Are You Running on Empty?
Thyroid Deficiency Syndrome
By Gail Valentine, D.O.
eeling tired? Mentally dull? Depressed? Perhaps a little constipated? Are you cold when everyone else is warm or comfortable? Gaining weight? Losing your hair? Have dry skin? Brittle nails? Do your joints ache? Is your blood pressure too low? Slightly high cholesterol? Have you lost interest in sex?
Dr. Jonathan V. Wright and Dr. Gail Valentine
If any of this sounds like you, you may have thyroid deficiency syndrome.
Thyroid deficiency syndrome means that your thyroid gland, which sits like a bow tie around the front of your neck, just below the Adam's apple, is churning out less thyroid hormone than the body needs. Normally the thyroid combines two tyrosine molecules, each with two atoms of iodine to produce thyroxine, also known as T4 (so named because each molecule contains four iodine atoms.) When functioning properly the body converts T4 into T3, which is the major active thyroid hormone. Some T2 and T1 are also formed, although their precise function is not yet understood.1
The production and secretion of thyroxin are controlled by another hormone, thyrotropin, or TSH (thyroid stimulating hormone) which is synthesized by and released from the pituitary gland. TSH is secreted in a pulsatile manner with a circadian (daily rhythmic) pattern. As signals reach the pituitary that more thyroxin is needed throughout the body, the pituitary releases more TSH. When that TSH reaches the thyroid, the gland responds by stepping up its production and release of thyroxin. A negative feedback mechanism reduces TSH secretion as thyroxin levels rise.1
Although a little thyroid hormone normally goes a long way, the body's needs are extensive. The thyroid is a vital link in the endocrine system. Even a small decline in the output of thyroid hormone, if sustained over an extended period of time, can have profound consequences for health and longevity. With no thyroid hormone, we would die within a short time.
Thyroid hormone helps regulate virtually every cell in the body, including those in the brain, heart, liver, kidney, skin, and bone. Among its most important functions in our cells is to control the rate of metabolism, altering thermogenesis and oxygen consumption. If cellular metabolism drops too low, the result is widespread dysfunction that can manifest in a variety of ways, including depression; anxiety; cognition, learning, and/or memory impairment; loss of hair, hearing and muscle tone; weight gain; heart disease; hypoventilation; psychosis; and,in extreme cases, death.2,3
Thyroid deficiency syndrome most often affects women over 40, but men and teenagers can also have reduced thyroid function, especially if it runs in the family.4 According to some estimates, as many as 15 to 20% of women over age 60 may have subclinical hypothyroidism (meaning they would benefit from thyroid supplementation even though most conventional doctors would insist, based on standard laboratory test results, that they had no thyroid pathology requiring treatment). Each year, 5 to 15% of these women develop symptoms, some of which may contribute to shortening their lives.2,5,6
Some hypothyroidism, clinically diagnosed as thyroid deficiency syndrome, may be caused by a condition called Hashimoto's thyroiditis. This is an autoimmune disease in which the body's own immune defenses turn on the thyroid gland, causing an inflammatory process that can eventually destroy it.2 Immunosenesence, immune decline with aging, is associated with increased autoimmune reactions.7 This progressive destructive process is a major reason why thyroid function commonly declines with age. (Nine out of ten cases of Hashimoto's syndrome occur in women.)
Hashimoto's thyroiditis is commonly seen in people who have other autoimmune diseases, including insulin-dependent diabetes mellitus, pernicious anemia, or myasthenia gravis. It may also occur with greater frequency in people who are left-handed or who have prematurely gray hair.2
If you have several of these symptoms you may have
a thyroid deficiency: tiredness, fatigue, mental dullness,
depression, constipation, cold hands and feet, weight gain,
loss of hair, "aches and pains," low blood pressure,
high cholesterol, or loss of interest in sex.
Hypothyroidism can also be caused by certain drug treatments (e.g., alpha-interferon, used to treat hepatitis C) or destruction of thyroid tissue by radioactive iodine treatment or surgery for conditions such as Grave's disease or thyroid cancer.2 It can also have a genetic origin, in which case it may manifest shortly after birth.8
And, finally, there is simply the frequent slowdown in thyroid function that accompanies the general aging of the endocrine system. This is a problem often missed by conventional doctors.
