by Dr. Joseph Debé
One treatment option for hypothyroidism is thyroid hormone replacement therapy. This simply involves taking thyroid hormone in pill form to make up for what the body is failing to produce on its own. This is routinely the only treatment used for hypothyroidism by conventional medicine because it is believed that nothing more can be done. Hypothyroidism is believed to be a condition that is idiopathic – "cause unknown". As you are about to learn, the reality is that there are many factors that have been shown to lower thyroid function. Interestingly, most of the following information has been published in mainstream scientific journals and textbooks. To use no intervention other than thyroid replacement hormone almost guarantees that it will be needed for life. If you are comfortable with this proposition, that’s fine.
There is, however, another option. The underlying causes of the underactive thyroid can indeed be sought out and corrected. One good reason to consider this approach is the fact that whatever caused the underactive thyroid is likely to also cause other problems in the body. Investigation and treatment of the underlying causes of hypothyroidism can be carried out alone or in conjunction with thyroid hormone replacement therapy. There is no guarantee that any given case of hypothyroidism can be reversed, but if it can be done, our program is likely the one to accomplish it. We know of no other program that is nearly as comprehensive.
Restoring underactive thyroid function to normal is no minor undertaking. To do so will require thorough investigation and effort by both patient and doctor. Before we get into our program for reviving the thyroid, let's first review some basics about the thyroid.
The thyroid gland, located in the lower part of the neck, produces the hormones calcitonin, T4 (tetraiodothyronine) and T3 (triiodothyronine). However, about 80 percent of the body's T3 is actually produced outside the thyroid gland, primarily in the liver, by chemical modification of T4. T4 and T3 are composed of the mineral iodine and the amino acid tyrosine. Hormones are messenger molecules that circulate throughout the body, regulating diverse bodily functions. Calcitonin plays a role in calcium metabolism and is not involved in hypothyroidism. T4, and the more powerful hormone, T3, regulate body temperature and the metabolic (biochemical reaction) rate of every cell in the body. When the level and/or activity of these hormones falls, the body temperature drops and the rate of chemical reactions slows throughout the body. Less energy is produced and more bodyfat accumulates. Because thyroid hormones govern metabolic rate in all body cells, hypothyroidism (underactive thyroid activity) can affect all body functions and manifest in a variety of symptoms. Deficient levels of thyroid hormones can produce: fatigue; weight gain; depression; constipation; low body temperature; cold intolerance; hoarseness; muscle weakness; joint pain and stiffness; morning headaches; carpal tunnel and similar syndromes; goiter; hypertension; impaired kidney function; slow heart rate; dry, rough, yellow skin; thin, brittle nails; loss of sex drive; shortness of breath; muscle pains; water retention; impairment of concentration and memory; learning disabilities; altered immunity; coarse, dry, brittle hair; hair loss; high blood cholesterol and triglycerides; menstrual irregularities; miscarriage; premature deliveries; still births; and infertility.
There are many different factors that can contribute to hypothyroidism. These include: genetics, aging, stress, surgical or pharmaceutical treatment of hyperthyroidism, anorexia nervosa, fasting, malnutrition, nutrient insufficiencies, systemic illness, insulin resistance, inflammation, autoimmunity, physical trauma, smoking, radiation, iron-deficiency anemia, imbalance of other hormones including estrogen and progesterone, exposure to environmental pollutants and other toxins, some medications, inactivity, and even certain foods.
Sluggish thyroid activity can result from impairment of any of a number of steps in thyroid hormone metabolism. These steps include: stimulation of the thyroid by TSH (thyroid stimulating hormone) from the pituitary gland, accumulation of iodine within the thyroid gland; production of thyroid hormone; release of hormone from the thyroid gland into the blood; transport of thyroid hormone within the bloodstream; conversion of T4 to the more active thyroid hormone, T3; binding of thyroid hormone to cell receptors; transport of thyroid hormone into the cells (where it produces its activity); elimination of thyroid hormone from the body.
