Thyroid and adrenal dysfunction

[Guest guest]

Hi Everyone,

Here is an article by Dr Barry Durrant-Peatfield which

presents a huge amount of information in very readable

form.

The phone number at the end may be of interest to UK

members.

http://www.i-c-m.org.uk/Journal/2006/feb/a02.htm

Thyroid and adrenal dysfunction: the diagnosis and

treatment of an endemic syndrome

Thyroid specialist Dr Barry Durrant-Peatfield explains

why practitioners should check for thyroid and adrenal

problems when presented with a familiar range of

symptoms that often mask prolonged dysfunction in

these two organs.

Introduction

The first quarrel many people may have – but most

especially doctors – may well be in the title: the use

of the word endemic. To read a number of learned

articles would leave the impression that thyroid

dysfunction was a matter of a few percent of the

general population and adrenal dysfunction much less

than this.

I have to say now, right at the outset, that this

widely held view, held by orthodox medicine, is quite

wrong, disgracefully so. It is, in the profession,

politically correct to believe that thyroid

dysfunction is not common at all and the symptoms are

due to other things, notably depression. If you want

to appear really learned, you will speak of

maladaption to one’s environment due to a personality

dysfunction.

Adrenal dysfunction fares worse and is believed to be

about as rare as hens’ teeth. In any event, the

argument goes, ’s disease (total adrenal

failure), by definition, hardly occurs.

I cannot emphasise strongly enough that both thyroid

and adrenal dysfunction are so commonly met with as

indeed to be endemic and disgraceful diagnostic

failure is the rule. I speak after more than 25 years

of practical study and treatment of both conditions

and I have suffered at the hands of an ignorant

establishment for daring to diagnose and treat these

problems. If you gain from this article nothing else,

you must take away this fact: thyroid dysfunction, and

its partner in crime, adrenal dysfunction are all

around us, every day, in our clients/patients and even

our colleagues. So common are they that whenever your

opinion as a practitioner is asked on an apparently

complex illness, you must ask yourself first: could

there be an underlying thyroid and adrenal problem?

(For the moment I shall not consider over-activity of

either, but only sub-optimal activity.)

Down-regulation of the metabolism

Thyroid and adrenal dysfunction usually come together

but in varying degrees of emphasis. They cause a

down-regulation of all metabolic processes, hence

these clients/patients are all hypometabolic.

Metabolism, as I need not remind you, may be defined

as the rate at which energy is produced and consumed

by the tissues. Glucose, oxygen in; carbon dioxide,

water, energy out. For everything to work properly

this process has to be optimally regulated and it is

the thyroid hormone that does this.

Thyroid hormones ensure that the cell membrane is

actively and positively involved in the transport of

the raw materials of energy production – not just

oxygen and glucose but all the required enzymes and

co-factors passing into the cell; and, equally, the

passage out of the waste products once the energy has

been released. The activity of the Krebs cycle within

the mitochondrion is equally thyroid dependent.

It’s helpful to think of the whole organism as an

incredibly complex and intricate, electric machine

that is built and wired up for 240 volts. If we try to

run it at 190 volts it’s not going to work properly.

The lights flicker and grow dim. A down-regulated

metabolism affects the organism in the same way. This

means nothing works properly. Every tissue, every

organ, every biological process, suffers. Some pieces

of the equipment are affected more than others and

differently, depending on the original design.

In humans probably the organ most sensitive to

metabolic down-regulation is the brain. Not far behind

are the highly metabolically active liver, then the

kidneys, then digestive processes, then our

temperature control and the intricate working of our

immune system. You see, the point is you name it and

it doesn’t work properly. Our clients/patients may

have lots of different things wrong with them, so many

that even they think they are hypochondriacs, never

mind the doctor who came to that conclusion some time

before.

It is essential to understand that a down-regulated

metabolism has a total effect on the body’s

functioning. You cannot, you must not, focus on one or

two symptoms; they must all be considered as a whole.

How difficult this is in today’s environment. There’s

never enough time, it’s all got to be written down,

quick decision, then out the door. Another symptom?

Ah! Make another appointment and we will talk about it

later. Here the advantage many of us have who practise

away from the mainstream becomes apparent – we have

time!

Hypothyroidism – recognising the symptoms

Let’s take hypothyroidism first - probably the most

common misdiagnosis of all common illnesses. A decent

history soon gives us a few facts. Fatigue, weight

gain, brain fog, depression, cold/heat intolerance,

arthralgic aches and pains, fluid retention, bad skin,

menstrual problems and infertility, hair loss,

intractable constipation and lots of others. If you

take these separately, how easy it is to narrow the

focus and go for the wrong thing. Typically, a

standard assessment might be:

Fatigue: well, go to bed early, don’t work so hard,

you are depressed, anaemic - some Prozac and iron

pills and you’ll be OK. Weight: you eat too much - try

this diet. Brain fog: well, none of us are getting any

younger, are we – too much stress. Depression. Ah! We

can help you there, no trouble. Cold/heat intolerance:

your age - wear warmer things. Arthralgia: bit of

arthritis here I’m afraid - try these NSAIDs. Fluid

retention - lovely pills here, make you pee, no

trouble. Skin: bad diet, hormones. Bad periods: one of

the crosses you women all have to bear. Hair loss:

age, diet - better hairdresser. Constipation: got

something for that or try the chemist.

All the time the underlying problem is being missed. A

simple examination can pick out the thyroid deficiency

in minutes. And we’ll come to the tests later.

Possible causes

Now, as to why the thyroid goes wrong there are

various possibilities. It may be due to control

failure – dysfunction in the hypothalamus or

pituitary. It may be failure of conversion of T4 into

T3, due to enzyme failure and poor adrenal function.

There may be failure or resistance to binding of T3 at

the receptor sites, damaging gene expression – the

Gq/11 proteins may be activated to switch off this

response. And, most of all, it may be primary failure

in the gland itself. Primary failure in the gland may

be:

1. Genetic, appearing at, or soon after, birth. A baby

with thyroid failure is true cretinism.

2. It may be due to environmental deficiencies, like

iodine, or the presence of toxins such as fluoride,

PCBs, dioxins and endless others.

3. Trauma - general surgery, especially in women; for

example, cholecystectomy, hysterectomy. Or damage to

the gland from whiplash.

4. Glandular fever.

5. Autoimmune disease.

6. Pregnancy and childbirth.

A word about the over-active thyroid. Again, more

common in women, but you don’t see that many; probably

two for every 100 under-active. Not a difficult

diagnosis; the patient is hot, terribly nervy, has

loose bowels, is losing weight and has a racing pulse.

The only real differential diagnosis is an anxiety

state.

Adrenal dysfunction and the General Adaption Syndrome

Now for adrenal dysfunction. The glands can go wrong

in two ways: too much or too little. Too much and we

have Cushing’s disease. Only three causes really; too

much cortisone for the asthma, rheumatoid arthritis or

whatever; an adenoma on the gland itself; or one on

the pituitary. We are all familiar with the moon face,

thin skin, obesity, buffalo hump, so it shouldn’t be

difficult. A lot of people are checked out for

Cushing’s just because they are a funny shape but,

unless caused by over-medication, it isn’t very common

at all.

Adrenal hypo-function is a different kettle of fish

entirely. The diagnosis is missed more decisively even

than hypothyroidism because most clinicians only seem

to think of it in terms of ’s disease. In fact,

the adrenals can malfunction in degrees. A failure in

pituitary control may play a role, often as a spin-off

from a generally low metabolic state; but usually the

failure is the result of long-term stress. Hans Selye

recognised three major stages in adrenal

hypo-function, which he called the General Adaption

Syndrome (GAS).

Stage I is the stressed phase where, due to illness or

other stress, the adrenals mobilise cortisol and DHEA

(dehydroepiadrenosterone) to help the body deal with

the problem. This is an acute phase; the stress

settles and the adrenals settle down.

Stage II, resistance, is where it all goes on and on

and the adrenals enlarge and increase their hormone

output on a longer-term basis. This can go on for

weeks, months, or even years but eventually they can’t

take it any more and start to regress into exhaustion,

stage III. The degree of exhaustion is reflected in

their output and balance of their two chief hormones,

cortisol and DHEA, which is where the Adrenal Stress

Index (ASI) comes in.

The last phase of the GAS is what we will often see if

we are looking for it. Important causes, of course,

are major life-events, trauma, operations and the

general and prolonged ghastliness of existence. But,

for our purposes, the big cause is persistent and

chronic illness. In the attempt to help the body deal

with, and compensate for, the illness, adrenal

exhaustion starts to take over. An example of a

persistent and chronic illness untreated, or

mistreated, is hypothyroidism.

So now you see why thyroid and adrenal hypo-function

have to be considered together. Here’s a precept for

you. Anyone with undiagnosed or unsatisfactorily

treated hypothyroidism will sooner or later inevitably

slip into adrenal exhaustion. May take months or

years, but it will happen. Symptoms of adrenal

exhaustion exaggerate pre-existing thyroid symptoms.

