Bio-identical Hormone Therapy and Sage Advice 4 Women from

There are different types of thyroid problems.   Ones that are genetic and ones that are acquired. You can produce too much thyroid from the gland or too little. You can have an autoimmune response to the thyroid hormones where the body's immune system attacks the thyroid hormone made. You can make the right amount of thyroid hormone but not be able to get that hormone into the mitochondria of cells for it to make a difference. The thyroid gland make mostly T4 and some T3. The conversion of T4 to active T3 that will fit into thyroid receptors is done in the body else where.  There are no T4 receptors in the human body.  Some people do a great job of converting T4 to T3 and others do not. Many things affect the body's ability to get thyroid that really works for us. These processes are really complicated. Some persons have normal laboratory tests but still feel poorly. These may have sub clinical thyroid problems. People with thyroid symptoms may have brain or adrenal problems that are affecting the production and utilization of thyroid hormones. There are many women who have thyroid symptoms but lab tests show them to be normal. We call these sub-clinical.

There are many sources for information on sub-clinical hypothyroidism available in alternative medical journals, abundant internet information, articles in lay journals and scientific research reported by physicians like Dr. Broda Barnes.  They come to many gynecologic practices,  women who have done their homework and are requesting to try natural thyroid medication for a multitude of complaints, not the least of these fatigue and malaise. Investigation and correction of brain neurotransmitter and adrenal status is also necessary as part of this evaluation.

  Caring for these women and providing them with a trial of Armour Thyroid or sustained release T3 requires that a practitioner diligently screen for conditions that may be affected by thyroid supplementation.

    Pre-menopausal women do not have as high a risk of bone loss from thyroid medication like menopausal women have and may be less rigorously monitored for bone loss.  In a recent British journal, a large study revealed that women on thyroid medication did have a decrease in bone mineral density but because they felt better and were fit the actual rate of fracture did not increase.

     Because of the potential of cardiac changes with thyroid medication specifically increased heart  rates and arrhythmias, patients need education to recognize potential problems and report them promptly.

     Thyroid medication should only be started on persons who have been evaluated for adrenal fatigue and neurotransmitter brain issues.  More adverse symptoms may occur if the adrenals are not addressed prior to thyroid medication being started.  The adrenals and brain are integral to all the hormone function and all hormone compartments must be considered at the same time.

    The benefits from natural thyroid supplementation grounded in medical literature, range from lifting of depression, energy ,improved sexual function, memory improvement, reduction in anxiety, cancer prevention, elimination of fibromyalgia and chronic fatigue symptoms, ease of menopausal symptoms, prevention of diabetic complications, and the list goes on and on.

    A diagnosis of hypothyroidism is often missed because standard laboratory tests return to the physician's office with normal results and the patient is deemed euthyroid. These tests are expensive and need to be repeated on a regular basis to determine effective thyroid supplementation. The cost to the health care system of these tests count up and the test researched by Dr Broda Barnes and reported 4 decades ago has been ignored by many physicians. The use of basal body temperatures done by patients at home in their own bedrooms and require only the cost of a digital thermometer have been reported in studies by Dr. Barnes and other physicians. The oral temperature done upon waking and prior to arising in the morning should be greater than 98.2 and less than 99 degrees.  Hypothyroid being less than 98.2 and hyper thyroid greater than 99. This should be performed three days in a row to determine if the temperature is not normal. Temperatures are done in bed under the covers before getting up out of bed.

The TSH should be between 0.5 and 2.0 in functional medicine according to Pam Smith, MD. The ideal TSH is 1.5. and the Free T3, Free T4, and Revese T3 should be dead center of the normal range.

     The diagnosis of Hashimoto’s autoimmune thyroiditis is frequently missed because routine thyroid function tests are normal. and no additional testing is done.  Anti-thyroglobulin and microsomal antibody testing is required for the diagnosis in these patients.  The immune system may be dampened enough that antibodies are not present all of the time for the test. Testing may have been done at a time of remission and appear normal.Thyroid medication is not necessarily a lifetime commitment. Careful attention paid to a well balanced diet of natural food and proper supplements allows for weaning off thyroid medication in those patients so motivated.

