Thyroid Problems
The Thyroid gland itself is a small butterfly shaped
structure weighing about an ounce, which lies astride the windpipe in the
front of the neck, just below the "Adams apple". It is one of the set of
glands that form the endocrine system. Other glands of the endocrine system
are:
Adrenals
Parathyroid
Pancreas
Pituitary
Ovaries and Testes
Thymus.
To demonstrate this system in action, consider you are
just going about your own business, doing your own thing in an unperturbed
sort of way when you get a sudden fright! what happens? You start to breathe
faster, blood rushes to your head and your heart beats quicker and louder,
you feel hot and the palms of your hands start to sweat. Without even a second
thought you are preparing for the 'fight or flight'. It is this reaction that
our primitive ancestors were saved from being killed, in their daily hunt to
survive, and that we still have to save us from our modern day life threatening
dangers.
Your adrenals secrete adrenaline which results in the heart beating faster,
this pumps more oxygen into your bloodstream and so to your muscles. The spleen
releases more red blood cells to carry this oxygen and the liver secrete stored
nutrients to feed the muscles. Neurons stimulate the sweat glands in your skin
to regulate your temperature of the overheating body.
This is an example of the endocrine system responding to a stressful event and
how, in tandem with the nervous system, it regulates and co-ordinates bodily
functions.
The endocrine glands produce over a hundred hormones between them, a word derived
from the Greek meaning "to set in motion", and play an important role in regulating
the activity of most of the vital organs in the body. Some of these hormones have
a restricted range, but others, especially the Thyroid hormones; effect a wide
range of the body's cells.
Hormones exert their effects by binding to a special receptor site on the surface
of the cell, or to receptors inside the cell for example on the cell nucleus.
Thyroid hormone works by binding to receptors on the cell nucleus and the mitochondria,
which are the energy factories inside cells. Binding to a receptor site has the
effect of switching on or activating other chemicals within the cell. These chemicals
are called second messengers, and they carry out the instruction ordered by the
arrival of the hormone.
Receptors are designed to fit the shape of the hormone and no other chemical that
is normally present in the body. Only the right hormone can bind to the receptor
site. Receptor sites can be opened or closed depending upon the cells needs.
When the cell needs more hormone, the receptor sites are opened and they are able
to capture any present. They remain closed when the cell has sufficient hormone to
meet its needs.
Unfortunately, when faced with a chronic shortage of its hormone over a period of
time, the receptor sites can shut down and decrease in number, and remain that way
even when the hormone is restored to normal levels. This can present problems with
using any remaining thyroid hormone or when hypothyroidism is treated. The patient
finds that they simply do not respond to the increased levels, even though the TSH
may be back within "normal limits" as defined by the standard blood test.
Chemicals found in the environment, which find their way into our bodies, can mimic
the shape of the hormone so that it can fit the receptor site, where they block the
real hormone. This can be a good thing, as with drug treatments, or a bad thing, as
with chemicals in the environment which work against us, called hormone disrupters.
It is at this level that problems can occur, especially in our modern society with
increasing incidence of these Environmental Hormone Disruptors.
The hormones directly determine
response in an emergency
sexual maturity process
allow the body to fight infection and feed its cells
determine growth
directly influence intelligence and physical agility and sexual drives.
This is a dynamic system, constantly varying production and
secretion of hormones, according to need. This is a finely balanced system requiring
full and correct function of all glands to properly regulate all body processes in an
interdependent partnership with the nervous system.
The endocrine and nervous systems between them are responsible for so many chemical
signals throughout the blood stream, acting as a feedback mechanism; so that when
there is enough of a specific hormone available, a chemical signal is circulated to
instruct the gland that produces it, to stop further secretion. When this situation
changes so that more is required like when it has been used and is becoming depleted
in the blood stream, this will act as a chemical signal to instruct the gland to
secrete it again and produce it.
When this fine balance is broken, it can be responsible for potentially life threatening
diseases, such as diabetes, which is the break down of the proper insulin hormone
response from the pancreas.
