Hypothyroidism (Low Thyroid) and Associated Conditions
Dr. Kellman treats a wide variety of diseases, but he is especially known for his understanding and expert handling of thyroid disease, particularly hypothyroidism. He has successfully diagnosed and treated thousands of patients with hypothyroidism. Patients who had been suffering for years finally began to feel better, regained their energy and discovered the reason why they felt fatigued, couldn’t lose weight, were suffering from depression, hair loss and other symptoms.
If you complain of just one of the following conditions
Difficulty losing weight
Or if you have been diagnosed with chronic fatigue syndrome or fibromyalgia
Your thyroid might be low even if routine tests come out normal.
Millions of people in this country have hypothyroidism and yet routine blood test such as TSH, T4, and T3 come out normal. Deep down many people know there is something wrong with their metabolism and thyroid. Yet they are mistakenly told their thyroid is normal and needlessly suffer from fatigue or inability to lose weight regardless of how little they eat. Millions of people are being told “everything is normal” when in fact they have a slow or under-active thyroid.
If this sounds like you, you are not alone. If you have any of these above symptoms your thyroid might be low. Don’t let the routine thyroid tests mislead you.
Dr. Kellman is a pioneer in the use of a more sensitive thyroid test called the TRH stimulation test, which can detect hypothyroidism missed by the routine tests.
By using the TRH test, he has changed the lives of thousands of patients. These are people who had suffered fatigue for years and then regained their energy. Or people who couldn’t lose weight no matter how little they ate, and then lost weight. Or people misdiagnosed with depression and incorrectly put on anti-depressants, who improved in mood given thyroid hormone. Or people with “brain fog” and memory issues whose thinking and memory became sharp again after proper diagnosis and treatment. Many of these patients suspected they had low thyroid, but their doctors told them that the routine tests showed they were normal.
Landmark studies published in 2007, showing that the TRH test is the most accurate tool for diagnosing hypothyroidism and recommending the TRH test for accurate diagnosis. Not given this test, millions of people who actually do have a low thyroid continue to be misled, told by doctors that “everything is normal.”.
Dr. Kellman will also help you get to the root causes of why you develop a low thyroid on the first place. He will identify the various toxins that can have a direct toxic effect on the thyroid signaling system and that can adversely affect the immune system causing an auto-immune thyroid disorder. Dr. Kellman’s understanding of the gastrointestinal immune thyroid connection, has helped many patients uncover the underlying causes of their health issues.
The TRH test and Dr. Kellman’s approach to uncover the root causes of thyroid disease has changed the lives of thousands. It can change your life for the better too.
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After looking for low thyroid, Dr. Kellman also looks at other hormones, such as adrenal hormones, because all these hormones work together as a complex interconnected web. Any problem in one endocrine gland usually means problems in another system or systems. This holistic way of understanding the endocrine system opens a way for better diagnosis and treatment - and much better outcomes. Patients treated holistically function much better and are able to live life to its fullest.
The crucial thing is to establish optimal hormonal balance individually, because balance can vary from person to person. It’s also important to recognize that in blood testing for hormone levels and results, what’s in the right range for one individual differs from the right level for another individual. For example, one woman may require a certain estrogen level to feel best, but another woman might require a different level to feel best.
Because hormones are mutually-dependent, a deficiency of one can create excesses of another, and vice versa, with numerous possibilities for imbalance and unhealthy symptoms. Imbalances of estrogen, progesterone, and cortisol are linked to low thyroid. 80% of low thyroid patients have low cortisol or “Adrenal Fatigue” and vice versa. Many studies have found that Human Growth Hormone (hGH) levels are very low in hypothyroid patients and when hGH is replaced in these people, the thyroid is usually normalized. Low Testosterone levels are also found in hypothyroid patients (especially men) and Testosterone replacement therapy improves significantly their thyroid function.
Causes of Hypothyroidism
Research on the causes and factors contributing to hypothyroidism has lately concentrated on exposure to toxic chemicals. Some 3,000 synthetic chemicals are produced in high volume annually. These chemicals are routinely detected in air, drinking water, and food. They abound in building materials, many consumer goods, cosmetics, household products, medications, and motor fuels. Hazardous waste sites are full of them. Yet less than 20% of these chemicals have been tested as potential causes of toxicity. At least 1,000 chemicals known to be neurotoxic in animals have never been investigated for their effects in humans. Here are some well recognized chemicals with adverse effects on the thyroid.
Endocrine disruptors. Synthetic or naturally occurring chemicals, endocrine disrupters can interfere with the balance of normal hormone functions. This imbalance can cause various abnormalities. In the reproductive system, feminization of males and masculinization of females. Among other abnormalities: enlargement of the thyroid gland, birth defects, behavioral changes, depressed immune systems, and an increased vulnerability to disease.
Typically, endocrine disrupting chemicals affect the endocrine system in three ways. They mimic, block, or trigger a hormone response. Endocrine disruptors that mimic respond like normal hormones inside the body.Endocrine disruptors that act like hormone blockers bind to the same protein receptors as the real hormone but do not stimulate any action; they get in the way of the natural hormone and prevent it from sending its message. Endocrine-disrupting chemicals that act as triggers attach to protein receptors, then trigger an abnormal response. They cause growth at the wrong time, or an alteration of metabolism, or synthesis of a different product.
The number of substances acting as endocrine disruptors is broad and varied, including both natural and synthetic materials. Note: endocrine disruptors can be present in the environment at very low levels and still cause harm.
