Monday, December 24, 2012

Hidden Hypothyroidism

Hypothyroidism is a deficiency in the ability of the body to maintain an optimal basal metabolic rate. It can be due to malfunctioning of the brain, pituitary gland, thyroid gland, enzyme systems that make thyroid hormone, thyroid receptors in cells, or the powerhouses where you make energy – mitochondria. However, a large number of people who exhibit symptoms of hypothyroidism have clinically acceptable TSH (thyroid-stimulating hormone) and T4 (levothyroxine) levels. Because of this, neither they nor their doctors pursue further diagnosis or treatment. Unfortunately, this means many people go years, or even a lifetime, without addressing an easily treatable condition. And, there are many ways to be hypothyroid with completely normal TSH and T4 levels.

Hypothyroidism on the Rise
A family of Belgian endocrinologists, the Hertoghes, and the late Broda Barnes MD in Austria and this country, have tracked the progression of hypothyroidism over the years, providing valuable data to physicians all over the world. Because of their work we now know that only 10-20 percent of the population was hypothyroid a century ago. Today, that figure is between 50 and 80%.

You might be wondering why there has been such a dramatic increase in this condition in such a relatively short amount of time. There are several reasons. Antibiotics, toxins, and lack of iodine and other nutritional deficiencies top the list.

An important reason is that modern medicine has allowed more hypothyroid people to survive. Because hypothyroidism weakens a person's immune system, many of the people who had it in the past died of infections early in life. Once antibiotics were introduced, people with thyroid conditions were better able to survive serious infections like pneumonia, despite their compromised immune systems.

Another problem that's contributed to an increase in hypothyroidism is exposure to toxins. The proliferation of toxic substances in our current environment has led to a predictable rise in thyroid dysfunction.

Toxins can disrupt thyroid functioning in a number of different ways. Toxins damage the thyroid gland, alter the metabolism of the thyroid hormones: triiodothyronine (T3) and thyroxine (T4), interrupt the binding of the thyroid hormones to cell receptors and damage the mitochondria in the cell.

Mitochondria are the powerhouses that allow cells to make energy and perform their specific vital functions. These powerhouses are also where you burn your last meal or burn fat when you fast or exercise. This is where your calories are converted into energy. So if you just ate a meal and your mitochondria aren't functioning optimally, you're not going to make energy and the calories are going to be put into storage. This condition will make you sluggish and cause you to gain weight, the two most common symptoms of hypothyroidism.

The toxins most likely to create thyroid problems include bromine, mercury, and numerous pesticides and industrial toxins. Bromine, for example, interferes with the use of iodine in the production of thyroid hormones. Unfortunately, bromine is widespread as an additive in bread (brominated wheat), medications containing bromine and soft drinks. Iodine, on the other hand, is not as extensively present in our diets and environment. Small amounts of iodine can be ingested through iodized salt, but the best way to get it is through supplements or kelp. However, if your exposure to bromine isn't reduced, it cancels out the positive effects of the iodine.

Pesticides including chlorinated pesticides like DDT, organophosphates, pyrethroids and many others have compromised thyroid activity in a variety of animals and some human studies.

Mercury displaces zinc and selenium which are needed to produce the most active form of thyroid hormones, T3, tri-iodothyronine. It also triggers an autoimmune reaction against the thyroid gland, slowly destroying it.  This is called Hashimoto’s thyroiditis. Other heavy metals including aluminum, lead and arsenic compromise thyroid function. As do industrial toxins like dioxins and PCB’s.

Iodine is the most important nutrient for thyroid function.  Iodine is necessary for the production of thyroid hormone.  Is also critically important for the immune system to function normally.  Lymph will not flow without adequate iodine.  Iodine is also important for breast health.  Women need more iodine than men because women have larger breasts than men.  This is partly why there are more women affected by hypothyroidism.

