More on Thyroid from Alternative Medicine Magazine

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Energizing Chronic Fatigue

http://www.alternativemedicine.com/digest/issue19/19008R00.shtml

Fatigued from an Underactive Thyroid

Although my clinical experience shows that a significant number of chronic fatigue patients have underlying hypothyroidism, this fact is often not picked up in the standard thyroid hormone tests.

The case of Kristi, aged 34, excellently illustrates how an underactive thyroid gland can contribute to many of the symptoms associated with chronic fatigue and, for Kristi, to an unusual and highly premature stroke.

She reported that she had been overweight much of her life and that in recent months she had developed various gastrointestinal problems, including constipation and abdominal pain, that she was fatigued much of the time, and that she had recently sustained a stroke and had been admitted to the hospital. She was still able to work, but was deeply tired all the time and needed about 11 hours of sleep every night.

Kristi’s conventional doctors were unable to account for her stroke nor could they explain (or treat) her symptoms of weight gain and fatigue. Kristi also suffered from allergies, rashes, occasional hair loss, and concentration difficulties, and often felt unaccountably cold.

Most of these symptoms are straightforward markers for a thyroid deficiency, which means the thyroid gland (located in the throat) is not producing enough hormones to sustain its multiple functions. However, to determine whether the thyroid is underworking, you need to use the right thyroid test.

The thyroid gland, one of the body’s seven endocrine glands, is located just below the larynx in the throat with interconnecting lobes on either side of the trachea. The thyroid is the body’s metabolic thermostat, controlling body temperature, energy use, and, in children, the body’s growth rate. Of the hormones synthesized in and released by the thyroid, T3 (triiodothyronine), represents 7%, and T4 (thyroxine), accounts for almost 93% of the thyroid’s hormones active in all of the body’s processes. Iodine is essential to forming normal amounts of thyroxine. The secretion of both these hormones is regulated by thyroid-stimulating hormone, or TSH, secreted by the pituitary gland in the brain. The thyroid also secretes calcitonin, a hormone required for calcium metabolism. Hyperthyroidism refers to an overactive gland, while hypothyroidism indicates an underactive thyroid.

Although my clinical experience shows that a significant number of chronic fatigue patients have underlying hypothyroidism, this fact is often not picked up in the standard thyroid hormone tests. These check for levels of T3, T4, and TSH thyroid hormones; when TSH (thyroid stimulating hormone, secreted by the pituitary gland) readings are high, for example, it indicates that thyroid activity is low.

Yet this test is not sensitive enough for all cases. There are fatigued patients who have thyroid failure; while their regular blood test comes out normal, they are suffering from hypothyroidism, or a low degree of thyroid activity.

We often correlate TSH results with the patient’s body temperature (less than 98.6°F suggests a thyroid problem) with the results of a thyroid sonogram, which indicates if the thyroid is enlarged.

The gold standard for accurately detecting an underactive thyroid is the TRH (thyrotropin releasing hormone) stimulation test. This is an inexpensive test (costing about $100) performed by most laboratories. The physician measures the patient’s TSH level (a simple blood test), gives an injection of TRH, then draws blood 25 minutes later and remeasures the TSH. If the first TSH level is normal and the second TSH level is high—above ten—it tells us the patient’s thyroid is underactive. A TSH reading of 15 is suspicious, while 20 strongly points to hypothyroidism.

The TRH test proves how important it is for doctors to listen to their patients. In many cases, patients know that something is still wrong even after regular blood test results come back negative. Of the patients I’ve seen with three or more typical symptoms of underactive thyroid but who have tested “normal” in standard tests, 35-40% actually have underactive thyroids based on the TRH test.

Clinically, the bottom line is that when we treat many of these chronically fatigued people, basing treatment on the assumption of an underactive thyroid, they get much better, thereby confirming the diagnosis.

In Kristi’s case, her TSH levels after the TRH injection were 25, way above normal. Armed with this information, I put her on a synthetic thyroid supplement called Synthroid, at a starting dosage of 0.125 mcg daily. To complement this, I gave Kristi an animal-derived glandular called Thyrosine Complex (containing pancreas, spleen, and liver extracts). Kristi took this three times daily.

A vitamin and nutrient status blood test indicated that Kristi was deficient in vitamins C and B complex. For patients with hypothyroidism and poor gastrointestinal function and nutrient absorption, I supply nutrients by intravenous infusion rather than through oral supplements. Once weekly, for about six weeks, Kristi received an IV infusion of B complex and magnesium (4 cc each), and 6-10 g of vitamin C.

At the same time I gave Kristi grape seed extract (200-300 mg daily), a bioflavonoid that enhances the concentration of vitamin C between cells. It also helps the cells pick up, absorb, and retain the vitamin C, enabling the tissues to be saturated with it rather than having it excreted into the urine. In addition to the IV intake, Kristi took oral vitamin C at 500 mg six times daily, along with a complete vitamin B complex (125 mg), and magnesium (1,000 mg daily, in two divided doses).

Raphael Kellman, M.D., is an internist blending conventional and holistic/alternative medicine, a fusion he calls “post-modern medicine.” He is the founder and medical director of the Life Center in New York City. He also holds a degree in philosophy. To contact the author: The Life Center, 140 West 69th Street, New York, NY 10023; tel: 212-721-6633; fax: 212-721-6714.

In a companion study, 32 CFS patients had a once-weekly injection of either magnesium or a placebo for six weeks. Those who received the magnesium reported improved energy levels, a better emotional state, and reduced pain, and 12 out of the 15 who received magnesium said they had benefited from it. Levels of red cell magnesium returned to normal in all 15 patients.

As a further boost to her energy levels and to support her immune system, Kristi started taking the Chinese herb astragalus (500 mg, twice daily). Astragalus is a tonic for strengthening the immune system, enabling it to better resist disease and infection.

Kristi noticed some improvement immediately on this program, and within four weeks she felt a significant difference. After four months, she was 100% better. She had lost 45 pounds, her hair had grown back, and she felt “vital” for the first time in her life. Today, eight months later, Kristi feels like a “new” person. This case shows how the TRH test made all the difference in outcome. Had Kristi undergone this test some years earlier, it is possible the stroke and obesity could have been prevented.