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LE Magazine September 2004
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Thyroid Deficiency
Preventing a Metabolic Meltdown
By Raphael Kellman, MD

Thyroid dysfunction can also contribute to insulin resistance, especially among overweight people, and in such cases is often a precursor to diabetes.28,29 Insulin, produced by the pancreas, results in the storage of excessive calories. But in insulin resistance, the cells become less responsive to the action of insulin. The body therefore produces more and more insulin as a result, trying to maintain normal blood sugar levels, a condition known as hyperinsulinemia. High insulin levels also stimulate appetite: when glucose levels drop, the insulin sends a signal to the brain to keep the food coming. Thus, you begin to eat when you least need to, with intractable weight gain being the result. A high insulin output over many years because of poor diet can cause the pancreas to “burn out” and insulin output to drop, resulting in diabetes. A number of studies suggest that hypothyroidism is associated with diabetes mellitus.30

The connection between the thyroid and the hypothalamus-pituitary axis results in three different types of hypothyroidism. Primary hypothyroidism arises from a deficiency in the thyroid itself, while secondary and tertiary hypothyroidism involve the pituitary and hypothalamus, respectively. In tertiary hypothyroidism, the hypothalamus shuts down protectively in response to stress, producing low levels of thyroid hormone.31 Often linked to chronic fatigue syndrome and fibromyalgia, this condition can cause low body temperatures, a tendency toward infections, and the other metabolic consequences of low thyroid.32 It has been suggested that problems with the mitochondria, the cellular structures that furnish us with energy, may cause this suppression of the hypothalamus. Since dysfunction of the mitochondria is also a result of hypothyroidism, here again we have an example of how processes behave reciprocally in the body.

Weight gain is an effect of hypothyroidism that can similarly become a cause. In response to the metabolic slowdown and corresponding weight gain, patients may lower their caloric intake, which in turn can lower production of T3, initiating a vicious cycle in which the basal metabolic rate slows and leads to even more weight gain. I use the little-known Achilles Tendon Reflex Recovery Test and the Barnes Basal Temperature as measures of deficient conversion of T4 to T3 to ascertain whether hypothyroidism is implicated in cases of obesity. In addition to those previously mentioned, several other blood tests also gauge T3 and T4 levels, including the reverse T3, T3 uptake, T4, and complete thyroid panel tests.

Thyroid and Hormonal Imbalances
Thyroid function is intimately tied to adrenal function, which reciprocally acts to stimulate the pituitary, where TSH is produced. If the adrenals are not working well, the thyroid and pituitary often will be affected. Adrenal imbalances can be measured via cortisol levels. Stress tends to raise cortisol levels, increasing insulin and thereby leading, in some cases, to insulin resistance and overproduction of cortisol, as measured by the saliva test, thus signaling trouble for the thyroid.33,34 Excess cortisol causes a decrease in thyroid expression by leading to diminished conversion of T4 into T3, the active hormone.

A progesterone-estrogen imbalance can similarly interfere with thyroid function as well as result from diminished thyroid function. Estrogen and thyroid hormone have opposite effects: estrogen causes calories to be turned into fat, and thyroid hormone causes fat calories to be turned into energy. So when progesterone is low and estrogen is dominant (even when TSH blood levels are normal), if symptoms of hypothyroidism are present, high estrogen levels could be the cause.35,36 Weight gain can also upset the progesterone-estrogen balance. To counteract this effect of estrogen, I generally recommend the use of topical progesterone creams. Higher levels of progesterone activate estrogen receptor sites in the body and cause the estrogen to be used before it can do harm. The progesterone-estrogen balance can be determined by a monthly saliva test or by progesterone and estrogen blood tests.

