Thyroid Imbalances Can Lead to Some Serious Medical Conditions, Iodine Deficiency May Have a Role in That
David Brownstein, MD, the author of “IODINE: Why You Need It, Why You Can’t Live Without It” wrote has written an interesting article about iodine, thyroid imbalances, and their connection with many medical conditions.
article by David Brownstein, MD
What if I told you that four out of 10 adult Americans (more than 52 million people) have a serious medical problem that is not being diagnosed or treated appropriately? Furthermore, this same condition has been linked to the epidemic of heart disease, stroke, and cancer that is afflicting more and more people. I have found it impossible to treat many chronic illnesses, such as fibromyalgia, chronic fatigue syndrome, and arthritis, without appropriately diagnosing and treating this condition first.
The illness to which I am referring is hypothyroidism. In this issue of Natural Way to Health, I will show you how conventional doctors use the wrong diagnostic tests and do not treat hypothyroidism effectively to prevent many chronic illnesses. I will discuss how hypothyroidism is being misrepresented and poorly treated by conventional medicine, and what you can do to assure that your thyroid gland is functioning at optimal levels.
Judy, a 34-year-old attorney, tearfully told me her story: “I feel like I am an old person. I can’t exercise since everything hurts, and I am always tired. I go to my doctor and she just wants to treat me with an antidepressant. Something is wrong with me.”
Judy was diagnosed with fibromyalgia, a condition marked by pain in the muscles and fatigue. When I took Judy’s history, she reported having irregular and painful menstrual periods, a feeling of coldness, constipation, hair loss, and dry skin. Each of these symptoms can be linked to hypothyroidism. Judy’s thyroid blood tests were all within the normal range. She had low basal body temperatures, averaging 96.2 degrees Fahrenheit (normal is 97.8 degrees). And she had many physical exam signs that meet the diagnosis of hypothyroidism, including slow reflexes, dry skin, swelling under her eyes, and an enlarged thyroid gland.
Because of her symptoms and physical exam signs, I elected to give Judy a therapeutic trial of natural, desiccated thyroid hormone, Westhroid. When I saw Judy back for a follow-up visit two months later, she was ecstatic. “I feel so much better. Everything is better. I feel like I have my family and my life back,” she said.
I hear stories like Judy’s over and over in my practice.
Let’s talk first about the thyroid. This gland sits in the lower part of the neck — below the Adam’s apple — and weighs about 1.5 ozs. During a year, the thyroid gland produces approximately a tsp of thyroid hormone. This small amount of hormone drives the metabolic rate of each of the trillions of cells in the body every day. Little variations in thyroid hormone thus have big effects on the body.
I became very interested in thyroid problems about 18 years ago. A 61-year-old patient of mine was suffering from severe heart disease. He had his first heart attack at age 40 and suffered a second heart attack a few years later. Over the next 20 years, he had two bypass surgeries and two angioplasties. This patient was overweight, smoked cigarettes, and suffered from adult-onset diabetes. He did not exercise and ate a very poor diet. For nearly 20 years, he suffered from continual angina. This patient was my father, Ellis.
He saw the best doctors in the Detroit area. My father was on a host of medications to treat diabetes, angina, an irregular heartbeat, elevated cholesterol levels, and blood pressure. At the time, I had just finished my residency and I was practicing strictly conventional medicine. My father looked terrible, and I felt he was going to die at any moment.
At that point in time, I had no interest in holistic medicine and mocked those who believed in it. However, I eventually came across a book titled Hypothyroidism, the Unsuspected Illness by Broda Barnes, M.D. Dr. Barnes was a family doctor
who dedicated more than 50 years of his medical practice to diagnosing and treating thyroid problems appropriately. When Dr. Barnes wrote this book in the early 1970s, he felt that most doctors were missing the diagnosis of hypothyroidism in patients who were clearly suffering from the condition.
