ThyroidDeficiencyStrikesOneinSix

Hypothyroidismisthemostcommonofallthehormonediseases,yetmostpeoplewhohaveitareunaware.Thetestfor
thisdeficiencyissimpleandalmostpainless,andthetreatmentiseffective,safe,andinexpensive.Leftunattended,a
subtlemalfunctioncouldmeanheartdiseaseandanearlierdeath.Withonlyaslightdecreaseinthyroidhormoneactivity
therearenosymptomshowever,becausethisglandaffectsthefunctionofalmosteverytissueinthebody,severe
deficiencycancausecomawithmultisystemfailure.
Hypothyroidismcanbetheresultofiodinedeficiency,medications,surgery,and
radiation,butthemostcommoncauseinWesternpopulationsisapersonsown
immunesystemattackinghisownthyroidgland.Theinflammatoryprocessisknownas
autoimmunethyroiditis(alsocalledHashimotosthyroiditisafterthedoctorwhofirst
describedtheconditionin1912).Theresults:515%ofthegeneralpopulation,andas
manyas20%ofwomen,middleagedandolder,haveanoticeablelossofthyroid
function.Thecauseisconsideredtobeunknown,butaswithotherautoimmune
diseases(type1diabetes,rheumatoidarthritis,multiplesclerosis,etc.),therich
Westerndietisthelikelysource.(Theimmunesystemistrickedbyanimalproteins
thatpeopleconsumetoattacktheirpancreas,joints,brain,thyroidandothertissuesby
aprocessknownasmolecularmimicry.)
DiagnosisbyaSimpleBloodTest
Hypothyroidismmaybesuspectedwhenpeoplecomplainoffatigue,weightgain,
depression,slowmentalprocessing,muscleweakness,constipation,and/orfeelingcold.However,thesearesymptoms
commonlyseenwithotherconditions,includinggenerallypoorhealth.Becausethepresentationissononspecific,anyone
whodoesnotfeelwellshouldautomaticallyhavetheirthyroidstatuschecked.
Hypothyroidismisdiagnosedbymeasuringahormoneproducedbythepituitarygland,calledthyroidstimulatinghormone
(TSH).Asthenameimplies,thishormonestimulatesthethyroidtosynthesizemorehormonesandwhenthethyroidgland
failstorespondasdirected,thenmorestimulatinghormoneisreleasedinanattempttocorrectthedeficiency.Thusan
elevationofTSHmeanshypothyroidism.NormalTSHlevelsaregenerallyconsideredbetween0.4and4.0mU/L.Some
authoritiesrecommendloweringtheupperlimitsofnormalto2.5mU/L,becauselevelshigherthanthiscouldmeanmore
heartdisease.1a
Beforecommittingsomeonetoalifetimeofthyroidreplacementtherapy(pills),theTSHlevelshouldberepeatedafterall,
thelaboratoryinstrumentscouldhavebeenincorrectlycalibratedthatdayoryourspecimencouldhavebeenmixedupwith
someoneelses.
TreatmentofHypothyroidism
Formostotherwisehealthyadultswithhypothyroidism,theinitialdoseofthyroidreplacementshouldbeanamount
equivalentto0.125mgdailyoflevothyroxine.Lowerstartingdosesmaybenecessaryforpeoplewithseverecoronaryartery
disease.TSHlevelsshouldbemonitoredevery4to6weeksandappropriateadjustmentsindosemadebasedonresults.
Usingtheresultsfrombloodtests,ItrytokeeptheTSHlevelsofmypatientsbetween0.5and2.0mU/L.1aOncethe
correctdoseisdetermined,thentheTSHlevelshouldbecheckedannually,unlessthepatientshealthsuggestsotherwise.
Eventhoughtreatmentmayseemsimple,aboutonefifthofpatientsreceivetoolittleandonefifthreceivetoomuch
replacementwiththyroidmedication.
CommonSupplements
(Costof90pillswithapotencyequalto0.125mglevothyroxine)
ArmourThyroidisanextractmadefromdriedpigthyroidglands($21.99)
Thyrolarissyntheticproductcombiningtriiodothyronine(T3)andlevothyroxine(T4)($64.99)
Synthroidisthemostpopularbrandofsyntheticlevothyroxine(82%ofthemarket)($39.97)

Levoxylisagenericbrandofsyntheticlevothyroxine($27.97)
Levothroidisagenericbrandofsyntheticlevothyroxine(26.97)
Unithroidisagenericbrandofsyntheticlevothyroxine($24.99)
Cytomelissynthetictriiodothyronine(rarelyusedalonetotreathypothyroidism)
GenericbrandsoflevothyroxineandSynthroidallworkequallywell.1
ShouldMildHypothyroidismBeTreated?
