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853 Thyroid Controversies

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Bonus Interview:
Dr. Kirk explains the current medical approach to diagnosing and treating thyroid disorders.

click here if you cannot view audio player: DeepaKirkThyroidExtended.mp3

Bonus Interview:
Mary Shomon offers an expert patient's perspective on thyroid diagnosis and treatment.

click here if you cannot view audio player: ShomonThyroidExtended.mp3

Bonus Interview:
Dr. Holtorf describes alternative treatments for thyroid problems.

click here if you cannot view audio player: HoltorfThyroidExtended.mp3

Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here's what it's about:

Thyroid dysfunction is extremely common, and the symptoms make a person miserable. They are often non-specific, however, and it sometimes takes a while for the big picture of thyroid disease to emerge from the details of fatigue, dry skin, constipation, heavy menstrual periods, hair loss and so forth.

The diagnosis and treatment of underactive thyroid have been changing. We get both conventional and alternative perspectives from leaders in the field, offering views on the use of TSH for monitoring thyroid function as well treating with T4 alone vs T4 plus T3 or even the natural treatment, desiccated thyroid gland.

Guests: Deepa Kirk, MD, is assistant professor in the department of medicine at the University of North Carolina at Chapel Hill School of Medicine in the division of endocrinology and metabolism. The photo is of Dr. Kirk.

Kent Holtorf, MD, is founder and medical director of Holtorf Medical Group, specializing in innovative evidence-based therapies for hard-to-treat and poorly understood illnesses: hypothyroidism, complex endocrine dysfunction, chronic fatigue syndrome, and fibromyalgia. He established the National Academy of Hypothyroidism at NAHypothyroidism.org


Mary Shomon is a nationally-known patient advocate and author of many books, including Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know. Her latest book is The Thyroid Diet Revolution. She manages two popular Web sites on thyroid issues: http://thyroid.about.com and www.thyroid-info.com. Mary also edits a newsletter for patients, Sticking Out Our Necks.


The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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Your discussion failed to mention that Dr. Holtorf is extremely controversial and borders on malpractice in the treatments he advocates. I am certain that some individuals who cannot lose weight will happily blame some problem other than over eating. Americans are generally more accepting of therapies that do not involve any personal responsibility. Andrew Tice MD MPH

On the Peoples Pharmacy Program an under active thyroid was mentioned ..what about an over active thyroid?? My mother was in for a regular checkup in July resulting in a normal thyroid test. By September her thyroid was way over active,to the point where the doctors eliminated her thyroid gland.

By the end of February the next year my mother was deceased due to pancreatic cancer. Does the testing of an over active thyroid have any connection to an early diagnosis of pancreatic cancer?? This not only happened to my mother ...it happened to her cousin as well. Has there been any research done on an over active thyroid dealing with pancreatic cancer is my question?? If not, could there be?

Although you prefaced your discussion with the acknowledgment that these topics may be controversial, you did not adequately address the conflict of interest inherent in having an "expert" who markets his own line of alternative treatments. I am further disturbed by Holtorf's statement that patients should change their doctors, if they cannot convince them to change treatments. He seems to be intent on getting more business for himself.

Offering him a platform with very little challenge is an extreme disservice to your listeners. It is very difficult to deal with chronic fatigue, and we would all love to have the magic answer. Acknowledging the limits of modern medicine is much harder (and less profitable) than claiming to be the Messiah who brings salvation.

PEOPLE'S PHARMACY RESPONSE:

Dear Denise, We presented 3 different perspectives:

1) Standard academic endocrinology viewpoint
2) Dr. Holtorf's alternative approach
3) A patient advocate's perspective

We like to let our listeners hear a variety of voices on a controversial subject.

Very helpful for me. I am type 1 diabetic and found I had low thyroid function. Fortunately for me my P.A. listed to me when I suggested that "T3 does matter" after listening to a previous show and this one. I am feeling great again. Way to go Peoples' Pharmacy!

