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Solved: Some Common Thyroid Problems
Help from Thyroid Expert and Author, Stephen Langer, M.D.

by Mary Shomon

When I was first diagnosed with thyroid disease, one of the first useful books I found was Solved: The Riddle of Illness, by Stephen Langer, M.D. and James Scheer. In the years since , I've gotten to know Dr. Langer, and have had the chance to talk with him on several occasions regarding his theories about and treatments for the many thyroid patients he treats.

Some would call Dr. Langer a practitioner of alternative medicine, but he chafes at that label. Says Langer lightheartedly, "I hate the term alternative medicine, because if it's right, it ain't alternative!" Langer's focus has been on nutritional and holistic approaches to chronic conditions, especially autoimmune thyroid problems.

"I hate the term alternative medicine, because if it's right, it ain't alternative!"
-- Dr. Stephen Langer
A new edition of the book Solved: The Riddle of Illness has been recently published, and the book still ranks as one of the best books on thyroid disease, and is a welcome addition to any thyroid patient's bookshelf. The book focuses in on nutritional medicine, and the relationship between thyroid disease and many conditions, such as arthritis, obesity, depression, diabetes, heart disease, cancer, sexual problems, and much more.

I had a chance to talk with Dr. Langer recently about some of the questions and challenges he's finding are coming up frequently with his patients. He shared some fascinating information about thyroiditis attacks, which are probably far more common than we realize. Dr. Langer also has a technique that can help hypothyroid patients who cannot tolerate even small doses of thyroid hormone replacement. He also talks about palpitations and the role of nutritional deficiencies, weight loss challenges, whether thyroid blood tests are really necessary, and things to explore further when you don't get better on adequate treatment.

Dealing with Thyroiditis Attacks

Dr. Langer referred to thyroiditis as like an "arthritis of the thyroid." He explains that just as arthritis attacks the joints with pain and inflammation, thyroiditis can mean pain and inflammation in the thyroid for some sufferers. And in particular, during a thyroiditis attack, common symptoms you might experience are anxiety, panic attacks, heart palpitations, swelling in the thyroid area, problems swallowing, and frequently, problems sleeping.

"Thyroiditis attacks classically happen in the middle of the night," says Dr. Langer, which can be particularly troublesome in terms of your ability to sleep.

Dr. Langer suggests taking some calcium/magnesium, which are nutrients that have a sedative effect, along with a pain reliever to relieve inflammation -- buffered aspirin or ibuprofen -- before you go to bed, this might help. He's found that this helps about two-thirds of his patients suffering from nighttime thyroiditis symptoms.

Reducing swelling is a key aspect of dealing with thyroiditis attacks, according to Dr. Langer. "Just as with arthritis, an anti-inflammatory pain reliever doesn't cure the problem, but it temporarily ameliorates the symptoms."

Palpitations

Palpitations can be a common feature of thyroiditis attacks. Says Dr. Langer, "What happens with Hashimoto's patients having thyroiditis attacks is that many wind up in the emergency room seeing cardiologists. It happens a few times and then they're written off as psychiatric cranks. They end up with large doses of anti-anxiety medications or antidepressants."

Frequently, when not misdiagnosed as a heart problem, anxiety, or depression palpitations may be misinterpreted as a sign that a patient is getting too much thyroid hormone. But when medical evaluation rules out hyperthyroidism due to too much thyroid medication, mitral valve problems, or other cardiac abnormalities, Dr. Langer has found that nutritional deficiencies may be to blame -- in particular, deficiencies of calcium, magnesium or Vitamin D.

Says Dr. Langer, "There's compelling evidence coming to the surface that Vitamin D is not only a vitamin but a hormone...The recommended daily allowance for Vitamin D is 400 IU, but scientists doing studies actually believe that people who do not get regular exposure to sunshine should be getting 2000-4000 Vitamin D. The Vitamin D also has profound effects on absorption of calcium and magnesium."

Solutions for People Who Can't Tolerate Thyroid Medications

According to Dr. Langer, another subset of people with profound thyroiditis and hypothyroidism find that taking any amount of thyroid hormone creates problems. These people will have palpitations, and extreme hyperthyroid-like symptoms after taking even the smallest standard dosage of thyroid hormone replacement medicine.

