Monthly Archives: June 2009

Major Revision Possible in Guidelines for Diagnosing and Treating Hypothyroidism


In a suprise announcement a prominent leader in the field of thyroid disease, Dr. Leonard Wartofsky, suggested that a new lower level of TSH be utilized when attempting to evaluate and treat hypothyroidism.

When diagnosing hypothyroidism (low thyroid function) most physicians are trained to obtain a TSH measurement. TSH (thyroid stimulating hormone) is produced by the pituitary gland not the thyroid. The pituitary’s job is to act like a thermostat regulating the amount of thyroid hormone in the blood. When the pituitary senses thyroid hormone deficiency this “master gland” releases TSH into the blood to stimulate the thyroid to make more thyroid hormone. TSH therefore increases when thyroid hormone levels are low.

According to good medical training, it is appropriate to diagnose hypothyroidism and give thyroid hormone replacement only if the TSH level is above normal. The normal TSH level is generally recognized to be between 0.4 up to 4 or 5 (microIU/ml) depending on the lab where the assay is done.

I have found that relying strictly on the normal TSH range may fail to render a correct diagnosis of hypothyroidism. Take the situation in which an individual’s TSH level a year ago was 1.0 but this year is 2.8. Both of these TSH levels are within the normal range. Hasn’t something changed, however? Why is the pituitary releasing more TSH this year? My thought is in this situation the pituitary is sensing thyroid hormone deficiency and is trying to compensate by releasing more TSH. In such a case it may be appropriate to try thyroid hormone supplementation if there are also complaints compatible with low thyroid function.

The major flaw in the TSH measurement stategy is to fail to recognize how much variation in thyroid function can be hidden within the TSH normal range. To explain this I like to use the analogy of shoe sizes (you heard it here first!). It is common knowledge that although most people have normal foot size, only one shoe size is appropriate for each person. Similarly with TSH, for each individual there is very likely to be a particular level that is the “best fit”. Recall the normal TSH range is between 0.4 and 4.5. This is equivalent to a normal range of shoe size from 4 to 45! How difficult is it then to find the “best fit”?

For years, endocrinologists have debated what level of TSH is appropriate for the diagnosis of hypothyroidism. In a suprise announcement Dr. Wartofsky from Washington Hospital Center suggested lowering the upper limit of TSH to 2.5 (microIU/ml). This was after an analysis showed that 97% of the population had TSH levels below 2.5. In comparison the official American Association of Clinical Endocrinologists (AACE) statement recognizes the upper normal limit as 5.0, although dissenting members of this organization have been using 3.0 as the upper limit. By recognizing that a TSH level of 2.5 may signify thyroid hormone deficiency, Dr. Wartofsky and his colleagues legitimatize treatment with thyroid hormone replacement for a much broader range of patients then ever before. Public action groups have for years been seeking this reform in the medical community’s method for diagnosing and treating thyroid hormone deficiency.

My comments are intended as informational only, not to diagnose and treat medical conditions. Consult your own physician for individual advice on diagnosis and treatment of medical conditions.

Gary Pepper, M.D. Editor-in-Chief, metabolism.com

Al, Type 2 Diabetic, Shares His Thoughts on Treatment


Al is a type 2 diabetic. He has learned a lot about how diet and exercise can influence his blood sugar but still has frustrations with treatment options. He shares his thoughts with metabolism.com:

I am a male 47 years of age. 2 years ago my A1C was at 9.9 i was eating horribly and not exercising. Now my diet consists of South beach diet phase 2 my A1C is now 6.5 and my sugars are between 80 to 130 . My exercise routine is every other day due to my weight I am 5′ 7 1/2 lbs and at 282lbs my back is killing me.

I understand that there needs to be a lot of testing for these things and rightly so. Ive noticed that there is some hazards with Byetta and am glad im not on that and on avandia. I must point out that with the problems diabetics already have we do not need to compound it with more even though I do wish the testings would some how be able to go faster and that more and more research is done with stem cell testing.

My next option is to go for bariatric surgery..but my insurance wont cover it.

So here i am at a catch 22 . I hope they come up with something soon.

I am a male 47 years of age. 2 years ago my A1C was at 9.9 i was eating horribly and not exercising. Now my diet consists of South beach diet phase 2 my A1C is now 6.5 and my sugars are between 80 to 130 . My exercise routine is every other day due to my weight I am 5′ 7 1/2 lbs and at 282lbs my back is killing me.

I understand that there needs to be a lot of testing for these things and rightly so. Ive noticed that there is some hazards with Byetta and am glad im not on that and on avandia. I must point out that with the problems diabetics already have we do not need to compound it with more even though I do wish the testings would some how be able to go faster and that more and more research is done with stem cell testing.

