Hyper or Hypothyroid ?

"Subclinical Hypothyroidism: To Treat or Not to Treat, That is The Question," Franklyn, Jayne, Clinical Endocrinology, 1995;43:443-444. Subclinical hypothyroidism is defined as a raised serum TSH level in association with a normal serum total and/or free T4 concentrations. There is still debate but the clinical course of this disorder suggests that treatment is appropriate for those with a history of radioiodine therapy or positive thyroid antibodies, but evidence is lacking that all patients with a high serum TSH level be treated as a matter of routine.

"Subclinical Hypothyroidism in Older Persons", Sawin, Clark T., M.D., Clinics in Geriatric Medicine, May 1995;11(2):231-238. In 1886 it was noted by a 28-year-old London surgeon that "the symptoms of mere senility may be accounted for by the loss of functions of the thyroid body."  In the late 1890s and for a period of about 40 years desiccated thyroid was given to delay or prevent age-related changes.  Subclinical hypothyroidism is common in older individuals and more so in women than men.  With the use of clearly raised serum TSH community surveys of persons older than the age of 60 years in the United Kingdom and the United States showed that 48% have subclinical hypothyroidism.  The prevalence is less than iodine-deficient areas.  A decrease in HDL cholesterol may be a possible sign of subclinical hypothyroidism.  Treatment can improve left ventricular function somewhat.  There may also be an improvement in cognition in some cases of dementia and in constipation.  Raised serum TSH levels generally greater than 10 mU/L is suggestive of hypothyroidism.  Risk factors for thyroid failure include family history of thyroid disease, history of hyperthyroidism, subacute thyroiditis, postpartum thyroid disease, radiation to the head, neck or chest, autoimmune disease over the age of 60, medications such as Lithium, Amiodarone, iodine and elevated serum cholesterol.  Not all thyroid failure is permanent. In a small number of older patients with raised serum TSH levels the serum TSH can spontaneously return to normal over a year's time. 

If thyroid failure is due to current medication it is usually reversed if the medication can be stopped.  If the autoimmune process remits itself before the thyroid gland is destroyed normal functioning may return.  Treatment can occur with TSH levels greater than 10 mU/L.  A potential side effect is thyroid induced decreasing bone mineral content and a possible increased fracture rate.  Older women with subclinical hypothyroidism showed no decrease in bone density when administered oral Thyroxine.  This appears to be true when higher doses of Thyroxine are used for suppressive therapy in the management of thyroid cancer. 
"Improper Thyroid Hormone Therapy Often Missed", Bates, Betsy, Family Practice News, January 15, 1996;22. Thyroid is the sixth most commonly prescribed drug in the United States.  Some elderly patients have been placed on thyroid in excessively high doses years ago in the absence of primary thyroid gland failure.  A low thyroid stimulating hormone may be indicative of inappropriate thyroid suppression therapy or atrial fibrillation.

"Impaired Action of Thyroid Hormone Associated With Smoking in Women With Hypothyroidism", Muller, Beat, M.D., et al, The New England Journal of Medicine, October 12, 1995;333(15):964-969. In evaluating 138 normal women and 135 women with primary hypothyroidism of which 84 were subclinical and 51 had overt hypothyroidism, it was found that smoking increased the metabolic effects of hypothyroidism in a dose-dependent fashion. The inhibition of thyroid function may be due to higher serum thiocyanate concentrations in smokers which is a goitrogenic agent, or pyridine or other components of cigarette smoke that have a mild antithyroid effect. 

"Sleep Apnea and Hypothyroidism", Kittle, William M., M.D. and Chaudhary, Bashir, M.D., Southern Medical Journal, November 1988;81(11):1421-1425. Hypothyroidism is a well recognized cause of sleep apnea. Thyroid replacement therapy has been shown to diminish or completely eliminate apnea episodes and arterial oxygen desaturation as well as improving sleep patterns and overall sleep efficiency. The author suggests it is reasonable to evaluate thyroid function in all sleep apnea patients. The authors believe that patients with sleep apnea and subclinical hypothyroidism receive a trial of thyroid replacement therapy before operative therapy for sleep apnea is instituted. We suggest considering a more natural approach.

Subjective Indicators for use of Cytozyme-AD or ADHS

Basically, consider Cytozyme-AD with hypo-cortical function and consider ADHS with hyper-cortical function.

                                                                  When to Consider Cytozyme-AD: 

* True reactive hypoglycemia (LDH decreased or low normal; normal blood sugar, triglycerides and blood lipids [total cholesterol, and HDL/LDL/VLDL cholesterol]). Adrenal cortical hypo-function is present (inability to call stored glycogen from the liver).

* Reduced systolic blood pressure (below 110 mm) with other indicators of adrenal stress (fatigue, weakness, dizziness, poor circulation, afternoon headaches, etc). Include Bio-Glycozyme Forte between meals.

