Chapter 1- Thyroid Imbalance: A Hidden Epidemic As an endocrinologist who has focused his research, teaching, and patient care on thyroid conditions, I realized early on in my practice that taking care of thyroid patients was not as easy as I had expected. Treating and correcting a thyroid condition with medication may not always make the patient feel entirely better. I discovered that to care fully for my patients, to help them heal completely, I had to treat their feelings as well as their bodies. If they didn't feel better even though their lab tests said they were cured, I learned to listen to them, believe them, and work with them to help them become wholly cured. In taking care of thyroid patients, the physician's role is not merely to address physical discomfort, test the thyroid, and make sure blood test results are normal (including normal amounts of the various thyroid hormones in the bloodstream). Addressing the effects of thyroid disorders on the mind, addressing the health of the immune system (often the root of the thyroid condition), helping patients cope with their condition, and counseling them sympathetically are equally important.
Chapter 2- I’m Tired of Being Tired: Could It Be My Thyroid?
- For many thyroid patients, the root of the thyroid imbalance is the immune system's attack on the thyroid gland. Their immune system becomes overly activated and produces inflammation chemicals that, beyond damaging their thyroid gland, affect physical and mental well-being in numerous other ways. Immune system reactivity explains why patients treated with thyroid medication may continue to struggle with lingering fatigue and other annoying mental and physical symptoms. For mental and physical thyroid symptoms to fully resolve, thyroid patients often need more than just thyroid medication. They need more in-depth care of their immune system in order to make it less agitated and reactive. Because the mind, thyroid, and immune system are so interconnected, thyroid patients need to embrace the mind-body program I will detail throughout this book. Not only will this help reduce inflammation throughout the body, but it will make thyroid hormone work more efficiently for overall wellness.
- When your immune system attacks your own thyroid, the body is showered with many inflammatory chemicals called cytokines. In addition to affecting the thyroid gland, these substances also have negative effects elsewhere in the body, including the brain. The inflammation generated by the immune system has a tremendous effect on both physical and mental energy. Even more significant, immune system reactivity can actually intensify as thyroid hormone levels become imbalanced; it's as if the thyroid imbalance makes the immune system even angrier and more reactive, and symptoms worsen. When this cascade occurs, thyroid patients can experience major, debilitating fatigue, including fibromyalgia and adrenal fatigue.
Chapter 3- When the Immune System Strikes the Thyroid Your immune system is constantly working to differentiate between "self" and "not self." Ideally, the immune system is designed to prevent you from getting sick; it destroys only foreign cells, things that are "not self," and does not attack your own organs and tissues. However, in some instances the immune system fails to recognize what belongs to you and views certain molecules in your own organs as foreign. This results in the immune system attacking and fighting cells that contain these molecules, a process known as autoimmunity. Resulting from an overactive immune system mistakenly attacking normal cells, autoimmune diseases can cause dramatic dysfunction in an organ or body system. It turns out that the most vulnerable body part to immune system attacks is the thyroid gland, explaining the high rate of thyroid disease in the general population. The two main autoimmune thyroid diseases, which are also the most common causes of thyroid imbalance, are Hashimoto's thyroiditis, the most prevalent disorder that can results in thyroid hormone deficiency, and Graves' disease, the most common root of excessive thyroid hormone production and hyperthyroidism.