I had the right lobe of my thyroid remove 4 years ago after my doctor watched a small growth over two years. In spite of several tests to determine what the growth was. Fortunately it was not cancer but six months later my mammography (#41) at 62 years of age turned out to show a single small area (less than a 1/2 centimeter) which in fact turned out to be cancer. I asked if there might be a connection but was told no.

Within 3 months of the thyroid surgery I was on a small dosage of synthroid. It remained so for about two years and then slowly began to move up. I was also on tamoxifen and a statin. I started to notice that my hair was thinning and my nails were splitting. When I spoke with my doctor she said it wasn't related to the thyroid med. she did lower it though. I also am now mildly anemic which she prescribed an iron supplement to deal with. Today I am listening to your show and I learn that the iron and calcium I am taking should not be taken for at least 4 hours instead of the one hour recommended by my doctor.

I will also be seeing my oncologist to see what the anemia is about since the iron supplement did not change the anemia. I love your show and I think there needs to be a special field for doctors who treat drug interaction. It seems that in spite of the expensive medical costs we are still left at the mercy of good doctors who just pay more attention to the drug company claims and not what these cocktails which include all the supplements, will do to a person.

There are thousands of practicing doctors who, in their medical training, received very little training in endocrinology and very little (or none) in nutrition. Any patient with hypothyroidism symptoms and who is getting no help from a doctor who relies only on the TSH blood test is WELL-ADVISED to look for a doctor who is up-to-date on this issue. There is great help to be had and no need to suffer for years like so many have been made to do.

For those who suspect they may be suffering from symptoms of low thyroid and have not yet gone through the process of trying to get a proper diagnosis and proper treatment, and who may be confused by Denise's comments, keep in mind that his comments are also most probably profit motivated.

Low thyroid creates a "constellation of symptoms" that profoundly affects ones sense of well-being, energy, and overall health. Proper diagnosis and treatment can wonderfully enhance one's life. Of course, the consequence of failure to properly diagnose and treat low thyroid is repeated visits to doctors offices for decades with no relief for the patient.

For those who suspect they may be suffering from symptoms of low thyroid and have not yet gone through the process of trying to get a proper diagnosis and proper treatment, and who may be confused by Denise's comments, keep in mind that his comments are also most probably profit motivated.
Low thyroid creates a "constellation of symptoms" that profoundly affects ones sense of well-being, energy, and overall health. Proper diagnosis and treatment can wonderfully enhance one's life. Of course, the consequence of failure to properly diagnose and treat low thyroid is repeated visits to doctors offices for decades with no relief for the patient.

I was treated with Levothyroxine for 18 years. Then I developed Fibromyalgia and went to the Fibro & Fatigue Center for 9 months. They diagnosed low thyroid, explained "reverse T3," and began treating me with a compound of T3.

During the next 9 months, I got sicker & sicker and lost 25 lbs. I was gaunt. I finally went to the Mayo Clinic where I met with the chair of the Endocrinology, and he totally debunked this notion of "reverse T3," saying the straight T3 I was taking was totally unreliable, and had put me in danger. He put me back on Synthroid where over the next 6 weeks I stabilized & regained about 10 lbs. I still had Fibro, which they've treated with other meds, and I have done really well. I look good & usually feel good.

This guy is peddling dangerous false science. DON'T make the mistake I did by believing this garbage.

Well I would be willing to dismiss this guy for his profit pushing except for the fact that I'm 2.8 and the range is 3 or 5 depending on who you ask so i'm either just under or right smack in the middle. I have chronic illness, stress and all the other factors he listed including a genetic predisposition to Crohn's and FMS and CMS and when I convinced a Doc that we should experiment it was like the elusive magic bullet pill that everyone said did not exist.

Synthroid rocked. I agree if your doc is not listening to you that you should doc shop but sometimes being told no is a good thing and there's a reason. Am going through genetic testing next week and if that turns out negative think I will have a talk with my endocrinologist about whether or not it's time to experiment again.

