Your Thyroid Gland. Metabolism Metabolism is defined as the sum of all physical and chemical changes that take place within the body.

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1 Treating and Beating Low Thyroid With Dr. Rodger H. Murphree DC, CNS The majority of this material comes from 5 th edition Treating and Beating Fibromyalgia and CFS New Patient Phone Consults available Your Thyroid Gland The thyroid gland is shaped like a butterfly and is located in the lower front part of your neck (just above the breastbone). It s responsible for secreting thyroid hormones, which travel through the bloodstream and help cells convert oxygen and calories to energy. Basically, thyroid hormones control a person s metabolism. Metabolism Metabolism is defined as the sum of all physical and chemical changes that take place within the body. If your thyroid is compromised, every cell and organ is affected. 1

2 Thyroid Disorders According to the American Association of Clinical Endocrinologists over 27 million Americans suffer from thyroid dysfunction, half of which go undiagnosed. Over 500,000 new cases of thyroid disease occurs each year. Hypothyroidism Over 10 million women with thyroid dysfunction go untreated. Another 8 million have true or classic hypothyroid and go undiagnosed. Hypothyroidism affects women 5-7 times more than men. Thyroid Disorders Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormoneunderactive or low Hyperthyroidism or Graves Disease, is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often referred to as an "overactive thyroid." 2

3 Thyroid Hormones The thyroid produces hormones that influence every organ, tissue, and cell in the body. Thyroid hormones also control heart rate, body weight, body temperature, energy level, muscle strength and and menstrual regularity. Your thyroid controls cellular energy (metabolism), maintains body temperature, regulates proper cell and tissue growth, affects brain function, moods and emotions. Symptoms of Hypo(low)Thyroid fatigue (the most profound symptom) headache dry skin swelling weight gain cold hands and feet 3

4 Symptoms of Hypo(low)Thyroid poor memory hair loss hoarseness nervousness depression Symptoms of Hypo(low)Thyroid joint and muscle pain burning or tingling in the hands and/or feet yellowing of skin from a build up of carotene (conversion of carotene to vitamin A is slowed by hypothyroidism) carpal tunnel syndrome Symptoms of Hypo(low)Thyroid problems with balance and equilibrium constipation myxedema (non pitting edema due to the deposition of mucin in the skin), especially around the ankles and below the eyes 4

5 Symptoms of Hypo(low)Thyroid high blood pressure chest pain hardening of the arteries high cholesterol menstrual irregularities, PMS, and infertility Symptoms of Hypo(low)Thyroid fibrocystic breast disease polycystic ovary syndrome reactive low blood sugars Psoriasis nasal allergies-sinus infections Thyroid Hormones Hormones are internal secretions transported through the bloodstream to various organs. The thyroids main purpose is to produce, store, and release two important hormones- triiodothyronine (T3) and thyroxine (T4). 5

6 Thyroid Releasing Hormone TRH causes the pituitary gland to secrete thyroid stimulating hormone (TSH). TSH goes up when the body needs more thyroid hormones and down when the body needs less thyroid hormones. Thyroid Hormone Feedback Loop The pituitary gland produces thyroid stimulating hormone (TSH). TSH then triggers the thyroid gland to produce thyroid hormones. Once the brain brain senses the thyroid gland has released enough hormones, TSH will be decreased. TSH Through this negative feedback system TSH and thyroid hormone production is controlled. The higher the TSH number the less thyroid hormones in the circulatory system (blood). The lower the TSH number the more thyroid hormones in the circulatory system (blood). 6

7 TSH When TSH is elevated (high) in a blood lab test Above 4.5 on conventional lab tests Above 3.0 on functional medicine lab tests This is interpreted by doctors as Hypothyroid or low thyroid (TSH going up to trigger release of more thyroid hormones) TSH When TSH is deficient (low) in a blood lab test Below.04 on conventional lab tests Below 1.0 on functional lab tests This is interpreted by doctors as Hyperthyroid or overactive thyroid (TSH going down to trigger release of less thyroid hormones) Thyroid Peroxidase (TPO) The release of TSH triggers thyroid peroxidase enzymes (TPO) to combine iodine with hydrogen peroxide creating T3 and T4 hormones. Anything that disrupts TPO enzyme function, interferes with proper thyroid hormone production and lowers thyroid function! 7