My next option is to go for bariatric surgery..but my insurance wont cover it.

So here i am at a catch 22 . I hope they come up with something soon.

Al Lazzara

Suzann offers advice on managing thyroid treatment


Suzann has learned a lot in her search for the best approach for treating her thyroid condition. She is a big fan of the well known medical writer Mary Shamon. Suzann offers our members the following advice:

I have seen a nutritionist before….what a great education I got. Lost 30lbs…but it came back slowly. I still recommend it though. The information I told you about came from a book a friend of mine gave me. I believe every person who even think they might have a thyroid problem should read this book. “The Thyroid Diet” by Mary J. Shamon – http://www.thyroid-info.com. These days we need to be our own doctors. I believe everyone should seek professional medical help, but before you go educate yourself, be your own advocate. I did and I got results. Mary states in her book, “be persistent, but unemotional…..show the doctor articles about thyroid disease that reflect your symptoms”. She goes on to say you need to fully explain your symptoms. Don’t just say I have gained weight…..tell the doctor I only intake 1500 (or whatever your intake is) calories a day and I am still gaining weight. Or I sleep 10 hours every night and by dinnertime I am exhausted. I stress this enough to everyone. My last endo told me my problem is not endocrine related….no??? then why am I feeling better on T3 replacement? Get this book….it will change your life!

I have seen a nutritionist before….what a great education I got. Lost 30lbs…but it came back slowly. I still recommend it though. The information I told you about came from a book a friend of mine gave me. I believe every person who even think they might have a thyroid problem should read this book. “The Thyroid Diet” by Mary J. Shamon – www.thyroid-info.com. These days we need to be our own doctors. I believe everyone should seek professional medical help, but before you go educate yourself, be your own advocate. I did and I got results. Mary states in her book, “be persistent, but unemotional…..show the doctor articles about thyroid disease that reflect your symptoms”. She goes on to say you need to fully explain your symptoms. Don’t just say I have gained weight…..tell the doctor I only intake 1500 (or whatever your intake is) calories a day and I am still gaining weight. Or I sleep 10 hours every night and by dinnertime I am exhausted. I stress this enough to everyone. My last endo told me my problem is not endocrine related….no??? then why am I feeling better on T3 replacement? Get this book….it will change your life!
myonlineshop@optonline.net
Suzann

Unreasonable Standards by the FDA for New Diabetes Drug Approval?


This post is the third in a series under the title: 2009. Another Troubled Year for Endocrinologists.

This year the FDA has instituted new standards for diabetes drugs coming up for approval. These new standards require that each new drug prior to approval must demonstrate the lack of any negative impact on cardiovascular (heart and blood vessel) health. While this may seem a legitimate requirement, in reality it requires thousands of patients be treated for many more years in research settings to acquire this information. So far three new diabetes medications from Takeda Pharmaceuticals, Novo Nordisk and Bristol Myers have all been put in limbo due to delays on their approval based on the new requirements.

I would point to the case of Avandia as an example of how difficult it is to prove that a drug has negative cardiovascular effects. In 2007 an alarm was sounded by several outspoken critics, whose analysis pointed to increased cardiovascular risk from Avandia. At that time Avandia was a key diabetes medication on the market for over 5 years with millions of individuals treated. Although the diabetes community remained split on the truth of these assertions major medical organizations such as the American Diabetes Association placed a virtual ban on the use of this medication and the FDA placed its highest “black box” level warning on Avandia use. At that time the FDA was criticized widely for allowing this supposed public danger to go unrecognized for so long. Many think that it is in response to this criticism that the FDA was forced to add the new much more stringent requirements on new drug approval.

Since 2007 however, a large V.A. study (the VADT study) and the 2009 RECORD study both found no evidence of cardiovascular risk with Avandia use. The belief is growing that the FDA was initially correct in allowing Avandia to come to market, although so much negative publicity has hurt the use of Avandia and led the FDA to take a highly defensive approach to new drug approval.

Some pharmaceutical executives believe the new FDA requirements will double the cost of bringing a new drug to market. Approval of several promising new diabetes treatments has already been stalled and the companies developing new medical therapies are beginning to move diabetes treatment to the back-burner. It is likely that it will takes years to reverse this trend, if a reversal is possible at all.

Gary Pepper, M.D. Editor-in-Chief, Metabolism.com

Medicinal Salad


Salad to the rescue!

Salad to the rescue!

Ugh! I ate too much/ate the wrong things/have indigestion/feel gassy!!!!