Much of your thyroid rejuvenation program will need to be customized based on results of special laboratory tests. However, we feel that some recommendations apply to virtually all patients with an underactive thyroid. Because certain foods impair thyroid function, we suggest that you consume only small amounts of these until your thyroid is normalized. These foods include: cabbage, Brussels sprouts, broccoli, kale, cauliflower, maize, turnips, sweet potatoes, lima beans, bamboo shoots, mustard greens, onions, green tea, peanuts, pinenuts, walnuts, almonds, sorghum, cassava, millet, grapefruit and apples. Although many of these foods have a reputation for being health promoting, they can be counterproductive for the individual striving to boost a sluggish thyroid. The question is: how much of these foods can be tolerated without adversely affecting thyroid function? Cooking some of these foods will eliminate their negative effects. Other foods that should be limited include those foods rich in saturated fats (beef, lamb, pork, dairy, organ meats, processed coconut and palm oils); trans fatty acid-containing, partially hydrogenated vegetable oils (found in margarine and most processed foods); and refined carbohydrates (table sugar, candy, cookies, crackers, muffins, bagels, cakes, pasta, most cereals and breads).
Eat mostly whole, unrefined foods the way nature provides them. For example, eat baked potatoes, rather than French-fries. Assure adequate protein intake. Eat liberal amounts of vegetables, legumes, fruits, nuts, seeds, fish and eggs. Consume smaller amounts of lean meats, poultry, dairy products, whole grains, whole grain breads and pastas. Cold water fish such as mackerel, salmon, and sardines should be consumed at least several times per week. Larger fish, such as tuna and swordfish, as well as shellfish and sea vegetables, often are contaminated with high levels of mercury, which can suppress thyroid function. Limit consumption of these foods, as well as fresh water fish, which are often contaminated with thyroid-suppressing PCBs. For those who will not eat fish, other options are supplements of fish oil, krill oil, cod liver oil, and algal oil. Choose "organic" produce and "free range" animal products whenever possible, in order to lower possible exposure to pollutants which poison thyroid metabolism. (For a list of some of the environmental toxins identified to interfere with thyroid function, see page 9.) Organic produce also has more vitamins, minerals, and phytonutrients than does conventional produce.
Further reduce pollution exposure by using a good quality water filter. A special filter to remove fluoride is required for those water supplies where fluoride is added. Chlorine and fluoride both substitute for iodine within molecules of thyroid hormone and alter its function. Not only is chlorine ingested in drinking water, it also enters the body through the skin and is inhaled in water vapor while showering. For those whose water supply has added chlorine, a shower filter to remove chlorine is also necessary. A whole house filter, to remove impurities in all the water supplied to your home, is something to consider.
Several natural supplements are worthy of consideration by any person with hypothyroidism. Guggulsterone, a plant-derived Ayurvedic remedy, aids in the stimulation of thyroid function, weight loss, and lowering of elevated blood cholesterol and triglycerides (which often result from hypothyroidism). Supplements of mixed mineral phosphates have been shown to prevent weight loss-induced drops in T3 levels. So, for those attempting to lose weight, mineral phosphates are a good choice. Thyrosol and GTA Forte are nutritional products formulated to support thyroid function. Ask us if they are appropriate in your particular case. Supplemental riboflavin (vitamin B2) can help drive a cellular energy-producing chemical reaction that becomes sluggish in hypothyroidism. This can make a difference for those hypothyroid individuals not using thyroid hormone replacement therapy. Individuals whose hypothyroidism is autoimmune in origin (Hashimoto’s Thyroiditis) may benefit from Inflamm-A-Stat, Kaprex A.I., and extra vitamin D3. Supplements of quercetin, alpha lipoic acid, P.A.B.A. and melatonin should be used with caution, as these have the potential to suppress thyroid activity.
Melatonin is a hormone produced by the body. Its production increases in response to darkness. That is one of the reasons people tend to gain more weight in the winter. To guard against melatonin suppressing your thyroid function, make sure to get regular exposure to sunlight (a good fifteen minutes a day). When this is not possible, an option is to sit within six feet of a special 10,000-lux lamp for half an hour or more on a daily basis.
Exercise stimulates thyroid hormone secretion and improves tissue sensitivity to the hormone. Regular exercise needs to be a part of your program. It is important to realize that weight loss programs that do not incorporate exercise can result in blunting of thyroid activity and excessive loss of healthy lean body tissue. Ideally, exercise should include muscle strengthening, stretching, and cardio-respiratory conditioning. If exercise is something new for you, ask us for some help in getting started on a regular program.