Autoimmune diseases, most commonly Hashimoto’s disease. This is the number one cause of hypothyroidism. In autoimmune diseases like Hashimoto’s disease, the immune system attacks the thyroid, which affects the thyroid’s ability to produce hormones. Hashimoto’s disease sometimes causes only a thyroid goiter (swelling), but other times it causes hypothyroidism.
Surgery to remove all or part of the thyroid gland. Sometimes people need to have thyroid surgery if they have lumps on the thyroid, thyroid cancer or Graves’ disease. If the entire thyroid is removed, the person always gets hypothyroidism. If only part of the thyroid is removed, the thyroid hormones sometimes are not affected at all, or they are affected to varying degrees.
Radiation treatment. Sometimes people with thyroid lumps, thyroid cancer, cancer of the head or neck, Hodgkin’s disease, lymphoma or Graves’ disease need radiation treatment. This can cause total or partial loss of thyroid function.
Hyperthyroidism treatment. Sometimes people with hyperthyroidism (thyroid gland makes too much of the hormone thyroxine) are treated with radioactive iodine or anti-thyroid medications. These treatments sometimes result in hypothyroidism.
Certain medications. Medications like lithium (used to treat psychiatric disorders) and interferon (used to treat cancer and other diseases) can cause the thyroid to make less thyroid hormone, resulting in hypothyroidism.
Less common causes of hypothyroidism include congenital disease (defective thyroid gland or no thyroid gland at birth), disorder of the pituitary gland (pea-sized gland located in the brain), iodine deficiency and others.
The Testing Controversy
Diagnosing hypothyroidism has sparked an ongoing debate in the medical community over what hormone levels constitute a hormone deficiency. Generally, doctors use the TSH (thyroid blood test to diagnose thyroid conditions. (TSH stands for thyroid stimulating hormone.) TSH is produced in the brain’s pituitary gland. A pituitary that produces excess TSH indicates that the thyroid is functioning below par and therefore requires more stimulation than normal. The problem lies in defining the standard range for TSH levels. Dr. Kellman has found that even at the edges of the so-called “normal” range, many patients suffer from untreated hypothyroidism, with significantly diminished health.
The reference ranges published by various laboratories are subject to change as new information becomes available. In fact, the medical profession always adjusts these ranges to reflect new discoveries in clinical practice.
In 2002, the American Academy of Clinical Endocrinology revised the normal range for TSH levels downward to the current values of 0.2-5.5 mµ/ml. From testing and treating patients who present with significant health problems, Dr. Kellman and many other doctors believe that this upper value is still too high.
Studies have shown that values of more than 4.0 mµ/ml increase the prevalence of heart disease after correcting for other known risk factors. Research also links hypothyroidism with high cholesterol. When the level of TSH is over 1.9 mµ/ml, with concomitant high levels of cholesterol, doctors should look for thyroid deficiency before treating the patient with cholesterol-lowering drugs. Other research reveals that people with TSH values of more than 2.0 mµ/ml have a higher risk of developing overt hypothyroid disease over the next 20 years. These findings all show a notable difference between the optimal TSH range and the so-called “normal” range.
Even when tests reveal “normal” TSH levels, I sometimes suspect the presence of hypothyroidism, In such cases, Dr. Kellman performs a stimulation test using thyrotropin-releasing hormone (TRH) to disclose low thyroid performance even if a blood test is normal.
The TRH Stimulation Test
The TRH stimulation test is conducted only under the direct supervision of a physician. The test requires the intravenous injection of the hormone TRH with additional blood sampling before and after the injection. Up until 10 or 15 years ago, the TRH was the test that doctors use to detect a low thyroid. They stop using it when the routine blood test became available but as we shall see, the two tests are radically different.
Currently, doctors evaluate three blood test to see if your thyroid is low, TSH, T3 and T4. If the thyroid is low, and it does not produce enough T3 and T4, the pituitary gland, a gland in the brain that controls the thyroid will begin to produce more TSH. One of the ways that doctors can detect a low thyroid is by checking the TSH level, if it is high, greater than 5, hypothyroidism is suspected.
The TRH Stimulation Test is a very different test. If your thyroid is low, as we mentioned, the pituitary will start producing ad storing a lot of TSH. If we inject TRH, a compound of the hypothalamus, which controls the pituitary, it will stimulate the pituitary and cause it to release a lot of TSH. Once again, if ones thyroid is low the pituitary will be full of TSH and upon stimulation of TRH; it will release it into the blood. If we could look into the pituitary in someone with low thyroid, we will see a lot of TSH. Obviously, we cannot do that, but we can do the best next thing, which is to inject TRH and stimulate the pituitary. It is like opening up the pituitary and seeing what is happening.
Routine TSH test can be terribly misleading; it frequently misrepresents what is happening in the thyroid and the pituitary. More and more doctors and certainly patients are coming to realizing this. On one blood test, perhaps the TSH might be high and the other one might be low, depending on a myriad of metabolic conditions. A low metabolic state may deceivingly lower TSH levels and for a number of other reasons TSH values may appear to be normal, even though one has a low thyroid. Clearly, the better test is the TRH Stimulation Test, which looks right into the pituitary gland.
