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

Pre-fireInterval

FireInterval

Euthyroid

Hammer Strike

Pre-Fire Fire

HYPOTHYROID

Prefire Interval Fire Interval

Hyperthyroid

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

TSH2.29

0.350.01

0.195

0

0.5

1

1.5

2

2.5

NO MEDS BEST ATTARGET

HYPER

TSH

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