The abnormal Thyroid responses are call Hypothyroidism when it under-produces its
hormone(s) and Hyperthyroidism when it over produces them. These are also referred
to as under and over active respectively. An abnormal response is to act against or
at odds with the chemical signal in the blood stream, including inadequate or complete
lack of response as in Hypothyroidism.
The thyroid gland controls the rate of METABOLISM, This is to say - Thyroid hormone
controls the rate at which energy is produced.
Metabolism is the name given to the group of complex chemical processes inside the cell,
which take glucose and burn it to produce energy and heat. Glucose comes directly from
carbohydrates in food, but proteins and fats can be modified into glucose if the need
arises. The complex steps of metabolism are to dismantle the fuel (glucose) molecule by
molecule so that the energy and heat is released in controlled and manageable steps.
Oxygen is the substance which stokes the fire of metabolism, which is why it is needed
to maintain life.
The energy released at each stage is stored in a form that is readily available called
ATP or Adenosine Tri Phosphate. Any surplus glucose is removed from the blood by the
hormone insulin and stored as glycogen in the liver and muscles for future use. Larger
quantities of surplus energy are turned into fat and stored under the skin, around
organs and inside muscles.
Energy or ATP is needed to drive every function in every cell of the body. These
functions simply cannot take place without the energy in ATP and they will slow down
or stop if energy is in short supply.
All this means, that if you are exerting yourself and need a lot of energy, the Thyroid
will step up production of its hormone to increase the metabolism to produce more energy.
A high metabolism means lots of energy, so you feel full of beans so to speak. If the
Thyroid does not respond this way, your exertions are limited to the available energy
and that produced by a low metabolism as a result of a sluggish Thyroid. If you are
not producing enough energy, the effects are very quickly felt as fatigue and listlessness,
but the effects very soon become much more serious. On the other hand, if the Thyroid
keeps winding up the metabolism when you've had enough or want to sleep, you get so
full of beans as to soon start climbing the walls!
If you consume too many calories, the thyroid gland will help you to dispose of these
by burning them off as heat . Some tissues have the ability to switch all energy
production to the generation of heat - you may of heard of this, it is called brown
fat. By doing this, brown fat in effect, wastes the extra calories.
To return to Lower metabolism (lower energy production), means less heat production.
That heat is needed to help to maintain a body temperature of around thirty seven
degrees centigrade, ninety eight point four Fahrenheit. This is vitally important
because it is the optimal temperature for enzymes, which catalyze or initiate the
various steps of metabolism, to work.
When energy production falls, less heat is produced, and the enzymes work more
sluggishly. As less energy is available, all cellular processes are on short rations,
which means that all the activities which take place in the cell which keep us well
maintained and healthy, run at a level which cannot keep up with demand. This includes
such functions as protein synthesis which is explained below.
Protein synthesis is the production of new proteins in the body. Proteins are needed
to make new cells such as blood cells and those in the immune system which fight
infection, others, which repair damaged cells and help to carry out important tasks
such as maintaining blood pressure and the production of the hormones of the endocrine
system themselves.
In children, protein synthesis is an even more vital function, as it provides the raw
materials for healthy growth and development not only of the body and all its organs
and muscles but also of the brain and the rest of the central nervous system. the result
of deficiency is a developmentally delayed child with poor physical development.
Another role of protein is to transport vitamin A around the body. Without this,
protein vitamin A which is made in the liver, cannot leave the liver, and this results
in damage to liver cells and elevated enzyme levels which are detected as abnormal
liver function tests.
This now means that without adequate amounts of thyroid hormone to accelerate metabolism
in response to need, the body cannot function properly. In addition, the lower heat
production caused by this lowered metabolism, causes the cellular processes to slow
down even further, leading to less energy and less heat, which in turn leads to an even
lower metabolic rate, which leads to lower energy and heat production, and so on in a
vicious downward spiral until the state of myxoedema or complete loss of thyroid function
occurs and death soon follows.
Fortunately today, a physician is likely to recognize the physical signs of myxoedema
before it becomes fatal.
However, it is very difficult to reverse some of the changes brought about by lack of
thyroid hormone once they have developed to an advanced stage, so it is preferable for
the diagnosis to be made before there are physical signs which adversely affect the
patients quality of life and appearance.