LABORATORY INVESTIGATION OF HYPOTHYROIDISM
Hopefully, by now, you are gaining an appreciation for the fact that the thyroid is not an isolated gland, functioning autonomously, without connection to other parts of the body. To get a better feel for just how complex thyroid metabolism (and metabolism in general) is, let's take a look at the influence of a single compound on thyroid function.
Reduced glutathione is a tripeptide (composed of three amino acids), produced by the body, which plays a role in the conversion of T4 to T3. Low levels of reduced glutathione can result in impaired thyroid function. Now take a look at all the things that can result in inadequate levels of reduced glutathione in the body: deficiencies of vitamins B2, B3, C, E, alpha-lipoic acid, and good quality protein; toxins from diverse sources such as medications (including acetaminophen), environmental pollutants, and heavy metals (lead, mercury, etc.); oxidative stress (imbalance of free radicals in relation to antioxidants); heavy alcohol consumption; and insulin resistance. These influences on levels of reduced glutathione are, in turn, affected by other factors such as: genetics, aging, inactivity, nutrient deficiencies, smoking, infection, inflammation, impaired detoxication, poor dietary choices, stress, suboptimal digestion and absorption function. Sound complex? It is. That is why we need to take a holistic approach and leave no stone unturned in our quest to normalize your thyroid and improve your health in general.
Many nutrients are required for proper thyroid function. Insufficiencies of any of these could result in impaired thyroid metabolism. These include: iodine, selenium, cobalt, zinc, iron, rubidium, copper, reduced glutathione, L-tyrosine, and vitamins A, B2, B3, B6, C, D and E. Iodine is critically important to thyroid function. Iodine status is evaluated by an iodine loading test done on a specimen obtained from a 24 hour urine collection. Iodine deficiency is the rule, not the exception. Most of the other nutrients are measured as part of an Individualized Optimal Nutrition (ION) Profile, which is a panel of eight different tests done on blood and urine specimens. The ION Profile evaluates other important areas including cellular energy production, neurotransmitter status, toxic metals, oxidative stress, adequacy of the body's detoxication pathways, and the waste produtcs of intestinal organisms.
The Comprehensive Digestive Stool Analysis is another important test for the hypothyroid individual. This test involves analysis of a stool specimen for two dozen different compounds. You may be eating the proper foods and consuming the right nutrients, but if you have suboptimal digestion or absorption, your body, including the thyroid, will suffer. The Comprehensive Digestive Stool Analysis gives a good indication as to your body's ability to digest and absorb food. This test gives additional information that can have a bearing on thyroid function, including the make-up of the different species of bacteria and yeast inhabiting your intestinal tract. Certain bacteria, parasites and yeast can provoke an inflammatory response by the body that can result in reduced thyroid function. Additionally, The body's immune system can sometimes produce antibodies against yeast and bacteria, which cross-react with the thyroid gland. This results in autoimmune hypothyroidism. Incidentally, the environmental pollutants PBBs (poly-brominated biphenyls) and PCBs (poly-chlorinated biphenyls), the grain protein gluten, as well as antipsychotic medications like phenothiazines, have also been implicated in autoimmune hypothyroidism. However, even without evoking an immune response, waste products from toxic organisms in the intestinal tract pass into the bloodstream and can poison various biochemical reactions and suppress thyroid metabolism. What’s more, abnormal intestinal flora, vegetarian diets, and rapid transit time (speed at which food passes through the gastrointestinal tract) can all contribute to reduced enterohepatic circulation of thyroid hormones. Enterohepatic circulation can be simply viewed as a way the body conserves thyroid hormones. Treatment to improve digestion, absorption, and bowel ecology is customized from results of the Comprehensive Digestive Stool Analysis. Testing for genetic intolerance to foods like gluten and testing for acquired delayed food rections is also important.
Obviously, toxicity is a potential contributor to hypothyroidism. We therefore advocate evaluation of toxins and the body's ability to detoxify itself. Two thyroid-suppressing toxins we test for are bromide and mercury. Bromide can be tested from blood. Mercury toxicity is best assessed with an evaluation of porphyrin levels from urine.