8 T3 and T4 T3 hormone is a combination of the amino acid L- tyrosine and three iodine molecules. T4hormoneis a combination of L-tyrosine and four iodine molecules. T3 and T4 Eighty percent of thyroid hormones are T4 hormones and seven percent are T3 hormones. T3 is considered the active hormone. It is 300times stronger or more active than T4and the hormone responsible for increasing metabolism. T3 and T4 Twenty percent of T4 becomes active in the intestines, provided there is enough good bacteria available (probiotics). Eighty percent of T3 comes from the conversion of T4 into the more active T3 Most of the conversion of T4 into T3 conversion takes place in the liver. 8

9 T3 and T4 Hormones T3 and T4 are carried through the blood stream by protein molecules known as thyroxine binding globulin (TBG). TBG carries the thyroid hormones to the appropriate cells. Anything that interferes with TBG will compromise thyroid function. Stress and Nutritional Deficiencies The thyroid gland which is controlled by the hypothalamus and pituitary may become compromised by any disruption to the HPA axis. So stress definitely takes a toll on thyroid function. Short-term stress causes an elevation of cortisol, which then blocks the conversion of T4 to active T3. Long-term stress can also compromise thyroid function Stress Compromises Thyroid Function The thyroid gland which is controlled by the hypothalamus and pituitary, and linked with the adrenal glands (HPA axis) may become compromised by any disruption to the HPA axis. So stress definitely takes a toll on thyroid function. 9

10 Hypothalamus Regulation Your hypothalamus gland constantly monitors all the systems in your body. This master gland acts as your body s regulatory computer, monitoring then making adjustments as needed. The hypothalamus produces thyroid-releasing hormone (TRH). Adrenal Fatigue Acute or chronic long-term stress may compromise the adrenals leading to a condition known as adrenal fatigue syndrome. Many of the symptoms of adrenal fatigue, fatigue, low moods, cold hands and feet, headaches, brain fog, low body temperature, etc., mimic those of low thyroid. G.A.S General Adaption Syndrome 3 Phases 1. Fight or Flight Response is the initial alarm reaction. Pituitary releases adrenocorticotrophic hormone (ACTH) Adrenaline and cortisol are released from the adrenal glands. Short-term stress causes an elevation of cortisol, which then blocks the conversion of T4 to T3. 10

11 Resistance Stage Cortisol is the main player in this phase of GAS. The resistance reaction allows the body to endure chronic stress. However long term stress comes at a price. Adrenal Exhaustion Chronic over secretion of cortisol leads to adrenal exhaustion, which accelerates the downward spiral towards chronic poor health. Once in adrenal exhaustion your body can t release enough cortisol to keep up with the daily demands. Eventually you become deficient in cortisol Adrenal Fatigue Clues you may have adrenal fatigue: Crave salt Skip breakfast Low blood sugar Low blood pressure Cold hands/cold feet Less tolerant of stress 11

12 Adrenal Fatigue The best way to test for adrenal fatigue is to work with your functional doctor and have them order a four sample adrenal cortisol/dhea panel done. Another option is to self test by taking your blood pressure lying down, then again within 30 seconds of standing. Your systolic number should go up by 10 points, if not then you most likely have adrenal fatigue. Adrenal Glandular Supplements Adrenal cortical glandular extracts Typically use 500mg twice a day breakfast and lunch. Here is the adrenal supplement I use for my patients html Don t recommend using whole glandular supplements only adrenal cortex Read more about adrenal fatigue Stress and Nutritional Deficiencies Long-term stress-depletes the nutrients needed to keep thyroid hormones at peak levels. Nutrition is involved in every aspect of T4 production, utilization, and conversion to T3. The minerals zinc and iodine; vitamins A, B2, B3, B6 and C; and the amino acid tyrosine are all needed for the production of T4. 12