     Once the diagnosis is made, a regimen of natural or synthetic thyroid may begin. The number of  patients coming in requesting natural thyroid  grow everyday.  One regimen of natural thyroid is started at 15 mg. a day and the dose is best taken twice a day rather than all at once due to T3's rapid turnover rate in the body. The dose is increased weekly by 15 mg. until the temperature reaches 98.2 or any problem such at heart palpitations, chest pressure or headaches occur  which would necessitate backing down the dose.  Thyroid labs must be done every 6 weeks when doses are changing to insure that the thyroid is not suppressed. Bone loss and cardiac arrhythmias can be life threatening and need to be avoided.

Subjective information gathered to aid in diagnosis include: Family history of thyroid abnormalities, complaint of constipation, history of menorrhagia and dysmenorrhea,  paresthesias of the extremities, history of depression and emotional disturbances, history of memory loss, intolerance of cold, fatigue, palpitations, excessive sleep, infertility, irritability, abdominal bloating, and muscle pain and cramps.

Objective signs of hypothyroidism include  carotenemia ( orange color to the skin), especially of the palms of hand and feet, anemia (usually normocytic,  normochromic and of unknown etiology,) hypercholesterolemia, enlarged tongue, skin depigmentation, hypoglycemia, ovarian failure, premature grey hair, loss of eyebrows, thinning hair, skin thickness, decreased body temperature, greater than ideal body weight, muscle weakness, brittle nails, and hoarse voice.

Treatment consists of labs for thyroid abnormalities, including thyroid antibodies. In clinically euthyroid patients, the patient need to perform basal body oral temperatures on three consecutive days. Pre-menopausal women need to take these during the luteal phase of their cycles. If the temperature is below 98.2 upon awakening three days in a row, the diagnosis of hypothyroidism may be made.
    Patients should make a list of all the applicable symptoms and signs she has noticed and watch weekly for changes in each system and document them for signs of improvement and bring this list to every visit with her health care provider in addition to her temperature charts.
    Menopausal and pre-menopausal women should have bone status carefully watched with baseline dexa scans and N-telopeptide (ntx) urinary studies in the interval between dexa scans for any loss of bone status.
     Patients with known cardiac abnormalities should be cleared by their cardiologists prior to initiation of therapy.  Patients with family history of cardiac and vascular problems might be screened with c-reactive protein and homocysteine laboratory tests. Treatment with sustained release T3 necessitates a baseline EKG and cardiologist evaluation.

    Patients should be seen after initiation of therapy after six weeks and every one to three months while the doses of Thyroid medicine are changing.

    Some patients do not do well on Armour thyroid and need the synthetic formulations of thyroxine alone or in combination with T3. Some women do not respond to synthetic thyroid and need to be changed to Armour or natural porcine glandular thyroid or sustained Release T3. Natural thyroid contains 4.22 parts T4 to one part T3 and has also T1 and T2. Some authorities believe that T1 and T2 have function in the body and patients do better with Porcine thyroid which contains all 4. Hashimotos patients may do better on synthetic thyroid in a sustained release form A4M compounded to provided optimal thyroid testing.
 


   The diet of a female hypothyroid patient should include iodine, either by supplement or by a diet  rich in iodine.  The correct dosage varies from one expert to the next. The RDA for Iodine is 150 micrograms. The recommendations seen in the literature are from 5 to 50 milligrams.  Anyone taking over 1 mg per day should  have thyroid status monitored. If positive thyroid antibodies are present, iodine supplementation must be carefully done.   Iodine supplementation can start the detox of other competing halides which may be attached to receptors.  The release of these such as floride, Bromine and chlorine can create difficult symptoms necessitating a slower and lower administration of iodine initially.  Lugol’s solution 2-4 gtts in 2 ounces of water or juice may be prescribed. Kelp capsules are available over the counter.  Iodoral is available over the counter. Selenium should be supplemented , 200 mcg per day to encourage the formation of T3 and discourage the formation of reverse T3 in the transformation of the T4 in Armour thyroid.  Adequate vitamin D is also essential for the conversion of T4 to T3.  Vitamin D is a hormone not a vitamin really.  Care must be taken to have enough and not too much Vitamin D.  Testing should be done when supplementing at greater than the 1000 iu that is recommended. And many women need much more that 1000 iu daily. Hashito's thyroid patients need much more than normal Vitamin D.

