Transcript THYROID STUDY - thyroidinstitute

SUBCLINICAL HYPOTHYROID
MANAGING PATIENTS USING
RESTING METABOLIC RATE
AND
BRACHIORADIALIS REFLEXOMETRY
SUBCLINICAL HYPOTHYROID
 NORMAL TO SLIGHTLY HIGH TSH
 NORMAL FREE T3, FREE T4
 NORMAL T3U, T4, T7
 SYMPTOMS COMPATIBLE WITH
HYPOTHYROID
 LOW BBT
 SLOW REFLEXES
 LOWER RMR
 PREVALENCE UNKNOWN
CARDIOVASCULAR
RISK
 INCREASED
 SERUM LIPIDS
 HOMOCYSTEINE
 C-REACTIVE PROTEIN
 CORONARY HEART DISEASE
 HYPERTENSION
 ISCEMIC HEART DISEASE
 ENDOTHELIAL DAMAGE
 COAGUABILITY
 PERIPHERAL ARTERY DISEASE
 DECREASED
 STROKE VOLUME
 CARDIAC OUTPUT
DIABETES RISK
 DISRUPTION OF GLP-1 SIGNALLING
 DECREASED THYROID FUNCTION
UP TO 18 HOURS AFTER
HYPOGLYCEMIC EPISODES
 INCREASED HOMA AND TRIG/HDL
 ASSOCIATED WITH INSULIN
RESISTANCE
 INCREASED DYSGLYCEMIA
ARTHRITIS &
INFLAMMATION
 INCREASED RATES OF
HASHIMOTO’S
 INCREASED EUTHYROID SICK RISK
 RA PATIENTS WITH SUBCLINICAL
HYPOTHYROID HAD
DYSFUNCTIONS OF GLUCOSE
METABOLISM AND INSULIN
RESISTANCE
NEUROLOGICAL RISK
 INCREASED HOFFMAN’S SYNDROME
 WEAKNESS AND STIFFNESS
 INCREASED DUPUYTREN’S
 INCREASED CARPAL TUNNEL
 POLYMYOSITIS-LIKE SYNDROME
 INCREASED PARKINSONS
 INCREASED HEARING LOSS
 1.97 RELATIVE RISK OF COGNITIVE
DECLINE
 INCREASED ANXIETY AND DEPRESSION
BONE RISK
 INCREASED RESORPTION IN
HYPERTHYROID
 INCREASED
URINARY PYRIDINOLINE
 INCREASED URINARY
DEOXYPYRIDINOLINE
 INCREASED URINARY CALCIUM
 NO CALCIUM METABOLISM
PROBLEMS IN HYPOTHYROID
PREGNANCY
 FERTILITY ISSUES
 3 FOLD INCREASE IN PLACENTA
PREVIA
 2 FOLD INCREASE IN PREMATURE
DELIVERY
 MAY AFFECT MENTATION IN
OFFSPRING
 NOT
WELL STUDIED
FACTORS AFFECTING
THYROID FUNCTION
 PERIPHERAL CONVERSION OF T4 TO T3

HEPATIC, RENAL, MITOCHONDRIAL FUNCTION
 DECREASED 5’D-1

INHIBITED BY IL-1, IL-6
 TOXIC MATERIALS



LEAD, MERCURY
PCB
FUNGICIDES, ORGANO-CHLORINE INSECTICIDES
 DRUGS

AMIODORONE, ANTI-CONVULSANTS, SALSALATE
 MITOCHONDRIAL PROTEIN LEAKAGE

UNCOUPLING PROTEIN 3
 CYTOKINES



NF-KAPPA-B
TNF-ALPHA
IL-1 ALPHA/BETA
 EUTHYROID SICK SYNDROME IMPAIRS FUNCTION UP TO
60 DAYS FOLLOWING ACUTE SEVERE ILLNESS
NUTRIENTS AND THYROID
 SELENIUM