The TRH Stimulation Test in a normal person will raise the TSH to greater than 10; in a person with a low thyroid this number will be much higher. Doctors in the past only used this test because the routine blood test was not able to detect a TSH lower than. So, they used this test not realizing that there was another important reason for using The TRH Stimulation Test, it is a challenge test that helps us look beneath the tip of the iceberg.
When the routine assays and doctors were able to pick up a lower level of TSH value they abandoned the TRH test. This was a terrible mistake and countless number of people has suffered because of it.
Dr. Kellman took the TRH test off the dusty shelves of medical archives and began to use it on my patients 15 years ago. He has tested over 13,000 patients since then, and in a large percentage, he has detected what the patient themselves suspected: hypothyroidism.
Based on this test, he treats hypothyroidism with bio-identical thyroid hormone and the lives of many of his patients have changed radically for the better. So many patients finally have their lives back.
The TRH Stimulation Test has changed thousands of lives and it can change your life too.
The results of this test help to distinguish between outright hypothyroidism and “subclinical” or developing hypothyroidism. In some individuals (and depending on the physician’s interpretation of the laboratory tests), outright hypothyroidism may take as long as 20 years to develop. With the help of measures such as the TRH stimulation test, he is able to diagnose hypothyroidism when the onset of symptoms (fatigue, weight gain, etc) precedes abnormal laboratory values. Early intervention thus may save patients from years of needless suffering.
Symptoms of Hypothyroidism
Hypothyroidism, a deficiency of the thyroid gland, is associated with many diverse symptoms. While a low thyroid may not cause people to die, if can cause many who have a low thyroid to feel half dead.
According to the pioneering physician Broda Barnes, author of Hypothyroidism: The Unsuspected Illness, there are at least 47 symptoms of low thyroid function—most of them overlooked by routine blood tests.
“The development and use of thyroid function blood tests,” Barnes wrote, “left many patients with clinical symptoms of hypothyroidism undiagnosed and untreated.” For this reason, Barnes estimates that up to 34% of the adult population has some form of thyroid deficiency.
Dr. Kellman has found that symptoms of hypothyroidism may include:
Decreased cognitive function (“brain fog”)
Irregular menstrual cycle
A feeling of accelerated aging
Muscle and joint pain
Discoloration of the skin
A sluggish thyroid can also be linked to a fatty liver or high cholesterol, candida, and low glucose and insulin levels. In extreme cases, untreated hypothyroidism can cause anemia, low body temperature, and heart failure.
Additional tests to better determine the significance of such symptoms include a liver panel, a complete blood count (CBC), a chemistry panel including a cholesterol profile, the candida antibody test, and a fasting insulin level.
Because the thyroid governs metabolic processes extending all the way down to the cellular level, every organ and system of the body can potentially be affected by its dysfunction. For example, hypothyroidism can affect the digestive tract, leading to constipation. This occurs when a sluggish metabolism affects the cells lining the gut walls, in turn slowing peristalsis, the contractions that govern bowel movements.
Slowed metabolic activity in the brain can manifest as lowered mood and depression, the result of a decreased production of neurotransmitters. Nerve cells that are not firing well may produce decreased cognitive function. In fact, many elderly people with hypothyroidism have been misdiagnosed as suffering from dementia.
One of my patients, Dr. Kellman recalls, a 78-year-old woman who was progressively declining at home, had lost overall function, was tired and forgetful, and could not remember the names of those close to her. Routine tests for TSH showed her to be in the “normal” range, and her doctors had concluded that she was suffering from “beginning dementia,” an all-too-common misdiagnosis in the elderly. Suspecting hypothyroidism, he tested her and then started her on low doses of thyroid hormone, to which she immediately responded. Her memory returned and her overall function improved dramatically.
“I feel like I was rescued from the dead,” she told him. Although many patients with sub-clinical hypothyroidism show no symptomatic improvement upon treatment according to the medical literature, it is impossible to refute this anecdotal observation. It is tragic that so many elderly patients are considered untreatable and dismissed as “over the hill” when their symptoms, due to hypothyroidism, can be alleviated with hormone treatment.
Role of the Thyroid
The thyroid is a small, butterfly-shaped organ in the neck, located above the collarbone and below the Adam’s apple. This tiny gland is vital to regulation of the body’s metabolism. Made up of small sacs, the thyroid is filled with an iodine-rich protein called thyroglobulin, along with the two thyroid hormones, T4 (tetraiodothyronine, or thyroxine) and T3 (triiodothyronine). T3, the more active of the two thyroid hormones, is produced in much smaller amounts than T4, which accounts for about 93% of the hormone produced. Most of the T3 is created by conversion from T4, which occurs in the liver and kidneys. The primary function of these two hormones is to convert food into energy and to regulate the body’s other systems. A deficiency in the production (or absorption) of thyroid hormones can cause a global decline in the body’s metabolic reactions and lead to a host of symptoms, most commonly fatigue, weight gain, low body temperature, dry skin, and hair loss in the eyebrows. But low thyroid function—that is, hypothyroidism—can also produce more far-ranging symptoms, potentially affecting all of the body’s organs and cells. That is why Dr. Kellman makes it a point to test a patient’s thyroid levels whenever he or she presents with a common and often interrelated series of health problems.
The Thyroid-Autism Connection
Studies into the causes and factors contributing to autism and ASD in recent years have indicated that gene mutations and other genetic anomalies factor into the development of autism, but genetic factors appear to account for a comparatively small fraction of cases.
