Guest guest Posted March 1, 2001 Report Share Posted March 1, 2001 Check out the chart to see if you might be leaning toward adrenal malfunction, or thyroid malfunction: Bruce Rind, M.D. HOLISTIC APPROACH TO HEALTH CAREFUNCTIONAL MEDICINE, VASCULAR CONDITIONS & NON-SURGICAL ORTHOPEDIC MEDICINE11140 Rockville Pike, Suite 550 Rockville, MD 20852Telephone: (301) 816-3000 Fax: (301) 816-0011 Contact our office Checklist of signs & symptoms: thyroid/adrenal Comparison of low energy states caused by adrenal fatigue vs. thyroid system dysfunction Key: generally absent - Possibly present + Often present ++ always or almost always present +++ Sign or symptom Adrenal Mixed Thyroid Main function of the gland ® Manage stress, maintain stability Turn on energy production Induced by stress¹ +++ +++ +++ Body type Thin, can’t gain weight Gains easily, can lose it Can’t lose the weight Face shape Eyes, cheeks sunken when severe Normal to full Full, puffy around eyes Eye brows Tend to be full Normal to sparse Missing outer thirds Facial coloring Tendency to pallor, especially around mouth² Pallor around mouth (more visible with light skin) Ruddy complexion Skin coloring Light skin®fragile adrenals Dark skin®stronger adrenals No significant difference Nails Thin, brittle Break easily Break easily Pigment distribution In late phase, may tan too easily. Vitiligo (spots or patches of de-pigmentation) may be present Light sensitivity or night blindness + + + - After image (e.g., seeing the image of a flash bulb or bright light moving by longer than others) + + + -/+ Sex distribution _:_ Approximately 8:1 Approximately 4:1 Approximately 4:1 Typical pains Headaches, migraines, muscles, carpal tunnel muscles, carpal tunnel Occasionally joints, muscles, feet/lower legs Temperature pattern Thermal chameleon (hot in hot weather and cold when it’s cold). Tends to low body temperature around 97.8 or lower. Fluctuating³ pattern. Fluctuating³ pattern, usually averaging 97.8 but can be lower. Stable³ non-fluctuating pattern, average can be from 98.4 (mild) to 95.0 (severe). Cold intolerance + + + + + + Cold hands / feet + + + + + Heat intolerance + + + + Tolerance to change or stress Poor Poor/Moderate Moderate Sign or symptom Adrenal Mixed Thyroid Hair quality Thin and wispy. Dry. Tendency to become sparse Tends to be coarse, may become wavy or curly (rare) or change color Skin Dry. Thin. Finger-prints often ‘smoothed out’ or flat/shiny and may have longitudinal wrinkles over finger pads (probable cause: low collagen level May be thin, dry, bruise easily, poor healing. Poor healing. May bruise easily. Connective tissue quality (Typically seen in ligaments, tendons, skin, hair, and nails) Poor. More easily injured than ‘healthy’ friends. Joint strains / sprains common. Flat feet common Poor. More easily injured than ‘healthy’ friends. Poor. Poor healing, easy bruising + + + + + + Tendency to osteoporosis + + + + + + Sweating May be excessive in early phase. Poor sweating in late phase. Not very affected Immune system: Allergies + + + + + + Immune system: Autoimmune + / + + + + 4 4 Immune system: Infections (e.g., sinusitis, bladder, bowel, skin etc.) + + + + + + Sensitivity to medications, supplements etc.. Needs very small doses + + + - 5- Intuitive + + Picks up other peoples feelings e.g., at malls, parties. Intuition especially strong if adrenal weakness is present since early age. Rarely present in later onset. + + / - Personality tendency: Humor - / + + + + Personality tendency: Serious + + /+ + + + + - / + Depression + + + + + + Anxiety, panic attacks, worry, fear, insecurity, feelings of impending doom (any combina-tion). "I thought I was dying..." + + + + + + Mental abilities Can have difficulty with focus, concentration, short term memory Startle easily + + if severe adrenal fatigue + - Sign or symptom Adrenal Mixed Thyroid Sleep pattern Insomnia tendency. Sleep tends to be not refreshing. Mixed Tend to oversleep. Occas-ionally, narcolepsy (an un-controllable need to sleep) Dietary habits Often lean toward being vegetarian or avoids certain foods Tends to have fewer dietary restrictions than the pure adrenal type Tends to eat everything Digestion Often has difficulty digesting meat. 6 Poor but they often think it’s good. Poor but they often think it’s good. Tendency to constipation Malabsorption of nutrients + + + + + + + Cravings Sweets, carbohydrates, salt (any combination),black licorice Mixed Fats Blood sugar 7 Tendency to hypoglycemia. May need many small meals or ‘crash’ Can range from mild hypoglycemia to hyper-glycemia Normal to hyperglycemia Exercise tolerance Causes fatigue. Can’t persevere. If severe, body temp. drops after exercise Mixed Can’t exercise much. Tires easily. Standing still is difficult. Walking is easier. + + + _ Fibromyalgia / chronic fatigue + + + + + + Problems with menses and/or fertility (females) + + + + + + Pins and needles sensation in hands, may also be in feet if severe. Can present as numbness + If adrenal problem is severe. Tends to be symmetrical. + / - - Blood pressure Tends to run low, e.g., 80/50 (low end) to 110/70 (high end) Can be low, normal or high Ranges from normal to very high Orthostatic hypotension (light-headed when getting up to stand from laying or sometimes, even sitting) + + + / - - Heart: Palpitations ("feels like my heart was about to jump out of my chest") + + + / - - Bruce Rind, MD Center for Holistic Medicine Rockville MD 20852 Copyright - All rights reserved Typical findings on blood tests Sign or symptom Adrenal Mixed Thyroid Chem: Total cholesterol Usually low to low normal (e.g., under 160) Mixed (can be low, mid-range, or high) Usually high. Very hard to reduce. Chem: HDL (the good cholesterol) Usually normal to high Mixed Usually normal to low Chem: Cholesterol/HDL ratio 9 Usually 3.0 or less Mixed Usually3.5 or more Chem: Serum potassium tends toward high normal Chem: Serum sodium tends toward low normal Chem: DHEAS low to low normal Chem: Testosterone _:_ _: tends to be low _: normal to low CBC: WBC 10 Tend to low normal Normal to low normal CBC: Platelets 10 Tend to low normal Normal to low normal CBC: MCV (mean corpuscular volume) 11 Tends to be high or high normal. Taking B12 regularly may normalize it. CBC: RDW (reticulocyte distribu-tion of width) 12 Normal to high normal Typical findings on physical examination Missing outer third of eyebrows - -/+ + + Full eyebrows, especially outer + + -/+ - Pupillary light response 13 usually under 3 secs. Usually under 5 secs. Usually over 5 secs. Tissue around the eyes Sunken appearance normal or some ‘bags’ under the eyes puffy around the eyes, often bags under the eyes Typical weight distribution Uniformly thin Gravitates to lower body (tummy/hips) Uniformly heavy or more at lower body Pale, especially around the mouth 2 (light skinned individuals) + + + + + + - Ruddy complexion (light skinned individuals) - Mixed: Face can be ruddy while pale around mouth + + Edema (non-pitting) at lower legs - -/+ + Sign or symptom Adrenal Mixed Thyroid Reflexes 14 Brisk Often seem normal Slow 14 Heart: Mitral valve problems 8 + / + + + - Hair: Thin/sparse on arms and/or absent on lower half of lower legs + + + - Typical values of thyroid function tests -15 Condition Temp -19 TSH-18 Total T4 Total T3 Reverse T3 Hypothyroid (primary)-20 ¯ high low-normal low but high relative to T4 -16 low -17 Hypothyroidism (secondary/pituitary) ¯ low low low but high relative to T4 -16 low -17 Hypothyroidism (secondary/LES-Adrenal) ¯ low to low normal low to low normal low to low normal low Euthyroid sick syndrome / ’s syndrome ¯ normal normal normal high Graves disease (hyperthyroid) /nl low high high high Hashimoto’s-4 thyroiditis: early phase or hyperthyroid phase /nl low high high high Hashimoto’s-4 thyroiditis: late phase, hypothyroidism-untreated ¯ high low low low Hashimoto’s-4 thyroiditis: late phase, hypothyroidism-treated with T4 soon after hypothyroidism was discovered (’s syndrome) nl normal normal normal but tends to be low normal relative to the T4 high Hashimoto’s thyroiditis: late phase, hypothyroidism-treated with T4 late after hypothyroidism was discovered (normal thyroid function or may be LES-Adrenal)è nl or ¯ normal è(or low normal normal è(or low normal normal è(or low normal low è(low) Toxic interference to metabolism ¯ high- normal high-normal high-normal low The above chart is based on a combination of literature based knowledge and Dr. Rind’s experience with treating over 1,000 patients with thyroid and/or adrenal problems. It is for informational purposes only and should not be used for medical self diagnosis. Any diagnosis or treatment should be done in consultation with a physician 1- Stress can be any of these: Emotional Physical (chronic pain or overtraining- especially female athletes) or physiologic stress (e.g., surgery) Chemical: Exposure Metabolic: Excessive metabolic stimulation such as hyperthyroidism. This often occurs in the early phase of Hashimoto’s (autoimmune) thyroiditis or Graves disease. Chronic infection such as viral (e.g., Epstein Barr virus) 2- Facial pallor: A pale color, especially around the mouth. Easiest to see in light skinned individuals. In olive skinned individuals it is much harder to see. Since wrinkles stay in the pale area, puckering the lips artificially creates wrinkles for the moment and their location identifies the pale zone in darker skinned individuals. It is also easier to see in women than men (because of the beard hair which interfere with color identification and thicken the skin to make it more resistant to wrinkles). 