IMPROVES FUNCTION DECREASES RECOVERY TIME IN
EUTHYROID SICK SYNDROME
 IRON AND ZINC


INCREASE THYROID FUNCTION IN IRON/ZINC DEFICIENT
NO EFFECT IN IRON/ZINC SUFFICIENT
 CALCIUM

INHIBITS ABSORPTION
 ALPHA-TOCOPHEROL

NO EFFECT
 KELP AND ALL IODINE


HELPFUL IN IODINE DEFICIENT
DOSE DEPENDENT DECREASE IN THYROID FUNCTION IF
IODINE SUFFICIENT
 L-CARNITINE DECREASES THYROID FUNCTION

PREVENTS THYROID HORMONE ENTRY INTO NUCLEUS OF
CELLS
PHYSIOLOGICAL MEASUREMENTS
OF THYROID FUNCTION
 BODY MASS INDEX
 CORRELATION WITH RESTING METABOLIC RATE
 BASAL BODY TEMPERATURES


IDENTIFY SUBCLINICAL HYPOTHYROID
TOO SLOW TO RESPOND TO TREATMENT
 RESTING METABOLIC RATE
 SOME ARTIFACTS



CONGESTION
REACTIVE AIRWAY DISEASE
ASTHMA OR OTHER COPD
 REFLEXES
 ACHILLES, BRACHIORADIALIS, STAPEDIAL
 NO ARTIFACTS UNLESS NERVE DAMAGE
 SERUM MEASUREMENTS
 INSENSITIVE WHEN APPROACHING NORMAL
METHODOLOGY
 ENTRY CRITERIA
 BBT<97.50 F AXILLARY AVERAGE (BRODA BARNES)
 BASELINE MEASUREMENT AND THIRTY DAY
TREATMENT INTERVALS





SYMPTOM SURVEY
BODY MASS INDEX
RESTING METABOLIC RATE (oxygen consumption)
BRACHIORADIALIS REFLEXOMETRY (mean of 4)
TSH,T3U, T4, T7