Chapter 4- Stress and Thyroid Disease: Which Comes First? There has also been speculation that President Bush's overactive thyroid had preceded the war. Some news reporters described the president as animated by an incredible level of energy immediately after Iraq's August 2, 1990, invasion of Kuwait. His heightened interest in sports activities as the time, his fast pace, and his overactivity led some to speculate that Bush might have been suffering from an overactive thyroid as far back as August 1990 – almost six months prior to the war. This would put the onset of Graves' disease during the months of preparation leading up to the war, one of the most intense periods in Bush's presidency. It must be noted that a number of alternative mechanisms have been identified that may well have played a more important role in triggering Bush's ailment. Two years before President Bush was diagnosed with Graves' disease, First Lady Barbara Bush has been diagnosed with the same condition. Cases in which partners are diagnosed with Graves' diseases are known as "conjugal Graves' disease." Conjugal Graves' disease may be due to environmental factors, such as toxins in the home or workplace, or even too much iodine and other chemicals in the water. The search for such factors in the White House was fruitless. Viral infections are also considered environmental in nature and can be implicated if there is a genetic predisposition, which both George and Barbara Bush could have. (Coincidentally, the Bushes' dog, Millie, was suffering from lupus. When the news broke that the Bushes' and their pet all had autoimmune disorders, the president's personal physician, Dr. Burton Lee, received numerous letters reporting cases of pets suffering from lupus whose owners have Graves' disease). There is increasing evidence that links infection, specifically infection by retrovirus, with Graves' disease. The possible link between a retrovirus and Graves' disease can be measured through the level of antibodies in the patient's system. It turned out that both the Bushes had significant levels of antibodies to the virus in their systems. These findings were never made public, however, perhaps because these results did not provide clear-cut proof that the virus was the direct cause of their condition. The medical evidence does strongly suggest, through that in the cases of the president and Mrs. Bush, infection by a virus contributed to the Graves' disease.
Chapter 5- Hypothyroidism: When the Thyroid is Underactive Once not discussed of even suspected, low-grade hypothyroidism and its effects on physical and mental health are increasingly pervasive. Numerous studies have now concluded that low-grade hypothyroidism can contribute to high cholesterol levels, infertility, miscarriages, tiredness, and depression. Small deficits of thyroid hormone can slow down your metabolism and the ability to burn extra fat, making you gain weight and even develop metabolic syndrome. Research has shown that correcting low-grade hypothyroidism will result in a lowering of both total cholesterol and "bad" LDL cholesterol. Low-grade hypothyroidism can also cause high blood pressure and elevated triglycerides. It makes the cells that cover blood vessels (endothelial cells) lose their ability to protect the blood vessels. The abnormality reverses with thyroid treatment as well; left untreated, it will make you more likely to have coronary artery disease and cardiovascular death than people with normal thyroid function. Untreated low-grade hypothyroidism can also contribute to worsening peripheral vascular disease. Research has also shown that in older people, peripheral vascular disease was present in 78 percent of those with low-grade hypothyroidism and in only 17 percent of those with normal thyroid. The reason for this increased risk of vascular disease among patients with low-grade hypothyroidism stems from elevation of blood pressure caused by low thyroid, higher levels of triglycerides and cholesterol, and high homocysteine levels. Even to this day, however, many physicians continue to believe that low-grade hypothyroidism has no significance. Some will tell their patients, "The condition isn't serious enough the treat." The most common physical symptoms experienced by patients with low-grade hypothyroidism are fatigue, dry skin, hair loss, and cold intolerance. Some women may experience heavier and longer menstrual periods (menorrhagia).
Chapter 6- Hyperthyroidism: When the Thyroid Is Overactive
- The mental effects of excess thyroid hormone are often described merely as nervousness and hyperactivity, terms that hide a deeper level of mental and behavioral instability. In fact, in the mind of many physicians, the term nervousness connotes a physical effect (motor restlessness and the need to move around) rather than a mental effect.
Doctors frequently fail to emphasize the wide array of mental effects likely to occur in a hyperthyroid patient. The mental symptoms of hyperthyroidism may precede, or even be more prominent than, the physical symptoms. In fact, hyperthyroidism can precipitate or cause virtually any form of psychiatric condition, although admittedly, psychosis triggered by Graves' disease is an exceptional occurrence nowadays. Anxiety and panicky feelings may be the earliest and most noticeable symptoms of hyperthyroidism. As time passes, the way these symptoms show up changes with the appearance of other symptoms. The most common mental effects that we see in hyperthyroid patients are:
- Social anxiety disorder
- Anxiety
- Restlessness
- Panic attacks
- Depression
- Excessive concerns about physical symptoms
- Disorganized thinking
- Guilt feelings
- Loss of emotional control
- Irritability
- Emotional swings
- Episodes of erratic behavior
- Bipolar disorder, mania, hypomania
- Paranoia
- Aggression
- Recently, doctors have become more aware of the wide range of physical and mental effects of low-grade hyperthyroidism. This condition is defined as thyroid hormone excess that has not yet resulted in abnormally high thyroid hormone levels but has caused TSH levels to become low. Low-grade hyperthyroidism (called subclinical hyperthyroidism) often results from an overactive thyroid gland due to Graves' disease or to thyroid lumps that produce excessive amounts of thyroid hormone. It may also result from taking too much thyroid hormone. Low-grade hyperthyroidism due to Graves' disease may resolve spontaneously. Even if it resolves, it can recur down the road. Low-grade hyperthyroidism can progress into more severe hyperthyroidism and can exacerbate cardiac problems in patients who have heart disease,
Low-grade hyperthyroidism may induce depression, rapid heartbeat, weight loss, heat intolerance, increased appetite, increased sweating, and trembling of the fingers. It is likely to make a person more irritable and anxious. This minimal thyroid hormone excess can also result in bone loss over time, particularly in postmenopausal women. Although minimal thyroid hormone excess can also affect the bone density of premenopausal women, this negative effect on the bone is counterbalanced by estrogens. Low-grade hyperthyroidism may provoke heart rhythm problems in older people. In addition, it can disturb the functioning of the heart and lower cardiovascular fitness.
