Hypothyroidism

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[[File:(S)-Triiodthyronine_Structural_Formulae.png|thumb|right|160px|T<sub>3</sub>, enough of which will miraculously solve all your problems]][[File:Reverse_triiodothyronine.png|thumb|right|160px|Reverse T<sub>3</sub>, which will infect your soul, curve your spine, and keep the country from winning the war]]

'''Hypothyroidism''' is a condition in which the thyroid gland doesn't produce adequate levels of thyroid hormones, resulting in symptoms such as lethargy and [[obesity|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.<ref>[[Quackwatch]] lists hypothyroidism among the [http://www.quackwatch.com/01QuackeryRelatedTopics/fad.html Fad Diagnoses] prevalent in the past.</ref> 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 {{wpl|Hashimoto's thyroiditis|'''Hashimoto's thyroiditis'''|.}}{{efn|Other common causes of hypothyroidism include pregnancy, and getting your thyroid gland surgically removed or destroyed due to cancer. In Hashimoto's thyroiditis, the patient creates antibodies that attack her (it's far more likely to be "her") own thyroid peroxidase (TPO) enzymes; it can be tested for by looking for anti-TPO antibodies in the patient's blood, but since not all people with Hashimoto's thyroiditis develop hypothyroidism, such a test isn't definitive for diagnosing hypothyroidism.}} 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 [[Big Pharma|pharmaceutical industry]] soon developed synthetic levothyroxine (T<sub>4</sub>, sold as Synthroid by Abbot Labs) and synthetic triiodothyronine (T<sub>3</sub>, 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.<ref name=AACE-guidelines2012>{{cite journal |author=American Association of Clinical Endocrinologists |title=Clinical Practice Guidelines for Hypothyroidism in Adults |journal=Endocrine Practice |volume=18 |issue=6 |year=2012 |month=November/December |pages=988-1028 |url=https://www.aace.com/files/final-file-hypo-guidelines.pdf |format=PDF}}</ref> 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.{{efn|A test for the anti-TPO antibodies caused by Hashimoto's Thyroiditis is also recommended in pregnant patients with a history of Graves’ disease who were treated with radioactive iodine or thyroidectomy prior to pregnancy. (c.f. Recommendation 5 in the PDF file).}}
* Hypothyroidism should be treated by prescription T<sub>4</sub>.
* The dose of T<sub>4</sub> should be adjusted until the patient's TSH level is brought down within the therapeutic target range of 0.45<ref>According to [http://www.sciencedaily.com/releases/2010/03/100315230910.htm 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.</ref> to 4.12 μIU/mL. (Or a tad lower if the patient is [[pregnancy|preggers]].)

== T<sub>4</sub>, T<sub>3</sub>, and Reverse T<sub>3</sub>: Questionable claims ==

T<sub>4</sub> is technically a "prohormone" &mdash; it isn't biologically active until it's deiodinated into T<sub>3</sub>. Two enzymes (D1 and D2) turn T<sub>4</sub> into as much T<sub>3</sub> as the body thinks it needs; D1 and another enzyme (D3) turn the rest of the T<sub>4</sub> into Reverse T<sub>3</sub> (rT<sub>3</sub>), which is inert. Mainstream endocrinologists tend to prefer prescribing synthetic T<sub>4</sub> over synthetic T<sub>3</sub> or desiccated thyroid extract (which contains some T<sub>3</sub>) for two reasons: (1) In the vast majority of hypothyroid cases, the only dysfunction is in the production of T<sub>4</sub>, not in the conversion of T<sub>4</sub> to T<sub>3</sub>; and (2) having too much T<sub>4</sub> in your blood isn't nearly as bad as having too much T<sub>3</sub>.

Unfortunately, treating hypothyroidism won't always get rid of the all the symptoms that can be associated with hypothyroidism &mdash; depression, fatigue, weight gain, intolerance of cold, dry and scaly skin, etc.. And that's where the woo peddlers come in.

