|NOTE: Thyroid replacement must be taken on an absolutely empty stomach. Even a little bit of food, milk or what not will bind it and render the medication ineffective.
NOTE #2: Body teemperature fluctuates with daily biorhythms. It also tends to change seasonally. That is, as mammals, we tend to lower core body temperature during cold-weather months to conserve nutrients. This is particularly the case with women, who teliologically, are conserving nutrients for a fetus that is to be delivered in the Spring. During the Winter months, it is a great deal harder to keep weight off as a result, and it is very difficult to titrate medications upward to increase temperatures to the more normal ranges. dsk
Hypothyroidism is perhaps one of the most underdiagnosed of all medical conditions. Perhaps the sadddest fact of all is that those individuals fortunate enough to have been properly identified as being hypothyroid is the inadequate or unenlightened manner in which they are treated.
The thyroid is a 'butterfly'-shaped gland situated superficially in the neck, immediately anterior to the trachea, or windpipe. The role of the thyroid gland is to produce thyroid hormone, which is actually a mixture of hormones. The principal thyroid hormones are levothyroxine (T4) and L-triiodothyronine (T3).
Thyroid hormone is made from the amino acid tyrosine and molecular iodine. The "3" and the "4" refer to the number of iodine molecules in each thyroid hormone molecule. The function of thyroid hormone involves the regulation of the overall rate of metabolism, or basal metabolic rate. Thyroid hormone is important in other ways, as well, and the presence of the proper balance of thyroid hormone is essential to overall health.
More than 10 million Americans have been diagnosed with thyroid disease, and another 13 million people are estimated to have undiagnosed thyroid problems. A dysfunctional thyroid can affect almost every aspect of health.It is one of the most under-diagnosed hormonal imbalances of aging. You have a higher risk of developing thyroid disease if you:
A study from BMC Psychiatry evaluated the association between mood and anxiety disorders and thyroid autoimmunity. A statistically significant result with anti-thyroid peroxidase auto-antibodies was found. The results demonstrated that individuals with thyroid autoimmunity may be at high risk for mood and anxiety disorders. (1)
Another study found high prevalence of brain perfusion abnormalities in thyroiditis. This may suggest a higher than expected involvement of the central nervous system in thyroid autoimmune disease (2). Another study reported on central nervous system demyelination as a complication of autoimmune thyroid disease. (3).
Symptoms of Low Thyroid
T3 is the more biologically active hormone. T4 must be converted to T3 before it is biologically active. This conversion from T-4 to T-3 is not always quite so straight forward. That is, one of the body's mechanism for controlling the metabolic rate of individual organs relative to others involves the conversion of T-4 to 'reverse T-3' (r-T-3) which is biolobically inactive.
Administration of T-4 under these circumstances can actually make the symptoms of hypothyroidism worse, because the pharmacologically administered T-4 (Synthroid, l-thyroxine) are converted by the body into the inactive r-T-3. The result is that the blood studies performed for the patient show 'improved function,' and the patient experiences worsened symptoms. It is for this reason that many patients do poorly with the administration of straight T-4 in the form of medications such as Synthroid(r). Levothyroxine products such as Synthroid® contain a synthetic version of only the T4 hormone; levothyroxine tablets directly replenish the T4 that the thyroid gland fails to sufficiently produce and rely on the ability of the blood to convert it to T3.
Armour™ Thyroid is a natural, porcine-derived thyroid replacement containing both T4 and T3. In this way, it supplements both the T4 and the T3.
NOTE: the principal physical finding most suggestive of hypothyroidism is low body temperature.
Body temperature varies as the day goes on. It is at the low point around 4:00 am, and the expected temperature at that time is aroun 97.6 F. Temperature increases from that point, reaching the low 98's by 9:00 am, and should reach 99.6 F by 4:00 pm. Appropriate temperature is only 'appropriate' relative to the time of day in which it is taken.
Further, there is no such thing as a 'normally' low temperature. If a person has observed that their temperature is 'always low,' or that it takes a massive infection before they run a fever, the likelihood of hypothyroidism being present increases substantially.
The medical community is all too often reluctant to use Armour Thyroid, which in my opinion (dsk), is the best of the available thyroid medications. The standard conversion or relative potency of the currently available thyroid medications is posted, below:
The basic "rule of thumb" in converting thyroid doses is that 100 mcg of T4 is roughly equivalent to 25 mcg of T3, or 1 grain (60 mg) of desiccated thyroid (Armour™ Thyroid), or liotrix-1 (Thyrolar™).
One common criticism of the use of Armour Thyroid comes from the misconception that the pharmaceutical is 'not regulated' by the FDA. This is absolute nonsense. The potency of Armour Thyroid is ensured by the same analytical procedures as is used by all manufactured pharmaceuticals.