Mostdoctorsbelievethatslightdecreasesinthyroidhormoneproduction,seenbyanincreaseinTSHlevelintotherangeof
2.5mU/Lto10mU/L,shouldbeleftuntreated.2However,Iholdaminorityopiniononthisissueandoftenrecommend
treatmentfortheselaboratoryresultsforseveralreasons.ManypeoplewithamildelevationofTSHgoontodevelop
definitehypothyroidismearlysupplementationwillpreventthemfrombecomingclinicallyhypothyroid,ifandwhentheir
conditionprogresses.Treatmentofmilddeficiencyhasbeenshowntorelievetroublesomesymptoms,likefatigueand
muscledysfunction,andimprovementalperformance.3,4
However,themostimportantreasonthatItreatmildelevationsofTSHistoreducetheriskoffuturecoronaryartery(heart)
disease.PeoplewithelevatedTSHlevelshavehighercholesterollevelsandtreatmentwiththyroidhormonesupplements
willlowertheirtotalandLDLcholesterollevels.3,4ThiselevationofcholesterolassociatedwithaslightlyhigherTSHlevel
translatesintoanincreasedriskofheartdiseaseduetoblockedcoronaryarteries.5Treatmenthasbeenfoundtoreduce
thickeningsinthewallsofthearteriesaconditionassociatedwithahigherriskofheartattacksandstrokes.6Mild
hypothyroidismisassociatedwithanincreasedriskofcongestiveheartfailureamongolderadults.7Finally,theoverallrisk
ofdeathmaybeincreasedbyamilddecreaseinthyroidactivityasreflectedinaslightelevationofTSH.5
Islevothyroxinealonesufficienttreatment?
Ithasbeenclaimedthatpatientswithhypothyroidismshowgreaterimprovementsinmoodandbrainfunctioniftheyreceive
treatmentwithArmourthyroidratherthanSynthroid(levothyroxine).8Thisconclusionisbasedona1999studypublishedin
theNewEnglandJournalofMedicinethatactuallytestedasyntheticmixtureoflevothyroxine(T4)andtriiodothyronine(T3),
ratherthepigderivedArmourpreparation.9Thestudyshowedsomeofthemeasuresformentalperformance,moodand
physicalstatuswereimprovedinpeopletakingthecombinationofbothformsofthyroidhormone,ratherthanthesingle
hormone,levothyroxine.Sucharevelationcausedquiteastirinthemedicalcommunitybecausedoctorsaretraditionally
taughtthatusinglevothyroxinealoneisthebestwaytotreathypothyroidism.
Inresponse,severalstudieswereperformedtotrytoverifythesefindings.ContrarytotheNewEnglandJournalofMedicine
study,eachofthenewerstudiesfailedtofindanimprovementinmoodormentalperformancewiththecombinationover
singlehormonetherapy.1a,1015Onestudyreportedahigherriskofoverdosingpatientscausinghyperthyroidism
accompaniedbyfeelingsofimpairedwellbeingduetothefastactingT3mixedinwiththepreparation.11Consideringallof
theresearchtodate,levothyroxine(thesinglehormone)aloneshouldremainthetreatmentofchoiceforreplacementtherapy
ofhypothyroidism.14(Thereissomepharmaceuticalindustrymoneyfundingthisconclusion,soasalways,Ireservemy
righttochangemyopinionondrugtherapy.)
SomeofthereasonsforcautionarebecauseofitsquickonsetandshortdurationofactionT3cancauserapidandirregular
heartbeatsandbedifficulttomonitor.AlloftheT3werequireisnaturallyproducedinourbodyfromT4thetissuesslowly
andsafelymakeametabolicconversionofsomeoftheT4toT3.
AnimalExtractsMayNotBeSafe
ManypatientsIseeexpressadesirefornaturaltherapies.Therefore,itshouldbenosurprisetohearthattheywantto
avoidtakingsyntheticthyroid(levothyroxine)andinsteadrequestanaturalpreparation,liketheArmourbrand.Extracts
madefromtheglandsofanimalscontainseveralformsofthethyroidmolecule,includingT3andT4andsomedoctors
considerthisanadvantage,whilemostresearchdoesnotsupportthisviewpoint.
Theoriginaltreatmentofhypothyroidismdevelopedbackin1891wasmadefromextractsfromthethyroidglandsofsheep.
