THYROID INFORMATION, RESOURCES AND EXCERPTS OF ARTICLES

For your reference:

USP natural thyroid hormone:

1 grain = 65 mg
½ grain = 32.5 mg
¼ grain = 16.25 mg
1/8 grain = 8.125 mg

Armour, West Throid, WP Thyroid or Nature Throid

(pharmaceutical grade without a slow release):
1 grain = 60 mg
½ grain = 30 mg
¼ grain = 15 mg

Following is a thyroid conversion chart (synthetic thyroid hormone dosages compared to

natural thyroid hormone dosages):

http://centraldrugsrx.com/pdf/Thyroid_Conversion_Chart_08-13a.pdf

__________________

An excellent site about synthetic thyroid hormone versus natural thyroid hormone, as well as
detailed information about the differences of Nature Throid, Armour, West Throid and natural
thyroid. This site connects to other very informative articles written from top thyroid experts,
including renowned thyroid expert, Mary Shomon, author of: Stop the Thyroid Madness

http://jeffreydachmd.com/why-natural-thyroid-is-better-than-synthetic/

Mary Shomon is a leading top thyroid expert and best-selling author in the US. She shares
much info about natural thyroid hormone, different brands, etc. Here is one very good
article:

http://hypothyroidmom.com/thyroid-hormone-replacement-drug-madness/

__________________

Following are excerpts from published articles by the American Association of Clinical
Endocrinologists (AACE), medical doctors, authors and other thyroid experts who state the
present lab reference ranges for TSH are incorrect and that an ideal TSH IS: 1.0-1.5. For quick
reference, please read yellow highlighted sections:
______________________________________________________________________________
http://hypothyroidmom.com/top-5-reasons-doctors-fail-to-diagnose-hypothyroidism/

Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism By thyroid expert, Dr. Weston Wiggy, MD.

The Thyroid Federation International estimates there are up to 300 million people worldwide suffering from thyroid
dysfunction yet over half are presumed to be unaware of their condition. Hypothyroidism, an underactive thyroid, is
one of the most undiagnosed, misdiagnosed, and unrecognized health problems in the world. It is an epidemic that is
sweeping the globe yet doctors are failing to recognize and diagnose hypothyroidism. Hypothyroid patients are
falling through the cracks of mainstream medicine, left to suffer debilitating and even life-threatening symptoms.
What is going on?

1. Reliance on TSH

According to mainstream medicine, TSH (thyroid stimulating hormone) is the gold standard for the diagnosis and
treatment of thyroid dysfunction. This hormone released by the pituitary gland in the brain stimulates the butterfly-
shaped thyroid gland in our necks to produce thyroid hormones. Unfortunately TSH alone does not provide a
complete picture. Most doctors typically don’t run a full thyroid blood panel nor do they investigate fully the
patient’s medical history, symptoms, family history and thorough physical exam. They rely on this one blood test,
TSH, leaving millions of people undiagnosed and suffering from debilitating symptoms.

Many patients complain to their doctors of common hypothyroid symptoms yet because their TSH falls in the
‘normal’ range, their thyroid is declared normal. Patients will walk into their doctors’ offices complaining of fatigue,
weight gain, and depression, and their doctors will pass them prescriptions for sleeping pills and anti-depressants
and tell them to just exercise more, instead of recognizing the underlying thyroid issue.

2. Outdated TSH Lab Ranges

TSH alone does not provide a complete picture. If doctors are going to rely on TSH alone, however, they should at
least give consideration to the controversy over the TSH normal reference range and consider this when diagnosing
patients. Mainstream medicine relies on a normal TSH range from 0.5 to 5.0 with variations depending on the
laboratory. However thyroid advocates and many integrative physicians are fighting to narrow that range. Thyroid
doctor Dr. Weston “Wiggy” Saunders posted this important message on his Dr. Wiggy Thyroid MD Facebook page.

_________________________________
Excerpt of article written by James Faix MD and Linda Thienpont PhD:
http://www.aacc.org/publications/cln/2013/may/Pages/TSH-Harmonization.aspx#Thyroid-
Stimulating Hormone

May 2013 Clinical Laboratory News: Volume 39, Number 5

Thyroid-Stimulating Hormone
Why Efforts to Harmonize Testing Are Critical to Patient Care

By James D. Faix, MD, and Linda M. Thienpont, PhD

TSH Reference Interval

For many years, most physicians have considered TSH levels >10 mIU/L evidence of thyroid
failure, and levels of 5–10 mIU/L evidence of mild or subclinical hypothyroidism. During the
past decade, however, there has been considerable debate about the correct upper limit of
the reference interval for TSH.