{{sbs|title=1|Claim|Why it's questionable}}

{{sbs |
Your body isn't turning enough T<sub>4</sub> into the biologically active T<sub>3</sub>, or is turning too much T<sub>4</sub> into the biologically inactive Reverse T<sub>3</sub>. Therefore, you should be taking less T<sub>4</sub> and more T<sub>3</sub>.
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While stress, or at least TNF which can be released by stress, may decrease the conversion of T<sub>4</sub> to T<sub>3</sub>,<ref>{{cite journal |pmid=8180680 |year=1994 |last1=Ongphiphadhanakul |first1=B |last2=Fang |first2=SL |last3=Tang |first3=KT |last4=Patwardhan |first4=NA |last5=Braverman |first5=LE |title=Tumor necrosis factor-alpha decreases thyrotropin-induced 5'-deiodinase activity in FRTL-5 thyroid cells |volume=130 |issue=5 |pages=502–7 |journal=European journal of endocrinology}}</ref>, and at least one study does show a potential quality-of-life benefit for replacing some T<sub>4</sub> with T<sub>3</sub>,<ref>Nygaard et al., [http://www.eje-online.org/content/161/6/895 Effect of combination therapy with thyroxine (T4) and 3,5,3′-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study], ''European Journal of Endocrinology'', vol. 161 no. 6 (December 2009), pp. 895-902</ref> no conclusive benefit has been shown for adding T<sub>3</sub> to an existing T<sub>4</sub> regimen in general.<ref>{{cite journal |pages=4946–54 |title=Treatment of Hypothyroidism with Combinations of Levothyroxine plus Liothyronine |year=2005 |last1=Escobar-Morreale |first1=H. F. |journal=Journal of Clinical Endocrinology & Metabolism |volume=90 |issue=8 |pmid=15928247 |last2=Botella-Carretero |first2=JI |last3=Escobar Del Rey |first3=F |last4=Morreale De Escobar |first4=G}}</ref><ref>{{cite journal |pages=379–84 |title=Treatment of Clinical Hypothyroidism With Thyroxine and Triiodothyronine: A Literature Review and Metaanalysis |year=2007 |last1=Joffe |first1=R. T. |last2=Brimacombe |first2=M. |last3=Levitt |first3=A. J. |last4=Stagnaro-Green |first4=A. |journal=Psychosomatics |volume=48 |issue=5 |pmid=17878495}}</ref>}}

{{sbs |
Testing your TSH level is misleading, you need to test Free T<sub>3</sub> / Total T<sub>3</sub> / Reverse T<sub>3</sub> / your Free-T<sub>3</sub>-to-Reverse-T<sub>3</sub> ratio.
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TSH is an indirect indicator of thyroid hormone levels. The hypothalamus senses the level of circulating thyroid hormones, and produces TRH if the level is too low. The pituitary responds to the TRH by producing TSH. A (healthy) thyroid gland, in turn, responds to the TSH by producing thyroid hormones (mostly T<sub>4</sub> with a little bit of T<sub>3</sub>). If the thyroid is underproducing, the TSH level will be elevated. Clinical studies have repeatedly shown that, for the general population, testing the TSH level is the most reliable way to gauge thyroid function.

Saying that the TSH test shouldn't be trusted provides a convenient excuse to recommend a higher prescription dose. Proponents often cite a study on elderly men from 2005,<ref>van den Beld et al., [http://press.endocrine.org/doi/full/10.1210/jc.2005-0872 Thyroid Hormone Concentrations, Disease, Physical Function, and Mortality in Elderly Men], ''The Journal of Clinical Endocrinology & Metabolism'', vol. 90 no. 12 (1-Dec-2005), pp. 6403-6409</ref> which showed that high T<sub>4</sub> and rT<sub>3</sub> levels were associated with reduced physical functioning in the test subjects. The problem is, T<sub>3</sub> has a rather short half-life ''in vivo'', and serum T<sub>3</sub> levels can vary over the course of a day depending on a number of factors. Worse, Reverse T<sub>3</sub> has a different half-life ''in vivo'' than T<sub>3</sub> does, and so the ratio could theoretically vary over the course of a day as T<sub>3</sub> is broken down by the liver but Reverse T<sub>3</sub> isn't, or vice-versa.}}

