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Hypothyroidism

DIABETES AND ENDOCRINE SYSTEM

Endocrine System

  •  Graves' disease

  •  Goiter

  •  Male hypogonadism

  •  Hyperthyroidism

  •  Hypothyroidism

  •  Addison's disease

  •  Hyperparathyroidism

  •  Polycystic ovary syndrome

  •  Cushing's syndrome

  •  Acromegaly

  •  Hypopituitarism

  •  Thyroid nodules

  •  Thyroid cancer

  •  Prolactinoma

  • Hypothyroidism or under active thyroid is a disease resulting from deficiency of thyroid hormone secretion. It manifests as lowered basal metabolism generally and to a lesser degree as cretinism. Symptoms may include obesity, dry skin and hair, both of which tend to be lusterless, low blood pressure, slow pulse, sluggishness of all functions, depressed muscular activity and goiter. It is measured in the laboratory with a TSH (thyroid stimulating hormone) test. The normal reference range is 0.7-5.0. One may perform a differential diagnosis of primary hypothyroidism from secondary and tertiary hypothyroidism. An increase of serum TSH indicates low thyroid. It tends to be more common in elderly women. One study by Savin et al, found that 22 of 344 (5.9%) healthy persons over the age of 60 had a TSH level over 10. Ten of these had a low T4 and FT4 index. 14.$5 of the 344 had a slightly elevated level of serum TSH but did not have low T or FT4 levels. In general elderly people, experience symptoms of lower metabolism associated with a degree of hypothyroid and subsequent raised serum TSH levels. It there are associated symptoms of hypothyroidism without elevated serum TSH levels then one may suspect hypopituitarism as a cause.

    Diagnosis of hypothyroidism is important because much of its symptomology corresponds to conditions associated Deficient Spleen Qi and Yang with Dampness. The typical slow, slippery or soft pulse may be present with a pale, moist, swollen or scalloped tongue with pale facial pallor, swollen and edemic constitution are all indications of hypothyroidism. These symptoms are often associated with symptoms associated with Candida overgrowth and various fungal infections. Mild to severe obesity without extraordinary high caloric consumption is also a common condition. A symptom of high cholesterol, another sign of dampness, is also associated with some conditions of Hypothyroidism.

  • Candida/yeast/fungi
  • Besides hereditary factors, it may be that chronic low protein consumption over a prolonged period could be a contributing cause of hypothyroidism. This is to be considered in the light of the various high protein diets such as the Zone diet that seems to be efficacious especially for some to control weight.

    It is not clear to what extent herbal therapy is efficacious in treating hypothyroidism. In any case, various seaweeds such as kelp are commonly used in many cultures such as in Western and Chinese herbal traditions, for regulating thyroid conditions generally.

  • Graves' disease

  • Goiter

  • Male hypogonadism

  • Hyperthyroidism

  • Hypothyroidism

  • Addison's disease

  • Hyperparathyroidism

  • Polycystic ovary syndrome

  • Cushing's syndrome

  • Acromegaly

  • Hypopituitarism

  • Thyroid nodules

  • Thyroid cancer

  • Prolactinoma

  • Current Thyroid Testing Inadequate

    TSH level above 2 has important implications

    The concept of subclinical hypothyroidism is based on the log-linear feedback loop between thyroxine and thyroid stimulating hormone: for one unit change in thyroxine there is a 10 unit change in thyroid stimulating hormone.

    The prediction of disease by the measurement of an intermediate marker is now well established in the absence of clinical symptoms for example, calcium concentration, cholesterol concentration, and blood pressure.