Chapter 7- Getting The Proper Diagnosis In short, many people may be suffering from minute imbalances that have not yet resulted in abnormal blood tests. If we included people with low-grade hypothyroidism whose blood tests are normal, the frequency of hypothyroidism would no doubt exceed 10 percent of the population. What is of special concern, though, is that many people whose test results are dismissed as normal could continue to have symptoms of an underactive thyroid. Their moods, emotions, and overall well-being are affected by this imbalance, yet they are not receiving the care they need to get to the root of their problems. You don't need to be a thyroid expert to realize from what I have said so far that if your TSH is close to the upper limit of the normal range set by laboratories, you have a higher risk of being low-grade hypothyroid. In fact, researchers are beginning to recognize the upper segment of the normal range as suspicious for hypothyroidism. Nearly a third of patients who are receiving thyroid hormone replacement for hypothyroidism or have a goiter and whose TSH level is in the suspicious range turn out to be hypothyroid when they are evaluated by TRH stimulation testing (a procedure that measures TSH after injection of thyrotropin-releasing hormone into the blood stream). One study showed that more than 50 percent of women who have a positive antithyroid antibody marker for Hashimoto's thyroiditis and a TSH level ranging between 2 and 4.5 (considered normal) became clearly hypothyroid (showed a definite elevation of TSH) within ten years. Even when this marker was absent, 30 percent of women with a TSH level in this high-normal range became clearly hypothyroid.
Chapter 8- Thyroid Imbalance, Depression, Anxiety, and Mood Swings
- Diagnosing and treating a thyroid hormone imbalance may help prevent you from slipping into major depression. But if you are already suffering from depression, as in Sara's case, you must have your thyroid hormone imbalance diagnosed and treated. If the thyroid imbalance is not corrected, the depression will not be helped by conventional antidepressants. Research has shown that 52 percent of patients who suffer from major depression and do not respond to antidepressants have hypothyroidism. Once doctors add thyroid hormone treatment to the antidepressant, the depression often resolves. Hypothyroidism also accounts for nonresponse to antidepressants in a significant percentage of people suffering from chronic minor depression. If you are suffering from depression of have recently experienced depression, you should be tested for a thyroid imbalance.
- If you are suffering from depression and test positive for hypothyroidism, in general you can expect the depression to clear once you correct the thyroid imbalance. The depression, in some cases, may not fully respond to the thyroid hormone treatment alone. The depression may have taken on a life of its own and require additional treatment, particularly if the underactive thyroid had been undiagnosed for a long time.
Generally speaking, if you have dysthymia, an atypical depression, or a low-grade lingering type of depression and your doctor diagnoses an underactive thyroid, your doctor should treat the underactive thyroid first for at least three months. The depressive symptoms are more likely to improve or resolve if you are treated with medications that combine T4 and T3 (see Chapter 20). If the depression does not fully resolve despite adequate thyroid hormone treatment, your doctor will add an antidepressant, such as a selective serotonin reuptake inhibitor (SSRI). However, if you have major depression and hypothyroidism, you must immediately begin treatment with both thyroid hormone and an antidepressant. After your thyroid is well regulated and the depression has fully resolved, your doctor will probably consider stopping the conventional antidepressant after twelve months. If, despite normal thyroid levels, depression recurs after you stop the antidepressant, then antidepressant treatment should be resumed. (See Chapter 18 for information on antidepressants).
