LEF Thyroid Deficiency

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Thyroid Deficiency

The Problem with Current Reference Ranges:

How to best diagnose thyroid deficiency has been a long-standing medical

controversy. Conventional doctors rely on thyroid blood tests, whereas

alternative physicians look for signs and symptoms of thyroid deficiency. An

article in The Lancet revealed surprising findings about reference ranges

that may alter the way physicians assess individual thyroid status.

Before The Lancet article is discussed, the reader should be reminded of the

serious consequences of a thyroid hormone deficiency. Aging people encounter

a variety of ailments that doctors often attribute to problems other than

thyroid deficiency. Some of the most noticeable symptoms caused by low

thyroid are poor concentration, memory disturbances, cold hands and feet,

accumulation of excess body fat, difficulty in losing weight, menstrual

problems, dry skin, thin hair, and low energy levels. Some specific

disorders related to thyroid deficiency include depression, elevated

cholesterol, migraine headaches, hypertension, and infertility (Stanosz 1992

Saito et al. 1994; Vierhapper 1997; Michalopoulou et al. 1998; Pop et al.

1998; Lincoln et al. 1999; Krassas 2000; Hagen et al. 2001; Spierings 2001).

Broda O. was a physician-scientist who dedicated more than 50 years

of his life to researching, teaching about, and treating thyroid and related

endocrine dysfunctions. In his book entitled Hypothyroidism: The Unsuspected

Illness, Dr. described more than 47 symptoms that may be related to

poor thyroid function. During his many years of research and practice, Dr.

condemned conventional doctors who ignored obvious clinical

manifestations of thyroid deficiency. According to Dr. : " The

development and use of thyroid function blood tests left many patients with

clinical symptoms of hypothyroidism undiagnosed and untreated. "

In lieu of blood tests, Dr. advocated that patients measure their

temperature upon awakening. If the temperature is consistently below normal

ranges, this is indicative of a thyroid deficiency. The Basal

Temperature test, which appears earlier in this protocol, provides specific

instructions on how best to measure your body temperature in order to assess

thyroid hormone status.

Dr. Broda believed that 40% of the adult population suffered from

thyroid deficiency. Based on the percentage of adults now taking

prescription drugs to treat depression, elevated cholesterol, high blood

pressure, and so forth, Dr. 's observations about the epidemic of

thyroid deficiency may now have been validated.

The Lancet is one of the most prestigious scientific journals in the world.

It often reports new medical findings that defy convention wisdom. According

to the August 3, 2002, issue of The Lancet, the problem with thyroid blood

tests may be caused by inadequate laboratory reference ranges that fail to

reflect what the optimal level of thyroid hormone should be in a particular

individual (Dayan et al. 2002).

The Life Extension Foundation has discussed the issue of faulty laboratory

reference ranges for many years. The problem is that for many blood tests,

the laboratories provide a wide range that represents " average " populations,

rather than what the optimal level should be to maintain good health.

Back in the 1960s, for instance, the upper reference range for cholesterol

extended up to 300 (mg/dL). This number was based on a statistical

calculation indicating that it was " normal " to have total cholesterol levels

as high as 300. At that time, it was also " normal " for men to suffer fatal

heart attacks at relatively young ages. As greater knowledge accumulated

about the risk of heart attack and high cholesterol, the upper limit of the

reference range gradually dropped to the point where it is now 200 (mg/dL)

(ADVANCEDATA).

The same situation occurred with homocysteine reference ranges. Up until

recently, it was considered normal to have a homocysteine blood reading as

high as 15 (mm/L) (Mahanonda et al. 2001). Most reference ranges now provide

a chart showing that homocysteine levels above 7 increase risk of heart

attack and stroke ( et al. 1995).

It is not just blood laboratory reference ranges that fail to provide

physicians and patients with optimal numbers. For example, when your blood

pressure is checked, a diastolic number up to 90 (mmHg) is considered normal

Yet a diastolic blood pressure reading greater than 85 is associated with

an increased stroke risk. A high percentage of people over age 60 have

diastolic readings greater than 85, and this is the age group most

vulnerable to stroke (Hansson et al. 1998). So when your doctor checks your

blood pressure and says it is normal, your response should be that " normal "

is not good enough because it is also normal for people over age 60 to

suffer a stroke. Instead, you should ask your doctor what is the " optimal "

range. In the case of diastolic blood pressure, taking steps to keep it at

85 or below could greatly reduce long-term vascular damage. It is important

to note that midlife hypertension predisposes people to stroke later in life

so keeping blood pressure readings in optimal ranges is important at any

age.

