Thyroid Replacement Therapy
Slowing of the Heart
Hyperactivity of Childhood
Susceptibility to Infections
Disturbed Menstrual Flow
High Blood Pressure
Dosage and Administration
Broda Barnes and Denis Wilson
The thyroid gland is an endocrine gland, meaning that it secretes its hormones directly into the blood stream. It is shaped like a butterfly and located under the skin just below the larynx (Adam’s apple). In the normal state it is not visible but can be palpated, felt, by the experienced examiner.
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, when too much T3 and/or T4 are produced, and hypothyroidism when too little T3 and/or T4 are produced.
Hyperthyroidism is treated with radioactive iodine, which is taken up by the thyroid gland. It destroys, in a dose-dependent fashion, a portion of the cells of the gland. The other treatment of hyperthyroidism is surgical removal of part or all of the gland. In either case, there is subsequent administration of thyroid replacement to fix the hypothyroid condition caused by the radioactive or surgical destruction of the gland. Hyperthyroidism gained national prominence when not only Barbara Bush, but then her husband, the president and the first dog all came down with this condition in the space of thirteen months.
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. What you need to know about allopathic doctors is that they attend the Church of the Holy Lab Test on a regular basis. 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 new messiah, 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.
The T3 and T4 tests pick up eighty percent of cases of hypothyroidism, which leaves twenty percent of patients out of luck. That is, out of luck until Dr. Broda O. Barnes, who spent his entire adult life doing thyroid gland research and working with people with thyroid dysfunction, developed a simple but highly accurate test called the "basal temperature test." Take a mercury thermometer to bed with you when you retire for the night, shake it down and leave it at your bedside. When you wake up in the morning, place it in your armpit, and hold it snugly for ten minutes. Then read it. A temperature above 98.2 Fahrenheit indicates hyperthyroidism and a temperature below 97.8 indi
cates hypothyroidism. This test is more accurate than any of the expensive tests mentioned above, much to the displeasure of the lab test industry.
A man can take this test on any given morning as can any woman before menarche or after menopause. However, a woman in her childbearing years, unless pregnant, should take the test on the second and third day of her cycle. Otherwise, there are other effects on body temperature which influence the outcome. Three readings are necessary to determine if you can benefit from thyroid replacement therapy.
Other conditions can lower body temperature. Starvation will do it. Cachexia, the wasting away associated with some chronic illnesses, also will lower body temperature. So will hypoadrenalism. However, with these exceptions, the basal temperature is a reliable indicator of thyroid dysfunction. Because it is free and easy to administer, I suggest you test yourself periodically — whether or not you have noticed symptoms.
Ah symptoms! There is the rub. Few doctors would miss a case of classic hypothyroidism. The pictures of cretinism in children and myxedema in adults seem to wear a large name tag reading "hypothyroidism." Nevertheless, most cases of hypothyroidism are not so severe that these unmistakable pictures are produced. Let us look at the symptoms commonly seen.
Fatigue leads the list. A person feeling just plain dog-tired despite adequate rest should be considered hypothyroid until proven otherwise by the basal temperature test. 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.
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.
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.
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.
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.
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.
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.
During childhood, hyperactivity and a short attention span are typical of hypothyroidism. These children often are treated with Ritalin, an amphetamine-like drug, or amphetamines themselves. Apparently, this solves the problem of fatigue for the child and allows for better concentration and less hyperactivity. The more appropriate treatment, of course, would be thyroid replacement. ,Milder hypothyroidism can allow growth to be normal and even produce extreme height due to a delayed closing of the epiphyses where bone elongation takes place during growth. Tall hypothyroid patients are not rare.
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.
The advent of antibiotics saved the lives of many hypothyroid people beginning in the 1920s. Many of these people would have died from infections except for antibiotics. It can be hypothesized that many of these people lived to reproduce and have children who also are hypothyroid. This may be why we are seeing so much clinical hypothyroidism, up to forty percent of the population by Dr. Barnes’ estimation. Whatever the reason, Dr. Barnes figures that the incidence of hypothyroidism has increased from twenty to forty percent since the dawn of the age of antibiotics. My guess is that it has a lot more to do with the inhibition of iodine by chlorine, fluorine, and bromine levels present in our water supply.
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 thyr
oid 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.
Anyone with a skin disease should at least have a basal temperature test and, if found to be below 97.8, thyroid should be prescribed. This may help the skin disease, and even if it doesn’t the patient will have been done a service. Regarding the skin disease, it may take up to six months to get results, so do not become prematurely discouraged if the problem doesn’t respond immediately.
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.
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.
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.
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."
Thyroid hormone comes as an extract of whole thyroid tissue in pill form. In children under six, we begin with 1/4 grain thyroid extract daily. From age six to thirteen, the beginning dose is 1/2 grain daily. Above thirteen, the proper beginning dose is one grain daily. In each case, the beginning dose is maintained for two months. Results are not immediate and require two months for full expression. If the basal temperature is not in the normal range at the end of two months, we increase the dosages by the same amount as the initial dose: small children, 1/2 grain; larger children, one grain; teenagers and adults, two grains.
We then follow the same procedure using the basal temperature as our guide. Rarely are higher doses necessary but when they are, we use the same procedure. It is important to use the lowest dose which gets the job done, because this preserves what thyroid production is naturally present, as well as the pituitary gland’s role in fine tuning the production of this endogenous thyroid hormone. Treatment should not be rushed. Loading up on large doses of thyroid extract in the beginning of therapy accomplishes nothing except to make the patient ill. Time is required for the body to adjust to this therapy.
While it is possible to buy T3 (Synthyroid) and T4 (Thyroxin) separately I believe it is best to use the whole extract, which contains T3, T4 and di-iodo-tyrosine. This is the way nature designed thyroid, and I am not one to second-guess nature.
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.
It has long been noted among doctors that there are many people out there with classic symptoms of hypothyroidism who, when tested, have normal levels of thyroid hormones. Historically speaking Broda Barnes was the man with the courage to codify the treatment of these people in the face of a medical establishment enthralled with lab tests and conformity to treatment standards which let these people hang out to dry with no treatment available. While Dr. Barnes showed great courage, nevertheless he still was unaware of the real causes of hypometabolism and therefore his treatment did not get to the root cause of the problems he saw. To read more on the root causes of these problems, go to Mercury, Gut Wall Infection, and Fatigue.