The liver is the main organ of detoxication and the site of greatest production of T3. The test we routinely use to assess the body's detoxication capacity is the Organix, which can be ordered as part of the ION Profile. The Comprehensive Detoxification Profile can be done if additional information is needed.. This test involves analysis of saliva, urine, and blood specimens after "challenging" the body to detoxify caffeine, Tylenol, and aspirin. The Comprehensive Detoxification Profile gives detailed information about the body's ability to process toxins, its current load of toxins and free radicals, and the status of its antioxidant defense system. Results from this test allow for recommendation of specific nutrients and foods to improve detoxication.
In fact, one of the most important therapies for improving thyroid function, and health in general, is an individually tailored metabolic detoxification program. Many people think of detoxification as simply colon cleansing. Metabolic detoxification is far more comprehensive. It involves use of food, scientifically proven detoxification supplements, and other natural therapies to help the body process and eliminate toxins from every cell, tissue and organ, not just the intestines. Metabolic detoxification is the single most powerful therapy we have. It often produces a significant reduction in chronic symptoms in a matter of weeks. We strongly encourage you to allow us to coach you through a metabolic detoxification program in order to rid the body of thyroid-suppressing toxins. Metabolic detoxification is an excellent way to start a weight loss program, as the loss of bodyfat liberates stored toxins and introduces them into circulation. Without proper detoxication, these toxins can produce damage throughout the body, including the thyroid.
Another test we recommend for our hypothyroid patients is The Adrenal Stress Index. This test involves analysis of saliva samples for levels of the stress hormones, cortisol and DHEA. Cortisol and DHEA are largely antagonistic to each other, and must be in proper balance for good health. Prolonged stress results in elevation of cortisol and suppression of DHEA. This causes breakdown throughout the body. High cortisol to DHEA ratios suppress TSH (thyroid stimulating hormone) levels. TSH, produced by the pituitary gland, which is located at the base of the brain, stimulates the thyroid to take-up iodine, manufacture and release thyroid hormones. Therefore, suppression of TSH results in lower thyroid activity. Elevated cortisol to DHEA levels also impair the conversion of T4 to T3. The body makes less T3 and more reverse (r) T3 in response to high cortisol to DHEA ratios. Reverse T3 is slightly different in structure from T3 and does not appropriately bind to receptor sites, as does T3. The rT3 blocks T3 from binding to receptor sites and exerting biologic activity, and fails to exert thyroid action of its own. The result is a slowing of metabolism. It is important to realize that the stress that can cause cortisol-DHEA imbalance is not only mental-emotional strain. These hormones also become altered by: excessive levels of sound and light, certain chemicals, fatigue, starvation, acute illness, pain, tissue injury, trauma, surgery, long airplane flights, heat, cold, and rapid fluctuations in blood sugar levels. The three most common stressors appear to be mental-emotional, tissue injury, and rapid fluctuations in blood sugar levels. The results of The Adrenal Stress Index test reveal whether imbalance of cortisol and DHEA may be impacting your health. The exact nature of abnormal values leads us to appropriate therapies to restore a normal stress response and, thus, "unstress" the thyroid.
Laboratory blood tests that identify inflammation are also important. These include SED rate, C-reactive protein, fibrinogen, white blood cell count, basophil cell count, and cytokines (IL-1, IL-6, TNF). Inflammation is another cause of low thyroid function. When present, the cause of the inflammation needs to be sought and dealt with appropriately. Common causes are infection, food antigens, nutritional imbalances, stress and toxicity.
Other tests may be indicated in any given case of hypothyroidism. For example, some women may have suppressed thyroid function due in part to elevated estrogen and/or low progesterone levels. These hormones are best evaluated with a "Female Hormone Panel". This is a laboratory test that measures these hormones from saliva samples. The results lead to customized treatment. However, to summarize, our general work-up for most individuals with hypothyroidism includes:
1. Individualized Optimal Nutrition Profile
2. Iodine loading test
3. Comprehensive Digestive Stool Analysis
4. Food sensitivity test
5. Adrenal Stress Index
6. Tests to identify inflammation
Results of these tests lead to customized treatment, which can correct the underlying causes of your impaired thyroid metabolism.