There will be ongoing and endless fatigue, even less

tolerance to cold, depression, dizziness (postural

hypotension), body hair loss, pigmentation (especially

in skin folds), poor response to treatments generally

and an obviously weak immune system. Most

particularly, if there is an adrenal malfunction – I

still prefer to call this low adrenal reserve – the

patient responds poorly to thyroid hormone, or rapidly

gets ill and toxic on even quite small doses of

thyroxine.

Chronic fatigue and attendant problems

And now I want to broaden my sweep even further

because we have to consider chronic fatigue. Something

else to remember: all clients/patients suffering from

chronic fatigue, CFS, ME, and fibromyalgia have a

number of features in common. Most importantly, they

are metabolically down-regulated. Whatever else is

wrong, their thyroid and adrenal function is damaged.

It’s not as simple as that, of course, because the

illness brings in its train other problems too.

There is likely to be viral load. This may follow from

the original event that started it all off, a nasty

flu or glandular fever. If there has been a deficiency

in EFAs at any time, there may have been a lower than

normal eicosapentaenoic acid (EPA) level since some of

these big, nasty viruses can damage the

6-delta-desaturase enzyme that makes EPA (which is

viricidal and makes interferon) from linolenic acid.

There may be systemic candida. Because it’s systemic

and lurking in the gut, it may not have been thought

of but will be producing toxins and allowing all the

problems of dysbiosis and a leaky gut. This must be

looked for and treated.

There may be sex hormone imbalance, especially around

the menopause; oestrogen dominance, which interferes

with thyroid hormone, transport, production and

receptor uptake. Intervention may be considered here

if there is marked deficiency or imbalance. Food

allergies can be an associated problem, especially if

dysbiosis has been marked. There is often deficiency

of essential minerals and vitamins which have to be

sought for, especially if malabsorption is a feature,

as is likely. Prof Basant Puri’s work at Imperial

College, London, has focused on EPA and virgin EPO as

a method of clearing the viral load, which has had

some success; and Dr Myhill, a private GP in

north Wales, uses D-ribose, L-carnitine, magnesium,

co-enzyme Q10 and high dosage B12 as another approach.

Treatment strategies for thyroid and adrenal

dysfunction

I am going to pull together later the diagnostic

approach to the detection of thyroid and adrenal

dysfunction but before I do, it’s time to consider our

treatment strategies.

Thyroid

There are three levels of approach. The first is

nutritional. To manufacture thyroid hormone there

needs to be tyrosine, selenium and iodine, together

with vitamin and mineral cofactors. We are most

especially thinking of the B complex – B6 is crucially

important – and magnesium, zinc, manganese and

chromium. A number of companies make excellent thyroid

support products – an example is Thyrocomplex from

Nutri Ltd.

The next level is the use of natural glandular

concentrates. In this country they are successfully

produced as nutritional supplements. Nutri make Nutri

Thyroid, which contains 130 mg of glandular

concentrate and enzymes and enough thyroid hormones to

improve thyroid levels greatly. A dose of one to four

tablets daily is recommended.

The third level is thyroid hormone replacement. Many

of you are aware of the prescription-only medicine,

natural desiccated thyroid; Armour is the most

well-known. This is available on-line in 30 mg, 60 mg,

120 mg and 240 mg tablets and may be used with

confidence where the glandular concentrate has not

provided significant improvement. A usual starting

dose would be either 30 or 60 mg.

Then there is the use of synthetic thyroxine or

levothyroxine. Because the generics appear to vary in

potency (an accusation thrown quite unfairly and

wrongly at Armour thyroid), clients/patients may not

do awfully well on them, first because the dose is

managed purely on the outcome of blood tests - instead

of asking the patient and actually listening to them

as an alternative to blood tests, which is actually

not just frowned upon, it is now a hanging offence.

(Thus far has evidence-based medicine brought us!)

And, secondly, there is often an adrenal problem

which, if not dealt with, will cause T4 toxicosis

and/or an adrenal crisis.

Adrenal

Adrenal dysfunction may be detected clinically without

difficulty – the Raglan test, Romberg test and

pupillary reflex are most helpful and the Adrenal

Stress Index will confirm the diagnosis. Treatment of

low adrenal reserve has, like the thyroid, three

levels and, if hypothyroidism is present, must be put

in place before thyroid supplementation is begun.

Nutritionally, the adrenals need vitamin C, 4 grams or

more daily; they need pantothenic acid (B5) and

benefit from the use of liquorice (wood or tincture),

Siberian ginseng and coenzyme Q10.

Extremely valuable is the adrenal glandular

concentrate; that made by Nutri Ltd is widely

available (I recommend them because I have found their

products to be very efficacious). One product contains

80 mg of the concentrate alone and another, 221 mg,

together with a number of vitamins and minerals.

If this proves unsatisfactory, which is uncommon and

usually because the adrenals have been really badly

damaged over a period of time, the use of the adrenal

hormone, cortisol (hydrocortisone), 2.5 mg up to 25

mg, may be considered by the practitioner, together

with DHEA 25 mg or 7-keto DHEA 50 mg.

These measures will remedy the underlying damage, but

intervention may be necessary to balance low

progesterone or high oestrogen – the use of natural

transdermal creams is the best method.

Systemic candida must be treated where present, using

a fungicide (fluconazole can be helpful), together

with grapefruit seed extract, caprylic acid, horopito,

etc, along with an effective pre- and probiotic.

Food allergies have to be dealt with on their merits,

usually by simple avoidance, while malabsorption may

require the use of Betaine HCl and/or pancreatic

enzymes. Nutri Ltd make a combination called

Nutrigest.

A viral load may respond to VegEPA, the EPA – EPO

formulation I mentioned earlier.

Treatment of thyroid and adrenal insufficiency along

these lines can be extremely rewarding and successful

and a similarly broad approach in dealing with CFS has

been proving very helpful also.

Pathological aids to diagnosis

Now we have a working knowledge of diagnosis and

treatment, it is right to discuss the use of available

pathological aids to diagnosis. Long recognised by

many practitioners as an invaluable indication of

thyroid deficiency is the waking temperature, as

described by the American pioneer in this field, Dr

Broda (author of The Unsuspected Illness and

founder of the Foundation in Trumble, Conn).

Thyroid first of all. Standard NHS testing tends to be

restricted to TSH (thyroid-stimulating hormone)

usually, with Free T4 thrown in if you’re lucky. The

full range, which includes T4, T3, TSH and TPO and

TgAb antibodies will not usually be done, even under

extreme demand, and so clients/patients will often

seek the help of private laboratories.

The full thyroid screen, if possible, should always be

done, but you must remember that the TSH is often

unreliable if the pituitary is suffering from a

hypo-metabolic state and there are other reasons that

can affect its reliability. If it’s high, well and

good; if it’s at normal levels, it proves nothing. T4,

if low, again good, if it’s normal, it may mean that

it is not being properly used, is building up and

causing a false result. The same argument applies to

the T3, but the antibody test may be relied upon.

Thyroid tests should always be considered against the

clinical findings and, remember, clinical observation

is very much more reliable than tests. As you may have

observed, I have a deep-rooted cynicism about the

politically correct obsession with evidence-based

medicine. Surely it should be observation first, tests

second?

Where doubt continues to exist, this may be resolved

by the 24-hour urine test. As far as I know only

Individual Wellbeing and Diagnostic Lab, New Malden,

Surrey, do this test in the UK; European Laboratories

of Nutrition do it in The Netherlands. It relies on

the findings of Hertoghe & Baisier, who showed the

greatly increased reliability of the 24-hour urine

which, after all, measures the thyroid production over

a whole day, as opposed to the blood test, which is a

snapshot of a single moment showing levels that can

vary widely with time of day and other variables. The

test demonstrates the amount of T4 and T3 actually

used and passed through the tissues. It is much more

useful than other tests and will show even minor

degrees of low thyroid function. In an ideal world

both the full-serum, thyroid screen and the 24-hour

urine should be done, but there are logistic and

financial difficulties that have to restrain one’s

enthusiasm. While interpretation of the 24-hour urine

is perfectly straight-forward, the blood thyroid

screen has to be carefully assessed.

Beware the pitfalls

The first stumbling block is the TSH; a rise of TSH

indicates poor thyroid response but the level

considered to be indicative of this can be a matter of

different interpretation by laboratories and doctors.

The recent guidelines issued by the British Thyroid

Association suggesting that treatment should not be

offered below 10 units is quite unbelievable. The

American Association of Clinical Endocrinologists has

recently considered a level of 3.2 to be the cut-off

point and in my view anything over this, combined of

course with a clinical appraisal pointing to the

diagnosis, should demand intervention. Labs seem to

vary between about four and six; but I say again,

anything over two should arouse suspicion and anything

over 2.5 should result in a trial of treatment at the

very least.

