Post on 14-Dec-2015
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
CARDIOVASCULARRISK
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
PREDICTED vs MEASURED RMR
1442.84
1919.16
1499.89
1874.72
1442.78
2040.7
0
500
1000
1500
2000
2500
ENTIRE NO MEDS AT TARGET
RMR-HB
RMR
76.94 83.05 85.1796.5 96.57 96.64
23.58
120.6115.44110.77111.08109.24
215.4215.03 200.08206.85
200.14
89.1394.8
37.5225.14 33.03
27.0623.13
9696.41
4.112.191.721.45 1.81
618.35 20.94 18.65
0
50
100
150
200
250
1367.03 1761.05 2188.51 2686.78 3495
Resting Metabolic Rate(calories)
Pre-Fire
Fire
FIRE-PREFIRE
BMI
BBT
TSH
SYMPTOMS
1367.03 n = 1081761.05 n = 3082188.51 n = 1322686.78 n = 393495 n = 6
25.69 28.56 26.69 26.73
96.66 96.47
112.62124.2
111.42 117.05
172.28
220 213.99
234.15
50.27
97.2 96.38
95.8 101.83
96.88
17.61 22.94 17.4323
0
50
100
150
200
250
<0.3 0.3-0.5 0.5-4.5 >4.5
TSH
BMIBBTPre-FireFireFIRE-PREFIRESYMPTOMS
<0.3 n = 1090.3-0.5 n = 50.5-4.5 n = 146>4.5 n = 22
TSH BECOMES LOW BEFORE EFFECT
138.62
382.57
0
50
100
150
200
250
300
350
400
CHANGE IN RMR
N=100
TSH <0.3 FIRE-PREFIRE<66
WORST TO BEST
18.47
25.96
96.46110.27
217.56
104.13
16.5
25.79
96.74
113.73
180.28
66.45
0
50
100
150
200
250
WORST BEST
Symptoms
BMI
BBT
Prefire
Fire
Fire-Prefire
N=100
SONORA QUEST NORMALSTEST LOW END
NORMALHIGH 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
2.23
30.88
7.11
2.35 3.21.05 0.35
31.65
7.76
2.53
7.88
1.3
0
5
10
15
20
25
30
35
WORST BEST
TSH
T3U
T4
T7
FREE T3
FREE T4
N=100
OTC THYROID AGENTSAGENT 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, DI-CALCIUM 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
3030
202517761716.67
0
500
1000
1500
2000
2500
3000
3500
NO MEDS HOMEO 50 HOMEO 100 HOMEO 150
RMR
n=5 n=2 n=1n=5
OTC THYROID AND RMR
19801850
2305
2210
1825
0
500
1000
1500
2000
2500
NO MEDS 300 MG 600 MG 900 MG 1200 MG
RMR
n=3 n=5 n=1 n=1n=4
TISSUE AND COFACTORS AND RMR
1797.14
1925
16101618
1755
1450
15001550
1600
16501700
1750
1800
18501900
1950
NO MEDS 2/DAY 3/DAY 4/DAY 6/DAY
RMR
n=4 n=7 n=3 n=6 n=1
RX THYROID PREPARATIONSAGENT EQUIVALENT
DOSE½ LIFE ADDITIVES
CYTOMEL 25 MCG 1.4 DAYS CALCIUM SULFITE, GELATIN, STARCH, STEARIC ACID, SUCROSE, TALC
SYNTHROID 0.1 MG 6-7 DAYS ACACIA, SUGAR, CORN STARCH, LACTOSE, MAGNESIUM STEARATE, POVIDONE, TALC
DESSICATED
38 mcg T4
9 mcg T3
1 GRAIN
60 MG3-7 DAYS CALCIUM STEARATE,
DEXTROSE, MICROCRYSTALLINE CELLULOSE, SODIUM STARCH GLYCOLATE, OPODY WHITE
NATURETHROIDAND REFLEXES
225.25
174.8
84.5
90.3
113.96109.8115.5110.4
208.13 194.45
180.24
57.57
7087.8
83.22
0
50
100
150
200
250
60 MG 90 MG 120 MG 180 MG 240 MG
PRE-FIRE
FIRE
FIRE-PREFIRE
n=10 240 mgn=76 180 mgn=103 120 mgn=5 90 mgn=101 60 mg
RMR Response to Medication
0
500
1000
1500
2000
2500
3000
Cytomel
Synthroid
Levoxyl
Armour
Naturethroid
Tissue andCofactorsOTC
AT TARGET (FIRE-PREFIRE<66)
2.29 3.032.72.7
7.53
30.92
5.77
1.652.92
7.86
32.54
1.720
5
10
15
20
25
30
35
TSH T3 T4 T7 FREET3
FREET4
NO MEDS
TREATED
AT TARGET(RMR CHANGE > 355)
2.293.03
2.72.7
7.53
30.92
0.141.46
8.18
2.24
7.06
32.76
0
5
10
15
20
25
30
35
TSH T3U T4 T7 FREET3
FREET4
NO MEDS
AT TARGET
HYPERTHYROID SIGNS
PALPITATIONS 6:815 0.7% TACHYCARDIA 4:815 0.4% SHAKEY/HYPER 2:815 0.2% HAIR LOSS 1:815 0.1% HYPERTENSION 1:815 0.1% TOTAL 14:815 1.7%
REFLEX PARAMETERS
209.61
111.3
92.17
180.27
113.73
66.45
147.83
118.05
29.6
181.64
12.71
60.93
0
50
100
150
200
250
NO MEDS BEST AT TARGET HYPER
FIRE
PREFIRE
FIRE-PREFIRE
n=195 n=101 n=14n=56
RMR
1874.72
2072.75
19802019
1750
1800
1850
1900
1950
2000
2050
2100
NO MEDS BEST ATTARGET
HYPER
RMR
HASHIMOTO’S AND RMR
0
500
1000
1500
2000
2500
3000
START MED DX MED CHANGE BEST
PATIENT 1
PATIENT 2
PATIENT 3
PATIENT 4
PATIENT 5
PATIENT 6
MEAN
THYROID EFFECTS ON SERUM LIPIDS
209.24195.25
126.51112.68
64.54 65.75
108.64 106.06
0
50
100
150
200
250
CHOL LDL HDL TRIG
WORST
BEST
N=30
COST OF THYROID MEDSPHARMACY
30 day supply
ARMOUR
120 mg
SYNTHROID
200 mcg
CYTOMEL
50 mcg
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
NATURETHROID 120 MG #28 DISPENSED TO PATIENT $5.00
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