{{sbs |
''All'' clinical lab tests for hypothyroidism are flawed, and you need to look exclusively at the patient's symptoms.
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This is a favorite of the I-don't-feel-adequately-treated online-support-group crowd. It's also potentially dangerous, in that seeking out an alternative medicine practitioner or fast-and-loose endocrinologist who'll up your dose because you're not feeling good can end up overmedicating you, or mask other potential causes for your symptoms.}}

{{sbs |
The pituitary (or the hypothalamus) preferentially senses T<sub>4</sub> over T<sub>3</sub>. This means that your TSH level will go down in response to taking T<sub>4</sub>, ''even if'' inadequate T<sub>3</sub> is still being produced. Therefore, you should be taking less T<sub>4</sub> and more T<sub>3</sub>.
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This claim runs contrary to the evidence. A March 2013 study states: "Given that the ''TSHB'' and ''TRH'' genes are negatively regulated by T<sub>3</sub> (and not T<sub>4</sub>), it is crucial that T<sub>4</sub> be converted to T<sub>3</sub> in order to activate the negative feedback mechanism."<ref>Fonseca et al., [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613903/ Coordination of hypothalamic and pituitary T3 production regulates TSH expression], ''The Journal of Clinical Investigation'', vol. 123 no. 4 (1-April-2013), pp. 1492–1500</ref> (Of course, if this conversion is only happening at a high rate locally within the brain, near the hypothalamus and pituitary, and isn't happening at the same rate elsewhere in the body, the subject ''could'' theoretically still have both low circulating T<sub>3</sub> levels and a TSH level within the normal range. And in fact, nearly half of the intracellular T<sub>3</sub> in the pituitary is created via local deiodination.<ref>Silva and Larsen, [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC372646/ Contributions of Plasma Triiodothyronine and Local Thyroxine Monodeiodination to Triiodothyronine to Nuclear Triiodothyronine Receptor Saturation in Pituitary, Liver, and Kidney of Hypothyroid Rats], ''Journal of Clinical Investigation'', vol. 61 no. 5 (May 1978), pp. 1247-1259</ref><ref>Silva et al., [http://www.ncbi.nlm.nih.gov/pubmed/217671 The contribution of local tissue thyroxine monodeiodination to the nuclear 3,5,3'-triiodothyronine in pituitary, liver, and kidney of euthyroid rats.], ''Endocrinology'', vol. 103 no. 4 (Oct. 1978), pp. 1196-207</ref><ref>Larsen et al., [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC372097/ Inhibition of intrapituitary thyroxine to 3.5.3'-triiodothyronine conversion prevents the acute suppression of thyrotropin release by thyroxine in hypothyroid rats.], ''Journal of Clinical Investigation'', vol. 64 no. 1 (July 1979), pp. 117-128</ref>) }}

{{sbs |
Reverse T<sub>3</sub> interferes with the D2 enzyme, preventing it from turning T<sub>4</sub> into T<sub>3</sub>. Therefore, you should be taking less T<sub>4</sub> and more T<sub>3</sub>.
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Although rT<sub>3</sub> has been shown to interfere with the conversion of T<sub>4</sub> into T<sub>3</sub> ''in vitro''<ref>Han et al., [http://www.ncbi.nlm.nih.gov/pubmed/3732155 3,3',5'-Triiodothyronine inhibits iodothyronine-5'-deiodinating activity induced by 3,5,3'-triiodothyronine at equimolar concentrations in cultured fetal mouse liver], ''Endocrinology'', vol. 119 no. 3 (Sept. 1986), pp. 1076-82</ref>, the ''minimum'' concentration at which this effect has been detected is 100 pmol/L of free rT<sub>3</sub>. The median normal serum concentration of free rT<sub>3</sub> is 0.59 pmol/L.<ref>Faber et al., [http://www.ncbi.nlm.nih.gov/pubmed/6507005 Serum free T4, T3, rT3, 3,3'-diiodothyronine and 3',5'-diiodothyronine measured by ultrafiltration], ''Acta Endocrinologica'', vol. 107 no. 3 (Nov. 1984), pp. 357-65</ref> (Note: The most common blood test for rT<sub>3</sub> measures the ''total'' rT<sub>3</sub> in the blood, including the rT<sub>3</sub> bound to TBG. This is typically hundreds of times higher than the free rT<sub>3</sub> level.)}}