Although there is a consensus that the lower limit of the euthyroid reference interval for TSH
should be 0.2–0.4 mIU/L, experts disagree about the appropriate upper limit. In 2002,
researchers published an analysis of thyroid function test results from a large survey of
individuals representative of the U.S. population (3). The study revealed that within a small
standard error the mean TSH level in the general population is approximately 1.5 mIU/L

***

Thyroid: More Evidence That “Normal” is Unhealthy

Posted by Dr. Paul Jaminet on July 30, 2010

Two inexpensive blood tests should be done routinely, but often aren’t: Vitamin D levels (by
serum 25-hydroxyvitamin D) and thyroid stimulating hormone levels (TSH). There are few easier
ways to substantially improve health than to normalize levels of these hormones.

One difficulty, however, is disagreement over what “normal” levels are. The standard “normal”
range for TSH on lab tests is about 0.5 to 4.6 mIU/L. This range originally encompassed two
standard deviations about the US mean, meaning that 95% of the population fell in the
“normal” range. Unfortunately, evidence that TSH values in this range were healthy has always
been lacking. In fact, many people with “normal” TSH live with symptoms of hypothyroidism.
As awareness has grown of the biological significance of thyroid hormone, researchers have
looked more closely into the correlation of TSH levels with health. This research is revealing is
that many people are thyroid-deficient and that improving thyroid status can dramatically
improve health.

The best research has been conducted in Europe:

 The HUNT study of 25,000 healthy Norwegians found that their prospects were
substantially affected by thyroid function. Those with a TSH level of 1.5 to 2.4 were
41% more likely to die over the next 8 years than those with TSH below 1.5; those
with TSH 2.5-3.4 were 69% more likely to die. [1]
 An Italian study showed that pregnant women with TSH between 2.5 and 5.0 had a
miscarriage rate 70% higher than women with TSH below 2.5. [2]

Now, a Dutch study shows that the likelihood of breech birth rises monotonically with the
mother’s TSH levels at gestational week 36. [3] Breech birth is a significant hazard: it commonly
requires a Caesarean section delivery, and both mother and infant are more likely to die or
otherwise suffer damaged health if the baby presents in the breech position. The Dutch study
found that:

 Pregnant women with a TSH of 0.5 or less had NO breech births at all, and those
between 0.51 and 0.71 had only a 1% chance of a breech birth.
 Pregnant women with a TSH between 0.71 and 2.49 had about a 5% chance of
breech birth.
 Pregnant women with TSH of 2.50 to 2.89 had an 11% chance of breech birth, while
those with TSH above 2.89 had a 14% chance of breech birth.

The authors didn’t provide a detailed breakdown of breech rates for TSH levels in the middle
range, but it is a safe bet that TSH levels of 1.5 to 2.49 were much more dangerous than TSH
levels of 0.72 to 1.0.

What these studies are telling us is that:

1. People with the healthiest thyroid status have very low TSH. A TSH level below
0.5 can indicate either hyperthyroidism (too much thyroid hormone) or perfect
health. Any TSH above 0.5 is suggestive of, at a minimum, a slight deficiency of
either iodine or selenium.
2. You can have impaired thyroid status with normal free T4 hormone levels. This
study and others have found that TSH levels, not free thyroid hormone levels, are
the best indicator of health.
3. Health becomes significantly impaired above TSH levels of about 1.5. Any TSH
above 1.5 should be addressed, if only through iodine and selenium
supplementation (or abundant seaweed consumption with ~3 Brazil nuts per day.)
 Since a TSH of 1.5 is about the population mean, it’s a fair inference that most
Americans are needlessly suffering impaired health due to impaired thyroid status.
4. Especially during pregnancy, thyroid and iodine status are critical. Breech birth
and miscarriage are far from the only negative consequences of impaired thyroid
status. An elevated TSH usually indicates an iodine deficiency, and “even a mild
iodine deficiency during pregnancy and during the first years of life adversely
affects brain development.” [4] Iodine deficiency is the most common worldwide
cause of mental retardation (cretinism), and elevated TSH during pregnancy can be
expected to reduce the IQ of the child by up to 10 points and to produce other
neurological deficits, including “visuomotor, memory, attention and posture”
deficits. [5]

So, if your doctor doesn’t do it routinely, ask for TSH and vitamin D measurements at your next
physical. There are few easier ways to improve your health than fixing thyroid and vitamin D
status.

[1] Asvold BO et al. Thyrotropin levels and risk of fatal coronary heart disease: the HUNT study.
Arch Intern Med. 2008 Apr 28;168(8):855-60. http://pmid.us/18443261.

[2] Negro R et al. Increased Pregnancy Loss Rate in Thyroid Antibody Negative Women with TSH
Levels between 2.5 and 5.0 in the First Trimester of Pregnancy. J Clin Endocrinol Metab. 2010
Jun 9. [Epub ahead of print] http://pmid.us/20534758.

[3] Kuppens SM et al. Maternal thyroid function during gestation is related to breech
presentation at term. Clin Endocrinol (Oxf). 2010 Jun;72(6):820-4. http://pmid.us/19832853.

