Thyroid: Tired-All-The-Time

TAT syndrome, Tired-All-The-Time

Fatigue is one of the most common problems addressed by Naturopaths. It can often be tracked down to a poor functioning thyroid. Your thyroid is a butterfly shaped gland that sits astride the trachea, just below the larynx. It controls metabolic rate. Metabolism is the rate at which normal chemical processes occur in the body and the speed at which the body burns its fuel (food and oxygen). The thyroid is responsible for the proper working of every cell, every organ, and every process in the body, it is essential for health and well being. The way the body reacts and deals with illness and disease depends on a healthy and vigorous metabolism.

If you have been advised that you may have Jersey ‘Island Fever’ look closely at the thyroid symptom questionnaire, it may well be that the thyroid is playing a role in your condition.

Thyroid and Metabolic function.

These functions have an important impact on health, energy levels and sleep. The thyroid gland is the regulator of body metabolism. It is ‘paired’ with the adrenal glands; they in turn are governed by pituitary gland function.

Thyroid hormone is necessary for oxidative processes to take place throughout the body – energy production. Nearly all of the cells of the body have their metabolic rates controlled by the thyroid hormone. The only organs whose metabolic rates are not directly controlled by thyroxin are:

  • brain
  • retina
  • spleen
  • gonads
  • thymus
  • lungs

It’s easy to see that a change in thyroid function creates a wide variety of effects throughout the body. It is possible to override a low thyroid condition by increasing adrenal stimulation, exercise and stress etc – all this usually manages to achieve is a short term reduction in symptoms and often leads to the depletion of the adrenal system. Low functioning thyroid is commonly encountered, although it is frequently overlooked, primarily because most physicians are looking for blood pathology (low thyroxin levels).

Functional hypothyroidism will not generally show up on standard diagnostic tests. Read Dr. Broada Barnes’ books, Heart Attack Rareness in Thyroid Treated Patients and Hypothyroidism: The Unsuspected Illness.

Hypo-Thyroid Questionnaire:

  1. Are you gaining weight in spite of dieting?
  2. Do you have a decreased appetite?
  3. Do you tire easily?
  4. Are you tired all of the time?
  5. Are you sleepy or drowsy during the day?
  6. Are you sensitive to the cold?
  7. Do you have dry or scaly skin?
  8. Are you constipated?
  9. Are you mentally sluggish?
  10. Is you frontal hair falling out or thinning?
  11. Do you wake up with a headache?
  12. Have you lost your drive and initiative?
  13. Are you grumpy first thing in the morning?
  14. Can you face eating breakfast?
  15. Do you suffer from PMS?
  16. Do you wake up tired?
  17. Do you have cracks in the skin of your heels?
  18. Do you find it hard to concentrate?
  19. Do you find it difficult to concentrate- does your mind wander?

If you answer yes to more than five of these questions, you should consider doing the Barnes test. In adition you should question your diet, are you a vegan or follower of an ultra low fat diet? So when confronted with a possible hypothyroid condition, you should consider asking these additional questions:

Hypoglycaemia Questionnaire:

  1. Do you eat when nervous?
  2. Do you have an excessive appetite?
  3. Are you hungry between meals?
  4. Do you get irritable between meals?
  5. Do you get shaky when hungry?
  6. Does eating relive fatigue?
  7. Do you get light headed if you miss a meal?
  8. Do you get a pounding heart if you miss a meal?
  9. Do you get headache in the afternoon?
  10. Do you have a poor sleep pattern?
  11. Do you crave sweets and or coffee in the afternoon?
  12. Do you get mood swings or the blues Do you crave sweets or biscuits and breads?
  13. Do you have a short attention span?
  14. Do you have short term memory loss?
  15. Are colleagues complaining that you are forgetting things?

If you answer yes to 5 or more of these questions, there is a possibility that you are hypoglycaemic.

These are just some of the questions I ask during a consultation. If you you find yourself relating to a significant number of them I would recommend that you seek the appropriate naturopathic/medical help.

Wilson’s Syndrome

If you have a body temperature of less than 98.6 F. and some of the symptoms in the questionnaire you may have Wilson’s Syndrome. This condition involves a disorder where the cells of the body are unable to convert the inactive thyroid hormone, T4, into the more active hormone, T3. Wilson’s Syndrome itself does not alter the thyroid hormone tests. It may exist in association with true hypothyroidism. The presence of the syndrome can often explain the problem of having ‘thyroid symptoms,’ yet the blood test is within the accepted reference interval.