Didn't realize there was so much controversy about treatment. Will also definitely check my tpo as I'm not positive it's been done before but since I know they have checked for hashimoto's think maybe it has. More research mode for me i guess as I'm almost 42 and am about to have a hysterectomy due to endometriosis and that will sink my metabolism even lower than it currently is and due to birth deffects and pain conditions any exercise is extremely crippling and eating so few calories i walk around with a headache and crap attitude all day barely tips the scale at a pound or so. Also know my temp is 97.3 and not 98.6 like normal people.

I know I have to get my bmi down because while i'm not extremely obese I know my pain would be less if I could lose 20-30 lbs.

Thank you, thank you, thank you Dr. Holtorf for describing so succinctly the issues that I have been dealing with for years. I was diagnosed with fibromyalgia (of which a major component is the thyroid issues (reverse T3 to T3 ratio) about 3 years ago (have had it for 20 years and have been misdiagnosed).

I have had a turnover of primary care doctors but was treated by an internist in Pittsburgh. No local doctors in my small town area have even heard of reverse T3. I have kept going to the internist even though they are out of network for my insurance (translation, expensive), but the treatment is probably the only reason I am still standing at all.

I wish more doctors were educated on this set of disorders. I look around me and I can see those that are likely affected, but rely on local less educated doctors. I notice a strong need to educate the current medical community on the proper way to test for hypothyroidism. I don't think the American public can afford another generation of misinformed doctors.

Thank you for your work and efforts at informing the public on the correct way to test and treat hypothyroidism.

Thank you for this program on a most important topic. I will be listening to the complete podcast once it is available. Mary Shomon made a very important comment that it is tricky treating thyroid problems in patients. I would recommend her newsletter, Sticking Our Necks Out. It has a lot of good info in it. I went to a lecture on Thyroid and the Doctor who had been studying the topic said there are 22 different patterns for thyroid dysfunction.

The most common cause for hypothyroidism is Hashimoto's--an autoimmune disease which I have. I am thin and so don't have the problem so many have of losing weight. My body prefers Armour Thyroid to levothyroxine. It feels more natural to me plus provides T3 and T4 instead of just T4. With Hashimoto's, it's important to build up one's immune system so I would recommend 5000-6,000 IUs daily of Vit D3 to adults, and also a good probiotic. The Vitamin D levels in one's blood need to be in the 60-80 range (therapeutic levels) to promote optimal health. I would demand a blood test for Vitamin D if you haven't had one.

I haven't been sick in over a year and I attribute it to the Vit D, probiotics, and mostly good eating. It's also important to look at your adrenal function and to nourish your adrenal glands.

There was a mention on the show about gluten being a trigger for auto immune disease (including thyroid disease). I have thyroid disease and strong gluten sensitivity. My health has improved tremendously and my thyroid medication (Armour) has been reduced twice since eliminating gluten from my diet. If you have thyroid problems consider being tested for gluten sensitivity (simple blood test) because gluten sensitivity could be the root cause of the problem.

I am 62 and have been on thyroid medication (first Synthroid, then Armour) for over 35 years.

I only was able to hear part of the program because I found it late. I will be listening to the show in it's entirety and taking some of this back to my Dr. My TSH at my last check was 41.7. My Dr has opted to 'watch' it. I don't think that's a good plan especially after listening to this program. I appreciate the good information I got from the show and any and all advice will be most welcome and appreciated.

So, I have 4 friends who have different types of thyroid problems. One friend that I talked with today says that her Dr. will not even discuss T3 and T4 testing. Dr. Holtorf says to find a Dr. that knows about this. How do you find one?

Excellent, excellent. There is two questions I have that I don't believe was addressed.
My doc told me 20 years ago that once on a thyroid always on a thyroid med because Synthroid will cause the thyroid not to produce so you will always need a supplement. Is that true? I am also hesitant to go on a natural thyroid hormone because it is not regulated and one can use too much or too little. What do you suggest for using natural thyroid like Armour?

