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Wellness and Health and Hypothyroidism

Permission graciously given by the author to reproduce this paper:   

Wellness and Health and Hypothyroidism

Douglas W. Weiss
2003

      Hypothyroidism is a condition that many Americans will have to address to live a completely healthy life.  This condition is not some peculiar disease that does not impact the quality of life for many.  It truly does because this learner is one of the many who must understand and positively treat hypothyroidism to lead a healthy and high quality lifestyle.  Mary Shomon (no date) states, “more than 10 million Americans have been diagnosed with thyroid disease, and another 13 million people are estimated to have undiagnosed thyroid problems in the US alone” (p. 1).

    Richard Shames and Karilee Shames (2002) the author of the book, Thyroid Power comments on the prevalence of hypothyroidism in America.  They state, Many physicians do not seem to be aware of the excessive prevalence of low thyroid in the population, or of its collective toll on the nation’s health.  As we have noted, investigations by university medical centers, as well as by the Mayo Clinic, have determined that the prevalence of this condition is quite high--compromising the health of as much as 10 percent of the population--and appears to be very much on the increase (p. 69). These authors note their belief of physicians not being aware of the disease of hypothyroidism.  If the medical front line is unaware, the disease could grow in the future.

    The Mayo Clinic on their website estimated that, “about 6 million to 7 million Americans, mainly women older than age 40, have an underactive thyroid.” (no date, p. 1)  The Mayo Clinic (no date), like Mary Shomon, cites no sources for these numbers.  Gary Canaris, Neil Manowitx, Gilbert Mayor and Chster Ridgway (2000) state that, “The prevalence of abnormal thyroid function in the United States and the significance of thyroid dysfunction remain controversial” (p. 526).  Leslie Greco (2001) shares this same perspective when it comes to hypothyroidism and the elderly.  She states that, “The true incidence of thyroid disease in the elderly is probably underdiagnosed because of its insidious presentation” (p. 44). 

    Shames and Shames (2002) also believe that hypothyroidism is prevalent in America.  They have a few comments on this: “Although extremely common, low thyroid is largely an unsuspected illness.  Even when suspected, it is frequently undiagnosed.  When it is diagnosed, it often goes untreated. When it is treated, it is seldom treated optimally (p. xvii).

    Canaris, Manowitz, Mayor and Ridgway (2000) were not content to leave the estimate of the prevalence of hypothyroidism up to guessing.  They did a study with 25,862 participants at a statewide health fair in Colorado. The measures of this study included, “serum thyrotropin (thyroid stimulating hormone [TSH] and total thyroxine ([T. sub .4]) concentrations, serum lipid levels, and responses to a hypothyroid symptom questionnaire (p. 528). The results were, “The prevalence of elevated TSH levels (normal range, 0.3-5.1 mIU/L) in this population was 9.5% and the prevalence of deceased TSH levels was 2.2% (p. 526). The researchers found that, “Of the 24,337 subjects who did not report taking thyroid medication, 9.9% had a functional abnormality of the thyroid gland that was apparently unknown (p. 536).  Another interesting result of this very large study was that among patients taking thyroid medication, only 60% were within the normal range of TSA (p. 536).  This may support Shames and Shames (2002) notion of this disease even when identified may not be treated adequately.

    The researchers concluded that, “By extrapolation, there may be more than 165,000 adult cases of undetected thyroid gland failure in Colorado.  If the Colorado experience can be generalized, there may be in excess of 13 million cases of undetected thyroid gland failure nationwide” (p. 537).  This study may be the undocumented source of Mary Shomon (no date) and underscores scientifically that hypothyroidism may be affecting the healthy living of many Americans.

    Canaris, Manowitz, Mayor and Ridgway (2000) in their article quoted two other researchers findings over several cultures that study hypothyroidism.  They state that, “After reviewing 12 such studies across many different cultures, Vanderpump and Tunbridge [2] concluded that primary thyroid gland failure (TSH [is greater than] 6 mIU/L) occurs in 5% of multiple populations (p. 527).  Whether the amount of people who suffer from hypothyroidism is 5% or 9.9% this is a significant issue for millions of people this learner included.  Canaris, Manowitz, Mayor and Ridgway (2000) research makes a great statement that; “Abnormal thyroid function has important public health consequences (p. 527).  The following pages will cover what is a thyroid, the risk factors for hypothyroidism, the causes of hypothyroidism, the symptoms of hypothyroidism, the diagnosis of hypothyroidism and the treatment of hypothyroidism.