{{sbs |
Reverse T<sub>3</sub> acts as a T<sub>3</sub> antagonist, by blocking or "clogging up" the cellular T<sub>3</sub> receptors<ref>[http://thyroid.about.com/od/t3treatment/a/Reverse-T3-triiodothyronine-RT3-Thyroid.htm The Role of Reverse T3 Testing in Thyroid Treatment], by Mary Shomon on about.com</ref>, producing "tissue resistance" to T<sub>3</sub><ref>http://www.thyroid-rt3.com/whatdo.htm</ref><ref>http://nahypothyroidism.org/deiodinases/ , section "Deiodinase type III (D3)"</ref> which results in reduced response ''even when'' your T<sub>3</sub> levels should be adequate. Therefore, you should be taking less T<sub>4</sub> and more T<sub>3</sub>.
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Of course, still others have claimed the opposite.<ref>http://tiredthyroid.com/rt3.html</ref><ref>Venkatraman, Lefebvre. [http://www.sciencedirect.com/science/article/pii/S0006291X87803017 Multiple thyroid hormone binding sites on male rat liver nuclear matrices], Biochemical and Biophysical Research Communications, Volume 148, Issue 3, 13 November 1987, Pages 1496–1502</ref><ref>Wiersinga WM, Chopra IJ, Solomon DH, [http://www.ncbi.nlm.nih.gov/pubmed/7075548 Specific nuclear binding sites of triiodothyronine and reverse triiodothyronine in rat and pork liver: similarities and discrepancies], Endocrinology. 1982 Jun;110(6):2052-8</ref> According to two sources<ref>[http://books.google.com/books?id=yfE5u6OrGDIC&pg=PA93&lpg=PA93&source=bl&ots=HerA40XyI1&sig=3vSio00emMZuVA2pZWygEOTkMpo&hl=en&sa=X&ei=RzAZU67xC8aQiAen2oHIAg&ved=0CGYQ6AEwBw#v=onepage&q&f=false Molecular Basis of Thyroid Hormone Action, page 93]</ref><ref>Papavasiliou et al., [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC372479/ Thyroid Hormonelike Actions of 3,3′,5′-l-Triiodothyronine and 3,3′-Diiodothyronine], ''The Journal of Clinical Investigation'', vol. 60 no. 6 (Dec 1977), pp. 1230-1239</ref>, Reverse T<sub>3</sub> ''does'' compete with T<sub>3</sub> at the nuclear receptors, but only ''very weakly''; the rT<sub>3</sub> concentration has to be 10 to 1000 times higher than the T<sub>3</sub> concentration before the number of receptors bound to T<sub>3</sub> is halved. In a normal patient, serum concentrations of total T<sub>3</sub> are anywhere from 2.5 to 18 times ''higher'' than rT<sub>3</sub>.<ref>http://www.globalrph.com/labs_t.htm</ref>

Interestingly, actual receptors for Reverse T<sub>3</sub> do exist in rats, but their function is not yet known.<ref>[http://www.ncbi.nlm.nih.gov/pubmed/6312037 Specific 3,3',5'-triiodothyronine (reverse T3) binding sites on rat liver plasma membranes: comparison with thyroxine (T4) binding sites], ''Journal of Receptor Research'', vol. 3 no. 3 (1983), pp. 393-407</ref>}}

