The Thyroid Solution Excerpts

Chapter 1: Thyroid Imbalance - The Thyroid and the Mind (pages 4 to 6)
At any given time in the United States, more than 30 million people suffer from a thyroid disorder, more than 10 million women have low-grade thyroid imbalance, and nearly 10 million people with thyroid imbalance remain undiagnosed. Some 500,000 new cases of thyroid imbalance occur each year. All of these people are vulnerable to mental and emotional effects for a long time even after being diagnosed. Incorrect or inadequate treatment leads to unnecessary suffering for millions of these people. But these are numbers. Behind the numbers are the symptoms and ravaging mental effects experienced by real human beings.

For the past two decades, we have witnessed a major increase in the recognition and detection of thyroid diseases. This stems in part from improved medical technology, which has led to the development of sensitive methods of screening and diagnosing thyroid disorders. It also stems from the increased public awareness that thyroid disease may remain undiagnosed for a long time and that even mild thyroid dysfunction may affect your health. It is also likely that thyroid imbalance has become more common as a result of deleterious effects related to our environment. Recently, some medical associations such as the American Association of Clinical Endocrinologist have initiated public screenings for thyroid disease, much as cholesterol testing has become available in shopping malls and other public places. At any given time, more than half of patients with low-grade hypothyroidism remain undiagnosed. In a thyroid-screening program involving nearly two thousand people that I directed in the Houston area, 8% of those tested has an underactive thyroid. Many people screened had never heard of the thyroid gland but rushed to be tested when they recognized that they were suffering many of the symptoms listed in the announcement of the screening. In a statewide health fair in Colorado conducted in 1995, 9.5% of the 25,862 participants who were screened for thyroid imbalance were found to have an underactive thyroid and 2.2% had thyroid hormone excess. The public’s awareness of thyroid disease was boosted by press reports about former president George Bush and his wife, Barbara, Russian president Boris Yeltsin and Olympic track champion Gail Devers when they were diagnosed with thyroid disease. Thanks to these factors, people with unexplained symptoms are becoming increasingly likely to ask their physicians whether these symptoms might be related to an undiagnosed thyroid disorder.

As an endocrinologist who has focused his research, teaching, and patient care on thyroid conditions, I realized early on in my practice that taking care of thyroid patients was not as easy as I had expected. Treating and correcting a thyroid condition with medication may not always make the patient feel entirely better. I discovered that to care fully for my patients, to help them heal completely, I had to treat their feelings as well as their bodies. If they didn’t feel better even though their lab tests said they were cured, I learned to listen to them, believe them, and work with them to help them become wholly cured. In taking care of thyroid patients, the physician’s role is not merely to address physical discomfort, text the thyroid, and make sure blood test results are normal (indicating normal amounts of the various thyroid hormones in the bloodstream). Addressing the effects of thyroid disorders on the mind, helping patients cope with their condition, and counseling them sympathetically are equally important.

Many physicians treat dysfunctioning thyroids, but few of them listen to the person attached to the gland. They concentrate on the blood tests, and once your lab results become normal, for these physicians you case is closed. Yet you may go on to suffer for years from a variety of physical and mental symptoms left over from the thyroid imbalance. Research has shown that patients with thyroid imbalance continue to have symptoms even after their thyroid hormone blood levels have become normal with treatment. Physicians should be treating the still-suffering patients in a more comprehensive way for as long as it takes for the mental effects to subside. The reality today, however, is that millions of patients suffer needlessly while their doctors continue to treat thyroid dysfunction as a simple physical disorder rather than what it is: a complex blow to the body and brain.

In general, primary care physicians have not been adequately trained to detect and manage thyroid disease and may lack the expertise needed to diagnose and treat a wide range of thyroid disorders; they also receive little teaching on the effects of thyroid disease on mental health or on understanding the interplay between mind and the thyroid.

The majority of practitioners of internal medicine and family medicine complete their residency without having had some form of training in endocrinology (the field of hormones). When they leave their training programs, they have inadequate knowledge of thyroid disorders and inadequate experience in diagnosing and treating these disorders. As a consequence, they seldom look for subtle indications of thyroid disease. Often a primary care physician ignored the thyroid gland in a routine examination and fails to examine the gland by touch. Yet the simple touch examination, or palpation, of the thyroid gland is quite important in finding clues to the presence of thyroid disease. Often physicians are not taught how to palpate the thyroid gland during their training. Many physicians would admit that they were never taught the right way to examine the thyroid gland and do not do the exam routinely in their practice. Because both the physical and mental symptoms of thyroid disease masquerade as signs of many other illnesses, getting the proper diagnosis can sometimes take a long time. Often symptoms are misdiagnosed and mistreated. Until patients find the right doctor, they are left alone to deal with devastating effects, which may include depression or even upsetting changes in personal behavior. Thyroid imbalance can quickly escalate into a destructive brain chemistry disorder – as powerful and pervasive as major depression, an anxiety disorder, or manic-depression.