Researchers have since concentrated their investigations on early exposure to toxic chemicals. The list of chemicals now suspected of causing the neuro-developmental disabilities associated with autism and ASD has increased considerably, yet it remains a short list – the currently visible tip of a greater mass of chemicals.
American children are at risk today of exposure to some 3,000 synthetic chemicals produced in high volume annually. These chemicals are routinely detected in air, drinking water, and food. They abound in building materials, many consumer goods, cosmetics, household products, medications, and motor fuels. Hazardous waste sites are full of them.
Measurable quantities of several of these chemicals have been traced in the blood and urine of nearly all Americans. They’re also traceable in human breast milk and in the blood in umbilical cords in newborn infants. Less than 20% of these chemicals have been tested as potential causes of neuro-developmental toxicity.
The center for Disease Control and Prevention (CDC) estimates that an average of 1 in 110 children in the United States have an ASD. To quote the CDC web site: “ASDs are reported to occur in all racial, ethnic, and socioeconomic groups, yet are on average 4 to 5 times more likely to occur in boys than in girls. If 4 million children are born in the United States every year, approximately 36,500 children will eventually be diagnosed with an ASD. Assuming the prevalence rate has been constant over the past two decades, we can estimate that about 730,000 individuals between the ages of 0 to 21 have an ASD.”
A study in the Journal of Pediatrics in October 2009 revealed similar numbers. Autism is the fastest growing developmental disability affecting more children than cancer, diabetes, and AIDS combined.
Autism is associated with the increasing burden of environmental toxicity. Both the brain and the thyroid are very susceptible to toxins. Additionally, neurotoxins such as PCBs and Dioxin, likely to be associated with neurological disorders such as autism, exert some of their effects on the brain through their effects on the thyroid.
Hypothyroidism can have a profoundly deleterious effect on the developing brain, thus significantly contributing to the web of causes of autism.
Other toxins which can contribute to both autism and hypothyroidism include lead and mercury. According to a study published in the Archives of Internal Medicine, 1983, 143 (2) 220- 224 lead, a heavy metal commonly found in children with autism and ASD can also cause hypothyroidism.
Mercury, another metal associated with autism and ASD, can also cause hypothyroidism, and researchers address the possibility that high exposure to mercury may perturb neurodevelopment processes by selectively affecting thyroid hormone function. Thus, many of the neurotoxic effects of mercury may be mediated through the thyroid as well. Hypothyroidism can also lead to impaired detoxification, leading to secondary buildup of lead and mercury.
Again, according to the CDC web site: “Approximately 13% of children have a developmental disability, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism…Recent studies have estimated that the lifetime cost to care for an individual with an ASD is $3.2 million .”
There are yet other reasons to believe that there is a thyroid-autism connection. Celiac disease and gluten sensitivity, known to be a factor contributing to autism, is also associated with other autoimmune disorders such as autoimmune thyroiditis, a cause of hypothyroidism. One of the most effective therapies for autism, ASD, and PDD is a gluten free diet. Studies show removing gluten can also heal secondary autoimmune disorders such as hypothyroidism. Perhaps one of the reasons why the gluten free diet is so effective in children with autism is that it can help heal the underlying thyroid disorder.
Thyroid hormone is essential for normal brain development during a critical period beginning in utero and extending through the first 2 years post partum. It regulates neuronal proliferation, migration, and differentiation in discrete regions of the brain during definitive time periods. Thyroid hormone also regulates development of cholinergic and dopaminergic neurons in the brain. Deficiencies in thyroid hormone during this critical time can have significant behavioral and cognitive effects.
A study by researchers at University of California, published in the Journal of the American Medical Association (JAMA), Dec 11, 2010 (Giulivi C et al, Mitochondrial dysfunction in autism) found that cumulative damage and oxidative stress in mitochondria could influence the onset and severity of autism. Mitochondria, the primary source of energy production in cells, have their own set of genetic instructions, mitochondrial DNA (mtDNA), to carry out aerobic respiration.
Autistic children, the researchers observed, are much more likely to have deficiencies in their ability to produce cellular energy than typically-developing children. The heart is the greatest consumer of energy in the body, the brain the second greatest. The investigators theorized that deficiencies in the ability to fuel brain neurons might lead to certain cognitive impairments associated with autism.
“Children with mitochondrial diseases may present exercise intolerance, seizures and cognitive decline, among other conditions. Some will manifest disease symptoms and some will appear as sporadic cases,” said Cecilia Giulivi, the study’s lead author and professor in the Department of Molecular Bio-sciences in the School of Veterinary Medicine at University of California, Davis. “Many of these characteristics are shared by children with autism.”
Another suggestive finding in this study: The researchers found that mitochondria from children with autism consumed far less oxygen than mitochondria from the group of control children, a sign of reduced mitochondrial activity. For instance, the oxygen consumption of one critical mitochondrial enzyme complex, NADH oxidase, in autistic children was only a third of that found in control children.
Reduced mitochondrial enzyme function proved widespread among the autistic children.
Mitochondria also are the main intracellular source of oxygen free radicals, which can harm cellular structures, including DNA. Cells can repair typical levels of oxidative damage, but Giulivi and her colleagues observed that hydrogen peroxide levels in autistic children were twice as high as in normal children, suggesting that the cells of children with autism were exposed to higher oxidative stress.
