Hypothyroidism and the Role of Armour Thyroid, Seaweed, Exercise, and More
Cutting-Edge Interview with Joseph Mercola, D.O.
Q. You have said that you feel that it's a "big myth" that that an elevated TSH (thyroid stimulating hormone) level is always required before a diagnosis of hypothyroidism can be made. First, can you explain why you feel this is a big myth? And second, why do you feel that conventional medicine seems to cling pretty firmly to this myth as the sole means of diagnosing hypothyroidism?
A: I would say over 90% of the patients that I diagnose with underactive thyroids have a completely normal TSH level. Even with this relatively insensitive test, a study published earlier this year concluded that 13 million Americans have undiagnosed thyroid disease. I suspect it may be as high as five times that number. From my perspective, most traditionally based physicians have long abandoned their physical examination and diagnosis skills and appear unwilling to believe that patients who complain of all the classic hypothyroid symptoms are in fact truly hypothyroid if their TSH is normal.
They would rather believe a lab test than the patient sitting in front of them. I suspect this may be related to the trust physicians place in the researchers who developed the original assay. I suspect that the same issues are involved in nearly all traditional physician's incredible reluctance to use natural thyroid hormones for replacement and their insistence on using synthetic hormones. This is remarkable in light of the New England Journal of Medicine article last year that quite clearly showed that natural hormones are far superior, especially with respect to brain function and mood.
Q. You have said that if a TSH is above 1.5 there is a strong chance the thyroid gland is not working properly. Can you explain why you feel that is the case?
A: I have carefully analyzed hundred's of patient's symptoms and had many of them take their basal body temperatures. There appears to be a strong correlation between this threshold value of a TSH above 1.5 and the diagnosis of hypothyroidism. Most patients who have TSH levels above 1.5 seem to respond quite well to natural therapies that either improve or replace thyroid function.
Q. Why do you feel that Free T3 and Free T4 levels are the only accurate measures of the actual active thyroid hormone levels in the blood? Why do you feel these are more accurate than the TSH level, which is considered the standard by the majority of conventional physicians?
A. The Free T3 and Free T4 levels represent the active hormones circulating in the blood. The typical thyroid tests: Total T4, T3 Uptake (and Free Thyroxine Index (FTI) are virtually worthless and should have been abandoned years ago. I believe that the Free T3 and Free T4 are not superior to TSH, but should be used in conjunction with TSH. My contention is that the reference range for TSH is inaccurate. TSH is quite a good screen and will in fact assess most cases of hypothyroidism if the new ranges are utilized. The value of Free T3 and Free T4 comes into play when one needs to diagnose secondary and tertiary hypothyroidism. These are cases of hypothyroidism due to pituitary or hypothalamic dysfunction. These are far less common than primary hypothyroidism, but nevertheless they do constitute a significant percentage of individuals.
Q. You mention that for people who have low T3 levels, a combination of T4 and T3 can compensate for the inability to convert T4 to T3. You typically favor Armour thyroid, the desiccated natural thyroid product made from the glands of pigs. Is there a reason you prefer this, versus Thyrolar, the synthetic T4/T3 combination drug, or adding Cytomel (synthetic T3) or a time released compounded T3, to levothyroxine (Synthroid-synthetic T4)?
A. Excellent question Mary, and it also demonstrates your deep understanding of this complicated subject. It is my experience the vast majority of individuals seem to empirically do better on natural hormones, rather than synthetic ones. I can't provide a definitive explanation for this observation. It may be related to the fact that the natural hormones also have T1 and T2. Little is said about these forms of thyroid hormones, but they may have some influence on optimizing thyroid function. There are clearly however, individuals who do not tolerate desiccated thyroid hormones at all. This is when I would use a combination synthetic product like Thyrolar or combine levothyroxine (synthetic T4) with Cytomel (synthetic T3).
Q. You recommend splitting the Armour thyroid pill and taking it twice a day. Can you explain why you feel this is particularly important?
A. Armour thyroid is a combination of T3 and T4. T3 products (like Cytomel) need to be taken twice a day to provide a steady concentration of thyroid hormone as it has a much shorter half-life than T4.
Q. You describe something called secondary or tertiary hypothyroidism, where TSH is below 1.5 and Free T3 (and possibly the Free T4 as well) is below normal. How does this differ from primary hypothyroidism? Are there different causes for these different types of hypothyroidism?
A. These are forms of hypothyroidism that are not directly due to the thyroid gland failing. Traditional viewpoints would classify this as pituitary or hypothalamus dysfunction. However, there are far more common reasons for this that tend to be primarily related to the adrenal gland. My experience has been that the bulk of individuals who have thyroid impairment with the new TSH criteria above 1.5, are in fact related to adrenal insufficiency. Other causes of thyroid dysfunction would be related to an impairment of the body's ability to convert T4 to T3 (the active form of thyroid hormone). This is generally related to depressed DHEA levels. However, one must be very careful to not use DHEA without first measuring levels of other hormones, especially testosterone. DHEA given as supplement can clearly cause more harm than good if it is not needed.