Sincethenthedesiccatedglandsofotheranimals,includingcowsandpigs,havebeenused.Theprocessofmakingthis
medicationbeginswithremovingtheanimalsthyroidgland,thendryingit,andfinallygrindingitintoapowder.Becauseof
variationsinconcentrationsofactivehormonesintheanimalsglandulartissuesthepotencyofthepreparationscanvary
greatlypeoplehavedevelopedserioussideeffectsfromnaturalthyroidproductsthatcontainedgreaterthanexpected
amountsofT3.Becauseoftheforeignanimaltissuesusednaturalthyroidsupplementscanalsocauseallergictype
reactions,especiallyinpeopleknowntobeallergictoanimalproteins.
Onepotentialproblemthathasreceivednoseriousinvestigationistheriskofcontractinginfectionfromconsumingglandular
tissuesinpillform.Muchworkhasbeendoneshowinganimalbornemicrobescanbespreadtopeoplebyeatinganimalsas
food16,17andthereiseveryreasontobelievethesamecanoccurwhendriedanimaltissuessoldasmedicationsare

consumed.Cancer,includingleukemia,virusesandAIDSlikevirusesarecommonlyfoundincowsandpigs.18,19These
virusesareknowntoinfectpeople.20Couldthesesupplementsbeanunintendedmediaforthespreadofprionbasedbrain
diseases,likemadcowdisease?Therearemanyreasonstobelievethatthisisarealrisk.21,22
ThedeadlyH5N1strainofbirdfluhasrecentlybeenfoundinpigpopulations.23Historymayberepeatingitself.Thedeadly
humaninfluenzavirusof1918thatkilledmorethan20millionpeopleworldwidewasamutationofaswinefluvirusthat
evolvedfromAmericanpigsandwasspreadaroundtheworldbyUStroops.24
Sincetherehasbeenessentiallynoeffortbythelivestockindustryinmost(butnotall)countriestocleanuptheiranimals,
hundredsofdifferentkindsofinfectiousmicrobesarebeingconsumedbybillionsofpeople.Therefore,toprotectyourself
andfamilythereiseverygoodreasontonoteattheseanimalsandtheirbyproducts,includingglandularextracts,like
naturalthyroidextract.(FormoreinformationseemyFebruary2004newsletterarticle:WidespreadInfectionwithLeukemia
VirusfromMeatandMilk.)
OverdosingBySelfmedicatingandtheNaturalDoctor
InmypracticeIoftenseepatientswhoaretakinganoverdoseofthyroidmedication.Theymaybeselfmedicatinginhopes
offeelingmoreenergeticorlosingweighteffortlessly.Anotherrealpossibilityistheirdoctor,oftenreferredtoasalternative,
holistic,and/orcomplementary,prescribesasupraphysiologicdosetotreatvariousailments,suchaschronicfatigue
syndromeorarthritis.
Inactualpractice,peoplealmostneverrequiremorethan0.2mgoflevothyroxine(equaltoabout2grainsofthyroidextract).
Inadditiontofailingtoresolvehealthandweightproblems,toomuchthyroidcanresultinbonelossandheart
arrhythmias.25,26
AChangeinDietWillNotCorrectHypothyroidism
OncethethyroidtissueisdestroyeditwillnotregrowandIknowofnowaytostimulatetheremainingglandtoworkharder.
Manypeopleaskifavoidingcruciferousvegetablefoodsortakingextraiodinewillcuretheirthyroidcondition.Compounds
inplantfoods,likecabbage,cauliflower,Brusselssprouts,milletandsoyhaveantithyroideffects.Thesefoodsarereferred
toasgoitrogenicfoodsbecausetheoreticallytheycanleadtoaconditionoflowthyroidwithanassociatedgland
enlargement,calledagoiter.Supplementationwithiodinecompletelyreversesthegoitrogenicinfluenceofanyvegetables.
(Incidentally,thesesamefoodshavecompoundsthatprotectagainstthyroidcancer.27)
Thereisnoharmintryingtoimproveyourthyroidfunctionbyavoidingcruciferousvegetables,soyandmillet,and/oradding
moreiodine(likefromseavegetables)toyourdiet,butmyexperiencehasbeenthatthiseffortwillmakenodifference.Let
meknowifyoufindotherwise.