13 Nutritional Deficiencies A deficiency in just about any of the B vitaminswill contribute to low thyroid function. Low levels of copper, magnesiumand manganesemay also prevent optimal thyroid function. Stress and Nutritional Deficiencies Seleniumis needed to convert T4 to T3, so a deficiency in this mineral can also cause thyroid dysfunction. High blood levels of fatty acids can also inhibit conversion of T4 to T3. A deficiency in iodine or the amino acid tyrosine especially can lead to thyroid dysfunction. Iodine Deficiency Iodineis simply necessaryto generate thyroid hormones (T4 has four atoms of iodine, and T3 has three). While many experts suggest that iodine deficiencies are rare in this country, our consumption has dropped drastically over the last 20 years. 13

14 Iodine Deficiency One test for iodine deficiency is the skin-patch test. Using a 2% Lugol s solution (available at any drug store), paint a 2-inch square patch onto your abdomen. Iodine deficiency is indicated if the painted patch disappears within 24 hours. If it lasts longer than 24 hours, your iodine status is normal. Iodine Self Testing If you test low in iodine, add one of any number of kelp or iodine supplements to your diet. Hashimoto s Thyroiditis may become worse with iodine therapy (check for thyroid antibodies). Prescription Medications and Low Thyroid Antidepressant medicationsalter the HPA axis by making the thyroid-releasing hormone(trh) and thyroidstimulating hormone (TSH) pathway less efficient. Antidepressants also divert the amino acid L-tyrosine, the precursor for the neurotransmitters dopamine and norepinephrine, from converting into the thyroid hormone T4. This is a bit ironic, since low thyroid function is a major cause of depression. 14

15 Prescription Medications and Low Thyroid Interferontypically interferes with thyroid function, and secondary thyroiditis occurs in up to 14% of those taking interferon. Methadone, synthetic estrogen, Tamoxifen,and cholesterol-lowering drugs increase the binding of thyroid hormones to chemicals that inactivate thyroid hormones. Dilantin(Phenytoin) and Carbamazeprine (Tegretol) decrease T4 and T3 by about 20%. Leads to Low Thyroid Function Certain Foods:Some foods eaten to excess may contribute to goiters and alter thyroid function: broccoli, cauliflower, Brussels sprouts, cabbage, mustard, kale, turnips, canola oil, soy, pine nuts, millet, and peanuts. Hashimoto s Thyroiditis Chronic thyroiditis is a swelling (inflammation) of the thyroid gland that often results in reduced thyroid function (hypothyroidism). 15

16 Over-Stimulated Immunity Hashimoto s thyroiditis is a type of autoimmune thyroid disease in which the immune system attacks and destroys the thyroid gland. Hashimoto s thyroiditis is the most common form of hypothyroidism and is generally treated with thyroid hormone replacement therapy. Hashimoto s Thyroiditis In most cases of Hashimoto s thyroiditis there is a steady slow, gradual attack against the thyroid tissue leading to a decline of optimal thyroid function. In Graves disease the attack is against the thyroid cells-leading to hyperfunction. Most people who have Hashimoto s never actually develop over active thyroid disease. Hashimoto s Thyroiditis Treating the symptom, elevated TSH, instead of the autoimmune disease leaves patients vulnerable to ongoing health issues and risk for further thyroid decline. Patients often go on meds yet never feel any better. The key is to treat the trigger or cause of the autoimmune attack-the trigger that is causing the attack of thyroid tissue. 16

17 Hashimoto Thyroiditis Symptoms include those normally seen in hypothyroid disease, including fatigue, depression, sensitivity to cold, weight gain, muscle weakness, coarsening of the skin, dry or brittle hair, constipation, muscle cramps, increased menstrual flow, and goiter (enlargement of the thyroid gland). Hashimoto s Thyroiditis Polycystic ovary disease syndrome (PCOS)-has been identified as a trigger for causing autoimmune thyroiditis. PCOS is the most common female hormone disorder in the United States. It typically presents as the inability to lose weight, infertility, hair loss, fatigue after meals, hormone dysfunctions, and sugar cravings. Insulin resistance is the driving factor. PCOS A blood test will reveal elevated fasting glucose, triglycerides, testosterone, and cholesterol. Triglyceride levels above the total cholesterol is strongly suggestive of insulin resistance. Insulin resistance is a condition in which the cells of the body become resistant to the hormone insulin. 17