Chapter 9- Medicine from the Body: Thyroid Hormone as an Antidepressant Norma and Melissa are among the millions of patients suffering either clinical depression or mood swing disorders who can benefit from treatment with thyroid hormone. Research has shown that antidepressants do not work in 40 percent of patients diagnosed with depression, even when high doses of antidepressants are used. Half of those who fail to respond to tricyclic antidepressants, for instance, improve when the potent thyroid hormone T3 is added to the antidepressant medication. Augmenting or potentiating the action of antidepressants is not the only way T3 can be useful. Thyroid hormone treatment also accelerates the action of antidepressants. In most patients, it takes several weeks for an antidepressant to begin showing an effect on the depression. When T3 is added to the antidepressant from the outset, the antidepressant may begin to relieve the symptoms sooner. An analysis of research published in the
American Journal of Psychiatry showed that in five of six studies, T3 is much more effective than placebo in speeding up the response to the antidepressant. The speeding up effect is more obvious in women than in men. We don't know why this accelerating effect of T3 is seen mostly in women. T3's effectiveness in boosting the efficacy of antidepressants in controlling depression is similar to that of lithium. The patient's symptoms often respond to the addition of a T3 medication within a few weeks. Therefore, if no beneficial effect has been noted within three to four weeks, T3 treatment should be stopped. Taking T3 along with the more modern antidepressant drugs—such as the SSRIs fluoxetine, sertraline, paroxetine, and citalopram—seems to benefit patients who have failed to respond using these medications alone. A study published in the
Journal of Affective Disorders showed that the addition of T3 to an SSRI antidepressant causes a significant improvement in depressive symptoms and even remission of depression in 42 percent of patients who failed to respond to an SSRI alone. Another study showed that the addition of T3 to fluoxetine was effective in 62.6 percent of patients.
Chapter 10- The Struggle with Weight Gain and Sluggish Metabolism Most patients believe that once their hypothyroidism has been corrected with thyroid medications, their weight issue will disappear. Unfortunately, often this is not the case. Many patients are disappointed by their lack of weight loss after beginning medications; some may actually continue to gain weight. This is a typical dead end faced by many thyroid patients, who may think that their thyroid is still poorly regulated and responsible for their weight problem. Part of the problem is that balancing thyroid hormone levels doesn't always completely reverse the inefficiency of metabolism-boosting hormones that had been triggered by the low thyroid and associated autoimmunity. If you are treated with a T4-only medication, you may be missing the right amount of T3, which can slow your metabolism. Also, low T3 makes leptin less efficient at regulating satiety and making you burn fat. So in addition to working on your overall thyroid hormone levels, you may also need a change in your medication regimen that included the right amounts of T4 and T3. Another important reason for having a hard time losing weight is the body inflammation caused by immune system that continues to agitated and reactive.
Chapter 11- Hormones of Desire: The Thyroid and Your Sex Life The frustrations related to sexual dysfunction that hypothyroid women experience stem from an inability to cope with the changes. The effect on self-esteem and the fact that the women may not understand the reason for the changes tend to exacerbate these frustrations. An additional frustration, which may preoccupy women more than the dysfunction itself, is the need to deal with unsatisfied partners. Whereas one male partner may feel rejected and no longer desired, another may be understanding (or at least give the impression that he is). The woman may reassure him that her problem "has nothing to do with him" and that she "is working on it." The hypothyroid woman who described this situation to her gynecologist may be given estrogen to improve the sexual dysfunction, often to no avail. A friend may advise the woman that, to reduce the conflict with her partner, she should just have sex when her partner wants, regardless of whether she is in the mood. Often, however, if a woman isn't aroused, she simply doesn't want to bother with sex. A good example of this problem is Olivia, who was hypothyroid for at least a couple of years. She told me, "When I was hypothyroid, I didn't want anybody near me." Another hypothyroid woman said, "You need more sleep, your hair is falling out, and you have no sexual drive, which is abnormal for a young married woman. Watching something erotic on TV doesn't do anything for you. You know something is wrong. You don't want to be bothered or touched. You may think to yourself, 'I know it's my problem. I don't want to tell him no. That's not right for him.'"