Thank you for addressing the complexities of thyroid testing in such a comprehensive, unbiased fashion. There is no "one size fits all" in medicine, especially in these times of chronic inflammation, polymorphisms, oxidative stress, insulin and leptin resistance with near epidemic prevalence of autoimmune/immune dysregulation (cytokine) syndromes.

To think that TSH and T4 alone give enough information to define thyroid function and make treatment decisions is naive. I'm truly surprised, given the science we know, that any professional would think that these ideas were presented for personal profit. The only controversy about considering these other tests to follow function (T3 and reverse T3) comes from the clinicians who still doggedly only consider TSH year after year, even when their patients are clinically hypothyroid - but usually patients aren't asked in depth about symptoms. I've seen doctors start reducing synthroid when TSH is low normal range and T4 is right on the border of low, with the patient feeling tired, gaining wt., having cold intolerance, feeling depressed and having more cognitive problems.

Doctors are treating the TSH - there's no doubt about that - and I've been trying to understand that approach. It only makes sense to me that D1,D2,D3 polymorphisms might alter the active hormone and lead to tissue hypothyroidism that might not be reflected by the pituitary. I agree this is all more complex than the thyroid alone - when in doubt, treat the whole patient. I may be wrong, but I believe Osler said that 99% of diagnosis was in the history and physical exam.

From what I understand, thyroid levels naturally fluctuate throughout our monthly cycles in an up/down fashion.

One Dr told me, those hi/lows can become more severe with thyroid problems and age. I would like to know if test results vary depending on where you are in your natural cycle and should we consider this when we schedule are testing.

I was told by another professional that TSH turns on when you eat, so I would also like to know if thyroid hormone, et al can simply be regulated naturally with a healthier diet and more exercise.

thanks

I have read that metformin, taken for type 2 diabetes, can lower TSH levels. What does this mean for TSH and T4 testing and test interpretation?

OMGOSH RUN from your Dr...

Dear Joe and Terry,
As a family physician who treats thyroid disorder on a regular basis, I was concerned with the show last week. There have been some studies in JAMA that showed some modest improvement in symptoms with the addition of Cytomel (T3), other studies that showed it did not help.
My biggest concern with the show is that you started with a specialist residency trained in treating thyroid disease, then to a family doctor who set up his own specialty board (?) and referred to "studies" but not what journals whether double blind placebo controlled, then to an "expert patient" who's views were even more off standard treatment. It would've made more sense to me, and done a better service to your listeners to reverse the order and let the endocrinologist comment on the other treatment recommendations. As it was the alternative and as far as I can tell, unstudied that got the last word and the most weight.
I have listened to your show for at least 15 years and have got some good information to share with my patients in the past, but this past weeks show I believe was a disservice to the listeners without a medical background who could be easily swayed. As you know the symptoms of hypothyroidism are vague and share a lot of symptoms with depression. To treat all patients with fatigue, dry skin/hair and weight gain with thyroid meds and to come up with a lot of new and understudied ways of diagnosing hypothyroidism is not appropriate.
Sincerely,
Mark Farnsworth MD

While there is no doubt that simply bringing TSH into the normal range by L-T4 supplementation frequently fails to give good results and that this is a complex problem that is sometimes badly handled, I do not think Dr. Holtorf is correct when he says that TSH test misses 80% of hypothyroid cases.

In the absence of other health or mental problems it seems to generally do well. (Reference below) I think there is little value in extensive tests before thyroid supplementation when little can be done other than give the active hormone. One modification of the conventional approach that I think is sometimes helpful and usually easy, but in my experience hard to get the doctors to do is to allow supplementation based on patient feedback as long as TSH, fT3, and fT4 are kept within the normal range, rather than using supplementation just to get within the normal range.