Autoimmune Thyroid Disease
Low progesterone in women between the ages of 30 and 50 may lead to autoimmune hypothyroiditis, or Hashimoto’s disease, as a consequence of immune stimulation by the dominant estrogen. In this condition, the body’s immune system develops antibodies to thyroid cell components, resulting in self-destruction of the thyroid gland; specifically, antibodies to thyroid peroxidase and thyroglobulin are generated pathologically. Twenty-five percent of such cases may also result from a genetic predisposition. This attack by the immune system on the thyroid results in damage to the cellular mitochondria, the energy producers in the cytoplasm, and the progressive destruction of the thyroid itself. Stress can also provoke this mitochondrial response, which in turn can result in other types of inflammation and allergies. To improve mitochondrial function, we use N-acetylcysteine (a precursor to glutathione), coenzyme Q10, and alpha lipoic acid, an antioxidant for liver and nerve health that also works to regenerate coenzyme Q10.37 This treatment also improves cholesterol and fat levels in the liver, and helps the gall bladder.

Looking for the Cause
In addition to treating both symptoms and organic dysfunction, it is important to identify and eliminate all other possible causative factors. These may include:

Iodine deficiencies. Iodine is an important component of T4 and T3. Although dietary iodine deficiencies are now almost nonexistent in the US, some people need to supplement their iodine intake with kelp, seaweed, or iodine tablets. Iodine is also found in dietary supplements such as Thyroid & L-Tyrosine Complex™ capsules, which contain other trace minerals needed for optimal endocrine function—such as iodine, magnesium, zinc, copper, and manganese—as well as tyrosine, the precursor to thyroid hormone.38

Toxicity/heavy metals. Metal toxicity, determined by hair analysis, can be addressed with chelation, both intravenous and oral. Selenium supplementation can also help remove heavy metals by working in conjunction with glutathione peroxidase, a compound found in asparagus, garlic, and mushrooms.39,40 A blood test can determine if selenium supplementation is needed; if so, there are several options, including Se-methylselenocysteine caps.

Candida. Candida is detected using stool testing for overgrowth of yeast and yeast antibodies. Eliminating yeast, sugar, and wheat from the diet helps to starve out candida. People suffering from this disorder should eliminate even honey and fruit sugars from their diet at first, and then slowly reintroduce them into the diet later. Twinlab Yeast Fighters include biotin, fiber, acidophilus, and herbs to support a healthy intestinal environment.

Environmental radiation. Radiation can cause free-radical damage to the thyroid, as has happened in Ukraine as a result of the Chernobyl nuclear reactor disaster. The cell mitochondria are also prone to free radical damage. I recommend turning off cell phones and unplugging bedside electronic and electrical devices (including the telephone) at night, even though these devices produce relatively low levels of radiation. Because electromagnetic radiation in food can also be problematic, eating organic food whenever possible is also recommended.

Treating Hypothyroidism
Conventional treatment calls for patients to take an oral, synthetic form of T4. Synthroid®, the most popular such medication, is used by about 8 million Americans. Especially in older people for whom the side effects can be more problematic, it is important to advance the dosage slowly until TSH blood levels return to normal. This medication usually must be taken for life.

I have discovered that many people respond better to Armour® Thyroid, which is desiccated porcine thyroid. A recent article in the New England Journal of Medicine claimed greater improvements in mood and brain function with Armour® Thyroid than with Synthroid®.41 I recommend starting treatment with a dose of 60-120 mg of Armour® desiccated thyroid, and then retesting in a month.

One of my patients, a woman in her early forties, complained of fatigue along with dry scalp and hair loss. She had gained 10 pounds and had irregular periods of depression. Because her blood test results were in the “normal” range, she went from doctor to doctor, until one physician prescribed birth control pills and Prozac®. When she consulted me, I noticed that her TSH level was 3 mµ/ml; this score, though considered to be within the normal range, may indicate low thyroid. I treated her empirically with Armour® Thyroid. I also tested her adrenals and found that they were hypofunctioning, and thus prescribed ashwagandha and Panax ginseng.42,43 Two weeks after treatment, the woman regained her energy and told me, “I have my life back!” The weight also disappeared—she dropped 10 pounds in eight weeks, her skin returned to normal, and her mood lifted.

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