• Solving The Thyroid Puzzle

    Posted October 25, 2017: by Bill Sardi

    Low thyroid hormone levels can result in mental confusion. Which only adds to the bewildering state of affairs when it comes to recognizing and rectifying low or high thyroid hormone levels.

    While thyroid hormone dysfunction affects 1% of the general population it affects 10% of senior adults (10% females; 6% males).

    Many millions of Americans rely on thyroid hormone replacement. But about as many (13 million estimated) may have low thyroid levels and don’t know it.

    To make matters worse, an estimated 40% are over-treated; 48% undertreated. Wary of overtreatment which can lead to bone loss and irregular heart beats, many physicians are hesitant to prescribe thyroid hormone replacement, particularly in the oldest old.

    The biggest problem is that in 90% of subjects with low thyroid (hypothyroid) their thyroid gland is under attack by their immune system. This autoimmune form of thyroiditis is poorly addressed by modern medicine, which is a focus of this report.

    Thyroid primer

    Before you go on reading this report, an oversimplified primer on how the thyroid gland works is in order. The thyroid gland regulates your metabolism, that is, the rate at which your body burns calories. High thyroid hormone and you feel hot, your heart rate increases and you lose weight. Low thyroid and your heart rate slows, even your speech slows, you gain weight and feel cold. The thyroid gland makes T4 hormone (iodine). If insufficient T4 then Thyroid Stimulating Hormone (TSH) is produced in the pituitary gland located at the base of the brain. A high TSH level is the lazy doctor’s way of diagnosing low (hypo) thyroid. T4 must convert to T3, the active hormone. The leading brand of synthetic thyroid replacement is solely T4. There is also natural desiccated thyroid from animal source that provides T4 and T3 that modern medicine largely snubs. High (hyper) thyroid that often occurs from overdosing thyroid hormone. The biggest problem with thyroid hormone replacement is lack of absorption. Now you are ready to learn why all this goes haywire.

    There are at least 25 ways thyroid hormone replacement can baffle even the most expert of endocrinologists.

    1. You can be told you don’t have low thyroid levels but you have the symptoms of low thyroid. This is often due to inaccurate blood tests.
    2. There is overreliance on blood testing. This report doesn’t delve into all the confusing thyroid and mineral blood levels. That is for doctors. But if you want to check on what is considered normal, you can access an authoritative source online. Some physicians consider symptoms carry more weight in the decision to prescribe thyroid hormone than blood tests.
    3. When thyroid levels drop, Thyroid Stimulating Hormone (TSH) is secreted from the pituitary gland at the base of the brain. But this is not always the case. Chronic inflammation, obesity, stress, diabetes, insulin and leptin resistance, and advanced age may lower TSH levels.
    4. The conversion of T4 to the active T3 may be impaired by the lack of available selenium or zinc.
    5. Many subjects who think they may have symptoms of fatigue and brain fog that are caused by low thyroid hormones often opt to try iodine. Zinc and selenium in addition to iodine are of such importance that they ought to be provided in a combination dietary supplement. None are.
    6. The variance in absorption of thyroid pills (reported to be 62-82%) points to a lack of stomach acidity accounts for this variance. Anything alkaline (calcium pills, dairy products, antacids), or polyphenols like those found in coffee or grapes for example may impair absorption of supplemental thyroid. In one study calcium pills reduced absorption of levothyroxine (T4) by 20-25%.
    7. Supplemental T4 (thyroxine) varies from brand to brand and batch to batch. Inconsistent results may occur.
    8. Improper storage of thyroid tablets may result in impotency. Store in cool, dry, dark place.
    9. Thyroxine (T4) tablets must be consumed 60 minutes prior to a meal to be properly absorbed.
    10. H. pylori infection, which is common in the population, shuts off stomach acid secretion and impairs absorption of supplemental thyroid. H. pylori eradication improves thyroid hormone levels by up to 94%. Even high-dose T4 (levothyroxine) may not overcome the lack of stomach acid induced by H. pylori infection and subject patients to toxic levels of thyroxine.
    11. Low iron levels, particularly in young females, may induce hypothyroidism. This is usually due to heavy prolonged menstrual flow. But also because high estrogen levels interfere with thyroid metabolism by increasing proteins that bind to thyroid hormone. A GI tract enzyme called beta glucuronidase reactivates estrogen. Cruciferous vegetables (broccoli, cauliflower, cabbage, Brussel’s sprouts, kale) help lower beta glucuronidase by their calcium glucarate content. Calcium glucarate is also available as a dietary supplement.