Chapter 12- “You’ve Changed”: When the Thyroid and Relationships Collide Women and men are fundamentally different in how they communicate and interpret each other's language, behavior, and emotions. Many couples come to recognize their real differences, accept them, and eventually learn to deal with them. The intrusion of a thyroid imbalance into a couple's relationship very often exacerbates these differences. Subtle changes in how the afflicted person speaks and acts alter the dynamics of the relationship. Thyroid patients, particularly those suffering from an overactive thyroid, often become moody, anxious, angry, and irritable. And many begin to have a distorted perception of their partner's behavior. Unfortunately, their partners may not understand what causes these changes. Inability to cope with changing demands and difficult in communicating can lead to chaos, with misunderstandings, false expectations, and arguments over trivial matters. For many people, the relationship becomes a burden. People with a thyroid condition are having terrible trouble understanding themselves and their new, confusing feelings, so they are unlikely to understand their partners. Indeed, thyroid patients are so overwhelmed by their new emotional problems that they cannot cope properly with the stress of the relationship, which becomes a cycle of reactions and counterreactions. Both partners then share the mental stress provoked by the thyroid condition.
Chapter 13- Overlapping Symptoms: Adrenal Fatigue, Fibromyalgia, Hypoglycemia, and Chronic Fatigue Syndrome Immune attack on the thyroid is common in patients with fibromyalgia. One of three patients with fibromyalgia has an autoimmune thyroid disease. Patients suffering from fibromyalgia are four times more likely to have an autoimmune thyroid disease than people without fibromyalgia. Patients with fibromyalgia in conjunction with an autoimmune thyroid disease often have had depression or another mental ailment. If, on top of fibromyalgia, you become affected by an autoimmune thyroid condition, your fatigue and depression will become worse. This is clearly an example of how the immune system's production of inflammation chemicals can exacerbate fatigue and depression in patients with other conditions. Doctors refer to fibromyalgia cause by hypothyroidism as "hypothyroid fibromyalgia," opposed to "euthyroid fibromyalgia" (meaning fibromyalgia not caused by a dysfunctioning gland). Nealy 12 percent of all cases of fibromyalgia are caused by an underactive thyroid. If you have been diagnosed with fibromyalgia, you need to be tested for underactive thyroid. Doctors typically diagnose fibromyalgia months or even years after a person has been diagnosed with hypothyroidism. Often the patient has complained of fatigue, aches, and pains before therapy, but these symptoms were initially attributed to hypothyroidism. After the thyroid has been adequately regulated, however, the patient continues to complain of these and a few other symptoms that, taken together, are consistent with fibromyalgia.
Chapter 14- Premenstrual Syndrome and Menopause: Turning the Cycles For most women, menopause if a physiological reality. It is not only a marker for the end of the reproductive years, but also a critical period during which hormonal and sociocultural influences reshape how a woman perceives herself. Wide fluctuations of hormone levels affect your neurotransmitters and may make you more susceptible to depression and anxiety. Vasomotor instability may make you experience hot flashes and night sweats. Your sleep may become disturbed, and your sexuality may change. You are at a higher risk for bone loss, impaired cognition, and cardiovascular disease. Your metabolism slows down, and you may begin to gain weight. Through this transition, you will also have a higher risk of developing a thyroid imbalance. Because of the hormonal changes and for the other poorly understood reasons, women become more vulnerable to immune attacks on the thyroid when they become menopausal. The frequency of low-grade hypothyroidism increases sharply at menopause, with at least one in eight women becoming afflicted with hypothyroidism. A thyroid imbalance often makes symptoms of menopause worse, as its effects may prevent women from being able to cope with the broad range of physical and emotional stresses that occur with this transition. Thyroid disease during menopause may have a significant effect on how a woman perceives her menopausal symptoms and even on the nature of those symptoms. Even low-grade hypothyroidism can ignite hot flashes, sleep problems, depression, and worsening anxiety.