Simple,Safe,EffectiveMedicalCare
Partoftheroutineevaluationofallofmypatientsisacheckoftheirthyroidstatus.IftheirTSHlevelsareabove3mU/L
(aftertwoseparatetests),thenIconsiderrecommendingsupplementationwithlevothyroxine.Ileanmoretowardstreatment
thehighertheTSHlevel(themoreseverethehypothyroidism).Also,iftheyhaveahigherriskforheartdisease,thenIam
moreinclinedtorecommendtreatment.
EventhoughIhavenotfoundthebenefitstobegreat,Iamsometimespersuadedtotreatwhenweightlossorfatigueisthe
patientsconcern,andtheyalsohaveaslightlyabnormalTSHlevel.Othertimes,whenthedecisiontotreataslightly
abnormalTSHlevelsisnotstraightforward,Imaysuggestasixmonthtrialonthyroidandlookforsubjective(feelingsof
wellbeing)andobjective(lowercholesterol)improvements.
ThyroidsupplementationisoneoftheveryfewtreatmentsIcommonlyprescribe.(SeemyNovember2004newsletterfora
morecompletelistofMcDougallusedmedications.)Formypatientswithadamagedthyroidgland,correcting
hypothyroidismwiththerightamountoflevothyroxinecanbeaninexpensivemedicalmiraclewithoutsideeffects.
References:
1a:SpencerCA.DemersLM.LMPG:LaboratorySupportfortheDiagnosisandMonitoringofThyroidDisease(Published
Guidelines):http://www.nacb.org/lmpg/thyroid/3c_thyroid.doc
1)DongBJ,HauckWW,GambertoglioJG,GeeL,WhiteJR,BubpJL,GreenspanFS.Bioequivalenceofgenericand
brandnamelevothyroxineproductsinthetreatmentofhypothyroidism.JAMA.1997Apr16277(15):120513.
2)CrapoLM.Subclinicalhypothyroidismandcardiovasculardisease.ArchInternMed.2005Nov28165(21):24512.
3)RobertsCG,LadensonPW.Hypothyroidism.Lancet.2004Mar6363(9411):793803.
4)AyalaAR,WartofskyL.Thecaseformoreaggressivescreeningandtreatmentofmildthyroidfailure.CleveClinJMed.
2002Apr69(4):31320.
5)ImaizumiM,AkahoshiM,IchimaruS,NakashimaE,HidaA,SodaM,UsaT,AshizawaK,YokoyamaN,MaedaR,

NagatakiS,EguchiK.Riskforischemicheartdiseaseandallcausemortalityinsubclinicalhypothyroidism.JClin
EndocrinolMetab.2004Jul89(7):336570.
6)MonzaniF,CaraccioN,KozakowaM,DardanoA,VittoneF,VirdisA,TaddeiS,PalomboC,FerranniniE.Effectof
levothyroxinereplacementonlipidprofileandintimamediathicknessinsubclinicalhypothyroidism:adoubleblind,placebo
controlledstudy.JClinEndocrinolMetab.2004May89(5):2099106.
7)RodondiN,NewmanAB,VittinghoffE,deRekeneireN,SatterfieldS,HarrisTB,BauerDC.Subclinicalhypothyroidism
andtheriskofheartfailure,othercardiovascularevents,anddeath.ArchInternMed.2005Nov28165(21):24606.
8)UseArmourthyroidratherthanSynthroid:http://www.mercola.com/1999/archive/armour_thyroid.htm
9)BuneviciusR,KazanaviciusG,ZalinkeviciusR,PrangeAJJr.Effectsofthyroxineascomparedwiththyroxineplus
triiodothyronineinpatientswithhypothyroidism.NEnglJMed.1999Feb11340(6):4249.
10)EscobarMorrealeHF,BotellaCarreteroJI,GomezBuenoM,GalanJM,BarriosV,SanchoJ.Thyroidhormone
replacementtherapyinprimaryhypothyroidism:arandomizedtrialcomparingLthyroxineplusliothyroninewithLthyroxine
alone.AnnInternMed.2005Mar15142(6):41224.(Mercksponsored).
