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continued from previous page... The use of thyroid hormone supplementation is an extremely controversial topic. Even deciding which lab tests to use as a means to determine whether or not to begin supplementation, as well as how to monitor your dosage, is hotly debated. No physician would disagree with providing thyroid supplementation to a patient, who has multiple symptoms of low thyroid function combined with abnormal lab tests. However, the majority of debate centers around whether it is useful, as well as healthful, to offer thyroid supplementation to patients who have some of the symptoms of low thyroid but whose lab tests are still within the normal range. I will try to guide you through this complex topic by first describing the most common symptoms of low thyroid followed by information on the correct lab tests to check. In Part Two (see April’s E-newsletter), I will describe the different types of currently available thyroid supplements, as well as how to best utilize them in your healing program. Please understand that since this is a newsletter forum, the discussion of this topic must remain somewhat general. However, I will do my best to provide you with as much information as possible. It is then up to you and your physician to decide if thyroid supplementation is right for your medical needs. Symptoms of Low Thyroid It is important to realize that the majority of low thyroid symptoms can be reproduced by many other conditions. Just because a person feels tired and fatigued by no means indicates that thyroid supplementation is necessary. In fact, treating fatigue with thyroid supplementation alone can be a huge mistake; if the energy it provides in the short term masks the true underlying reason for the fatigue…which then goes untreated. Conditions that have similar symptoms to low thyroid include but are not limited to: diabetes, low adrenal function, depression, Chronic Fatigue Syndrome, and heavy metal toxicity to name but a few. Again, treating fatigue with a thyroid supplement alone can be a huge mistake if the true reason for the fatigue is not addressed. The most commonly experienced symptoms of low thyroid function include: fatigue, lethargy, foggy thinking, depression, cold intolerance, constipation, painful menstruation, dry skin, thinning hair, and weight gain. Since many people have one or more of the above symptoms, it is important not to jump to the conclusion that your thyroid output is low. A careful and thorough medical history, combined with a physical exam as well as appropriate lab testing, must be used to arrive at the correct diagnosis. Lab Testing The most obvious indication of significantly low thyroid hormone output is an elevation of serum TSH (thyroid stimulating hormone). This hormone is released by the hypothalamus at the base of the brain and is responsible for stimulating the thyroid gland to produce a higher output of thyroid hormone (T4) to the body. If the TSH level is abnormally high, there is a clear deficiency of thyroid hormone and supplementation is warranted. Two other useful thyroid function tests are the free T4 and free T3. These can be measured as either total or “free” levels. Testing the “free” T4 and “free” T3 levels are more useful since what is not available as “free” hormone is bound to large protein molecules in the blood and generally unavailable for use by the body. While there are many opinions on how to interpret the free T4 and T3 tests, I will tell you what has worked extremely well in my practice over the years. It is similar to my philosophy with evaluating other hormone levels that are important for providing energy and immune support to the body. As I mentioned in my previous two E-newsletters, there is a BIG difference between the “normal range” for hormones as reported by most laboratories and the “optimal range for energy and immune system support”. I define optimal hormonal range as the upper half of the laboratory’s stated normal range. Therefore, if you add the upper and lower limit of the lab’s normal range together and divide by two, you will get the midpoint of the range. The optimal range is between this midpoint and the upper limit of normal. When monitoring thyroid hormone levels, especially if you are symptomatic and could benefit from greater energy and enhanced immune function, the preferred level for your free T3 and free T4 hormones is in the upper half of the lab’s stated normal range. If you achieve levels in this range, you will feel your best and have the highest level of immune function. In Part Two of this report on thyroid function, I will review the available thyroid supplements and the most common way I advise my patients on how to initiate treatment and monitor their dosage. Finally, I would like to make the important point that supplementing thyroid hormone without first supporting your adrenal function (DHEA, testosterone, vitamins, herbs, and adequate