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                                       THYROID HORMONES

The thyroid endocrine system directly effects more bodily functions then all the other endocrine glands because it controls cellular metabolism. Metabolism means the rate and how effective the cell does its particular job. Thus it is extremely important that this endocrine system functions normally. As with any body system, there can be one of two types of dysfunctions, either hypothyroidism or hyperthyroidism.

There are several things to consider when trying to understand the thyroid system and whether or where a problem might be within it. First of all, one needs to have an understanding of the physiology of the thyroid hormone itself. To break this down into simplistic terms there are six distinct areas to investigate: the higher CNS(central nervous system), the hypothalamus(a section of the lower brain communicating with the pituitary gland), the anterior pituitary gland, the thyroid gland, the local cellular tissues, and the thyroid hormones or precursors themselves. It is beyond the scope of this site to delve into each in depth but I will try to give the reader a good feel for how each might affect the ability of the system to be normal. 

The CNS is affected by its input, meaning its external and internal environment.
These stressors come in the form of emotions, sensations of temperature, chemical, magnetic, electric, sound, light, etc. Depending on the intensity and type of input the higher brain recieves and how it has been programmed, will determine the signal that it will send to the hypothalamus. Depending on whether we percieve or have been trained to percieve a stressor as "friend or foe", "mild or intense", or "strong or weak", will determine the strength and type of signal. Let's say for instance that someone is in a situation that is physically and mentally taxing such as a car accident and there is no great physical harm to the body. In most instances this would not greatly change the amount of long term output to the hypothalamus, but for some this might be "the straw that breaks the camels back". Meaning if they have not been trained to handle this type of stress or that they have too many other negative stressors, this might tend to put the system into a shock state. Physiologically, this would be similar to a hibernation mode whereby the CNS would essentially try to shut down metabolic function and let the body rest. Of course this would be the correct response if the stressor was winter in a severely cold climate. When this happens though the amount of active thyroid hormone decreases and all cellular functions slow down, because in a hibernation state we of course need to have extremely slow metabolism. In other cases, we can have a hyperfunction stimulus telling the lower brain that an increased metabolism would be needed. This can happen from the same stressors that allowed it to perform hypofunctions, and again it just depends on the prior training that the brain has recieved in fetal life and beyond.  When we also think about any part of the brain and its possibly malfunctions, we must think about tumors. This is why when checking for endocrine function we sometimes do CT scans of the brain.

The hypothalamus is like a relay station getting input from the higher brain functions(cerebrum) and telling the pituitary gland what hormones it needs. In the case of the thyroid it signals the pituitary via a messenger called TRH(thyroid releasing hormone). TRH controls how much signal the anterior pituitary gland will send to the thyroid gland. In the case of the hypothalamus, besides the signal relay from the upper brain telling it what to secrete, a tumor could alter its function.  

Once the signal(TRH) is recieved from the hypothalamus, the pituitary gland secretes the appropriate amount of TSH(thyroid stimulating hormone) into the blood which does two important things to the thyroid gland. It speeds up the thyroid gland metabolism so that it can make an increased amount of the thyroid hormones and it allows the increased the release of the thyroid hormones. Again a major reason for pituitary failure to release or an increased release of TSH is a tumor. Another cause might be a disorder of the negative feedback loop from the thyroid hormones themselves.

The reason I say thyroid hormones is that there are essentially two thyroid hormones, T4(tetraiodothyronine) and T3(triiodothyronine). T3 is only about 3% of the total amount of thyroid hormone present but is much more biologically active. Most of the T4 is in abound state to TBP(thyroid binding protein) and is inactive. The free plasma form is the active form. The exact mechanism of action of T4 & T3 at the tissue level is not known but the effects that they exert effect nearly every tissue of the body. While the diversity of these effects seems endless and only limited by the imagination of the investigator, most of the effects appear to participate in the regulation of two general types of processes (1) growth & differentiation; and (2) oxidative or energy metabolism.

The clinical effects of low thyroid utilization are many and varied but present with symptoms such as: low energy, weight gain or inability to lose weight, hair loss, intolerence to cold or heat, lack of perspiration, indigestion, constipation, bilateral carpal tunnel syndrome, fibromyalgia, chronic fatigue syndrome, water weight gain, menstrual abnormalities, infertility, among many others.

The clinical effects of hyperthyroidism may include but are not limited to: weight loss, excessive sweating, overheating, restlessness, heart palpatations, insomnia, tachycardia, lump in throat, inability to swallow, headaches, diarrhea, bulging eyes, discoloration of skin in the front of the leg, goiter, tremors, increased appetite, fatigue, light sensitivity, eye pain, increased tears to name some.

One of the problems with thyroid dysfunction is the way it gets diagnosed. Most typically a HS-TSH(highly sensitive TSH) level, and a T4 level are screening tests. If they are with in normal limits then thyroid dysfunction is usually overlooked. I find that if blood work is done in addition to the above named tests a reverse T3, free T4, TPO, and a antithyroglobulin antibody level will give a better picture. I do not limit myself to those tests though as frequently they will also miss the thyroid dysfunction also. I also have my patients perform at least one weeks worth of a BBT(basal body temperature) and at least three other times per day an oral temperature. Let me explain these in detail. First a BBT is taken just as one opens their eyes in the morning but without leaving the bed. A glass thermometer is put in the armpit and left there for ten minutes while you go back to sleep. The three other temperatures are recorded sometime before lunch, dinner, and sometime in the evening. These are also taken with a glass thermometer and put under the tongue for five minutes. One does not have to be sitting or at rest during this test. After one weeks worth of temperatures I and many other physicians can get a good idea of the patients metabolism as it is temperature related. A good reference and more indepth look at this method can be found at It is a very useful website for both the diagnostic aspect of thyroid dysfunction and a very viable way to treat it.

Which brings me to some general thoughts about treatment of thyroid dysfunction. Always seek the help of a physician when dealing with any hormone problem. The very least you can expect is to get the neccessary lab tests that you might need, even if you disagree with the conclusions or the possible treatment modalities. The endocrine system is highly interactive and a physician is trained to see all the possibilities that you may not. But after all the data is in and a thyroid condition is definitely the conclusion, treatments vary depending upon who you see as a physician. I use as a first line treatment atomidine(a organic iodine compound), kelp tablets, and dessicated thyroid tablets. I also tell people to either end their showers with cold water or to walk in the cold grass barefoot, if their case is mild. In the more severe cases I can add a sustained release T3 preparation in ever increasing dosages until the desired effect is achieved and then wean them off totally, leaving them with normal thyroid function. In the incrementally worsening cases I also use armour thyroid(a natural thyroid hormone preparation). In the worst cases I use thyrolar(a synthetic T3/T4 preparation) or cytomel(a synthetic T3 preparation).

In conclusion, I would guess that over 50% of the thyroid dysfunction cases are never discovered and are being treated for all the other problems associated with the thyroid. I would also guess that out of all the people being treated for thyroid dysfunction over 75% are being treated with just mild palliation of symptoms with no real change in their true metabolisms. This is one area where it is really important to dig up the real truth about your thyroid and seek the proper treatment for without these lies a life truely wanting.

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These statements have not been evaluated by the Food and Drug Administration.
They are the sole opinion of Dr. Schwartz and are not intented to diagnose, treat, cure or prevent any disease.

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