Thyroid & Adrenal Issues

The most common complaint amongst all patients in America today are fatigue and insomnia. A close second are anxiety, pain and depression. Most have no idea that this can be caused by physical problems, problems that are not in their head. According to different statistics more than 20 million people suffer from a thyroid disorder, more than 10 million women have low-grade thyroid imbalance, and the same amount of people with thyroid imbalance remain undiagnosed or, in the words of Shames and Shames: "although extremely common, low thyroid is largely an unsuspected illness. Even when suspected, it is frequently undiagnosed. When it is diagnosed it often goes untreated. When it is treated, it is seldom treated optimally."

Patients are relieved when they are told something wrong, which is quite ironic, given that so many Drs. have told them the contrary. This is quite disturbing, and it is one of the reasons why I chose to expand my practice to aid in hormonal problems.

Symptoms of underactive thyroid (Hypothyroidism) can resemble symptoms of numerous other diseases. Although there are various "classic" hypothyroid symptoms related to the low metabolism such as tiredness, fatigue, depression, obesity, coldness, high cholesterol, slow thinking, speech and movements, there are also many other lesser known symptoms. These symptoms, which include mania, hyperactivity, anxiety, palpitations and insomnia, may be related to deficiency of T3 in brain cells. T3 (trijodothyronin) is an active thyroid hormone that works in all cells of the body versus T4 (thyroxine which is nonactive hormone, produced by thyroid gland. One of the major health problem can be connected to poor transformation of T4 to T3 due to low adrenal gland function. It is interesting to note a recent report that hypothyroidism may effect brain size. A more comprehensive list of symptoms is as follows.



As Dr. Rind noted, "If severe enough, any one of these can overwhelm the body's metabolic mechanisms and become the leading cause of the problem. However, these are not as common as the low metabolism caused by adrenal and/or thyroid dysfunction. The corrections described below relate to the most common causes we see, namely sub-optimal adrenal and/or thyroid function.

If poor thyroid function is the only cause, we typically see a reddish complexion, thinning of the outer eyebrows, easy weight gain, depression, sluggishness, excessive sleep, high blood pressure, and a decreased ability to fight infection. If poor adrenal function is the only cause, we typically see pallor, full eyebrows, difficulty gaining weight, anxiety, exaggerated startling, insomnia, unrefreshing sleep, low blood pressure, allergies and auto-immune problems. Most people have a mixture of poor thyroid and poor adrenal function rather than purely one or the other, and therefore a mixture of symptoms."

According to the Colorado Thyroid Disease Prevalence Study 10% of Americans, or 13 million adults have an undiagnosed thyroid disorder and the figure of 10% seriously understates the problem since conventional medical tests fail to diagnose around 30% of those with hypothyroidism. This makes the true incidence of hypothyroidism in America around 40% or 52 million adults. Clearly, many doctors today have considerable difficulty diagnosing hypothyroidism. Other cases are falsely diagnosed as suffering from psychiatric disorders such as depression. Misdiagnosed hypothyroid patients have even been led to believe by psychiatrists that all their various thyroid symptoms may be due to depression.

Depression

An article in the Journal of Clinical Psychiatry shows that T3 can be used to treat post- traumatic stress disorder, commonly seen in soldiers and people who have been through other causes of terrible emotional trauma. T3 is a powerful brain chemical found in the synapses (junctions between nerve cells) that allow these cells to communicate with one another. Any attempt to explain the frequent misdiagnosis of hypothyroidism as depression on the basis of the apparently common nature of depression and the occurrence of stressful events in the lives of patients is totally without logic or justification. Since depression only effects 10% of the population while undiagnosed hypothyroidism has an estimated incidence of 10% to 40%, and may also be related to stress there is considerably more scientific evidence for doctors to assume that all patients with emotional disturbances need thyroid treatment. The vital lesson to be learned here is that depression is merely a symptom, not a cause.

Another reason why hypothyroidism is so frequently misdiagnosed is because of excessive reliance upon imperfect medical tests and the fact that conventional or non-holistic doctors commonly prefer to treat a series of test results rather than an individual patient. However I shall consider this matter in more detail below.

Hypothyroidism then, is a disease which many doctors not only find very difficult to diagnose with any degree of accuracy, but furthermore, even after correct diagnosis, effective treatment may be difficult to obtain. Undoubtedly the two biggest problems when it comes to the reliability of thyroid tests is the imprecise nature of normal ranges and the inability of current tests to detect exactly what is happening inside cells. Measurements of thyroid hormone levels may also be particularly misleading in the presence of autoimmune disorders such as Hashimoto's disease. The presence of thyroid antibodies in such diseases may displace thyroxine from cellular receptors and prevent it from working thus causing hypothyroidism in the presence of normal hormone levels. It is generally considered that the TSH (Thyroid Stimulating Hormone) test is the single most sensitive and reliable laboratory test for diagnosing hypothyroidism. Yet, in spite of this, modern medical science has yet to determine what is a normal level of TSH. While some doctors will declare that the maximum permissible level for TSH is 5, or perhaps even 10, increasing medical evidence suggests that this limit should be lowered to 1.5-2.00 , the "optimum" value being between 1.3 and 1.8, values above these figures being indicative of hypothyroidism.

