Guest Articles from Our Medical Practitioner
The article below is written and submitted by our prescribing practitioners and partners. Their comments and opinions are not necessarily those of Synergy Pharmaceuticals and are not intended to be a medical diagnosis or method of treatment.
Treatment of Thyroid
Robert Carlson, MD from the Andlos Institute
I found the treatment of thyroid condition or insufficiency to be fairly worthwhile, and the results are beneficial to the long-term wellness of the individual. I have always been interested in surgical endocrinology, spending time at Harvard with Dr Blake Cady and having a great experience in my general operation residency at Shands Hospital under Dr. William Pfaff. I believe the challenge of managing thyroid issues depends on listening to the individual. Yes, listening to the individual. Unfortunately, usually people describe classic signs of low thyroid function, and their doctor checks certain labs, deeming the labs general, and therefore the patients’ “classic” signs are disregarded.
- Progressive weight gain,
- Fatigue, especially in the later piece of the afternoon,
- Thinning of hair, dry skin and swelling,
- If not in menopause, may frequently be cold, or at least colder than everyone else. Are you presently wearing a sweatshirt to go grocery shopping inthe heat of the summer?
- In women, continued weight gain, or failure to reduce weight despite exercising and eating correctly. This really is a thyroid issue!
Recently, I talked with a individual who had all signs I have indexed above, and her doctor checked the labs and had the receptionist call to tell her everything was “normal”. In truth, he even implied that she was eating more than she was telling him. But she wasn’t, and all he needed to do was to check the right labs, speak to his patient, and he might have realized that she was in a severely low thyroid state. She lost over twenty pounds in the initial month following beginning Armour Thyroid Substitution Therapy, no longer takes naps in the afternoon, and her hair stopped dropping out. There is hope.
It is not unusual for thyroid issues to surface during menopause, so women don’t usually complain of the classic cold intolerance or feeling more frequently cold than hot, considering they are dealing with hot flashes.
Thyroid imbalance may affect each organ inside the body. The thyroid is important in keeping energy by close regulation of metabolism and temperature control. Ongoing development and repair of cells with protein synthesis is an important function of the general working thyroid. Whenever thyroid function is not at its maximum, then abnormalities start to surface, initially subtle, but becoming slowly worse.
The thyroid controls an amount of additional significant systems like digestion, with low thyroid degrees causing irregularity and indigestion. The negative effects of low thyroid degrees have extensive ramifications on the function of the heart, with improved atrial fibrillation, worsening heart function with acceleration of congestive heart failure, and an improved mortality associated with heart attacks. Additionally, low thyroid hormone degrees result in metabolism abnormalities with elevation of the LDL, or bad cholesterol, plus diminishing HDL degrees, or good cholesterol.
Patients with low thyroid degrees usually demonstrate abnormalities in skin, hair and fingernail development, all connected to the value of thyroid protein metabolism. It is for this cause that individuals furthermore experience swelling . The list for signs associated with thyroid function is lengthy, though a few of the signs include depression, the inability to focus on a task and reduced memory. Fatigue, weight loss, and anxiousness with panic attacks has furthermore been attributed to low thyroid degrees. External manifestations can include weight gain, brittle nails, rough or dry skin, enlarged legs, feet, hands and face. Hair development is usually sparse, and hair reduction is accelerated. One of the classic signs of bad thyroid function is the thinning of the lateral eyebrows. This means that the hair found on the outside area of the eyebrows either becomes thin or will even disappear. There is an extremely close relationship with thyroid hormones, estrogen, cortisol, and development hormones; therefore, signs are frequently compounded by abnormalities of different hormonal systems.
I believe the most significant components of lab testing for the thyroid is the free T3 level. This level is regrettably not frequently tested, yet it ought to be. T3 or triiodothyronine is the most active of all of the thyroid hormones. It is the worker bee which interacts with the significant functions inside the body which the thyroid controls. Other lab values examined include the TSH, that is the hormone which the pituitary utilizes to communicate with the thyroid. The TSH makes the thyroid provide T4, or thyroxine. This really is comparatively inactive and should be transported from the liver to be triggered into T3, so that it may do its job inside the blood stream. Let’s analyze the thyroid function results. Again, laboratory values are just a piece of the picture. Patients might have usual laboratory results in acceptable ranges or optimum ranges, however, nonetheless demonstrate signs of low thyroid function. I adjust dosages about treatments based based on how the individuals feel, rather than on laboratory tests. Additionally, optimizing the T3 level or active shape of thyroid hormone into the upper 75thpercentile can supply the individual the maximum advantage of thyroid supplement, without increasing dangers. A number of doctors consider TSH degrees as indicators of thyroid function. In optimizing the thyroid, these degrees are frequently lower than usual, as well as the T3, and patients’ signs ought to be the values used to change the thyroid substitution therapy.