{{sbs |
If the evil mainstream medical establishment duped you into taking T<sub>4</sub>, all that awful Reverse T<sub>3</sub> will have to be [[cleanse]]d from your system. You should take an elevated dose of T<sub>3</sub> for some weeks.
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Even if Reverse T<sub>3</sub> ''does'' block T<sub>3</sub> receptors, Reverse T<sub>3</sub> has a half life ''in vivo'' of only a few hours.<ref>Peeters et al., [http://jcem.endojournals.org/content/90/8/4559.full Serum 3,3′,5′-Triiodothyronine (rT3) and 3,5,3′-Triiodothyronine/rT3 Are Prognostic Markers in Critically Ill Patients and Are Associated with Postmortem Tissue Deiodinase Activities], Journal of Clinical Endocrinology & Metabolism, vol. 90, issue 8, page 4559 (August 2005)</ref> There ''might'' be a "hidden pool" of Reverse T<sub>3</sub> lurking somewhere in the body, which could result in extra rT<sub>3</sub> being introduced into the blood after the circulating rT<sub>3</sub> has cleared.<ref>LoPresti et al., [http://www.ncbi.nlm.nih.gov/pubmed/2335581 Does a hidden pool of reverse triiodothyronine (rT3) production contribute to total thyroxine (T4) disposal in high T4 states in man.], ''Journal of Clinical Endocrinology and Metabolism'', vol. 70 no. 5 (1990), pp. 1479-84</ref>}}

{{sbs |
Desiccated thyroid extract is what we used to use before [[Big Pharma]] pushed that awful artificial Synthetic T<sub>4</sub> on us, and we should go back to using it.
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It was abandoned because it came from ground up cow and pig thyroids, which have a different ratio of T<sub>3</sub> to T<sub>4</sub> than is normal for a human. It also contains T<sub>2</sub> and T<sub>1</sub>, which have never been proven helpful in treating hypothyroidism but which desiccated thyroid proponents claim makes it "better." Also, until the last couple of decades, desiccated thyroid preparations had an alarming variation in dose from one batch to the other; and even with tightened USP requirements, the [[FDA]] issued a recall of over half a million bottles of desiccated thyroid in 2005 due to unstable concentrations of thyroid hormones.<ref>[http://www.fda.gov/safety/recalls/enforcementreports/2005/ucm120349.htm Enforcement Report for May 11, 2005], from the FDA's site. Note that this page lists all recalls issued on 11-May-2005, not just those recalls issued for desiccated thyroid extract. Note also that the Class II recall of desiccated thyroid shown at the top was later downgraded to a Class III recall.</ref>}}

{{sbs |
T<sub>4</sub> causes lung cancer!<ref>[http://www.stopthethyroidmadness.com/2013/08/12/t4-only-lung-cancer More BAD news if you are on T4-only like Synthroid?: it can cause Lung Cancer, says a study!], stopthethyroidmadness.com, 12-Aug-2013</ref>
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The study in question, an abstract of which can be found [http://www.rbej.com/content/11/1/75/abstract here], is a population study. It looks at 18 different regions in Italy and tries to see if there's any [[correlation does not imply causation|correlation]] between ''sales'' of levothyroxine and various types of cancer. It happened to find one such correlation with lung cancer, but failed to find any correlation with breast, colorectal or gastric cancers. In other words, they were [[P-value fishing]].}}

=== T<sub>3</sub>'s antidepressant properties ===

The questionable push for T<sub>3</sub> over T<sub>4</sub> may be related to the fact that T<sub>3</sub> has had some benefit in treating depression. Some depression sufferers that don't respond well enough to conventional antidepressants have shown improvement when T<sub>3</sub> was added to their antidepressant regimen.<ref>[http://evolutionarypsychiatry.blogspot.com/2012/02/treatment-of-depression-with-t3.html The Treatment of Depression with T3], ''Evolutionary Psychiatry'', Feb. 2012</ref><ref>Abraham et al., [http://www.ncbi.nlm.nih.gov/pubmed/16483669 T3 augmentation of SSRI resistant depression], ''Journal of Affective Disorders'', April 2006</ref>. It's possible that many of these hypothyroid patients, who still show symptoms when their TSH levels are brought within the normal range by T<sub>4</sub> and who swear up-and-down that they feel better with T<sub>3</sub> (or with desiccated thyroid extract, which contains some T<sub>3</sub>), may in fact be suffering from undiagnosed depression.