One small study of interest is M. H. Samuels et al Health Status, Mood, and Cognition in Experimentally Induced Subclinical Thyrotoxicosis. J Clin Endocrinol Metab. 2008 May; 93(5): 1730–1736 in which 33 subjects (31 with autoimmune hypothyroid) being treated for hypothyroid (pre-screened for no acute or chronic illness, no below normal I.Q., and no psychiatric disease) had their dose adjusted in a crossover study from what gave a nominal TSH of 2.5 to a nominal .17 without any significant adverse effects. Subjects could not reliably guess whether their TSH was low or normal. 15 preferred the low TSH, 7 preferred the normal dose, and 11 had no preference. The main point here is that there was no reason not to adjust the supplementation to get TSH to the lower limit of the normal range, and the secondary point is that some preferred it. I think most problems arise when the screening criteria in this study are not met.

That Dr. Holtorf’s claim that the best lab test is fT3/rT3 which should be >2 is wrong can be seen from two LabCorp test ranges. rT3 test 002212 had a reference interval of 90-350 pg/ml and fT3 test 010389 has a reference interval of 2-4.4 pg/ml. Clearly the normal person cannot achieve fT3/rT3>2. If you look at total T3 rather than free T3, the test is 002188 with a reference range of 710-1800 pg/ml so T3/rT3>2 is achieved with such great margin that it could not be used alone.

I listened and took notes on the information your guests regarding thyroid. I have taken Levothyroxine for years - now at 75mcg.

I would like to see a doctor who you consider a specialist - would that be an endocrinologist? I have fibromyalgia, a high stress level, and I fit the list of symptoms to a "T". My doctor recently suggested that "I worry too much"!!!! Not going back to her.

I would appreciate any help you can give me. Susan

Do doctors check iodine levels? I was under the impression that the thyroid uses iodine as part of what makes it work properly. I too am struggling with my weight. I exercise and my diet is one my dietician asked if she could share with other patients, she could offer no changes that would be better than what I already am doing, yet I still have trouble with my weight.

I bought some kelp tablets at the health food store and within a week, I lost 2 pounds so I am wondering if there is a connection. My doctor says my TSH levels are within normal range. Should I ask for additional tests to be done?

I went strait to my chiropractor; he tested my arm with iodide, which shows what is going on/wrong if it goes away very quickly, gave me pills (which reminded me that I had done this before but had been too tired to think about it) and within 3 days, I'm sooo much better. Forget the docs.

The patient advocate interviewed for this radio show has websites that help sort out many things related to thyroid disease, excellent resource for info (including help finding local practitioner, which tests to have done when, how to get tests/labs done at best price, and much much more).

As mentioned by P's Pharmacy in their intro paragraph above, "Mary Shomon is a nationally-known patient advocate and author of many books, including Living Well With Hypothyroidism: What Your Doctor Doesn't Tell You...That You Need to Know. Her latest book is The Thyroid Diet Revolution. She manages two popular Web sites on thyroid issues: http://thyroid.about.com and www.thyroid-info.com. Mary also edits a newsletter for patients, Sticking Out Our Necks."

Dr. Farnsworth, Your comments that patients with fatigue, dry skin/hair and weight gain are merely "depressed" seems very very short-sighted. Since when does depression cause dry skin, thinning hair and weight gain???

It is this attitude by main stream doctors that cause them to miss the real problem and not look farther. I am one of them. Told by docs I had IBS. Then told I had IBD. Then told I had collagenous colitis. Finally found out it was a cancer caught too late. All of these docs only went so far using tests to do the homework for them instead of listening to the subtle symptoms that suggested far worse then the IBS.

I may have missed it but no one spoke about the high rate of folks who claim thyroid disorders and are just plain huge consumers of calories. We have one friend who claims her Doctor is treating her for a thyroid disorder that is making her very heavy (280lbs) but all you have to do is watch her eat and there is the problem right before your eyes...she eats like a pig! high fat high sugar foods and zero exercise. Many Doctors in he US go straight for the pill solution when many issues can be resolved by good advice....but where are the dollars in that? A great example of what is wrong with our medical system today.

By the way love the show.

good luck

I am taking a compounded armour because I found that the regular armour from pharmacy had fillers of gluten - after doing some research discovered on celiac forums that many others experienced gluten reactions from armour.