ADDED FREE T3, FREE T4
SOME HAD
–
–
–
–

MICROSOMAL (TPO) AB
THYROGLOBULIN AB
REVERSE T3
THYROTROPIN RELEASING HORMONE
LIPIDS




CHOLESTEROL
LDL
HDL
TRIGLYCERIDES
Hammer Strike
Pre-fire
Interval
Fire
Interval
Euthyroid
Pre-Fire
HYPOTHYROID
Fire
Prefire Interval
Fire Interval
Hyperthyroid
PREDICTED vs MEASURED RMR
2500
1919.16
2040.7
1874.72
2000
1442.84
1499.89
1442.78
1500
RMR-HB
RMR
1000
500
0
ENTIRE
NO MEDS
AT TARGET
250
200
215.03
200.14
200.08
206.85
215.4
Pre-Fire
Fire
150
100
109.24
111.08
110.77
115.44
96.5
96.57
83.05
96.64
85.17
96.41
89.13
76.94
50
0
23.13
18.35
1.45
1367.03
25.14
27.06
20.94
18.65
1.81
1.72
1761.05
2188.51
33.03
23.58
120.6
96
94.8
37.52
6
Resting Metabolic Rate
(calories)
BBT
TSH
SYMPTOMS
4.11
2.19
2686.78
FIRE-PREFIRE
BMI
3495
1367.03 n = 108
1761.05 n = 308
2188.51 n = 132
2686.78 n = 39
3495 n = 6
250
234.15
220
213.99
200
172.28
150
100
50
0
112.62
96.66
124.2
95.8
117.05
101.83
97.2
111.42
96.47
96.88
96.38
28.56
23
26.69
22.94
26.73
17.43
BMI
BBT
Pre-Fire
Fire
FIRE-PREFIRE
SYMPTOMS
50.27
25.69
17.61
<0.3
0.3-0.5
0.5-4.5
TSH
>4.5
<0.3 n = 109
0.3-0.5 n = 5
0.5-4.5 n = 146
>4.5 n = 22
TSH BECOMES LOW BEFORE EFFECT
400
350
382.57
300
250
200
CHANGE IN RMR
150
100
N=100
138.62
50
0
TSH <0.3
FIRE-PREFIRE<66
WORST TO BEST
250
217.56
180.28
200
150
100
110.27
96.46
113.73
96.74
104.13
66.45
25.96
50
18.47
25.79
16.5
0
WORST
Symptoms
BMI
BBT
Prefire
Fire
Fire-Prefire
BEST
N=100
SONORA QUEST NORMALS
TEST
LOW END
NORMAL
HIGH END
NORMAL
TSH
0.45
4.5
T3U
23.4
42.7
T4
4.5
12.5
T7
1.2
4.3
FREE T3
1.8
5.4
FREE T4
0.8
1.9
WORST TO BEST
35
31.65
30.88
30
TSH
T3U
T4
T7
FREE T3
FREE T4
25
20
15
10
5
7.76 7.88
7.11
2.23
2.35 3.2
1.05
0
WORST
1.3
0.35
2.53
BEST
N=100
OTC THYROID AGENTS
AGENT
CONTENTS
HOMEOPATHIC THYROID
STIMULATOR
THYROID 5C, NATIVE GOLD 8X,
BLACK CURRANT BUDS 1DH,
BLOODTWIG DOGBERRY BUDS 1
DH, SWEET ALMOND BUDS 1DH,
ETHANOL, GLYCERIN, WATER
OTC THYROID TISSUE
NEW ZEALAND SHEEP THYROID
TISSUE, RICE POWDER, DICALCIUM PHOSPHATE, GELATIN
OTC THYROID TISSUE
PLUS CO-FACTORS
NEW ZEALAND BOVINE THYROID,
L-TYROSINE, ANTERIOR PITUITARY,
L-ASPARTIC ACID, IRIS
VERSICOLOR, KELP
HOMEO AND RMR
3500
3030
3000
2500
2000
1500
1716.67
1776
RMR
2025
1000
500
0
NO MEDS
n=5
HOMEO 50 HOMEO 100 HOMEO 150
n=5
n=2
n=1
OTC THYROID AND RMR
2305
2500
2000
1500
1850
2210
1980
1825
RMR
1000
500
0
NO MEDS
n=4
300 MG
n=3
600 MG
n=5
900 MG
n=1
1200 MG
n=1
TISSUE AND COFACTORS
AND RMR
1950
1900
1850
1800
1750
1700
1650
1600
1550
1500
1450
1925
1797.14
1755
RMR
1618
NO MEDS
n=4
2/DAY
n=7
3/DAY
n=3
4/DAY
n=6
1610
6/DAY
n=1
RX THYROID PREPARATIONS
AGENT
EQUIVALENT
DOSE
CYTOMEL
25 MCG
SYNTHROID
0.1 MG
DESSICATED
38 mcg T4
9 mcg T3
1 GRAIN
60 MG
½ LIFE
ADDITIVES
1.4 DAYS
CALCIUM SULFITE,
GELATIN, STARCH,