  • Calcium (Calcium citrate)

  • Calcium Gluconate)

  • It has been shown that changes in endothelial function and cholesterol concentration are apparent in subclinical hypothyroidism and even in people whose thyroid stimulating hormone is greater than 2 mU/l. (3,4) This provides a physiological basis for the Rotterdam study, which clearly shows that subclinical hypothyroidism is associated with an increased risk of ischaemic heart disease.(5)

    A value outside the reference interval is not simply a minor variation but is important both in terms of predicting future hypothyroidism and in causing biological effects. (3,4)

    Alun Price, chief medical laboratory scientific officer, clinical chemistry. A P Weetman, honorary consultant physician. Northern General Hospital, Sheffield, UK

    How To Know If Your Thyroid Is Working Properly With Blood Tests

    A recent study showed that nearly 13 million Americans may be unaware of and undiagnosed for their thyroid conditions. Are you one of them? Another study showed that if you are a pregnant woman and you have a low thyroid your child's IQ will be affected. Yet another recent study showed that if you an elderly woman with thyroid problems you will have an increased risk of heart disease

    The big myth that persists regarding thyroid diagnosis is that an elevated TSH (thyroid stimulating hormone) level is always required before a diagnosis of hypothyroidism can be made. Normally, the pituitary gland will secrete TSH in response to a low thyroid hormone level. Thus an elevated TSH level would typically suggest an underactive thyroid.

    Your Doctor Does Not Likely Understand How To Interpret Your Tests Properly

    Thyroid function tests have always presented doctors with difficulties in their interpretation. Laboratory testing is often misleading due to the complexity and inherent shortcomings of the tests themselves. Many doctors not having an adequate understanding of what the test results mean, will often make incorrect assumptions based on them or interpret them too strictly. A narrow interpretation of thyroid function testing leads to many people not being treated for subclinical hypothyroidism.

    Old Laboratory Tests Unreliable

    Most all older thyroid function panels include the following:

    • Total T4
    • T3 Uptake and
    • Free Thyroxine Index (FTI).

    These tests should be abandoned because they are unreliable as gauges of thyroid function. The most common traditional way to diagnose hypothyroidism is with a TSH that is elevated beyond the normal reference range. For most labs, this is about 4.0 to 4.5. This is thought to reflect the pituitary's sensing of inadequate thyroid hormone levels in the blood which would be consistent with hypothyroidism. There is no question that this will diagnose hypothyroidism, but it is far too insensitive a measure, and the vast majority of patients who have hypothyroidism will be missed.

    Basal Body Temperature

    Basal body temperature popularized by the late Broda Barnes, M.D. He found the clinical symptoms and the body temperature to be more reliable than the standard laboratory tests was provided. This is clearly better than using the standard tests. However there are problems with using body temperature.

    • Sleeping under electric blankets or water beds falsely raise temperature
    • Sensitive and accurate thermometer required
    • Inconvenient and many people will not do (poor compliance)

    New and More Accurate Way To Check for Hypothyroidism

    This revised method of diagnosing and treating hypothyroidism seems superior to the temperature regulation method promoted by Broda Barnes and many natural medicine physicians. Most patients continue to have classic hypothyroid symptoms because excessive reliance is placed on the TSH. This test is a highly-accurate measure of TSH but not of the height of thyroid hormone levels.

    New Range for TSH to Diagnose Hypothyroidism

    The basic problem that traditional medicine has with diagnosing hypothyroidism is the so-called "normal range" of TSH is far too high: Many patients with TSH's of greater than 2.0 (not 4.5) have classic symptoms and signs of hypothyroidism (see below).

    • So, if your TSH is above 2.0 there is a strong chance your thyroid gland is not working properly.

    Free Thyroid Hormone Levels

    One can also use the Free T3 and Free T4 and TSH levels to help one identify how well the thyroid gland is working. Free T3 and Free T4 levels are the only accurate measure of the actual active thyroid hormone levels in the blood.

    When one uses free hormone levels one will find that it is relatively common to find the Free T4 and Free T3 hormone levels below normal when TSH is in its normal range, even in the low end of its normal range. When patients with these lab values are treated, one typically finds tremendous improvement in the patient, and a reduction of the classic hypothyroid symptoms.

    Secondary or Tertiary Hypothyroidism

    There are a significant number of individuals who have a TSH even below the new 1.5 reference range mentioned above, but their Free T3 (and possibly the Free T4 as well) will be below normal. These are cases of secondary or tertiary hypothyroidism, so, TSH alone is not an accurate test of all forms of hypothyroidism, only primary hypothyroidism.

