Hypothyroidism
Hypothyroidism is an easily detected and readily treated condition that affects millions nationwide. It has a
progressive course of bothersome symptoms that interfere with daily living and the quality of life.
Untreated, it can have a benign course but more likely it can become debilitating and lead to heart failure,
coma and even death.
Hypothyroidism affects one in five women over the age of 65. When tested, 26% of women going through
menopause are found
to be suffering from hypothyroidism.
Symptoms of Hypothyroidism
Fatigue
Weight gain
cold intolerance
Dry/coarse hair and skin
Muscle cramps
Tingling and numbness in fingers
and toes and fragile nails
Constipation
Shortness of breath
Hearing loss
Puffiness in the face, specially around the eyes, hands and feet
Depression, irritability, poor
memory and confusion
Heavy or irregular menses.
Diagnosis
Symptoms of hypothyroidism are similar to some of the normal symptoms of menopause. The single most
reliable way of diagnosing hypothyroidism in peri-menopausal women remains blood testing for TSH, free
T3 and T4. These tests may be used for interpretation based on whether the results fall within a "normal"
range on one occasion or on successive occasions in order to establish a trend towards hypothyroidism.
By appropriate interpretation it is possible to make a diagnosis about a disorder that is developing but has
not yet fully taken on a classic presentation and typical laboratory abnormalities.
Diagnosis of this ever more common disorder is supported based on:
Typical Symptom complex
Average Axillary Basal Body Temperature < 97.6
High sensitivity TSH along with free T3 andT4 levels
Demonstrating underproduction of thyroid (low T4) or body's inability to activate T4 (low T3)
with or without concomitant TSH elevation.
Cortisol levels that are either too high or too low in the morning.
Unfavorable cholesterol profile.
Obesity.
Understanding thyroid Physiology
Thyroid gland is a small butterfly gland that sits right below the Adam’s apple. It is controlled by hormones
secreted by the hypothalamus (TRH) and then the pituitary (TSH) in response to the body’s general
condition and perceived metabolic needs. The thyroid subsequently produces T4, which is essentially an
amino acid, Tyrosine, with 4 iodine molecules attached to it. Iodine and tyrosine are essential for the
production of T4. Once in circulation T4 is converted to T3 by an enzymatic reaction that requires
selenium for appropriate activity. The conversion occurs in the liver as well as in the most other peripheral
tissues. The conversion is critical as T3 is 5 times more potent than T4.
T3/T4 Activity Comparison
Hormone concentration Potency Onset Duratioon
T3 1 5 6 hrs 2 days
T4 7 1 24-48 hrs 7 days
Factor Reducing Thyroid Function
Medications
propylthiouracil
amiodarone
propanolol
Lithium
Dilatin
Tegretol
Dopamine
Iodine
Environmental exposures and Diets
Heavy Metals
Brussel sprouts
Rutabaga
Turnips
Kahlrabi, cabbage, radishes, cauliflower, kale,
soy
Millet
High carbohydrate Diet
Cigarette smoke
Chronic disease
Cell phones
Radiation, EMF
Deficiencise in
Zinc
Glutathione
Cobalt
Vitamin D
Riboflavin
Medications for Treatment
Synthroid and Levoxyl are synthetic versions of the thyroid hormone T4 and are the most widely
prescribed medications for the treatment of hypothyroidism. In patients with difficulty with activating T4 to
T3 this medication is a poor choice.
Cytomel or Triostat (liothyronine) is synthetic thyroid hormone, T3. It is effective even in patients with
peripheral conversion problems (inabiliy to activate T4 to the active T3 hormone). However, because of
the short half life of T3 it may require twice a day dosing or be associated with high T3 levels shortly after
a dose followed by very low levels towards the end of the day.
Armour Thyroid, a natural product of ground up porcine thyroid, and contains natural proportions of T4
and T3. It overcomes both sets of problems associated with the other two medications. It is the form of
thyroid medication most commonly prescribed to our patients.
Time release preparations of T3 are often more effective and better tolerated than either armour thyroid
or Cytomel. T3 in the latter preparations are short acting and sometimes require a second dose in the
afternoons as the T3 wears off by mid-day leading to an afternoon "crash" in energy levels. As such, time
release preparations of T3 provide a constant level of T3 release from the intestines leads to a more
reliable and constant level of T3 in the blood stream. Use of this preparation avoids the jitteriness that
some patients feel 1-2 hours after taking immediate release preparations of T3 as well as the mid day
fatigue.
Nutritional Options and Supplements for Therapy
L-Tyrosine 500 mg twice daily on empty stomach.
Iodine – Kelp 2- 3 grams a day
Selenium 100 mcg per day
Nutritional deficiency in any of the above compounds is an increasingly unlikely cause for hypothyroidism
considering the average Western diet. The most likely deficiency that can contribute to the development of
hypothyroidism is selenium deficiency. Thus, although many practitioners recommend supplementing with
all these substances I only recommend selenium, which is only occasionally effective in altering T3
activation. Measuring selenium levels in serum is not readily available.