The trouble with the TSH is that it may not be a

proper response to thyroid uptake since there are four

types of thyroid receptor and a metabolically

challenged pituitary cannot respond properly anyway.

So a high level is valuable, a low level may mean

nothing.

Measurement of T4 and T3 has always been very much

subject to error. The obvious difficulty is that it is

only, as I said earlier, a snapshot of a level that

may vary a lot during the day, but it goes deeper than

that. Failure of uptake by exhausted and missing

receptors will allow levels to be normal or even high

in the bloodstream, simply since thyroid hormone isn’t

being used, and conversion deficits can further

distort the picture. The presence of thyroid

antibodies (TPO and TgAb) should not usually cause

much difficulty: either they are well raised or they

are not, allowing an immediate diagnosis of

Hashimoto’s or Graves’ disease to be made. It should

be borne in mind that the levels fall away with the

passage of time.

Reverse T3 is sometimes of help; high levels may

indicate poor T3 receptor uptake, with the system

trying to rid itself of surplus T3. General illness,

malnutrition and trauma will also raise the T3.

Tests for adrenal function

We come now to the tests for adrenal function. Once

again, one simply must place the clinical picture to

the fore. A serum cortisol is greatly relied on by

orthodox medicine. It is almost useless. Similarly,

the Synacthen (long or short), in which ACTH is

injected to test adrenal function seems to be of

significance only where the adrenal insufficiency is

plainly ian.

More helpful by far is the salivary Adrenal Stress

Index, which measures cortisol and DHEA output in 24

hours. Here the true picture of adrenal stress may be

recognised and the three stages of the General

Adaption Syndrome clearly shown.

High levels of cortisol and DHEA show adrenals under

stress. Sometimes the cortisol pathway starts to fade

as exhaustion sets in, with DHEA still reasonably

present. Less commonly, there may be a really high

DHEA – a response to ACTH stimulation – but with the

cortisol pathways responding poorly. Erratic levels in

both are evidence of strain and uneven response.

The 21-hydroxylase and 17-hydroxylase enzyme

deficiencies may be apparent here; really weak

cortisol with high androgenic output enough to cause

virilisation. Where cortisol levels are obviously weak

and DHEA response is weak and flat, the diagnosis of

adrenal insufficiency (low adrenal reserve) slowly

heading toward ’s disease may be made.

Sex hormones

We have to consider the sex hormones in more depth.

Many of us are aware that in women hypothyroidism may

start with, and parallel, the menopause. One scenario

is the progressive loss of progesterone often some

years before the menopause itself. Apart from the

obvious increased risk of osteoporosis, the imbalance

will lead to oestrogen dominance – with weight gain,

bloating, mastalgia and heavy, painful periods. This

will increase thyroid-binding globulin, thus taking

some thyroid out of use; it will adversely affect

thyroid manufacture and receptor uptake. All the

symptoms are put down to the menopause, of course,

when actually the increasing deficiency of thyroid is

the main problem.

Later, both hormones run down and under the principle

of permissive action, where hormone production

requires the other players in the endocrine orchestra

to play their parts well and in tune, thyroid

production and processing may be affected adversely.

So being able to detect oestrogen dominance is pretty

helpful – one can correct the balance with natural,

transdermal progesterone. If levels of both are low,

careful use of natural progesterone and oestrogen can

be very valuable.

So, we should consider most carefully the menopause

profile, or at the very least, a spot check of a day’s

output of progesterone and oestrogen. In menstruating

women, thought may be given to assessment of both

throughout a month. In general, however, getting the

thyroid and adrenal status right will often provide

welcome correction in much of the menstrual

difficulties and it may perhaps be considered at a

later date.

The lads must not be left out of the equation. The

male menopause most certainly happens – we can call it

the andropause – but is usually an altogether more

gradual and insidious affair. Ideally, assessment of

testosterone levels should be carried out if the

slightest doubt exists.

The role of candida I have considered earlier and it’s

so common that its presence must be sought for. The

old-fashioned, nutritionist, spit-in-a-glass test

should be done, I think, as a routine. The presence of

a miniature Medussa means that the candida antibody

profile simply must be carried out and, if active

candida antibodies are present, treatment is

essential. I find it in rather more than half of my

clients/patients.

Conclusion

To sum it all up, I am here making a plea for the

recognition of the very common syndrome of thyroid and

adrenal deficiency, using observation and medicine

practised as an art, as the primary diagnostic method,

with the lab playing a secondary role. Further, be

aware that the syndrome has global effects, with

imbalance of other hormones, the likely presence of

systemic candida and dysbiosis, malabsorption and food

allergy all playing a probable role.

Dr Durrant-Peatfield is the author of The Great

Thyroid Scandal and How to Survive it, which is about

to be re-published in April in a fully updated, 2nd

edition as Your Thyroid and How to Keep it Healthy by

Hammersmith Press (www.hammersmithpress.co.uk), from

which the above information is taken.

Based in Meopham, Kent, he can be contacted at

info@... or on 01474 815793.

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[Guest guest]

> Hi

That's a really excellent article..lots of good information.

Thanks for sharing.

> Hi Everyone,

> Here is an article by Dr Barry Durrant-Peatfield which

> presents a huge amount of information in very readable

> form.

> The phone number at the end may be of interest to UK

> members.

>

>

>

> http://www.i-c-m.org.uk/Journal/2006/feb/a02.htm

>

> Thyroid and adrenal dysfunction: the diagnosis and

> treatment of an endemic syndrome

>

> Thyroid specialist Dr Barry Durrant-Peatfield explains

> why practitioners should check for thyroid and adrenal

> problems when presented with a familiar range of

> symptoms that often mask prolonged dysfunction in

> these two organs.

> Introduction

> The first quarrel many people may have – but most

> especially doctors – may well be in the title: the use

> of the word endemic. To read a number of learned

> articles would leave the impression that thyroid

> dysfunction was a matter of a few percent of the

> general population and adrenal dysfunction much less

> than this.

> I have to say now, right at the outset, that this

> widely held view, held by orthodox medicine, is quite

> wrong, disgracefully so. It is, in the profession,

> politically correct to believe that thyroid

> dysfunction is not common at all and the symptoms are

> due to other things, notably depression. If you want

> to appear really learned, you will speak of

> maladaption to one's environment due to a personality

> dysfunction.

> Adrenal dysfunction fares worse and is believed to be

> about as rare as hens' teeth. In any event, the

> argument goes, 's disease (total adrenal

> failure), by definition, hardly occurs.

> I cannot emphasise strongly enough that both thyroid

> and adrenal dysfunction are so commonly met with as

> indeed to be endemic and disgraceful diagnostic

> failure is the rule. I speak after more than 25 years

> of practical study and treatment of both conditions

> and I have suffered at the hands of an ignorant

> establishment for daring to diagnose and treat these

> problems. If you gain from this article nothing else,

> you must take away this fact: thyroid dysfunction, and

> its partner in crime, adrenal dysfunction are all

> around us, every day, in our clients/patients and even

> our colleagues. So common are they that whenever your

> opinion as a practitioner is asked on an apparently

> complex illness, you must ask yourself first: could

> there be an underlying thyroid and adrenal problem?

> (For the moment I shall not consider over-activity of

> either, but only sub-optimal activity.)

> Down-regulation of the metabolism

> Thyroid and adrenal dysfunction usually come together

> but in varying degrees of emphasis. They cause a

> down-regulation of all metabolic processes, hence

> these clients/patients are all hypometabolic.

> Metabolism, as I need not remind you, may be defined

> as the rate at which energy is produced and consumed

> by the tissues. Glucose, oxygen in; carbon dioxide,

> water, energy out. For everything to work properly

> this process has to be optimally regulated and it is

> the thyroid hormone that does this.

> Thyroid hormones ensure that the cell membrane is

> actively and positively involved in the transport of

> the raw materials of energy production – not just

> oxygen and glucose but all the required enzymes and

> co-factors passing into the cell; and, equally, the

> passage out of the waste products once the energy has

> been released. The activity of the Krebs cycle within

> the mitochondrion is equally thyroid dependent.

> It's helpful to think of the whole organism as an

> incredibly complex and intricate, electric machine

> that is built and wired up for 240 volts. If we try to

> run it at 190 volts it's not going to work properly.

> The lights flicker and grow dim. A down-regulated

> metabolism affects the organism in the same way. This

> means nothing works properly. Every tissue, every

> organ, every biological process, suffers. Some pieces

> of the equipment are affected more than others and

> differently, depending on the original design.

> In humans probably the organ most sensitive to

> metabolic down-regulation is the brain. Not far behind

> are the highly metabolically active liver, then the

> kidneys, then digestive processes, then our

> temperature control and the intricate working of our

> immune system. You see, the point is you name it and

> it doesn't work properly. Our clients/patients may

> have lots of different things wrong with them, so many

> that even they think they are hypochondriacs, never

> mind the doctor who came to that conclusion some time

> before.

