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Dr. Kennedy, hypothyroidism and thyroid replacement therapy, thyroidby Ron Kennedy, M.D.(For an appointment with Dr. Kennedy in
Santa Rosa, CA, write to nexus@sonic.net)

Hypothyroidism and Thyroid

Replacement Therapy

E-mail, hypothyroidism and thyroid replacement therapy, thyroid

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Hypothyroidism
Fatigue
Anemia
Slowing of the Heart
Toxic Buildup
Delayed Healing
Headache
Emotional Disorders
Susceptibility to Infections
Skin Diseases
Disturbed Menstrual Flow
Infertility
High Blood Pressure
Premature Presbyopia
Arthritis
Final Recommendation

The thyroid gland puts out two hormones known as "T3," or "tri-iodo-thyronine" and "T4," also known as "thyroxin." These two hormones together regulate the rate at which the cells of the body use oxygen; that is to say they regulate the metabolic rate. Metabolism produces heat, and so T3 and T4 also regulate body temperature. A third hormone is produced, di-iodo-tyrosine, which may potentiate T3 and/or T4.

Two abnormal conditions are possible with thyroid function, namely hyperthyroidism (also called Graves' disease), when too much T3 and/or T4 are produced, and hypothyroidism when too little T3 and/or T4 are produced.

Hypothyroidism

First, let me say that hypothyroidism is an uncommon and overdiagnosed cause of hypometabolism. The major cause of hypometabolic states in modern man is the dental profession which wantonly installs tons of mercury in the teeth of living human beings every day. You can read on that here: Mercury Toxicity, Gut Wall Infection, and Fatigue. Nevertheless, since this article is about true hypothyroidism, let us proceed with that subject.

Hypothyroidism was first described in 1873 in England, and the English have continued to break new ground in the discovery of further aspects and treatments of thyroid dysfunction since that time. From the turn of the century until 1940, doctors treated hypothyroidism based on symptomatology and clinical acumen, sometimes aided with a basal metabolic rate test, which most doctors recognized as flawed.

In 1940, the PBI or protein bound iodine test was developed. Beginning in 1940, patients who did not have an abnormal PBI were not given thyroid replacement therapy, even if they had symptoms of hypothyroidism and had already been benefiting from thyroid replacement before the appearance of the PBI. These people were cut off from the therapy they needed because of blind faith in the PBI lab test. The PBI, or protein bound iodine test, after 27 years as the Holy Grail of thyroid disease diagnosis, was shown to be relatively useless in 1967.

Because hypothyroidism is the more common condition, we will focus on it here. Because both T3 and T4 contain iodine, iodine deficiency can account for hypothyroidism. In such a case, iodine replacement may completely handle the problem. More commonly there is either a failure to produce enough thyroid hormone or there is some defect in the body's use of thyroid hormone. The final effect of thyroid hormone occurs inside each cell, and this is a place we have no way to measure T3 and T4 levels. Therefore, blood tests for T3 and T4 often are not useful in evaluating the presence or absence of thyroid dysfunction.

If there is a deficiency of thyroid hormone, it can be caused by either a failure of the pituitary gland to produce sufficient TSH (thyroid stimulating hormone), or a primary failure of the thyroid gland itself. TSH is the hormone which affects only the thyroid gland and commands it to produce T3 and T4. Regardless of whether the failure is in the thyroid gland or the pituitary gland, the result is the same (hypothyroidism), and the treatment is the same: replacement of thyroid hormone.

Deficiency of thyroid hormone is called "goiter" when the cause is insufficient dietary iodine, and it is called "myxedema" when there is a primary failure of either the pituitary or the thyroid itself. In goiter, the thyroid gland is typically hypertrophied, or overgrown and is easily palpated and seen on examination. By contrast, in myxedema the thyroid gland appears normal. Myxedema means literally "mucus swelling," so-called because the swelling of tissues is produced by the presence inside the cells of excess quantities of mucus, also called "mucopolysaccharide" in polite scientific circles, or "snot" by my kids. Whereas ordinary edema is caused by the presence of excess water between the cells and can be "pitted" by applying pressure with, for example, your finger, myxedematous edema is caused by mucus inside the cells which cannot be squeezed out and therefore cannot be pitted. Myxedematous edema therefore also is called "non-pitting edema."