      If relying upon blood tests to determine anemia, obtain a ferritin test. It is iron storage protein (ferritin) levels that correlate with a higher T3 to T4 ratio. Normal range of ferritin is 20-70.

    12. Iron pills, which young anemic women often take during pregnancy or for anemia induced by prolonged heavy menstrual blood flow, are also reported to impair T4 absorption.
    13. Adrenal gland failure may induce symptoms that are confused with hypothyroid. Dr. Alan Gaby says intolerance of low-dose (15 mg) desiccated (Armour) thyroid suggests subtle adrenal failure, for which thyroid medication is discontinued and trial use of licorice root extract (tincture preferred) is suggested. Note: licorice root may induce high blood pressure. Take with potassium.
    14. Body temperature is one way to determine if a low thyroid condition exists. Called the Barnes test, an axillary (underarm) temperature (10 minutes) is taken upon awakening in the AM, before getting out of bed. If 97.4° F or less, a low thyroid condition may exist. Even though this at-home test was published in the Journal of the American Medical Assn. in 1942, thyroid sufferers will be hard pressed to find any mention of it in conventional medical journals. Self-care is nothing modern medicine cultivates.
    15. Many seemingly disparate health problems such as allergy, PMS, fibrocystic breast disease, asthma, high blood pressure, and many skin conditions (eczema, acne, psoriasis, urticaria/red welts, skin dryness), diminished sex drive, chest pain, chronic constipation, mental problems, have been be resolved with thyroid supplementation.
    16. The human body normally secretes T4 over T3 in an 11:1 ratio. However, levothyroxine (Synthroid), the most widely prescribed thyroid pill, only provides T4. While some alternative medicine physicians resorted to using T3-T4 combination desiccated (Armour) thyroid when Synthroid (T4) failed to produce resolution of symptoms, this occurred in an era when physicians failed to recognize thyroid T4 is poorly absorbed for a variety of reasons described elsewhere in this report. Thyroid tablets were also found to be unstable and have a short shelf life and were being stored improperly by many patients, further robbing hypothyroid patients of a symptomatic cure.

      Chart: Iodine and Thyroid hormones

    17. Poor absorption of T4 pills (Synthroid and other brands) often led physicians to needlessly increase dosage. The poor absorption of levothyroxine (T4-Synthroid) finally led to the recent availability of liquid T4 in soft-gel capsules that largely resolves the problem of malabsorption and eliminates the need for patients to take their thyroid pills 60 minutes prior to meals, which led to very poor patient compliance. Soft-gel T4 capsules have been demonstrated to overcome the well-known problem that coffee poses to T4 absorption. Hypothyroid patients no longer need to avoid coffee or take their pills an hour prior to eating, which should improve compliance.

      And it is noteworthy to mention liquid T4 in soft-gel capsules even improves absorption among patients with no malabsorption disorders.

      The problem with soft-gel liquid T4 capsules is that the manufacturer is guilty of price gouging. A 100-microgram T4 Synthroid tablet ranges from ~40-94-cents each. Whereas the liquid T4 sells ~$4.50 per soft-gel cap. Otherwise thyroid sufferers could all switch to the soft-gel capsules and be done with many of the problems associated with hypothyroid therapy. One wonders if the pharmaceutical companies are making thyroid tablets that don’t properly dissolve on purpose so as to force the liquid soft-gel capsules to be prescribed.