One alternative method of the diagnosisof thyroid function is based upon measuring the body temperature. Temperatures consistently below 97.8F being suggestive of hypothyroidism.

Dr. Rind makes the point that significant reductions in body temperature reflect a reduced metabolic rate and therefore may also be due to other factors such as adrenal insufficiency which, unlike hypothyroidism, produces a more unstable temperature pattern. Since holistic practitioners do not rely upon body temperature alone but also give a much higher priority to clinical history and symptoms than do conventional practitioners, they are more equipped to distinguish between different causes of reduced temperature patterns. They care more about how the patient FEELS. Although often forgotten by conventional practitioners, it is the clinical picture which is of absolute paramount importance, abnormal laboratory test results only being significant in so far as they indirectly and imprecisely reflect the patients clinical condition.

To assist in providing an accurate clinical assessment of the various causes of low metabolic rate Dr. Rind also uses a detailed and informative "metabolic scorecard". While total diagnostic dependence upon pathology tests may be simpler and less time consuming for the practitioner, from a patients perspective it is the actual real life effects of his/her illness, the symptoms and signs, which are of primary concern. What is needed are clinical trials comparing the various systems of diagnosis rather than simplistic criticisms and suggestions that the use of body temperature tests should be abandoned. Bearing in mind that the yardstick for evaluating any test should be how the patient feels, we could do no better than examine the results of real life clinical trials performed by doctors throughout the world on their patients. These clinical trials, as discussed above, are far from impressive. Laboratory tests are merely an indirect and imprecise aid to attaining this end. Shames and Shames advise patients to make the following query of their doctors: "listen, the goal of therapy is not to have a normal TSH or normal hormones levels. The goal of therapy is to have a normal patient. Can't you work with me on this?"

If both the thyroid and the adrenals are weak, adrenal repair must precede thyroid repair, to determine whether problem is adrenal, thyroid, or both). If the adrenals are weak, then even normal thyroid activity places an excessive burden on them. One may begin to feel "hypoadrenal" (coldness, weight loss, dryness, fatigue, insomnia, and/or anxiety) and then the body innately turns down the thyroid energy production. Conversely, if the adrenals are strong and the thyroid is weak or unable to keep up with the adrenals, one begins to feel "hypothyroid" (heat intolerance, weight gain and fluid retention, tiredness, excessive need to sleep and/or depression). A very common error is to focus entirely on the thyroid and ignore the adrenals. In a weakened adrenal state, prescribing thyroid medication that contains T4 and/or T3 may produce limited or transient improvement. Subsequent increases of the dose offer little or no benefit as the medication pushes the energy machinery into overdrive. Unfortunately, this higher energy level is unsustainable due to the stress on the adrenals. Eventually the adrenals become fatigued and the symptoms of low energy return. If, however, the adrenals are functioning well, the thyroid hormones can do their job and the result is good metabolic energy.

Adrenal Repair Basics

In general, things that cause stress hurt the adrenals. The opposite of these helps the adrenals. Avoid the stressors and seek out those things that help. Eat more proteins, especially amino acids. Limit carbohydrates, especially sugars. Avoid stimulants and physiologically stressful substances such as caffeine, diet pills, alcohol, cigarettes, etc. If you have allergies, avoid the allergens (common allergens are wheat and dairy). Although this may sound surprising, we actually tend to crave foods to which we are allergic.

Mold is a common serious stress but difficult to avoid. Reduce as much stress as possible. Even 'good stress', such as celebration, can sometimes be excessive for the adrenals. Look for opportunities to experience security, joy and optimism. Learn to avoid negative emotions such as fear (e.g. horror movies), anger, etc. Increase rest, get as much sleep as possible and make the timing as regular as possible. Pushing too hard, excessive work or exercise, and any sleep deprivation stresses the adrenals.

Restoring Thyroid Function

For mildly poor thyroid function, one can often get the needed support with supplements such as tyrosine and iodine (e.g. kelp). Supplements containing mixtures of thyroid nutrients are available at health food stores. Some thyroid glandular may offer more complete support.

If the thyroid condition is more severe, one may require prescription medication. Giving only T4 (e.g. Levothyroxine, Synthroid, Unithroid, Levoxyl etc) is a good choice if T4 is the only missing component. In individuals with poor conversion of T4 to T3, a desiccated thyroid preparation (e.g. Armour Thyroid) often works best because it contains the needed T3 as well. Breaking up the dose into two or three doses daily provides a more stable blood level of T3 and generally produces better results. Taking the daily dose all at once in the morning tends to be stressful on the adrenals and often leaves one feeling depleted by afternoon. What is Wilson's Syndrome?

Around 1990, Dr. Dennis Wilson identified a condition in which the thyroid tests are in the 'normal' range but patients have low body temperature and many symptoms suggestive of hypothyroidism. The old name for this condition was Euthyroid Sick Syndrome. Dr. Wilson defined it more clearly, including the role of Reverse T3 (RT3). He called it Wilson's Syndrome and developed a therapeutic regiment that helps many sufferers. His pioneering work brilliantly recommends te use of slow release T3 as opposed to the quick release.

I have observed that T3 therapy is much more effective if the adrenals are supported. In my own experience, I have found that, when T3 is needed, using lower doses of T3 along with adrenal support produces fewer undesirable effects.