> It is essential to understand that a down-regulated

> metabolism has a total effect on the body's

> functioning. You cannot, you must not, focus on one or

> two symptoms; they must all be considered as a whole.

> How difficult this is in today's environment. There's

> never enough time, it's all got to be written down,

> quick decision, then out the door. Another symptom?

> Ah! Make another appointment and we will talk about it

> later. Here the advantage many of us have who practise

> away from the mainstream becomes apparent – we have

> time!

> Hypothyroidism – recognising the symptoms

> Let's take hypothyroidism first - probably the most

> common misdiagnosis of all common illnesses. A decent

> history soon gives us a few facts. Fatigue, weight

> gain, brain fog, depression, cold/heat intolerance,

> arthralgic aches and pains, fluid retention, bad skin,

> menstrual problems and infertility, hair loss,

> intractable constipation and lots of others. If you

> take these separately, how easy it is to narrow the

> focus and go for the wrong thing. Typically, a

> standard assessment might be:

> Fatigue: well, go to bed early, don't work so hard,

> you are depressed, anaemic - some Prozac and iron

> pills and you'll be OK. Weight: you eat too much - try

> this diet. Brain fog: well, none of us are getting any

> younger, are we – too much stress. Depression. Ah! We

> can help you there, no trouble. Cold/heat intolerance:

> your age - wear warmer things. Arthralgia: bit of

> arthritis here I'm afraid - try these NSAIDs. Fluid

> retention - lovely pills here, make you pee, no

> trouble. Skin: bad diet, hormones. Bad periods: one of

> the crosses you women all have to bear. Hair loss:

> age, diet - better hairdresser. Constipation: got

> something for that or try the chemist.

> All the time the underlying problem is being missed. A

> simple examination can pick out the thyroid deficiency

> in minutes. And we'll come to the tests later.

> Possible causes

> Now, as to why the thyroid goes wrong there are

> various possibilities. It may be due to control

> failure – dysfunction in the hypothalamus or

> pituitary. It may be failure of conversion of T4 into

> T3, due to enzyme failure and poor adrenal function.

> There may be failure or resistance to binding of T3 at

> the receptor sites, damaging gene expression – the

> Gq/11 proteins may be activated to switch off this

> response. And, most of all, it may be primary failure

> in the gland itself. Primary failure in the gland may

> be:

> 1. Genetic, appearing at, or soon after, birth. A baby

> with thyroid failure is true cretinism.

> 2. It may be due to environmental deficiencies, like

> iodine, or the presence of toxins such as fluoride,

> PCBs, dioxins and endless others.

> 3. Trauma - general surgery, especially in women; for

> example, cholecystectomy, hysterectomy. Or damage to

> the gland from whiplash.

> 4. Glandular fever.

> 5. Autoimmune disease.

> 6. Pregnancy and childbirth.

> A word about the over-active thyroid. Again, more

> common in women, but you don't see that many; probably

> two for every 100 under-active. Not a difficult

> diagnosis; the patient is hot, terribly nervy, has

> loose bowels, is losing weight and has a racing pulse.

> The only real differential diagnosis is an anxiety

> state.

> Adrenal dysfunction and the General Adaption Syndrome

> Now for adrenal dysfunction. The glands can go wrong

> in two ways: too much or too little. Too much and we

> have Cushing's disease. Only three causes really; too

> much cortisone for the asthma, rheumatoid arthritis or

> whatever; an adenoma on the gland itself; or one on

> the pituitary. We are all familiar with the moon face,

> thin skin, obesity, buffalo hump, so it shouldn't be

> difficult. A lot of people are checked out for

> Cushing's just because they are a funny shape but,

> unless caused by over-medication, it isn't very common

> at all.

> Adrenal hypo-function is a different kettle of fish

> entirely. The diagnosis is missed more decisively even

> than hypothyroidism because most clinicians only seem

> to think of it in terms of 's disease. In fact,

> the adrenals can malfunction in degrees. A failure in

> pituitary control may play a role, often as a spin-off

> from a generally low metabolic state; but usually the

> failure is the result of long-term stress. Hans Selye

> recognised three major stages in adrenal

> hypo-function, which he called the General Adaption

> Syndrome (GAS).

> Stage I is the stressed phase where, due to illness or

> other stress, the adrenals mobilise cortisol and DHEA

> (dehydroepiadrenosterone) to help the body deal with

> the problem. This is an acute phase; the stress

> settles and the adrenals settle down.

> Stage II, resistance, is where it all goes on and on

> and the adrenals enlarge and increase their hormone

> output on a longer-term basis. This can go on for

> weeks, months, or even years but eventually they can't

> take it any more and start to regress into exhaustion,

> stage III. The degree of exhaustion is reflected in

> their output and balance of their two chief hormones,

> cortisol and DHEA, which is where the Adrenal Stress

> Index (ASI) comes in.

> The last phase of the GAS is what we will often see if

> we are looking for it. Important causes, of course,

> are major life-events, trauma, operations and the

> general and prolonged ghastliness of existence. But,

> for our purposes, the big cause is persistent and

> chronic illness. In the attempt to help the body deal

> with, and compensate for, the illness, adrenal

> exhaustion starts to take over. An example of a

> persistent and chronic illness untreated, or

> mistreated, is hypothyroidism.

> So now you see why thyroid and adrenal hypo-function

> have to be considered together. Here's a precept for

> you. Anyone with undiagnosed or unsatisfactorily

> treated hypothyroidism will sooner or later inevitably

> slip into adrenal exhaustion. May take months or

> years, but it will happen. Symptoms of adrenal

> exhaustion exaggerate pre-existing thyroid symptoms.

> There will be ongoing and endless fatigue, even less

> tolerance to cold, depression, dizziness (postural

> hypotension), body hair loss, pigmentation (especially

> in skin folds), poor response to treatments generally

> and an obviously weak immune system. Most

> particularly, if there is an adrenal malfunction – I

> still prefer to call this low adrenal reserve – the

> patient responds poorly to thyroid hormone, or rapidly

> gets ill and toxic on even quite small doses of

> thyroxine.

> Chronic fatigue and attendant problems

> And now I want to broaden my sweep even further

> because we have to consider chronic fatigue. Something

> else to remember: all clients/patients suffering from

> chronic fatigue, CFS, ME, and fibromyalgia have a

> number of features in common. Most importantly, they

> are metabolically down-regulated. Whatever else is

> wrong, their thyroid and adrenal function is damaged.

> It's not as simple as that, of course, because the

> illness brings in its train other problems too.

> There is likely to be viral load. This may follow from

> the original event that started it all off, a nasty

> flu or glandular fever. If there has been a deficiency

> in EFAs at any time, there may have been a lower than

> normal eicosapentaenoic acid (EPA) level since some of

> these big, nasty viruses can damage the

> 6-delta-desaturase enzyme that makes EPA (which is

> viricidal and makes interferon) from linolenic acid.

> There may be systemic candida. Because it's systemic

> and lurking in the gut, it may not have been thought

> of but will be producing toxins and allowing all the

> problems of dysbiosis and a leaky gut. This must be

> looked for and treated.

> There may be sex hormone imbalance, especially around

> the menopause; oestrogen dominance, which interferes

> with thyroid hormone, transport, production and

> receptor uptake. Intervention may be considered here

> if there is marked deficiency or imbalance. Food

> allergies can be an associated problem, especially if

> dysbiosis has been marked. There is often deficiency

> of essential minerals and vitamins which have to be

> sought for, especially if malabsorption is a feature,

> as is likely. Prof Basant Puri's work at Imperial

> College, London, has focused on EPA and virgin EPO as

> a method of clearing the viral load, which has had

> some success; and Dr Myhill, a private GP in

> north Wales, uses D-ribose, L-carnitine, magnesium,

> co-enzyme Q10 and high dosage B12 as another approach.

> Treatment strategies for thyroid and adrenal

> dysfunction

> I am going to pull together later the diagnostic

> approach to the detection of thyroid and adrenal

> dysfunction but before I do, it's time to consider our

> treatment strategies.

> Thyroid

> There are three levels of approach. The first is

> nutritional. To manufacture thyroid hormone there

> needs to be tyrosine, selenium and iodine, together

> with vitamin and mineral cofactors. We are most

> especially thinking of the B complex – B6 is crucially

> important – and magnesium, zinc, manganese and

> chromium. A number of companies make excellent thyroid

> support products – an example is Thyrocomplex from

> Nutri Ltd.

> The next level is the use of natural glandular

> concentrates. In this country they are successfully

> produced as nutritional supplements. Nutri make Nutri

> Thyroid, which contains 130 mg of glandular

> concentrate and enzymes and enough thyroid hormones to

> improve thyroid levels greatly. A dose of one to four

> tablets daily is recommended.