The syndrome is clinically identified by the following:

  • Subnormal Body Temperature. Usually 1 – 1.5 degrees low
  • Thyroid test often “Normal”
  • Irregularities of T3 / T4 thyroid hormone conversion

Wilson’s Syndrome appears to be a survival adaptation, lowering metabolic processes to deal with famines and other problems of food availability, at the expense of some enzymatic efficiency. Under normal circumstances, the body resumes normal functioning when food supply is restored and/or stress removed. The disadvantage of the body going into ‘survival hibernation’, is that not all enzymatic pathways operate at optimal rates during this temporary low nutrition period. In a portion of the population, once the body has entered this “conservation state”, it may stay there for years. If the state persists too long, chronic fatigue, allergy and immune problems, and other “poorly defined” health complaints may become common.

You may be susceptible if you have been subject to:

  • High stress
  • Divorce
  • Death of loved one
  • Extreme family or job stress
  • Other acute or chronic occupational stress

You may be susceptible if you have A family history of:

  • Scottish Ancestry
  • Irish Ancestry
  • Russian Ancestry
  • American Indian Ancestry
  • Holocaust Survivors
  • Chronic Dieters
  • Sufferers of Candida and other yeast problems
  • Persons having hypoglycaemia
  • Persons with eating disorders
  • Persons with sleep disorders

Depression is one of the factors that can accompany low thyroid and AFS (Adrenal Fatigue Syndrome). Deficient levels of dopamine activity in the brain can often be responsible.

Dopamine Deficient Depression (DDD) is experienced uniquely by each individual but the common symptoms/feelings are low energy, lack of motivation and a feeling of grouchiness. A severe case of DDD can leave a person praying to go to sleep and never wake up again, this feeling of life has no point is common but the DDD individual lacks motivation or energy to do anything about it. The DDD state and symptom picture can look very similar to hypothyroidism, where the thyroid gland does not produce enough thyroxin or is suffering from Thyroxin resistance.  Interestingly the neurotransmitter dopamine and the thyroid hormone thyroxin are made from the same amino acid, L-Tyrosine. Taking L-Tyrosine can actually help both conditions. For the pure DDD case thyroid support often helps due to the L-Tyrosine and supporting vitamins, minerals, in the case of a pure thyroid based condition iodine, selenium, iron would be the co-factors of choice.

 

Thyroid – the correct prescribing of thyroid hormones

This has been take from Dr Sarah Myhill’s website with her permission. Sarah Is a fellow member of the British Society of Ecological Medicine (BSEM)

(By Dr Sarah Myhill and Craig Robinson)

There are four reasons why UK citizens are not subject to “best practice” with respect to prescribing thyroid hormones. All relate to the prescribing of thyroid hormone for under-active thyroid glands (hypothyroidism).

The threshold for thyroid stimulating hormone (TSH) is set too high.

When levels of thyroid hormones in the blood start to fall, the pituitary gland increases its output of thyroid stimulating hormone (TSH), which kicks the thyroid into life and increases output of thyroid hormones. If the thyroid gland starts to fail, this is reflected by levels of TSH rising. The question is at what point should the prescription of thyroid hormones begin?

The normal range for TSH in this country varies enormously from one laboratory to another. This means in some locations in the UK a thyroid prescription would not be given until the TSH rose above 5.0mlU/l.

As a result of research, the normal range for TSH in America has now been reduced so that anybody with a TSH above 3.0mlU/l is now prescribed thyroid hormones. This research has shown that people with a TSH above 3.0mlU/l are at increased risk of arterial disease (a major cause of death in Western culture), insulin resistance (and therefore diabetes), inflammation and hypercoagulability (sticky blood). Indeed, there is a recommendation afoot in America to further reduce the threshold for prescribing to 2.5mlU/l.

What is completely illogical is that in UK the target TSH level for patients on thyroid replacement therapy is often stated as being less than 2mlU/l or even less than 1.5mlU/l. This is a ridiculous anachronism given that prescription is not recommended until levels exceed, say, 5.0mlU/l! So, someone could have a level of 4.0mlU/l and not be receiving thyroid replacement therapy (because their level is not above 5.0mlU/l), whereas if someone was on thyroid replacement therapy, a level of 4.0mlU/l would be considered much too high and would need to be brought down to below 2.0mlU/l or even 1.5mlU/l!

We should amend the threshold for prescribing thyroid hormones to 3.0mlU/L or better still 2.5mlU/l.