    Shomon (no date) states that, “thyroid disease can affect almost every aspect of health, so understanding more about the thyroid, and the symptoms that occur when something goes wrong with this small gland, can help you protect or regain good health” (p. 1).  This learner can attest to the large impact the hypothyroidism had on my health, cognition and quality of life.  Shomon (no date) as one of our guides on this journey is correct in stating this issue is something we must understand for our health’s sake.  So what is a thyroid and what does it actually do?  To answer this question, we will consult several guides on our journey to understanding the thyroid.  The Mayo Clinic website (no date) states that,  Your thyroid is a butterfly-shaped gland located at the base of your neck, just below your Adam’s apple.  Although it weighs less than an ounce, the thyroid gland has an enormous effect on your health.  All aspects of you metabolism, from the rate at which your heart beats to how quickly you burn calories, are regulated by thyroid hormones (p. 1).  Sara Rosenthal (2002) states that, “The thyroid was named in the 1600s, and is Greek for ‘shield’ because of its butterfly shape.  Your thyroid gland is located in the lower part of your neck, in front of your windpipe (p. 2).  On the website endocrineweb.com (no date), in the section under how your thyroid works, they had this to say,  The function of they thyroid gland is to take iodine, found in many foods, and convert it into thyroid hormones: thyroxine (T4) and triiodothyronine (T3).  Thyroid cells are the only cells in the body which can absorb iodine.  These cells combine iodine and the amino acid tyrosine to make T3 and T4.  T3 and T4 are then released into the blood stream and are transported throughout the body where they control metabolism (conversion of oxygen and calories to energy) (p. 1).

    Going back to the Mayo Clinic website (no date), they discuss the hormones that the thyroid produces.  Your thyroid gland produces two main hormones, thyroxine (T-4) and triiodothyronine (T-3).  They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate and help regulate the production of protein.  Your thyroid gland also produces calcitonin, a hormone that regulates the amount of calcium in your blood (p. 1).  These previous guides certainly have made it clear that although this thyroid organ is small, it is significant.  The little guy of an organ is responsible for so much in this large organization we call the human body. The thyroid however is just one part in a much larger system of a person’s body.  Shomon (no date) on her website states what you need to know about thyroid.  The site has a succinct description of the larger process that the thyroid is about that goes from the brain to the blood.  She states, The thyroid is part of a huge feedback process.  The hypothalamus in the brain releases something called Thyrotropin-releasing Hormone (TRH).  The release of TRH tells the pituitary gland to release something called Thyroid Stimulating Hormone (TSH).  This TSH, circulating in your bloodstream, is what tells the thyroid to make thyroid hormones and release them into your bloodstream (p. 2).

    At RxMed: Illness Information (no date) under hypothyroidism, they mention another aspect of importance of the thyroid.  They state, “Thyroid hormone is essential to the body in the consumption of oxygen by the cells, and in protein synthesis” (p. 1).  These procedures are very helpful for anyone who wants to remain healthy and have a high quality of life.  Shames & Shames (2002) have a great way of communicating the importance of the thyroid gland to the body.  They state, The thyroid gland can be viewed as a tiny but powerful throttle mechanism, because the energy hormone it produces acts like a gas pedal for the rest of the body.  The hormone circulates through the bloodstream and enters each cell.  Then, in the presence of thyroid hormone, a complex protein molecule binds to DNA in a different manner than it would without the presence of thyroid hormone.  This entire mechanism described above functions like a toggle switch to turn cellular machinery on or off.  In doing this, it regulates cell temperature, cell function, and cell growth (p. 7).

    So how does someone know if they are at risk for hypothyroidism?  For those answers we will again consult those guides who are versed in this issue of the risk of hypothyroidism.
Two of the greatest risk factors of becoming hypothyroid are two things we can do nothing about.  The RxMed: Illness Information (no date) reports that being a woman increases your odds about 5 times to 1 (23-H).  This learner is a male so it can definitely happen to the male gender as well.  Also these writers state that risk does increase, the older we get.  Aging is truly something that none of us can do anything about.

    The Mayo Clinic website (no date) also has a more concise list of risk factors for becoming hypothyroid.  They state if you, 
•    Have a close relative, such as a parent or grandparent, with an autoimmune disease
•    Have diabetes, making it more likely you’ll develop hypothyroidism during or after
     pregnancy
•    Have been treated with radioactive iodine or antithyroid medications
•    Have had thyroid surgery (thyroidectomy) (p. 1)

    The Mayo Clinic (no date) states several risk factors for hypothyroidism.  They firstly state that autoimmune disease can be a factor in hypothyroidism.  They explain that, “autoimmune disorders occur when your immune system produces antibodies that attack your own tissues.  Sometimes this process occurs within the thyroid gland (p. 1).”  What these are saying is that the body attacks itself.  If it attacks the thyroid, then hypothyroidism can be the result.  These writers state being treated with radioactive iodine to treat hyperthyroidism can also be a risk factor in obtaining hypothyroidism (p. 1).  What happens here is that the thyroid by this treatment is shut down too far thus causing the other extreme of hypothyroidism that being hyperthyroidism.  This could truly be a sad state of affairs if someone went into treatment for one condition and left the facility with the opposite condition.  Yet this is a legitimate risk factor for hypothyroidism.