Once the brain has been denied thyroid hormone or oversupplied with it because of thyroid disease, it takes a long time to recover. If the symptoms are ignored, they can intensify. A vicious cycle occurs wherein the patients gets depressed, the thyroid disease worsens, physical and emotional effects multiply, and mental health suffers further. This cycle is not widely understood or recognized, and many physicians do not know how important it is to halt the cycle – or, indeed, how to halt it.

To understand how we got to this sad state of affairs, it is instructive to take a look at how perceptions of the thyroid and knowledge of its function have evolved over the past century.

Chapter 2: Stress and Thyroid Imbalance Which comes first? (Pages 20 – 22)
At the end of a lecture I gave to a third-year medical class, a student named John came to me and said that his twenty-three-year-old wife, Christy, had been experiencing, “odd symptoms” for the previous year and that her primary care physician could find nothing wrong with her. “I’m wondering whether she has a thyroid condition, because she has many of the symptoms you described,” he said. In my first encounter with Christy, she told me what was happening to her. Her scenario was typical of that many thyroid patients go through. Christy traced her symptoms to a period the year before when she and John had married and she had started law school. About the time, she began to gain weight and be extremely fatigued. At times, she felt her heart was beating fast; she was moody and would cry for no reason. Christy was having a hard time functioning and frequently felt “strange” in her body, which is often typical of panic attacks. She attributed her symptoms to the stress of being newly married and feeling torn between her husband and her studies. Her mother frequently blamed her for having brought her symptoms on herself, saying that Christy shouldn’t have started law school and gotten married at the same time. [beark] Her primary care physician was initially concerned that Christy’s palpitations might indicate a heart problem, but her heart exams turned out normal. Once he learned more about Christy’s schedule, the doctor, like her mother, suggested that her symptoms were due to stress. When Christy finally consulted me, I determined through blood test that she had an underactive thyroid. Christy told me:

“Before this time, I was a relaxed person. But suddenly anything would set me off. Even little annoyance or problems seems like the end of the world and had to be resolved right then. Even though I’m not a devoted cook, if John didn’t finish the meal I served, I would fly off the handle. I overreacted to everything, and john wouldn’t know from minute to minute what might set me off. This went on for an entire year.”

Clearly the stress Christy was feeling was actually creating more stress. Her thyroid imbalance made her unable to deal with the minor stresses that had never affected her previously.

Chapter 3: Hypothyroidism (When the Thyroid is underactive) (pg 47 -48)
Low-Grade Hypothyroidism
Once not discussed or even suspected, low-grade hypothyroidism and its effects on physical and mental health are increasingly pervasive, numerous studies have now concluded that low-grade hypothyroidism can contribute to high cholesterol levels, infertility, miscarriages, tiredness and depression. Research has shown that correcting low-grade hypothyroidism will result in a lowering of both total cholesterol and “bad” LDL cholesterol. Low-grade hypothyroidism can also cause high blood pressure and elevated triglycerides. Low-grade hypothyroidism causes the cells that cover blood vessels. This abnormality reverses with thyroid treatment as well left untreated; it will make you more likely to have coronary artery disease and heart attack. A recent study published in the Achieves of Internal Medicine showed that patients with low-grade hypothyroidism suffer more from coronary artery disease and cardiovascular death than people with normal thyroid function. Untreated low-grade hypothyroidism can also contribute to worsening peripheral vascular disease. Recent research has shown that in older people, peripheral vascular disease was present in 78% of those with low-grade hypothyroidism and in only 17% percent of those with normal thyroid. The reason for this increased risk of vascular disease among patients with low-grade hypothyroidism stems from elevation of blood pressure caused by low thyroid, higher levels of triglycerides and cholesterol, and high homocysteine levels. Even to this day, however, many physicians continue to believe that low-grade hypothyroidism has no significance. Some will tell their patients, “the condition isn’t enough to treat.” the most common physical symptoms experiences by patients with low-grade hypothyroidism are fatigue, dry skin, hair loss and cold intolerance. Some women may experience heavier and longer menstrual periods (menorrhagia) as a result of low-grade hypothyroidism.