It is vital that newly born babies are diagnosed within their first 6 months of any
under activity, as we have already seen, the thyroid controls growth, and if there is
a lack, the brain and the skeleton of the child does not mature properly or at all. It
is for this reason that most countries screen all new born babies. Replacement therapy
will of course right this situation if diagnosed in time.
The thyroid puts out five different compounds in the hormone we know as thyroxine. They
are classified according to how many iodine atoms it has in its molecule. T4 or
tetraiodothyronine contains four iodines, T3 or triiodothyronine contains three iodines,
T2 or Di iodothyronine has two iodines, T1 or monoiodothyronine has one iodine, then
there is T, or thyronine, which has no iodines present in its molecule.
They make up the following proportions of thyroxine T4 80% T3 15% T2 4.5% and traces of
T1 and thyronine make up the other 0.5%.
The only active substance in thyroxine is tri iodothyronine or T3. T4 is converted to T3
by the enzyme 5 deiodinase which is present in the liver and kidneys. The enzymes catalyse
the loss of one iodine by T4 so that it becomes T3. T2 is thought to be responsible for
stimulating the production of 5 deiodinase. The roles of T1 and thyronine are unknown.
T3 enters the cell and binds to proteins in the cytoplasm which then acts as a small
reservoir of the hormone for the cell. When the reservoir gets low, the cell opens up
its receptors again and allows more T3 to enter. From the reservoir the T3 is then
transferred to the nucleus where it binds to receptors which causes the DNA to start
organizing the production of specific proteins. These proteins have an acceleratory effect
on metabolism. T3 also binds to receptors on the inner walls of mitochondria and by doing
this speeds up oxygen consumption and ATP (energy) production.
How is the Thyroid output managed?
The right amount of hormone depends upon a negative feedback system.
This means that as levels of a hormone fall, the glands are stimulated to produce more.
The structure which monitors the levels of the hormone in the bloodstream is the
hypothalamus in the brain. When levels of thyroid hormone fall, or when demand increases,
the hypothalamus which is aware of the state of all the body's functions, detects this and
orders the endocrine system to produce more hormone.
The hypothalamus sends an instruction in the form of a hormone called TRH (Thyrotropin
Stimulating Hormone) to the pituitary gland which in turn sends a message in the form of
another hormone TSH (Thyroid Stimulating Hormone, which used to be called thyrotrophin)
to the thyroid gland which causes it to secrete more thyroid hormone.
What is Hypothyroidism?
Hypothyroidism can have many different causes. It may be when the
thyroid gland has lost its ability to produce enough hormones. This can be by sheer wear
and tear as part of the aging process.
The body may produce antibodies against its own thyroid gland resulting in its destruction
(autoimmune thyroiditis) , there may be a problem with the gland resisting the effects of
TSH, the pituitary gland may not produce enough TSH, the hypothalamus may not produce
sufficient TRH, there may be an iodine deficiency in the diet.
The problem may not be with the production of the hormone but with its utilization in the
tissues. Thyroid hormone is unique in that it has to be activated once it is secreted.
Several things can go wrong with the process of utilization of T3.
Firstly, the receptors may be closed if the hypothyroidism has been untreated for a long
period of time, There may be a genetically inherited deficiency in the number of receptors.
There may be a shortage of the enzyme which catalyses the conversion of T4 to T3.
There may be a deficiency of T2 which is now thought to stimulate 5 deiodinase production.
These utilization problems are not detectable with the standard thyroid tests.
Physicians test the level of TSH in the blood. If TSH levels are elevated there is a
problem with the thyroid hormone production. However, when the problem is with the use of
thyroid hormone, the unused T4 T3 and T2 in the blood will cause the hypothalamus to believe
that the body has plenty of thyroid hormone. It will reduce the secretion of TRH, which means
that TSH production is reduced, in turn this means that the thyroid is not stimulated to produce
the hormone. The blood levels are therefore "normal", yet the cells are starved of thyroid
hormone and in reality the blood levels are stagnant with the unused hormone remaining in
the blood stream.