    Radiation therapy that may be used to treat cancers located in the neck or head area can also be a risk factor for hypothyroidism.  The Mayo Clinic writers also state the obvious that if you have thyroid surgery where all or a significant part of your thyroid has been removed, you may also have a risk factor in becoming hypothyroid.  Rosenthal (2002) the author of the book The Hypothyroid Sourcebook makes a comment about radiation therapy.  She states. “Roughly 25 to 50 percent of all people who have received external radiation therapy to the head and neck area for cancers such as Hodgkin’s disease tend to develop hypothyroidism within five years after their treatment (p. 1).  These writers also address medication as a risk factor for becoming hypothyroid.  They state, “A number of medications can contribute to hypothyroidism.  One of the most common is Lithium (Lithonate, Lithane), which is used to treat certain psychiatric disorders.  If you’re taking medication, ask your doctor about its effect on your thyroid gland.” (MayoClinic.com, no date, p. 1)  This information would be helpful for clinicians who work with clients with manic depression or bi-polar disorders.  This can help the clients make intelligent choices about their medicine.  If a medicine has a potential for future disease, our clients need to be intelligently informed.

    Hypothyroid condition can also be a congenital disease.  The writers state that in the United States, one baby per every 5,000 babies will be, “born with a defective thyroid gland or no thyroid gland at all (p. 2).”  This condition obviously has no answers to avoid this from becoming a risk factor for hypothyroidism.

    Pituitary disorder can also be a risk factor for hypothyroidism.  The Mayo Clinic (no date) authors suggest that this risk factor accounts for about 1% of hypothyroidism cases (p. 2).  This goes back to the previous discussion of the body attacking itself.  It appears that pregnancy can trigger this process.  Pregnancy can also be a risk factor for hypothyroidism.  The authors write that, “some women develop hypothyroidism during or after pregnancy, often because they produce antibodies to their own thyroid gland (p. 2).”

    The last risk factor these Mayo Clinic (no date) writers suggest is iodine deficiency.  They make some great comments in this risk factor so here it is in it’s entirety. The trace mineral iodine-found primarily in seafood, seaweed, plants grown in iodine-rich soil, and iodized salt -- is essential for the production of thyroid hormones.  Before the 1920s, it wasn’t unusual for people to develop hypothyroidism because they consumed too little of this mineral.  But the addition of iodine to table salt has virtually eliminated this problem in the United States.  In other parts of the world, however, as many as 200 million people may suffer from iodine deficiencies (p. 2). This looks like an earlier generation has taken iodine deficiency seriously.  So common is the work of iodine salt in all of our cabinets.  Now we know why the salt is iodinized.

    Victor Adlin (1998) in his article in the American Family Physician called “Subclinical hypothyroidism: Deciding when to treat” adds two more risk factors for hypothyroidism.  He states that a family history of hypothyroidism and a personal history of hypothyroidism are also risk factors in becoming hypothyroid.

    Shoman (no date) adds a couple of risk factors that were not in other resources.  She states that, “Overconsumption of uncooked ‘giotrogenic’ foods, such as Brussels sprouts, broccoli, rutabaga, turnips, kohlrabi, radishes, cauliflower, African cassava, millet, babssu (a palm-tree coconut fruit popular in Brazil and Africa), cabbage and kale (p. 3)”
The second risk factor she adds that is not located in other literature as a risk factor for hypothyroidism is, “Overconsumption of isoflavone-intensive soy products, such as soy protein, soy capsules, soy powders (p. 3).”  These dietary risk factors were not substantiated by studies or other research.

    There are many risk factors to become hypothyroidic.  This wide range of factors only begins to tell the tale of hypothyroidism.  We turn next to the chapter in the book of hypothyroid that addresses the symptoms of someone who suffers from being hypothyroid.  This chapter may be arguous but we continue to have competent guides to help us through the rockier roads.

    These symptoms we are about to discuss covers a wide area of terrain with many guides.  Our first guide on this terrain of symptoms is no other than Anthony T. Dugbartey, Ph.D. (1998).  Dr. Dugbartey is from the department of psychiatry and behavioral science at the University of Washington School of Medicine.  Dr. Dugbartey covers the terrain of the affects that hypothyroidism has on cognition.  He states that, “hypothyroidism is associated with significant neurocognitive deficits that develop across the lifespan” (p. 1413).

