HGH, Testosterone, Increase Libido, ProFractional, Laser Peel, Leg Vein Treatment, Age Management Orange County, Anti Aging of Orange County, Dr. Judi Goldstone

Sep 05 2008

Hypothyroidism – by Judi Goldstone, M.D.


Hypothyroidism is a disease state whereby the thyroid gland fails to produce enough thyroid hormone. Epidemiology

In the United States studies have shown the prevalence of hypothyroidism to be anywhere from 3-10%. Internationally the prevalence has been reported as 2-5%, increasing to 15% by age 75 years. Cretinism refers to congenital hypothyroidism, which has been estimated to affect one per 4000 newborns. However, the numbers could be higher due to many cases that go undetected. Even when lab tests are in the “normal range” one must remember normal for one person may be inadequate for someone else. In my practice I look at each patient as an individual and optimize their thyroid function based on symptoms, clinical exam and lab findings. Hypothyroidism is one of the most under diagnosed hormonal imbalances of aging. It is more common in women than men and the incidence increases with age. Other risk factors include having a family history of thyroid problems, a history of chronic fatigue syndrome, female gender, age greater than 50 yrs, exposure to radiation, chemical exposure (flouride, perchlorate), obesity or a history of thyroid surgery.

Thyroid structure and function

The thyroid is a butterfly shaped gland that wraps around the windpipe.. The cells inside the thyroid gland take in iodine, combine the iodine with an amino acid called tyrosine, and convert that into the thyroid hormones called T3 and T4. Released into the bloodstream, 80% of the thyroid hormones are in the form of T4 and 20% in the form of T3. T3 is the biologically active hormone and is several times stronger than T4.

The main function of thyroid hormone is to help cells convert oxygen and calories into energy. Thyroid, like other hormones, is regulated by an extensive negative feedback system. The system starts in the hypothalamus of the brain and releases Thyrotropin Releasing Hormone (TRH). TRH signals the pituitary gland to release Thyroid Stimulating Hormone (TSH). TSH in turn instructs the thyroid gland to make thyroid hormones and release them into the bloodstream. When the level of thyroid hormone in your body is high, a negative feedback system exists to reduce the production of TSH, and vice versa. Therefore, a high TSH is indicative of hypothyroidism, while a low TSH can be indicative of hyperthyroidism(an overactive gland).

Causes of Hypothyroidism

There are a variety of causes of hypothyroidism. Worldwide, iodine deficiency remains the foremost cause of hypothyroidism. Hypothyroidism can be primary, secondary or tertiary. Primary hypothyroidism is due to the failure of the thyroid gland itself to produce enough hormones. Secondary hypothyroidism is low thyroid hormone secretion due to failure of adequate thyroid-stimulating hormone (TSH) secretion from the pituitary gland. Tertiary hypothyroidism is failure of adequate thyrotropin releasing hormone (TRH) from the hypothalamus.

Causes of Primary Hypothyroidism

1. Autoimmune thyroiditis (Hashimoto thyroiditis)

2. Postpartum thyroiditis: Up to 10% of postpartum women may develop Lymphocytic thyroiditis in the 2-10 months after delivery

3. Inflammatory conditions or viral syndromes

4. Medications such as amiodarone, interferon alpha, thalidomide, lithium, and stavudine have been associated with primary hypothyroidism.

5. Use of radioactive iodine for treatment of hyperthyroidism (Graves╩╝ Disease)

6. Post surgical removal of all or part of the thyroid

7. Radiation treatment to the head and neck area

8. Iodine deficiency

9. Over-consumption of uncooked broccoli, turnips, radishes, cauliflower, brussels sprouts

10. Adrenal insufficiency (commonly caused by chronic stress)

11. Mercury intoxication (amalgams are 50% mercury)

12. Over consumption of isoflavone-intensive soy products

Causes of Secondary or Tertiary Hypothyroidism

(damage to the hypothalamic-pituitary axis)

1. Pituitary adenomas

2. Tumors impinging on the hypothalamus

3. History of brain irradiation

4. Drugs (e.g., dopamine, lithium)


Hypothyroidism commonly manifests as a slowing in physical and mental activity but may be asymptomatic. Symptoms and signs of this disease are often subtle and neither sensitive nor specific. Classic signs and symptoms are cold intolerance, puffiness, decreased sweating, and coarse skin. Many of the more common symptoms are nonspecific and difficult to attribute to a specific cause. Individuals can even present with obstructive sleep apnea (secondary to enlarged tongue) or carpal tunnel syndrome. Women can present with galactorrhea (milky discharge from a nipple) and menstrual disturbances. Consequently, the diagnosis of hypothyroidism is based on clinical suspicion and confirmed by laboratory testing.