There is a further inconsistency in BTA (British Thyroid Association) guidelines. The level of thyroid hormones in pregnancy is critical for foetal development. For pregnancy the target for TSH is a level below 2.5mlU/L. Furthermore requirements during pregnancy increase, so thyroid function should be checked every three months. What is the logic of only prescribing thyroid hormones to a non-pregnant woman with a TSH of above 5.0mlU/l but if pregnant the prescribing of thyroid hormones would start when levels exceed 2.5mlU/l?

Dr Kenneth Blanchard states that reliance on a TSH to diagnose hypothyroidism is the biggest single medical error of modern times. It has resulted in millions of people missing out on this safe, life transforming, disease preventing treatment.

Population normal range versus individual normal range – they are not the same

The population normal range for levels of thyroid hormone in the blood is not the same as the individual normal range. We differ as individuals in our biochemistry as we differ in our looks, intelligence and morphology. This biochemical variation should be taken into account when it comes to prescribing thyroid hormones.

The population normal range of a Free T4 is 12 – 24pmol/L. A patient, therefore, with blood levels of 12.1 would be told they were normal because they are within the population reference range. But actually that person’s personal normal range may be high. They may feel much better running a high T4 of say 22, i.e. nearly twice as much but still within the population reference range.

Research done originally in UK, and now repeated in America, clearly shows that the individual normal range of thyroid hormones is not the same as the population reference range. In order to find out who these individuals are, patients have to be assessed clinically as well as biochemically. In actual UK clinical practice this is rarely done except by a few physicians conversant with this issue.

Some people feel better on different preparations of thyroid hormones

In theory, if the patient has been shown to be hypothyroid, then all their symptoms should be improved with synthetic sodium thyroxine. In practice, this is not always the case – there is no doubt that clinically some patients feel very much better taking biologically identical hormones such as natural thyroid (a dried extract of pig thyroid gland which is a mix of T4 and T3). Indeed, before synthetic thyroid hormones became available, all patients were routinely treated with natural thyroid. The purity and stability of these preparations has been long established, indeed much longer established than synthetic thyroxine!

Part of the reason why people feel better taking natural bio-identical hormones is that some people are not good at converting T4 (which is relatively inactive) to T3 (which is biologically active). However, this does not explain the improvement in every case. It is difficult to explain why there should be an additional effect, but for many people it is the difference between drinking cheap French plonk ( Plonk) and good quality Spanish Rioja ( Rioja) . The alcohol content is the same, but the experience completely different!

According to Dr A Toft, Consultant Endocrinologist, Edinburgh, “It would appear that the treatment of hypothyroidism is about to come full circle.”

“In patients in whom long-term T4 therapy was substituted by the equivalent combination of T3 and T4 scored better in a variety of neuropsychological tests. It would appear that the treatment of hypothyroidism is about to come full circle”. Ref: Endocrine Abstracts 3 S40, T3/T4 combination therapy. AD Toft, Endocrine Clinic, Royal Infirmary, Edinburgh, UK. 

Timing of dosing

I have learned much more from consultant endocrinologist Dr Kenneth Blanchard’s book “The functional approach to treating hypothyroidism”. (Amazon.co.uk link to “The Functional Approach to Hypothyroidism”. He makes many useful clinical points:

  • Thyroid hormones should be taken with food – he observes that cravings can be triggered by thyroid hormones on an empty stomach
  • T4 (thyroxin) is slow acting and “base loads”. It is the night hormone – we should split our daily dose into two. The evening dose should be taken with supper which should be at least 4 hours before bed time.
  • By contrast T3 is the day hormone that wakes us up.
  • Our requirements change with the seasons – in Nature TSH falls in winter so levels of T4 and T3 fall – this puts us into semi-hibernation and allows energy conservation by causing mild fatigue and depression with greater need for sleep. The reverse is true for the summer. In modern times with food and warmth aplenty the imperative to do this declines. However some people need more thyroid hormones in winter to prevent severe fatigue and depression. In this event Dr Blanchard suggests “jump starting” followed by a different maintenance dose – so for example in the Autumn someone taking 100mcgms of T4 would have a jump start of 150mcgms for 3 days then maintenance dose of 110mcgms. In the Spring one would do the reverse – stop T4 for 3 days then return to the usual 100mcgms per day.