Armour™ Thyroid is a 'natural product,' made from desiccated (dried) pork thyroid glands. Becausse the amount of thyroid hormone may vary from animal to animal, the manufaccturer assays the lots to ensure that Armour™ Thyroid tablets are consistently potent from tablet to tablet and lot to lot. These analytical tests are performed on the thyroid powder (raw material) and on the actual tablets (finished product) to measure actual T4 and T3 activity.
Different lots of thyroid powder are mixed together and analyzed to achieve the desired ratio of T4 to T3 in each lot of tablets. This method ensures that each strength of Armour™ Thyroid will be consistent with the United States Pharmacopoeia (USP) official standards and specifications for desiccated thyroid lot-to-lot consistency. The ratio of T4 to T3 equals 4.22:1 (4.22 parts of T4 to one part of T3). Armour™ Thyroid meets established federal health standards for thyroid tablets. Armour™ Thyroid Tablets, USP contain the labeled amounts of levothyroxine and liothyronine, as established by the United States Pharmacopeia (USP). To meet quality standards it must also pass bacteriological testing and must meet other product quality tests.
NOTE: Thyroid medications of all types should be taken on an empty stomach. Even a small amount of lactose (present in milk, cream, some cheese) can substantially inhibit absorbption.
Articles of Interest
Divi RL, Chang HC, Doerge DR: Anti-thyroid isoflavones from soybean: isolation, characterization, and mechanisms of action. Biochem Pharmacol Nov 15 54:10 1087-96, 1997.
The soybean has been implicated in diet-induced goiter by many studies. The extensive consumption of soy products in infant formulas and in vegetarian diets makes it essential to define the goitrogenic potential.
In this report, it was observed that an acidic methanolic extract of soybeans contains compounds that inhibit thyroid peroxidase- (TPO) catalyzed reactions essential to thyroid hormone synthesis. Analysis of the soybean extract using HPLC, UV-VIS spectrophotometry, and LC-MS led to identification of the isoflavones genistein and daidzein as major components by direct comparison with authentic standard reference isoflavones.
NOTE: Thyroid peroxidase antibody, sometimes referred to as TPO or TPA is not a 'normal' consitiuent of blood. When it is positive, it is associated with active hyperthyroidism (autoimmune) or burned out Hashimoto's Thyroiditis. This is of greatest concern when resting temperatures are lower than the expected 98-99 degree range.
The incidence of TPO in the general population is as high as 30%, and because of the high prevelenace of this abnormal anti-body, it is not necessarily considered 'abnormal.' That is the way statistics operates. Basically, because more than 5% of the population is sick, it is 'normal' to be sick.
Saraiva PP, Figueiredo NB, Padovani CR, et al: Profile of thyroid hormones in breast cancer patients. Braz J Med Biol Res. 2005 May;38(5):761-5.
Estrogen involvement in breast cancer has been established; however, the association between breast cancer and thyroid diseases is controversial. Estrogen-like effects of thyroid hormone on breast cancer cell growth in culture have been reported. The objective of the present study was to determine the profile of thyroid hormones in breast cancer patients. Serum aliquots from 26 patients with breast cancer ranging in age from 30 to 85 years and age-matched normal controls (N = 22) were analyzed for free triiodothyronine (T3F), free thyroxine (T4F), thyroid-stimulating hormone (TSH), antiperoxidase antibody (TPO), and estradiol (E2). Estrogen receptor ss (ERss) was determined in tumor tissues by immunohistochemistry. Thyroid disease incidence was higher in patients than in controls (58 vs 18%, P < 0.05). Subclinical hyperthyroidism was the most frequent disorder in patients (31%); hypothyroidism (8%) and positive anti-TPO antibodies (19%) were also found. Subclinical hypothyroidism was the only dysfunction (18%) found in controls. Hyperthyroidism was associated with postmenopausal patients, as shown by significantly higher mean T3 and T4 values and lower TSH levels in this group of breast cancer patients than in controls. The majority of positive ERss tumors were clustered in the postmenopausal patients and all cases presenting subclinical hyperthyroidism in this subgroup concomitantly exhibited Erss-positive tumors. Subclinical hyperthyroidism was present in only one of 6 premenopausal patients. We show here that postmenopausal breast cancer patients have a significantly increased thyroid hormone/E2 ratio (P < 0.05), suggesting a possible tumor growth-promoting effect caused by this misbalance.
Rattarasarn C, Diosdado MA, Ortego J, et al: Thyroid autoantibodies in Thai type 1 diabetic patients: clinical significance and their relationship with glutamic acid decarboxylase antibodies.Diabetes Res Clin Pract. Aug;49(2-3):107-11,.2000.