Not taking medicine is not a solution, because hypothyroidism ultimately requires treatment, but many of these patients are in a catch-22 -- treat the hypothyroidism and prevent long-term illness -- but suffer debilitating symptoms and side effects due to their over-sensitivity to thyroid medications.

Dr. Langer's answer? He works with a reputable compounding pharmacist to produce an aqueous solution of the thyroid medicine. Then, he has patients start with a daily dose as small as one drop, which is 1/10th of a quarter of a grain. He then has them go up in dosage one drop at a time. According to Dr. Langer, "with most of these patients, it takes a much longer period of time, but they can get to the right quantity of thyroid using the aqueous thyroid and can eventually be transferred over to the tablets."

Weight Loss Challenges: What About Diet Drugs for People with Hypothyroidism?

Dr. Langer doesn't believe in diet drugs such as Xenical or Meridia for thyroid patients, and he typically does not prescribe them. "I don't think an overweight condition is due to a Meridia deficiency."

He's found that with thyroid patients, many find they cannot lose weight taking only T4 (i.e., Synthroid or levothyroxine), but when he puts them on natural thyroid, or a combination of T4/T3 synthetic, they are able to lose weight.

"I don't think an overweight condition is due to a Meridia deficiency."
-- Dr. Stephen Langer
He also believes that while aerobic exercise is helpful and healthful for his patients, for those with hypothyroidism, muscle building and progressive resistance is essential, because building muscle can help raise metabolism.

Basically, though, he doesn't want to discourage patients, but feels that "there is no magic solution. You can be eating all organic food that's pristine, and taking all the right vitamins and minerals, and doing everything right, and still your body may not be responding."

"My best advice," says Dr. Langer, "is to get your thyroid adjusted, eat well, exercise (which patients know, but usually don't do) and if all these things are done religiously without results, then you try and optimize other biochemical and physiological functions, and hope your body will eventually take care of it automatically."

As for optimizing biochemical and physiological functions, his recommendation is to get a total metabolic workup with a good orthomolecular specialist. This sort of testing would involve "amino acid fractionation test, essential fatty acids levels, and other types of metabolic testing to see if there are deficiencies."

This is not inexpensive, however, and this type of testing -- which can cost $1000 to $2000 -- is rarely covered by insurance, so patients should pursue this only after exhausting other opportunities, and only with an experienced orthomolecular specialist.

Are Thyroid Blood Tests Really Necessary?

Some hard-line conventional practitioners believe that blood tests are the sole means of diagnosis and treatment. Others have abandoned thyroid blood tests completely, in favor of basal body temperature testing and symptomatic diagnosis and treatment only. What are Dr. Langer's thoughts on blood tests?

"No matter who you're seeing and no matter what your approach is, they should do blood tests periodically. Some doctors feel they can go by basal body temperate, or heart rate, and they don't do blood tests. But this is dangerous, because you can end up hypo or hyperthyroid for long periods of time, and not know what's going on."

Dr. Langer also believes that testing should be done more frequently than is currently done by most physicians. He believes that you should be tested every 45 to 90 days at minimum while your doctor is getting you on the right dose. Says Dr. Langer, "Then you should be tested every three months the first year, every six months during your second year, and every year after that if you're entirely regulated."

When You Don't Get Better

According to Dr. Langer, even doctors who approach thyroid treatment with the best of intentions and knowledge find that patients who are being adequately treated still don't feel their best. This is when his investigations turn to one of the following issues, which can frequently interfere with the body's ability to properly heal and respond to treatment:
  • Food allergies
  • Bowel dysbiosis
  • Adrenal imbalances
  • Nutritional deficiencies
  • Deficiency in DHEA
We'll be talking more about these issues in future discussions and articles here at the Thyroid site.

Read the Book

The new edition of Dr. Langer's book is a great starting point for further helpful information. Click here for more information on Solved: The Riddle of Illness.

Contacting Dr. Langer

Dr. Langer is available for in-office and phone consultations regarding thyroiditis, hypothyroidism, fibromyalgia, chronic fatigue, orthomolecular medicine, optimal nutrition, metabolic medicine, and food allergies.

Dr. Stephen Langer
3031 Telegraph Avenue, Suite 230
Berkley, CA 94705
Telephone: 510-548-7384

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