Scientists are now examining epidemiological data related to thyroid hormone

reference ranges, and their findings indicate that it may be time to change

the way laboratories report their TSH results.

The Thyroid Stimulating Hormone (TSH) TeST

Defying the Reference Ranges

Measuring Thyroid Hormone Levels

The standard blood test used to determine thyroid gland hormone output is

the TSH test. When there is a deficiency in thyroid hormone, the pituitary

gland releases more TSH to signal the thyroid gland to produce more hormones

When the TSH test is in normal range, doctors usually assume that the

thyroid gland is secreting enough thyroid hormone. The question raised by

The Lancet authors, however, is whether today's reference range for TSH

reflects optimal thyroid hormone status.

The TSH reference range used by many laboratories is between 0.2-5.5 (mU/L).

A greater TSH number is indicative of a thyroid hormone deficiency. That is

because the pituitary is oversignaling TSH based on lack of thyroid in the

blood. Any reading more than 5.5 alerts a doctor to a thyroid gland problem

and that thyroid hormone therapy may be warranted.

The trouble is that the TSH reference range is so broad that most doctors

will look at a TSH reading as low as 0.2 and think it is as normal as a 5.5

reading. The difference between 0.2-5.5, however, is an astounding 27-fold.

It would seem almost absurd to think that a person could be in an optimal

state of thyroid health anywhere along this 27-fold parameter, that is, TSH

readings between 0.2-5.5.

A review of published findings about TSH levels reveals that readings of

more than 2.0 may be indicative of adverse health problems related to

insufficient thyroid hormone output. One study showed that individuals with

TSH values of more than 2.0 have an increased risk of developing overt

hypothyroid disease over the next 20 years (Vanderpump et al. 1995). Other

studies show that TSH values greater than 1.9 indicate abnormal pathologies

of the thyroid, specifically autoimmune attacks on the thyroid gland itself

that can result in significant impairment (Hak et al. 2000).

More ominous was a study showing that TSH values of more than 4.0 increase

the prevalence of heart disease, after correcting for other known risk

factors (Hak et al. 2000). Another study showed that administration of

thyroid hormone lowered cholesterol in patients with TSH ranges of 2.0-4.0,

but had no effect in lowering cholesterol in patients whose TSH range was

between 0.2-1.9 (Michalopoulou et al. 1998). This study indicates that in

people with elevated cholesterol, TSH values of more than 1.9 could indicate

that a thyroid deficiency is the culprit causing excess production of

cholesterol, whereas TSH levels below 2.0 would indicate no deficiency in

thyroid hormone status.

Doctors routinely prescribe cholesterol-lowering drugs to patients without

properly evaluating their thyroid status. Based on the evidence presented to

date, it might make sense for doctors to first attempt to correct a thyroid

deficiency (based on a TSH value over 1.9) instead of first resorting to

cholesterol-lowering drugs.

In a study to evaluate psychological well-being, impairment was found in

patients with thyroid abnormalities who were nonetheless within " normal " TSH

reference ranges (Pollock et al. 2001).

Defying the Reference Ranges

The authors of The Lancet study stated that " the emerging epidemiological

data begin to suggest that TSH concentrations above 2.0 (mU/L) may be

associated with adverse effects. " The authors prepared a chart based on

previously published studies that provide guidance when interpreting the

results from TSH blood tests. Here are three highlights from their chart

that may be useful in ascertaining what your TSH values really mean:

TSH greater than 2.0: Increased 20-year risk of hypothyroidism and increased

risk of thyroid autoimmune disease (Vanderpump et al. 1995)

TSH greater than 4.0: Greater risk of heart disease (Hak et al. 2000)

TSH between 2.0-4.0: Cholesterol levels decline in response to thyroxine

(T4) therapy (Michalopoulou et al. 1998)

Despite presenting these intriguing findings, The Lancet authors stated that

more studies were needed to define optimal TSH level as between 0.2-2.0

instead of between 0.2-5.5. For a health-conscious person, however, this

type of precise information provides an opportunity to correct a medical

condition that has been unresponsive to mainstream therapies or possibly to

prevent disorders from developing in the first place.

