MINNEAPOLIS—To effectively manage thyroid problems, look beyond the thyroid, said Lisa Everett, RPh, CCN, at the annual meeting of the American Holistic Medical Association.

Many patients with hypo- or hyper-thyroid conditions actually have underlying autoimmune or inflammatory imbalances that cannot be corrected simply by manipulating thyroid hormones. Though hormone-based treatments are important in many cases, they are only part of the therapeutic picture, said Ms. Everett, of the Kansas City Holistic Centre.

“Balance the biochemical terrain of the patient. Don’t just focus on the hormones.” The underlying inflammatory processes are often driven by dietary factors and environmental toxin exposures, none of which can be cleared up through hormone therapies alone. The comprehensive holistic management of patients who show symptoms suggestive of thyroid conditions should include a thorough assessment of the patient’s diet and environmental toxin exposure.

“Thyroid disease most often involves inflammation, and is frequently autoimmune related. Eliminating the causes of the inflammation can often restore normal thyroid functioning.”

Dump the Dairy

Total elimination of milk and dairy products is the single most beneficial change an individual with thyroid problems can make, stressed Ms. Everett.

“Dairy is the most inflammatory food we can put in our bodies. The literature is pretty clear about this. Dairy proteins can get out of the gut and they can induce autoimmune reactions. In some people it manifests in the joints, in some it’s the lungs, and in others it is the thyroid,” said Ms. Everett. She noted that some patients seen at her clinic have shown thyroid peroxidase levels in the 4,000 range drop down to the 2,000 range just by eliminating dairy.

Whey, casein, and lactose from other species are problematic for many individuals. “It’s not about allergies. It is about the direct physiologic and metabolic effects of dairy proteins and sugars. These compounds were produced for baby animals, not adult humans.”

The American Academy of Pediatrics recently issued guidelines stating that children under age 2 should not be fed cow’s milk or dairy products because they arrest the development of the cellular immune system in the Th2 phase. High dairy consumption at an early age predisposes children to a host of Th2-related diseases like asthma and chronic allergies. Ms. Everett believes Th2-mediated inflammatory processes underlie many cases of thyroid dysfunction.

The inflammatory nature of milk proteins is only part of the problem, however. Unless one buys organic dairy products, one risks exposure to a number of hormones and potential endocrine disruptors that are bioconcentrated in the fat component of milk and dairy products. These, too, can affect thyroid function.

Eliminating dairy is admittedly difficult for many people, said Ms. Everett, who said she herself comes from a long line of dairy farmers. The reality is, though, thyroid patients do better if they get free of milk. “The first step is always to stop the dairy. Some people will normalize soon after. In many cases you can get people off thyroid hormone, or at least reduce the dose.”

She recommended a product called Natural D-Hist, from Orthomolecular Products (www.orthomolecularproducts.com), to help people with IgE-mediated allergic symptoms. The product contains quercetin, a botanical compound that inhibits histamine release. It also contains as extract of stinging nettle, which inhibits cyclooxygenase and lipoxygenase-mediated inflammation, as well as N-acetyl cysteine, a natural mucolytic, and Bromelain, an anti-inflammatory enzyme extracted from pineapple.

She has also found CTR Support, a botanical combination from Physiologics (www.physiologics.com) to be very effective in quelling the autoimmune and inflammatory processes underlying many cases of thyroid diseases. CTR Support contains Turmeric, Boswellia, Bromelain, Ginger, Devil’s Claw, Quercetin and Yucca. In some cases, daily treatment with this herbal combo can actually normalize thyroid hormone levels while reducing inflammation.

It is also important to reduce or eliminate exposure to environmental toxins, especially heavy metals. “Mercury interferes with thyroid hormone function. It can attach to many different things, and it can enter the thyroid itself, interfering with hormone production. It also interferes with the normal activity of these hormones.

Dietary Recommendations

In addition to eliminating dairy, Ms. Everett also made the following dietary recommendations for patients with thyroid problems:

• Eat organic foods as much as possible, to reduce exposure to pesticides, xenobiotics, endocrine disruptors and other environmental toxins.
• Drink 64 oz of purified water daily.
• Use olive oil or grapeseed oil in cooking, rather than butter. For eating, butter is preferable to margarine, which is high in hydrogenated fats.
• Make fruit and vegetables 50%–70% of the total daily food intake.
• Keep carbohydrate consumption to 2–3 servings of complex carbs daily.

Understanding Thyroid Hormones

There are three main categories of thyroid hormones: tri-iodothyronine (T3), which comprises roughly 25% of the thyroid’s output; thyroxin (T4), which accounts for 75%; and reverse T3, which is the stereoisomer of T3. T3 is 3–4 times more active than T4, and has a much shorter half-life (2.5 days) than T4 (7.5 days).

Thyroid problems can be the result of over-production of either T3 or T4, as in Grave’s disease and other forms of thyroiditis; under-production of either of them, as in Hashimoto’s thyroiditis, goiter or Wilson’s syndrome; or impaired uptake, metabolism and conversion in the target tissues. The latter processes are often missed, leading to misdiagnosis and improper treatment in many cases.

Thyroid hormones do not operate in a vacuum, and they need to be assessed in the context of the entire web of endocrine signals. In working up a patient, “You really need to understand the interconversions of hormones,” said Ms. Everett. In other words, simply measuring T3 and T4 is not enough.