3- See model temperature graph. 4- Hashimoto’s thyroiditis is common and is an autoimmune condition in which the individual develops an allergy to their own thyroid gland. In the early phase when there is destruction of thyroid gland and spillage of thyroid hormone (T4), there is a hyperthyroid effect. The hypermetabolic state that occurs usually stresses the adrenal glands and causes adrenal fatigue. When enough destruction has occurred and there is little T4 production, one goes into a hypothyroid phase. Now one has hypothyroidism and adrenal fatigue. Autoimmune antibodies are almost always present on blood testing. 5- Intuition is an interesting quality of early life adrenal fatigue. The later in life the development of adrenal fatigue, the less likely one is to spontaneously develop intuitive ability. People that develop adrenal fatigue early in life are often described as empaths and will tell their friends (but not their doctor) about their ability to pick up feelings. They often suffer because of their high sensitivity and are always looking for new ways to ‘ground’ themselves. This problem often clears by simply supporting the adrenals and getting them to function well again. Poor adrenal function is not essential for intuitive development. Strengthening the adrenals does not weaken the intuition once it is there. Individuals that develop adrenal fatigue later in life (because of high stress, virus etc.) tend not to claim this intuitive ability. Spiritual orientation is more common in those with early adrenal fatigue. Less common in those with later onset adrenal fatigue and those with strong, healthy adrenals. There seems to be a personality difference (archetype) between those with strong adrenals and those with weak adrenals 6- These individuals tend to digest meat poorly because of low gastric acidity. They often think they have high acidity because of occasional heartburn or heartburn with digestive enzymes containing digestive acid. The problem is usually one on inadequate acid production but less adequate gastric protection. This could be helped by chewing or sucking on a specific type of licorice candy called DGL found in health food or vitamin store. Suck or chew on it about ½ hr before the meal. It produces increased secretion of gastric (stomach) mucous protective layer. This helps to prevent irritation by the acids in the stomach. 7- Hypoglycemia = low blood sugar. Hyperglycemia = elevated blood sugar 8- Mitral valve problems seem to affect individuals with adrenal fatigue more often than others. Typically one would see it in a female, body proportions tend to be smaller at the top, heavier at the bottom where weight gain, if any, tends to take place. The tendency to valve problems may be related to connective tissue quality since it sometimes improves with connective tissue support. Hawthorn berry seems to help. Individuals with plain hypothyroidism don’t appear to have a higher incidence of valvular problems compared to the rest of the population. 9- In adrenal fatigue, the total cholesterol tends to run low to low normal while the HDL tends to run high normal to high. In hypothyroidism (or in ’s syndrome or LES-Thyroid where there may be ‘normal’ lab tests for the thyroid but actually the body functions as if hypothyroid), the opposite tends to occur with a nigh normal to high cholesterol and normal to low HDL. 10- In low metabolic energy states, it is common to see WBC (White Blood Cells ® the front line soldiers against infection) and Platelets (they work to initiate a clotting response in areas of vascular injury) at the low end of ‘normal’. Typically, the WBC is under 6 and the platelets are under 210. 11- The MCV (mean corpuscular volume) is a measure of the size of the red blood cells. Their size tends to increase as vitamin B12 deficiency increases. Individuals with poor digestion / absorption tend to run low on vit. B12, so they tend to have larger blood cells, i.e., MCV tends to be at high end of normal or high. This is more common in adrenal fatigue since these individuals tend to eat less meat, tend to digest it poorly if they do eat it and generally absorb poorly. 