If your TSH level is between 1 and 2. TSH is the hormone which the pituitary utilizes to communicate with the thyroid. The TSH makes the thyroid make T4, or thyroxine, and might control the degrees minute to minute. The TSH level represents a true regular for general thyroid function. Despite a general amount of TSH, an individual nevertheless will demonstrate signs of hypothyroidism, and this might be usually better defined by searching at the free T3 degrees.
The regular or reference laboratory ranges indexed based on many laboratory results types are grossly inaccurate and list a TSH of virtually 5.5 as normal. Patients with TSH’s this excellent are frequently, with exception, profoundly hypothyroid. An Endocrinological society pertains to an amount of 2.8, yet different endocrinologists have employed the worth of 2 as a cut-off for determining a usual TSH. Especially with signs, a TSH of better than 2 must recommend a degree of hypothyroidism. The correspondence involving the pituitary, that is situated behind the bridge of the nose and inside the brain, as well as the thyroid gland, is from the hormone TSH or Thyroid Stimulating Hormone. TSH is made in the pituitary gland, secreted inside the blood and travels to the thyroid to affect thyroid function. Whenever the TSH is under 2, the correspondence between a pituitary and a thyroid is a lot like a soft spoken conversation. “How are we doing now?”, “What are we having for dinner?”, “What are we doing this weekend?”. Whenever degrees of TSH are between 2 and 3, the conversation becomes a little different, with the pituitary asking the thyroid questions like: “What’s going about down there?”, or “You’re no longer working as hardas you used to, so what’s the matter?” Then, whenever the level goes over 3, the pituitary begins yelling at the thyroid to function harder. Whenever the TSH surpasses 4, the pituitary is now violently yelling at the thyroid, struggling to convince it to create more thyroid hormone. Going over 5, the pituitary is using expletives every other word, screaming at the top of its proverbial lungs, striving to convince the thyroid to commence functioning.
If your TSH level is less than 1. This might represent a general range, or it may represent a reduced function of the pituitary, as well as its inability to answer to the requirement for high thyroid degrees. Or maybe it doesn’t care what the thyroid is doing. This really is a possibility. The TSH makes the thyroid provide T4, or thyroxine, and it may control the degrees minute to minute. The TSH level represents a true general range for general thyroid function. Despite a usual amount of TSH, a individual nevertheless can demonstrate signs of hypothyroidism, or below active thyroid, and this really is usually better defined by looking at the free T3 degrees. If the TSH degrees fall below three, then another consideration is to evaluate for hyperthyroidism or overactive thyroid. But, with thyroid treatment, low degrees of TSH are acceptable, because the T3 degrees are inside the general range. Optimization of thyroid function is attained by optimizing T3 degrees.
If your T4 level is in the upper 75th percentile of the usual referenced degrees. This really is inside the best level and supports promoting of the thyroid hormone degrees. T4, or thyroxine, is yielded inside the thyroid gland in reaction to stimulation within the pituitary gland. T4 is a reasonably inactive form of thyroid hormone, lower than 1/5 the activity of T3. I like to consider T4 like a group of employees standing about, waiting to be told what to do. If they aren’t functioning, then the job isn’t getting done. We understand the sensation of driving by a team of employees that are repairing a road and nobody appears to be working. Well ,guess what? The road repairs may not be completed. The T4 is then triggered inside the liver into T3. The T3 is the active form of thyroid hormone, five times more effective and active than T4. It is the workhorse of the thyroid hormonal program. That is why it is very important to measure the T3 degrees.
If your T4 level is between the 40thas and 75th percentile.This really is not inside the best level and promoting of the thyroid hormone degrees might indicate signs of underactive thyroid. T4, or thyroxine, is yielded inside the thyroid gland in reaction to stimulation within the pituitary gland. T4 is a comparatively inactive form of thyroid hormone, lower than 1/5 the activity of T3.