    Dr. Dugbartey (1998) continues in his discussion on hypothyroidism and cognition by stating that: Of the cognitive domains that have been studied, one may conclude that hypothyroidism is associated with deficits in memory, psychomotor slowing, and visuoperceptual and construction skills, none of which appear to show a consistent pattern of recovery following intervention with TRT.  In contrast, sustained auditory attention abilities, language comprehension, and motor functions (ie, strength of grip) do not appear to be notably impaired in adults with hypothyroidism” (p. 1420).  This particular area of memory and cognitive slowing were symptoms that this learner has experienced.  It appeared that my once sharp never-forget-a-name was forgetting names of neighbors and friends I see regularly.  For a counselor and writer, this symptom was painful.

    The information on the Mayo Clinics (no date) website under the signs and symptoms concurs with Dr. Dugbartey (1998) on the point of the hypothyroid condition and cognition.  They state, “You also may become more forgetful, your thought processes may slow or you may feel depressed” (p. 1).  Dr. Dugbartey (1998) suggests that cognition would also be important in early recognition of hypothyroidism.  He states that, “The early recognition of conditions such as dementia, depression, and other neuropsychiatric abnormalities known to be associated with hypothyroidism are almost exclusively dependent on the routine and systematic assessment of cognition” (p. 1413).

    This dream of Dr. Dugbartey’s (1998) would be great if fulfilled.  Imagine if your doctor has a way to regularly measure your cognition as a symptom for a disease.  As a patient, you might sit at a computer in a waiting room and get a score placed in your chart.  The doctor would say, “hmmm.  It looks like your cognition is down 20%.  We better check that thyroid of yours.”

  Depression is another common symptom related in the literature.  They symptoms of depression according to the DSMIV-TR (2002) are several. 

  Criteria for Major Depressive Episode…

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).  Note: In children and adolescents, can be irritable mood.
(2)  markedly diminished interest or pleasure in all, or almost all, activites most of the day, nearly every day (as indicated by either subjective account or observation made by others)
(3)  significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day.  Note: In children, consider failure to make expected weight gains.
(4) insomnia or hypersomnia nearly every day
(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
(6) fatigue or loss of energy nearly every day
(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or suicide attempt or specific plan for committing suicide (p. 356)

The brave team of Lorah Dorn, Ellen Burgess, Helen Dichek, Frank Putnam, George Chrousos, and Philip Gold (1996) take us into a study of “Thyroid hormone concentrations in depressed and nondepressed adolescents: Group differences and behavioral relations.”  This journey is captured in the Journal of the American Academy of Child and Adolescent Psychiatry. 

    These researchers used a sample and method of, “21 depressed adolescents and 20 matched control adolescents.  Blood was drawn to measure thyroid-stimulating hormone (TSH), free thyroxine (FT4), thyroxine (T4), and triiodothyronine (T3).  Major depression (MD), attention deficit (AD), and obsessive-compulsive (OC) symptom scores were abstracted from the Diagnostic Interview Schedule for Children” (p. 298).

    Their study demonstrated that the FT4 or free thyroxine was influential for these adolescents.  They state, “FT4 concentrations were lower in depressed adolescents.  These findings suggest a relationship between negative behaviors and dysfunction of the hypothalamic-pituitary-thyroid axis in adolescents with depression” (p. 298).

    The researchers concluded that their FT4 findings, “there were significant group differences (p=.008) … showing lower concentrations in depressed adolescents than control subjects, suggesting that the former might be functionally hypothyroid” (p. 298).

    Hypothyroidism may impact the behavior of an adolescent and possibly adults.  This study points out other options for helping depressed adolescents other than the traditional group therapy and medication.

    In the General Illness Information under hypothyroidism from the RxMed (no date) there are several symptoms they list that can be related to hypothyroidism.  These symptoms include: 1) weakness, fatigue or lethargy, 2) cold intolerance, 3) decreased memory, 4) hearing impairment, 4) constipation, 5) muscle cramps, 6) arthralgias, 7) paresthesias, 8) modest weight gain (10 lbs.), 9) decreased sweating, 10) menorrhagia, 11) depression, 12) hoarseness, 13) carpel tunnel syndrome, 14) dry, coarse skin, 15) dull facial expression, 16) coarsening or huskiness of voice, 17) puffiness around the eyes, 18) swelling of hands and feet, 19) slow heart beat, 20) hypothermia, 21) reduced systolic blood pressure, 22) increased diastolic blood pressure, 23) reduced body and scalp hair, 24) delayed relaxation of deep tendon reflexes, 25) anemia and 26) enlarged heart on chest x-ray.