THYROID SUPPRESSING ENVIRONMENTAL CHEMICALS
As you read this list, think carefully about any possible exposure to these chemicals, past or present. Notify Dr. Debé if you think there is even a remote chance of any exposure (excluding food sources).
(Most of the following information on sources of chemicals and medications comes from The Merck Index, Twelfth Edition, 1996)
Methimazole and Carbimazole - used in silver electroplating; also used as antihyperthyroid medicine.
Goitrin - found in cruciferous vegetables.
Dichlorodiphenyltrichloroethane (DDT) - insecticide still in wide use in other countries; absorbed by ingestion, through the skin, and by inhalation.
Resorcinol - may be present in community water supplies, particularly in coal-rich areas of the world; used in tanning, resin adhesives, dyes, explosives, cosmetics, dyeing and printing textiles. Present in cigarette smoke.
Pyridines – found in coal and in cigarette smoke.
Phthalate esters and phthalaitic acids and their metabolites- found naturally in plants, fungal metabolites, shale, crude oil, and petroleum; common industrial water pollutants; used in varnishes and perfumes. As compounds that impart flexibility to plastics (comprising up to 40% of the weight of plastic), polyvinylchloride polymers (PVC) are widely used, including: in building and construction, home furnishings, cars, clothing and food wrappings. The thyroid-suppressing effect of these compounds results when they are chemically modified by certain types of bacteria (Gram-negative) which may contaminate drinking water or inhabit your intestinal tract!
Thiocyanate -found in brassica vegetables and cigarette smoke.
Fisetin, Kaemferol, Naringenin, and Quercetin- among the most potent of the thyroid – suppressing flavanoids, found in plants. Onions are a rich source of quercetin, grapefruits contain naringenin.
P-aminobenzoic acid (PABA) - used in sunscreens; a B vitamin co-factor.
Lithium - found in food; used in the production of alloys for aircrafts and aerospace; used in the plastics industry, ceramics, electrochemical cells, batteries, lubricating greases.
Nabam - agricultural fungicide.
Zineb - agricultural fungicide.
Ziram - agricultural fungicide; rubber vulcanization accelerator.
Aromatic Amines - fungicide, emulsifier, soil stabilizer.
Barbituric Acid - used in manufacture of plastics, pharmaceuticals.
Ethylene thiourea - accelerator in synthetic rubber production.
Polychlorinated biphenyls (PCBs) and Polybrominated biphenyls (PBBs) - once widely used industrial chemicals whose high stability contributed to long term deleterious environmental and health effects. Airborne PCBs accumulate in foliage. Used in electrical capacitors, electrical transformers, gas transmission turbines, vacuum pumps. Formerly used in the U.S. as hydraulic fluids, plasticizers, adhesives, fire retardants, wax extenders, dedusting agents, pesticide extenders, inks, lubricants, cutting oils, in heat transfer systems, carbonless reproducing paper. PCBs and PBBs are found in our food supply, especially certain fish.
Uracil - used in biochemical research.
Amphenone - used in biological research.
Meta-aminophenol - dye intermediate.
3-Methylcholanthrene - used in cancer research.
Phloroglucinol - used in chemistry, printing, and textile dyeing.
Rotenone - insecticide.
2,4-dinitrophenol - insecticide; herbicide; fungicide; wood preservative; used in the manufacture of dyes.
Quinone - used in the manufacture of dyes; in photography; tanning hides.
Perchlorate - salts for explosives and for plating of metals.
Thiourea - used in manufacture of resins; photographic fixing agent; used to remove stains from negatives.
Pentachlorophenol - wood and leather preservative. Found in the urine of 71% of Americans in a random sample.
Perfluorinated carboxylic acids (PCFAs) - persistent organic pollutants found in some cosmetic products, talc, and sunscreens.
Perfluoroalkyl Substances (PFASs) - contaminate some American drinking water, including Nassau County, New York
Fluoride - added to some water supplies (all of New York City), and toothpaste.
Chlorine - added to most water supplies, including all of New York City.
Bromide - added to grains; found in many medications.
MEDICATIONS KNOWN TO IMPAIR THYROID FUNCTION
The following list shows first, the class of medication. In most cases this is followed by additional information: the chemical name of the medication and then the brand names. Notify Dr. Debé if you have used any of these medications.