> The third level is thyroid hormone replacement. Many

> of you are aware of the prescription-only medicine,

> natural desiccated thyroid; Armour is the most

> well-known. This is available on-line in 30 mg, 60 mg,

> 120 mg and 240 mg tablets and may be used with

> confidence where the glandular concentrate has not

> provided significant improvement. A usual starting

> dose would be either 30 or 60 mg.

> Then there is the use of synthetic thyroxine or

> levothyroxine. Because the generics appear to vary in

> potency (an accusation thrown quite unfairly and

> wrongly at Armour thyroid), clients/patients may not

> do awfully well on them, first because the dose is

> managed purely on the outcome of blood tests - instead

> of asking the patient and actually listening to them

> as an alternative to blood tests, which is actually

> not just frowned upon, it is now a hanging offence.

> (Thus far has evidence-based medicine brought us!)

> And, secondly, there is often an adrenal problem

> which, if not dealt with, will cause T4 toxicosis

> and/or an adrenal crisis.

> Adrenal

> Adrenal dysfunction may be detected clinically without

> difficulty – the Raglan test, Romberg test and

> pupillary reflex are most helpful and the Adrenal

> Stress Index will confirm the diagnosis. Treatment of

> low adrenal reserve has, like the thyroid, three

> levels and, if hypothyroidism is present, must be put

> in place before thyroid supplementation is begun.

> Nutritionally, the adrenals need vitamin C, 4 grams or

> more daily; they need pantothenic acid (B5) and

> benefit from the use of liquorice (wood or tincture),

> Siberian ginseng and coenzyme Q10.

> Extremely valuable is the adrenal glandular

> concentrate; that made by Nutri Ltd is widely

> available (I recommend them because I have found their

> products to be very efficacious). One product contains

> 80 mg of the concentrate alone and another, 221 mg,

> together with a number of vitamins and minerals.

> If this proves unsatisfactory, which is uncommon and

> usually because the adrenals have been really badly

> damaged over a period of time, the use of the adrenal

> hormone, cortisol (hydrocortisone), 2.5 mg up to 25

> mg, may be considered by the practitioner, together

> with DHEA 25 mg or 7-keto DHEA 50 mg.

> These measures will remedy the underlying damage, but

> intervention may be necessary to balance low

> progesterone or high oestrogen – the use of natural

> transdermal creams is the best method.

> Systemic candida must be treated where present, using

> a fungicide (fluconazole can be helpful), together

> with grapefruit seed extract, caprylic acid, horopito,

> etc, along with an effective pre- and probiotic.

> Food allergies have to be dealt with on their merits,

> usually by simple avoidance, while malabsorption may

> require the use of Betaine HCl and/or pancreatic

> enzymes. Nutri Ltd make a combination called

> Nutrigest.

> A viral load may respond to VegEPA, the EPA – EPO

> formulation I mentioned earlier.

> Treatment of thyroid and adrenal insufficiency along

> these lines can be extremely rewarding and successful

> and a similarly broad approach in dealing with CFS has

> been proving very helpful also.

> Pathological aids to diagnosis

> Now we have a working knowledge of diagnosis and

> treatment, it is right to discuss the use of available

> pathological aids to diagnosis. Long recognised by

> many practitioners as an invaluable indication of

> thyroid deficiency is the waking temperature, as

> described by the American pioneer in this field, Dr

> Broda (author of The Unsuspected Illness and

> founder of the Foundation in Trumble, Conn).

> Thyroid first of all. Standard NHS testing tends to be

> restricted to TSH (thyroid-stimulating hormone)

> usually, with Free T4 thrown in if you're lucky. The

> full range, which includes T4, T3, TSH and TPO and

> TgAb antibodies will not usually be done, even under

> extreme demand, and so clients/patients will often

> seek the help of private laboratories.

> The full thyroid screen, if possible, should always be

> done, but you must remember that the TSH is often

> unreliable if the pituitary is suffering from a

> hypo-metabolic state and there are other reasons that

> can affect its reliability. If it's high, well and

> good; if it's at normal levels, it proves nothing. T4,

> if low, again good, if it's normal, it may mean that

> it is not being properly used, is building up and

> causing a false result. The same argument applies to

> the T3, but the antibody test may be relied upon.

> Thyroid tests should always be considered against the

> clinical findings and, remember, clinical observation

> is very much more reliable than tests. As you may have

> observed, I have a deep-rooted cynicism about the

> politically correct obsession with evidence-based

> medicine. Surely it should be observation first, tests

> second?

> Where doubt continues to exist, this may be resolved

> by the 24-hour urine test. As far as I know only

> Individual Wellbeing and Diagnostic Lab, New Malden,

> Surrey, do this test in the UK; European Laboratories

> of Nutrition do it in The Netherlands. It relies on

> the findings of Hertoghe & Baisier, who showed the

> greatly increased reliability of the 24-hour urine

> which, after all, measures the thyroid production over

> a whole day, as opposed to the blood test, which is a

> snapshot of a single moment showing levels that can

> vary widely with time of day and other variables. The

> test demonstrates the amount of T4 and T3 actually

> used and passed through the tissues. It is much more

> useful than other tests and will show even minor

> degrees of low thyroid function. In an ideal world

> both the full-serum, thyroid screen and the 24-hour

> urine should be done, but there are logistic and

> financial difficulties that have to restrain one's

> enthusiasm. While interpretation of the 24-hour urine

> is perfectly straight-forward, the blood thyroid

> screen has to be carefully assessed.

> Beware the pitfalls

> The first stumbling block is the TSH; a rise of TSH

> indicates poor thyroid response but the level

> considered to be indicative of this can be a matter of

> different interpretation by laboratories and doctors.

> The recent guidelines issued by the British Thyroid

> Association suggesting that treatment should not be

> offered below 10 units is quite unbelievable. The

> American Association of Clinical Endocrinologists has

> recently considered a level of 3.2 to be the cut-off

> point and in my view anything over this, combined of

> course with a clinical appraisal pointing to the

> diagnosis, should demand intervention. Labs seem to

> vary between about four and six; but I say again,

> anything over two should arouse suspicion and anything

> over 2.5 should result in a trial of treatment at the

> very least.

> The trouble with the TSH is that it may not be a

> proper response to thyroid uptake since there are four

> types of thyroid receptor and a metabolically

> challenged pituitary cannot respond properly anyway.

> So a high level is valuable, a low level may mean

> nothing.

> Measurement of T4 and T3 has always been very much

> subject to error. The obvious difficulty is that it is

> only, as I said earlier, a snapshot of a level that

> may vary a lot during the day, but it goes deeper than

> that. Failure of uptake by exhausted and missing

> receptors will allow levels to be normal or even high

> in the bloodstream, simply since thyroid hormone isn't

> being used, and conversion deficits can further

> distort the picture. The presence of thyroid

> antibodies (TPO and TgAb) should not usually cause

> much difficulty: either they are well raised or they

> are not, allowing an immediate diagnosis of

> Hashimoto's or Graves' disease to be made. It should

> be borne in mind that the levels fall away with the

> passage of time.

> Reverse T3 is sometimes of help; high levels may

> indicate poor T3 receptor uptake, with the system

> trying to rid itself of surplus T3. General illness,

> malnutrition and trauma will also raise the T3.

> Tests for adrenal function

> We come now to the tests for adrenal function. Once

> again, one simply must place the clinical picture to

> the fore. A serum cortisol is greatly relied on by

> orthodox medicine. It is almost useless. Similarly,

> the Synacthen (long or short), in which ACTH is

> injected to test adrenal function seems to be of

> significance only where the adrenal insufficiency is

> plainly ian.

> More helpful by far is the salivary Adrenal Stress

> Index, which measures cortisol and DHEA output in 24

> hours. Here the true picture of adrenal stress may be

> recognised and the three stages of the General

> Adaption Syndrome clearly shown.

> High levels of cortisol and DHEA show adrenals under

> stress. Sometimes the cortisol pathway starts to fade

> as exhaustion sets in, with DHEA still reasonably

> present. Less commonly, there may be a really high

> DHEA – a response to ACTH stimulation – but with the

> cortisol pathways responding poorly. Erratic levels in

> both are evidence of strain and uneven response.

> The 21-hydroxylase and 17-hydroxylase enzyme

> deficiencies may be apparent here; really weak

> cortisol with high androgenic output enough to cause

> virilisation. Where cortisol levels are obviously weak

> and DHEA response is weak and flat, the diagnosis of

> adrenal insufficiency (low adrenal reserve) slowly

> heading toward 's disease may be made.

> Sex hormones

> We have to consider the sex hormones in more depth.

> Many of us are aware that in women hypothyroidism may

> start with, and parallel, the menopause. One scenario

> is the progressive loss of progesterone often some

> years before the menopause itself. Apart from the

> obvious increased risk of osteoporosis, the imbalance

> will lead to oestrogen dominance – with weight gain,

> bloating, mastalgia and heavy, painful periods. This

> will increase thyroid-binding globulin, thus taking

> some thyroid out of use; it will adversely affect

> thyroid manufacture and receptor uptake. All the

> symptoms are put down to the menopause, of course,

> when actually the increasing deficiency of thyroid is

> the main problem.

