to desiccated thyroid, report that the results were even better. That’s impressive. Besides, with desiccated thyroid, you are getting exactly what your own thyroid gives you–T4, T3, T2, T1 and calcitonin. Makes a difference.
# THINKING YOUR DOCTOR KNOWS MORE THAN YOU DO. Granted, we have great respect for education, and we appreciate the knowledge that a medical school trained doctor brings to our health quest. It’s important! BUT… that education does NOT take away from our OWN knowledge and our OWN intuitive sense about our bodies… about what works, about what doesn’t work… no matter what that doctor says. This website, and even more the STTM book, represents just that! So, patients have discovered that the doctor-patient relationship is best as a TEAM, with respect going BOTH directions. Doctors are not “gods”. They can and DO make mistakes in judgment. TEAMWORK counts. Find a good doc!!
What is the Optimal TSH Level for Thyroid Patients?What is the Optimal TSH Level for Thyroid Patients?
by Mary Shomon
Turkish researchers, reporting in the International Journal of Clinical Practice, looked at Thyroid Stimulating Hormone (TSH) levels and the connection to a number of cardiovascular risk factors, including homocysteine, C-reactive protein (CRP), fibrinogen, D-dimer and serum cholesterol levels. The patients were all taking levothyroxine, the synthetic thyroid medication. More than 400 patients were evaluated, and evaluated as part of three groups. Group 1 patients had a TSH value of 0.4 to 2.0, and Group 2 were from a TSH of 2.0 to less than 5.5, and Group 3 were from 5.5 to less than 20.
The researchers found that as TSH level elevated, so did homocysteine and CRP levels, with the highest levels seen in Group 3 patients. Elevated homocysteine is a risk factor for heart disease, and elevated CRP is additionally a marker for inflammation. No statistically significant differences were noticed in respect to fibrinogen and d-dimer levels between three groups. There was some correlation between TSH and cholesterol levels.
The key conclusion of the researchers? A target TSH level of less than 2 is advisable to lower CRP levels and homocysteine levels, and possibly lipid parameters.
Targeting a TSH level of 2.0 or less is controversial, however. Currently, the recommended reference range for TSH is from approximately 0.3 to 3.0. A much wider range of approximately 0.5 to from 5.0 to 6.0 is being used by labs and doctors who are not following the latest recommendations by the American Association of Clinical Endocrinologists. (This controversy is described in detail in my article, The TSH Wars.
Traditionally, practitioners have, for most patients, had their own particular approach to thyroid hormone replacement that fall into 5 categories.
1. Minimum Medication / High-Normal TSH
Some practitioners have preferred to take the most conservative approach, providing the lowest possible dose of thyroid medication, and targeting the top end of the normal range for a patient's TSH level. Their justification has been a concern over the effects of a lower TSH on bone density, as well as concerns that medication might have negative effects on the heart. This approach itself has been controversial however, because there is contradictory evidence as to whether patients medicated to the lower normal range face an increased risk of osteoporosis. It's also been shown that thyroid medication is safe for most patients, and dosage should be increased slowly and monitored carefully for cardiac implications in only the elderly and people with a history of preexisting heart conditions.
2. Medication to Mid-Normal Range
Many practitioners have as their objective to provide enough thyroid hormone replacement for a patient's TSH level to end up somewhere in the middle of the "normal range" -- and again, most often, using the older, broader normal range of approximately 0.5 to 5.0 to 6.0. This is considered a "safe" strategy for the physician, as conventional medicine says that hypothyroidism is fully "treated" when the patient is euthyroid (has a normal TSH level).
3. Medication to the 1.0 to 2.0 Range
Some practitioners -- including more of the integrative and holistic practitioners, have focused on a TSH level of between 1.0 and 2.0 as the target range. This target has typically been based not on definitive research, but more on clinical experience over time noting at which TSH level the majority of their patients typically report feeling their best.
4. Suppression of TSH to 0.0 or Nearly Undetectable Levels
TSH suppression, where higher doses of medication are given to suppress the thyroid's ability to produce any, or most, thyroid hormone is a strategy used with thyroid cancer survivors. Suppression prevents any remnant thyroid tissue from becoming active, and can help prevent cancer recurrence in many patients, and is often recommended by practitioners managing thyroid cancer patients. This approach is considered an important part of the ongoing treatment for thyroid cancer survivors.
5. Medication to Eliminate Symptoms
Some practitioners -- mainly from the holistic, alternative or integrative community -- believe that the TSH levels are irrelevant in managing a patient. They may occasionally test the TSH, but their target is resolution of thyroid symptoms, and they will change the dosage of thyroid hormone medication based on a patient's self-reported symptoms, as well as clinical signs including pulse rate, blood pressure, and observable thyroid symptoms such as reflexes, goiter size, eye irritation, and swelling in the face and extremities.
IMPLICATIONS FOR PATIENTS
With the publication of this new research, there is now scientific justification for doctors to avoid undermedicating patients to high-normal or mid-range TSH levels, and instead, target a level of 2.0 or less, in order to ensure that their patients are receiving optimal care.
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