Non-Steroidal Anti-Inflammatory Drugs
Antiarrhythmic - Amiodarone - Amiordar, Ancoron, Angiodarona, Attansil, Cordarex, Cordarone, Cordarone X, Miocard, Miodacon, Ortacrone, Ritmocardyl, Rythmarone, Trangorex.
- Propranolol - Inderal
Antianginal - Amiodarone (see above) and 2-Thiouracil
Antihypertensive – Propranolol - Inderal
Tranquilizer – Chloropromazine – Thorazine
Antimalarial - Chloroquine - Arechin, Avloclor, Imagon, Malaquin, Resochin, Tresochin.
Antiamebic - Chloroquine (see above).
Antirheumatic - Chloroquine (see above).
Lupus Erythematosus suppressant - Chloroquine (see above).
Antibacterial - P-aminosalicylic acid - Aminocil, Aminopar, Bactylan, Entepas, Gabbropas, Osacyl, Pamisyl Sodium, Paracipan, Paramisan Sodium, Pasid, Pasara Sodium, Pasmed Sodium, Salvis.
Antibacterial - Sulfadiazine - Adiazine, Diazyl, Sulfolex.
- Sulfathiazole - Thiazamide, Cibazol, Duatok, Enterobiocine, Sulfamul, Sulfavitina, Sulzol.
Tuberculostatic - P-aminosalicylic acid (see above).
Fluoroquinolone Antibiotics - Ciprofloxacin, Cipro, Ciloxan eye drops, Levofloxacin, Levaquin, Quixin, Moxifloxacin, Avelox, Vigamox eye drops, Norfloxacin, Noroxin, Ofloxacin, Ocuflox, Floxin, Floxin Otic, Floxacin, Trovafloxacin, Trovan, and Alatrofloxacin
Antidepressants - Amitriptyline –Flavil
- Clomipramine –Anafranil
Doxepin – Adapin, Sinequan
Imipramine – Tofranil
Trimipramine – Surmontil
Amoxapine – Asendin
Desipramine – Norpramin, Pertrofrane
Maprotiline – Ludiomil
Nortriptyline – Pamelor
Protriptyline – Vivactil
Antihelmintic - 4-hexylresorcinol - Ascaryl, Caprokol, Crystoids, Gelovermin, Sucrets, Worm-Agen.
Topical Antiseptic - 4-hexylresorcinol (see above).
Topical Antiseptic - Substituted phenols
Kerotolytic - Resorcinol
Antiseborrheic - Resorcinol
Antihyperthyroid - Methimazole
Analgesic - Antipyrine - Analgesine, Anodynine, Parodyne, Phenylone, Sedatine.
Antispasmodic - Phloroglucinol
Sedative - Amobarbital - Somnal, Dormytal, Isomytal, Eunoctal, Amal, Mylodorm, Sednotic, Amasust, Stadadorm, Amytal.
Hypnotic - Amobarbital (see above)
Antifungal - Oligomycin
Anticoagulant - Dicumarol - Dicoumarol, Dicoumarin, Dicumol, Dufalone, Melitoxin.
Glucocorticoids - Betamethasone – Celestone Soluspan
- Cortisone Acetate - Cortone Acetate
- Dexamethasone – Dalalone D.P., Decadron
- Prednisolone – Hydeltrasol, Hydeltra-T.B.A., Pediapred, Prelone
- Hydrocortisone - Hydrocortone
Antihypotensive – Dopamine – Intropin, Dopastat
Cardiotonic - Ouabain
Topical Anti Pruritic - Substituted phenols
Ultraviolet Screen - P-aminobenzoic acid (PABA) - Amben, Paraminol, Sunbrella. Ingredient in Pobanol, Presun.
Topical Anesthetic - Substituted phenols
Congestive Heart Failure Medication - 2-Thiouracil
Interferon-a – used in cases of hepatitis C and some cancers
Estrogen (oral, not vaginal or transdermal) – Premarin and others
Cholesterol-Lowering – Clofibrate
Anti-Cancer - 5-fluorouraci – Efudex
- Tamoxifen - Nolvadex
Anticonvusant - Phenytoin – Dilantin
- Carbamazepine - Tegretol