    Needless to say, the terrain of symptoms became incredibly bumpy.  This list is amazingly long.  Most people could probably find one or more symptoms from this list for sure even if they were not in a hypothyroid condition.

    Still other guides have a few more symptoms to add to this journey on the hypothyroid.  Adlin (1998) adds two more symptoms to the twenty-seven listed above.  He adds the “slowing of return reflexes (e.g. knee jerk)” and bracycardia.

    Shames and Shames (2002) also have quite the extensive list of symptoms for hypothyroid.  There are a few that have yet to be mentioned.  They cite chronic recurrent infections as a symptom of hypothyroidism.  They also see decrease sweating even with mild exercise as characteristic of someone with a hypothyroid condition.

    A tendency to be slow to heat up even in a sauna is another symptom Shames and Shames (2002) list for hypothyroidism.  Brittle finger nails that crack or peel easily is another symptom.

    Several other symptoms from Shames and Shames (2002) are: 1) frequent headaches, 2) high cholesterol despite a good diet, 3) difficulty in drawing a full breath, 4) gum problems, 5) difficulty swallowing and 6) infertility.

    In the introduction, causes and symptoms of hypothyroid section on endocrineweb.com (no date) they add more symptoms to hypothyroid that have yet to be mentioned.  They first state hair loss as a symptom of hypothyroidism.  Secondly, they stated abnormal menstrual cycles as a symptom of hypothyroid.  Lastly that state decreased libido as a symptom of hypothyroid.

    A sad symptom not mentioned by other literature as a symptom of hypothyroidism is that of spontaneous abortions.  Charles Grossman, William Morton, and Rudi Nassbaum (1996) studied 335 women.  They state their findings as, “A total of 147 hypothyroid women reported that they had experienced 84 spontaneous abortions, compared with a total of 188 nonhypothyroid women, among whom 38 spontaneous abortions had occurred” (p. 176). 

    There appears to be many symptoms to hypothyroid.  The writers of the endocrineweb.com (no date) has this to say about symptoms and symptom severity, “Each individual patient will have any number of these symptoms which will vary with the severity of the thyroid hormone deficiency and the length of time the body has been deprived of the proper amount of hormone” (p. 2).

    So with so many symptoms, how does one diagnose such a disease as hypothyroidism?  This part of the journey is as easy as going through Kansas.  M.P.J. Vanderpump, J.A.O. Ahlquist, J.A. Franklyn and R.N.Clayton (1996) make diagnosis simple.  “The diagnosis of thyroid dysfunction must be confirmed biochemically” (p. 540).

   The Mayo Clinic (no date) authors go slightly deeper on the diagnosis of hypothyroid.  They state that, “Diagnosis of hypothyroidism is based on your symptoms and the results of blood tests that measure levels of TSH and sometimes the levels of the thyroid hormone thyroxine” (p. 1).  The endocrineweb.com (no date) writers add, “if your hormone levels fall below the normal range, that is consistent with hypothyroidism” (p. 1).

    If you would like to take a quiz before you have a nurse prick you for your blood test, there is a hypothyroid test.  Richard Shames, M.D. and his wife Karilee Shames R.N., Ph.D. (2002) have a great website called Thyroid Power (www.thyroidpower.com).  They offer information, telephone consulting and a little thyroid quiz.  To take this quiz, you simply answer each of the following questions yes or no.  The questions are:

•    Have unusual fatigue unrelated to exertion?
•    Feel chillier than most people, often needing to wear socks to bed?
•    Dress in layers because of needing to adjust to various temperatures throughout the day?
     (sometimes too hot, sometimes too cold)
•    Having feelings of anxiety that sometimes lead to panic?
•    Have trouble with weight, often eating lightly, yet still not losing a pound?
•    Experience aches and pains in your muscles and joints unrelated to trauma or exercise?
•    Have increased problems with digestion or allergies?
•    Feel mentally sluggish, unfocused, or unusually forgetful, even though you’re not old
     enough to have Alzheimer’s?
•    Know of anyone in your family who has ever had a thyroid problem (even yourself at an
     earlier age)?
•    Suffer from dry skin, or are prone to adult acne or eczema?
•    Go through periods of depression, and/or lowered sex drive, seemingly out of proportion
      to life events?
•    Have diabetes, anemia, rheumatoid arthritis, or early graying of hair?  Does anyone in
      your family?
•    Experience your hair as feeling like straw, dry and easily falling out?
•    Experience significant menopausal symptoms, including migraine headache, without full 
     relief after taking estrogen?
•    Have a history of whiplash or other neck injuries (which may have damaged your thyroid)?
•    Have a significant exposure, now or in the past, to chlorine, bromine, or fluoride? (which
     compete with iodine in your thyroid)
•    Feel utterly exhausted by evening, yet have trouble sleeping?
•    Do you wake up tired? (p. 1)

