Hypothyroidism

Hypothyroidism is a condition in which the thyroid gland doesn't produce adequate levels of thyroid hormones, resulting in symptoms such as lethargy and weight gain. It affects perhaps 5% of the adult American population, most of whom are women with subclinical symptoms.
With so much of the American population overweight and with lethargy having so many possible causes, it was inevitable that some woo meisters would claim that hypothyroidism is an "epidemic" and that you probably have it.Quackwatch lists hypothyroidism among the Fad Diagnoses prevalent in the past. Or, if you've been diagnosed with hypothyroidism and you still feel tired and fat on the medication, that your hypothyroidism must not be adequately treated yet.
==What mainstream medicine says==
In the ancient past, iodine deficiency was the primary cause of hypothyroidism. In the modern developed world, though, iodine deficiency is very rare, and the primary cause of hypothyroidism is an autoimmune disorder called The only treatment is thyroid hormone supplements. The first such treatment was desiccated thyroid extract — ground up cow and pig thyroid glands, originally sold by the Armour meat packing company (eventually Forest Labs took over the Armour Thyroid brand name). By the 1950s, the individual hormones involved in thyroid function had been identified, and the pharmaceutical industry soon developed synthetic levothyroxine (T4, sold as Synthroid by Abbot Labs) and synthetic triiodothyronine (T3, sold as Cytomel by King Pharmaceuticals).
The American Association of Clinical Endocrinologists published their most recent guidelines for the diagnosis and treatment of hypothyroidism in November 2012. While these standards are not cut-and-dried absolutes, they basically boil down to this:
* Hypothyroidism should be diagnosed by measuring the level of Thyroid Stimulating Hormone (TSH) in the blood. If it's above 5 μIU/mL, and symptoms of hypothyroidism are present, the patient is probably hypothyroid.
* Hypothyroidism should be treated by prescription T4.
* The dose of T4 should be adjusted until the patient's TSH level is brought down within the therapeutic target range of 0.45According to this 2010 article, it may be safe to go as low as 0.04 μIU/mL, at least as far as your risk of heart disease, abnormal heart patterns, and bone fractures go. That doesn't mean you'll be safe from other risk factors at such a low TSH level, though, which is why the AACE still recommends a low end of 0.45 μIU/mL. to 4.12 μIU/mL. (Or a tad lower if the patient is preggers.)
== T4, T3, and Reverse T3: Questionable claims ==
T4 is technically a "prohormone" — it isn't biologically active until it's deiodinated into T3. Two enzymes (D1 and D2) turn T4 into as much T3 as the body thinks it needs; D1 and another enzyme (D3) turn the rest of the T4 into Reverse T3 (rT3), which is inert. Mainstream endocrinologists tend to prefer prescribing synthetic T4 over synthetic T3 or desiccated thyroid extract (which contains some T3) for two reasons: (1) In the vast majority of hypothyroid cases, the only dysfunction is in the production of T4, not in the conversion of T4 to T3; and (2) having too much T4 in your blood isn't nearly as bad as having too much T3.
Unfortunately, treating hypothyroidism won't always get rid of the all the symptoms that can be associated with hypothyroidism — depression, fatigue, weight gain, intolerance of cold, dry and scaly skin, etc.. And that's where the woo peddlers come in.
=== T3's antidepressant properties ===
The questionable push for T3 over T4 may be related to the fact that T3 has had some benefit in treating depression. Some depression sufferers that don't respond well enough to conventional antidepressants have shown improvement when T3 was added to their antidepressant regimen.The Treatment of Depression with T3, Evolutionary Psychiatry, Feb. 2012Abraham et al., T3 augmentation of SSRI resistant depression, Journal of Affective Disorders, April 2006. It's possible that many of these hypothyroid patients, who still show symptoms when their TSH levels are brought within the normal range by T4 and who swear up-and-down that they feel better with T3 (or with desiccated thyroid extract, which contains some T3), may in fact be suffering from undiagnosed depression.
== Listen, Damn You! == 
Suppose a hypothyroid patient is taking a prescription for synthetic T4, and the patient's TSH levels are now down within the therapeutic target range, but the patient still feels lethargic, fat, and unhappy. It could be because the T3 levels are inadequate, but it might also have nothing to do with hypothyroidism. A good endocrinologist might be willing to test for T3 levels, or adjust the dose of T4 to target the low end of the normal TSH range instead of the high end, or even try supplementing the T4 with a small amount of T3 — but (s)he should also be wary of overmedicating his/her patient all the way into the hyperthyroid range.
As a result, books like Stop the Thyroid Madness scream up-and-down about the need to get your doctor to LISTEN!! to you. By which they mean, if your doctor isn't giving you exactly the drugs you tell them to, then they are an evil dupe in the hip pocket of Abbot Laboratories and you should keep looking for one until you find one that will rubber-stamp your prescription mandates. The fact that you couldn't be bothered to either listen to your endocrinologist or read the fucking label, which clearly says to take on an empty stomach and even defines exactly what this means, couldn't possibly be the issue; improper administration be dammed, there must be a conspiracy at work.