12- RDW measures the distribution or variability of the size of young red blood cells. Individuals with stable health tend to have little variability in cell size. An unstable or poor state of health generally shows up as higher variability in cell size. 13- I’ve learned that poor adrenal function corresponds to poor ability to maintain constricted (small) pupils when a light is shined into the eye. Iridologists have known this for a long time. The same type of problem these individuals have that interferes with their ability to maintain constriction of blood vessels when getting up (thus allowing blood to pool downward and cause dizziness as an initial response) is what happens when light is shined into the eye. The pupil needs to constrict to protect the inner eye from too much light. It can’t maintain it but keeps trying. This produces a vacillation in which the pupil alternates between contracting and dilating. If the constriction is maintained for 8 or more seconds, it is usually a sign of a healthy adrenal system. Brown eyes tend to be more stable in bright light and the movement is more difficult to distinguish than in blue eyes. I grade the duration on a scale of 10. Thus if the pupil is stable for 3 seconds and then starts dilating/constricting, I give it a score of 3/10. This helps track progress. Light should not be shined directly into the center of the eye not should it be uncomfortably intense (see diagram) 14- When thyroid function is low (frank hypothyroidism or ’s Syndrome or LES-Thyroid), the reflexes slow down. This is most easily seen in the Achilles tendon (ankle) reflex where the downward motion and return of the ankle to position is slow. Approximately ½ to 1 second is OK. If it’s slower, it may give the impression that there is ‘no reflex’ when it is only that the reflex hammer may be too fast for the Achilles tendon. The way to test it then would be to for the health practitioner to flip the foot upwards (dorsally) in a rapid jerking motion, then relax the hand while gently exerting a subtle upward (dorsal) pressure. In a very slow reflex, the foot slowly moves downward then slowly upward. The cycle can last several seconds. I’ve seen it as slow as 12 seconds in severe cases. See the video demonstration. This allows for easy monitoring of thyroid replacement therapy and its effectiveness. 15- It is helpful to compare lab values relative to their position on the scale of ‘normal’. Usually there is an optimal point at which function is near the ideal for the average individual. The ‘ideal’ may be found by looking at the average value for very healthy individuals. Often, it is near the mathematical midpoint of the total range of acceptable values. This tends to be the case for Total T4 and Total T3. For example, most labs list the acceptable or ‘normal’ range for T4 as 5 to 12. The mathematical midpoint is 8.5 and this is the value I most often see in healthy individuals plus or minus 0.5. For T3 it is usually between 60 and 120, the mathematical mid-point is 120. I also find this to be true for healthy individuals (usually they are around 115-130). The TSH is different. Normal range is around 0.5 to 5.5. The midpoint here is 3.0 but I find that ‘healthy’ individuals tend to have values of around 1.5 to 2.5. This can vary a among individuals and these numbers are not carved in stone. They do, however, give an idea of approximate preferred values. When looking at ‘normal’ values, remember, normal does not mean optimal. It is normal to have a $5,000 debt on one’s credit card. It is not, however, ‘optimal’. Most doctors would agree that the following ‘normal’ values spell trouble for the patient: TSH= 0.6, T3= 175, T4= 11.5 The above values are those of an individual who is producing high normal levels of thyroid hormone yet the pituitary gland is producing very little thyroid stimulating hormone (TSH). This person’s thyroid is overly active and s/he may be heading toward hyperthyroidism. They need to be watched for possible autoimmune thyroiditis developing. TSH= 5.4, T3= 75, T4= 6.0 The above values are those of an individual whose thyroid gland is barely producing enough thyroid hormone to stay within normal limits in spite of strong stimulation by the pituitary (high ‘normal’ TSH) to produce thyroid hormone. These individuals tend to feel better with a little T4 support. Although both examples are ‘normal’, the patients came to the doctor with opposite complaints. The first probably can’t gain weight, is having anxiety, nervous, can’t sleep well, reflexes are brisk, body temperature is running at around 98.6 or maybe a little higher. S/he has symptoms suggestive of hyperthyroidism. The second is probably having trouble losing weight, feels sluggish, poor concentration and memory, needs to sleep more or more often, has constipation, low body temperature(usually below 98.0). The signs and symptoms are suggestive of hypothyroidism. Both are technically ‘normal’ yet they obviously are not in the same medical condition regarding their thyroid gland. 