In addition to having symptoms of depression or becoming vulnerable to depression (see Chapter 5); patients with low-grade hypothyroidism may experience hysteria, more frequent anxiety, and physical complaints. They may also have some impairment in memory-related abilities.

Chapter 4: Hyperthyroidism (When the Thyroid is Overactive) (pg 56 – 57)
Common sense might suggest that if too little thyroid hormone can cause you to sink into a state if clinical depression and rob you of your ability to function as before, too much thyroid hormone would make you feel happy, perky and on top of the world. This assumption however is only partially correct. When the brain is flooded with too much thyroid hormone, some people do experience a lasting elation. Thoughts race through the mind. Activities crowd the day.

Several years ago, my neighbor Nancy had the reputation of being overly friendly. She incessantly helped others with their chores and knew almost everyone in the condominium complex where we lived. She initiated conversations with everyone and constantly came up with new ideas and projects. It never occurred to anyone, including me that what animated Nancy with this incredible energy and enthusiasm was an overactive thyroid.

Talking to a retired woman one day, Nancy mentioned that her electric bill was outrageous because she always felt hot and had to use air-conditioning most of the time. When I got close to Nancy, I noticed the shakiness in her hands and the stare in her eyes, symptoms of an overactive thyroid.

It turned out that Nancy’s mildly manic (hypomanic) behavior was not her original nature. Nancy had, in fact, been a somewhat reserved person before she decided to move from Dallas to Houston to study and join her boyfriend. Nancy also suffered from many physical symptoms. She had lost weight despite eating more, her menstrual periods has become scanty, she had some acne on her face, her bowel movements had become increasingly frequent, she was losing some hair and she had a rapid heartbeat – but to her all these symptoms were trivial. Her brain and body were animated by extraordinary energy and elation. Nancy did not even consider that something might be wrong with her; she simply thought that she has become happier after joining her boyfriend in Houston.

Chapter 5: Thyroid Imbalance, Depression, Anxiety, and Mood Swings (pg 77 -79)
Your brain is unique. It creates your individual talents, perceptions and moods. Yet its individuality presents some challenges to physicians and brain researchers when they try to figure out how the brain, body and mind work together to generate specific mental states. For example, exact measurements or even precise definitions of what constitutes normal mental health continues to elude scientists. In recent past, some doctors may have defended normal mental health merely as the absence of overt mental disease such as manic-depression or schizophrenia. Today, most doctors have come to recognize that millions of people have various, more subtle forms of depression and anxiety.

More often than not, thyroid imbalance gives rise to mental and emotional symptoms of mild depression, intermittent rage disorder, mild attention deficit disorder, or other “minor syndromes” – conditions that cause suffering but are not pronounced enough to meet the psychiatric criteria of a mental condition. People with these conditions will find that their symptoms are magnified when a thyroid imbalance occurs. For a minority patients, such magnified symptoms may cause them to slip into a more pronounced mental illness, but for most thyroid patients, the mental effects of thyroid disease – such as fatigue, low mood and mood swings and lack of mental clarity – cause great suffering without being “psychiatric.”

Just as severe hypothyroidism is much less common than low-grade hypothyroidism, low-grade and borderline depression is much more common than easily diagnosed major depression.

Low-Grade Depression: Thyroid Shadow Syndrome
It is a common misconception that depression means mere sadness. The feeling of sadness is a normal response to the occurrence of a distressing event or to a disappointment in life. Although you may feel down and sad when depressed, sadness is not always a symptom of depression. In depression, a person’s feelings are disconnected from all that surrounds that person, so that he or she may be neither sad nor happy. This disconnection causes a blunting of excitement about life in general. Although when someone is asked whether he or she is depressed, the typical response is, “No, I don’t feel I’m depressed. I’m not sad,” this person may in fact be suffering from the characteristic symptoms of depression.

Chapter 7: Weight, Appetite, and Metabolism (The Thyroid’s Actions) (pg 123 – 125)
How Thyroid Hormone Affects Both Eating Behavior and Metabolism
Thyroid hormone is one of the main hormones that regulate the amount of leptin produced and the efficiency of leptin. It also interacts with the hypothalamic chemicals involved in regulating our satiety level and the chemical hormones that are released by the gastrointestinal tract that allow communication between the gastrointestinal system and the brain. Too much thyroid hormone in your system will make your leptin levels go down, and this will contribute to the excessive hunger will also make your ghrelin level lower, and this will make your metabolism speed up, causing you to lose weight despite eating more.