Chapter 15- Thyroid Balance for Healthy Pregnancy In addition to potentially impairing your ability to conceive and promoting miscarriages, thyroid hormone imbalance can cause a wide range of adverse consequences for your health and your baby's health. Throughout pregnancy, thyroid hormone is essential for fetal growth and development. In the early stages of pregnancy, the mother's thyroid begins to produce more thyroid hormone to provide for both herself and the fetus, causing the gland to swell by about 20 percent in size. The baby is dependent on free T3 and free T4 from the mothers' bloodstream until sometime during the second trimester, when the baby's thyroid becomes crucial for its continued growth and development. During the period in which the growing fetus receives all of its thyroid hormone from the mother, too much or too little in the mother's bloodstream can impact how the baby grows. Both hypothyroidism and hyperthyroidism during pregnancy have been associated with smaller babies and low birth weight. Hypothyroidism in the mother, even if it's low grade, can result in neuropsychological deficits in the baby, including decreased intelligence and poor motor skills, and may even lead to fetal death. Research has shown that one out of four women with a TSH level higher than 4 mIU/L will miscarry between 7 and 20 weeks of gestation. It is possible that fetal death related to thyroid disease is linked both to thyroid hormone deficiency and to autoimmunity. And thyroid levels that are lower than normal toward the end of pregnancy give baby a greater risk of respiratory disease.
Chapter 16- Postpartum Depression: The Hormonal Link The onset of a thyroid imbalance may occur as early as one to two months after delivery, and the imbalance may show up in different patterns. The most typical pattern has three distinct phases: a transient or temporary hyperthyroidism lasting two to three months, followed by a period of hypothyroidism and then spontaneous return of thyroid levels to normal. In a significant number of women, the function of the thyroid gland returns to normal by seven to eight months into the postpartum period. In essence, many cases of thyroid imbalance occurring in the postpartum period are temporary. Some women, however, will have a persistent and even permanent imbalance. The reason for this pattern is related to a rapid autoimmune attack on thyroid cells, similar to the condition of silent thyroiditis (see Chapter 6), which tends to occur in people with Hashimoto's thyroiditis. During the first phase, the destruction of thyroid cells results in the release of thyroid hormone into the bloodstream, causing hyperthyroidism. As the destruction subsides, thyroid hormone levels decrease. This frequently results in hypothyroidism because the cells that were healthy and previously making adequate amounts of thyroid hormone are no longer present to maintain normal thyroid levels. Once the patient become hypothyroid, thyroid cells begin to regenerate. It takes a few weeks before the thyroid completes its recovery and thyroid hormone levels return to normal.
Chapter 17- Treating the Imbalance Some doctors recommend that when a patient's thyroid function has returned to normal with a specific dose of thyroid hormone replacement, further thyroid tests should be cone once a year. I simply do not agree with this approach, because your thyroid condition may not be stable. Not only could the function of the gland deteriorate significantly in the interim, but patients with Hashimoto's thyroiditis may have noncomitant Graves' disease that may be more active at some times than at others. If you have hypothyroidism due to Hashimoto's thyroiditis and are taking a stable dose of thyroid hormone, a flare-up of Graves' disease and production of the antibodies that stimulate the thyroid gland may make you require less thyroid hormone. Rarely, it can even cause the rapid onset of hyperthyroidism and require stopping the thyroid hormone treatment. Several of my patients with underactive thyroids suffer from frequent fluctuations in the activity of the gland. You need to be aware that the residual activity of the gland affected by Hashimoto's thyroiditis does change and can fluctuate over time. As a result, patients with an underactive thyroid may require frequent adjustments in the dose of the thyroid hormone. Retesting patients once a year will ignore possibly significant changes in their thyroid activity. Some patients may suffer from the effects of thyroid hormone excess or deficiency and not know it. Because changes in thyroid levels in patients receiving stable doses of thyroid hormone are common, a better recommendation is that thyroid tests be done regularly every six months and that the test results be closely scrutinized in conjunction with a careful assessment of symptoms. Unfortunately, hypothyroid patients are in general not monitored adequately. One recent study showed that only 56 percent of hypothyroid patients treated with thyroid hormone were monitored at the minimum recommended frequency. If you are hypothyroid as a result of the treatment of Graves' disease, you may need more frequent testing (every three to four months), at least initially.