* Serum Potassium is above 4.5 - Adrenal cortical function is involved in taking potassium from the serum into the cell.

* Using blood postural pressure test; test blood pressure recumbent, then immediately on standing and standing BP is lower.

* Salivary adrenal stress tests taken morning, mid-day, evening and midnight all have low levels, indicates reduced cortical function. 

                   When to Consider ADHS:

* Dysinsulinism or Syndrome X (increased triglycerides, HDL decreased in relation to total cholesterol, LDL increases in relation to total cholesterol). Include GlucoBalance.

* Systolic blood pressure above 130 and other indicators of adrenal stress (see above), especially if diastolic is 90 mm or higher.

* Serum potassium is below 4.0 indicates hyper-cortical function.

* Using blood postural test, and the standing systolic pressure is equal to or higher the recumbent and symptoms of adrenal fatigue noted above are present.

* Salivary adrenal stress test: if the morning and mid-day cortisol levels are normal, but the evening and midnight levels are increased, or all levels are increased, include Cytozyme-PT/HPT and Glucobalance. In general the most likely reason for increased cortisol (and generally decreased DHEA) is over stimulation by the anterior pituitary (excess ACTH) due to either lack of feed-back from the adrenals or simply pituitary dysfunction.

ADHS - Adrenal Support Product

Do you know anyone that is stressed or maybe, who isn't? We continue to get very positive reports about this product. It seems to be effective even with the most difficult "stressed out" patients. The regaining and sustaining of mental acuity, being more relaxed and more rested late into the day, easier number recall, feeling less taxed handling demanding situations, normalizing high or low blood pressure, are the types of examples reported. The broad range of natural adaptogens in ADHS supports functional needs. As example: syndrome X (insulin insensitivity) comes about by maintaining the high blood sugar levels that the "fight or flight", sympathetic state, demands with prolonged stress. By providing balanced support for function, we internally adapt and, both mentally and physically, operate on a level that is not stressful. Body systems will normalize blood sugar, blood pressure, etc.

Hypothyroidism Grows More Prevalent.                

The following has been taken from a three part series of excellent newsletters by Jeff Moss, DDS, CCN. For the 26 pages of text complete with sources, please call 800-524-5183, or to subscribe 800-359-5054.

As many as 40 percent of Americans today are affected by some degree of hypothyroidism. They usually complain of lethargy, weakness, slow speech, and dry coarse skin. They may also experience fatigue, cold intolerance and hoarseness. The list is much longer.

Thyroid hormone activity is very broad and affects every tissue in the body. This includes regulating oxygen consumption, temperature, building up or breaking down of lipids (adipose and fatty acids), carbohydrate metabolism, protein synthesis, sympathetic activity, the cardiovascular and nervous systems affecting mood and mental acuity. 

Textbook hypothyroidism exists when symptoms and serum tests show elevated TSH (thyroid stimulating hormone from the pituitary telling the thyroid to work harder), low T4 (thyroxine produced by the thyroid and sent to the tissues) and low T3 (triiodothyronine converted from T4 to affect cellular metabolic processes). (Note, most T4 and T3 are mostly protein-bound as serum soluble thyroglobulin for synthesis, transportation and as ready reserves.) However, most of the time hypothyroidism symptoms and serum levels usually do not co-relate very well. Yet to give optimal treatment, considering finances and its actual resolution, there is much more to be understood to treat the ultimate causes of this illness.

Factors Affecting Thyroid Hormone Production  (Knowing the right questions as to WHY)

First there are the internal feedback loops of hormone levels regulating the pituitary and hypothalamus, which then directly affect the thyroid. Also the availability of serum iodine levels directly affect thyroid activity. The use of iodized salt helps address this issue. But the most overlooked problem with thyroid function is with the peripheral conversion of T4 to T3 by the enzymeT4-5'-deiodinases, and this actually has nothing to do with the thyroid.  And the favorite standard treatment of hormone replacement therapy (HRT) using synthroid will not work here. In that there are many environmental factors and illnesses that interfere with this enzyme, the causes of this problem need to be accessed and addressed. Examples include starvation, diabetes mellitus, and uremia. Deficiencies in selenium, glutathione, zinc as well as other nutrients affect T4 to T3 conversion. Note various drugs also will decrease this specific enzyme's activity.

Stress affects thyroid activity. Glucocorticoids, such as elevated cortisol due to stress, (who doesn't experience this) suppress the secretion of TSH and decrease the conversion of relatively inactive thyroxine (T4) to the potent triiodothyronine (T3). The list of stressors include infection, noise, decreased oxygen supply, pain, malnutrition, heat, cold, trauma, prolonged exertion, responses to life events, including anxiety, depression, anger, fear, excitement, radiation, obesity, old age, drugs, surgery, etc,

Nonthyroidal illness is common. Low T3 with normal T4 and TSH are observed, but either or both T4 and TSH may be also lowered as the situation worsens. The T3 also may appear normal, but may be produced in a less active form.