In fact, he felt that the reliance on the common thyroid blood tests of that time was missing most of the people who had hypothyroidism. Dr. Barnes wrote, “40% of the American people — four of every 10 children and adults — today are suffering needlessly & many are dying for lack of an ingredient vital for health. Is the ingredient unknown? No. Or unavailable? No. For years, medicine has recognized the role of iodine deficiency in some areas of health and disease & has had clues to its great importance in many other areas.
“But the knowledge too often has not been used — and still is not being used — because of the unreliability of laboratory tests that have failed to show iodine deficiency even when doctors could see its manifestations clearly enough in patients before them. And while laboratory tests have erred and have misled both doctors and patients, patients have suffered.”1 Unfortunately, history still is repeating itself. Thirty years later, the same problem continues to happen.
Understanding the Gaps in Thyroid Testing
In medical school, I was taught to diagnose a hypothyroid problem by drawing laboratory tests in a patient that was suspected of having a thyroid problem. What are those laboratory tests? T4, T3, and TSH (or thyroid stimulating hormone). To understand the meaning of these tests, you have to understand the physiology of the thyroid gland.
The thyroid gland is part of the endocrine system. It produces thyroid hormone. Most of the thyroid hormone produced is known as thyroxine or T4. The number “four” in T4 refers to the number of iodine molecules attached to the thyroid hormone. In this case, there are four iodine molecules attached to the thyroid hormone. T4 is considered the “inactive” thyroid hormone, and T3 is considered the “active” thyroid hormone.
At the cell, T3 is the hormone that increases the cell’s metabolic rate. Research has shown that T3 (triiodothyronine) is 300 percent more active than T4.2 T4 is released into the bloodstream and carried throughout the body to the tissues. At the tissues and individual cells, the majority of T4 is converted to the more active T3.
Back to the laboratory tests: Remember, in medical school, doctors are trained to order thyroid tests. The primary test ordered is the TSH test. This hormone is secreted from the pituitary gland in the brain, stimulating the thyroid gland to produce thyroid hormone. In times of need, the pituitary gland will produce more TSH to try to force the thyroid gland to produce more thyroid hormone. If the TSH is elevated, doctors are taught that it is a sign of an underactive thyroid.
Normal TSH ranges generally run from approximately 0.4 to 5.0 mIU/L. If the TSH is in the normal range, doctors are trained that everything is working well in the thyroid and that there is no thyroid problem present. This philosophy has been taught to every single doctor in every medical school since the TSH test became available in the 1970s.
In fact, in medical school, in order to evaluate the thyroid gland, we were taught to check only the TSH level. We were told that if that level is normal, the patient does not have a thyroid problem. Sadly, most doctors today still follow this protocol and deride their patients who ask for further thyroid testing.
My job is to educate you on how to make the best choices for your health. When you learn about thyroid testing, you will see why checking solely the TSH is a poor way to evaluate thyroid function.
The job of the TSH hormone is to stimulate the thyroid gland to release thyroid hormone. The major problem with the TSH test is that the “normal” range is much too broad. There has been a lot of controversy over the years about what the optimal normal range for the TSH test should be. Some groups claim the range should be from 0.3 to 3.0 mIU/L and others say the range should be 0.5 to 5.0 mIU/L.
Since you are reading my newsletter, I assume you would like to know what I think. (Did you think I was not going to weigh in here?) My clinical experience has shown that most people do the best with a TSH level between 0.3 and 1.5 mIU/L. Having said that, each patient should be considered a unique biochemical individual. Some may do better at higher TSH levels, some at lower levels. I do believe the TSH test is a valuable test. But the TSH test never should be the only thyroid test ordered.
To evaluate thyroid function fully, thyroid hormone levels need to be drawn — T3 and T4 levels. These levels provide information on how the thyroid gland is functioning. If the TSH test is normal and T3 and T4 levels are low, one might conclude that the thyroid gland is malfunctioning. You would never know this, however, if you did just the TSH test.