== T4 vs. Desiccated Thyroid: A False dichotomy == 
Since desiccated thyroid is derived from ground up animal glands, it is therefore "natural", and must therefore inherently be better than that wicked, man-made synthetic T4. 
The book Stop the Thyroid Madness, by Janie A. Bowthorpe, seems to imply that the only two courses of treatment available to a hypothyroid patient are an evil corporate-sponsored dose of synthetic T4 and <I>only</I> synthetic T4, or the "natural alternative" of desiccated thyroid (which she dubiously calls "Armour thyroid"). Almost no mention is made anywhere in the book of the existence of synthetic T3. Nowhere is the suggestion made of asking ones doctor to add synthetic T3 into the prescription mix, if you're not feeling fully treated on T4 alone. The few places that do mention people who have been prescribed synthetic T3 are quick to remind the reader: "But Armour Thyroid contains everything, so you should use that instead!"
She also claims that "mainstream" endocrinologists are receiving kickbacks from Abbot Laboratories, the makers of Synthroid (the first and most-recognized brand of synthetic T4). It is not known whether Ms. Bowthorpe is receiving kickbacks from Forest Labs.
Bowthorpe's book isn't the only hypothyroidism information source to present this false dichotomy. This about.com article, for example, also touts the virtues of desiccated thyroid extract over a regimen of pure synthetic T4, while neglecting to mention the synthetic T3 option except in an off-the-cuff remark about inflexible endocrinologists.
Quackwatch now recommends that you be wary of doctors who prescribe desiccated thyroid extract.Desiccated Thyroid: Be Wary of Doctors Who Prescribe It, Quackwatch, last revised 10-Sept-2013
==Synthetic T4 shelf life==
According to an FDA press release from 2007Thyroid Drug Potency is Being Tightened: FDA Changes Specs for Levothyroxine, synthetic T4 can break down if stored in a hot or humid environment (like, say, a bathroom with a working tub or shower).
As of 2008, the FDAhttp://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm161266.htm and USPhttp://www.usp.org/usp-nf/notices/retired-compendial-notices/usp-announces-revised-monograph-levothyroxine-sodium-tablets now mandate that synthetic T4 must meet a 95%-105% potency specification <I>throughout</I> its shelf life. All formulations sold by pharmacies since that time are required to meet these standards against degradation.
To desiccated thyroid proponents, such degradation with storage time was one more reason not to trust synthetic T4. To more sane individuals, though, it brings up the question of whether the natural T4 in desiccated thyroid doesn't also break down if stored in a hot or humid environment.
==Wilson's Syndrome==
Wilson's Temperature Syndrome, more commonly known as Wilson's Syndrome (and not to be confused with Wilson's disease), is a commonly pushed for thyroid diagnosis in the alternative medicine community,, a major Wilson's crankery website though it has never been recognized as a valid diagnosis within the established medical community.Is Wilson's syndrome a legitimate ailment?, From the Mayo ClinicThe American Thyroid Association's Statement on “Wilson’s Syndrome”Wilson's Syndrome also appears on Quackwatch's list of fad diagnoses. Originally proposed in 1990 by Dr. E. Denis Wilson (the syndrome's namesake), the premise of the Wilson's pushers is that, if you have non-specific symptoms similar to hypothyroidism, you must have hypothyroidism regardless of what the blood tests say your thyroid count is. Among the nonspecific symptoms seen as "definitive" for hypothyroidism is a body temperature below 98.6°F, so apparently the Wilson's folks feel that playing in the snow will make you hypothyroid.
Even more dangerously, the cranks who support treating Wilson's Syndrome often prescribe T3 as its treatment. Unsurprisingly, it was treating a phony diagnosis with T3 that led to a patient dying of a heart attack and to the subsequent disciplinary actions against Dr. Wilson by the Florida Board of Medicine.Doctor's syndrome a sham, board says
== Hypothyroid diet ==
Not content with a choice between modern synthetic treatments that have been proven to work, and the older ground-up-thyroid gland that was also proven to work in its own time, various woo peddlers have chimed in with the claim that you can cure your hypothyroidism by diet.
There are some legitimate dietary concerns if you have hypothyroidism:
* There are some foods known to be such as soybean protein and cauliflower; these foods contain isoflavones that can interfere with thyroid peroxidase (TPO), thereby reducing the thyroid gland's ability to manufacture T4 -- but only in cases of iodine deficiency. A reasonable recommendation would be to limit your intake of goitrogenic foodstuffs.