OBJECTIVE: To study the clinical significance of thyroid autoantibodies in Thai patients with type 1 diabetes and their relationship with glutamic acid decarboxylase antibodies (GAD(65)Ab).
Jiskra J, Limanova Z, Barkmanova J, et al: Autoimmune thyroid diseases in women with breast cancer and colorectal cancer. Physiol Res 53(6):693-702, 2004.
The aim of the study was to compare the prevalence of autoimmune thyroid diseases in three groups of women (66 with breast cancer (CaB), 68 with colorectal cancer (CaC) and 49 without oncological diseases as a control group). Serum levels of thyroid-stimulating hormone (TSH), free thyroxin (fT4), antibodies to thyroglobulin (TGB-ab) and thyroperoxidase (TPO-ab) and tumor markers CEA, CA 15-3 and CA 19-9 were investigated in all subjects by using the chemiluminiscence method. In contrast to Graves' disease (no observed case), autoimmune thyroiditis was diagnosed in 24.2 % women with CaB (4.5 % euthyroid and 19.7 % with subclinical or overt hypothyroidism), compared to 16.7 % in women with CaC (2.0 % euthyroid and 14.7 % with subclinical or overt hypothyroidism) and 16.2 % controls (4.0 % euthyroid and 12.2 % with subclinical or overt hypothyroidism). Serum levels of TGB-ab were higher in the group with breast cancer as compared to those with colorectal cancer and the control group (medians: 35.80 vs. 31.75 vs. 27.70, p<0.001). Similarly, the percentage of positive TGB-ab and TPO-ab serum levels was higher in women with breast cancer as compared to those with colorectal cancer and the control group. The results of the study support the controversial theory that there is an increased prevalence of autoimmune thyroiditis in women with breast cancer.
Smyth PP, Shering SG, Kilbane MT, et al: Serum thyroid peroxidase autoantibodies, thyroid volume, and outcome in breast carcinoma. J Clin Endocrinol Metab. Aug 83(8):2711-6, 1998.
The prevalence of thyroid peroxidase autoantibodies (TPO.Ab) was assessed in patients with either breast carcinoma or benign breast disease, and its association with disease outcome in breast carcinoma was studied. TPO.Ab were detected by direct RIA in serum from 121/356 (34.0%) of patients with breast carcinoma, compared with 36/194 (18.5%) of controls (P < 0.001); and in 31/108 (28.7%) with benign breast disease, compared with 12/88 (13.6%) of controls (P < 0.05). Survival analysis in a group of 142 women with breast carcinoma demonstrated that TPO.Ab titres > or = 0.3 U/mL were associated with a significantly better disease-free [relative risk (RR) = 1.84, P < 0.05] and overall survival (RR = 3.46, P < 0.02), compared with those who were TPO.Ab-negative. Better outcome associated with higher TPO.Ab titres was confined to those who had thyroid volumes within the intermediate range (10.1-18.8 mL) and did not further enhance the good outcome recorded when volumes were < or = 10.0 mL or > 18.8 mL. Multivariate survival analysis showed that both TPO.Ab and thyroid volume were independently associated with prognosis in breast carcinoma and that RRs for disease-free survival were of a similar order of magnitude to well-established prognostic indices such as axillary nodal status or tumor size. These findings supply evidence that manifestations of thyroid autoimmunity are associated with a beneficial effect on disease outcome in breast carcinoma and provide the strongest evidence to date of a biological link between breast carcinoma and thyroid disease.
Woenckhaus U and Girlich C: Therapy and prevention of hyperthyroidism. Internist (Berl). Oct 18, 2005.
A decreased serum TSH level can be observed in more than 10% of the German population. Although treatment is not mandatory in each of these cases patients with an unrecognized autonomous thyroid dysfunction have a substantial risk of developing thyrotoxicosis when exposed to large amounts of iodine. Thionamid drugs in combination with potassium perchlorate are given for preventive and therapeutic reasons until definitive thyroidectomy or radioiodine therapy is performed. In younger patients Graves' disease is the main cause of hyperthyroidism. Medical treatment with antithyroid drugs is established to render patients euthyroid. Having decreased the dose as far as possible, drug therapy is continued for 12-18 months to achieve a maximum rate of permanent remission. Ongoing clinical research aims to characterize clinical or laboratory predictors associated with a high risk of relapse after medication is stopped. Selenium supplementation is proposed to be a new therapeutic approach for autoimmune thyroid disease. It is already used quite liberally although data of powerful randomized trials are not available.
Kohrle J, Jakob F, t al: Selenium, the Thyroid, and the Endocrine System. Endocr Rev. Sep 20, 2005.