Some people only feel well using pure T3

At present we do not have biochemical tests to predict who these people are! A reverse T3 test may help but may not. If symptoms are typical of hypothyroidism but not responding to T4 or T4/T3 mixes, then a trial of pure T3 may be in order. T3 is short acting and must be taken at least 3, possibly 5 times daily. The smallest size tablet is prescription only tertroxin 20mcgms (equivalent to 100mcgms of T4). A starting dose would be 10mcgms split into 3 doses – tricky! I suggest crushing half a tablet, and using a wet finger tip to take a third of the powder three times daily. One may know within a few days if this was making a difference but a proper trial would be a few weeks. For details, see Paul Robinson’s excellent book on the subject – Recovering with T3: My Journey from Hypothyroidism to Good Health Using the T3 Thyroid Hormone. (Amazon.co.uk link to “Recovering With T3: My Journey from Hypothyroidism to Good Health Using the T3 Thyroid Hormone”).

For more detailed discussion see Thyroid Hormone Transport where the importance of pure T3 is explained in terms of transport of T3 across cell membranes.

The correct proportion of T4 to T3

Dr Kenneth Blanchard maintains that the correct proportion is 98.5% T4 to 1.5% T3, for some a bit more, others less. Achieving this is difficult because armour thyroid is 80% T4 and 20% T3. He uses slow release T3 – not available in UK. However transdermal T3 could be an option – watch this space!

The timing of dosing with T3 may be critical

Paul Robinson, in his excellent book on T3, hypothyroidism and the Circadian rhythm (Amazon.co.uk link to The Ct3m Handbook) has made the interesting observation that our circadian rhythms, essential to health, are determined by when hormones are produced. Since they work synergistically we need them to be produced at the same time. Timing is triggered by the pituitary gland, the conductor of the endocrine orchestra! It starts with TSH levels rising sharply at midnight and is followed by increases in T4, T3 and cortisol later in the night. As they come together they trigger wakefulness. Paul found out for himself, and proved it to his satisfaction through blood tests, that his health was further improved by taking his morning dose of T3 at 5.30am. See his website Recovering with T3 for his account of this.

Initial improvement followed by decline

Dr Blanchard observed that some patients improved on thyroxin and then worsened. He describes a “sweet spot” of optimal levels of T4. He believes the reason for this is that TSH is partly responsible for converting T4 to T3 – so if levels of these hormones are too high, TSH is switched off and with that comes a switching off of T4 to T3 conversion. T3 is the day hormone that fires us up and because T4 is slow acting there may be a delay in noticing this “switch off” of T4 converting to T3 and this can be clinically very confusing.

Monitoring treatment just by using a TSH can be misleading

In his article (follow the link below in External Links) Peter Warmingham cogently explains how just a TSH is not a good way to monitor replacement therapy. It is vital to measure levels of free T4, ideally free T3 as well, and assess the patient clinically – ie how do they feel? Are there any clinical symptoms of under or over dosing?

Finally anyone who is hypothyroid for reasons other than autoimmunity, is likely to be iodine deficient. 

Why are we seeing an epidemic of thyroid disease?

A whole range of chemicals have been shown to be goitrogenic (substances that suppress the function of the thyroid gland by interfering with iodine uptake) and/or suppressors of the HPA axis and/or suppressors of thyroid hormones uptake and/or suppressors of T3 uptake. These include perchlorates (washing powder), phthalates (added to plastics to increase their flexibility, transparency, durability, and longevity) and bisphenol A (in plastic wrappings), pyridines (cigarette smoke), PCBs and PBBS(fire retardants in soft furnishing), UV screens (sunblocks and cosmetics), and many others. For a full list see Oxford Medicine Chapter 3.2.2 Environmental Factors. A recent study showed that hypothyroidism was 30% more common in areas of fluoridated water – that makes perfect biological sense – fluoride is a smaller molecule which fits and blocks the iodide receptor. Please see Water Fluoridation A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention

Related Articles

Related Tests

Thyroid profile: free T3, free T4 and TSH

External Links


Sarah Myhill Limited

Roderick is the administrator of the Facebook group Thyroid Care Group. The Thyroid Care Group provides support and administration worldwide for those who are seeking information concerning thyroid health and support them during both conventional and naturopathic thyroid treatment. The Thyroid Care Group page provides lots of basic information about what you can do for yourself without having to resort to expensive testing procedures.

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I have had particular success using Ark1 with endocrine management and endocrine/hormonal regulation and function. Arkworld are a small nutrition company with some of the most amazing products in the field of nutrition today. I am particularly fond of ARK1 in my practice.
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