== Listen, Damn You! == 

Suppose a hypothyroid patient is taking a prescription for synthetic T<sub>4</sub>, 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 T<sub>3</sub> levels are inadequate, but it might also have nothing to do with hypothyroidism. A good endocrinologist might be willing to test for T<sub>3</sub> levels, or adjust the dose of T<sub>4</sub> to target the low end of the normal TSH range instead of the high end, or even try supplementing the T<sub>4</sub> with a small amount of T<sub>3</sub> &mdash; but (s)he should ''also'' be wary of overmedicating his/her patient all the way into the ''hyperthyroid'' range.{{efn|Technically, it's only called hyperthyroidism if the patient's own thyroid produces the excessive hormones. The clinical term for excessive thyroid hormone levels due to oversupplementation is ''thyrotoxicosis.'' Symptoms of thyrotoxicosis include nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, difficulty sleeping, thinning of the skin, fine brittle hair, and muscular weakness — especially in the upper arms and thighs.}}

As a result, books like ''[http://www.amazon.com/Stop-Thyroid-Madness-Revolution-Treatment/dp/0615477127 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 [[Big Pharma|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; [[Hanlon's razor|improper administration]] be dammed, there ''must'' be a conspiracy at work.

== T<sub>4</sub> vs. Desiccated Thyroid: A False dichotomy == 

Since desiccated thyroid is derived from ground up animal glands, it is therefore "[[appeal to nature|natural]]", and must therefore inherently be better than that wicked, man-made synthetic T<sub>4</sub>. 

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 T<sub>4</sub> and <I>only</I> synthetic T<sub>4</sub>, 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 T<sub>3</sub>. Nowhere is the suggestion made of asking ones doctor to add synthetic T<sub>3</sub> into the prescription mix, if you're not feeling fully treated on T<sub>4</sub> alone. The few places that ''do'' mention people who have been prescribed synthetic T<sub>3</sub> are quick to remind the reader: "But Armour Thyroid contains ''everything'', so you should use that instead!"

She also claims that "mainstream" endocrinologists are [[shill gambit|receiving kickbacks]] from Abbot Laboratories, the makers of Synthroid (the first and most-recognized brand of synthetic T<sub>4</sub>). 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]]. [http://thyroid.about.com/b/2009/01/27/the-desiccated-thyroid-controversy-why-endocrinologists-dont-like-armour-thyroid.htm?nl=1 This about.com article], for example, also touts the virtues of desiccated thyroid extract over a regimen of pure synthetic T<sub>4</sub>, while neglecting to mention the synthetic T<sub>3</sub> 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.<ref>[http://www.quackwatch.org/01QuackeryRelatedTopics/armour.html Desiccated Thyroid: Be Wary of Doctors Who Prescribe It], [[Quackwatch]], last revised 10-Sept-2013</ref>

==Synthetic T<sub>4</sub> shelf life==
According to an FDA press release from 2007<ref>[http://thyroid.about.com/od/thyroiddrugstreatments/a/fdapotency2007.htm Thyroid Drug Potency is Being Tightened: FDA Changes Specs for Levothyroxine]</ref>, synthetic T<sub>4</sub> 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 FDA<ref>http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm161266.htm</ref> and USP<ref>http://www.usp.org/usp-nf/notices/retired-compendial-notices/usp-announces-revised-monograph-levothyroxine-sodium-tablets</ref> now mandate that synthetic T<sub>4</sub> 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 T<sub>4</sub>. To more sane individuals, though, it brings up the question of whether the natural T<sub>4</sub> 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 [http://www.mayoclinic.org/diseases-conditions/wilsons-disease/basics/definition/con-20043499 Wilson's disease]), is a commonly pushed for thyroid diagnosis in the alternative medicine community,<ref>[http://www.wilsonssyndrome.com/], a major Wilson's crankery website</ref> though it has never been recognized as a valid diagnosis within the established medical community.<ref>[http://www.mayoclinic.com/health/wilsons-syndrome/AN01728 Is Wilson's syndrome a legitimate ailment?], From the Mayo Clinic</ref><ref>[http://www.thyroid.org/american-thyroid-association-statement-on-wilsons-syndrome/ The American Thyroid Association's Statement on “Wilson’s Syndrome”]</ref><ref>Wilson's Syndrome also appears on [[Quackwatch]]'s list of [http://www.quackwatch.org/01QuackeryRelatedTopics/fad.html fad diagnoses].</ref> 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 [[Confirmation bias|''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&deg;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 T<sub>3</sub> as its treatment. Unsurprisingly, it was treating a phony diagnosis with T<sub>3</sub> 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.<ref>[http://archive.is/dDew9 Doctor's syndrome a sham, board says]</ref>