Incidentally, a very high reading of TSH levels greater than 20mU\L are actually the norm for a few days after an illness as the system is kicking the thyroid back in again. Do not mistake it for hypothyroidism.

Many healthy foods affect thyroid function.  While stress (elevated cortisol) and malnutrition (poor enzyme, mineral vitamin support) are more prominent causes for hypothyroidism, foods eaten for specific purposes may actually contain anti-thyroid compounds or contain compounds that can be acted upon by intestinal flora to become anti-thyroid compounds. These specific foods include cassava, maize, bamboo shoots, sweet potatoes, lima beans, and flavonoid containing plants and cruciferous vegetables. Do not quit eating these food but note that while other factors may be involved, a significant part of the hypothyroidism in a patient just may be due to excessive quantities of any one of these particular foods. Asking hypothyroid patients to fill out a seven-day diet diary may convert what, at first, appears to be a very difficult hypothyroid case into one that is quite obvious. They may not realize there is no one food that is a panacea for everything. 

Environmental Pollutants as a Cause of Hypothyroidism. (A nutritionally sound diet and a well functioning gut and good liver detoxification system more readily counters may of these insults.)

Cigarette smoke, second hand included, contains a variety of goitrogenic resorcinol derivatives, flavonoids and hydroperoxides that may produce goiter. Recent studies indicate that smoking increases the severity and metabolic effects of hypothyroidism, probably by alteration of both thyroid function and hormone action.

Halogens, such as chlorine and fluorine used in water supplies may definitely contribute to hypothyroidism by interfering with iodine (an electomagnetically weaker halogen) metabolism.

Phthalates, which include PVC's, used extensively in plastics for flexibility, are biodegradable by Gram-negative bacteria which may explain in part the relationship established between frequency of goiter and bacterial contamination of water supplies. 

Red dye No. 3, a popular coloring agent used in foods, cosmetics, and pharmaceuticals, has a consistent effect on thyroid economy with a striking increase of reverse T3 (rT3), an inactive form of T3 and an inability to degrade it. So T3 levels appear normal on a thyroid panel and to the body, but active T3 is low.

Pharmacological Agents as a cause of Hypothyroidism. Some of the most popular medications in use today can be profound causative factors for hypothyroidism and patients should be well screened for the possibility of these iatrogenic causes.

Antidepressants - Tricyclic antidepressants and antipsychotic phenothiazines can affect thyroid function at many levels. Some may block iodine as electrodonor drugs either by complexing or deactivating iodine or blocking it from binding to thyroglobulin. All antidepressant and antipsychotic psychotic drugs act on norepinephrine and dopamine pathways and as such alter the hypothalamic-pituitary pathway of thyroid releasing hormone (TRH) and TSH by shunting tyrosine (precursor of both hormones) away. Phenothiazine drugs are suspect of exerting immunogenic effects. It has been shown that chloropromazine, a dopamine antagonist, also binds to histamine receptors and is able to induce systemic lupus erythematosus.   Hashimoto's thyroiditis, another autoimmune disorder, could be the result of phenothiazines.  

Estrogen-containing medications greatly increase thyroxine-binding globulin, which in turn reduces the amount of the unbound free active T4 and T3 available for thyroid function.  

Intestinal flora and detoxification pathways are altered by medications. This has an impact on hormone elimination and/or reabsorption affecting overall thyroid function.


Nutritional Recommendations for Hypothyroidism.

Core supplementation: (with clean water, proper diet and exercise)

1.    Thyro-Stim - 2-3 tablets 3 time per day with meals. (Pituitary/hypothalamus, iodine support)

2.    GTA - 1 tablet 3 times per day with meals. (Direct thyroid glandular support)

3.    Meda-Stim - 1-3 capsules 3 times per day with meals. (T4 to T3 conversion support)

Excessive stress (elevated cortisol):

a.     ADHS - 2 tabs with breakfast and 2 tabs with lunch.

b.     Cytozyme Pt/HPT - 1-2 tabs 3 times per day with.

Excessive carbohydrate intake:

a.      BioGlycozyme Forte or Glucobalance - 2 tabs 3 times per day between meals.

b.      Flax Seed Oil - 1 pearl 3 times a day with meals.

Chemical toxicity due to environmental pollution or pharmaceutical agents:

a.       MCS - 2-4 caps twice per day with meals.

c.       MSM - 6-9 caps per day.

Gastrointestinal dysbiosis

a.        IPS - 2 caps 3 times per day with meals.

b.       ADP - 2-3 tabs 3 times per day with meals

c.        Biodophilus FOS - after 20 days, 1/2 teaspoon 1-3 times a day with meals.