While it is fairly easy to identify gross over- or under-production of thyroid hormones, in many cases, the problem is in the binding or conversion of T4 into the more active form. Many conditions can impair tissue conversion, including acute or chronic illnesses, pregnancy, poor nutritional status, over-consumption of trans-fats and imbalances between omega-3 and omega-6 fatty acids, selenium deficiency, and a host of medications including β-blockers, amiodarone, glucocorticoids, or cholecystographic agents.

Diseases like porphyria, hepatic diseases, and HIV, as well as medications like methadone, tamoxifen, clofibrate, 5-fluorouracil, and exogenous estrogens can increase binding of thyroxin (T4) to thyroid binding globulin (TBG), a key transport molecule. This can result in a hyperthyroid appearance. On the other hand, androgens, furosemide, salicylates, corticosteroids, and some anti-seizure medications inhibit thyroxin binding, leading to T3 under-activity and apparent hypothyroidism.

Ms. Everett stressed the importance of paying attention to sex hormones in women with signs of thyroid disorder. Endogenous estrogen and progesterone play a dual role of regulating thyroid gland function and also regulating transport of thyroid hormones into the mitochondria of target tissues. Women who are on oral contraceptives may show thyroid dysfunction owing to the estrogenic effects.

Progesterone inhibits transport of T4 into target tissues, so women who go on progesterone often appear hypothyroid, as do women previously treated with thyroid hormone who go into menopause. In all of these cases, the solution to the thyroid problem may lie in balancing the secondary sex hormones properly.

Rethinking Thyroid Hormone Testing

She believes standard approaches to testing are wholly inadequate to make meaningful assessments. “Insurance companies tell us to look at TSH, and most docs think they’ve done the job if they look at TSH, Free T4 and Free T3. But that’s an incomplete picture, because serum levels reflect homeostasis. The body will deplete a lot of tissue reserves to preserve homeostasis.”

The key, she said, is to get a sense of a patient’s tissue reserve of T4, “that can be converted to T3 at the drop of a hat.” This principle is true of all hormones. “Free serum levels can look very well, but available reserves may be very low. And you need to look at what’s available for conversion.”

While it is important to measure the obvious (TSH, total T3 and T4, free T3 and T4), she strongly advised looking at anti-thyrogloblulin antibodies, anti-microsomal antibodies, free thyroxin index and thyroid peroxidase, as well. “These will tell you about autoimmune processes that may be involved.”

It is essential to look comprehensively at thyroid function in any patient on chemotherapy, as many of the drugs used to treat cancer can have profound effects on thyroid hormone function.

When to Use a “Thyroid Punch”

For individuals with true-blue Wilson’s syndrome, characterized by low basal temperature, symptoms of hypothyroidism, and reverse T3 levels in the upper range of normal or higher, a quick “thyroid punch” with high-dose T3 can be very effective in restoring more-or-less normal metabolic function.

“It doesn’t really deal with the underlying problems, but it can help Wilson’s syndrome patients. It is kind of like pushing the reset button on your computer,” said Ms. Everett. However, this strategy can have major consequences if the patient has other co-morbid conditions, which many Wilson’s patients do.

“If the patient has chronic fatigue, Lyme disease, or compromised adrenal function, you can really disable someone with a thyroid punch. It really only works if there’s nothing else wrong with them. But if someone’s really sick, you do not want to crank them up to 40 mcg of T3. You’ll end up making them feel worse, because the rest of the endocrine system cannot handle the extra energy.”

For patients in whom a punch is appropriate, begin with 7.5 mcg of sustained release T3 for 2 days, and then double the dose to 15 mcg for another two days. Continue doubling until you’re up in the 30–40 mcg range per day, and then gradually decrease the dose by 7.5 mcg every three days.

For patients who do require ongoing thyroid augmentation, it is best to use desiccated or flash-frozen porcine thyroid preparations such as Armour (Forest Pharmaceuticals) or Nature-Throid (Western Research Laboratories). Porcine thyroid hormones are identical to human hormones, and the porcine preparations provide a fixed T4/T3 ratio of 4:1. Porcine hormones, “are safer and more reliable than the bovine glandulars. We know what’s in the porcine products, but we don’t really know what’s in the bovine products.”

For patients who cannot or will not take porcine hormones, synthetics are an option, but so are natural timed-release hormones derived from soy or wild yam, which, Ms. Everett said, do work like natural thyroid in many cases. In all cases, she strongly advises patients against using over-the-counter glandular products, thyroid or otherwise. Aside from the fact that there may be little quality control or safety oversight in production of these products, continuous use of exogenous glandular extracts affects the pituitary and hypothalamus, down-regulating endogenous hormone production.

Supplement Support for Thyroid Function

Ms. Everett has found a number of botanical and nutritional products to be helpful for patients with thyroid problems. These include the following:

Atomadine or Lugol’s Solution: Either one of these products provides iodine, essential for production of thyroid hormones. 200 mcg iodine daily is a reasonable daily intake, and is particularly important for patients who under-produce thyroid hormones.

Essential Fatty Acids: An omega-3 fatty acid supplement can help reduce inflammation and autoimmune reactions, by restoring a healthier balance between anti-inflammatory omega-3s and pro-inflammatory omega-6s, which are widely prevalent in many peoples’ diets.

Selenium: Selenium deficiency will cause a decrease in thyroid hormone production. Supplementation is a good idea for patients who show low T3 and T4 levels.

Anti-inflammatory Herbs: Turmeric (Curcuma longa), Boswellia serrata (frankincense), Bromelain (an enzyme derived from pineapple), Ginger (Zingiber officinalis), and Stinging nettles (Urtica dioica), all contain compounds that reduce inflammation by modulating cyclooxygenase and lipoxygenase pathways.