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Thyroid hormone is responsible for the regulating the metabolic rate of every cell in the body Since every cell in the body depends on its metabolism to perform its function, when the thyroid system is malfunctioning it can affect every system of the body. Thyroid malfunction is very serious. It can cause death whether it is too high or too low. Low thyroid is by far the most common. Low thyroid function causes lowered body temperature, weight gain, elevated cholesterol, increased rates of atherosclerosis, heart failure and heart attacks. It is a common cause of fibromyalgia and chronic fatigue syndromes. It can cause menstrual irregularities and difficulties (heavy flow, irregular flow, painful menses), as well as fertility problems, problems getting pregnant and difficulty staying pregnant to term.  If low thyroid function is severe and left untreated, it can even cause coma and death.

In response to a hormonal signal from the brain, the thyroid gland makes and releases thyroxine into the blood stream This thyroxine molecule is also known as T4 because there are 4 iodide ions attached to it. Thyroxine (or T4) is not very active in telling your body cells how fast to run their metabolism. T4 circulates until it leaves the bloodstream and enters the fluid space around the body cells. There is an enzyme which removes one of the iodide ions to turn T4 into T3. T3 is the active form of thyroid hormone and is very good at binding to the cell thyroid hormone receptors and telling the cells how fast to run their metabolism.

Most physicians were taught to measure TSH from the hypothalamus and T4 or free T4, and to balance this relationship. However, this approach may miss many patients with low functioning thyroids. T3 is the active form of the hormone and does 95% of the work at the cellular level. Often patients with hypothroidism are treated with levothyroxine (Synthroid® or Levoxyl®) and lab testing may show normal TSH and T4 levels, yet the patient continues to not feel well. At SARAH, LLC we measure TSH, bio-available free T-3, free T-4, Reverse T-3, Total T4 and T3, anti-thyroid antibodies and, sometimes we measure the amount of thyroid carrier protein, TBG as well.

We understand that in a high percent of cases the Adrenal glands may be underperforming as well, and unless this issue is addressed, the correction of the thyroid problem simply is not going to occur.

Vitamin D deficiencies can also complicate this issue, as well as iodine levels. In most parts of the US, iodine is deficient in the soil plants grow in, thus it is deficient in our foods. Fluoride and Bromine both have greater affinity for the serum protein binding sites than iodine. It is interesting that when it was determined we may be getting to much Iodine in our diets and Iodine was taken out of foods, the rate of breast cancer started rising, a suspicious relationship.

When we approach Thyroid Issues we not only evaluate iodine levels, but also look at adrenal function as well. We were created with an incredible harmony in the function of our bodies, and we are looking to simply recreate that symphony, without causing bigger problems.

Detection of Thyroid Disease
The problem is, much thyroid disease is not detected in the United States. Most doctors are trained to only check TSH and T4 levels and rely completely on those values no matter what symptoms the patient may be having. Even many endocrinologists often say that, "If the TSH is normal, the patient does not have hypothyroidism. Period." this despite the fact that multiple studies have demonstrated that TSH by itself is a lousy indicator of thyroid disease.

There are several ways to have low thyroid function. The thyroid gland could produce too little thyroxine, (Actually, there are several causes of not enough thyroxine production.), the body could be bad at converting T4 to T3 (either by not converting it, or converting it incorrectly into reverse-T3, a form not metabolically active), or the body could have a problem that in some way prevents the T3 from working properly in the cell (Secondary Hypothyroidism). The problem with the "standard" thyroid tests utilized by most physicians, is that it will only detect low thyroid function if there is too little thyroid hormone in the blood. It will pick it up if the TSH is elevated, but the TSH is usually only elevated if the thyroid hormone in the blood is very low anyway. The other ways to have low thyroid function are usually not tested for by physicians traditionally trainned to look only at the TSH and T4 tests.

Thyroid Replacement Therapy
The best form of thyroid hormone replacement therapy would include both T4 and T3, and have a natural, physiologic ratio between the two. Levo-thyroxine (Synthroid®, Levoxyl®) whether generic or brand name, is a synthetic form of T4 only. Liothyronine (Cytomel®) is a synthetic form of T3 only. However, there is a thyroid hormone replacement that is bio-identical (natural to the human body) and comes in a natural T4/T3 ratio. These are the dessicated porcine products, of which Armour Thyroid is probably the most famous. However, porcine means from the pig. If someone has a religious reason for not consuming pig products, or if someone has Hashimotos Thyroiditis (an auto-immune condition where antibodies are formed against the thyroid), then synthetics are the only choice for thyroid HRT.

Dessicated porcine products (Armour, Nature-Throid, Westhroid) are superior to the synthetics for most people. This is my clinical experience as well as that of many other physicians. This conclusion was also backed up by a study published by the New England Journal of Medicine in 1999. This study showed that when patients were switched from synthetic to Armour, most had symptom improvement across multiple symptoms assessed. No one was noted to have improvement in any of the studied symptom categories when being switched away from Armour to the synthetic. Your doctor may prescibe a form of T3 (T3SR) which is sustained release as an alternative to immediate release T3 (Cytomel) so as to provide a longer and more consistent level of the T3 hormone.  Sustained release T3 must be prepared by a compounding pharmacy.

No food for two hours before, or one hour after taking this medicine. Thyroid hormone should be taken with water only.  Coffee and other drinks can interfere with the absorption of thyroid hormone as well as the iodine which the body needs in sufficient quantities for proper thyroid hormone metabolism and function.