A simple fix to the occasionally off tummy caused by a variety of mealtime experiences including a strange combination of foods from a sunny day picnic, a late night out with alcohol and cheap diner food or even just monthly gassiness or eating too much of something you know always gives you gas, try this simple medicinal salad at your next meal:

MEDICINAL SALAD
  • 4 cups of washed mixed greens or lettuce (this looks like a lot, but you’ll love it)
  • Enough raw apple cider vinegar or fresh lemon juice to coat the clean dried leaves (about 2-3 tbsp)
  • 1 tsp olive or flaxseed oil
  • a tiny bit of salt and fresh pepper
  • top with cilantro/parsley and or cucumber if you have it
This is a recipe for one. Stay away from tomatos, carrots, olives or any other normal salad topping. Have this at your next meal following the unhappy meal that caused the upset.
How’s it work?
The greens and raw vinegar/lemon juice act as alkalizing brooms through your system, helping the body to process that funny meal with ease.
What’s it do?
It will relieve bloating, gas, slight reflux and sluggishness. Don’t be afraid to have this late at night after your meal in question to get a better night’s rest or as an appetizer for the next meal you’re hungry for.
Kimberly, counselor since 1998 and founder of www.RedAppleYoga.com, holds a Masters in Health & Healing as a Certified Nutritional Counselor, a Masters in Education and is an internationally trained advanced  Yoga and Yoga Therapy instructor that has worked and studied in New York, Spain and in Southern India. Her practice is based in New York City. She believes in showing her clients how to combine time-tested ancient theories with modern knowledge to get the best benefits from both worlds.

Indycat Shares Her Experience with Thyroid Hormone Treatment


Finding the best replacement dose of thyroid hormone can be a frustrating experience for many people. Symptoms of fatigue, hair loss, itchy skin, bloating, hot or cold intolerance etc. can resist numerous attempts to correct them by changing dosages and even the type of thyroid medication used. Indycat shares her experience here with metabolism.com and wonders what next?

Indycat writes:

I tried a couple of endocrinologists and was constantly heckled about my point blank refusal to not come off of the Armour. In the end I simply went back to my GP who now run the relevant blood work and prescribes my meds. I cannot compare Armour with Synthroid because I refused to take it from the beginning but I did a lot of research and I have other complications that I did not need compounded.

I am not sure I am on the correct dosage however, it seems to get lowered everytime I have bloodwork and I am now just taking one grain (60mg) but still have some symptoms. Increasing my dose makes my hair fall out more and so does decreasing it so I am caught between a rock and a hard place!

I was diagnosed back in 2001 and the one main thing I wish I could fix would be my libido… That seems to have left the building.

I tried a couple of endocrinologists and was constantly heckled about my point blank refusal to not come off of the Armour. In the end I simply went back to my GP who now run the relevant blood work and prescribes my meds. I cannot compare Armour with Synthroid because I refused to take it from the beginning but I did a lot of research and I have other complications that I did not need compounded.

I am not sure I am on the correct dosage however, it seems to get lowered everytime I have bloodwork and I am now just taking one grain (60mg) but still have some symptoms. Increasing my dose makes my hair fall out more and so does decreasing it so I am caught between a rock and a hard place!

I was diagnosed back in 2001 and the one main thing I wish I could fix would be my libido… That seems to have left the building.
indycat@cfl.rr.com

Balance Your Thyroid for Sleep, Weight, Nutrition


Another gift from the sea bringing balance to your body

Another gift from the sea bringing balance to your body

Did you know that yourthyroid and parathyroid,located in the base of thethroat is responsible for a number of important bodily functions including: balancing your weight, regulating your sleep and absorbing key nutrients like calcium?


It’s true! We’re so concerned in our culture about the size and shape of our hips, waists and more, but we need to take a closer look at the pit of our lower throat, because that’s where the thyroid is located. The thyroid requires iodine to function normally, and the best way to supply this nutrient is NOT through iodized table salt, but through a natural source: Sea Kelp.

Kelp is a seaweed naturally rich in minerals like calcium and iron, but also iodine. It is used in many Japanese and Macrobiotic recipes. The good thing about taking kelp is that the nutrients will balance your thyroid, but will not overload the system like taking an artificial source of these supplements could.

You can find sea kelp supplements in any health store, I suggest you take a 650mg tablet once or twice a day with a meal for a month, careful not to take too much and see if you notice any changes.
Kimberly, counselor since 1998 and founder of www.RedAppleYoga.com, holds a Masters in Health & Healing as a Certified Nutritional Counselor, a Masters in Education and is an internationally trained advanced  Yoga and Yoga Therapy instructor that has worked and studied in New York, Spain and in Southern India. Her practice is based in New York City. She believes in showing her clients how to combine time-tested ancient theories with modern knowledge to get the best benefits from both worlds.