Mitochondria often respond to oxidative stress by making extra copies of their own DNA. This helps ensure that some normal genes are present despite others having been damaged by oxidation. The researchers found higher mtDNA copy numbers in the lymphocytes of half of the children with autism. These children showed equally high numbers of mtDNA sets in their granulocytes, another type of immune cell, demonstrating that these effects were not limited to a specific cell type. Two of the five children also had deletions in their mtDNA genes; none of the control children showed deletions.
Taken together, the various abnormalities, defects and levels of malfunction observed in the mitochondria of autistic children imply that oxidative stress could be influencing the onset of autism. “The various dysfunctions we measured are probably even more extreme in brain cells, which rely exclusively on mitochondria for energy,” said Isaac Pessah, director of the Center for Children’s Environmental Health and Disease Prevention and professor of molecular bio-sciences at the University of California, Davis, School of Veterinary Medicine.
The researchers cautioned that these new findings, which may help physicians provide early diagnoses, do not establish the cause or identify the effects of autism. They also noted that previous studies, hinting at a connection between autism and mitochondrial dysfunction, have been anecdotal or involved tissues that might not be representative of neural metabolism.
“We took a snapshot of the mitochondrial dysfunction when the children were 2-to-5 years old, Giulivi emphasized. “Whether this happened before they were born or after, this study can’t tell us,” she said. “However, the research furthers the understanding of autism on several fronts and may, if replicated, be used to help physicians diagnose the problem earlier.”
“The real challenge now is to try and understand the role of mitochondrial dysfunction in children with autism,” Pessah said. “For instance, many environmental stressors can cause mitochondrial damage. Depending on when a child was exposed, maternally or neonatally, and how severe that exposure was, it might explain the range of the symptoms of autism.”
“This important exploratory research addresses in a rigorous way an emerging hypothesis about potential mitochondrial dysfunction and autism,” said Cindy Lawler, program director at the National Institute of Environmental Health Sciences (NIEHS), which provided funding for the study. “Additional research in this area could ultimately lead to prevention or intervention efforts for this serious developmental disorder.”
Thyroid disease in children and in autism have many overlapping signs and symptoms. These include but not limited to:
Poor muscle tone
Trouble holding up head
Protrusion of belly
Lack of play and interaction with others
Poor Hair Growth/Bald spots
Difficulty gaining weight
Poor bone development
Decreased ability to concentrate
Fading of the personality’s color and vivacity
Progressive loss of interest and initiative
Slowing of mental processes
Other researchers are beginning to appreciate the thyroid- autism connection as well. A study done in the Royal Berkshire Hospital showed that out of 62 autistic children, 45 were found to be hypothyroid. In a study published in the Journal of Child Psychology and Psychiatry five children with autism were evaluated. Three were shown to have hypothyroidism and two had mothers who had probably been hypothyroid in pregnancy. The researchers concluded that “thyroid hormone deficiency in early development might cause nervous system damage such that autistic symptoms are likely to ensue”.
If thyroid disease is a major contributor to the web of causes of autism, why is it not widely known? The answer is that the routine thyroid blood tests frequently fail to detect the problem. The routine thyroid blood tests TSH, T4, and T3 are notoriously unreliable. Even the American Association of Clinical Endocrinologists (AACE) have realized that the TSH reference range (the most relied upon thyroid test) has been too wide and has missed detecting low thyroid in a large percentage of patients. What experts have come to realize was that the upper TSH normal range has included people who actually have mild thyroid disease and their higher TSH levels skewed the curve. This understanding led to the recommendation in Jan. 2003 by the AACE that doctors consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of .3 to 3.0. The American Association for Clinical Chemistry, or AACC, feels that the upper limit of the TSH range should be reduced to 2.5. Yet most doctors are unaware of these new guidelines.
Even the new range of .4 to 2.5 for TSH is very narrow and it is likely that even this could miss a large percentage of patients. We know that TSH tests on any given patient can vary on any given day. Additionally, many patients with TSH in one range of .4 to 2.5 have symptoms of low thyroid. This has led many doctors to abandon the routine test altogether and instead many use body temperature to diagnose hypothyroidism. This is called the Broda Barnes method. Unfortunately, it also misses the mark for many patients especially children with low thyroid, have a normal body temperature. To make matters even more complicated many people who clearly have hypothyroidism based on the fact that they have many of the classic symptoms, have TSH values between 1 and 2.5.
Cancer and Hypothyroidism
The NCI Cancer Bulletin (Feb. 19, 2008, Volume 5/Number 4) reported that “since the early 1970s, the incidence of thyroid cancer has more than doubled. Among women, in fact, it is the cancer with the fastest rising number of new cases. Nevertheless, it’s still a relatively uncommon cancer, with approximately 33,500 new cases annually, and 1,500 deaths, most of which are due to rare, aggressive types.”
Of the increase, 87 percent was attributable to cancers smaller than 2 centimeters, nearly all of which are the most treatable and common type, papillary thyroid cancer. In addition, despite the increased incidence, there was no associated change in mortality rates, which have remained very low.
Both factors, the NCI Cancer Bulletin proposes, suggest greater detection of “subclinical” disease, not some unknown influence spurring the development of more thyroid cancers. That conclusion, however, leaves one big question: In the absence of any directed efforts toward early detection - such as those for breast or colon cancer, for example - why is anyone looking for these unobtrusive nodules in the first place?
