Proper levels of thyroid hormone are critically important. The hypothalamus (an area of the brain) measures blood thyroid levels. When low, it signals the pituitary gland to secrete thyroid stimulating hormone (TSH) into the blood. TSH stimulates the thyroid gland to produce thyroid hormone. There are two thyroid hormones: T3 (the most active) and T4 (thyroxine) - which are measured by the blood test "T7" or "FTI."

The symptoms of over and underactive thyroid conditions are listed on the reverse side of this newsletter. Children born without thyroid hormone develop "cretinism" - a syndrome of severe growth and mental retardation which is totally preventable by taking thyroid replacement medication. Many disorders are associated with abnormal thyroid function. Stress reduces the conversion of T4 to the more active T3 - in effect slowing down the entire body. Some patients need higher doses of thyroid medicine during periods of intense stress. Some medicines can give falsely low thyroid blood test results - especially Tegretol (carbamazepine).

Many psychiatric disorders and symptoms are related to thyroid hormones. Both underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid hormone blood levels can trigger panic attacks. In approximately 1/3 of patients with depression, borderline personality disorder, panic disorder, bulimia, alcoholism in remission, and anorexia nervosa the pituitary gland does not properly increase blood levels of TSH when signaled to do so by the hypothalamus. This can cause "hypothyroidism" with "normal" blood values. "Normal" is a statistic referring to the middle 96% of the population - it does not mean that "normal" is normal or healthy for you. "Normal" cholesterol by the middle 96% technique includes cholesterol levels of 300, whereas the middle statistically is 220, and the goal is less than 200.

I do not treat lab tests - I treat people. Treating thyroid problems is much easier when the lab tests are normal - the TSH is the most sensitive indicator. Rarely patients are suffering from hypothyroidism with "low normal" blood tests - especially those whose levels have dropped over the years. I’ve had patients with a normal T7 and a very high TSH (a clear case of hypothyroidism), as well as patients with a normal TSH and an immeasurably low T7 (also clearly hypothyroidism). They either have a malfunctioning pituitary system, have one of the psychiatric disorders listed above, or have nothing wrong. If thyroid replacement hormones are prescribed, the blood levels must be very carefully monitored to keep them in the proper range. Treatment of normal lab hypothyroidism (called secondary or tertiary hypothyroidism) can theoretically increase the risk of osteoporosis (especially if overtreated) and can occasionally trigger other problems such as high blood pressure, irregular heartbeats and palpitations, strokes, and heart attacks - it is a serious problem if not treated that can be dangerous if overtreated.

The medicine for hypothyroidism is usually Synthroid. Thyroid "extract" (from chopped up animal thyroid glands) may not be reliable, and should generally not be prescribed.

10/20/99