The big problem in thyroid disease is making the diagnosis. For many years the basal metabolic rate was used as the index to make or refute a diagnosis. However, it soon became apparent that finding the true basal metabolic rate was near impossible, because almost any disturbance, physical or mental, would raise the metabolic rate. The only accurate BMR is that taken immediately upon awakening before the patient has aroused from bed. That requires the person doing the testing to be present when the person wakes up in the morning, a rather impractical requirement.

For many years, the PBI, or protein bound iodine, was the test most commonly used — but it proved to be quite inaccurate. Then T4 and T3 tests became available, but these tests only measure circulating levels of these hormones and say nothing about the amounts of T3 and T4 available to the cells. Therefore, these tests are not completely reliable in making a diagnosis.

Fatigue

Fatigue leads the list. A person feeling just plain dog-tired despite adequate rest should be considered hypothyroid until proven otherwise. Fatigue affects a person in diverse ways. It makes some people tense, irritable: grouchy for no apparent reason. It causes others to withdraw, and still others become depressed. Some individuals expend what energy they have on their favorite activity and, after that, are just too knocked out to participate in anything, including normal conversation.

Anemia

People with hypothyroidism become anemic because of hypothermia. Most red blood cells are made in the bone marrow located in the proximal portion of the long bones of the body, because that is where temperature is highest. However, when body temperature drops, even these areas have difficulty producing red blood cells, even in the presence of sufficient iron and vitamins. On examination, the red blood cells are found to be normal in size, shape and hemoglobin concentration. There simply are not enough of them. Anemia contributes to fatigue.

Slowing of the Heart

In addition, the heart slows down and delivers up to forty percent less blood. This results in less oxygen being delivered to the tissues and contributes further to fatigue. Normal activities feel like going to war.

Toxic Buildup

When metabolism slows down, the rate at which waste products are broken down and eliminated also slows down resulting in a buildup of toxic products. This accounts for most of the symptoms of hypothyroidism discussed here.

Delayed Healing

The body is in a constant state of repair. The act of living and moving about carries with it the inevitable small cuts, scratches, bumps, bruises, etc. The body is designed to heal these minor wounds so quickly and efficiently that you hardly notice their presence. When metabolism slows down in hypothyroidism (or for any other cause), wound healing also slows down. You become aware of these minor wounds, because they sit there for several days longer than they should. Delayed wound healing, regardless of the age of the person, should make you think of hypothyroidism and a basal temperature test should be done.

Headache

It may be that brain swelling is part of this edema, and this may explain why hypothyroidism is so commonly present in people complaining of migraine and tension headaches. Many conditions can cause headache, but hypothyroidism should be at the top of the list when evaluating chronic headaches — especially those which happen when fatigue is pronounced.

Emotional Disorders

Any and every emotional disorder can be brought on or simulated by thyroid dysfunction. Hypothyroidism slows the thought process, produces depression and sometimes hallucinations, delusions and even paranoia. Slowness of thought and activity is a hallmark of this disease. When present and untreated from early childhood, the final outcome of severe hypothyroidism is idiocy, growth failure and early death in the late teens or early twenties. In adulthood, a change in personality or depression, fatigue, uncharacteristic irritability or a change in sleep pattern should raise a suspicion of thyroid dysfunction.

Susceptibility to Infections

It only makes sense that if the metabolic rate is slowed, the response to bacterial or viral invasion also will be slowed. So it is no surprise to find out that the person with hypothyroidism is unusually susceptible to infection.