Unfortunately, the only type of hypothyroidism which physicians seem aware of, are problems
with the production of the hormone, they ignore problems with utilisation, believing them to
be too rare to even consider as a diagnosis. This leaves many people whose blood results are
"normal" with debilitating symptoms of hypothyroidism and no hope of any help from the medical
profession.
The situation worsens for the undiagnosed hypothyroidism sufferer, as it leads to disheartening
visits to the doctor, extensive and expensive tests which frequently identify nothing of
significance , while all the time, the sufferer is getting more and more debilitated.
The sufferer may be labeled a malingerer, attention seeking, suffering from depressive
illness - all too often. The person may even have surgery, hysterectomy or endometrial
resection is often done as a last resort for debilitating heavy periods, when the cause
is actually hypothyroidism.
Doctors are aware of six basic symptoms of hypothyroidism. weight gain, dry skin and hair,
hoarse voice, fatigue, cold intolerance and puffy facial feature, but these symptoms are
trivial compared to the effects thyroid deficiency can have on the body.
Every cell in the body needs thyroid hormone, therefore, every cell in the body will feel
the effects of deficiency. Which systems develop symptoms first depends upon individual
strengths and weaknesses. A man may develop impotence and libido problems, a woman may develop
gynecological or fertility problems, another person may suffer migraine headaches or arthritis
or depressive illness.
The symptoms are as diverse as the number of functions to be found in the body and the
sufferer of hypothyroidism may not develop the "classical" symptoms at all.
Some of the signs and symptoms include
exhaustion
dry coarse skin
weight gain
cold and/or heat sensitivity
poor memory and brain fog
palpitations
low basal temperature
gynecological disorders
lethargy
need for sleep
skin pallor
nervousness
hearing sensitivity
skin becomes yellow
muscle pain and swollen muscles
constipation
infertility and male impotence
loss of outer third of eyebrow
slow growing and brittle nails
headaches
tinnitus or slight deafness
deepening of the voice as the vocal chords thicken
breathlessness
low pulse rate
loss of hair
and many many more.
If left undiagnosed, not only does your quality of life reduce, you are put at risk from
high blood pressure
diabetes
emphysema
arthritis
depression
constant weight problems
migraine
myalgic encephalitis (ME)
carpal tunnel syndrome
and more.
We have seen that the blood tests conducted to evaluate thyroid function only
measure the hormones in the bloodstream. These tests take no account of an
individuals personal requirements, we are not all the same, and cannot detect
complications at the cell face.
You may have been told by your Doctor that you are 'normal' after blood test
results show you fall into the arbitrary range. Many people fall into 'borderline',
when treatment would be beneficial, but many Doctors send them away until they fall
within the 'range'.
The range or the correct term is 'reference' was, and still is, designed to be
just that a reference point not an absolute. These are to give a Doctor a pointer
not a total diagnosis. Biochemists say these references should never take the place
of the clinical diagnosis but provide part of the picture, not the total picture.
Dr. Broda O Barnes of America , carried out 40 years of study and research. He
wrote several books and over 100 medical papers, many of which were published
in medical journals. He predicted that by the 90's we would have some 40% of the
population with thyroid dysfunction of some kind. He reached 2 conclusions with
his research:
the blood tests are unreliable as they only tell you how much hormone is in the blood but not how much is usable or how much each individual needs.
that Hypothyroidism is more widespread than supposed
He also developed a very simple test that is considered by some
more enlightened professionals, to be more accurate than blood tests. As we have
heard, the thyroid controls metabolic rate, so it stands to sense that a temperature
test taken at the right time, in the right conditions, will give a good indication if
this rate has slowed down.
Our body functions happen at an optimum temperature and so if this is below the well
accepted normal then there is something wrong. If you have a fever then this is taken
notice of and appropriate diagnosis and treatment administered, so is it not the same
for below normal temperatures that the same action is applied?
Dr. Barnes found by substantial research, that with Hypothyroidism, the basal
temperature was below normal and developed the following simple test to perform
at home. It requires only a glass mercury thermometer (it should strip type as this
may give a higher reading).
This is known as the "Barnes Basal Temperature Test" and should not be confused
with the BMR (Basal Metabolic Rate).