Overt hypothyroidism is relatively simple to diagnose, if - and this is a big IF - you and/or your doctor look for it. Hashimoto's thyroiditis may cause the gland to enlarge or swell, something an alert physician should be able to feel, even in its early stages. The diagnosis can then be confirmed by performing a series of blood tests, especially measures of TSH and antithyroid antibody. Elevated TSH is an indication that the thyroid is putting out insufficient thyroxine to maintain normal functioning; ergo hypothyroidism.5
Thyroid hormone helps regulate virtually every cell in the body,
including those in the brain, heart, liver, kidney, skin, and bone.
Among its most important functions in these cells is to control
the rate of metabolism, altering thermogenesis
and oxygen consumption.
However, the diagnosis of age-related thyroid slowdown is more problematic, largely because primary care doctors are not generally trained to look for it.6 Or it may be because age-related functional decline of any sort is considered "normal," and thus not a medical problem. On this basis, doctors may dismiss signs of hypothyroidism, like fatigue, chilliness, muscle cramps, hair loss, dry skin, and constipation as "just" part of the aging process. As a result, the disease can and probably does go undiagnosed in a large number of patients.
THE BODY TEMPERATURE TEST
There is one simple thing almost anyone can do at home to uncover an underfunctional thyroid: take your own temperature. The "basal body temperature" test was developed by Broda O. Barnes, M.D., a physician who, for decades, helped raise the consciousness of both physicians and others regarding the risks and prevalence of hypothyroidism and weak thyroid function. His book, Hypothyroidism: The Unsuspected Illness, first published in 1976, remains as the best clinical description of the syndrome.9
Because thyroid hormone is so vital to cellular metabolism, reduced thyroid function often manifests as a drop in body temperature to below the normal level of 98.6oF. Barnes recommended the following procedure:*
- Shake down an oral glass thermometer before going to bed and leave it on the night table overnight. (Actually, it is better to shake just before using it.)
- Immediately upon awakening, and with as little movement as possible, place the thermometer firmly in your armpit next to the skin. (It is more accurate when placed on mucous membranes such as under the tongue or in the rectum.)
- Leave it there for 10 minutes.
- Record the readings on three consecutive days.
*Menstruating women should measure their temperature only on the 1st, 2nd, 3rd, or 4th day of menses. Women taking progesterone should not take the hormone on the day before or on the days they take their basal temperature. Men, prepubertal girls, and postmenopausal or nonmenstruating women can take the test on any day.
If the average temperature over the three days is less than 97.8oF, then, according to Dr. Barnes, you may have hypothyroidism. Even if you have had a blood test and were told you did not have a low thyroid reading, you might go back and look at the test results again. You may find that your blood levels of thyroid hormones are actually low normal. Many people who are within the so-called "normal" range but below the midpoint could benefit enormously from thyroid supplementation.
According to some estimates, as many as 15 to 20% of women
over age 60 may have subclinical, or asymptomatic hypothyroidism.
Each year, 5 to 15% of these women develop
symptoms, some of which may
contribute to shortening their lives.
THYROID REPLACEMENT THERAPY
Proper thyroid function may require supplying the body with thyroid hormone or whole thyroid extract. In clinical use, it is common practice to use the TSH level as a gauge when titrating the proper dose of thyroid supplementation. As thyroid hormone levels rise in the body, TSH levels should fall (negative feedback loop). The dose of thyroid hormone required to return TSH to the "normal" range is one of the major considerations in dealing with thyroid underfunction. As we have pointed out, because thyroid function changes with age, it is helpful to monitor TSH levels periodically to assure that the quantity of thyroid supplement being taken remains at appropriately youthful levels.
Another major controversy in the treatment of hypothyroidism concerns the use of natural glandular concentrates or extracts containing thyroid hormone (e.g., Armour Desiccated Thyroid Hormone, Nathroid, Westhroid, and other brands derived from the thyroid gland of the pig) vs. synthetic (laboratory-made) thyroid hormone (e.g., Synthroid, Levothroid, levothyroxin, etc.). Not surprisingly, most conventional physicians prefer the synthetic product, which is widely promoted by pharmaceutical companies. (Synthroid is the third leading drug sold in the U.S.) Whether it is superior is open to serious question, however.