I like to employ the analogy of graduating from excellent school. It is normal to graduate from a good school. At the graduation ceremony, everyone is wearing their cap and gown and getting a diploma. With the exception of the valedictorian, we do not have idea where the pupils graduated in their class. Then, there is often a difference between your student which graduated inside the upper 20thpercentile, and is definitely attending university with the hopes of the bright future, in comparison as the student whom graduated inside the lower 20thpercentile, possibly no longer working too hard in a school, and now confronted with limited choices for future plans of enrichment. Are you presently happy being included in the 40thas well as the 75thpercentile of the class? Should you show signs of lower thyroid function than normal, treatment with a thyroid supplement is given. But in the event you are inside this range, plus experiencing signs of low thyroid function, than I believe people can benefit from stimulating of their thyroid degrees. I usually like Armour Thyroid, because it has T4, plus T3, in it, and the beneficial weight loss characteristics of T1 plus T2. Armour Thyroid equally has enzymes, calcitonin, selenium, and iodine which enable it to maintain the thyroid hormones, plus help inside conversion into the active T3 shape of thyroid hormone.
If your T4 level is less than the 40th percentile. This really is not inside the best level, and promoting of the thyroid hormone degrees can definitely indicatean underactive thyroid. T4, or thyroxine, is yielded inside the thyroid gland in reaction to stimulation within the pituitary gland. T
If your T3 level is in the upper 75th percentile. This is within the best level plus supports promoting of the thyroid hormone degrees.
Thyroid function is associated with many age-related condition including cardiovascular condition, degenerative neurological illnesses (Alzheimer’s/Dementia/Memory disorders), gastrointestinal abnormalities, fat gain, plus fibromyalgias.
If a individual presents to the hospital with a heart attack plus has a low T3 level, then they may do worse, having more problems. Additionally, there is a 5x heightened risk of heart illness with low free T3 degrees. Lower T3 degrees are a more risky risk element than fat degrees. Whenever the T3 level is low, there is a 23% lower blood flow to the brain. Additionally, depression is 8 instances more common with low T3 degrees. Lower T4 degrees are not correlated perfectly with signs like those with low T3 degrees. Needless to say, T3 degrees are crucial to adhere to and measure. I judge an individual’s reaction to therapy scientifically how well they are doing, as well as the T3 degrees.
If your thyroid antibodies are positive. This really is associated with an autoimmune illness called Hashimoto’s. Initially, this starts out as hyperthyroidism as your body attacks your thyroid with antibodies. This response results in high thyroid degrees due to over-stimulation. Eventually the thyroid, gland starts to become “burned out” due to the worsening thyroid function. Someone who was initially hyperthyroid following the antibodies attacking their thyroid, now becomes hypothyroid, They usually need thyroid supplement for the rest of their life. The task of Hashimoto’s thyroiditis is mediated by antibodies, which, whenever they are too high, may bind to thyroid receptors, therefore stopping thyroid hormone from binding to these receptors and activating the thyroid gland. A individual could have completely regular thyroid hormone degrees, however, nonetheless be hypothyroid or underactive thyroid considering the thyroid hormone can’t stimulate the receptors. Aging furthermore produces a reduced amount of thyroid hormone receptors, thus, when antibodies block alternative receptors onw can have regular hormone degrees, yet be severely hypothyroid. Studies have shown that as much as 20 % of women over age of 50 could have thyroid antibodies. In these individuals, symptomatic relief can NOT happen without high dosages of thyroid hormone, especially T3 and T4.
If your thyroid antibodies are negative. We never have evidence of antibodies to the thyroid, yet when they are too high they can bind to thyroid receptors, thereby stopping thyroid hormone from binding to these receptors, plus activating the thyroid gland. A individual can have completely normal thyroid hormone degrees, however, nonetheless be hypothyroid, or underactive thyroid considering the thyroid hormone can’t stimulate the receptors. Aging can equally provide a reduced amount of thyroid hormone receptors, so you might have normal hormone degrees, but have signs of low thyroid function.
Your reverse T3 degrees are elevated. This really is not desired. Reverse T3 can be yielded with all the conversion of T4 into T3. Unlike T3, that is fairly active, the reverse T3 is inactive, and is also not beneficial to thyroid hormonal activity. Stress, diabetes, elevated free revolutionary exposure, aging, and dieting result an improved manufacturing of reverse T3.
Reprinted with permission from Andlos Institute, Robert Carlson, MD