Step 1: upon retiring to bed, leave a thermometer,
well shaken down, by the bedside.
Step 2: before arising the next morning, place the thermometer
under the armpit for 10 minutes and then take a reading.
Women who still experience monthly periods should take their
temperatures on the 2nd, 3rd and 4th days of the menstruation, it is these days in
your cycle when your temperature is at its most accurate. Otherwise men and women
alike should take temperature readings on 12 consecutive days.
Normal readings are between 97.8 - 98.4 F or 36.6 - 37 C
Anything below these readings is considered abnormal unless you are suffering from
a cold or virus.
Thyroid Function Testing - blood tests or Barnes Basal Temperature which is more
accurate!
A low basal temperature reading together with signs and/or symptoms and your health
history can determine Hypothyroidism when blood test results may show a 'normal' reading.
It is recommended that you take records of your basal temperature readings and your
list of symptoms to your Doctor.
Doctors should take an holistic approach in diagnosis and not just take blood test
results in isolation.
A common condition that is also present when you have been under active but undiagnosed
for a long time, is Adrenal insufficiency. The stress to the body of being undiagnosed
for a long time, takes its toll on the adrenals and they become exhausted.
In many, if not all of the medical text books; it draws attention to checking for adrenal
problems with hypothyroidism, yet few doctors do this. Although there is a general test
performed to try and establish adrenal function, by its method it is far from conclusive.
The adrenals are stimulated by injection and their resulting function measured. This will
obviously show normal if the adrenals have some function and respond to the sudden demand.
It is our own self-preservation mechanism that would allow the rush of cortisone in this
situation.
It is widely considered that the correct test for adrenal function is to take the blood
pressure whilst the patient is in a sitting position, and then a few minutes later, get
them to stand up and take the blood pressure again. If there is a problem the blood
pressure will actually fall on standing up, hence the dizziness we experience when we
have adrenal exhaustion/insufficiency.
Chronic Fatigue Syndrome, Myalgic Encephalitis (ME) and Fibromyalgia are all associated
with thyroid and adrenal problems and it is only recently that research and Doctors are
beginning to accept the association that we have advocated for some time based on Dr.
Barnes extensive experience and treatment. (see articles Energizing Chronic Fatigue and
Diagnosis and treatment of M.E ).
Sadly Dr. Barnes died in 1988 but a Foundation continues his invaluable work. They can
be contacted at:
Broda O Barnes M.D. Research Foundation Inc.
P.O.Box 98
Trumbell. CT 06611 USA
Phone: (203) 261 2101
e-mail: info@BrodaBarnes.org
The Barnes Foundation maintains a list of Doctors that follow Dr.
Barnes protocol, treat patients as individuals and use clinical appraisal as part of
their diagnosis.
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1. Barnes B O, Galton L Hypothyroidism : The Unsuspected Illness (1976) Harper
Rowe New York
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Rat Anterior Pituitaryies in Vivo and in Reaggregate Cultures and GH3 Cells in Vitro*
Endocrinology Vol 138 no 8 (1997)
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in Athyrotic Human Subjects Journal of Clinical Investigation Vol 49 No 5 (1970)
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New York.
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England Reading Massachusetts
7. Durrant - Peatfield B. Suggestions for an Approach to Thyroid Deficiency ( 1997)
Foxley Lane Clinic Purley Surrey.
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Studied in Thyroidectomised Rats Infused With Thyroxine or Tri iodothyronine.
Endocrinnology Vol 138 No 6 (1997)
9. Gillham B. et al Wills' Biochemical Basis of Medicine Third Edition (1997)
Butterworth Heinemann Oxford.
10. Hennemann G. et al The Significance of Plasma Membrane Transport on the
Bioavailability of Thyroid Hormone Clinical Endocrinology Vol 48 1-8 (1998)
11. Jefferies W McK. Mild Adrenocortical Deficiency, Chronic Allergies,
Autoimmune Disorders, and the Chronic Fatigue Syndrome: Acontinuation of the
Cortisone Story.Medical Hypothesis (19940 Vol 42 pp183 - 189)
12. Kumar P. and Clark M Clinical Medicine Third Edition (1994) Saunders London
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