rest) can be detrimental to your long term health. That is why hormone balancing should be left to physicians with a lot of experience in this area. Thyroid Supplementation Once a decision has been made to begin thyroid supplementation based on a careful medical history and a thorough physical exam, the next important decision is what formulation to begin using. There are essentially three schools of thought. The first group believes that supplementation should be taken in the form of a “natural” product such as that found in Armour thyroid. This formulation is produced by collecting porcine (pig) thyroid glands after the animal’s slaughter, dehydrating the whole gland, and encapsulating the powder in a measured amount which is then prescribed to patients. The hypothesis behind prescribing thyroid hormone in this fashion is that the patient receives both kinds of thyroid hormones (T3 and T4) as well as a number of currently unrecognized “essential factors”. My personal belief regarding this method of thyroid supplementation is that you are getting imprecise amounts of animal thyroid hormones plus other animal proteins with poorly documented effects that may end up having both positive and negative effects. Also, the hormones in this thyroid preparation are not of human origin. Therefore, I do not prescribe this type of supplementation very often. A second school of thought is to use the thyroid preparation known as T3. A commonly prescribed brand name for this hormone preparation is Cytomel. Cytomel can be obtained at standard or compounding pharmacies. T3 is the form of thyroid hormone most commonly found in the body’s tissues after its conversion from T4 (the thyroid hormone released directly by the thyroid gland itself). While T3 can often be effective at ameliorating the symptoms of low thyroid output, it has an extremely short lifetime in the bloodstream and must be taken at least twice a day unless prescribed in a time release formulation. In my opinion, the time release formulations of T3 have not been adequately standardized nor compared to the tried and true method of prescribing thyroid hormone, that of taking the exact hormone released from the human thyroid gland itself…T4. T4 is produced by several pharmaceutical companies under the brand names Levothroid, Levoxyl, and Synthroid. Though produced in a laboratory, the final product is absolutely identical to the hormone your own thyroid gland produces. The dosage is standardized to increments of 12.5 micrograms (mcg). Therefore the dosage can be fine tuned in very small increments to meet a patient’s needs. One important thing to know about this kind of thyroid supplement, is that the only pill strength without any added artificial colors, binders, lubricants, or lactose is the 50 mcg strength. The main reason certain patients occasionally report unusual reactions to these brands of thyroid hormone is that they were prescribed a dosage other than 50 mcg and reacted to the additives, not to the hormone itself. Therefore, my preferred method for prescribing thyroid hormone is to begin with one tablet of 50 mcg strength T4 (using one of the above-mentioned brands) to be taken for 3- 5 days followed by an increase of an additional 1/2 tablet every week until a total dosage of somewhere 100-150 mcg (2-3 tablets) is reached. If at any point during this ramp up period symptoms of agitation, nervousness, sweating, palpitations, insomnia, aggressive behavior, and/or anxiety occur, the dosage should then be returned to the previously well-tolerated level. Sometimes, one day of skipping a dose may be necessary to quickly ameliorate any of the above symptoms. The exact ramp up instructions are carefully individualized for each patient. The taking of thyroid hormone must be supervised by a physician. Caution should be exercised in prescribing thyroid supplementation to patients with heart disease, angina, palpitations, hypertension, anxiety, bipolar disorder, irregular heartbeat, migraine headaches, and/or a history of stroke. Update on Thyroid Hormone and the Immune System In a recent answer that I posted on the “Ask Dr. Kaiser” section of my website, I stated that hypothyroidism was not more common in people with HIV infection. One of my readers politely pointed out that this statement was not true. He then directed me toward a recent study which showed an association between HIV infection and hypothyroidism. A French study ran between May and December 2001, and included a cohort of 350 patients. Thyroid function was assessed by measuring levels of thyroid-stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3). The French investigators concluded that HIV-infected individuals treated with D4T-containing HAART regimens, or with low CD4 cell counts (less than 200 cells/mm3), were at increased risk of developing hypothyroidism. Their results were published in the August 2003 edition of Clinical Infectious Diseases.
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