[4] Remer T et al. Iodine deficiency in infancy – a risk for cognitive development. Dtsch Med
Wochenschr. 2010 Aug;135(31/32):1551-1556. http://pmid.us/20665419.

[5] Joseph R. Neuro-developmental deficits in early-treated congenital hypothyroidism. Ann

Acad Med Singapore. 2008 Dec;37(12 Suppl):42-3. http://pmid.us/19904446.

Hypothyroidism, Iodine and selenium, TSH

***

Excerpt of article written by Steve Magness, Author of Stop the Thyroid Madness:

http://www.scienceofrunning.com/2013/04/thyroid-madness-everything-you-need-to.html

Once you start taking the drug, it’s all about fine tuning your dose. The goal is essentially to
regulate TSH to a “normal” level. The consensus by several Endocrinology societies is to try and
get the TSH between 1-1.5.

***
The Tragic and Invisible Epidemic of Thyroid Disease

http://www.vitality101.com/health-a-z/Thyroid-
tragic_and_invisible_epidemic_of_thryroid_disease

Published: October 5, 2012 by best-selling author and thyroid researcher Dr. Jacob Teitelbaum

For over a decade, research by Jacob Teitelbaum M.D. author of the best-selling book "From
Fatigued to Fantastic!"1 has shown that hypothyroidism, like most other illnesses that affect
predominantly women, has been dramatically under diagnosed.2,3 The American Academy of
Clinical Endocrinologists (AACE), the nation's largest organization of thyroid specialists, has now
confirmed this. After a 2002 meeting, the normal range for thyroid tests was dramatically
narrowed. As noted in the AACE press release:

Now, more than 6 years after the new directives have been given, doctors are still largely
unaware of these new lab guidelines for diagnosis and therapy. Even the major labs doing
thyroid testing have not bothered to change the now incorrect normal ranges for both
diagnosis and therapy of thyroid disorders.

***

Optimum Diagnosis and Treatment of Hypothyroidism With Free T3 and Free T4 Levels

Diagnosis of Hypothyroidism

The big myth that persists regarding thyroid diagnosis is that an elevated TSH level is always
required before a diagnosis of hypothyroidism can be made. Normally, the pituitary gland will
secrete TSH in response to a low thyroid hormone level. Thus an elevated TSH level would
typically suggest an underactive thyroid.

The traditional tests of thyroid function, the T4 (or total T4), T3-uptake, FTI, 'T7', total T3, and
T3-by-RIA tests should be abandoned because they are unreliable as gauges of thyroid function.
The most common traditional way to diagnose hypothyroidism is with a TSH that is elevated
beyond the normal reference range. For most labs, this is about 4.0 to 4.5. This is thought to
reflect the pituitary's sensing of inadequate thyroid hormone levels in the blood which would
be consistent with hypothyroidism. There is no question that this will diagnose hypothyroidism,
but it is far too insensitive a measure, and the vast majority of patients who have
hypothyroidism will be missed.

The clinical symptoms of hypothyroidism are many. Perhaps the most common is fatigue. The
skin can become dry, cold, rough and scaly. The hair becomes coarse, brittle and grows slowly
or may fall out excessively. There is a sensitivity to cold with feelings of being chilly in rooms of
normal temperature. It is difficult for a person to sweat and their perspiration may be
decreased or even absent even during heavy exercise and hot weather. Constipation that is
resistant to magnesium supplementation and other mild laxatives is also another common
symptom. Difficulty in losing weight despite rigid adherence to a low grain diet seems to be a
common finding especially in women. Depression and muscle weakness are other common
symptoms.

Most patients continue to have classic hypothyroid symptoms because excessive reliance is
placed on the TSH. This test is a highly accurate measure of TSH but not of the height of thyroid
hormone levels.

The basic problem that traditional medicine has with diagnosing hypothyroidism is the so called
"normal range" of TSH is far too high: Many patients with TSH's of greater than 1.5 (not 4.5)
have classic symptoms and signs of hypothyroidism.

The alternative to monitor thyroid disease is to use the Free T3 and Free T4 and TSH levels and
interpret them with new reference ranges. If one measures the Free T3 and Free T4 levels the
only accurate measure of the actual active thyroid hormone levels in the blood, as well as the
TSH, one will find out how often a low normal TSH does NOT exclude hypothyroidism. It is
relatively common to find the Free T4 and Free T3 hormone levels below normal when TSH is in
its normal range, even in the low end of its normal range. When patients with these lab values
are treated, one typically finds tremendous improvement in the patient, and a reduction of the
classic hypothyroid symptoms.

There are a significant number of individuals who have a TSH below 1.5 but their Free T3 (and
possibly the Free T4 as well) will be below normal. These are cases of secondary or tertiary
hypothyroidism, so, TSH alone is not an accurate test of all forms of hypothyroidism, only
primary hypothyroidism.