      T4: tablet vs capsule

    18. Many drugs impair absorption of thyroid drugs. Among these are blood thinners (warfarin, heparin), digoxin, ketamine, insulin, lithium and beta blockers. Metformin, the most popular anti-diabetic drug, reduces TSH levels in hypothyroid patients.Polyphenols in grapefruit juice, (dietary supplements (resveratrol, quercetin) inhibit (cytochrome p450) detoxification enzymes in the liver may allow more T4 to make it past the liver detoxification system. Thus thyroid medication may work too well, producing symptoms of excitability, anxiousness, anxiety, even a racing heart. Consume these foods or nutrients at least 4 hours apart from thyroid pills.
    19. Vitamin C improves absorption of levothyroxine (T4) pills. This is because most vitamin C pills are acidic ascorbic acid. Buffered vitamin C (mineral ascorbates) or fat-soluble C (Ascorbyl palmitate) are not expected to produce the same effect. It may be wise to take thyroid tablets with ascorbic acid.
    20. Gastrointestinal disorders such as lactose intolerance and celiac disease may impair absorption of thyroid pills.
    21. A slight decrease in thyroid function may raise cholesterol levels and increase blockages in the first blood vessel outside the heart (aorta). This may prompt physicians to inappropriately prescribe statin cholesterol-lowering drugs that impair liver function, an organ responsible for 60% of the conversion of T4 to T3. Hypothyroid patients, particularly those with TSH levels over 10 may lower their LDL cholesterol levels with thyroid hormone replacement.
    22. Among subjects taking thyroid medication, only 60% were within the normal range of TSH (thyroid stimulating hormone). When will TSH be abandoned as a reliable marker for the need to prescribe thyroid pills?
    23. The recently published report that females exposed to prolonged (8-hour a day) electromagnetic radiation (EMF) from computer monitors experience a decline in thyroid hormone secretion that is resolved with zinc supplementation, suggests zinc be given equal recognition of importance along with iodine for thyroid health.
    24. If you want to play junior endocrinologist, blood tests would be in order. According to Kent Holtorf MD at the National Academy of Hypothyroidism, the best test for hypothyroid is the ratio of free thyroxine 3 (FT3)/ to Reverse T3. If FT3 is 1.8 times greater than RT3, then hypothyroid is confirmed. Check with your endocrinologist.
    25. Now for a zinger. A shocking reality is that 90% of cases of hypothyroidism are among people (largely women) who have Hashimoto’s thyroiditis. This is an autoimmune disorder. This means the immune system is attacking the thyroid gland, thus impairing production of T4 and T3.

      This is not just an age-related withering of the thyroid gland. It is destruction of the glandular functions of the thyroid. Blockage of antibodies that attack the thyroid gland may switch from a hypothyroid to a hyperthyroid state. Many other autoimmune disorders (psoriasis, rheumatoid arthritis, type I diabetes, multiple sclerosis, lupus, alopecia, Graves disease, inflammatory bowel disease, to name a few) are associated with hypothyroidism.

      Typically when autoimmune thyroiditis gets out of control, either prednisone (steroid) or immune suppressant drugs are prescribed. But these are fraught with side effects. Some doctors even resort to surgical removal of part of the thyroid gland. This is an overkill.

    Very intensive statin drug therapy may reduce thyroid autoimmunity but very high doses which could be liver toxic (20-40 mg) are required. And the combination of statin drug therapy and hypothyroidism appears to increase the risk for muscle pain (rhabdomyolysis).

    Modern medicine is side-stepping whatever is causing a massive epidemic of autoimmune disorders and just treating symptoms. Steroidal medication (prednisone) is employed simply as an anti-inflammatory agent, but is not curative for hypothyroid.

    In the case of hypothyroidism, the autoimmune reaction is allowed to go unabated, mostly because of the side effects of drugs used to quell autoimmunity.

    As a report published at Atlas of Science points out, the lack of zinc (or balance of zinc with copper) is at the heart of autoimmune disorders.

    The lack of zinc not only impairs the thyroid gland, it causes the thymus gland that makes T-cells to shrink also.

    Selenium, another prominent trace mineral that is involved in the conversion of T4 to the active T3 form of thyroid hormone is critical in the activation of enzymes (deiodinases) that regulate T3 levels. Selenium supplementation seems to favorably alter the immune response in autoimmune thyroiditis.