This means if you have depression, heart disease, high cholesterol, chronic

fatigue, poor mental performance, or any of the many other symptoms

associated with thyroid deficiency, you may want to ask your doctor to " defy

the reference ranges " and try different thyroid replacement therapeutic

approaches.

Measuring Thyroid Hormone Levels

TSH is just one blood test that doctors use to assess thyroid status. Other

blood tests measure the actual amount of thyroid hormone found in the blood.

The primary hormone secreted by the thyroid gland is called thyroxine (T4).

The T4 is then converted in the peripheral tissues into metabolically active

triiodo-thyronine (T3). Doctors often test for TSH and T4 together, but this

may not accurately reflect thyroid deficiency in tissues throughout the body

One study found that psychological well-being could be improved if T3 (e.g.

the drug Cytomel) were added to T4 (e.g., the drug Synthroid) therapy,

while maintaining thyroid function broadly within the standard reference

ranges (Bunevicius et al. 1999; Walsh et al. 2001). What this means is that

even when TSH and T4 blood tests are within normal ranges, a person can

still be deficient in peripheral T3 and benefit from Cytomel therapy.

Because T3 is the metabolically active form of thyroid hormone, some

physicians use it exclusively in lieu of T4 drugs like Synthroid. The FDA's

recent notice to ban synthetic T4 drugs like Synthroid because of

inconsistent potencies helps to validate a statement made by Broda

more than 50 years ago: " Patients taking thyroid replacement therapy have

much better improvement of symptoms with natural desiccated thyroid hormone

rather than synthetic thyroid hormones. "

Although the FDA has found many problems in T4 drugs, the T3 drug Cytomel

has produced consistent clinical results and is not a subject of the FDA's

proposed ban. Dr. fought the drug companies against synthetic T4

drugs for years and recommended desiccated thyroid (Armour) drugs as the

therapy of choice for most patients.

An article in the New England Journal of Medicine described a study in which

patients with hypothyroidism showed greater improvements in mood and brain

function if they received treatment with Armour thyroid rather than

Synthroid (thyroxine). The authors also detected biochemical evidence that

thyroid hormone action was greater after treatment with Armour thyroid (Toft

1999).

Thyroid deficiency occurs when the thyroid gland underproduces the hormones

thyroxine (T4) and triiodothyronine (T3) needed to regulate the body's

metabolic rate. In some individuals, the thyroid does not properly convert

T4 to T3, the metabolically active form. Supplementation with synthetic or

animal-derived thyroid hormone is necessary to return hormone levels to

normal.

SUMMARY

Synthetic hormone supplementation, prescribed by a physician, includes

synthetic T4 (Synthroid, Unithroid, and Levoxyl), synthetic T3 (Cytomel),

and a combination of synthetic T3 and T4 (Thyrolar).

Natural glandulars (by prescription), such as Armour Desiccated Thyroid

Hormone, Nathroid, and Westhroid, derived from the thyroid gland of the pig,

contain T4 and T3, and most closely resemble natural human thyroid hormone.

Suggested supplements and their dosages follow:

Iodine, 1 mg a day

Selenium, 200-600 mcg a day

Tyrosine, 500-1000 mg a day

Melatonin, 300 mcg-6 mg at bedtime

DHEA, 25 mg 1-3 times a day (refer to DHEA Replacement Therapy protocol)

CoQ10, 100-200 mg daily

Life Extension Mix for vitamin A, vitamin B complex, magnesium, manganese,

selenium, and zinc, to be taken as directed

Thyroid & L-Tyrosine Complex, 2 capsules 3 times daily

For more informatiON

Contact the Thyroid Foundation of America, . For more

information on natural glandulars or the basal body temperature test,

contact the Broda O. , M.D. Research Foundation, P.O. Box 98, Trembly,

CT 06611, .

Product availabiliTY

Life Extension Mix, Coenzyme Q10, selenium, melatonin, L-tyrosine, and

Thyroid & L-Tyrosine Complex by Enzymatic Therapy are available by calling

or by ordering online.