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Friday, September 26, 2014

Thyroid 101

Christopher Bray MD PhD

This is a condition where your thyroid (a major endocrine organ that controls metabolism) is not producing enough of the normal hormone. This is often treated with a replacement of this hormone that is given by mouth. One form is called levothyroxine or Synthroid. There are other forms of this replacement, which can be recommended (Tirosint, Armour, Nature-Throid, WP Thryoid – my favorite bioidentical, Cytomel, Thyrolar). Make sure you take the thyroid replacement 30 minutes before breakfast, on an empty stomach in the morning to prevent variable absorption. We often need to adjust the dose of your medication and use blood tests to determine these adjustments. Once you are stable, then checking these hormone levels every 6 months is appropriate.

Symptoms of hypothyroidism (or under treatment):

fatigue, exhaustion, depression, difficulty concentrating, unexplained weight gain, dry skin, dry/thinning hair, feeling cold, constipation, muscle cramps, increased menstrual flow, more frequent periods, infertility

Symptoms of hyperthyroidism (or over treatment):

nervousness, irritability, increased sweating, thinning of the skin, fine brittle hair, shaky hands, insomnia, racing heart, frequent bowel movements, weight loss despite good appetite, light menstrual flow, less frequent periods

Thyroid disease and pregnancy:

You should continue your thyroid medication during pregnancy. Often we need to increase your dose during pregnancy due to changes that happen in your protein levels during pregnancy. Please discuss with your physician.

Thyroid disease and diet / lifestyle:

  • Consume foods with natural iodine regularly (each T4 needs 4 iodine atoms): Fish and shellfish, grass-fed cow’s milk and yogurt, and pasture-raised eggs. Iodized salt is not correctly balanced and not very helpful. Sea salt has a better balanced form of iodine and many more trace minerals. Seaweed flakes (Dulse flakes, Wakame, Kombu Kelp, Alaria, and Nori) are also a good source of iodine.
  • Consume foods with natural selenium regularly: Brazil nuts, sunflower seeds, onions, fish, shellfish, mushrooms, turkey, chicken, grass-fed beef, pasture-raised eggs, and garlic. Our soil in Florida is selenium (and magnesium) deficient. Taking selenium with iodine helps prevent complications with hyperthyroidism.
  • Iodine is a halide and is blocked by other halides. Reduce exposure to alternative halides like bromine found in baked goods, plastics, soft drinks and fruit drinks (Pepsi recently replaced its toxic brominated vegetable oil – BVO – with sucrose acetate isobutyrate in Gatorade, but left it in Mountain Dew), certain medications, pesticides, and fire retardants (carpets, mattresses, upholstery).
  • Other blocking halides include fluorine and chlorine which are commonly found in drinking water, toothpaste, and some medications. Be cautious about over exposure.
  • Open the windows on your car when you first get in, most of the inside parts are made with bromine and chlorine which leach out into the air in the hot sun.
  • Reduce exposure to chlorinated and bromine-based pools and hot tubs.
  • Be cautious about perchlorate exposure (rocket fuel), found in drinking water, vegetables and fruit (even organic ones), and milk. 97% of samples of breast milk were recently found to have perchlorates.
  • Be cautious with too many goitrogens, which are foods that can interfere with thyroid function. Goitrogens include broccoli, brussels sprouts, cabbage, cauliflower, kale, kohlrabi, rutabaga, turnips, millet, spinach, strawberries, peaches, watercress, peanuts, radishes, and soybeans.
  • Autoimmune thyroid disease may require additional measures to keep things under control.

Advanced Thyroid Issues:

  • T4 is considered the storage form as it makes up 80% of the circulating thyroid hormones. T3 makes up the other 20% and is considered the active form. T3 is 300% more potent than T4 at the receptor level.
  • The body can control the amount of T3 in circulation by shifting T3 to reverse T3 (to tone down the metabolic rate, for example with rapid weight loss or stress).
  • Hashimoto’s is a situation where you are producing antibodies directed against the thyroid which render it inactive.
  • Basal body temperature (temperature of your body at rest) is useful to check for thyroid problem. Normal temperatures are 97.8 to 98.2 F. If low, hypothyroidism is suspected. Women in their childbearing years will have a higher temperature in the second half of their menstruate cycle due to progesterone and so this test is less accurate.
  • Humans usually have a ratio of T4 to T3 of 11 to 1. Thyroglobulin is a protein in the blood that usually binds T4 and T3.
  • Armour Thyroid, Nature-Throid, and WP Thyroid (pig thyroid extract) have a T4 to T3 ratio of 4.22 to 1 (different from humans).
  • Compounding of thyroid products to an exactly “tuned” dose and balance of T4 to T3 is possible.
  • There is very little molecular difference between “synthetic” levothyroxine (L-thyroxine) and “natural” thyroxine, except that in glandular thyroxine it is bound. D-thyroxine (the mirror image of thyroxine) was previously on the market, but removed due to cardiac side-effects and is not in any of the thyroid products.
  • Natural thyroid preparations (dessicated thyroid / thyroid glandular) also contain a small amount of T1, T2, and calcitonin. T1 and T2 are hormone precursors and byproducts of thyroid hormone synthesis. They do not act on the thyroid hormone receptor and are believed to be totally inert (inactive). However this is a controversial point.
  • T3 replacement is best done through twice a day dosing due to a shorter half-life for T3 (as compared to T4) unless it is taken in a protein bound form.
  • Herbs / supplements that mau support the thyroid include: Ashwagandha, B-complex, Guggul, L-Tyrosine, Magnesium, Manganese, Rhodiola, Selenium, Zinc.
  • The molecular structure of gliadin, the protein portion of gluten, closely resembles that of the thyroid gland. When gliadin breaches the protective barrier of the gut, and enters the bloodstream, the immune system tags it for destruction. These antibodies to gliadin also cause the body to attack thyroid tissue. This means if you have autoimmune thyroid disease and you eat foods containing gluten, your immune system will attack your thyroid. This can last for 6 months or more after exposure to gluten.

