Are You Sick and Tired of being so Tired?

• Do you feel run down most of the time?

• Is it hard to get going in the morning?

• Do you feel wiped out after lunch?

• Do you tend to hibernate on the weekends to rest up?

• Has your get up and go got up and went?

If so, this newsletter will provide valuable information on why you may feel so lethargic and more importantly what you can do to feel more energetic.

Second only to pain, fatigue is a common patient complaint. My patients often ask how they can boost their energy levels. They complain of feeling drained of energy, making it hard to get out of bed and endure another demanding day. Some find that they are wiped out by early afternoon, others never get going before afternoon. Uncovering the reasons for chronic low energy states takes time and persistence. The good news is that there are several ways to correct low energy levels.

In this months newsletter I’ll address one of the common reasons for being chronically tired; undiagnosed or misdiagnosed hypothyroidism.

Some of the following material is taken from my updated and  expanded 3rd edition of Treating and Beating Fibromyalgia and Chronic Fatigue Syndrome, due in bookstores Fall 2006.

Hypothyroidism

Over 20 million Americans suffer from thyroid dysfunction. And over 500,000 new cases of thyroid disease occur each year. However, as staggering as those numbers appear, millions more go undiagnosed. It’s estimated that more than 10 million women have a low-grade thyroid dysfunction, which isn’t treated. And almost another 8 million people with low thyroid go undiagnosed.

Like my patient Allison, many individuals with low or hypothyroid simply fall through the cracks.

Allison K.

I really felt terrible most of the time. I had no energy at all. I’d gained 40 pounds over the last year even though I ate very little and tried to follow my Weight Watcher’s program. I kept cutting my calorie intake and even started skipping meals in an attempt to lose weight. The less I ate the worse I felt. I had numerous sinus infections, which I had never had before. My hair was falling out, I had tingling pain in my hands and feet and always felt cold even in the summer. I had this constant ringing in my ears. I was depressed or anxious a good deal of the time. Every doctor I consulted said that my blood tests were normal and it must be my fibromyalgia that was causing me to feel so bad. I knew something was wrong with me, but I couldn't find anyone who could help me. One doctor said I had all the symptoms of low thyroid. But, the endocrinologist she referred me to, said all my tests were normal. How could my thyroid be normal when I have all the symptoms of hypothyroid?

Allison’s story is a typical one. I routinely have new patients who present with all the symptoms of hypothyroid: 

• fatigue (the most profound symptom)

• headache

• dry skin

• swelling

• weight gain

• cold hands and feet

• poor memory

• hair loss

• hoarseness

• nervousness

• depression

• joint and muscle pain

• burning or tingling sensations in the hands and/or feet 

(hypothyroid neuropathy)

• yellowing of skin from a build up of carotene (conversion of 

carotene to vitamin A is slowed by hypothyroidism)

• carpal tunnel syndrome

• problems with balance and equilibrium (unsteadiness or lack of 

coordination)

• constipation (from slowed metabolism)

• edema around the ankles, below the eyes, and elsewhere

• observation of delayed Achilles tendon reflex test

• hypertension (high blood pressure)

• angina (chest pain)

• atherosclerosis (hardening of the arteries)

• hypercholesterolemia (high cholesterol)

• menstrual irregularities

• infertility

• PMS

• fibrocystic breast disease

• polycystic ovary syndrome

• reactive hypoglycemia

• psoriasis

• urticaria

• allergic rhinitis

Thyroid hormones control a person’s metabolism. Metabolism is defined as the sum of all physical and chemical changes that take place within the body; it’s all the energy and material transformation that occur within living cells. Every cell in the body depends on having enough thyroid hormone. If your thyroid gland becomes dysfunctional, every cell in the body suffers. This is why thyroid disorders can cause so many problems. Low thyroid is a common finding my chronically ill patients. This is especially true for those suffering with anxiety, depression, heart disease, and asthma.

I estimate that as many as 40% of my FMS and CFS patients suffer from low or hypothyroid function.

Understanding Thyroid Hormones,
T3, T4, AND TSH

When your thyroid gland produces too much thyroid hormone, this is known as hyperthyroid. When your thyroid doesn’t produce enough thyroid hormone, it's called hypothyroid. The hypothalamus stimulates the pituitary gland to produce thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to produce and release the hormone, thyroxine (T4). T4 hormone is then converted into the more active, triiodothyronine (T3). T3 hormone is essential for life and four times more active than T4. You can live without T4 but not without T3. If T4 doesn’t convert into active T3, symptoms of low thyroid start to show up. This can happen in spite of a normal TSH blood test reading.