I find that the best way to analyze these imbalances is through salivary hormone testing and I find Dr. Timmins's lab Bio Health Diagnostics (1-800-570-2000) to be the lab that most accurately and cost effectively can asses these hormone rhythms through their testing panels.
I have found the testing useful to diagnose myself with a mild case of secondary hypothyroidism. My TSH was below 1.5 but my main symptom was severe cold intolerance to Chicago winters, which has become progressively worse over the years. Once I went on sublingual DHEA and pregnenolone, my aversion to the winter was not due to the cold, but only the diminished sunlight.
Q. Are there any particular supplements you think most people with hypothyroidism should probably be taking?
A. I am not a huge fan of supplements and encourage most people to optimize their diet. I have an outline that I have all my patients follow and it is a good starting point. The nutritional changes help to optimize their insulin levels, which have an important element to normalizing the biochemistry that generally goes along with chronic illness.
But for specific recommendations for hypothyroidism, I feel the best supplement that one could possibly take for proactive thyroid health on a regular basis would be some form of organic iodine. A simple way to determine if one requires this is to paint a patch of tincture of iodine on your skin the size of a half dollar. The iodine brown coloration should last at least 24 hours. The faster it is absorbed the greater the body's iodine deficiency.
The best source of organically bound iodine that I know of is non-commercially harvested seaweeds. The dose is about 5 grams a day or about one ounce per week. So a pound would last about two months. Radioactive iodine is another factor that can damage the thyroid so one needs to flood the gland with healthy iodine from organic sources like seaweed. As you know this is particularly important for pregnant women as if they have untreated hypothyroidism their, a New England Journal of Medicine study showed that their children may have lower IQ scores.
The better seaweeds are hand picked and dried and not typically available in health food stores. They are the absolute best forms of minerals that I am aware of. Unfortunately the people who produce this usually run small operations, and do not make their products widely known. Kelp from the health food store may work, but it really depends on how it was harvested and there is no way to know that reliably, so I rely on seaweed harvesters who hand pick the seaweed and reliably dry them free from contaminants.
If one already has a thyroid problem the issue is far more complicated. It is difficult to make general recommendations without identifying the underlying cause of the individual's hypothyroidism. One of the most common is psycho-emotional stress that impairs the adrenal glands from working properly. Once the adrenals are compromised the thyroid gland attempts to compensate for the exhausted adrenals and the thyroid frequently loses its ability to function normally. I have four psychotherapists in my center who work on this issue using very sophisticated autonomic nervous system rebalancing that incorporates multiple forms of muscle testing.
Mercury is another common cause of hypothyroidism. Amalgams are 50% mercury and they are only inches away from the thyroid gland. If diagnostic testing determines mercury to be a problem then the amalgam fillings need to be removed by a biologically trained dentist and replaced with a non-metal (composite) filling. The mercury needs to be eliminated. I have written with Dr. Dietrich Klinghardt a comprehensive protocol for this that will be published shortly. A short summary of the protocol is on my web site.
Q. What are your thoughts about "Wilson's Syndrome," which uses body temperature as the sole means of diagnosis, and uses primarily T3 only as a treatment?
A. First of all traditional medicine already has established Wilson Disease (hepatolenticular degeneration). It was first described in 1912 as a problem resulting in copper accumulation in the liver and brain. Wilson Disease has to do with a reduction in the incorporation of copper into its transport protein, ceruloplasmin. This results in copper deposition in the cornea, brain and basal ganglia. Clearly this disease predates the Wilson syndrome, and although Wilson Syndrome and Wilson Disease are different names, I believe they are to similar and am surprised that someone would be so audacious to name a disease syndrome after himself that is so easily confused with a well defined existing medical entity.
Some have commented that his book for the public is of the worst of vanity-press publishing, although his doctor's manual is surprisingly well written and espouses some clever arguments, albeit based on some false premises. A previously interviewed clinician on your site, Dr. John Lowe, does a great job pointing this out in his book.
The Wilson protocol is so complicated and time-consuming to follow that it requires a truly unusual patient and more time than a physician can usually afford to have any chance of being executed properly. Unfortunately, until patients encounter something better, legions of desperate patients, incorrectly treated by the "endocrinologist-thyroidologist technocracy" have clung onto the hopes provided by Dr. Wilson's book. That is what you offer on your wonderful site, the chance to learn superior alternatives to the Wilson Syndrome complicated and generally non-effective approach.
However, giving credit where credit is due, Dr. Wilson's thoughts about "compensation" effects (and the differences therein among different patients) are useful and based on good logic and probably some quite astute clinical observations. Indeed, these dynamics are pertinent to what happens before a patient taking T3 stabilizes, and an awareness of this process may be a useful nugget to salvage from the considerable time many of us have invested into studying Wilson's approach. Of course, that does not suggest in any way that Wilson's cycling protocol with enormous doses of T3 has any merit or should be used.
Q. A major complaint many people with hypothyroidism have is difficulty losing weight, even after they've been diagnosed, and are on optimum amounts of thyroid hormone, including T3. Do you have any suggestions for those people who are finding it particularly difficult?