16- If the T4 is mid-normal (e.g., around 8.5), we would expect the T3 to also be around mid-normal (e.g., around 120). If the T4 is 8.5 and the T3 is 90, we might suspect that there is poor conversion of T4 to T3 such as in ’s syndrome or LES-Thyroid. The rest of the T4 is probably being converted to RT3. If the T4 is 8.5 and the T3 is 140, we might say that there is high conversion of T4 to T3. The body is trying to get more energy out of the available T4 (The T4 is converting mostly to T3 and not too much into RT3, thus the RT3 is probably very low). This can be found typically in states where there is an impediment in the energy manufacturing mechanism (Krebs cycle), for example, heavy metal toxicity or magnesium deficiency. The pituitary is ‘snapping the whip’ at the mitochondria by throwing more T3 at them in an effort to get them to produce ATP. They are producing too little ATP because the mechanism is either jammed by a heavy metal or the enzymes are low on an essential mineral such as magnesium. It is important to look at the relative values when trying to figure out what is the root cause behind the problem. 17- RT3 values need to be looked at in a relative sense. Almost all patients present values that are ‘within the normal values’. Nonetheless, any value above the lowest end of the ‘normal’ range provided by the lab is usually associated with symptoms of hypothyroidism (unless it is a response to high or high normal T4). In hyperthyroidism, we need a higher than usual RT3 to protect from the excessive stimulation of the high T3. The same high value in an individual withT4 of 8.5 would produce symptoms suggestive of hypothyroidism ('s syndrome or LES-Thyroid). If the body were a car, we would say that the car has an accelerator (T3) and a brake (RT3). Just as we always drive alternating acceleration-braking-accel-brake-accel etc., so does the body manage itself hormonally, driving the accel-brake-accel-brake etc. It uses T3 and RT3 for this purpose. The T4 in this case, is like the foot hovering above the pedals. Just like the ‘foot’ is neither an accelerator nor a brake (until you decide which it will be), so is the T4 neither a stimulant nor is it an inhibitor until the brain decides how to convert it. If we go back 10,000 years, the amount of metabolic energy we needed to chase or run from an animal is different from what we needed to take a nap. The body adjusts its energy levels accordingly. In our daily lives, we can see how troublesome it can get when the mechanism doesn’t work properly when we have too much energy to sleep (e.g., insomnia) or too little energy to stay awake (e.g., narcolepsy, oversleeping and fatigue). 18- The TSH reflects how the brain/hypothalamus/pituitary (lets say ‘pituitary’ for short) feels about the current need and supply of energy. Thus, a mid range TSH such as 2.5 is like the pituitary telling us it is content with the level of thyroid hormone available relative to the metabolic need of the body. If the TSH is low, the pituitary is saying that it’s receiving too much thyroid hormone for its needs. Conversely, a high TSH is the pituitary saying it would like to see more thyroid hormone being secreted (or given by pill if the case demands it). Thus we can think of the TSH as reflecting the ‘desire’ of the pituitary for thyroid hormone after it has checked out the metabolic needs of the body in relation to the amount of available thyroid hormone. 19- Temperature: It is important to compare temperatures with the thyroid hormone levels. For example, someone who is feeling sluggish, gaining weight etc. and has an average daily temperature of 96.4 and T3, T4, and TSH in the mid normal range is having a problem (either ’s syndrome, or LES-Thyroid or a problem with toxic load). As you can see from the table, it is one more piece of information that helps us solve the puzzle. The pattern of the temperature is very important. IF the average temperature is below 98.6, metabolic activity is sub-optimal. If the stability of the temperature is poor (vacillates from high to low to high to low etc.) then the adrenal function is poor. The adrenal glands help the body maintain stability. When they are too exhausted to function well, the temperatures oscillate. When adrenal function is strong, the temperatures are stable and vary little from day to day. It is important to remember that the average temperature in a population may be 98.0. That does not mean its ‘OK’. The average temperature in a healthy population (e.g., a group of athletes in peak condition, living in the Alps on organic food, sleeping adequately, no stresses etc) is 98.6. In a given population, the normal age of death may be 76 yrs. old but that is not optimal. If you live there and you’re 75 yrs old, you don’t want to be normal, you want to be in optimal medical condition. 20- Primary hypothyroidism is when the thyroid gland is either incapable of making T4 or has been removed and therefore the body can’t manufacture T4. In such cases, it needs to be replaced with T4 from an outside source, usually in tablet form. 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