A recent, unpublished analysis of SEER data (through 2004) by Dr. Susan Devesa, from NCI’s Division of Cancer Epidemiology and Genetics (DCEG), indicates that the increased incidence, while most prominent for smaller tumors, has occurred across all tumor sizes (even 5 centimeters and larger) and stages, suggesting that more intense scrutiny isn’t solely responsible for this trend.
The NCI Cancer Bulletin notes in summing up that some studies have suggested that factors such as body mass index, diet, and reproductive patterns can influence thyroid cancer risk. One factor now coming under increasing scrutiny, ironically, is diagnostic imaging, namely CT scans.
The number of CT scans performed annually has exploded, from just a few million in the early 1980s to an estimated 62 million in 2006. CT scans require higher radiation doses than other conventional imaging techniques - doses that, according to a recent paper by Drs. David J. Brenner and Eric Hall from Columbia University Medical Center, are in a range that could increase cancer risk.
Given the relatively short latency period for radiation-induced thyroid cancer…it is quite possible that CT is influencing current thyroid cancer rates in the United States in young people,” says Dr. Brenner, of the Center for Radiological Research at Columbia.
Dr. Elaine Ron, an expert on ionizing radiation and thyroid cancer in NCI’s DCEG, agrees that CT scans do represent a potential risk. But, she stresses, “We don’t have any data that show that at this point.”
Patients with thyroid cancer — even invasive forms of the disease — often have no symptoms. Surgery is often curative. However, understanding the extent of surgery that is required for each individual patient demands not just surgical experience, but an awareness of the risk profile of each patient. That insight comes from a thorough understanding of the biology of the various forms of thyroid cancer.
Some researchers feel that the significant increase in thyroid cancer is related to a significant increase in auto immune thyroid disease that goes untreated. Sub-clinical hypothyroidism associated with an elevated TSH can stimulate the thyroid gland, leading to the increased risk of cancer.
Additionally, according to researchers, if the upper portion of the normal range of TSH (the routine thyroid blood test) was lowered to 3 as The American Association of Clinical Endocrinologist (AACE) recommends, approximately 20% of the population would be hypothyroid.
Hypothyroidism and its Effects on the Heart
Thyroid hormone is vital for normal cardiovascular function. In hypothyroidism, when thyroid hormone is lacking, this weakens the heart muscle in contraction and relaxation phases. The heart doesn’t pump as strongly as it should; reducing the amount of blood it pumps with each heart beat.
Also, because the heart muscle isn’t relaxing normally between heart beats, a potentially serious condition called diastolic dysfunction may result.
Additionally, hypothyroidism can reduce the amount of nitric oxide in the lining of the blood vessels, stiffening the vessels.
Cardiac Symptoms of Hypothyroidism
Cardiac symptoms can present in anybody with hypothyroidism but are likeliest in an persons who have underlying heart disease.
Poor exercise tolerance and shortness of breath on exertion. Weakness in the skeletal muscles is responsible for these symptoms in many hypothyroid patients. In patients with heart disease, the symptoms may signal progressing heart failure.
Bradycardia (slow heart rate). Thyroid hormone modulates heart rate. Typically, in individuals with low thyroid, the heart beats 10 - 20 beats per minute slower than normal. But in patients also suffering with heart disease, hypothyroidism may worsen the tendency for premature beats and tachycardia such as atrial fibrillation.
Diastolic hypertension. The lack of thyroid hormone in hypothyroidism can stiffen arteries, causing diastolic blood pressure to rise.
Worsening or new onset of heart failure. Low thyroid can worsen controlled heart failure and cause heart failure in patients with comparatively mild underlying heart disease.
Worsening of coronary artery disease. The increase in LDL cholesterol (bad cholesterol) and in C-reactive protein associated with hypothyroidism can accelerate underlying coronary artery disease.
Edema (swelling.) Hypothyroidism can cause a type of edema called myxedema, the result of an accumulation of abnormal proteins and other molecules in the interstitial fluid.
Hypothyroidism often occurs without the “textbook” symptoms doctors usually look for. It’s also more common than many doctors realize. If you have any of the cardiac symptoms listed above, and especially if you already have heart disease of any type, ask your doctor to measure your thyroid hormone levels, preferably with the TRH Stimulation Test.
Hypothyroidism and Hair Loss in Women
Although most people believe that hair loss is generally a concern of men, as many as two-thirds of all women experience hair loss at some point. Forty percent of women have visible hair loss by the time they are forty according to the American Academy of Dermatology. The medical profession pays little attention to the issue of women and hair loss, and most doctors don’t take complains of hair loss in women seriously.
Hair loss in women can be devastating for self image and emotional well being. Even hair thinning can make a woman feel unattractive, stressed, and depressed. To make matters worse, doctors usually offer no explanation for hair loss or tell many women that hair loss is just part of the aging process. This is farthest from the truth.
Dr. Kellman has stopped and reversed hair loss in women by uncovering and treating the causes. The three most common types of hair loss are:
Hair loss due to thyroid disease or hypothyroidism;
Androgenic alopecia (caused by high levels of DHT, a metabolite of testosterone);
Alopecia Areata (an autoimmune disease).
Hypothyroidism is one of the most common causes of hair loss in women. Frequently this goes undetected when routine test thyroid blood test (TSH, T4, T3) fail to detect the problem. Many women complain to their doctor of hair loss and intuitively believe there could be a thyroid problem, yet blood tests come out normal. Using the TRH Stimulation Test, the most sensitive test for low thyroid, Dr. Kellman has found the many of these women were right after all; their thyroid was low, only they were misled by doctors telling them their thyroid was normal based on the routine thyroid tests.