Chronic Stress Leads to Low Thyroid

The symptoms of low thyroid tend to come on or become worse after a major stressful event. Childbirth, divorce, death of a loved one, job or family stress, chronic illness, surgery, trauma, excessive dieting, and other stressful events can all lead to hypothyroidism. Under significant physical, mental, or emotional stress, the body slows down the metabolism by decreasing the amount of raw material (T4) that is converted to the active thyroid hormone (T3). This is done to conserve energy. However, when the stress is over, the metabolism is supposed to speed up and return to normal. This process can become derailed by a buildup of reverse T3 (rT3) hormone. Reverse T3 can build to such high levels that it begins to start using up the enzyme that converts T4 to T3. The more stress the more likely rT3 can block T4 from converting into T3.

Blood Tests are Often Inaccurate

Blood tests for thyroid function measure the amount of TSH, T4, and T3 in the bloodstream. But thyroid hormones don’t operate within the bloodstream; the action takes place in the cells themselves. Blood tests are measuring how much thyroid hormone is  swimming around in the blood stream, but not what is in the cell. 

Traditional medical professionals know that thyroid blood tests are less than perfect.

The Journal of Clinical Psychiatry has reported: Laboratory blood tests for thyroid may be inaccurate for many who get tested for hypothyroid disorder.

Compounding the problem of using standard blood tests to diagnose hypothyroid is the inability of doctors to agree on the laboratory parameters. According to the American Association of Clinical Endocrinologists (AACE) guidelines, doctors have typically been basing their diagnoses on the "normal" range for the TSH test. The typical normal TSH levels at most laboratories, has fallen between the 0.5 to 5.0 range. Those with a TSH below .5 are considered to have too much thyroid hormone (hyperthyroid). Those whose test results are above 5 are considered to have too little thyroid (hypothyroid). However, it’s not uncommon to find doctors, including endocrinologists (thyroid specialist), who withhold the diagnoses and treatment of hypothyroid until a patient's TSH tests read considerably above 10. While some doctors believe that anyone who has a TSH above 2 and complains of hypothyroid symptoms (depression, fatigue, brain fog, etc.) should be placed on thyroid hormone. While doctors often debate which parameters or numbers are correct, millions of low thyroid patients are not properly diagnosed and treated.

“You have all the symptoms of hypothyroid but your blood work looks fine.”

Patients often relate that they, and sometimes their doctors, suspect a thyroid problem only to have their blood work return normal.

Doctors are typically reluctant to prescribe thyroid replacement therapy without a definitive test that reveals true hypothyroid. They’re afraid that by doing so, they would jeopardize the health of the patient. And true, excess thyroid can cause several unwanted health problems, including elevated heart rate, rapid pulse, and accelerated bone loss. However, millions suffer with symptoms far worse then these when prescription therapy is withheld. Certainly the dangers of thyroid replacement therapy should be a concern. But, if you weigh the pros and cons of administering thyroid replacement therapy to a patient with normal blood tests, yet all the symptoms of hypothyroid, fatigue, anxiety, depression, achy diffuse pain, weight gain, etc., it's easy to see that withholding therapy should be considered malpractice. This is especially true in light of the fact that many of these patients are taking numerous, potential dangerous drugs, to cover-up the symptoms of hypothyroid; Provigil or Aderall to increase energy, antibiotics for chronic sinus infections, a laxative for constipation, NSAIDs for  pain, SSRI medication for depression, Neurontin for tingling in the hands and feet, and perhaps a benzodiazepine  like Ativan or Xanax for anxiety. All of these drugs may cause side effects that may cause further symptoms (poor sleep, fatigue, depression, etc.). It’s not uncommon for my patients to be able to drastically reduce or eventually wean off these very medications once their thyroid disorder is corrected.

New Developments

To complicate matters, the parameters for determining who has a thyroid disorder, and who doesn’t, has recently been changed. The new guidelines narrow the range for acceptable thyroid function; the AACE is now encouraging doctors to consider thyroid treatment for patients who test the target TSH level of 0.3 to 3.04, a far narrower range. The AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder but have gone untreated until now.

Self-test for Low Thyroid

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 JAMA. 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.