Iodine used to be used in the production of wheat flour.  This was abandoned in favor of bromine years ago.  We do not consume adequate amounts of iodine to support normal bodily functions in our diet.  Iodinated salt doesn't come close.  Kelp when used on a very consistent basis may be sufficient.  However with all of the bromine and other halides like fluoride and chlorine that interfere with thyroid function in the environment, its best to take a supplement of at least 12.5 mg of iodine/iodide daily. Other potential causes of hypothyroidism are infections, other nutrient deficiencies, imbalances of other hormones and foods:

  • Infections: The most common infection that can impact the thyroid is parvovirus. We generally only think of this infection as a canine virus, but humans can get it, too. In humans, parvovirus can damage the thyroid gland. There are other infections that injure cell thyroid receptors.
  • Other Nutrient Deficiencies: It can't be overstated how important nutrients are to thyroid functioning. For example, vitamin D is the Velcro that holds thyroid hormones to receptors, and vitamin A helps to relay information from thyroid hormone to the mitochondria. Both should be between 50 and 100 in blood. Other necessary nutrients for a healthy thyroid are selenium and zinc. Just think of it this way: Thyroid hormones are your cheerleaders. Nutrients are the body's football players. If you don't have enough of those players in the right places, you can't win the game.
  • Hormone Imbalances: Too much estrogen interferes with thyroid function. Estrogen must be balanced by progesterone even in women who have had hysterectomies to avoid hypothyroidism. Too much or too little cortisol, the stress hormone, also interferes with thyroid function.
  • Foods: Soy and cruciferous vegetables can both interfere with the incorporation of iodine into thyroid hormones. They can cause a functional deficiency of iodine. Supplementing with iodine reduces the impact of this. Gluten, dairy and other foods can trigger an autoimmune reaction against the thyroid. Just like mercury.

Under the Radar
Despite the growing number of people who suffer from hypothyroidism, very few are diagnosed with the disorder. This is because hypothyroidism, as we understand it today, isn't always clearly identified by standard blood tests. While conventional doctors rely on blood tests and consider the above causes “atypical” and uncommon cases, integrative physicians routinely diagnose these same patients with hypothyroidism. These increasingly common instances of hypothyroidism are now frequently referred to as Hypothyroidism Type 2, the name of a book published in 2005 by Dr. Mark Starr. Dr. Starr explains that the majority of hypothyroid disorders are due to thyroid resistance. The hormones are present but the cells don’t “see” the hormones. Just like diabetes type 2 or insulin resistance when there is an elevated amount of insulin and the cells are resistant to it. They can’t “see” it or be affected by it.

But just because this kind of thyroid dysfunction isn't necessarily identified by traditional tests doesn't mean it's undetectable. On the contrary, there are a number of ways to determine if hypothyroidism is present.

In addition to the customary TSH and total T4 tests, a full thyroid panel should be given to patients in whom hypothyroidism is suspected. The additional tests include free T3, free T4 and reverse T3 tests, as well as a thyroid peroxidase antibody test.

Of course, you can have perfectly normal thyroid hormones and still be hypothyroid. It's not just the hormones. If you don't have the right nutrients, your thyroid hormones may be perfectly normal, but they can't get the job done. So you can't just rely on thyroid hormones testing, you also have to evaluate vitamin A, vitamin D, selenium and zinc levels.

Paying Attention to the Signs
Of course, thyroid testing is typically initiated because hypothyroidism is already suspected. A doctor, or even a layperson, can usually deduce with some degree of accuracy whether someone is hypothyroid. That's because the disorder comes with a number of telltale symptoms and signs:
  • Weight gain or inability to lose weight
  •  Cold intolerance, especially in the hands and feet
  •  Constipation
  • Brittle, ridged nails
  • Very dry skin, especially rough elbows
  • Coarsening of hair or loss of hair
  •  Low heart rate
  • Elevated blood pressure
  • Elevated blood cholesterol
  • Heavy periods
  • Infertility
  • Weakened immune system
  • Chronic pain
  • Chronic fatigue

There is a characteristic fatigue pattern seen with hypothyroidism. The person has a very difficult time getting out of bed in the mornings, then has to keep moving throughout the day to keep his or her energy level up. This is why people who are hypothyroid don't take naps; once they wake up, they feel awful.  If a hypothyroid person rests, reads, watches TV or a movie they are more likely to fall asleep.  They have to get everything done before they stop.  Once they stop, they cannot get going again especially in the evening.

Recognizing the unique characteristics of hypothyroidism is important because, otherwise, a person can be treated for the wrong condition. For example, many women have undergone unnecessary hysterectomies to treat painful, heavy periods when, if their hypothyroidism had been detected, they could have treated the root cause of their problems and avoided invasive surgery.