Often, when a low thyroid is the cause of hair loss, women have other thyroid related symptoms as well, including fatigue and weight gain (even though one might be eating very little). How demoralizing it is for women with hypothyroid-related hair loss when this condition is also associated with weight gain and fatigue!
But what is most troubling and frustrating is when women go from doctor to doctor and none give them an explanation or adequate treatment. Here’s an example of how Dr. Kellman’s use of the TRH Stimulation thyroid test changed the life of a patient of his. We will call her “Ellen.”
Since she was 35, Ellen has been losing hair, gaining weight yet eating very little, and feeling tired. She went to her doctor thinking that there was something wrong with her thyroid, but her doctor told her that her thyroid blood tests came out normal. Her doctor told her that her symptoms were likely due to stress and told her to go on a diet. Janet felt humiliated but didn’t give up on her search to find out what was wrong.
When she came to see him, Dr. Kellman did the TRH Stimulation Test. Sure enough, he detected a low thyroid. With natural thyroid hormone, the addition of biotin, silica in liquid form, iron, and selenium, her hair loss stopped, then her hair re-grew and her energy dramatically improved.
Ovarian cysts, high androgen index, birth control pills, pregnancy and menopause can cause hormonal shifts leading to hair loss. Women who have polycystic ovaries and high levels of testosterone, and thereby high levels of DHT, may also lose hair.
Hair loss in women is not just a cosmetic issue; frequently, it’s the tip of the iceberg of serious health issues. Taking hair loss in women seriously will not only result in an improvement in cosmetic issues, but also in an improvement in general health issues as well. Hypothyroidism and menopause — how hormonal imbalance affects the thyroid.
Menopausal Symptoms? It May Be Low Thyroid
Menopause is a normal change in life, not a disease. Regarding menopause as a disease, and relying on drugs that can quickly suppress menopausal symptoms, have led to widespread use of synthetic hormones.
Nor, as many believe, are menopausal symptoms signs of aging. Menopause is not a sign of aging, but if its effects are severe, it can appear to be so. Simply put, menopausal symptoms are related to a decline in certain hormones such as estrogen, progesterone, testosterone, and DHEA.
Symptoms of menopause include:
Depression and anxiety
Cold hands and feet
Natural (or Bio-identical) Hormone Replacement
Believing that every woman must be addressed individually, Dr. Kellman first gets a blood test and saliva test to measure hormone levels. Thyroid hormones can be low during menopause. Additionally, a full adrenal evaluation is necessary, especially for women complaining of fatigue.
There are two main types of estrogen, estradiol, and estriol. The risks in non bio-identical hormone replacement of these main estrogen types have more and more women seeking better and safer options. Many women are now choosing bio-identical natural hormone replacement therapy.
A Women’s Health Initiative study showed a 29% increase in breast cancer along with a higher risk of heart attack and stroke in women taking non-bio-identical estrogen/progestin drugs. Another study showed an association of synthetic hormone replacement with ovarian cancer. Bio-identical estriol, a far gentler and safer hormone replacement, may even protect against cancer.
Some women require the use of bio identical hormones. Some can be helped with phytoestrogens and by balancing the adrenal gland. Others do not have an estrogen issue at all; their symptoms may be substantially due to a low thyroid. Clearly, one needs to see a physician who has a broad view of your health, who is not quick to use even bio identical hormones.
Use of Phytoestrogens or Soy
Studies have found that soy phytoestrogens can reduce menopausal symptoms, but not all studies support the positive effects of soy. Most studies agree that soy intake at levels of greater than 50mg per day will lower cholesterol and increase bone strength – yet with no estrogenic effect clinically on vaginal and uterine epithelium. Clinical studies have also not shown consistent support for the benefits of soy in easing hot flashes over a long period of time.
Women either experiencing severe menopausal symptoms, or intuitively feeling they are just not themselves and need a boost in estrogen and progesterone, can take bio-identical estrogen and progesterone. The caveat here: only if they’ve had an adrenal evaluation and TRH stimulation test to evaluate the thyroid, ascertaining with certainty that their symptoms are not due to either a low functioning adrenal or a low thyroid.
Estriol, the main form of estrogen used in bio-identical hormone replacement therapy, is so safe that during pregnancy huge amounts of estriol are secreted by the placenta to protect the fetus. The cream form is also safer for a variety of reasons. An important one: It does not immediately go to the liver, which can alter detoxification pathways and change the production of various biochemicals, making one more susceptible to heart disease and clot formation.
Dosages Commonly Used
Estriol is used in doses of 2-8 mg per day. Even at 8mg per day, estriol does not cause endometrial hyperplasia, a condition that can lead to cancer. (Non bio-identical hormones do cause endometrial hyperplasia.)
A large long term study of estriol therapy for symptoms of menopause was conducted by Lauritzen in Germany at the University of ULM. The researchers concluded “estriol therapy was successful in 92% of cases. In 71%, hot flashes and sweating were completely eliminated. In 21%, they were ameliorated, becoming weaker and occurring more seldom. Depressive moods were entirely abolished in 24% of cases, and in 33% they were ameliorated so that an overall improvement occurred in 57%.” The study also found that forgetfulness, poor concentration, irritability, and palpitations were significantly improved. Migraine headaches improved. Vaginal dryness and atrophy, and the quality of the skin improved, too.
