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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
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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 www.wilsonsthyroidsyndrome.com
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.
For a personalized
consultation with Dr. Schwartz, via email,
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