The Way Up
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The Way Up Newsletter
Vol. 12
9/15/99

Dust storms usher in new light and understanding---

 

  Blessings and Welcome to this month's WAY UP NEWSLETTER!

  Several have requested a discussion of thyroid problems. So, within the confines of our brief newsletter, & requiring more medical detail than I uaually lay on you here goes.

Thyroid dysfunction in one form or another is among the top ten problems I see in my practice & it can be tricky to diagnose. The most common form is hypothyroidism ( low thyroid function). That's what we'll look at today.

WHAT ARE THE SYMPTOMS OF LOW THYROID FUNCTION?

Because thyroid hormone regulates the biochemical activity of most tissues, the deficiency symptoms can be myriad. Few people will have all of these findings, but rather some constellation of the following:
fatigue impaired memory
lethargy depression or low mood
sleepiness subtle personality changes
decreased initiative PMS
slowed speech & movement menstrual disturbances
dry or puffy skin, acne infertility
hair loss recurrent infections
coarse, brittle hair slowed wound healing
loss of hair curl increased allergies
thick slow growing nails headaches
weight gain muscle & joint pain/stiffness
difficulty losing weight bursitis
constipation hoarseness
watery eyes & puffy eyelids decreased sweating
swelling of face/extremities decreased sex drive
cold hands & feet decreased hearing
poor tolerance to cold anemia
increased cholesterol slowed heart rate
increased triglycerides heart dysfunction & irregularities
numbness & tingling shortness of breath
thick tongued difficulty maintaining normal physical & mental activity

HOW IS THYROID HORMONE MADE?

Thyroxine (T4) is formed & stored in the thyroid. It is made from a combination of Iodine (best derived from kelp) & the amino acid L-tyrosine. Certain enzymes & other nutrient co-factors must be present. Thyroid production is dependent on the average daily intake of these precursors.

After release from the thyroid gland T4 is converted to T3 (triiodothyronine) in the tissues. T3 has four times the potency of T4 & is more physiologically active. Certain tissues such as brain, spleen, & testes do not respond to T4 & must have T3. Some only consider T4 to be a prohormone. The conversion of T4 to T3 does not always occur as it should. Factors interfering with T3 production are Selenium deficiency, stress, chronic or severe illness, & malnutrition. Excessive Iodine (over 6000 mcg daily) will also inhibit thyroid hormone release.

Deficiency of adequate amounts of the dietary substrates is often the cause of a hypometabolic state in those under 50. Those over 50 are more likely to have actual glandular mal- function.

Repeated dieting can be problematic because the lowered nutrients produce lower metabolism which then induces lower absorption & utilization & even lower metabolism perpetuating a vicious cycle.

WHAT ARE THE TESTS FOR THE THYROID ?

Many have come to me feeling they have a thyroid problem, but previous Dr's have told them their thyroid was normal based upon the tests. Usually a test called TSH is ordered & if normal, the possibility of thyroid dysfunction is dismissed.

TSH stands for Thyroid Stimulating Hormone which is a pituatary hormone which can increase when thyroid levels decrease. Sufficient thyroid decrease must occur to trigger this feedback loop. TSH increases to try to stimulate the release of more thyroid. Accepting this result as definitive testing presupposes the pituatary & hypothalamus (which gives the signal to the pituatary) are doing their jobs. This may only detect grossly overt hypothyroidism.

Since low thyroid is relatively common, it is important to do additional testing to uncover borderline deficiencies which may still cause significant symptoms.

My favorite thyroid tests are: Free T3, Free T4, T3 Uptake, TSH, anti-thyroglobulin & anti-microsomal antibodies, & sometimes thyroid peroxidase antibodies. Of course, when the thyroid feels abnormal on a physical exam, we may need to have an Ultrasound or Scan.

The antibody tests are ordered to check for auto-immune thyroiditis which is increasing in our population, no doubt from excessive chemical exposure. There is also a strong heriditary pattern. For instance, in my family, my mother, sister, brother, aunt, & niece have auto-immune thyroiditis. I have thus far escaped, maybe from tremendously healthy living. They all smoked & smoking also increases the risk.

Often there will be a thyroiditis long before the hormone levels drop, although ultimately a thyroidits will alter thyroid production. The thyroiditis may influnce thyroid hormone utilization & create symptoms before the thyroid blood levels change. Early treatment with thyroid is helpful for some who have symptoms suggestive of hypofunction.

Some Dr's use what is called basal temperature testing to further ascertain hypometabolism & it can be useful. But one must keep in mind that othere health conditions can also produce a low body temperature.

WHAT IS THE BEST TREATMENT?

When the tests are normal, but the symptoms are present, we may first try adequate nutritional presursor loading.

When the tests are abnormal my first choice Is Armour Thyroid, or one of the other natural thyroids. I like this because it contains both T3 & T4. Because the tablet is tiny, I have the patient chew it for maximum absorption, though it is not a chewable per se. When the T4 levels are high normal, but the Free T3 is low or low normal, that suggests to me that inadequate conversion of T4 to T3 is a problem, so I may only prescribe sustained release T3 from a compounding pharmacy. I use this form because the usual T3 (Cytomel) has a very short half life & therefore does not provide consistent symptom improvement.

Probably 90% of those with diagnosed hypothyroidism are on Synthroid, thyroxine, or some form of T4 only. When these people cannot convert it to T3, they will have less than optimal results from their thyroid treatment. Not much attention is given to this problem. The drug detail people have done a good job on selling to the Dr's the so-called superiority of the synthetic T4 preparation

We could go on & on, but enough is enough. If you want to know more, see the books about Thyroid issues

If you know someone who would like to receive this newsletter, please feel free to forward it to them

Until next month. Stay happy & healthy.
Priscilla Slagle M.D.

A Pendulum A Rhythm
The oscillation inherent within all
Learn without assumption
Conserve and Plan
Act from decision
Reaction is no longer as important
As clear Action
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