Low thyroid affects leptin and its efficiency, too. Hypothyroidism is often associated with weight gain and an inability to lose weight by dieting. This weight gain is best explained by the slowing of the body’s metabolism, so the breakdown of fat and energy is much lower than normal. When the potent thyroid hormone T3 is not delivered in sufficient amounts, leptin becomes inefficient at enhancing metabolism. This inefficiency also increases your cravings. And if you metabolism is low due to inefficient leptin, this inefficiency will in turn make the thyroid hormone in your body less effective at burning calories.

Chapter 9: “You’ve Changed” When the Thyroid and Relationships Collide (pg 157 – 158)
Women and men are fundamentally different in how they communicate and interpret each other’s language, behavior and emotions. Many couples come to recognize their real differences, accept them and eventually learn to deal with them.

The intrusion of a thyroid imbalance into a couple’s relationship very often exacerbates these differences. Subtle changes in how the afflicted person speaks and acts alter the dynamics of the relationship. Thyroid patients, particularly those suffering from an overactive thyroid, often become moody, anxious, angry, and irritable. And many begin to have a distorted perception of their partner’s behavior. Unfortunately, their partners may not understand what causes these changes. Inability to cope with changing demands and difficulty in communicating can lead to chaos, with misunderstanding, false expectations and arguments over trivial matters. For many people, the relationship becomes a burden.

People with a thyroid condition are having terrible trouble understanding themselves and their new, confused feeling, so they are unlikely to understand their partners. Indeed, thyroid patients are so overwhelmed by their new emotional problems that they cannot cope properly with the stress of the relationship, which becomes a cycle of reactions and counteractions. Both partners then share the mental stress provoked by the thyroid condition.

Chapter 11: Premenstrual Syndrome and Menopause (Tuning the Cycles) (pg 193)
From puberty to menopause, women’s bodies and brains are influenced by continuous cycles of hormones. These hormones are crucial not only for reproduction but also for the nature of a woman’s feminine identity. Sex hormones – including estrogen, progesterone, testosterone, and DHEA – also play an important role in thinking and memory, and they interact with chemicals in the brain that regulate mood, emotions and sex drive. The well-defined pattern of women’s monthly cycles is tightly regulated by messages from the hypothalamus and pituitary gland. Even though the thyroid system and the sex hormone system are two independent systems governed by the same “master gland,” the pituitary, there are important relationships between the two.

First, thyroid hormone affects the levels of sex hormones and the way they work in your body. A thyroid hormone imbalance frequently causes either heavy, prolonged menstrual period (especially in hypothyroidism) or brief, scanty menstrual periods, or even cessation of periods (in hyperthyroidism and also in severe hyperthyroidism). Thyroid hormone is also critical for conception and for a successful, healthy pregnancy.

Chapter 14: Getting the Proper Diagnosis (pg 231)
For years, the public has received conflicting information on how to diagnose a thyroid imbalance properly. Some holistic doctors and alternative practitioners may diagnose you as hypothyroid if you suffer from tiredness and other symptoms of low metabolism. They will use your basal (resting) temperature as an index of low thyroid and will monitor the treatment by having you check your basal temperature three to four times a day. Some doctors will treat your allergies, asthma, hair loss, dry skin and gastrointestinal upset with thyroid hormone, believing that you have an underactive thyroid even if your blood test are normal. They may tell you that thyroid hormone is not working well in your body and you need thyroid hormone treatment because you are hypothyroid. Many conventional doctors, in contrast, go strictly by blood test and believe that you have a thyroid imbalance only if your blood tests are clearly out of normal range.

Because of these differences of opinion, some people have remained undiagnosed even though they sought medical help, whereas others have been subjected to inappropriate and overzealous treatments that were damaging to their overall emotional and physical health. To avoid these pitfalls, you need to know about the most reliable tests for evaluating your thyroid and how to interpret them in light of your symptoms. That way, you won’t fall through the cracks and fail to receive the help that your need from your doctor.

Chapter 16: Curing the Lingering effects of Thyroid Imbalance (pg 277)
If you suffered a thyroid imbalance, your symptoms will typically resolve with adequate treatment. Sometimes, however, even after the physical and mental symptoms of hypothyroidism or hyperthyroidism have disappeared, you may still not feel like your old self. If your imbalance was severe or of long duration, moreover, you may continue to have emotional problems, anxiety, depressive symptoms, and even some residual cognitive deficits. As a result, you may not feel normal even though, technically and medically, you no longer have a thyroid imbalance.