After you answer every question with a yes or no answer, total your yes scores.  The authors state that, “If you answered yes to four or more of these questions, you could be one of millions of people with an undiagnosed or undertreated low thyroid problem” (p. 2).  This test of course is not scientific, but some of the criteria they use would fit some of the symptoms we covered earlier.  So now we know what hypothyroidism is.  We know what its major risk factors are as well as the symptoms and diagnosis.  The only thing left on this winding road is to arrive at the place of treating someone with hypothyroid.  Throughout our journey we have had many guides point out various aspects of the disease along the way.  So also in this part of the journey, there will be many guides.

    The first guide is a tried and true safe guide.  The Mayo Clinic (no date) in its discussion of treatment states that, “Standard treatment for an underactive thyroid involves daily use of synthetic thyroid hormone levothyroxine (Levothroid, Synthroid).  The oral medication restores adequate hormone levels, shifting your body back into normal gear” (p. 1).

   Shames and Shames (2002) state that there are currently three major brands of Thyroxine sold in America.  These brands are Synthroid which is by far the largest seller of thyroxine and Levothroid, Levoxyl and Unithroid.  He states his clients tend to like one brand over others in his practice.  This understanding of different brands being the same medicine can help when reading the literature on treating hypothyroidism.  Dan Moore (1996) from the Madigan Army Medical Center in Tacoma, Washington also agrees with this modality of treatment for hypothyroidism.  He simply states, “treatment with Levothyroxine corrects hypothyroidism” (p.296).

    On the RxMed: Illness Information (no date) website, they discuss dosage of such drugs for a person who has hypothyroid.  They state, “Dosage requirements may vary with age, sex, residual capacity of thyroid gland, other drugs being taken by patient, intestinal function” (p. 3).

    Ross McDougall and Normal Maclin (1995) chime in on the dosage issue as well.  They state that, “The dosage of levothyroxine given to most patients generally is closely related to weight.  Although not precise for every patient, a dosage of slightly less than a microgram of levothyroxine per pound of body weight is a good general guideline” (p. 240).  This would mean that a 200 lb. man would roughly take 200 micrograms of Levothyroxine.  Adlin (1998) has another perspective on dosage that is note worthy.  He states, In patients with overt hypothyroidism, the average daily replacement dosage of levothyroxine is 75 to 125 [micro]g, or 50 to 100 [micro]g in the elderly, or about 1.6 [micro]g per kg per day.  Treatment is commonly initiated with 20 to 50 [micro]g daily and raised by increments of 25 to 50 [micro]g, according to TSH measurements at six- to eight-week intervals (p. 780) Adlin’s (1998) dosage would be significantly less than our 200 micrograms for our 200 lb. male friend.

    The British Medical Journal also weighs in on the dosage issue.  In the journal there is an article called “Consensus statement for good practice and audit measures in the management of hypothyroidism and hyperthyroidism” (1996).  They state, Thyroxine is the treatment of choice in hypothyroidism.  Dosage.  The initial dose of thyroxine should normally be 50-100 [mu]g daily.  Measurement of serum thyroid stimulating hormone concentration after six weeks will indicate the need for dose adjustment by 25-50 [mu]g increments.  In older patients-especially those with evidence of ischaemic heart disease--the initial dose should be 25 [mu]g daily and increased every three to four weeks by 25 [mu]g increments (p. 543).

    Whatever the dose a person uses, these writers in the British Medical Journal (1996) have another comment to make.  For the patient with hypothyroidism taking thyroxine they state, “Once the appropriate does of thyroxine has been established it remains constant in most patients” (p. 543).

    Rosenthal (2002) offers eight practical guidelines for those who are taking some form of replacement therapy pill.  She states:

    1.  Choose a brand of thyroid hormone pill that offers precise dosing.
    2.  If you feel good, stay on that brand.
    3.  Watch for signs of hyperthyroidism.
    4.  Watch for signs of hypothyroidism.
    5.  Get a thyroid function test every three months for the first couple of years after you begin
         your pills.
    6.  Always find out when the pills dispensed expire, and how long they’ve been on the
         pharmacist’s shelf.
    7.  If you miss a pill, don’t worry about it, just carry on the next day.
    8.  Take your pill on an empty stomach if you can (p. 57).

    The Mayo Clinic (no date) does add an important issue to treating hypothyroid with this replacement therapy with medicine.  They state that, “treatment with levothyroxine is usually lifelong” (p.1).  They go on to state, “People with hypothyroidism need to take medication for the rest of their lives” (p. 1).