18 PCOS Insulin resistance increases the activity of the enzyme 17,20 lyase, found in the theca cells of the ovaries, which leads to increased production of both testosterone and estrogen. Over-Stimulated Immunity Low progesteronein women age may lead to Hashimoto s disease as elevated estrogen levels cause the immune system to become over-stimulated. To compound this potential problem, estrogen-like chemical compounds can also block thyroid function. By binding to the estrogen-receptor sites on cells, they cause an increase in circulating estrogen. Over-Stimulated Immunity These chemicals include common environmental pollutants such as PCBs (polychlorinated biphenyls), dioxins, and pesticides. Unfortunately, though no longer produced in the US, these chemicals are routinely found in our food and water supply. 18

19 What Else Can Go Wrong with the Thyroid Gland? An imbalance in the estrogen-progesterone ratio can also interfere with proper thyroid function. So a vicious cycle may ensue when low thyroid function (from chronic stress) alters the normal estrogen-progesterone balance, which then contributes to further low thyroid. This case may be especially true for autoimmune thyroid disease. About 75% of autoimmune diseases occur in women, most frequently during their childbearing years. Hashimoto s Triggers Low vitamin D levels-vitamin D-optimal 50 ng/ml Gluten intolerance or full blown Celiac disease- Elevated estrogen Iodine is the major cofactor and stimulator for thyroid peroxidase (TPO). TPO is the enzyme under attack in Hashimoto s. Iodine supplements can make condition worse. Infectious agents Viral Triggers Rubella-German measles Rubeolla-measles Retrovirus-RNA Virus Influenza B Coxsackie Yersina-bacteria in the enterobacter family EBV I use XFLM to treat Hashimoto s: d1.html 19

20 Thyroid Antibodies Elevated thyroid antibodies indicate the body s immune system is attacking and compromising the thyroid gland. Thyroid antibodies may trigger hypo or hyper thyroid function. Thyroid Antibodies Thyroid Peroxidase antibody (TPO) This is the most common elevated antibody. Thyroglobulin antibodies (TgAb) isn t nearly as common as TPO but should be ordered on initial blood work. Thyroid stimulating Hormone Receptor Antibody (TRAb) is ordered only when hyperthyroid is suspected-tsi The first antibody, anti-tpo, attacks an enzyme normally found in your thyroid gland, called the Thyroid Peroxidase, which is important in the production of thyroid hormones. The second antibody, TgAb, attacks the key protein in the thyroid gland, the thyroglobulin, which is essential in the production of the T4 and T3 thyroid hormones. 20

21 There are three types of hypothyroid: primary, secondary, and tertiary. Primary hypothyroidismarises from a deficiency in the thyroid gland. Secondary hypothyroidism involves the pituitary gland. In tertiary hypothyroidism, the hypothalamus gland shuts down in response to overwhelming stress. Hypothyroid Protocols There are a variety of different causes or triggers for low thyroid function. In the next several slides I outline the various protocols. The majority of this information comes from my 5 th edition book, Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome Primary Hypothyroidism True dysfunction of thyroid gland TSH will be elevated above 3.0 on blood test Free and Total T4 usually normal or low Free T3 normal or low T3 uptake normal RT3 is normal 21

22 Protocol Thyroid glandular supplement or RX Priority One Thyroid 300 one BID on empty stomach Re-check labs in 6 weeks Good optimal daily allowance multivitamin Don t recommend thyroid glandular with iodine and or L-tyrosine. Iodine can aggravate autoimmune thyroiditis and tyrosine can suppress TPO function. Pituitary Hypofunction Protocol Thyroid glandular 300 Pituitary glandular Good optimal daily allowance multivitamin Patient will often have low blood sugar issues Adrenal cortisol panel and adrenal fatigue protocol recommended Under Conversion Chronic adrenal stress leads to excess cortisol Excess cortisol will block T4 from converting into active T3 hormone Infections and free radical damage can interfere with cellular absorption Since low T3 doesn t affect blood levels of TSH these patients often get missed 22