It is also important to look at thyroid antibody tests — antithyroglobulin and antimicrosomal antibodies. These are substances the body produces that attack the thyroid gland. Thyroid conditions such as Hashimoto’s disease and Graves’ disease may be diagnosed by having positive antibody tests. I will discuss these illnesses in a future newsletter.
Finally, it is important to do a reverse T3 test. Reverse T3 testing rarely is done in conventional medicine. If reverse T3 levels are too high, it is an indication that the body cannot convert inactive thyroid hormone (T4) into active thyroid hormone (T3). This is one of the most common causes of hypothyroidism, one that conventional doctors miss.
I hope I have convinced you that proper thyroid testing is much more than a TSH test. But what are the consequences of checking just a TSH level and missing a diagnosis of hypothyroidism? Let’s go back to my father’s case. He had a normal TSH level. For more than 20 years, this was the only thyroid level my father had checked.
When I became aware of the inadequacy of checking only a TSH level, I ordered his other thyroid tests. It turned out he had normal, but low in the normal range, T3 and T4 levels. He also had low basal body temperatures.
Basal Body Temperature and Your Health
One overlooked test for evaluating the thyroid gland is the basal body temperature test. This is the first temperature in the morning before you rise. It is thought to be an indirect measure of the metabolic rate of the body. Remember, the thyroid gland is the main control of the metabolic rate of the body; in a hypothyroid condition, the metabolic rate is lowered.
Normal basal body temperatures range from 97.8 to 98.2 degrees Fahrenheit, under the arm or orally. If you use a rectal thermometer, add one degree.
Dr. Barnes used the basal thermometer test on his patients. He felt that this test was the best indicator of thyroid function — better than any lab test that was available at that time. In fact, Dr. Barnes first reported on the efficacy of the basal test in 1942 in The Journal of the American Medical Association.
In a hypothyroid case, the body is not receiving adequate amounts of thyroid hormone. The basal metabolic rate will slow down in order for the body to try to conserve its dwindling energy supply and thyroid hormones. The end result is that the core body temperature drops.
Many doctors ignore the significance of the basal body temperature test. However, the core temperature of the body is a very important measurement. Enzymes, hormones, white blood cells, red blood cells, and other tissues of the body all function optimally at a narrow body temperature (97.8 to 98.2 degrees Fahrenheit, orally or under the arm). Too high or too low temperatures inhibit normal body function.
However, the basal thermometer test is not perfect. I have seen patients who feel great but have low basal body temperatures, and I have seen patients who feel terrible with low basal temperatures. It is just one measure of how the thyroid gland may be functioning. Just as with any thyroid test, it must be put into context with the other thyroid tests as well as the physical exam and history.
A lowered basal body temperature does not guarantee a thyroid problem. There are other conditions in which the basal temperature may be lowered, such as pituitary failure, low adrenal function, and starvation. However, a careful history, physical exam, and appropriate lab work can delineate these different conditions. Contrary to what conventional doctors claim, following your basal body temperature can provide you with useful information.
My father had a very low basal body temperature — 96.5 degrees Fahrenheit averaged over five days. When I put together all the information I had obtained on my dad — normal TSH, low-normal T3 and T4 levels, lowered basal body temperature, high cholesterol, obesity, and heart attack history — I decided to give him a therapeutic trial of natural, desiccated thyroid hormone.
Remember, conventional training would not give him a diagnosis of hypothyroidism, since his thyroid tests were in the normal range. What were the results of treating him with thyroid hormone? The response was astounding. It changed not only his life but also mine.
Within seven days, his 20-year history of angina melted away, never to return. Thirty days later, his cholesterol was below 200 mg/dl, and he was able to discontinue his cholesterol-lowering medication. In fact, he did not need the cholesterol-lowering medication at all; he needed his thyroid deficiency corrected. Ellis lost weight even without changing his diet. More importantly, my father looked better and acted better. At that point, I no longer felt he was going to die at any minute.