This revised method of diagnosing and treating hypothyroidism seems superior to the
temperature regulation method promoted by Broda Barnes and many natural medicine
physicians.

Treatment of hypothyroidism

After proper diagnosis of hypothyroidism, the next issue is with what substance to treat.. The
traditional approach is to use Synthroid/ Levoxyl/Levothroid (levothyroxine) which is only T4.
Natural medicine doctors tend to use Armour thyroid which is a mixture of mono and di-
iodothryonine and T3 and T4, the entire range of thyroid hormones.

If the Free T3 level is significantly lower than the Free T4 level, it is next to useless to treat with
Synthroid/ Levoxyl/Levothroid (T4) only replacements. If the patient could not muster sufficient
T3 from their gland (which produces some T3 directly), then they are certainly not going to
convert enough T3 from T4 only. Traditional medicine assumes that preparations like Synthroid
which are T4 only converts peripherally in the body to T3 in fairly standard amounts and at
fairly standard rates. Unfortunately, clinical experience shows this is not true for the majority of
patients. Consistent measuring of both free T3 and free T4 blood levels in hypothyroid patients
who are on T4 only therapy will very rapidly dispel this myth. A certain percentage of
hypothyroid patients do convert enough T4 to T3 at a sufficient rate for T4 treatment to be
adequate as a source of T3; but a substantial proportion of patients require some combination
of both exogenous T3 and T4.

Once on hormone replacement, the TSH remains useful until it goes BELOW 0.4. Then one has
optimized thyroid function by the TSH yardstick; it then remains to optimize thyroid function by
the yardstick of the accurate measures of the 2 thyroid hormones, the Free T4 and Free T3
levels.

So one should use a combination of T4 and T3 which compensates for the inability to convert
T4 to T3. This is most frequently done with Armour thyroid. However, Cytomel, which is T3
only, can be used in combination with one of the T4 only preparations. It is important to
recognize that T3 should always be prescribed twice daily due to its shorter half life. This is
typically after breakfast AND supper for compliance reasons.

Taking the dose at these times overcomes traditional medicine's major objection and resistance
to using natural thyroid preparations - its variability in its blood levels. Armour thyroid is
desiccated thyroid and has both T3 and T4. Most doctors using Armour thyroid are not aware
that Armour thyroid should be used twice daily and NOT once a day. The major reason is that
the T3 component has such a short half life and needs to be taken twice daily to achieve
consistent blood levels.

Once or twice daily dosing one can then optimize both the T4 and T3 levels, with whatever
thyroid preparation is required. This is not possible in most hypothyroid patients with T4 only
preparations. It is important to use a preparation with T3 because T3 does 90% of the work of
the thyroid in the body. The only exception to pursue optimization of the T3 level without using
Armour thyroid is in severe acute cardio-pulmonary conditions, when the metabolic slowing
effect of a low FT3 level can actually be life-saving. However, the vast majority of hypothyroid
patients do not have acute cardio-pulmonary conditions, such as congestive heart failure.

The most common starting dose for patients with hypothyroidism is Armour thyroid, 90 mg
which is cut in half with a razor blade and half is taken after breakfast and the other half after
dinner. Taking it after meals also helps to reduce volatility of the blood-level of T3. If the patient
has any problem breaking or cutting the pill, they should purchase a pill-cutter at the pharmacy.
The TSH, Free T3 and Free T4 are then repeated in one month and the dose is adjusted.

In order to optimize the hormone replacement, the Free T3 and Free T4 should be above the
median but below the upper end of the laboratory normal reference range. The goal for healthy
young adults would be to have numbers close to the upper part of the range, and for cardiace
and/or elderly patients, the numbers should be in the middle of its range. The Free T3 and Free
T4 levels should be checked every month and the hormone therapy readjusted until the Free T3
and Free T4 levels are in the therapeutic range described. A small number of large, overweight,
thyroid-resistant women may need 6-8 grains of Armour Thyroid or the equivalent of thyroxine
per day (counting 0.1mg of T4 as 1 grain of Armour Thyroid).

If the patient is currently taking Synthroid (thyroxine), their Free T4 level is usually at or above
the high end of its normal range and the Free T3 level is below. In this situation, or if a patient is
allergic to Armour thyroid or is resistant to taking Armour thyroid, one may then add 5-12.5
mcg Cytomel (pure-T3) after breakfast and supper daily, rather than Armour Thyroid or Thyrolar
(synthetic T4/T3 combo). It is important to remember that if the FT4 is being raised by a still-
high TSH, the FT4 level will drop some when the TSH drops when adequate T3 is added to the
hormone replacement.