A study conducted in the Chinese Great Wall Hospital (Cheng et al, 1992) showed that a derivative of estriol was also beneficial for osteoporosis. Animal studies by Lemon and associates at the University of Nebraska Medical Center show that estriol can prevent breast cancer. Lemon also found that women with breast cancer have low levels of estriol relative to the other forms of estrogen.
In many women estriol alone is insufficient to control all the symptoms of menopause. For these women, whose problem may not be estrogen or progesterone deficiency, frequently low dose estradiol is added. However what is most important is the concept of hormonal balance. When using hormones one must address all the hormones in the endocrine system. Often, estrogen and progesterone deficiency are not the only issues. Rather, DHEA, thyroid hormone, testosterone, and other adrenal hormones need to be balanced.
For some women, their problem is not estrogen or progesterone deficiency at all, but thyroid or adrenal hormone deficiency, or an imbalance of adrenal hormones such as DHEA or testosterone. Many women have an imbalance of estrogen and progesterone as well. This is especially true during the perimenopausal time when an imbalance is likely to develop.
During perimenopause progesterone declines more rapidly than estrogen, resulting in a phenomenon called estrogen dominance. Estrogen dominance causes fatigue, depression, fluid retention, weight gain, fat storage, and thyroid dysfunction. Estrogen dominance is exacerbated by environmental pesticides and obesity. Estrogen dominance can continue in menopause itself.
Estrogen dominance is another cause of thyroid disease which can easily be overlooked. Fatigue, weight gain, depression, poor memory, and low libido can all be due to a low functioning thyroid.
Additionally, a woman can have an imbalance between the three estrogens; estradiol, estriol, and estrange. It is best then to test hormone levels both in the saliva and the blood, evaluate the results and the chemical presentation, and decide on a personalized program for each patient.
If Dr. Kellman decides to use bio-identical hormones, the form he uses is called Biest. This consists of 80- 85% estriol, the safer estrogen and 15- 20% estradiol. He also uses progesterone in the natural form. Both are usually prescribed in cream form, as this is safer.
Most women develop a progesterone deficiency even before they develop an estrogen deficiency. This can occur even before perimenopause but certainly the decline becomes significant as women get closer to menopause. Symptoms of progesterone deficiency include premenstrual discomfort, hot flashes, night sweats, decreased sense of well being and depression, and a decreased ability to concentrate and focus. Progesterone in general could help women feel better physically and mentally.
Progesterone may also help prevent mental decline that can occur with aging. (Progesterone has been shown to increase neuronal energy production and to protect brain cells.) Progesterone has been shown to stimulate new bone formation as well. Therefore, it may prevent and reverse osteoporosis. (Heersche et al 1998)
Progesterone may help prevent breast cancer. A large body of evidence suggests that progesterone is protective against breast cancer. A study by Chang et al (995) showed transdermal progesterone decreased breast cell proliferation rate by over 400%.
According to studies, women undergoing breast cancer surgery during the luteal phase of the menstrual cycle, when progesterone is highest, have much longer survival times. (Cooper et al 1999)
Angiogenesis (formation of independent tumor blood supply) is essential for tumor growth. Vascular endothelial growth factor (VEGF) is one of the most potent angiogenesis promoting factors. Progesterone lowers VEGF expression, decreasing the potential for tumor spread.
Mohr et al (1996) showed that women with a progesterone level of 4ng/ml or more at the time of breast cancer surgery had a significantly better survival rate than those with lower progesterone levels; 65% were surviving 18 years later, compared to 35%. A study at Cowan showed that the incidence of breast cancer was 5.4 times greater in women with low progesterone compared to women with favorable progesterone levels.
The common form of “progesterone” prescribed as a drug in the non bio-identical form and sold under the name Provera, can produce a totally different response from its natural counterpart. Provera can actually lower a patient’s level of true progesterone, cause headaches, mood swings, and fluid retention. The natural progesterone or the other hand diminishes mood swings, improves mood, helps with migraine headaches, and helps alleviate fluid retention.
Loss of Sexual Desire
The problem of loss of sexual desire is far more common in women of all ages than is appreciated. While psychosocial issues can be a cause, hormonal imbalances can play a significant role, often overlooked. Low thyroid is a very common and frequently overlooked cause. Routine tests often miss the diagnosis of low thyroid. A more sensitive test called the TRH stimulation test from my experience is much more likely to pick up the problem.
Estrogen and progesterone deficiencies and imbalances can also play a role. Deficiency in estrogen has been showing to cause decreased libido and estrogen supplementation has been shown to enhance sex drive. Progesterone can also improve sex drive.
Declining levels of testosterone in women throughout the reproductive years, but accentuated around menopause, is a common cause of low libido. It has been shown that levels of testosterone play an important role in psychological and sexual changes that occur in menopause. The use of testosterone with post menopause women successfully increases their sexual desire. Clinical studies show that although estrogen improves libido as well, the combination of estrogen and testosterone provided greater improvement in energy, focus, mood, and sexual desire and function than estrogen alone. (Bachmann 1999, Geflan 1999).
For younger women with declining testosterone and other androgens, treatment with testosterone at low levels coupled with progesterone is safe and effective. Many women lose sexual desire after giving birth. This also can be due to a low thyroid frequently mistaken as post partum depression. For all women, younger or older, evaluating all hormones and establishing balance is the key to feeling well, youthful and vibrant.