Unfortunately, for 20 years, he was tested only for TSH levels. I believe his diagnosis of hypothyroidism was missed for those decades. In my father’s case, I believe that the consequence was the acceleration of his severe heart disease because of the failure
to diagnose and treat his hypothyroid condition properly.
The relationship between hypothyroidism and heart disease has been written in the medical literature for well over a hundred years. The first case reports of hypothyroidism causing heart disease were described in the 1800s. Dr. Barnes wrote about this relationship in his book. When I read that chapter, I remember getting a knot in my stomach. He was describing what had happened to my father.
Hypothyroidism and Heart Disease
How does hypothyroidism cause heart disease? For nearly a century, medical articles have been written linking the development of atherosclerosis with hypothyroidism. Animal studies have confirmed that hypothyroidism causes atherosclerosis.
Hypothyroidism is associated as well with elevated cholesterol levels. Again, this relationship has been known for more than 75 years. Any patient with elevated cholesterol levels deserves a thorough evaluation of the thyroid. This includes more than just checking the TSH level.
In my father’s case, his cholesterol level was always very high — averaging 350 mg/dl. Much to my consternation, he never ate a good diet. Ellis loved fast food and loved to eat in general. Once he was diagnosed and treated for hypothyroidism, his cholesterol level fell dramatically.
My dad’s response forced me to look at my practice of medicine differently. I had been taught to look at the TSH test as the only guide to diagnosing and treating hypothyroidism. Seeing the results in my father shook me to my core. In fact, it allowed me to look beyond my medical training to search for safe and effective natural therapies that treat the underlying cause of illness. I credit this experience for giving me my passion for holistic medicine.
Natural, desiccated thyroid is a glandular porcine (pig-derived) thyroid hormone. It has been used in its current form for more than a century. (In fact, it is one of the oldest medications known to man.) The most well-known brand of desiccated thyroid is Armour Thyroid. However, over the last year the largest manufacturer of desiccated thyroid, Armour Thyroid made by Forest Laboratories, has not made its product readily available.
There is no doubt that iodine status needs to be evaluated in anyone with a thyroid problem. In testing more than 5,000 patients, my partners and I clearly have found iodine deficiency occurring at epidemic rates. More than 96 percent of patients we have tested are deficient in iodine, with most significantly deficient.
Remember, the thyroid gland cannot manufacture thyroid hormone without adequate amounts of iodine available to it. If you are diagnosed with a hypothyroid condition, I suggest having your iodine levels checked before beginning thyroid hormone replacement therapy. If you take thyroid hormone and you are deficient in iodine, the thyroid replacement actually exacerbates the deficiency. Many patients can effectively treat their hypothyroid condition by correcting iodine deficiency.
Hypothyroidism is a common medical problem affecting between 10 percent and 40 percent of the population. It is, however, a treatable condition that can be managed. Untreated hypothyroidism leads to the development of many serious illnesses, including fibromyalgia, chronic fatigue syndrome, heart disease, and cancer. More information on a holistic approach to hypothyroidism can be found in my book, Overcoming Thyroid Disorders.
About David Brownstein
David Brownstein, M.D., is a board- certified family physician and one of the foremost practitioners of holistic medicine. His books include Drugs That Don’t Work and Natural Therapies That Do!; Iodine: Why You Need It, Why You Can’t Live Without It; Salt Your Way To Health; The Miracle of Natural Hormones; Overcoming Arthritis, Overcoming Thyroid Disorders; The Guide to a Gluten-Free Diet; The Guide to Healthy Eating; and The Guide to a Dairy-Free Diet. He is the medical director of the Center for Holistic Medicine in West Bloomfield, Mich. For more information about Dr. Brownstein, please go to www.drbrownstein.com.
References
1 Barnes, Broda. Hypothyroidism, the Unsuspected Illness. Harper and Row. 1976
2 Harrison’s Principles of Internal Medicine. 14th Edition. 1998