The test for low thyroid function, according to Dr. Barnes’s protocol, starts first thing in the morning. While still in bed, shake down and place the thermometer (preferably mercury; digital thermometers are not as accurate) under your arm and leave it there for 10 minutes. Record your temperature in a daily log. Women who are still having menstrual cycles should take their temperature after the third day of their period. Menopausal women can take their temperature on any day. A reading below the normal 97.8 degrees strongly suggests hypothyroid. A reading above 98.2 degrees may indicate hyperthyroidism (overactive thyroid).

Treatment for Hypothyroid, The Barnes Method

Dr. Barnes recommends patients take a desiccated glandular (derived from pigs) prescription medication known as Armour Thyroid, which was used before synthetic medications such as Synthroid were introduced. Armour Thyroid and other prescription thyroid glandulars (including Westhroid), contain both T4 and T3.

Synthroid and other synthetic thyroid medications contain T4 only. Since some individuals have a difficult time converting inactive T4 to active T3, these medications may not work at the cellular level. Individuals may take T4 medications for years and never notice much improvement. Their blood tests look good, but in the mean time they’re falling apart; gaining weight, having more aches and pains, battling one sinus infection after another, and becoming more and more fatigued, depressed, and withdrawn. Research is validating what many doctors including Dr. Barnes has been advocating for years, a combination of T4 and T3 therapy is superior to synthetic T4 therapy alone.

Low Thyroid and Depression

Several studies demonstrate that a combination of T4 and T3 or simply T3 therapy alone, may provide welcomed relief from a number of symptoms commonly associated with depression. Studies show that T3 therapy is more effective in reducing the symptoms associated with depression than SSRI antidepressants.

Overall Wellbeing

A study by the New England Journal of Medicine showed that patients who received a combination of T4 and T3 were mentally sharper, less depressed, and feeling better overall than a control group who received T4 only. The addition of T3 often helps with many symptoms of hypothyroidism that may not disappear with supplemental T4 only. It has improved or eliminated depression, brain fog, feeling cold, constipation, chronic fatigue, headaches, insomnia, muscle and joint pain, and chronic sinus infections.

Weight Loss

For some people it has helped them finally lose weight.

Fibromyalgia

One study showed that all the symptoms associated with FMS could be eliminated while the patient was taking high-doses (120 mcg.) of T3.  

Questions

Can I take Thyroid Boost to help me lose weight, increase energy, stop the hair loss, etc?

I’d only recommend taking Thyroid Boost if you’re hypothyroid. To determine if you’re hypothyroid, follow the directions above for monitoring your temperature.

I’m taking Synthroid or other prescription thyroid medication. Should  I take the Thyroid Boost as well?

If you’re taking a prescription thyroid medication and your temperature is running 97.8 or below, then yes you should consider adding Thyroid Boost. I’d recommend taking one Thyroid Boost in the A.M. and one in the early afternoon. Monitor your temperatures as outlined below and if your temperature rises above 98.2 then discontinue or reduce the Thyroid Boost.

If my lab tests are normal does this mean I don’t need thyroid medication?

Blood tests aren’t very accurate. You may have hypothyroid (low thyroid) even if your blood tests are normal. I would recommend you go by temperature testing.

My doctor has me on Synthroid or Levathyroid. Should I switch to  Armour or Nuthroid, or Westhroid?

If you’ve been taking one of the T4 only synthetic prescription drugs and haven’t noticed much difference in your symptoms, fatigue, weight gain, hair loss, tingling in your hands or feet, etc., then yes, you should consider asking your doctor to try you on one of these T3-T4 combination drugs. If they won’t switch you find another doctor or try adding Thyroid Boost and monitor your temperatures.

What if I’m taking one of these combination drugs (Armour, Westhroid,  or Nuthroid) but still have a low body temperature and symptoms of  low thyroid?

I’d recommend you ask you doctor to consider increasing your dose of your prescription medication. If this is not an option or doesn’t help then I suggest you start taking Thyroid Boost along with the prescription medication.

Please note taking the Thyroid Boost glandular supplement and/or the Thyroid Support formula will change your lab work. Typically  those taking these supplements will notice that their TSH level goes  down. TSH goes down when the body determines it has enough thyroid  hormones. By reducing the TSH, the body is telling the hypothalamus  that it doesn’t need to release any more thyroid hormone. A change on  the blood test (even though it may not be indicative of your true thyroid status) may alarm my patients primary care doctor, especially if the TSH drops to hyperthyroid levels. This really isn’t a concern, because TSH is only dropping due to taking the thyroid supplement(s). Patients should discontinue or reduce their dose until their TSH levels return to normal.

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Here's wishing you good health,

Dr. Rodger Murphree