> Later, both hormones run down and under the principle

> of permissive action, where hormone production

> requires the other players in the endocrine orchestra

> to play their parts well and in tune, thyroid

> production and processing may be affected adversely.

> So being able to detect oestrogen dominance is pretty

> helpful – one can correct the balance with natural,

> transdermal progesterone. If levels of both are low,

> careful use of natural progesterone and oestrogen can

> be very valuable.

> So, we should consider most carefully the menopause

> profile, or at the very least, a spot check of a day's

> output of progesterone and oestrogen. In menstruating

> women, thought may be given to assessment of both

> throughout a month. In general, however, getting the

> thyroid and adrenal status right will often provide

> welcome correction in much of the menstrual

> difficulties and it may perhaps be considered at a

> later date.

> The lads must not be left out of the equation. The

> male menopause most certainly happens – we can call it

> the andropause – but is usually an altogether more

> gradual and insidious affair. Ideally, assessment of

> testosterone levels should be carried out if the

> slightest doubt exists.

> The role of candida I have considered earlier and it's

> so common that its presence must be sought for. The

> old-fashioned, nutritionist, spit-in-a-glass test

> should be done, I think, as a routine. The presence of

> a miniature Medussa means that the candida antibody

> profile simply must be carried out and, if active

> candida antibodies are present, treatment is

> essential. I find it in rather more than half of my

> clients/patients.

> Conclusion

> To sum it all up, I am here making a plea for the

> recognition of the very common syndrome of thyroid and

> adrenal deficiency, using observation and medicine

> practised as an art, as the primary diagnostic method,

> with the lab playing a secondary role. Further, be

> aware that the syndrome has global effects, with

> imbalance of other hormones, the likely presence of

> systemic candida and dysbiosis, malabsorption and food

> allergy all playing a probable role.

>

> Dr Durrant-Peatfield is the author of The Great

> Thyroid Scandal and How to Survive it, which is about

> to be re-published in April in a fully updated, 2nd

> edition as Your Thyroid and How to Keep it Healthy by

> Hammersmith Press (www.hammersmithpress.co.uk), from

> which the above information is taken.

> Based in Meopham, Kent, he can be contacted at

> info@... or on 01474 815793.

>

>

>

>

>

>

______________________________________________________________________

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>

[Guest guest]

Gteat info and reference I am going to print this out before my next

check up and ask the doctor to read it. Maybe I can get him to be

more open with thyroid treatment.

Thanks,

Robiin

- In The_Thyroid_Support_Group ,

wrote:

>

> Hi Everyone,

> Here is an article by Dr Barry Durrant-Peatfield which

> presents a huge amount of information in very readable

> form.

> The phone number at the end may be of interest to UK

> members.

>

>

>

> http://www.i-c-m.org.uk/Journal/2006/feb/a02.htm

>

> Thyroid and adrenal dysfunction: the diagnosis and

> treatment of an endemic syndrome

>

> Thyroid specialist Dr Barry Durrant-Peatfield explains

> why practitioners should check for thyroid and adrenal

> problems when presented with a familiar range of

> symptoms that often mask prolonged dysfunction in

> these two organs.

> Introduction

> The first quarrel many people may have – but most

> especially doctors – may well be in the title: the use

> of the word endemic. To read a number of learned

> articles would leave the impression that thyroid

> dysfunction was a matter of a few percent of the

> general population and adrenal dysfunction much less

> than this.

> I have to say now, right at the outset, that this

> widely held view, held by orthodox medicine, is quite

> wrong, disgracefully so. It is, in the profession,

> politically correct to believe that thyroid

> dysfunction is not common at all and the symptoms are

> due to other things, notably depression. If you want

> to appear really learned, you will speak of

> maladaption to one's environment due to a personality

> dysfunction.

> Adrenal dysfunction fares worse and is believed to be

> about as rare as hens' teeth. In any event, the

> argument goes, 's disease (total adrenal

> failure), by definition, hardly occurs.

> I cannot emphasise strongly enough that both thyroid

> and adrenal dysfunction are so commonly met with as

> indeed to be endemic and disgraceful diagnostic

> failure is the rule. I speak after more than 25 years

> of practical study and treatment of both conditions

> and I have suffered at the hands of an ignorant

> establishment for daring to diagnose and treat these

> problems. If you gain from this article nothing else,

> you must take away this fact: thyroid dysfunction, and

> its partner in crime, adrenal dysfunction are all

> around us, every day, in our clients/patients and even

> our colleagues. So common are they that whenever your

> opinion as a practitioner is asked on an apparently

> complex illness, you must ask yourself first: could

> there be an underlying thyroid and adrenal problem?

> (For the moment I shall not consider over-activity of

> either, but only sub-optimal activity.)

> Down-regulation of the metabolism

> Thyroid and adrenal dysfunction usually come together

> but in varying degrees of emphasis. They cause a

> down-regulation of all metabolic processes, hence

> these clients/patients are all hypometabolic.

> Metabolism, as I need not remind you, may be defined

> as the rate at which energy is produced and consumed

> by the tissues. Glucose, oxygen in; carbon dioxide,

> water, energy out. For everything to work properly

> this process has to be optimally regulated and it is

> the thyroid hormone that does this.

> Thyroid hormones ensure that the cell membrane is

> actively and positively involved in the transport of

> the raw materials of energy production – not just

> oxygen and glucose but all the required enzymes and

> co-factors passing into the cell; and, equally, the

> passage out of the waste products once the energy has

> been released. The activity of the Krebs cycle within

> the mitochondrion is equally thyroid dependent.

> It's helpful to think of the whole organism as an

> incredibly complex and intricate, electric machine

> that is built and wired up for 240 volts. If we try to

> run it at 190 volts it's not going to work properly.

> The lights flicker and grow dim. A down-regulated

> metabolism affects the organism in the same way. This

> means nothing works properly. Every tissue, every

> organ, every biological process, suffers. Some pieces

> of the equipment are affected more than others and

> differently, depending on the original design.

> In humans probably the organ most sensitive to

> metabolic down-regulation is the brain. Not far behind

> are the highly metabolically active liver, then the

> kidneys, then digestive processes, then our

> temperature control and the intricate working of our

> immune system. You see, the point is you name it and

> it doesn't work properly. Our clients/patients may

> have lots of different things wrong with them, so many

> that even they think they are hypochondriacs, never

> mind the doctor who came to that conclusion some time

> before.

> It is essential to understand that a down-regulated

> metabolism has a total effect on the body's

> functioning. You cannot, you must not, focus on one or

> two symptoms; they must all be considered as a whole.

> How difficult this is in today's environment. There's

> never enough time, it's all got to be written down,

> quick decision, then out the door. Another symptom?

> Ah! Make another appointment and we will talk about it

> later. Here the advantage many of us have who practise

> away from the mainstream becomes apparent – we have

> time!

> Hypothyroidism – recognising the symptoms

> Let's take hypothyroidism first - probably the most

> common misdiagnosis of all common illnesses. A decent

> history soon gives us a few facts. Fatigue, weight

> gain, brain fog, depression, cold/heat intolerance,

> arthralgic aches and pains, fluid retention, bad skin,

> menstrual problems and infertility, hair loss,

> intractable constipation and lots of others. If you

> take these separately, how easy it is to narrow the

> focus and go for the wrong thing. Typically, a

> standard assessment might be:

> Fatigue: well, go to bed early, don't work so hard,

> you are depressed, anaemic - some Prozac and iron

> pills and you'll be OK. Weight: you eat too much - try

> this diet. Brain fog: well, none of us are getting any

> younger, are we – too much stress. Depression. Ah! We

> can help you there, no trouble. Cold/heat intolerance:

> your age - wear warmer things. Arthralgia: bit of

> arthritis here I'm afraid - try these NSAIDs. Fluid

> retention - lovely pills here, make you pee, no

> trouble. Skin: bad diet, hormones. Bad periods: one of

> the crosses you women all have to bear. Hair loss:

> age, diet - better hairdresser. Constipation: got

> something for that or try the chemist.

> All the time the underlying problem is being missed. A

> simple examination can pick out the thyroid deficiency

> in minutes. And we'll come to the tests later.

> Possible causes

> Now, as to why the thyroid goes wrong there are

> various possibilities. It may be due to control

> failure – dysfunction in the hypothalamus or

> pituitary. It may be failure of conversion of T4 into

> T3, due to enzyme failure and poor adrenal function.

> There may be failure or resistance to binding of T3 at

> the receptor sites, damaging gene expression – the

> Gq/11 proteins may be activated to switch off this

> response. And, most of all, it may be primary failure

> in the gland itself. Primary failure in the gland may

> be:

> 1. Genetic, appearing at, or soon after, birth. A baby

> with thyroid failure is true cretinism.