STEARIC ACID,
SUCROSE, TALC
6-7 DAYS
ACACIA, SUGAR, CORN
STARCH, LACTOSE,
MAGNESIUM
STEARATE, POVIDONE,
TALC
3-7 DAYS
CALCIUM STEARATE,
DEXTROSE,
MICROCRYSTALLINE
CELLULOSE, SODIUM
STARCH GLYCOLATE,
OPODY WHITE
NATURETHROID
AND REFLEXES
250
225.25
200
194.45
208.13
180.24
174.8
150
110.4
115.5
109.8
113.96
90.3
100
87.8
83.22
84.5
70
57.57
50
0
60 MG
PRE-FIRE
FIRE
FIRE-PREFIRE
90 MG 120 MG 180 MG 240 MG
n=10 240 mg
n=76 180 mg
n=103 120 mg
n=5
90 mg
n=101 60 mg
3000
RMR Response to Medication
2500
Cytomel
Synthroid
2000
Levoxyl
Armour
1500
Naturethroid
Tissue and
Cofactors
OTC
1000
500
0
25 m
cg /
100 m
50 m
cg/ 2
cg/6
0 mg
00m
cg/1
75 m
cg/3
20 m
g
00m
cg/1
100 m
80 m
g
cg/4
00 m
cg/2
40 m
g
AT TARGET
(FIRE-PREFIRE<66)
35
30.92
30
32.54
25
20
NO MEDS
TREATED
15
10
5
7.53
2.29
7.86
5.77
2.7 2.92 2.7
1.72
3.03
1.65
0
TSH
T3
T4
T7
FREE
T3
FREE
T4
AT TARGET
(RMR CHANGE > 355)
32.76
35
30.92
30
25
20
NO MEDS
AT TARGET
15
7.53
10
5
0
2.29
7.06
2.7
0.14
TSH
T3U
T4
8.18
2.24
T7
2.7
FREE
T3
3.03
1.46
FREE
T4
HYPERTHYROID SIGNS
 PALPITATIONS
6:815
 TACHYCARDIA
4:815
 SHAKEY/HYPER 2:815
 HAIR LOSS
1:815
 HYPERTENSION 1:815
 TOTAL
14:815
0.7%
0.4%
0.2%
0.1%
0.1%
1.7%
REFLEX PARAMETERS
250
209.61
200
181.64
180.27
147.83
150
111.3
100
113.73
FIRE
PREFIRE
FIRE-PREFIRE
118.05
92.17
66.45
60.93
50
29.6
12.71
0
NO MEDS
BEST
AT TARGET
HYPER
n=195
n=101
n=56
n=14
RMR
2100
2072.75
2050
1980
2019
2000
1950
1900
1874.72
RMR
1850
1800
1750
NO MEDS
BEST
AT
TARGET
HYPER
TSH
2.5
2.29
2
1.5
1
TSH
0.35
0.5
0.01
0.195
0
NO MEDS
BEST
AT
TARGET
HYPER
HASHIMOTO’S AND RMR
3000
2500
PATIENT 1
PATIENT 2
PATIENT 3
PATIENT 4
PATIENT 5
PATIENT 6
MEAN
2000
1500
1000
500
0
START MED
DX
MED CHANGE
BEST
THYROID EFFECTS ON
SERUM LIPIDS
250
209.24
200
195.25
150
126.51
112.68
108.64 106.06
100
WORST
BEST
64.54 65.75
50
0
CHOL
LDL
HDL
TRIG
N=30
COST OF THYROID MEDS
PHARMACY
ARMOUR
30 day supply 120 mg
SYNTHROID CYTOMEL
200 mcg
50 mcg
NATURETHROID 120 MG #28 DISPENSED TO PATIENT $5.00
WALGREENS $13.79
$28.19
$46.49
OSCO
$21.69
$39.00
$75.00
K-MART
$15.97
$29.69
$48.97
COSTCO
$10.19
$21.17
$41.89
AVERAGE
$15.41
$29.51
$53.09
Many on synthetic thyroid require both T3 and T4
Combination Therapy $82.60 for 30 day supply
THYROID MYTHS
 SUBCLINCAL HYPOTHYROID DOES NOT NEED
TO BE TREATED

HEALTH RISK IS HUGE IF UNTREATED
 TSH IS THE BEST CLINICAL MARKER
 INSENSITIVE NEAR NORMAL
 GETS TOO SMALL BEFORE FULL CLINICAL EFFECT
 IODINE IS GOOD FOR THYROID FUNCTION
 DECREASES THYROID FUNCTION IF NOT DEFICIENT
 SYNTHETIC THYROID MEDS ARE MORE
PRECISE AND MORE SCIENTIFIC THAN
NATURAL



NATURAL THYROID IS USP AND HAS > EFFECT
HALF-LIFE IS LONG IN MOST THYROID MEDS
MOST PEOPLE END UP ON 2 MEDS


IF SYNTHROID ALONE CAN’T CONVERT T4 TO T3
IF CYTOMEL ALONE T4 GOES TO ZERO