11)SiegmundW,SpiekerK,WeikeAI,GiessmannT,ModessC,DabersT,KirschG,SangerE,EngelG,HammAO,
NauckM,MengW.Replacementtherapywithlevothyroxineplustriiodothyronine(bioavailablemolarratio14:1)isnot
superiortothyroxinealonetoimprovewellbeingandcognitiveperformanceinhypothyroidism.ClinEndocrinol(Oxf).2004
Jun60(6):7507.(Nosponsorlisted)
12)ClydePW,HarariAE,GetkaEJ,ShakirKM.Combinedlevothyroxineplusliothyroninecomparedwithlevothyroxine
aloneinprimaryhypothyroidism:arandomizedcontrolledtrial.JAMA.2003Dec10290(22):29528.(Sponsor,NationalNaval
MedicalCenter)
13)SawkaAM,GersteinHC,MarriottMJ,MacQueenGM,JoffeRT.Doesacombinationregimenofthyroxine(T4)and
3,5,3'triiodothyronineimprovedepressivesymptomsbetterthanT4aloneinpatientswithhypothyroidism?Resultsofa
doubleblind,randomized,controlledtrial.JClinEndocrinolMetab.2003Oct88(10):45515.(SponsoredbyAventis)
14)EscobarMorrealeHF,BotellaCarreteroJI,EscobardelReyF,MorrealedeEscobarG.REVIEW:Treatmentof
hypothyroidismwithcombinationsoflevothyroxineplusliothyronine.JClinEndocrinolMetab.2005Aug90(8):494654
(SponsoredbyUniversityGrants)
15)WalshJP,ShielsL,LimEM,BhagatCI,WardLC,StuckeyBG,DhaliwalSS,ChewGT,BhagatMC,CussonsAJ.
Combinedthyroxine/liothyroninetreatmentdoesnotimprovewellbeing,qualityoflife,orcognitivefunctioncomparedto
thyroxinealone:arandomizedcontrolledtrialinpatientswithprimaryhypothyroidism.JClinEndocrinolMetab.2003
Oct88(10):454350.(SponsoredbySirCharlesGairdnerHospitalResearchFoundation)
16)zurHausenH.Proliferationinducingvirusesinnonpermissivesystemsaspossiblecausesofhumancancers.Lancet.
2001Feb3357(9253):3814.
17)TalbotSJ,CrawfordDH.Virusesandtumoursanupdate.EurJCancer.2004Sep40(13):19982005.
18)BurnyA,CleuterY,KettmannR,MammerickxM,MarbaixG,PortetelleD,vandenBroekeA,WillemsL,ThomasR.
Bovineleukaemia:factsandhypothesesderivedfromthestudyofaninfectiouscancer.VetMicrobiol.1988Jul17(3):197
218.
19)RandalJ.Xenograftsraisequestionsaboutcancervirustransfertohumans.JNatlCancerInst.1998Feb1890(4):264
5.
20)BuehringGC,PhilpottSM,ChoiKY.HumanshaveantibodiesreactivewithBovineleukemiavirus.AIDSResHum
Retroviruses.2003Dec19(12):110513.
21)CastillaJ,GutierrezAdanA,BrunA,DoyleD,PintadoB,RamirezMA,SalgueroFJ,ParraB,SegundoFD,Sanchez
VizcainoJM,RogersM,TorresJM.Subclinicalbovinespongiformencephalopathyinfectionintransgenicmiceexpressing
porcineprionprotein.JNeurosci.2004May2624(21):50639.
22)BradleyR.TheresearchprogrammeontransmissiblespongiformencephalopathiesinBritainwithspecialreferenceto
bovinespongiformencephalopathy.DevBiolStand.199380:15770.
23)Birdfluinpigs:http://news.bbc.co.uk/1/hi/world/asiapacific/3601798.stm
24)Pigscarried1918flu:http://www.lubbockonline.com/news/032197/1918flu.htm
25)QuanML,PasiekaJL,RorstadO.Bonemineraldensityinwelldifferentiatedthyroidcancerpatientstreatedwith
suppressivethyroxine:asystematicoverviewoftheliterature.JSurgOncol.2002Jan79(1):629.
26)SawinCT,GellerA,WolfPA,BelangerAJ,BakerE,BacharachP,WilsonPW,BenjaminEJ,D'AgostinoRB.Low
serumthyrotropinconcentrationsasariskfactorforatrialfibrillationinolderpersons.NEnglJMed.1994Nov
10331(19):124952.

27)TadiK,ChangY,AshokBT,ChenY,MoscatelloA,SchaeferSD,SchantzSP,PolicastroAJ,GeliebterJ,TiwariRK.
3,3'Diindolylmethane,acruciferousvegetablederivedsyntheticantiproliferativecompoundinthyroiddisease.Biochem
BiophysResCommun.2005Nov25337(3):101925.
<<<ReturntoNewsletterHomePage

YoumaysubscribetothisfreeMcDougall

Newsletterathttps://www.drmcdougall.com
Newsletterarchive

2005JohnMcDougallAllRightsReserved