Patients need to be warned about the overdosage symptoms which are frequently only
temporary during the adaptation stage. The symptoms may include: palpitations, nervousness,
feeling hot and sweaty, rapid weight-loss, fine tremor, and clammy skin. There is one exception
to the 1.5 level of TSH as the cutoff for treatment. Overweight patients who have classic
symptoms of hypothyroidism and have made heroic unsuccessful attempts to lose weight may
benefit from thyroid hormone replacement even if their TSH slightly below 1.5 and FT4 and FT3
are not below their normal ranges

Patients who are already on once daily Armour thyroid should split their doses immediately and
take half after breakfast and half after dinner. Since the only change will be in the FT3 level,
which has a short half-life, the serum FT4 and FT3 levels (and TSH, if indicated) can be
measured 48-72 hrs after the splitting of the doses if the patient had been on the hormone for
4-6 weeks before the splitting of the doses. This is because the T4 fraction is the one that takes
a number of weeks to build up to its steady-state serum level.

For more Information, read thyroid articles on Mercola.com

Article written by Dr. John Biffa MD

More evidence that ‘normal’ thyroid function tests do not necessarily mean that all is well
with the thyroid and health
By Dr John Briffa on 30 April 2008 in Food and Medical Politics, Women's Health

Earlier this month, one of my blogs focused on thyroid function testing. The main point I
wanted to make was that ‘normal’ thyroid function tests do not necessarily mean all is well with
the thyroid and health. The blog focused on research that shows that even with the ‘normal’
range, higher levels of the hormone known as thyroid stimulating hormone (raised levels of
which generally mean low thyroid function) are associated with increased body weight.

This week saw the publication of a study in a similar vein [1]. In this case, the researchers
involved in this study were looking at the relationship between TSH (also known as thyrotropin)
levels and risk of death due to a heart-related condition (heart attack being the main cause
here).
Again, this study focused on TSH levels in the ‘normal’ range, which the researchers cite as 0.5-
3.5 mlU/L. This is interesting in itself, as the lab I usually use for these tests quotes and upper
limit of TSH of 4.20, and I saw a patient yesterday who came with some blood test results
where the upper limit of TSH was quoted as 5.50! It seems there is a lack of consensus about
what the normal range of TSH should be�

Anyway, focusing back on the study, the research looked at the risk of cardiac death in a group
of about 17,000 women and 8000 men over a period of something more than 8 years.

They found no significant relationship between TSH levels and cardiac death risk in men.
However, in women, it was a different story. Compared to women with a TSH level of 0.5-1.4
(relatively low levels which should mean relatively high thyroid function):

Women with a TSH level of between 1.5-2.4 were found to be at a 41 per cent increased risk of
cardiac death.

Women with a TSH level of between 2.5-3.5 were found to be at a 69 per cent increased risk of
cardiac death.

Here again, it seems a study has found that ‘normal’ but perhaps somewhat impaired thyroid
function is associated with negative consequences for health.

Managing thyroid issues can be tricky, but I do think there is a case for treating some people
with ‘normal’ biochemistry if their clinical picture suggests low thyroid function. Biochemical
testing can be important, but at least as important, in my humble opinion, is to make treatment
decisions on what a doctor sees and hears in front of him or her.

Quite a few doctors I know express concern at the thought of someone with ‘normal’ test
results taking thyroid hormone. They often cite the risk of treatment, including risks to the
heart. Obviously, I think it’s a good thing that as doctors we should be aware of the risks
associated with thyroid hormone treatment. I just wish more doctors would see the other side:
that there can be considerable risks associated with not treating too.

Article written by Dr. Christiane Northrup MD

http://www.drnorthrup.com/womenshealth/healthcenter/topic_details.php?topic_id=59
 To find out if you have a thyroid disorder, work with a physician who understands thyroid
problems. Ask for a full panel of tests, including TSH, free T4, free T3, T3 uptake, and T4 uptake.
These tests are considered a complete battery of thyroid function tests. If you can afford only
one, however, make it a TSH (thyroid-stimulating hormone). This is the most sensitive test. The
following are the conventional lab values for various thyroid hormone markers:

 TSH: "Normal" / Random 0.3 – 5.0 mU/L (Newer data suggests that the TSH level should be
between 0.3 and 1.5. And that 5.0 is far too high. I agree!)
 TSH: High–Normal 3.0–5.0 mU/L
 TSH: Following Thyroid-Releasing Hormone (TRH) stimulation at 20–30 min 9 – 30 mU/L
 TSH: Borderline Increased 5 – 10 mU/L (I believe that borderline is anything over 1.5)
 TSH: High >10 mU/L
 Triiodothyronine (T3) 80 – 180 ng/dL
 Free T3 230 – 619 pg/dL
 Thyroxine (T4) 4 – 12 mg/dL
 Free Thyroxine (Free T4) 0.7 – 1.9 ng/dL
 Thyroid Peroxidase Antibodies (anti-TPO) < 2 IU/mL