Recent identification of new selenocysteine-containing proteins has revealed relationships between the two trace elements selenium and iodine and the hormone network. Several selenoproteins participate in the protection of thyrocytes from damage by H2O2 produced for thyroid hormone biosynthesis. Iodothyronine deiodinases are selenoproteins contributing to systemic or local thyroid hormone homeostasis. The selenium content in endocrine tissues (thyroid, adrenals, pituitary, testes, ovary) is higher than in many other organs. Nutritional selenium depletion results in retention while selenium repletion is followed by a rapid accumulation of selenium in endocrine tissues, reproductive organs and the brain. Selenproteins such as thioredoxin reductases constitute the link between the selenium metabolism and the regulation of transcription by redox sensitive ligand-modulated nuclear hormone receptors. Hormones and growth factors regulate the expression of selenoproteins and, conversely, selenium supply modulates hormone actions. Selenoproteins are involved in bone metabolism as well as functions of the endocrine pancreas and adrenal glands. Furthermore, spermatogenesis depends on adequate selenium supply, whereas selenium excess may impair ovarian function. Comparative analysis of the genomes of several life forms reveals that higher mammals contain a limited number of identical genes encoding newly detected selenocysteine-containing proteins.
Kohrle J. Selenium and the control of thyroid hormone metabolism.Thyroid. Aug;15(8):841-53, 2005.
Thyroid hormone synthesis, metabolism and action require adequate availability of the essential trace elements iodine and selenium, which affect homeostasis of thyroid hormone-dependent metabolic pathways. The three selenocysteine-containing iodothyronine deiodinases constitute a novel gene family. Selenium is retained and deiodinase expression is maintained at almost normal levels in the thyroid gland, the brain and several other endocrine tissues during selenium deficiency, thus guaranteeing adequate local and systemic levels of the active thyroid hormone T(3). Due to their low tissue concentrations and their mRNA SECIS elements deiodinases rank high in the cellular and tissue-specific hierarchy of selenium distribution among various selenoproteins. While systemic selenium status and expression of abundant selenoproteins (glutathione peroxidase or selenoprotein P) is already impaired in patients with cancer, disturbed gastrointestinal resorption, unbalanced nutrition or patients requiring intensive care treatment, selenium-dependent deiodinase function might still be adequate. However, disease-associated alterations in proinflammatory cytokines, growth factors, hormones and pharmaceuticals modulate deiodinase isoenzyme expression independent from altered selenium status and might thus pretend causal relationships between systemic selenium status and altered thyroid hormone metabolism. Limited or inadequate supply of both trace elements, iodine and selenium, leads to complex rearrangements of thyroid hormone metabolism enabling adaptation to unfavorable conditions.
Beckett GJ, Arthur JR. Selenium and endocrine systems. Endocrinol. Mar;184(3):455-65, 2005.
The trace element selenium (Se) is capable of exerting multiple actions on endocrine systems by modifying the expression of at least 30 selenoproteins, many of which have clearly defined functions. Well-characterized selenoenzymes are the families of glutathione peroxidases (GPXs), thioredoxin reductases (TRs) and iodothyronine deiodinases (Ds). These selenoenzymes are capable of modifying cell function by acting as antioxidants and modifying redox status and thyroid hormone metabolism. Se is also involved in cell growth, apoptosis and modifying the action of cell signalling systems and transcription factors. During thyroid hormone synthesis GPX1, GPX3 and TR1 are up-regulated, providing the thyrocytes with considerable protection from peroxidative damage. Thyroidal D1 in rats and both D1 and D2 in humans are also up-regulated to increase the production of bioactive 3,5,3'-tri-iodothyronine (T3). In the basal state, GPX3 is secreted into the follicular lumen where it may down-regulate thyroid hormone synthesis by decreasing hydrogen peroxide concentrations. The deiodinases are present in most tissues and provide a mechanism whereby individual tissues may control their exposure to T3. Se is also able to modify the immune response in patients with autoimmune thyroiditis. Low sperm production and poor sperm quality are consistent features of Se-deficient animals. The pivotal link between Se, sperm quality and male fertility is GPX4 since the enzyme is essential to allow the production of the correct architecture of the midpiece of spermatozoa. Se also has insulin-mimetic properties, an effect that is probably brought about by stimulating the tyrosine kinases involved in the insulin signalling cascade. Furthermore, in the diabetic rat, Se not only restores glycaemic control but it also prevents or alleviates the adverse effects that diabetes has on cardiac, renal and platelet function.
Perros P, Singh RK, Ludlam CA, Frier BM. Prevalence of pernicious anaemia in patients with Type 1 diabetes mellitus and autoimmune thyroid disease. <span title="Diabetic medicine : a journal of the British Diabetic Associat
David S. Klein, MD, FACA, FACPM, FACMIMS
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