Hyperthyroidism and hypothyroidism shake up your brain. Although you may recover completely if the imbalance is minimal and of short duration, a significant, long-term imbalance could affect your mind for a longtime even after you’ve been properly treated. Thyroid imbalances can affect your brain chemistry in the same way as long-term abuse of alcohol or drugs! Yet your physician may not know about these lingering effects because they have not been widely publicized, discussed or taught.

In this respect, conventional medicine has been unfair to thyroid patients with persistent symptoms. Because your doctor assesses whether you have been adequately treated for your thyroid condition by measuring blood hormone levels, he or she will look at the lab results and say, “Your thyroid test is normal; your symptoms are not due to your thyroid.” Yet you may feel deep inside that your persistent suffering does have something to do with your thyroid. And you would be correct.

Chapter 17: The New T4/T3 Protocol (pg 300 -301)
A few years ago, I was invited to a Christmas party at the home of a friend. Although I had known Alan for several years, I had never met his wife, Jennifer. When I arrived at the party, I noticed immediately that Jennifer has bulgy eyes, a symptom of the overactive thyroid condition Graves’ disease. Not only did her eyes protrude, but she also appeared depressed and withdrawn. She didn’t mingle easily and often snapped at her husband throughout the evening, clearly quite unhappy that she had to be at this party.

Later, I learned from Alan that Jennifer had been diagnosed with Graves’ disease two years earlier. What had driven her to seek a doctor’s help were her anger, extreme anxiety and wild mood swings, which were taking a toll on their marriage.

Alan also explained that her emotional problems hadn’t completely disappeared after her thyroid condition was treated. In fact, she never went back to “being herself”. As a result of the treatment of her overactive thyroid, Jennifer had become hypothyroid and was receiving thyroid hormone treatment in the form of synthetic thyroxine (T4). Several physicians told her that her thyroid hormone levels were normal and there was nothing more they could do for her. One even suggested that she go see a counselor. Jennifer did take a course of an antidepressant but stopped the medication after three months, when she realized that it produced no significant improvement in the way she felt.

Later, when I took over Jennifer’s care, she gradually returned to normal through an innovative treatment program that corrected the brain chemistry imbalance resulting from her thyroid condition. The program included the practice of a relaxation technique, but more important, it involved a dramatic change in the nature of her thyroid hormone treatment, from the use of a T4-only drug to a protocol I’ve devised that combines synthetic T4 (levothyroxine) and T3, the most potent and biologically active form of thyroid hormone. I believe that this protocol hold tremendous promise for a large number of people who, for whatever reason, are suffering from an underactive thyroid and need thyroid hormone treatment. I regard this new T4/T3 treatment as a state-of-the-art treatment for hypothyroidism and a viable alternative to the most widely accepted current medical approach, which has been to prescribe T4, a portion of which is then converted to T3 by bodily organs, including the brain.

“I think that there are a lot of women like me,” Jennifer told me, “who have to deal with the problems I faced every day without ever realizing that an effective treatment exists. And that’s too bad, because thyroid conditions can totally alter not only your personality but your physical appearance, and Lord knows that’s a tough burden to bear in today’s society.”

Chapter 18: Living a Thyroid-Friendly Life (Healthful Choices Day by Day) (pg 313)
Besides getting the right medical attention, you also need to follow a lifestyle that includes eating healthy foods, taking the right supplements, following an exercise regimen, and practicing relaxation techniques. All of these activities are important for you to reach and maintain optimal physical and mental health, even though some doctors may lead you to believe that regular monitoring of thyroid hormone levels and making adjustments in drug dosages is all you need. But given what we now know of the significant mind-body effects of thyroid disease, you have seen for yourself in the preceding chapters that a combination of therapies is a must.

We’ve seen the role of stress in triggering or perpetuating thyroid disease. But lifestyle factors also influence the likelihood of your developing a thyroid imbalance, including your diet and whether you exercise. These factors also determine to some extent how severe and consequential a thyroid imbalance will be. Your genes may make you susceptible to developing a thyroid condition, but whether or not you actually develop one is also linked to how you live your daily life.

It is certainly easier to prevent the onset of an autoimmune attack on the thyroid than to treat an imbalance once the attack has occurred. But even when the imbalance has already occurred, you can minimize and even halt some of its adverse effects on your health by following a thyroid-friendly lifestyle. Any such lifestyle must also take into account other health conditions to the mental and physical effects of a thyroid imbalance.