Armour Thyroid and other natural thyroid preparations contain natural thyroid hormone. Although these preparations have been criticized by some for being "impure" or "inconsistent" from dose to dose, it should be noted that Armour Thyroid and most natural thyroid preparations are made to standards approved by the United States Pharmacopeia (USP), which helps assure that its potency is accurately stated on the label.
They contain T4, T3, T2, T1, and most closely resemble natural human thyroid hormone. At the proper dose, natural thyroid hormone works quite well and are preferred by nearly all "natural" or "alternative" physicians. Synthetics, on the other hand, consist solely of T4. They depend on the body to convert the T4 to T3 and the other metabolites. This may be fine for some people, but, for those whose thyroid underfunction is caused not by a reduction in T4 production but by a defect in the conversion of T4 to T3, giving T4 may not help much.
A third option is likely to be the best of all for those who wish to help prevent age-related decline. This option is a new glandular formulation developed by Jonathan V. Wright, M.D., one of the leading practitioners of alternative medicine in the U.S. He offers a unique combination of glandular extracts, including those from glandular thyroid (1/4 grain), adrenal, hypothalamus, pituitary, and testicular (for males) or ovarian (females) tissue.**
** Most ingredients have been derived from New Zealand livestock, a source long recognized as safe and disease-free.
According to a classic study conducted by Dr. John Isaacs,
a pioneering cardiovascular surgeon from Baltimore,
people who took 1/2 grain of thyroid over a period of
10 years showed significant improvement
in cardiovascular function.
According to a classic study conducted in 1974 by Dr. James Isaacs, a pioneering cardiovascular surgeon from Baltimore, people who took 1/2 grain of thyroid along with vitamins and minerals over a period of 10 years showed significant improvement in cardiovascular function. Dr. Wright recommends oral thyroid supplementation for people over age 40 who have no overt endocrine disease. He points out that, even if one is not experiencing symptoms, all endocrine glands are beginning to slow down at this stage of life. The most common comment from people taking 1/4 grain of natural thyroid, according to Wright, is, "I just feel a little more energetic overall. My thinking seems a little clearer, and my bowel function is a little better."
Even if someone is already taking thyroid supplementation, most can still take a thyroid supplement to get the benefits of the other glandular extracts, says Dr. Wright. "Unless you are in very brittle condition - and brittle means to an endocrinologist that the amount you take has to be exactly right on - you might consider the use of my thyroid supplement, as part of your anti-aging program because, while it adds only 1/4 grain of the actual thyroid glandular itself, it also nourishes the rest of the endocrine network."
- Farwell A, Braverman L. Thyroid and anti-thyroid drugs. In: Hardman J, Limbird L, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th ed. New York: McGraw-Hill; 1996.
- Anonymous. A delicate balance. Harvard Health Letter. 1994;19:3-6.
- Smith C, Ain K. Brain metabolism in hypothyroidism studied with 31P magnetic-resonance spectroscopy. The Lancet. 1995;345:619-620.
- Saunders C. When the thyroid gland isn't working right. Current Health. 1996;22:30-31.
- Anonymous. Thyroid guidelines: use newer TSH tests for early, accurate diagnosis. Geriatrics. 1995;50:14-15.
- Kelley B. Running on empty. Health. 1997;11:64-69.
- Wick G, Grubeck-Loebenstein B. The aging immune system: primary and secondary alterations of immune reactivity in the elderly. Exp Gerontol. 1997;32:401-413.
- Weetman A. Hypothyroidism: screening and subclinical disease. Br Med J. 1997;314:1175-1179.
- Barnes B, Galton L. Hypothyroidism: The Unsuspected Illness. New York: Harper & Row; 1976.
- Food and Drug Administration. Prescription drug products: levothyroxine sodium. Federal Register. August 14, 1997;62:43535-43538.
- Isaacs JP, Lamb JC. Trace metals, vitamins, and hormones in ten-year treatment of coronary atherosclerosis heart disease. Delivered at the Texas Heart Institute Symposium on Coronary Medicine and Surgery, Houston, Texas on February 21, 1974. LC call No.:RC685.C6.I588.