Likewise, the money spent on fertility treatments is often wasted because of undetected hypothyroidism. If hypothyroidism is present in an infertile woman and she's treated properly for it, she can get pregnant within three to six months.

Another condition that often has an unexplored connection to hypothyroidism is fibromyalgia. Other types of chronic pain, such as headaches, joint pain and back pain can also indicate the disorder.  Chronic pain is a very common symptom of hypothyroidism.

Sometimes, however, hypothyroidism masks itself in universal symptoms like high blood pressure and high cholesterol. This can be problematic since standard therapies, such as beta-blockers and statins, can actually make a thyroid disorder worse.

Do-it-Yourself Thyroid Testing
If you're experiencing symptoms that make you suspect you have hypothyroidism, there are tests you can perform at home to confirm or dismiss your likelihood of having the disorder.

The best self-exam is the basal body temperature test discovered by Dr. Broda Barnes. You can perform this by taking your oral (mouth) or axillary (arm pit) temperatures first thing in the morning before getting out of bed. It must be taken at that time because the minute you get up and start moving your temperature will rise.

Although some physicians recommend the axillary method, it's perfectly fine to take your temperature orally as it is quicker. Once your temperature is taken, you should note what the reading is. If your thyroid functioning is normal, your basal body temperature will be 98 degrees, plus or minus 0.2 degrees. So, anywhere from 97.8 to 98.2 is considered normal. If you're hypothyroid, your temperature will read below 97.8.

To ensure your readings are accurate, take your temperature every morning for approximately five days in a row. Men, children and post-menopausal women can do this any time of the month. Ideally, women of childbearing age should conduct the test during the week of menstruation.

Basal body temperature testing can confirm hypothyroidism, but because it can also indicate low cortisol or sex hormone levels, you should have a doctor evaluate your findings.

Taking your temperature isn't the only way to determine whether or not you're hypothyroid. It's wise to do it in conjunction with a mirror test. The mirror test is very simple. It involves standing in front of a mirror and evaluating how your arms hang. As you stare into the mirror, just relax and look at your hands. Your palms should face your outer thighs. If they do, your thyroid function is probably normally. However, if your hands are naturally turned so that your thumb is aimed toward your thigh and your palm is facing backward, you may be hypothyroid.

Also, look at your face. Coarse features, loss of the lateral aspect of your eyebrows, bags beneath your eyes, a big tongue with scalloping, doughy pale dry skin, and overall puffiness are very suggestive of hypothyroidism.

Lastly, you can test for iodine sufficiency by applying tincture of iodine to the skin of your abdomen or forearm. It should still be present in 24 hours. If it has disappeared, you are deficient in iodine.  A second test can be done by measuring the amount of iodine in the urine. This is called an iodine loading test.

Treating the Thyroid
Because hypothyroidism is so under-identified, getting to a diagnosis is often the hard part. Treating the disorder, however, is fairly uncomplicated. The first step is to make sure the person is getting the nutrients (iodine, vitamin A, vitamin D, selenium and zinc) they need. And fish oil for healthier thyroid receptors.
This involves blood tests the fat soluble vitamins or blood or taste tests for the minerals. Iodine sufficiency can be easily tested by applying

The next step is to eliminate any problematic toxins. Don’t consume bromine-Mountain Dew and lemon lime Gatorade contain bromine. Check for brominated vegetable oil on the list of ingredients. This is used to keep citrus oils in suspension in these and similar drinks. Check your medications for bromine.

A provoked urine test for heavy metals followed by chelation therapy to remove them may be necessary. Dietary changes starting with the elimination of wheat and dairy may be critical if your TPO antibodies are elevated. A cleanse or detoxification program may be helpful.

The final critical treatment is thyroid hormone therapy. When done in combination, these treatments should return the entire thyroid system to normal functioning. 


Lily Daniali said...

great article. Vitamin D deficiency is prevalent and often under diagnosed. Additionally when you go into get your thyroid function tested, have them test you for anti thyroid antibodies. At times, a person may have normal free thyroid hormones but high levels of antibodies. This is highly suggestive of a subclinical hypothyroidism and ensuing autoimmune hypothyroidism.

Dr. Vaughan said...

Thank you for your knowledgeable response, Lily.