Hypothyroidism can be difficult to diagnose, because there is a continuum between overt and
subclinical hypothyroidism, with a great deal of overlap between the two. Depending upon
which expert you talk with and which criteria are used for the diagnosis, as many as 25 percent
of perimenopausal women have some kind of thyroid problem. Most of these are cases of
subclinical hypothyroidism: Although symptoms may be present, tests of thyroid function are
only slightly abnormal; for example, thyroid stimulating hormone is slightly elevated, with
normal levels of T3 and T4. Some argue that the "normal" range for TSH in most labs (0.5–5.0
mU/L) is too broad and that normal should be only 0.50–2.0 mU/L. I completely agree and
would use 1.5 as the cut off.

_________________________________________________________________

1. Excerpt from article written by Dr. David Marquis:

http://www.drdavidmarquis.com/thyroid.shtml

While searching for better ways to help my patients, I was fortunate to learn of Dr. Datis
Kharrazian, a pioneer in natural health care and author of the best selling book "Why do I Still
Have Thyroid Symptoms When My Thyroid Tests Are Normal?". I have spent a great deal of time
studying his work and in fact learning directly from him for quite some time now. On this page
you will have the opportunity to learn of some fundamental aspects of thyroid function and
dysfunction. I highly recommend reading Dr. Kharrazians book as well.

Introduction to Functional Thyroid Disorders

Functional thyroid disorders are incredibly common and often overlooked in our current
healthcare model. Most patients that have functional thyroid imbalances do not have primary
thyroid imbalances. In fact 5 out of every 6 thyroid patients are suffering from an undiagnosed
auto-immune problem driving their thyroid problem.

Thyroid problems are often misdiagnosed and mis-treated . . . and women are often affected
the most. Over 80% of our patients who have a thyroid problem are not being treated in a
manner that will provide them long term solutions and many are experiencing their problem
worsen because the root cause has been overlooked.

See if this sound familiar? Your labs come back "Normal" and yet you still feel tired, achy, cold,
depressed and mentally sluggish. I can't tell you how many people have been told…"go home,
get some rest, your blood work looks normal, you are probably just over worked."

Or even worse, you are put on thyroid hormone replacement and you still have all the
symptoms of hypothyroidism but your lab tests show that your thyroid levels are good. And
worst of all it's difficult to get anyone to listen to you. So now what do you do?

You go through your day with any one or more of these symptoms (some poor souls have them
all!).

Book by Dr. Kharrazian

It doesn't have to be that way. I have found that most patients will have inadequate labs (often
only two tests done: TSH and T4) to determine if they have a thyroid problem. These two tests
offer a simple screening for thyroid function but they certainly don't provide the complete
picture! Did you know there are over 20+ ways that your thyroid can go bad? Fundamentally
there are 6 major categories for thyroid dysfunction and 24 subsets off of these 6. And, only
one of those ways will respond to typical replacement therapy. So why is everyone treated with
hormone replacement if only 1 out of 6 will actually be resolved with the medication? Not
everyone fits into the replacement model of treatment. Modern approaches allow us to
determine your specific needs and then let the body correct itself with proper neurological and
metabolic support.

Don't go on feeling frustrated. We will always listen to your concerns and help you chart a
course to get you back on track. You need Comprehensive Blood Work (see our Laboratory
Analysis page) and Functional Neurological Analysis will help us determine the shortest path to
getting you better.

If you are ready to reserve an appointment please call (805) 481-3499. Below you will find
some core information on thyroid and the physiology of the gland.

Thyroid Physiology Review

Once the thyroid is stimulated by Thyroid Stimulating Hormone (TSH) from the pituitary, it
produces thyroxine (T4) and triiodothyronine (T3) by transporting iodine into the thyroid and by
stimulating Thyroid Peroxidase Activity (TPO). TPO is involved in the formation of T4 and T3 as it
catalyzes the oxidation of iodine using hydrogen peroxide. The thyroid will produce 94% of the
available T4 and 7% of the available T3. As we know, T4 is inactive and T3 is an active thyroid
hormone. Therefore, the majority of hormone production at the thyroid is inactive T4. Once the
thyroid has produced T4, it is metabolized peripherally from the thyroid into combination T3
hormones by the enzyme 5' deiodinase, mostly at the liver. Under normal circumstances, about
40% of the available T4 is converted into T3, 20% is converted into reverse T3 (rT3), which is
irreversibly inactive, and 20% is converted into T3 sulfate (T3S) and triiodothyroacetic acid
(T3AC). T3S and T3AC are inactive thyroid hormones until they circulate into the
gastrointestinal tract and are acted upon by intestinal sulfatase into active T3. Gastrointestinal
sulfatase activity is dependent upon a healthy gut microflora.