    Shames and Shames (2002) disagree with the notion that everybody will be on pills their whole life.  Although they acknowledge for some people this may be the case, they have this to say, “Not all sufferers of simple low thyroid need to be on their medication forever” (p. 104).

    There may be good news for those who are taking thyroxine plus thiiodothyronine according to an article in Geriatrics (1999).  In this study, the authors, R. Bunevicius, G. Kazanavicius, R. Zalinkevicius, and A.J. Prange (1999) took 35 patients and divided them into two treatment groups.  They share their results by stating; “Patients taking thyroxine plus triiodothyronine showed improved cognitive performance and were less depressed, tired, and angry (as indicated by three self-rating mood scales) than patients taking thyroxine alone” (p. 65).

     As in life unfortunately so it is in medicine.  One of the constants of life is that not everyone agrees with you.  So it is for those who treat hypothyroidism with both medicine and even without medicine at all.

    In the Family Practice News the author, Sherry Boschert (1999), states that, “Too little is known about the effects of trilodothyronine plus thyroxine therapy to recommend this approach to treating hypothyroid patients, several experts warned at a meeting on endocrinology and metabolism sponsored by the University of California, San Francisco” (p. 8).

    Shames and Shames (2002) use the various forms of thyroxine in their practice with hypothyroid patients.  They also have a comment on the usefulness of this replacement therapy.  They state, “A significant number of people might not do well, no matter what brand or dose of thyroxine they take.  The best improvement some people achieve with thyroxine alone is only 60 or 80 percent of their former sense of well-being” (p. 95).

    Greco (2001) also sings a similar song as Boschert (1999).  She clearly states, “The recommendations for thyroid hormone replacement therapy are controversial and vary as to whether to give T4 alone, T3 alone, or a combination of the two.  The best route of therapy is not uniformly agreed on either” (p. 48).

    In Pediatrics (2003) in an article called, “Treatment for congenital hypothyroidism: thyroxine alone or thyroxine plus triiodothyrine?”  These authors also address the same question as Boschert (1999) and Greco (2001).  Alessandra Cassio, Emanuele Cacciari, Alessandro Cocognani, Grazia Damiani, Guiliana Missiroli, Elena Corbelli, Antonio Balsamo, Milva Bal and Stefano Gualandi (2003) took fourteen infants and placed them into two treatment groups.  The one group was treated with just thyroxine and the other with thyroxine and triiodothyronine.  These researchers concluded that: “The combined treatment with T4 plus T3 seems not to show significant advantages, at least in our experimental conditions” (p. 1055).

    In an article called “Neurocognitive aspects of hypothyroidism” (1998) in the Archives of Internal Medicine Anthony Dugbartey states his opinion on thyroid replacement therapy.  He states, “acquired adult-onset hypothyroidism have variable responses to thyroid replacement therapy, which increases the risk of higher neurocognitive morbidity associated with congenital hypothyroidism” (p. 1413).

    J. Nuovo, A. Ellsworth and D.B. Christensen (1996) also have a note to play in this unsupportive song for thyroid replacement therapy.  They state clearly, “Too much thyroid hormone replacement (iatrogenic hyperthyroxinemia) is common and may cause serious long-term metabolic complications, including accelerated osteoporosis…”(p. 60).

    JAMA, The Journal of the American Medical Association (1989) also makes a note on thyroid treatment.  The authors state that, “Inappropriate thyroid treatment is potentially hazardous, particularly in the elderly, who have more cardiovascular disease than younger adults” (Sawin, Geller, Hershman, Castilli & Bacharach, p. 2654).

    Dr. E. Wilson disagrees with the life-long daily routine of medicine for hypothyroidism.  Herbert Selenkow (1996) presents Wilson to say, “…that hypothyroid disorders do not result from deficient thyroid production.  The author, Dr. E. Wilson, contends that such disorders are only temporary malfunctions and that the thyroid gland will resume its normal functioning if reset by applying L-triiodothyronine in cycle pulse manner” (p. 650).

    To make things even more interesting, treating the thyroid has other options than those discussed.  On the webpage, The Merck Manual of Diagnosis and Therapy (no date) under thyroid disorders, the writers have this to say, “A variety of thyroid hormone preparations are available for replacement therapy, including synthetic preparations of T4 (L-thyroxine), triiodothyronine (liothyronine), combinations of the two synthetic hormones, and desiccated animal thyroid” (p. 1).