A. Absolutely. This typically is easily resolved if the patient is compliant, as I have guided hundreds of patients through this process successfully. The central issue is compliance as my observation is that most people have an emotional issue that complicates optimal resolution of this problem. The first issue would be to abandon the traditional viewpoint that grains are healthy for most of us.
Grains convert to sugar and cause profound disturbances in insulin balance that lead to weight gain. I have a diet plan that I have put together over the years that seems to help most people in this area.
The second essential issue is that cardiovascular exercise is vital. Typically one hour per day, each and every day is required, until ideal weight is achieved. The one-hour can be split into two or three sessions and the exercise needs to be relatively intense. I explain to patients it should be just below the threshold where they lose the ability to talk comfortably to someone standing next to them. If they can talk easily they are not working out hard enough. Of course one needs to gradually build up to this level and have clearance from their physician if they have heart disease.
Q. In researching my book, I talked to a number of scientists who felt that overconsumption of soy isoflavones can create some health problems, including an increased risk of hypothyroidism. Do you have any thoughts about the current soy craze, and the pros and cons of soy consumption, including soy foods, and soy protein powders, and isoflavone supplements?
A. Once again Mary, you are right on target. There are very few professionals or media who understand this issue, and you are one of them. Dr. Enig is professor of biochemistry at the University of Maryland and is the researcher who brought trans fatty acid to the public's attention a few decades ago. I have a 15-page review by Dr. Enig, which is the best summary I have seen on the subject. I believe the soy issue is one of the biggest health misconceptions in the natural food movement today and I plan on doing some national TV interviews on this subject soon. 20/20 is the first media to begin to expose the problem and had a story with the soy infant formula on June 9 of this year. I believe soy formula is one of the worst foods on the planet for an infant and should be banned. It provided the hormone equivalent of five birth control pills a day and may be one of the reasons infertility and other female endocrine problems are so common today.
Q. Some experts are concerned that the fluoridation of water may be contributing to an increase in thyroid problems, among other health concerns. What are your thoughts about this? A. This is a very controversial area. One of my friends, Dr. Ted Spence, did an excellent review on this fluoride controversy and I also have many links where one can explore this area in great detail. I believe fluoride, like mercury, is a chemical toxin and poison and should be avoided. There is likely to be a direct antagonism with iodine that is well documented. I suspect most other logical and open individuals would reach the same conclusion if they critically analyzed the evidence.
Q. Do have any thoughts for patients who are having difficulties getting properly diagnosed or treated? People who cannot necessarily travel to see you, or who do not have access to doctors who are particularly savvy about thyroid treatment, and who are stuck with HMOs or who are limited to particular doctors with particular insurance plans?
A. Another excellent question. Like you, I receive 1,000 emails a week and I have long ago passed my ability to personally respond to all of them. The simple solution would be to ask every employee of a health food store for a medical doctor that practices natural medicine. Nearly every community has one, although you might have to travel somewhat. I would ask the storeowner and all the employees, don't just ask one part-time employee, be persistent and contact all the health food stores in your area. They are tremendous local resources.
If that option fails I would call the American College for the Advancement of Medicine (ACAM 714-583-7666). I am a member of this group and most of these physicians are open to using natural hormones. I would just give them a copy of the information on my web site regarding thyroid hormone diagnosis and management. If the ACAM physician had any questions I would be glad to answer them and help guide them through the process. But most of them are already using Armour thyroid, they just may not be familiar with the revised use of the Free T3 and Free T4 levels.
Q. Is there anything else you'd like to share about your thoughts on hypothyroidism?
A. I would encourage readers to be persistent. It has been my experience that the vast majority of "thyroid experts" including some of the ones listed on your site, are not in agreement with the material I have reviewed here. Readers need to be convinced that there is a solution that addresses the cause for many of their chronic health care complaints, despite the traditional medical paradigm insistence that there is not.
If one already has thyroid failure, then it is not possible to return the gland to normal and readers should seek a form of therapy that optimizes T3 levels. For the vast majority of patients levothyroxine (Synthroid) does not achieve this. I see many patients who have searched long and hard to find a physician who was willing to give them a thyroid replacement like Armour thyroid. It is my experience that once these individuals change their thyroid replacement to a natural thyroid product their quality of life soars.
For the past 25 years, tens of millions of Americans in hundreds of cities and towns have been drinking tap water that is contaminated with low levels of insecticides, weed killers, and artificial fertilizer. They not only drink it, they also bathe and shower in it, thus inhaling small quantities of farm chemicals and absorbing them through the skin and through breathing in the vapors. Naturally, the problem is at its worst in agricultural areas of the country. Pesticides have been shown to interfere with thyroid function and cancer risk, so it is imperative to drink clean water.
Q. How can people find out more about your work, or contact you?
A. The best way is my web site at www.mercola.com. All contact information is there. I provide a free weekly newsletter that reviews 10-20 peer-reviewed articles that are published every week. My associate editor and I review 2-300 articles every week to only publish and review the best of the best as they relate to natural health care. It is a labor of love and I have been doing it for over three years. All back issues are on my web site and readily available for review by using the search engine on the site.
All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician or health practitioner before starting a new treatment program. Please see our full disclaimer.