    Symptoms of Low Thyroid

    • The most common is fatigue.
    • Skin can become dry, cold, rough and scaly.
    • Hair becomes coarse, brittle and grows slowly or may fall out excessively.
    • Sensitivity to cold with feelings of being chilly in rooms of normal temperature.
    • Difficult for a person to sweat and their perspiration may be decreased or even absent even during heavy exercise and hot weather.
    • Constipation that is resistant to magnesium supplementation and other mild laxatives is also another common symptom.
    • Difficulty in losing weight despite rigid adherence to a low grain diet seems to be a common finding especially in women.
    • Depression and muscle weakness are other common symptoms.
  • Depression

  • fatigue

  • Treatment of Hypothyroidism

    Also available is an excellent text book article on thyroid testing for those with more technical interests.

    Living Well With Hypothyroidism

    Mary Shomon is the www.about.com thyroid expert. Her $11 352 page book published in March of 2000 is one of the most cost effective and valuable resources that you could own on this subject. If you have thyroid disease this book should be in your library.

    The Los Angeles Times wrote: March 27, 2000
    "Hypothyroidism is a common, very treatable disorder that is also poorly managed by doctors. In this first-rate book by Mary Shomon...the disorder, its myths, and medicine's successes and failures at dealing with it are thoroughly examined. This is not a book that rehashes old facts on thyroid disease. Shomon instead challenges patients and their doctors to look deeper and try harder to resolve the complicated symptoms of hypothyroidism...In a fascinating chapter, Shomon, who also has a Web site and an online newsletter about the disease, explores recent evidence that the addition of the thyroid hormone T3 to the standard T4 (levothyroxine) may help some people feel better. In addition, the section on babies born with hypothyroidism, although brief, has the best advice on how to give medication to an infant that I've seen. As Shomon writes: 'or years, thyroid problems have been downplayed, misunderstood and portrayed as unimportant.' With her advocacy, perhaps no more." -- Shari Roan

    Dr. John Lowe, author of "Speeding Up to Normal" wrote:

    Mary Shomon is the harbinger of the latest scientifically-sound information on hypothyroidism. With keen intellect, loyalty to truth, and plain language, she sweeps away the medical dogma that bars millions of patients from rational thyroid hormone therapies. In this book, she describes practical thyroid therapies that can improve patients' health and extend their lives. The book is vital for hypothyroid patients who want to get well, and for physicians who want to help them do so.

    Thyroid Testing Update

    Doctors are ignoring their patient's symptoms as long as their blood work comes back in the "normal" range. However, the blood hormone levels may not always yield a correct diagnosis, with both false positive and false negative results.

    Secretion of TSH (thyroid stimulating hormone) is influenced by many factors other than the negative feedback inhibition by thyroxine (T4) or triiodothyronine (T3). Levels of TSH are very often the sole parameter by which doctors diagnose hypothyroidism. According to the report, "symptoms are not considered a criterion by some authorities ... the clinical features of hypothyroidism seem to have been relegated to the status of historical curiosities."

    A 20 year follow-up study published in BMJ in 1995 showed that TSH concentrations above 2 mU/l are associated with an increased risk of hypothyroidism. Half of the population fall into this category and need to be concerned about the optimal functioning of their thyroid gland.

    Relation Between TSH and Risk of Hypothyroidism

    The equation to describe the relation between the probability of developing hypothyroidism and the serum thyroid stimulating hormone concentration is:

    ln {P/(1P)}=b0+b1 ln TSH+0.027 age (+1.79 if antibody positive).

    b0=5.02, b1=0.30 if TSH < 2 mU/l

    b0=6.38, b1=1.97 if TSH > 2 mU/l

    Another confounding factor is that changes in TSH, T4, and T3 concentrations during systemic illness are poorly understood and therefore thyroid function tests cannot be interpreted in these patients. Since rates of systemic illness are so high, especially in those with hypothyroidism, a high percentage of patients undergoing thyroid testing would fall into this category.

    BMJ 2000; 320: 1332-1334

     

     

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