> 2. It may be due to environmental deficiencies, like

> iodine, or the presence of toxins such as fluoride,

> PCBs, dioxins and endless others.

> 3. Trauma - general surgery, especially in women; for

> example, cholecystectomy, hysterectomy. Or damage to

> the gland from whiplash.

> 4. Glandular fever.

> 5. Autoimmune disease.

> 6. Pregnancy and childbirth.

> A word about the over-active thyroid. Again, more

> common in women, but you don't see that many; probably

> two for every 100 under-active. Not a difficult

> diagnosis; the patient is hot, terribly nervy, has

> loose bowels, is losing weight and has a racing pulse.

> The only real differential diagnosis is an anxiety

> state.

> Adrenal dysfunction and the General Adaption Syndrome

> Now for adrenal dysfunction. The glands can go wrong

> in two ways: too much or too little. Too much and we

> have Cushing's disease. Only three causes really; too

> much cortisone for the asthma, rheumatoid arthritis or

> whatever; an adenoma on the gland itself; or one on

> the pituitary. We are all familiar with the moon face,

> thin skin, obesity, buffalo hump, so it shouldn't be

> difficult. A lot of people are checked out for

> Cushing's just because they are a funny shape but,

> unless caused by over-medication, it isn't very common

> at all.

> Adrenal hypo-function is a different kettle of fish

> entirely. The diagnosis is missed more decisively even

> than hypothyroidism because most clinicians only seem

> to think of it in terms of 's disease. In fact,

> the adrenals can malfunction in degrees. A failure in

> pituitary control may play a role, often as a spin-off

> from a generally low metabolic state; but usually the

> failure is the result of long-term stress. Hans Selye

> recognised three major stages in adrenal

> hypo-function, which he called the General Adaption

> Syndrome (GAS).

> Stage I is the stressed phase where, due to illness or

> other stress, the adrenals mobilise cortisol and DHEA

> (dehydroepiadrenosterone) to help the body deal with

> the problem. This is an acute phase; the stress

> settles and the adrenals settle down.

> Stage II, resistance, is where it all goes on and on

> and the adrenals enlarge and increase their hormone

> output on a longer-term basis. This can go on for

> weeks, months, or even years but eventually they can't

> take it any more and start to regress into exhaustion,

> stage III. The degree of exhaustion is reflected in

> their output and balance of their two chief hormones,

> cortisol and DHEA, which is where the Adrenal Stress

> Index (ASI) comes in.

> The last phase of the GAS is what we will often see if

> we are looking for it. Important causes, of course,

> are major life-events, trauma, operations and the

> general and prolonged ghastliness of existence. But,

> for our purposes, the big cause is persistent and

> chronic illness. In the attempt to help the body deal

> with, and compensate for, the illness, adrenal

> exhaustion starts to take over. An example of a

> persistent and chronic illness untreated, or

> mistreated, is hypothyroidism.

> So now you see why thyroid and adrenal hypo-function

> have to be considered together. Here's a precept for

> you. Anyone with undiagnosed or unsatisfactorily

> treated hypothyroidism will sooner or later inevitably

> slip into adrenal exhaustion. May take months or

> years, but it will happen. Symptoms of adrenal

> exhaustion exaggerate pre-existing thyroid symptoms.

> There will be ongoing and endless fatigue, even less

> tolerance to cold, depression, dizziness (postural

> hypotension), body hair loss, pigmentation (especially

> in skin folds), poor response to treatments generally

> and an obviously weak immune system. Most

> particularly, if there is an adrenal malfunction – I

> still prefer to call this low adrenal reserve – the

> patient responds poorly to thyroid hormone, or rapidly

> gets ill and toxic on even quite small doses of

> thyroxine.

> Chronic fatigue and attendant problems

> And now I want to broaden my sweep even further

> because we have to consider chronic fatigue. Something

> else to remember: all clients/patients suffering from

> chronic fatigue, CFS, ME, and fibromyalgia have a

> number of features in common. Most importantly, they

> are metabolically down-regulated. Whatever else is

> wrong, their thyroid and adrenal function is damaged.

> It's not as simple as that, of course, because the

> illness brings in its train other problems too.

> There is likely to be viral load. This may follow from

> the original event that started it all off, a nasty

> flu or glandular fever. If there has been a deficiency

> in EFAs at any time, there may have been a lower than

> normal eicosapentaenoic acid (EPA) level since some of

> these big, nasty viruses can damage the

> 6-delta-desaturase enzyme that makes EPA (which is

> viricidal and makes interferon) from linolenic acid.

> There may be systemic candida. Because it's systemic

> and lurking in the gut, it may not have been thought

> of but will be producing toxins and allowing all the

> problems of dysbiosis and a leaky gut. This must be

> looked for and treated.

> There may be sex hormone imbalance, especially around

> the menopause; oestrogen dominance, which interferes

> with thyroid hormone, transport, production and

> receptor uptake. Intervention may be considered here

> if there is marked deficiency or imbalance. Food

> allergies can be an associated problem, especially if

> dysbiosis has been marked. There is often deficiency

> of essential minerals and vitamins which have to be

> sought for, especially if malabsorption is a feature,

> as is likely. Prof Basant Puri's work at Imperial

> College, London, has focused on EPA and virgin EPO as

> a method of clearing the viral load, which has had

> some success; and Dr Myhill, a private GP in

> north Wales, uses D-ribose, L-carnitine, magnesium,

> co-enzyme Q10 and high dosage B12 as another approach.

> Treatment strategies for thyroid and adrenal

> dysfunction

> I am going to pull together later the diagnostic

> approach to the detection of thyroid and adrenal

> dysfunction but before I do, it's time to consider our

> treatment strategies.

> Thyroid

> There are three levels of approach. The first is

> nutritional. To manufacture thyroid hormone there

> needs to be tyrosine, selenium and iodine, together

> with vitamin and mineral cofactors. We are most

> especially thinking of the B complex – B6 is crucially

> important – and magnesium, zinc, manganese and

> chromium. A number of companies make excellent thyroid

> support products – an example is Thyrocomplex from

> Nutri Ltd.

> The next level is the use of natural glandular

> concentrates. In this country they are successfully

> produced as nutritional supplements. Nutri make Nutri

> Thyroid, which contains 130 mg of glandular

> concentrate and enzymes and enough thyroid hormones to

> improve thyroid levels greatly. A dose of one to four

> tablets daily is recommended.

> The third level is thyroid hormone replacement. Many

> of you are aware of the prescription-only medicine,

> natural desiccated thyroid; Armour is the most

> well-known. This is available on-line in 30 mg, 60 mg,

> 120 mg and 240 mg tablets and may be used with

> confidence where the glandular concentrate has not

> provided significant improvement. A usual starting

> dose would be either 30 or 60 mg.

> Then there is the use of synthetic thyroxine or

> levothyroxine. Because the generics appear to vary in

> potency (an accusation thrown quite unfairly and

> wrongly at Armour thyroid), clients/patients may not

> do awfully well on them, first because the dose is

> managed purely on the outcome of blood tests - instead

> of asking the patient and actually listening to them

> as an alternative to blood tests, which is actually

> not just frowned upon, it is now a hanging offence.

> (Thus far has evidence-based medicine brought us!)

> And, secondly, there is often an adrenal problem

> which, if not dealt with, will cause T4 toxicosis

> and/or an adrenal crisis.

> Adrenal

> Adrenal dysfunction may be detected clinically without

> difficulty – the Raglan test, Romberg test and

> pupillary reflex are most helpful and the Adrenal

> Stress Index will confirm the diagnosis. Treatment of

> low adrenal reserve has, like the thyroid, three

> levels and, if hypothyroidism is present, must be put

> in place before thyroid supplementation is begun.

> Nutritionally, the adrenals need vitamin C, 4 grams or

> more daily; they need pantothenic acid (B5) and

> benefit from the use of liquorice (wood or tincture),

> Siberian ginseng and coenzyme Q10.

> Extremely valuable is the adrenal glandular

> concentrate; that made by Nutri Ltd is widely

> available (I recommend them because I have found their

> products to be very efficacious). One product contains

> 80 mg of the concentrate alone and another, 221 mg,

> together with a number of vitamins and minerals.

> If this proves unsatisfactory, which is uncommon and

> usually because the adrenals have been really badly

> damaged over a period of time, the use of the adrenal

> hormone, cortisol (hydrocortisone), 2.5 mg up to 25

> mg, may be considered by the practitioner, together

> with DHEA 25 mg or 7-keto DHEA 50 mg.

> These measures will remedy the underlying damage, but

> intervention may be necessary to balance low

> progesterone or high oestrogen – the use of natural

> transdermal creams is the best method.

> Systemic candida must be treated where present, using

> a fungicide (fluconazole can be helpful), together

> with grapefruit seed extract, caprylic acid, horopito,

> etc, along with an effective pre- and probiotic.