The following are symptoms of hypothyroidism:

Fatigue, loss of energy, lethargy with need for a daytime nap

Weight gain or difficulty losing weight

Decreased appetite

Cold intolerance

Skin that becomes dry, scaly, rough and/or cold

Hair becomes coarse, brittle or falls out


Muscle pain, joint pain, weakness in the extremities


Emotional lability, mental impairment

Forgetfulness, impaired memory, inability to concentrate


Menstrual disturbances, impaired fertility

Decreased perspiration

Parenthesis and nerve entrapment syndromes

Blurred vision

Decreased hearing

Fullness in the throat, hoarseness

The following are symptoms more specific to Hashimoto Thyroiditis (autoimmune thyroid disease)

Feeling of fullness in the throat

Painless thyroid enlargement


Neck pain, sore throat, or both

Low-grade fever


The traditional laboratory tests used to diagnose hypothyroidism are: Total T4, T3 Uptake and Free Thyroxin Index (FTI), TSH (Thyroid Stimulating Hormone) as well as Free T3 (FT3)and Free T4 (FT4). However, due to the complexity and weakness of the traditional laboratory tests, there can be widespread difficulty in lab interpretation.


The lower the amount of thyroid hormone in the body, the more TSH will be produced and secreted by the pituitary to stimulate the thyroid gland to put out thyroid hormones. For most traditional laboratories, the upper limit of the normal TSH level is 4.0 to 4.5. While those people who have TSH levels higher than 4.5 are highly likely to have hypothyroidism, many more with TSH levels less than 4.5 have a sub-clinical hypothyroidism or underactive thyroid. These cases can be missed if the focus on diagnosis is based on the traditional reference range only. Many patients with a TSH level of 2.0 (not 4.5) or more have classic symptoms and signs of hypothyroidism. Even though their TSH is considered “normal” by traditional standards, many are suffering from underactive thyroid or subclinical hypothyroidism. If your blood work comes back with a TSH of 2.0 and you have symptoms of hypothyroid disease, chances are your thyroid gland is not working properly. Most people feel good when their TSH level is about 1. TSH alone, however, is not an accurate test of all forms of hypothyroidism but only primary hypothyroidism. Additional tests like Free T3 (FT3) and Free T4 (FT4) are required. Some doctors also test for elevated thyroid antibodies in addition to FT3 and FT4. Many patients, especially women with elevated antibodies are in the process of developing autoimmune thyroid disease. Early detection is important to effect appropriate treatment.

Free T3 and Free T4
The thyroid gland produces four thyroid hormones called T1, T2, T3, and T4. The number indicates the number of iodine atoms attached to the molecule. T4 is a hormone precursor and is converted into T3, the form that performs most of the thyroid function in the body. Easily overlooked is the fact that many people cannot convert the T4 to T3. This is confirmed by measuring free hormone level, a practice most doctors are not trained to do. Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. At Griffin Medical Group we measure the Free T3 and Free T4 which are the active thyroid hormones that cross the cells membrane and act on the body to increase the basal metabolic rate, generation of heat, affect protein synthesis and increase the body’s sensitivity to catecholamines (such as adrenaline) by permissiveness. The thyroid hormones are essential to proper development and differentiation of all cells of the human body. These hormones also regulate protein, fat, and carbohydrate metabolism, affecting how human cells use energetic compounds. They also stimulate vitamin metabolism.


1. The traditional medications used to treat hypothyroidism for decades have been Levoxyl and Synthroid which consist of only the T4 hormone. We do not use these T4 only medications at Griffin Medical Group because they are not bio-identical (human identical) and do not contain any T3. T3 is the active thyroid hormone in the human body. Many patients cannot convert T4 to T3 and therefore if not given T3 the signs and symptoms of hypothyroidism will persist.

2. Armour Thyroid is made from porcine the (pig) gland and contains both T3 and T4 in a fixed ratio. Each grain of Armour has 38 mcg of T4 and 9 mcg of T3. This medication is prescribed on occasion but because of the fixed ratio of T4 to T3 it is not optimal for some of our patients.

3. The best medication that we have found is a compounded bio-thyroid which is a bio-identical (humanly identical) thyroid medication that contains both T4 and T3. This allows the clinician to adjust the exact amount of T4 and T3 hormone in the preparation. After you have been on thyroid medication for three months, follow up blood testing will be done and the level of T3 or T4 in the bio-thyroid compound adjusted if necessary.

4. Iodine, as mentioned previously, is extremely important to the functioning of the thyroid gland and is also recommended as part of the treatment. We prescribe Iodoral as an iodine supplement which can cause the thyroid gland to produce more natural thyroid hormone.


Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, et al. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J . Clin Endocrinol Metab. Feb 2002;87(2):489-499.

Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. Jan 14 2004;291(2):228-38.

Grozinsky-Glasberg S, Fraser A, Nahshoni E, Weizman A, Leibovici L. Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials. J Clin Endocrinol Metab. 2006/07;91(7):2592-2599.

Woeber KA. Iodine and thyroid disease. Med Clin North Am. Jan 1991;75(1):169-178.

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