The diet should be varied, as close to the food’s source as possible. It should consist of approximately 30% fats( good fats: olive oil, flax oil, fish oil, EFA’s, lignans etc.), 50% protein and 20% carbohydrates.

               
According to Dr.Stephan Langer,MD   there are four false assumptions most MD’s have about the normal range of laboratory findings and patients who are still hypothyroid with those normal laboratory findings.  First, the only cause for thyroid deficiency symptoms is hypothyroidism. Secondly, only patients with primary hypothyroidism should only be allowed to use thyroid hormones.  Thirdly, hypothyroid patient should only be allowed to take synthetic T4 formulas like Synthyroid and Levoxyl. And lastly, and most importantly, hypothyroid patients should be limited to amounts of hormone that keep the TSH within normal range. Some sources say that since TSH measures only 1 % of thyroid receptors( Beta 2's), it is an excellent tool for diagnosis of thyroid disorders but should not be used for management. TSH should never be allowed to be suppressed below the lowest of the normal range for TSH. Suppression is dangerous and can cause atrial fibrillation as well as other issues.

If symptoms are not relieved by thyroid supplementation, the next considerations should include food and environmental allergies, candida albicans systemic infections which also would affect adrenal function.  Adrenal function should be re-evaluated.
If no thyroid disease is found, some symptoms of thyroid dysfunction may be due to Wilson's syndrome. Dr. Dennis Wilson's website is a very interesting read. He offers a free E-Book which is interesting and an E-Manual for providers interested in learning more about his program and therapy.

Bibliography:

ArmourThyroid.com

Barnes, Broda, MD and Galton, Laurence. (1976). Hypothyroidism: the Unsuspected Illness. Harper and Row Publishers, New York.

Beers, Mark and Berkow, Robert. (1999). The Merck Manual, Seventeeth Edition, Merck and Co.,Inc.

Kharrizian, Datis, DHSc, MS, DC.(2010)  Why do I Still Have Thyroid Symptoms When MY Lab Tests Are Normal. Morgan James Press, NY.

Langer, Stephan, MD and Scheer, James, (2000). Solved: The Riddle of Illness, Third Edition, Keats Publishing, Lincolnwood, Illinois.

Speroff, Leon et al. (1999). Clinical Gynecologic Endocrinology & Fertility, Sixth Edition, Williams and Wilkins Co., Baltimore ,Maryland.
                                       
www.wilsonssyndrome.com

If you have been diagnosed with auto immune thyroid disease, it is imperative that you stop eating all gluten and dairy products( other food may also become a problem since anything that the body recognizes as an invader will be attacked and the that war is what is harmful to Hashimoto's patients. Once an auto immune reaction begins, it can not be stopped. One can only hope to minimize the auto immune expression of symptoms by dampening the bodies response to it's perceived invaders.Was the Hashimoto's caused by Celiac Disease or gluten intolerance or did the Hashimoto's cause the gluten intolerance?

          Thyroid References
 
Arem, Ridha, MD.  The Thyroid Solution

The American Association of Clinical Endocrinologists

Barnes, Broda, MD. The Unsuspected Illness.

Brownstein, David,MD. Iodine, Why You Need It.

Brownstein, David, MD.  Overcoming Thyroid Disorders.

Childs, Westin, DO. Restartmed.com

Kharrazian, Datis,DHSc. DC MS. Why Do I Still Have Thyroid Symptoms When My Lab Tests are Normal. (Check out his website: www.drknews.com for very interesting educational information.)

Langer, Stephen, MD   Solved the Riddle of Illness.

Shames, Richard MD and Karilee RN, PhD.    Thyroid Power.

Shames, Richard MD, and Karilee,RN, PhD.    Feeling Fat,  Fuzzy, and Frazzled           
Shimon, Mary.   Sticking Your Neck Out.
           
Shimon, Mary.  The Thyroid Diet.

Townsend Letter. Iodine:A lot to Swallow

The Thyroid Foundation of America

Teiltelbaum, Jacob MD.  From Fatigue to Fantastic.

West, Bruce DC. The Wellness Letter.

 www.thyroid.about.com