    We have seen the medical treatment mentioning before, but not the desiccated animal thyroid.  In the Mayo Clinic’s (no date) webpage on hypothyroidism, they have a subsection called complementary and alternative medicine.  These authors state more about the animal thyroid treatment, Although most doctors recommend synthetic thyroxine, natural extracts containing thyroid hormone derived from the thyroid glands of pigs are also available.  These products-Armour Desiccated Thyroid Hormone and Westhroid-more closely resemble natural thyroid hormones because they contain both thyroxine and triidothyronine.  Synthetic thyroid medications contain thyroxine only (p. 1).

    Well, this is an interesting turn in our journey.  It is possible to get great help from animal thyroid glands.  This learner tried the thyroxine and the dosage was going up about every three months.  If a day was missed, there was an incredible lack of energy and concentration.  Through research, this learner tried the animal thyroid and it has worked miracles.  Strange things can happen when you are on a journey.

    Shames and Shames (2002) also utilizes the animal glands to treat their hypothyroid patients.  They have this to say about his form of treatment: Taking desiccated animal thyroid gland (natural thyroid) might also supply a person with useful intermediary substances such at T-1 and T-2 thyroid hormone, in addition to the final products called T-3 and T-4.  Some patients seem to need the intermediary substances; others do not.  It is up to you to ascertain if natural thyroid works better in your particular body (p. 98).  Here Shames and Shames (2002) are empowering their patient to make decisions over their own bodies and their own treatment.  These two treatment providers appear to be very knowledgeable but yet also open minded to the differences of the client.

    Speaking of which, when you are on a journey, you’re only as good as your guide.  The British Medical Journal (1996) has given some great guidelines to qualify your medical guides if you find yourself on this journey of trying to heal from a hypothyroid condition.  They state: A clinical team managing a patient with thyroid disease should have the following expertise or facilities (audit):
    *An understanding of the underlying pathogenesis of thyroid disorders
    *Access to the latest thyroid function tests
    *Access to nuclear medicine facilities
    *Access to an ophthalmological opinion
    *Access to an experienced thyroid surgeon
    *A clear treatment and monitoring plan with an understanding of the risks, benefits, and
      individual appropriateness of different treatment modalities
    *Awareness of the psychological needs of patients with thyroid disease and access to a
     specialist nurse or patient self help groups for support if requested
  *Availability of informed staff to discuss any queries after the initial consultation--for
    example, a specialist nurse
  *Access to a centsalised thyroid disease register (preferably computerized) to improve the
   surveillance of patients treated for thyroid dysfunctions; there should be an effective audit
   procedure to ensure quality of information and follow up care provided by the system 
   used (p. 541).

    Although most of us may not be able to find a guide with exactly all those qualities, it is helpful to know what you are looking for in a guide.  Rosenthal (2002) leaves us with some places to look to for guidance and guides as well.  She lists a few organizations and their websites for more information on thyroid conditions.  They include, “American Foundation of Thyroid Patients, www.thyroidfoundation.org; ThyCa, Inc. (The Thyroid Cancer Survivors’ Association), www.thyca.org; Thyroid Foundation of America, Inc, www.tfaweb.org/pub/tfa; Thyroid society for Education and Research, www.the-thyroid-society.org” (p. 127).

    The journey of understanding what hypothyroid disease is and how it impacts the healthy life of someone is important to millions.  The journey of understanding the risk factors and symptoms were helpful.  The landing in the meadow of treating a hypothyroid person has been healing.  The journey would not have been the same without all the guides along the way to help us see what we are looking for as in life so in academics.  Even the best things in life come to an end.  And yet, this learner’s journey continues and this passage has increased my health and changed my life! 

References

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American Psychiatric Association. (2002).  Diagnostic and statistical manual of mental disorders: Text revision: DSM-IV-TR. (4th Ed.). Washington, D.C.: Author.
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Canaris, G.J., Manowitz, N.R., Mayor, G., & Ridgway, E.C., (2000).  The Colorado thyroid disease prevalence study.  Archives of Internal Medicine, 160, 526.

Cassio, A., Cacciari, E., Cicognani, A., Damiani, G., Missiroli, G., Corbelli, E., Balsamo, A., Bal, M., & Gualandi, S., (2003).  Treatment for congenital hypothyroidism: Thyroxine alone or thyroxine plus triiodothyronine?  Pediatrics, 111, 1055(6).

Burgess, E.S., Dichek, H.L., Putnam, F.W., Chrousos, G.P., & Gold, P.W., (1996).  Thyroid hormone concentrations in depressed and nondepressed adolescents: Group differences and behavioral relations.  Journal of the American Academy of Child and Adolescent Psychiatry, 35, 298(4).

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Shames, R.L., & Shames, K.H., (2002).  Thyroid Power: 10 Steps to Total Health.  New York, NY: Quill.

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