Thyroid function and disorders are certainly not "cut and dried" - perhaps cut and desiccated. Prepare to be attacked by the dogmatic crowd who attacked Dr. Wilson 20 years ago.
Amiodarone's effect on virtually everybody who is compliant is to decrease the conversion in the thyroid and peripheral tissues of T4 to T3 which is necessary for the thyroid effect. People have their own range of ability to decarboxylate T4 even without metabolic poisons although it is increasingly difficult to stay away from the 80,000 legal chemicals in the US.

I think a good TSH is 1.0. Looking back on the TSH values of hypothyroid patients with a TSH of 6, most have crept up slowly over time. Treating a patient with a rising TSH is probably a good idea at some level such as 2 or 3 and might allow the gland to function partially for a longer time instead of being stressed and burning out.

TSH values less than 1.0 typically happen with Amiodarone and low T3 hypothyroidism as the gland is putting out a little too much T4 but the patient has multiple hypothyroid symptoms.

Regardless of how thyroid disease is treated or not treated, careful follow up and listening to patients' symptoms, real medication reviews, checking reflexes and actually taking a history in addition to following appropriate labs are necessary.

Another complication for the last 20 years is the feeding of GMO corn to pigs. The increased incidence of gluten enteropathy has happened during the same time period while this new chemical has also been fed to us in great quantities. Could the desiccated pig thyroid be different in some way because of the change in feed?

In the early 1950's as a toddler I was treated with radiation therapy for tonsillitis. Twenty years later, I had developed a thyroid nodule and began a regimen of synthroid to avoid stimulating my actual gland. (At least this was how it was explained to me at the time.)

Over the years, my synthroid prescription was gradually decreased to such a point, I was exhausted, fat, cold, and was loosing hair at an alarming rate. Throughout these years my TSH, T-3 andT-4 were always within the normal range. In 2009 I heard about the parathyroid glands for the first time! These too can be affected by radiation to the neck and present all types of similar symptoms.

After doctoring with an Endocrinologist for 40 + years I was amazed no one thought to mention this to me before. I badgered my doctor into doing a PTH test which came out above average but as my calcium level was still in the "normal" range they decided to "watch" it.

Two years later and after much complaining, they did the nuclear test and it showed a hot parathyroid gland on the right side and as long as I was going to have that surgery, they decided to take out the right lobe of my thyroid where the nodule was located. The nodule turned out to be a 1 cm papillary carcinoma and the bad parathroid was actually on the left.

Two months later I also had the left side thyroidectomy. Throughout this entire time, my lab results were always considered to be in the "normal" range. You really have to be your own advocate when dealing with a doctor who fixates on lab results and ignores a patient's concerns and symptoms. I really am tired of blaming all my physical concerns on being a "post menopausal woman".

What exactly is this "high rate of folks who claim thyroid disorders" who "eat like pigs"?

Anyone with thyroid disease knows how difficult it is to get a diagnosis--it's not like you can go to the doctor and just ask for Synthroid. It doesn't work like that.

Many people who are hypothyroid DO have trouble losing weight--if you'd listened to the podcast you'd know that thyroid hormone is essential for regulating metabolism. However, many people who are hypo do NOT gain weight. In fact, some are underweight. Just because you know one person with a thyroid problem who eats poorly doesn't mean you should spew your generalizations on the internet.

I have spent the last several years slightly overweight and in a fog with no energy. Last year I looked in the mirror and realized the outer third of my eyebrows were gone and I had lost substantial body hair. I seldom felt hunger, ate little, and never lost weight. My tongue was FAT and scalloped and I was self conscious about speaking in front of others. What the heck happened to me? I'm only 50!

I'm ALWAYS looking for answers that don't come from the pharmacy and ran across articles about IODINE DEFICIENCY and HYPOTHYROIDISM. After much reading I began taking Lugol's Solution daily. (If it's not Lugols, it's probably poisonous!) Iodoral is the tablet form.