In the age of antibiotics, we do not think of infections with the same fear which gripped the heart of a person in the middle ages, or even earlier in this century. Dr. Broda O. Barnes, a doctor and researcher with a lifetime of experience, reports that the hypothyroid patient, often so susceptible to repeated infections, when given thyroid replacement therapy suddenly stops coming down with infections. He reports that this is effective against both bacteria and viruses. There is an association with the now popular, in-the-public-eye, "yeast syndrome." Hypothyroidism should be looked for in any patient who has the yeast syndrome for he/she may have the more fundamental disorder of hypothyroidism, which lowers resistance to yeast as to all infectious agents.

Skin Diseases

The most common skin finding in hypothyroidism is dry, flaky skin. However, skin disease of almost any kind should raise suspicion of hypothyroidism. Circulation to the skin is decreased, as it is to the rest of the body, and also the production of mucopolysaccharides is increased dramatically in the skin. These two factors together predispose the patient to acne, impetigo, erysipelas, cellulitis, eczema, psoriasis and ichthyosis (fish scale skin). Often these conditions are relieved with thyroid extract. The same is true for the syndrome of "winter itch," in which the skin below the elbows and knees itches severely during the winter. Even some cases of lupus involving the skin clear up with thyroid extract, and when they clear up, the disease does not progress to systemic involvement of the internal organs.

Disturbed Menstrual Flow

Another common symptom of hypothyroidism is dysfunction of the female cycle. In children, the onset of menses may be delayed or, paradoxically, it may come years early with hypothyroidism. At the other end, menopause may happen much too early or much too late. During childbearing years the menstrual cycle may be upset in just about any pattern imaginable. The most common condition is that of irregular bleeding. The lining of the uterus, the endometrium, just like other tissues in the body, requires thyroid hormone for proper growth and function.

Infertility

Hypothyroidism is a common cause of infertility in women and incompetent sperm in men. Many childless couples have the misfortune to be hypothyroid (one or both partners) and yet not have an abnormal lab value (T3 or T4 test) to convince the doctor to prescribe thyroid replacement therapy.

High Blood Pressure

Hypertension is another disorder associated with hypothyroidism (as well as with hyperthyroidism). If hypertension is present, along with a lower than normal basal temperature, the hypertension will almost always come down with thyroid replacement therapy alone. When this type of hypertension is treated with anti-hypertensive medications alone — without thyroid replacement — the blood pressure does not come down, and the doctor brands this patient as having "refractive hypertension." That term only means that the hypertension is refractive (resistant) to the treatment which the doctor knows to prescribe.

Premature Presbyopia

Some people, between the ages of 35 and 55, when they receive thyroid replacement therapy, will experience the return of the ability to focus for reading without the necessity of wearing reading glasses. Based on this observation, I assert that one of the symptoms of thyroid deficiency is the premature loss of the ability to focus for reading. The technical term for this condition is "presbyopia," literally "old seeing."

Arthritis

Hypothyroidism predisposes a person to arthritis, and thyroid replacement therapy often brings arthritic symptoms under control. Where gouty arthritis is concerned, thyroid replacement also helps here. Gout is caused by an inability to metabolize uric acid and the accumulation of uric acid, notably in the drainage system of the kidneys (as stones) and in the joints, especially the big toe. If the basal temperature (and thus the basal metabolic rate) is low, naturally the body is even less able to metabolize uric acid. Although thyroid replacement is not specific to gout, it is a valuable adjunct to the treatment of this painful disease.

Final Recommendation

Everyone should take a periodic check of his or her basal temperature. It is easy and free, and the information gained, if acted on, may make a world of difference. To repeat, simply get a mercury thermometer, shake it down, and lay it by your bedside. When you awake in the morning, before you get up, place it in your armpit and keep it snugly there for ten minutes. Then take the reading and record it.
The information in this article is not meant to be medical advice.
Treatment for a medical condition should come at the recommendation of your personal physician.

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