Chapter 18- Curing the Lingering Effects of Thyroid Imbalance The negative effect of thyroid disease may not end after you have your thyroid imbalance adequately treated. You may continue to suffer annoying symptoms that can affect your quality of life, as well as long-term health consequences that can becomes quite serious down the road. In Chapter 22, I will detail a comprehensive program that will help you reduce or abolish these symptoms and long-term effects. In this chapter, I will focus on some components of the program that will help counteract the common disturbing negative mental, cognitive, and cardiovascular consequences of thyroid disease. If you have suffered a thyroid imbalance, your symptoms will typically resolve with adequate treatment. Sometimes, however, even after the physical and mental symptoms of hypothyroidism or hyperthyroidism have disappeared, you may still not feel like your old self. If your imbalance was severe or of long duration, moreover, you may continue to have emotional problems, anxiety, depressive symptoms, and even some residual cognitive deficits. As a result, you may not feel normal even though, technically and medically, you no longer have a thyroid imbalance. Hyperthyroidism and hypothyroidism shake up your brain. Although you may recover completely if the imbalance is minimal and of short duration, a significant, long-term imbalance could affect your mind for a long time even after you've been properly treated. Thyroid imbalance can affect your brain chemistry in the same way as a long-term abuse of alcohol or drugs! Yet your physician may not know about these lingering effects because they have not been widely publicized, discussed, or taught.
Chapter 19- Living with Thyroid Eye Disease
- Thyroid eye disease, formerly known as Graves' eye disease, is one of the most dreadful thyroid-related conditions because of its potential emotional, personal, and professional effects on a person's life. In the minds of many people, having Graves' disease is associated with having bulgy eyes. I should not, however, that at the most half of those with Graves' disease have bulgy eyes, and some people with Hashimoto's thyroiditis who have either normal or below-normal thyroid function may have this thyroid-related eye disease.
Support group dealing exclusively with thyroid eye disease have formed in the United States and other countries to help patients understand their disease and cope with their suffering. Despite these organizations' efforts to help people become better informed about thyroid eye disease, fear generated by the unknown continues to be rampant among patients with thyroid eye disease. However, in less than 20 percent of patients with thyroid eye disease is the condition severe enough to require aggressive intervention. Technological advances in corrective surgery as well as other treatments have improved the prospects of these patients.
- Eye problems range along a continuum from minimal to severe in thyroid eye disease. If researchers did a diagnostic study, such a ultrasound or a magnetic resonance imaging (MRI) of the eye orbits (bony sockets), they would find that more than 90 percent of people with Graves' disease have some involvement not of the eyes themselves but of the fat surrounding the eyes and the muscles that are responsible for the movement of the eyes. There is typically an enlargement of the muscles due to inflammation. Nearly 40 to 45 percent of people with Graves' disease have evidence of minimal involvement of the tissue surrounding the eyes but show no symptoms. Of the more than 50 percent remaining, the eye disease can range from mild to very severe.
Although thyroid eye disease if not a direct consequence of the thyroid condition, it occurs as a result of the immune system's having produced antibodies that target the eye muscles and structures situated around the eyes. The reason for the production of such antibodies in person with thyroid disease is related to some molecular similarities in the tissues surrounding the eyes and the thyroid gland. Because of these similarities, the immune system attacks the eyes as well as the thyroid. Therefore, the eye disease may be viewed as an incidental process occurring in autoimmune thyroid disease. Some patients, however, have eye symptoms even though their thyroid function is normal. In fact, nearly 10 percent of patients with thyroid eye disease have normal thyroid levels. In such patients, the eye disease progresses on its own and may be the only actual problems the patient experiences. A number of these people, when followed for months or years, may subsequently develop some kind of thyroid dysfunction, either hypothyroidism or hyperthyroidism.