* In patients with Hashimoto's thyroiditis, there's some evidence that increasing your iodine intake can sometimes make the condition worse,Effect of small doses of iodine on thyroid function in patients with Hashimoto's thyroiditis residing in an area of mild iodine deficiency, European Journal of Endocrinology, vol. 139 no. 1 (July 1998), pp. 23-28Yoon et al., The Effect of Iodine Restriction on Thyroid Function in Patients with Hypothyroidism Due to Hashimoto's Thyroiditis (PDF file), Yonsei Medical Journal, vol. 44 no. 2 (2003), pp. 227-235 perhaps because it can result in elevated levels of TPO (which the Hashimoto's patient's anti-TPO antibodies attack).According to this article in Biological trace elements research, excessive iodine intake actually reduces TPO activity, rather than elevating TPO levels. A reasonable recommendation would be to ensure that your iodine intake is appropriate and not excessive. (Remembering to take the amount of iodine in your thyroid hormone drugs into account.)
* Conversion of T4 to T3 may be impaired in cases of selenium deficiency.Type I iodothyronine deiodinase is a selenocysteine-containing enzyme, Nature, vol. 349, pp. 438-440 (31 January 1991) A reasonable recommendation would be to ensure that your selenium level is adequate.
* People with Hashimoto's thyroiditis have a greater incidence of celiac disease than the general population.Akçay et al., The presence of the antigliadin antibodies in autoimmune thyroid diseases, Hepato-gastroenterology, 2003 Dec; 50 Suppl 2: cclxxix-cclxxx A reasonable recommendation would be to get checked for subclinical celiac disease.
However, the diet woo meisters go far beyond these reasonable recommendations.Smart Foods For HypothyroidismLiveStrong hypothyroidism diet -- at least this one doesn't recommend you use a diet instead of taking thyroid hormone medications.The HypoThyroid Diet: Lose Weight and Beat Fatigue in 21 DaysThe Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss; some sound advice mixed in with herbal supplement wooThe Gluten-Thyroid ConnectionMidlife plight: my thyroid or my teeth?, by Jennifer Berman, writer and sign language interpreter (rebuttal in Forbes) You'll see claims that you need to completely avoid all foods that might be goitrogenic, completely avoid all foods that have so much as a milligram of iodine in them (including iodized salt), go gluten-free, and (of course) try their new and improved diet program guaranteed to make you feel less hypothyroid in just 21 days or your money back.
The Mayo Clinic says there's no evidence for dietary control of hypothyroidism, outside of ensuring that the patient doesn't eat certain foodstuffs too soon after taking hormone supplements.Is there any truth to the hypothyroidism diet? Can certain foods increase thyroid function?
== Hypothyroidism treatments as weight loss gimmicks ==
One of the possible symptoms of hypothyroidism is weight gain. One of the possible symptoms of hyperthyroidism is weight loss. It didn't take long for those desperate to find an easy weight loss gimmick to think of deliberately taking thyroid hormones even when thyroid function is normal.
The American Thyroid Association has this to say about the subject:
In addition, Cytomel (prescription synthetic T3) is required by the FDA to come with this warning:
Dietary supplements used to be sold which contained actual thyroid hormones. Today, however, legal access to these drugs is impossible without a prescription. That hasn't stopped certain unscrupulous manufacturers from giving "thyroidally suggestive" names to their dietary supplements, like "T-3"S.A.N. T-3, even though they contain no triiodothyronine.
== Fluoride ==
Several alternative medicine sources claim that fluoridation can impair thyroid function.Fluoride and your ThyroidThe Daily Activity Every Middle Aged Woman Should Beware of, on Joseph Mercola's siteThyroid, on the Fluoride Action Network Fluoride was, at one point, even prescribed as a possible treatment for hyperthyroidism.[http://www.fluoridealert.org/wp-content/uploads/galletti-1958.pdf Effect of Fluorine on Thyroidal Iodine
Metabilism in Hyperthyroidism] (PDF), Galletti and Joyet, 1958The Merck Index (PDF), 8th Edition (1968), p. 959
However, a review of the literature published in Klinische Wochenschrift in 1984 found that "Published data failed to support the view that fluoride, in doses recommended for caries prevention, adversely affects the thyroid."Bürgi et al., Fluorine and thyroid gland function: a review of the literature, Klin Wochenschr. 1984 Jun 15;62(12):564-9. A population study in 2015 found "diease clusters" of hypothyroidism in areas of England with fluoridated waterPeckham et al., Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water, Journal of Epidemiology & Community Health (impact factor: 3.2), February 2015, but such population studies are notorious for finding dubious associations.Experts Criticize Thyroid Study, American Academy of Pediatrics campaign for dental health, 2-March-2015 (And even if the association is solid, WebMD points out that correlation does not imply causation.Alan Mozes, Fluoride in Water and Underactive Thyroid Rates, WebMD, 25-Feb-2015)
==External links==
* Hypothyroidism: The facts, the controversies, and the pseudoscience at sciencebasedmedicine.org
* The Case of the Missing Thyroid Nodules, on the Stop the Thyroid Madness blog. Read the heroic tale of how one woman, diagnosed with a harmless lump in her thyroid, was nevertheless convinced she was going to die but miraculously survived thanks to the placebo effect iodine and selenium.
==Notes==
==References==
Category:Medicine
Category:Woo
Category:Water fluoridation