So with most of your thyroid hormone conversion occurring in the liver and gut what happens if
your liver function is compromised or your have an inflamed gut. Do you know anyone with
either or both of those problems? The funny thing is (and its not really funny) that most people
end up being told they have 3 distinct problems and never realize that their GI problems and
toxic liver and Thyroid dysfunction are all part of the same disease. This is why so many people
are suffering and being medicated but not finding resolution to their complaints. Looking at
Thyroid dysfunction requires a comprehensive metabolic and neurological approach. In this
way no stone is left unturned and although the process generally takes time patients do finally
find the relief they have been seeking.

Understanding Thyroid Markers and Panels

TSH: Thyroid Stimulating Hormone (TSH) is also called thyrotropin. The pituitary releases this
hormone after the hypothalamus releases TRH (thyrotropin-releasing-hormone). This is the
most common marker used to assess thyroid function and it is also the most sensitive. The TSH
levels increase when the T4 levels drop, and the TSH falls when T4 levels increase. This is the
only test performed in the traditional health care model as a means to screen the patient for
thyroid disorders; this is because they are only concerned for screening the thyroid for
hormone replacement and not optimal physiological function. A TSH test alone does not
consider thyroid pituitary feedback loops, peripheral thyroid metabolism, or potential or active
risk factors as identified by antibody testing.

A high TSH with or without changes in T4 or T3 is diagnostic to determine hypothyroidism. If the

thyroid is not making enough T4, the pituitary will pump out TSH to stimulate its production. A
low TSH is used to determine hyperthyroid activity. If the thyroid is overactive such as in
Grave's disease, the antibodies bind to active thyrotropin(TSH) receptors on the thyroid cells
and stimulate T4 production without the influence of TSH. Please note that some antibodies
may inhibit thyroid function by inactivating instead of stimulating thyrotropin receptors. This is
called an autoimmune hypothyroid. These patterns will demonstrate a hypothyroid pattern
(elevated TSH) with elevated thyroid antibodies.

What is a Reference Range?

Reference range is a critical component, and the validity of the entire TSH test as diagnostic tool
depends on it. A TSH reference range is obtained by taking a large group of people in the
population, measuring their TSH levels, and calculating a mean value. Supposedly, these people
should be free of thyroid disease, so that the level represents the mean TSH of a typical thyroid
disease-free person in the population. The reference range is what determines whether or not
thyroid disease is even diagnosed at all, much less treated, and when it is diagnosed, how it is
treated.

Currently, at most laboratories in the U.S., the reference range for TSH tests is approximately
0.5 to 5.0. Depending on the lab, you may seem some variations, i.e., 0.4 to 5.5, or 0.6 to 5.7,
etc., but generally, 0.5 to 5.0 is considered typical of many labs.

Typically, doctors interpret levels below 0.5 as indicative of hyperthyroidism (an overactive
thyroid), and levels above 5.0 as indicative of hypothyroidism (an underactive thyroid.)

Changing the Reference Range

After noticing that patients who had TSH levels in the higher end of the normal range tended to
go on to develop hypothyroidism more often than those in the lower end of the spectrum,
researchers delved more fully into understanding the validity of the reference ranges in use.
They found that the upper TSH normal range has traditionally included people who have mild
thyroid disease, and their higher TSH levels skewed the standard curve, potentially making the
reference range wider than it should be, and excluding some people who legitimately had a
thyroid condition.
These findings led to the recommendation in January 2003 by the American Association of
Clinical Endocrinologists (AACE) that doctors "consider treatment for patients who test outside
the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.0. AACE believes
the new range will result in proper diagnosis for millions of Americans who suffer from a mild
thyroid disorder, but have gone untreated until now."

In a statement from the AACE, Hossein Gharib, MD, FACE, and president of AACE at the time,
said, "The prevalence of undiagnosed thyroid disease in the United States is shockingly
high...The new TSH range from the AACE guidelines gives physicians the information they need
to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health
- such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression."

AACE cited as evidence the guidelines issued by the National Academy of Clinical Biochemistry,
part of the Academy of the American Association for Clinical Chemistry (AACC), and presented
in their Laboratory Medicine Practice Guidelines for the Diagnosis and Monitoring of Thyroid
Disease. Late in 2002, the group concluded that "it is likely that the current upper limit of the
population reference range is skewed by the inclusion of persons with occult thyroid
dysfunction."

In their guidelines, the National Academy of Clinical Biochemistry reported that: "In the future,
it is likely that the upper limit of the serum TSH euthyroid reference range will be reduced to
2.5 mIU/L because 95% of rigorously screened normal euthyroid volunteers have serum TSH
values between 0.4 and 2.5 mIU/L." They also stated that "a serum TSH result between 0.5 and
2.0 mIU/L is generally considered the therapeutic target for a standard L-T4 replacement dose
for primary hypothyroidism."