== 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 {{wpl|goitrogenic||,}} such as [[soy#Goitrogenic_properties|soybean protein]] and cauliflower; these foods contain isoflavones that can interfere with thyroid peroxidase (TPO), thereby reducing the thyroid gland's ability to manufacture T<sub>4</sub> -- but only in cases of iodine deficiency.<ref name="pmid12060828">{{cite journal | author = Doerge DR, Sheehan DM | title = Goitrogenic and estrogenic activity of soy isoflavones | journal = Environ. Health Perspect. | volume = 110 Suppl 3 | issue = | pages = 349–53 | year = 2002 | month = June | pmid = 12060828 | pmc = 1241182 | doi = }}</ref> 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,<ref>[http://www.ncbi.nlm.nih.gov/pubmed/9703374 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. 23-28</ref><ref>Yoon et al., [http://www.eymj.org/Synapse/Data/PDFData/0069YMJ/ymj-44-227.pdf 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</ref> perhaps because it can result in elevated levels of TPO (which the Hashimoto's patient's anti-TPO antibodies attack).<ref>According to [http://www.ncbi.nlm.nih.gov/pubmed/20517655?dopt=AbstractPlus this article in ''Biological trace elements research''], excessive iodine intake actually ''reduces'' TPO activity, rather than elevating TPO levels.</ref> 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 T<sub>4</sub> to T<sub>3</sub> may be impaired in cases of selenium deficiency.<ref>[http://www.nature.com/nature/journal/v349/n6308/abs/349438a0.html Type I iodothyronine deiodinase is a selenocysteine-containing enzyme], ''Nature'', vol. 349, pp. 438-440 (31 January 1991)</ref> 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.<ref>Akçay et al., [http://www.ncbi.nlm.nih.gov/pubmed/15244201 The presence of the antigliadin antibodies in autoimmune thyroid diseases], ''Hepato-gastroenterology'', 2003 Dec; 50 Suppl 2: cclxxix-cclxxx</ref> A reasonable recommendation would be to get checked for subclinical celiac disease.

However, the [[diet woo]] meisters go far beyond these reasonable recommendations.<ref>[http://www.herbcompanion.com/cooking/Smart-foods-for-hypothyroidism.aspx Smart Foods For Hypothyroidism]</ref><ref>[http://www.livestrong.com/article/151973-hypothyroidism-diet/ LiveStrong hypothyroidism diet] -- at least this one doesn't recommend you use a diet ''instead'' of taking thyroid hormone medications.</ref><ref>[http://www.amazon.com/HypoThyroid-Diet-Lose-Weight-Fatigue/dp/1614480303 The HypoThyroid Diet: Lose Weight and Beat Fatigue in 21 Days]</ref><ref>[http://www.amazon.com/exec/obidos/ASIN/0060524448 The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss]; some sound advice mixed in with herbal supplement woo</ref><ref>[http://chriskresser.com/the-gluten-thyroid-connection The Gluten-Thyroid Connection]</ref><ref name=JBerman>[http://m.startribune.com/opinion/?id=238974761 Midlife plight: my thyroid or my teeth?], by Jennifer Berman, writer and sign language interpreter ([http://www.forbes.com/sites/peterlipson/2014/01/03/ignorance-can-make-you-sick/ rebuttal] in ''Forbes'')</ref> 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.<ref>[http://www.mayoclinic.org/diseases-conditions/hypothyroidism/expert-answers/hypothyroidism-diet/FAQ-20058554 Is there any truth to the hypothyroidism diet? Can certain foods increase thyroid function?]</ref>

== 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:

{{cquote|Thyroid hormones have been used as a weight loss tool in the past. Many studies have shown that excess thyroid hormone treatment can help produce more weight loss than can be achieved by dieting alone. However, once the excess thyroid hormone is stopped, the excess weight loss is usually regained. Furthermore, there may be significant negative consequences from the use of thyroid hormone to help with weight loss, such as the loss of muscle protein in addition to any loss of body fat. Pushing the thyroid hormone dose to cause thyroid hormone levels to be elevated is unlikely to significantly change weight and may result in other metabolic problems.|||[http://www.thyroid.org/patients/brochures/Thyroid_and_Weight.pdf Thyroid and Weight] (PDF), American Thyroid Association}}

In addition, Cytomel (prescription synthetic T<sub>3</sub>) is required by the FDA to come with this warning:

{{cquote|Drugs with thyroid hormone activity, alone or together with other therapeutic agents, have been used for the treatment of obesity. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.|||[http://www.rxlist.com/cytomel-drug/warnings-precautions.htm Cytomel (Liothyronine Sodium) Drug Information: Warnings and Precautions - Prescribing Information at RxList], retrieved on 14-April-2014}}

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"<ref>[http://www.bodybuilding.com/store/san/t3.html S.A.N. T-3]</ref>, even though they contain no triiodothyronine.

== Fluoride ==

Several alternative medicine sources claim that [[fluoridation]] can impair thyroid function.<ref>[http://www.thyroidpharmacist.com/1/post/2013/07/fluoride-and-your-thyroid.html Fluoride and your Thyroid]</ref><ref>[http://articles.mercola.com/sites/articles/archive/2011/08/13/fluoride-and-thyroid-dysfunction.aspx The Daily Activity Every Middle Aged Woman Should Beware of], on [[Joseph Mercola]]'s site</ref><ref>[http://fluoridealert.org/issues/health/thyroid/ Thyroid], on the Fluoride Action Network</ref><ref name=JBerman /> Fluoride was, at one point, even prescribed as a possible treatment for hyperthyroidism.<ref>[http://www.fluoridealert.org/wp-content/uploads/galletti-1958.pdf Effect of Fluorine on Thyroidal Iodine
Metabilism in Hyperthyroidism] (PDF), Galletti and Joyet, 1958</ref><ref>[http://www.fluoridealert.org/uploads/merck-1968.pdf The Merck Index] (PDF), 8th Edition (1968), p. 959</ref>

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."<ref>B&uuml;rgi et al., [http://www.ncbi.nlm.nih.gov/pubmed/6384648 Fluorine and thyroid gland function: a review of the literature], Klin Wochenschr. 1984 Jun 15;62(12):564-9.</ref> A population study in 2015 found "diease clusters" of hypothyroidism in areas of England with fluoridated water<ref>Peckham et al., [http://jech.bmj.com/content/early/2015/02/09/jech-2014-204971.abstract?sid=387994a1-4d28-493a-bef6-8fdf845ecbb0 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</ref>, but such population studies are notorious for finding dubious associations.<ref>[http://ilikemyteeth.org/experts-criticize-thyroid-study/ Experts Criticize Thyroid Study], American Academy of Pediatrics campaign for dental health, 2-March-2015</ref> (And even if the association is solid, WebMD points out that [[correlation does not imply causation]].<ref>Alan Mozes, [https://www.webmd.com/women/news/20150225/fluoride-in-drinking-water-tied-to-higher-rates-of-underactive-thyroid Fluoride in Water and Underactive Thyroid Rates], WebMD, 25-Feb-2015</ref>)

==External links==
* [http://www.sciencebasedmedicine.org/index.php/hypothyroidism-the-facts-the-controversies-and-the-pseudoscience/ Hypothyroidism: The facts, the controversies, and the pseudoscience] at sciencebasedmedicine.org
* [http://www.stopthethyroidmadness.com/2014/08/02/case-missing-thyroid-nodules/ 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==
{{reflist|group=note}}

==References==
{{reflist|2|80%}}

[[Category:Medicine]]
[[Category:Woo]]
[[Category:Water fluoridation]]

Categories: Medicine, Woo, Water fluoridation