    The highest selenium content is found in the thyroid gland. Selenium activates an antioxidant enzyme (glutathione peroxidase) that protects the thyroid form excess hydrogen peroxide.

    Selenium is considered adequate in the American diet. However, experts point to impaired gastrointestinal absorption of selenium. A few years back it was reported that selenium could play a therapeutic role in thyroid inflammation.

    Among women with high estrogen levels in the postpartum period, selenium was found to dramatically reduce hypothyroidism (from 48.6% to 28.65%). Pregnancy obviously raises estrogen levels that increase the need for selenium in the control of thyroid hormones.

    While zinc supplementation doesn’t always improve thyroid dysfunction, this could be explained by poor absorption of zinc that is vastly improved by combination with vitamin B6, and poor bioavailability of zinc as it is bound tightly to a transport protein (metallothionein). Selenium facilitates the release of zinc from its binding protein. Vitamins A & D improve zinc absorption. So does vitamin B6.

    Another recent study found the ratio of copper over selenium to be a significant factor among patients with Hashimoto’s thyroiditis.

    Summary and recommendations

    This is just maddening. How does anybody find their way out of the thyroid maze? It appears a thyroid hormone imbalance requires an encyclopedia of knowledge that challenges even the best endocrinologist.

    Given that most cases of hypothyroid involve autoimmunity, and modern medicine has nothing but problematic immune suppressant drugs, hypothyroid patients should attempt to quell the fires of autoimmunity with zinc and selenium along with vitamin B6 to enhance zinc absorption.

    Miracle molecule needed to quell the autoimmunity

    What is needed is a miracle molecule to quell the ravages of hypothyroidism. Resveratrol, shunned and dismissed by modern medicine is that molecule.

    Resveratrol Normalizes Thyroid Hormones

    While the masses wait for a sign from heaven to cure their insidious thyroid hormone imbalance, they should consider resveratrol pills as it is becoming increasingly clear resveratrol is the human body’s middle-age reset switch.

    Just when the thyroid gland, the body’s thermostat for calorie burning, begins to malfunction— resveratrol comes to the rescue.

    Resveratrol and thyroid hormones

    Only recently has it become clear that resveratrol helps to overcome low-thyroid conditions that are closely associated with mental depression and memory problems.

    In recent years evidence has accumulated to show resveratrol enhances thyroid function.

    Finally, resveratrol may tackle a medically challenging metabolic problem – that of subclinical low thyroid (hypothyroidism). Subjects with this condition don’t exhibit full-blown thyroid collapse with accompany weight gain and coldness but do experience anxiety and mental depression. Mental decline and learning problems are other manifestations of this thyroid disorder. Approximately 4-20% of adult populations have this hypothyroid condition, which is treated by prescription for T4 (thyroid 4) hormone.

    However, proper dosing of T4 is difficult to determine and patients may experience side effects from overdosing such as racing heart, angina (chest pain) and nervousness. The need for better medicines to treat subclinical hypothyroid is large.

    Subclinical hypothyroid is confirmed by elevated levels of thyrotropic-stimulating hormone (TSH) with other thyroid hormones in the normal range.

    Here is what happened when laboratory mice were given T4 or resveratrol for their chemically induced hypothyroid condition (see chart below). Note the remarkable almost 4 fold reduction in TSH levels (2.49 to 0.65) in resveratrol-treated mice!

    In the laboratory, resveratrol alleviated anxiety and depression in animals with subclinical hypothyroidism. Laboratory mice had their thyroid glands cauterized so only half of the lobes were operative in order to impair learning and memory. Then resveratrol was given with levothyroxine T4 and TSH levels dropped and the learning and memory problems were remarkably reversed! Resveratrol could become every thyroid hormone users best friend.

    Effect of Resveratrol Compared With T4 Therapy For Laboratory Mice with Subclinical Low Thyroid Condition

    Note: This condition is confirmed by elevated thyrotropic stimulating hormone (TSH) levels. Resveratrol compares favorably with T4 therapy without inducing potential side effects.