***

Turkish researchers, reporting in the International Journal of Clinical Practice, looked at Thyroid
Stimulating Hormone (TSH) levels and the connection to a number of cardiovascular risk
factors, including homocysteine, C-reactive protein (CRP), fibrinogen, D-dimer and serum
cholesterol levels. The patients were all taking levothyroxine, the synthetic thyroid medication.
More than 400 patients were evaluated, and evaluated as part of three groups. Group 1
patients had a TSH value of 0.4 to 2.0, and Group 2 were from a TSH of 2.0 to less than 5.5, and
Group 3 were from 5.5 to less than 20.

The researchers found that as TSH level elevated, so did homocysteine and CRP levels, with the
highest levels seen in Group 3 patients. Elevated homocysteine is a risk factor for heart disease,
and elevated CRP is additionally a marker for inflammation. No statistically significant
differences were noticed in respect to fibrinogen and d-dimer levels between three groups.
There was some correlation between TSH and cholesterol levels.
The key conclusion of the researchers? A target TSH level of less than 2 is advisable to lower
CRP levels and homocysteine levels, and possibly lipid parameters.

Targeting a TSH level of 2.0 or less is controversial, however. Currently, the recommended
reference range for TSH is from approximately 0.3 to 3.0. A much wider range of approximately
0.5 to from 5.0 to 6.0 is being used by labs and doctors who are not following the latest
recommendations by the American Association of Clinical Endocrinologists. (This controversy is
described in detail in my article, The TSH Wars.

***

Excerpt from article written by Dr. Bruce Rind MD

* Routine Testing: Free T3, Free T4, TSH.

* If there is a suspicion of Hashimoto’s Thyroiditis, I include TPO and ATA. I also use this to
monitor the severity of the Hashimoto’s Thyroiditis and to see if therapy is working.
* If there is suspicion of Grave’s Disease, I include TSI.

Which lab values are the most meaningful? Lab reports tend to provide only the high and low
limits of ‘normal’ values. Since we are striving for ‘optimal’, the ranges for optimal are noted
below along with standard lab high and low values. These optimal range values are based on
my observation of nearly 5,000 patients and reflect the lab test values that my healthiest
patients tended to have, e.g. a professional tennis player with a sprained ankle. Remember that
the optimal zone is an approximation and that it is meant to be used as a rough guide. People
can feel well outside the optimal range but the chances of feeling well become more remote
the further we get from the optimal zone. Note that laboratory techniques for these tests vary
and lab values may have a 5-10% margin of error depending on the laboratory used.

Test Lab Low Optimal Range Lab High

TSH 0.5 1.3-1.8 5.0
Free T4 0.8 1.2-1.3 1.8
Free T3 230 320-330 420
Free T3* 2.3 3.2-3.3 4.2
*Some labs divide FT3 results by 100 thus 230 is the same as 2.3,
etc.

In the cases of Free T4 (FT4) and Free T3 (FT3), the optimal zone is roughly half way between
the usual lab normal Low-High values. Note that the normal range for these hormones may
change a bit from lab to lab. In the case of TSH, the optimal zone is skewed far toward the low
end of the standard lab Low-High range.

***
Article written by Dr. Kent Holtorf MD
Excerpt from article: http://nahypothyroidism.org/how-accurate-is-tsh-testing/

How Accurate is TSH Testing?

Diagnosis of Hypothyroidism:
Are we getting what we want from TSH testing?

While a normal TSH cannot be used as a reliable indicator of global tissue thyroid effect, even a
minimally elevated TSH (above 2) demonstrates that there is diminished intra-pituitary T3 level
and is a clear indication (except in unique situations such as a TSH secreting tumor) that the rest
of the body is suffering from inadequate thyroid activity because the pituitary T3 level is always
significantly higher than the rest of the body and the most rigorously screened individuals for
absence of thyroid disease have a TSH below 2 to 2.5 (106). Thus, treatment should likely be
initiated in any symptomatic person with a TSH greater than 2. Additionally, many individuals
will secrete a less bioactive TSH so for the same TSH level, a large percentage of individuals will
have reduced stimulation of thyroid activity, further limiting the accuracy of TSH as a measure
of overall thyroid status. Reduced bioactivity of TSH is not detected by current TSH assays used
in clinical practice.

Due to the lack of correlation of TSH and tissue thyroid levels, as discussed, a normal TSH
should not be used as the sole reason to withhold treatment in a symptomatic patient. A
symptomatic patient with an above average reverse T3 level and a below average free T3 (a
general guideline being a free T3/reverse T3 ratio less than 2) should also be considered a
candidate for thyroid supplementation (13,14,18,69-76,85-106). A relatively low sex hormone
binding globulin (SHBG) and slow reflex time can also be useful markers for low tissue thyroid
and levels and can aid in the diagnosis of tissue hypothyroidism (93,107,115).
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