I felt more energetic by the end of the week. After 3 months my tongue is no longer fat. After 4 months my hearing is improved! I knew I was getting a little deaf, per the family, but that was a bonus! I have been on a low-carb diabetic diet and am finally losing the excess weight.

Years ago I had stopped buying Iodized salt and replaced it with Sea Salt. Stupid move! I robbed myself of the ONLY way we supply our bodies with crucial Iodine! Viva la Iodized Salt!

And I am rolling my eyes at all the Alternative medicine naysayers. Hippocrates said 'Let food be your medicine"!

The reason for concern with natural thyroid is that, because it is a natural product--dried and crushed animal thyroid glands--the actual amount of thyroid hormone in each pill may vary slightly.

I take three tablets of 65mg NatureThroid (a natural thyroid like Armour's) to equal my prescribed dose of 195mg. By taking three smaller pills rather than one large one, I'm pulling from more sources, giving me a better chance to get an equal dose every day.

Back when my daughter was the tech filling my prescription, she even took the precaution of filling my month's supply from several different manufacturer lots. (THAT was above and beyond the call of duty...)

If your body is making thyroid hormone, and you then take thyroid hormone, your body will stop making it.

Your (arrogant & cruel) comment infers that all overweight individuals are so b/c they do not take personal responsibility for their weight gain and are quick to blame something other than over-eating for their obesity. Certainly, there ARE people who eat too much and are overweight because of it. But please consider for a moment, my 17 yr old daughter who continues to gain weight despite eliminating carbs, eating no more than a 1000 calories/day (lean protein and green vegetables as well as working out up to 5 days/week). Her TSH, FT3, FT4 and RT3 are within the 'normal' reference range. But she displays nearly every hypothyroid symptom you learned about in med school.

My daughter was a teeny, tiny little girl until she hit puberty--that's when she progressively started gaining weight which has been accelerating each year (over the last two years alone, she's gained more than 60 lbs). Her dad, sister and myself are all NORMAL weight. None of us drink soda or eat potato chips, candy, ice cream, donuts, fried food or any other junk food for that matter. We rarely eat out (maybe twice a year).

So please tell me your hypothesis as to why my daughter continues to gain weight?? And please don't be like so many others who suggest my daughter is 'sneaking' food when she is not home... this child of mine rarely leaves the house anymore b/c of her fatigue and hating how she looks. She is a beautiful girl but my heart bleeds for her. If this was your daughter and you weren't getting any answers from the medical community, I highly doubt your advice to her would be to stop blaming everything else for your weight gain and to start taking more responsibility for the way you look.

Natural thyroid hormone such as Armour is ABSOLUTELY controlled. It is FDA approved as well as having the USP stamp of approval. Doctors prescribed it for years until the pharma companies started producing a synthetic version (e.g. Synthroid) and convinced the big (medical)boards that this was superior to natural thyroid. You get synthetic for synthetic and a natural response from a natural source.

So how about an overweight teen who eats no more than 1100 calories a day (lean healthy food...NO junk foods & virtually no simple carb intake), yet is exhausted all the time, has foggy thinking, irregular periods to name just a few symptoms), YET continues to gain weight at an average 3 lbs per month???

Oh please. You don't have to have an 'M.D.' after your name to have some intellect and knowledge!

When finding the ratio between RT3 & FT3, you need to do some conversion so you are applying apples to apples and not apples to oranges (e.g. ng/dL versus pg/mL)...

"Her TSH, FT3, FT4 and RT3 are within the 'normal' reference range. But she displays nearly every hypothyroid symptom you learned about in med school."
The ranges are too broad, some refinement is needed. Some references will say that FT3/RT3 should be greater than 2 which is imposable, but I have also seen T3/RT3 should be greater than 15. That makes since and may be helpful. I had T3/RT3=15 with some T4 supplementation and TSH above normal. FT3 was constant while varying TSH with T4 supplementation. The solution was T3 supplementation. I would try it due to symptoms alone. It is fast acting, need to start with 4 doses/day. Look for Cynomel.

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