Hypothyroidism, on evidence based management approach to overweight

Every one knows about epidemics of diabetes caused by the
impairment in metabolism of insulin, female hormones imbalance causing infamous
PMS and peri-menopausal problems, but not too many of us are familiar with
thyroid dysfunctions.

Many problems that we attribute to overeating, aging,
stress, etc are actually signs of decreased or dysfunctional thyroid complex.

In fact, the thyroid gland is the master control center for
the metabolic function of every single cell in our body. That is why any
problem with our thyroid function will have profound “ripple effects” on the
entire body.

Unfortunately, “normal” thyroid blood tests are not adequate
for catching dysfunction. There are two reasons for this: thyroid blood tests
do not measure nor the ability of mitochondrias (the small energy battery
inside the cell), neither the “potency” of the thyroid hormone. When hormones
are produced by the healthy gland, they are “locked” like a loaded gun. It
should be another hormone or enzyme that “unlock” it and “direct” to certain
system. Both hormones might be in the blood but they might not “meet” in the
right time. If we use the analogy with the lunch: pretend that you have a soup
at 12 pm, a spoon at 3 pm. If the next day I will ask you: “Did you have
YESTERDAY a soup and the spoon?” the answer is “Yes.” How much did you eat your
soup is another story. Blood tests measure just that – amount of hormones
within the last 24 hours, but not their activity. Did you get the message?

The other important news is that the thyroid hormones are
produced predominantly in sleep, and if sleep is chronically “screwed up”, the
same will be with your health.

What are the major functions of the thyroid hormones: your
body shape (when you talk about body weight, you actually think about your
body’s shape, don’t you?).

Thus, overweight is often a symptom of hypothyroidism, as
Mark Starr, MD (the author of the recent book: “Hypothyroidism, Type 2”)
suggests. Other problems such as heart disorders, chronic fatigue, depression,
even high cholesterol might be also symptoms of hypothyroidism.

Let’s review the classical patient’s symptoms that the
American Thyroid Association (ATA) used to make the diagnosis of
Hypothyroidism.

The classical presentation of lethargy, weakness, cold
intolerance, dry skin, coarse hair, and depression are seldom seen. More often
the symptomatology is subtle: hoarseness, paresthesia, hair thinning,
constipation, cold intolerance, increased arthritis, and other age-related
pathology.

The frequency of Hypothyroidism according to the ATA
guideline is 6%; however, when I review my practice, almost 10% of the patients
are under treatment. When I applied my thyroid treatment protocol to obesity,
metabolic syndrome, hyperlipidemia, diabetes, and sleep medicine the results
were overwhelming.

In my previous publication in Sleep and Health
I discussed how metabolic syndrome is defined by changes in cholesterol, heart
rate, peripheral vascular resistance, systolic function, and body habitus. It
is now apparent that thyroid hormone resistance (inactivity) can cause these
symptoms.

There are 17,000 people with antithyroid antibody. 80% of
these people will become overtly hypothyroid during the lifetime.

Could we diagnose and treat these patients before they
develop all symptoms?

The answer is: yes, and the first step is straightforward:
if the person has TSH and T4 abnormal treatment should be started ASAP. We now
understand that sleep apnea syndrome and other sleep disorders might be the
clinical indications of thyroid dysfunctions and cause alterations of TSH.
Thus, prevention and treatment of hypothyroidism should include corrections of
sleep.

Treatment should be performed by a specialist. There are 12
strengths of levothyroxine varying by as little as 9%. Do not assume
bioequivalency because underlying liver disease, renal disease, diabetes,
malignancy, and even psychiatric illness can affect the response. Adjustment
should be based on microgram per week dosage.

In the acutely symptomatic patient, Cytomel may be
considered.

When treating hypothyroidism your doctor will check for
related autoimmune disease, infiltrative disease, central nervous system, and
other endocrine diseases.

The main message is that when you gain weight, have more
colds as usual, get chronically fatigued and depressed, develop sleep problems,
do not waste your time with self-treatments, manipulations with nutrition,
diets and supplements, but have a professional medical evaluation and treatment
before your endocrine system will be seriously damaged.

Reference: Mark Starr, MD Hypotheriodism. Type 2. The
Epidemic. 2005.

Mark Levy, MD is a scientist and a practicing
internist in the North Suburbs of Chicago. If you wish to contact him, write
to: doctor@sleepandhealth.com.

Below is a checklist of the most common clinical symptoms of
hypothyroidism.

(If you have more then 5 “yes” symptoms, consider
consultation with your doctor.)

HYPOTHYROIDISM
SCALE


YES
NO

Allergies
_____ ______

Anxiety/Tension
_____ _____

Brittle/Rigid
nails
_____ ______

Cold hands and/or feet ______
______

Dry
skin
______ ______

Cold
intolerance
______ ______

Heat
intolerance
______ ______

Constipation
_______ ______

Chronic excessive Fatigue
_______ ______

Headaches
_______ ______

Hair
loss ______
______

Insomnia
______ ______

Long
sleeper
______ ______

Muscle
aches/pains
______ ______

Menstrual problems (for
females) ______ ______

Parasthesias (tingling
sensations) ______
______

Weather/Season Effect (rain, storm, darkness,
winter) ______ ______

Weight loss/gain

Score: ______ ______

Objective:

Heart
arrhythmias
______ ______

High/low blood
pressure ______
______

Tremor
______ ______

Hypoglycemia
_______ ______

Diabetes

Low body
temperature
_______ _____

Thyroid test abnormalities,
goiter ______ ______

Frequent infections ______
______

Delay ankle
reflexes
______ ______

Mixedema
______ ______

Score _______ ______

Total Score _______ ______