> Food allergies have to be dealt with on their merits,

> usually by simple avoidance, while malabsorption may

> require the use of Betaine HCl and/or pancreatic

> enzymes. Nutri Ltd make a combination called

> Nutrigest.

> A viral load may respond to VegEPA, the EPA – EPO

> formulation I mentioned earlier.

> Treatment of thyroid and adrenal insufficiency along

> these lines can be extremely rewarding and successful

> and a similarly broad approach in dealing with CFS has

> been proving very helpful also.

> Pathological aids to diagnosis

> Now we have a working knowledge of diagnosis and

> treatment, it is right to discuss the use of available

> pathological aids to diagnosis. Long recognised by

> many practitioners as an invaluable indication of

> thyroid deficiency is the waking temperature, as

> described by the American pioneer in this field, Dr

> Broda (author of The Unsuspected Illness and

> founder of the Foundation in Trumble, Conn).

> Thyroid first of all. Standard NHS testing tends to be

> restricted to TSH (thyroid-stimulating hormone)

> usually, with Free T4 thrown in if you're lucky. The

> full range, which includes T4, T3, TSH and TPO and

> TgAb antibodies will not usually be done, even under

> extreme demand, and so clients/patients will often

> seek the help of private laboratories.

> The full thyroid screen, if possible, should always be

> done, but you must remember that the TSH is often

> unreliable if the pituitary is suffering from a

> hypo-metabolic state and there are other reasons that

> can affect its reliability. If it's high, well and

> good; if it's at normal levels, it proves nothing. T4,

> if low, again good, if it's normal, it may mean that

> it is not being properly used, is building up and

> causing a false result. The same argument applies to

> the T3, but the antibody test may be relied upon.

> Thyroid tests should always be considered against the

> clinical findings and, remember, clinical observation

> is very much more reliable than tests. As you may have

> observed, I have a deep-rooted cynicism about the

> politically correct obsession with evidence-based

> medicine. Surely it should be observation first, tests

> second?

> Where doubt continues to exist, this may be resolved

> by the 24-hour urine test. As far as I know only

> Individual Wellbeing and Diagnostic Lab, New Malden,

> Surrey, do this test in the UK; European Laboratories

> of Nutrition do it in The Netherlands. It relies on

> the findings of Hertoghe & Baisier, who showed the

> greatly increased reliability of the 24-hour urine

> which, after all, measures the thyroid production over

> a whole day, as opposed to the blood test, which is a

> snapshot of a single moment showing levels that can

> vary widely with time of day and other variables. The

> test demonstrates the amount of T4 and T3 actually

> used and passed through the tissues. It is much more

> useful than other tests and will show even minor

> degrees of low thyroid function. In an ideal world

> both the full-serum, thyroid screen and the 24-hour

> urine should be done, but there are logistic and

> financial difficulties that have to restrain one's

> enthusiasm. While interpretation of the 24-hour urine

> is perfectly straight-forward, the blood thyroid

> screen has to be carefully assessed.

> Beware the pitfalls

> The first stumbling block is the TSH; a rise of TSH

> indicates poor thyroid response but the level

> considered to be indicative of this can be a matter of

> different interpretation by laboratories and doctors.

> The recent guidelines issued by the British Thyroid

> Association suggesting that treatment should not be

> offered below 10 units is quite unbelievable. The

> American Association of Clinical Endocrinologists has

> recently considered a level of 3.2 to be the cut-off

> point and in my view anything over this, combined of

> course with a clinical appraisal pointing to the

> diagnosis, should demand intervention. Labs seem to

> vary between about four and six; but I say again,

> anything over two should arouse suspicion and anything

> over 2.5 should result in a trial of treatment at the

> very least.

> The trouble with the TSH is that it may not be a

> proper response to thyroid uptake since there are four

> types of thyroid receptor and a metabolically

> challenged pituitary cannot respond properly anyway.

> So a high level is valuable, a low level may mean

> nothing.

> Measurement of T4 and T3 has always been very much

> subject to error. The obvious difficulty is that it is

> only, as I said earlier, a snapshot of a level that

> may vary a lot during the day, but it goes deeper than

> that. Failure of uptake by exhausted and missing

> receptors will allow levels to be normal or even high

> in the bloodstream, simply since thyroid hormone isn't

> being used, and conversion deficits can further

> distort the picture. The presence of thyroid

> antibodies (TPO and TgAb) should not usually cause

> much difficulty: either they are well raised or they

> are not, allowing an immediate diagnosis of

> Hashimoto's or Graves' disease to be made. It should

> be borne in mind that the levels fall away with the

> passage of time.

> Reverse T3 is sometimes of help; high levels may

> indicate poor T3 receptor uptake, with the system

> trying to rid itself of surplus T3. General illness,

> malnutrition and trauma will also raise the T3.

> Tests for adrenal function

> We come now to the tests for adrenal function. Once

> again, one simply must place the clinical picture to

> the fore. A serum cortisol is greatly relied on by

> orthodox medicine. It is almost useless. Similarly,

> the Synacthen (long or short), in which ACTH is

> injected to test adrenal function seems to be of

> significance only where the adrenal insufficiency is

> plainly ian.

> More helpful by far is the salivary Adrenal Stress

> Index, which measures cortisol and DHEA output in 24

> hours. Here the true picture of adrenal stress may be

> recognised and the three stages of the General

> Adaption Syndrome clearly shown.

> High levels of cortisol and DHEA show adrenals under

> stress. Sometimes the cortisol pathway starts to fade

> as exhaustion sets in, with DHEA still reasonably

> present. Less commonly, there may be a really high

> DHEA – a response to ACTH stimulation – but with the

> cortisol pathways responding poorly. Erratic levels in

> both are evidence of strain and uneven response.

> The 21-hydroxylase and 17-hydroxylase enzyme

> deficiencies may be apparent here; really weak

> cortisol with high androgenic output enough to cause

> virilisation. Where cortisol levels are obviously weak

> and DHEA response is weak and flat, the diagnosis of

> adrenal insufficiency (low adrenal reserve) slowly

> heading toward 's disease may be made.

> Sex hormones

> We have to consider the sex hormones in more depth.

> Many of us are aware that in women hypothyroidism may

> start with, and parallel, the menopause. One scenario

> is the progressive loss of progesterone often some

> years before the menopause itself. Apart from the

> obvious increased risk of osteoporosis, the imbalance

> will lead to oestrogen dominance – with weight gain,

> bloating, mastalgia and heavy, painful periods. This

> will increase thyroid-binding globulin, thus taking

> some thyroid out of use; it will adversely affect

> thyroid manufacture and receptor uptake. All the

> symptoms are put down to the menopause, of course,

> when actually the increasing deficiency of thyroid is

> the main problem.

> Later, both hormones run down and under the principle

> of permissive action, where hormone production

> requires the other players in the endocrine orchestra

> to play their parts well and in tune, thyroid

> production and processing may be affected adversely.

> So being able to detect oestrogen dominance is pretty

> helpful – one can correct the balance with natural,

> transdermal progesterone. If levels of both are low,

> careful use of natural progesterone and oestrogen can

> be very valuable.

> So, we should consider most carefully the menopause

> profile, or at the very least, a spot check of a day's

> output of progesterone and oestrogen. In menstruating

> women, thought may be given to assessment of both

> throughout a month. In general, however, getting the

> thyroid and adrenal status right will often provide

> welcome correction in much of the menstrual

> difficulties and it may perhaps be considered at a

> later date.

> The lads must not be left out of the equation. The

> male menopause most certainly happens – we can call it

> the andropause – but is usually an altogether more

> gradual and insidious affair. Ideally, assessment of

> testosterone levels should be carried out if the

> slightest doubt exists.

> The role of candida I have considered earlier and it's

> so common that its presence must be sought for. The

> old-fashioned, nutritionist, spit-in-a-glass test

> should be done, I think, as a routine. The presence of

> a miniature Medussa means that the candida antibody

> profile simply must be carried out and, if active

> candida antibodies are present, treatment is

> essential. I find it in rather more than half of my

> clients/patients.

> Conclusion

> To sum it all up, I am here making a plea for the

> recognition of the very common syndrome of thyroid and

> adrenal deficiency, using observation and medicine

> practised as an art, as the primary diagnostic method,

> with the lab playing a secondary role. Further, be

> aware that the syndrome has global effects, with

> imbalance of other hormones, the likely presence of

> systemic candida and dysbiosis, malabsorption and food

> allergy all playing a probable role.

>

> Dr Durrant-Peatfield is the author of The Great

> Thyroid Scandal and How to Survive it, which is about

> to be re-published in April in a fully updated, 2nd

> edition as Your Thyroid and How to Keep it Healthy by

> Hammersmith Press (www.hammersmithpress.co.uk), from

> which the above information is taken.

> Based in Meopham, Kent, he can be contacted at

> info@... or on 01474 815793.

>

>

>

>

>

>

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