23 Under conversion Free T4 and Free T3 will be low All other markers will be normal Thyroid Resistance Brought on by stress. Pituitary and thyroid producing adequate hormones but hormones aren t entering cells. All thyroid labs are normal. Adrenal Fatigue is the usual culprit here. Test for and treat adrenal fatigue using appropriate protocols. Autoimmune Thyroid Elevated TPO and or TBG = autoimmune attack and thyroid gland destruction Thyroid Peroxidase and Thyroglobulin antibody When either or of these antibodies shows up on a blood test-first look for trigger, look for and treat cause, second use appropriate nutritional protocols to reduce the antibody. Use XFLM to treat 23

24 TH-1 and TH-2 and Cytokines TH-1 dominance TH-1 is the initial response to a foreign invader or antigen. T-Helper cells are up regulated and release cytokines, cellular protein messengers. TH-1 release inflammatory cytokines IL-2 and TNF-a TH-2 TH-2 is a delayed reaction where cells release antiinflammatory cytokines IL-4, IL-5, IL,10, and IL-13. Blood Test for TH-1 or TH-2 TH-1/TH-2 Panel TH-1 dominant elevated IFN and or IL-2 will be elevated TH-2 dominant IL-4 and or IL-10 will be elevated 24

25 TH-1 TH-2 Challenge 90% of cases are TH-1 TH-2 dominance best treated with: Astragalus Echinacea Glycyrrhizin Lemon Balm Maitake mushroom Mycoceuticsis what I use TH-1 TH-1 dominance best treated with: Pine bark extract-pycnogenol Grape seed extract Green tea extract Resveratrol XFLM is what I use with my patients Challenging Use one or more of the stimulating products for either TH-1 or TH-2. Challenge one at a time. If symptoms become worse then suspect need the one not challenging. Ex-if challenging with TH-1 stimulants and have negative reaction then switch to TH-2 stimulant supplements 25

26 Antioxidant Mix I normally start an antioxidant anti-inflammatory supplement with with then if no problems redo blood tests in one month to see if the TPO and or TGB are going down. If they aren t going down I ll challenge with opposite formula and retest again in one month. To learn more about this formula go to store Hashimoto s Thyroiditis May not see an elevated TSH Blood work may still look normal WHY? Because doctors are not doing a comprehensive panel We want to catch them before they go through years of misery. Do the detective work! Review Triggers PCOS Elevated testosterone & estrogen levels Low vitamin D Gluten intolerance Insulin resistance Autoimmune, ie: Epstein Barr Virus 26

27 Elevated TSH OTC Glandular T3 (Priority One thyroid 300 one BID) Thyroid Most doctors don t treat people with a level of 3.5 or even 4.0, but in the Functional Medicine world, anything above 3.0, they need to be treated. TSH is Above 3.0 & Everything Else is Normal. Put them on a good Optimal Daily vitamin and Priority 300 one BID Make sure their adrenal function is optimal adrenal test kit or test them with an orthostatic blood pressure test. Most will need an adrenal protocol. Re-check at 6 weeks. Adjust OTC supplements that you recommended as needed. Elevated Reverse T3 Place them on OTC Thyroid 300 Re-check in 4 weeks, make sure it s decreasing. Thyroid 300 is what I use If patient is on a synthetic medication, ie, Synthroid, that can cause an elevated Reverse T3 because the synthetic T4 is NOT converting into active T3. Encourage them to get their doctor to write them a Rx for Armour Thyroid instead or use Thyroid