Drugs, foods, and conditions that may decrease T4 absorption.

Cholestyramine, cholestipol
Aluminum Hydroxide
Ferrous Sulfate
Calcium Carbonate
Cation-Exchange Resin
High Fiber Diet
Infants Fed Soybean Formula
Excess Soybean in Adults
Proton Pump Inhibitors
H-2 Blockers
Malabsorption Syndromes
Jejunum-ileal Bypass Surgery
Short Bowel Syndrome
Antiseizure medications (e.g., phenobarbital, phenytoin, carbamazepine, and rifampin)

Lifestyle, Enviromental, Pathologic Events causing decreased T3 (and increased  rT3)

Calorie restriction and fasting
Chemical exposure
Cold exposure
Chronic alcohol intake
Free radical load
Hemorrhagic shock
Insulin-dependent diabetes mellitus
Liver disease
Kidney disease
Severe or systemic illness
Severe injury
Stress (and elevated cortisol levels)
Toxic metal exposure (cadmium, mercury, lead)
Nutritional issues (iodine, selenium, zinc, niacin, Vitamin B12, lipoic acid, Vit E, Vit C)

What else is in your thyroid medication?

WP Thryoid Ingredients:
• Natural desiccated thyroid (porcine / pig)
• Inulin (from chicory root)
• Medium chain triglycerides

Tirosint Ingriedients:
• Levothyroxine (aka T4)
• Glycerin
• Gelatin
• Water

Nature-Throid Ingredients:
• Colloidal Silicon Dioxide (from mined ore: natural desiccant to protect from moisture and humidity)
• Dicalcium Phosphate (from mined ore, holds tablet together)
• Lactose Monohydrate (traceable amount as part of desiccated thyroid powder USP)
• Magnesium Stearate (from a vegetable source like palm oil; lubricating agent for tablet compress)
• Microcrystalline Cellulose (synthetic fiber base to provide volume & bulk: also binds thyroid hormones, sadly)
• Croscarmellose Sodium (aids in disintegration in stomach and sadly, even more cellulose!)
• Stearic Acid (from vegetable source–typically palm oil; holds ingredients together)
• Opadry II 85F19316 Clear (contains polyvinyl alcohol USP, talc USP and polyethylene glycol NF)
• Porcine Thyroid Powder, U.S. Pharmacopeia (USP)

Armour Ingredients:
• Porcine Thyroid Powder, U.S. Pharmacopeia
• Dextrose, Anhydrous (anhydrous means any water has been removed and makes the tablet more stable)
• Microcrystalline Cellulose, NF
• Sodium Starch Glycolate, NF
• Calcium Stearate NF (stabilizer and lubricant)
• Opadry White (Titanium dioxide used as whitening agent, but also contains trace amounts of PEG (polyethylene glycol), Polysorbate 80, and Hydroxypropyl Methycellulose)

Cytomel Ingredients:
• Liothyronine (aka T3)
• Calcium sulfate
• Gelatin
• Starch
• Stearic acid
• Sucrose
• Talc

Synthroid Ingredients:
• Acacia
• Confectioner's sugar (contains corn starch)
• Lactose monohydrate
• Magnesium stearate
• Povidone
• Talc
• The following are the color additives by tablet strength:
  • 25 FD&C Yellow No. 6 Aluminum Lake
  • 50 None
  • 75 FD&C Red No. 40 Aluminum Lake, FD&C Blue No. 2 Aluminum Lake
  • 88 FD&C Blue No. 1 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake, D&C Yellow No. 10 Aluminum Lake
  • 100 D&C Yellow No. 10 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake
  • 112 D&C Red No. 27 & 30 Aluminum Lake
  • 125 FD&C Yellow No. 6 Aluminum Lake, FD&C Red No. 40 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake
  • 137 FD&C Blue No. 1 Aluminum Lake
  • 150 FD&C Blue No. 2 Aluminum Lake
  • 175 FD&C Blue No. 1 Aluminum Lake, D&C Red No. 27 & 30 Aluminum Lake
  • 200 FD&C Red No. 40 Aluminum Lake
  • 300 D&C Yellow No. 10 Aluminum Lake, FD&C Yellow No. 6 Aluminum Lake, FD&C Blue No. 1 Aluminum Lake

Common medications with fluoride
  • Anesthetics (several agents for general anesthesia)
  • Antacids: Prevacid
  • Anti-axiety: Flurazepam, Halazepam, Hydroflumethaizide
  • Antibiotics: Cipro, Tequin, Levaquin, Avelox, Linezolid
  • Antidepressants: Celexa, Lexapro, Fluoxetine, Paroxetine, Fluvoxamine
  • Antifungals: Diflucan, Flucytosine, Voriconazole
  • Cholesterol: Lipitor, Zetia, Fluvastatin
  • Anti-malarial: Mefloquine
  • Chemo: Aprepitant, Fluoruracil
  • Arthritis: Celebrex, Sulindac
  • Psychotropic: Fluphenazine, Haloperidol, Trifluoperazine
  • Steroids: Betamethosone, Clobetasol, Dexamethasone, Flunisolide, Fluocinolone, Fluticasone (Flonase)

Is it possible to get off thyroid medication?
In short ... it depends, but the chances are not good if they thyroid is damaged.

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