    T3

    T4

    TSH

    Before

    After

    Before

    After

    Before

    After

    Resveratrol

    0.73

    0.56

    8.88

    6.71

    2.49

    0.65

    T4

    0.74

    0.91

    835

    13.97

    1.43

    0.14

    Sources: Frontiers Endocrinology 2016; Endocrinology Journal 2015

    Whether endocrinologists are ready to prescribe resveratrol for this common condition is unknown.

    More remarkably, in a 26-week study involving laboratory mice, two polyphenols, resveratrol and quercetin along with lipoic acid, an antioxidant naturally produced in the body and available as a dietary supplement, overcame high-fat diet- induced thyroid hormone abnormalities that usually lead to weight gain, elevated blood pressure and reduced antioxidant defense.

    Resveratrol by virtue of its ability to enhance iodine (iodide) maintained high metabolism and averted weight gain typical experienced among animals whose thyroid hormones are disturbed by a high-fat diet. While mice on a high-fat diet developed resistance to a satiety hormone (leptin) and therefore eat more food, resveratrol, quercetin and lipoic acid inhibited this.

    Effect Of Diet and Resveratrol, Quercetin, Lipoic Acid Antioxidants On Thyroid Hormone Levels & Internal Antioxidant Activity In Laboratory Mice (26 weeks)

    Regular Diet

    High-fat diet

    High-fat diet + resveratrol

    High-fat diet + quercetin

    TSH
    (thyroid stimulating hormone)

    526.1

    604.6

    677.5

    633.6

    T4
    (thyroid hormone)

    181.6

    208.5

    198.0

    186.3

    T3
    (thyroid hormone)

    20.5

    13.7

    18.6

    17.1

    Antioxidant capacity

    0.401

    0.487

    0.555

    1.057

    Glutathione
    (antioxidant)

    0.598

    0.482

    0.553

    0.524

    Catalase
    (antioxidant)

    36.02

    15.96

    40.18

    44.95

    Source: Journal Nutritional Biochemistry 2016

    Resveratrol has even been shown to counter the antagonism of iodine by fluoride, which naturally occurs in groundwater or is added to harden tooth enamel and reduce dental decay.

    In another experiment, among laboratory mice whose ovaries had been removed to replicate menopause, low-dose resveratrol increased T3 hormone levels.

    ©2017 Bill Sardi, Knowledge of Health Inc.

    Thyroid Hormone Basics

    Thyroid Hormone Basics

    Underactive Thyroid
    Hypothyroid
    Normal Thyroid
    Euthyroid
    Overactive Thyroid
    Hyperthyroid
    9% of Adults 1% of Adults

    13 milion Americans have undetected underactive or overactive thyroid glands; 1% of adults overall; 10% of elderly; by gender: 10% of females, 6% of males

    90% hypothyroid have autoimmune thyroiditis (Hashimoto’s) Goiter: enlarged thyroid gland (swelling base of neck); Grave’s disease
    Body is cold; axillary (underarm) temperature upon awakening in AM is under 97.4° Fahrenheit Normal axillary temperature; 98° Fahrenheit in AM upon awakening. Oral temperature 98.6° – 99.0° Fahrenheit (37.0°-37.2° Celsius) Subject feels hot; axillary (underarm) temperature is above 98.6° Fahrenheit
    Weight gain Weight loss
    Fatigue, puffy face, joint stiffness, muscle pain, constipation, dry skin, brittle nails, thinning hair, depression, decreased sweating, slow heart rate, hoarseness, slow speech, loss of taste and smell, bloating Rapid heart beat, fatique, palpitations, inscreased appetite, hand tremor, sweating, more frequent bowel movements, muscle weakness, insomnia, thin skin, brittle hair, bone loss, nervousness, anxiety
    Slow pulse under 85 beats per minute Resting pulse over 85 beats

    Biological Dyamics in Thyroid Hormone Synthesis

    Chart: Thyroid Hormone Synthesis

    Condition TSH T4 FT4 (free unbound thyroxine)
    Hyperthyroid Low High High
    Hypothyroid High* Low Low
    Hypothyroid (pituitary) Low Low Low

    *Not always

    Graphics: © Knowledge Of Health, INC

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