28 OTC Glandulars Alter Blood Work Tell them to discontinue the OTC medication at least 3-4 weeks before they go back to their doctor, because their blood work will be altered. The medical doctor will assume he needs to reduce their hormone replacement medication, which will then compromise their treatment. Dr. Broda Barnes was the first to show that a low basal body temperature was associated with low thyroid. His first study was published in 1942 and appeared in The Journal of the American Medical Association. This study tracked 1,000 college students and showed that monitoring body temperature for thyroid function was a valid if not superior approach to other thyroid tests. Self Test for Low Thyroid A reading at or below 97.8 strongly suggests hypothyroid. A reading above 98.2 may indicate hyperthyroidism (over active thyroid). If using a digital thermometer wait 2 hours after waking up and take under the tongue (don t eat, drink or brush your teeth 10 minutes before taking temperature). 28

29 Thyroid 300 Put them on OTC Thyroid Re-test in 4 weeks Continue to monitor their body temperature Will NOT always see the body temperature go up (Like in Wilson s protocol) Goal is to change the subjective symptoms and continue to monitor their blood work. Keep It Simple. Always address adrenal fatigue. Always check if TSH is above 3.0 Check under/over conversions Elevated Reverse T3 can be due to Stress Low body temp with Low thyroid symptoms Treat them for Euthyroid. Using these Protocols You can help 85-90% of people that come to your practice For 10%-15% who are not responding, take the Apex course, and you will definitely benefit, as I have. 29

30 Functional Thyroid Lab Test TSH thyroid stimulating hormone Most common marker used to assess thyroid function TSH increase when T4 levels drop Traditional Lab range mu/l Functional Lab range mu/l TSH is Elevated In: Primary hypothyroid Hashimoto s thyroiditis Thyrotoxicosis due to pituitary tumor And in patients taking insufficient dose of thyroid meds TSH is Low In: Primary hyperthyroid Secondary and tertiary hypothyroidism 30

31 Total T4 Measures bound and unbound levels of T4 Traditional Lab range ug/d Functional Lab range 6-12 ug/d Total T4 TT4 is increased with depressed TSH in hyperthyroid conditions TT4 is decreased in with elevated thyroid hypofunction TT4 is decreased with low TSH in functional pituitary hypofunction Free T4 (FT4) Traditional Lab range ng/dl Functional Lab range ng/dl FT4 may be elevated in-hyperthyroidism Overdose of thyroid meds Disorders of decreased thyroid-binding globulins 31

32 Free Thyroxine FT4 FT4 low in- Hypothyroidism Hypothyroidism treated with T3 therapy Insufficient thyroid HRT Disorders of increased thyroid-binding globulins Total T3 (TT3) Traditional Lab range ng/dl Functional Lab range ng/dl TT3 elevated in- Hyperthyroidism T3 thyrotoxicosis Acute thyroiditis Elevated TBG TT3 TT3 low in- Hypothyroidism (may also be normal in those hypothyroidism) Starvation diets Disruption of the enzyme 5-deiodinase (which converts T4 to T3) associated with elevated cortisol and or elevated lipid peroxidase 32

33 Resin T3 Uptake This is a test that measures the amount of sites for the active (unbound T3) to bind on thyroxine-binding proteins. The more open binding sites the lower the resin uptake. The less open binding sites the higher the resin uptake Resin T3 Uptake Elevated in thyroid hyperfunction Heparin Testosterone Phenytoin High doses of salicylates Resin T3 Uptake T3 uptake is low in thyroid hypofunction Elevated estrogen HRT, birth control pills Heparin Methadone 33

34 Free T3 Traditional Lab range pg/ml Functional Lab range pg/ml High in- Hyperthyroidism Thyroid toxicosis Peripheral resistance syndrome Free T3 Low in- Hypothyroidism Third trimester of pregnancy Elevated cortisol levels Reverse T3 (RT3) Your body, especially the liver, can constantly be converting T4 to RT3 as a way to get rid of any unneeded T4. In any given day, it s stated that 40% of T4 goes to T3 and 20% of T4 goes to Reverse T3. 34

35 Reverse T3 (RT3) When your body needs to conserve energy, it may convert 50% or more to RT3, and the T3 is compromised. Phone consults available Thyroid supplements I use Adrenal supplement I use html 35