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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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