Chapter 20- MyT4/T3 Approach While searching for the right amounts of T3 to be combined with T4 for my patients, I realized early on that each person needs a different amount, which depends not on the total amount of thyroid hormone required by that particular patient but also on the patient's symptoms and on whether he or she has depression, anxiety, and/or residual physical symptoms. Some patients require between 5 and 10 mcg of T3 a day to achieve the best symptom relief. Other patients, however, may require as little as 2 or 3 mcg a day. There is no magic amount of T3 that will work for all people. The amount of T3 needed should be quite close to the amount that a normal thyroid gland produces each day. But if you are suffering from symptoms of depression, the amount of T3 may need to be slightly higher without causing you to have excessive levels of T3 in your system. In essence, your doctor needs to find the ratio of T3 to T4 that will make you feel at your best without causing undue adverse effects. T3 in the right amount and in the right ratio can provide you with miraculous changes in the way you feel, but too much T3 not only will make you not benefit from the treatment but also can generate other symptoms, such as worsening anxiety, worsening depression and fatigue, rapid heartbeat, and palpitations. The T3 is best taken twice a day (before breakfast and at 2:00 PM) to avoid abnormal surges in T3 levels. You can get the T2 by taking a combination of low doses of desiccated thyroid (such as Armour Thyroid) or low doses of Nature-Throid (a combination of synthetic T4 and T3), in addition to an appropriate amount of synthetic thyroxine if needed. But again, this may or may not work in your particular case. You can get the T3 from synthetic T3 Cytomel; however, T3 levels typically rise and fall within a few hours of taking Cytomel.
Chapter 21- The ThyroLife Diet for Successful Long-Term Weight Loss and Healthy Metabolism Over the years I have seen hundreds of frustrated patients with thyroid-related weight gain problems who have tried many popular diets and failed to achieve their weight loss goals. They either initially lost weight and quickly gained it back or failed to lose any, all because of their intractable weight loss resistance and sluggish metabolism. The reason thyroid patients have a hard time losing weight with popular diets, such as the Paleo diet, is because most of them only focus on one fundamental, such as low carbohydrate intake or high protein intake, while ignoring the other important ones. Yes, as I explained in Chapter 10, patients affected by thyroid disease are haunted by a high level of body inflammation, insulin resistance, and leptin and thyroid hormone inefficiency, leading to a slowing of metabolism and abnormal appetite and food cravings. An effective weight loss eating plan needs to take into account how metabolism-regulating hormones work in the body. Any diet that does not take into account the fundamentals that keep your hormonal system harmonious becomes an imbalanced diet and will not be conducive to long-term healthy weight loss. If you want to boost leptin and thyroid hormone efficiency and lower insulin resistance and inflammation, it is crucial to follow an eating plan that combines high protein intake, high fiber intake, and low-glycemic index properties with the avoidance of metabolism-damaging and immune system-agitating saturated and trans fats. For years I have suggested to anyone with weight gain issues that they combine these fundamentals. Following an eating plan that respects all these principles has allowed thousands of people, whether they have a thyroid problem or not, to lose weight efficiently and healthily, and keep it off for good. The ThyroLife Diet that goes along with my comprehensive thyroid mind-body program is an immune-system-friendly version of my weight loss diet, the Protein Boost Diet (consult my book
The Protein Boost Diet [Atria, 2012]. In addition to boosting your metabolism and curbing your appetite with the right combinations of foods, the ThyroLife Diet focuses on avoiding foods that irritate your immune system or promote the production of inflammation chemicals that impair and deregulate the harmony of your metabolism-regulating hormones. Another important guideline of my diet if the avoidance of environmental toxic chemicals that may have been contaminating your foods up until now.
Chapter 22- My Thyroid Mind-Body Program Treating a thyroid condition with medications to restore and maintain thyroid hormone levels in a perfectly normal range is obviously necessary. However, thyroid medications alone are not sufficient for most patients. You also need to focus on continuously supporting the health of your thyroid gland and the health of your immune system, and on maximizing the effectiveness of the thyroid hormone at performing its bodily functions. Unfortunately, many healthcare professionals do not focus on the health of the immune system, the root cause of your problem, or on the overall health of the thyroid gland. To achieve your health goals, overcome the many consequences of immune system reactivity, and reduce the health risks of thyroid disease, you need to follow a lifestyle that includes eating healthy foods, taking the right supplements, following an exercise program, and practicing relaxation techniques. In addition, you need to address your sleep issues, any other hormonal imbalance, coexisting depression, and other possible autoimmune conditions you may have. All of these steps are important for you to reach and maintain optimal physical and mental health. While some doctors may lead you to believe that regular monitoring of thyroid hormone levels and making adjustments in drug dosages is all you need, you have seen for yourself throughout this book that a combination of therapies is a must to deal with all of the effects thyroid disease has on body and mind.
