Hitendra H. Shah M.D. WELLNESS MEDICAL CLINIC “Integrating Traditional and Alternative Medicine for Better Health” DIAMOND BAR, CA 91765 www.ThyroidSecondOpinion.com Today's Topic ARE YOU LAZY, CRAZY OR HYPOTHYROID? NEW CONCEPTS in DIAGNOSIS and TREATMENT of HYPOTHYROIDISM

Symptoms The symptoms of hypothyroidism are varied, and depend on such factors as: how hypothyroid you are, -; your age-; your general level of health, and how hypothyroidism affects you uniquely. One may have some or all of the following symptoms, in varying severity: You feel tired, exhausted, have difficulty getting enough sleep, or want to take daytime naps. You feel depressed, down, or sad. You feel cold when others do not, particularly in your hands and feet. You’ve gained weight inappropriately, or you are finding it difficult to lose weight, despite proper diet and exercise. You’re losing hair, particularly from the outer part of your eyebrow, -- or your hair is getting dry, or tangly. Your nails are breaking and splitting and becoming brittle. You have muscle and joint pains and aches, or you've been diagnosed with fibromyalgia. You’ve been diagnosed as having chronic fatigue syndrome. You have swelling and puffiness in the eyes, face, arms or legs. You have low sex drive. You have high cholesterol levels, particularly the type that is unresponsive to diet and medication. You have a heavier than normal menstrual period or your period is longer than it used to be, or comes more frequently. You’re going through menopause, and are having troublesome symptoms. You have worsening allergies, itching, prickly hot skin, rashes, hives, urticaria, chronic yeast infections, oral fungus or thrush, or stomach and abdominal bloating. You find it difficult to concentrate, your memory is not as good as it should be--; you feel that your thinking is “slow”. You are frequently constipated. You have a feeling of fullness, or an obvious swelling in your neck area.

Dr. Shah’s Wellness Medical Clinic Diamond Bar, CA (909) 860-2610 Temperature Chart Name:__________ Month:________ T3 Dose   Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 99.0 98.9 98.8 98.7 98.6 98.5 98.4 98.3 98.2 98.1 98.0 97.9 97.8 97.7 97.6 97.5 97.4 97.3 97.2 97.1 97.0 96.9 96.8 96.7 96.6 96.5 96.4 96.3 96.2 96.1 96.0

Types of Hypothyroidism Hypothyroidism is an energy-sapping illness with many diverse symptoms. It can result from any of the following: the thyroid gland not producing enough thyroxin or T4 * Primary, Secondary or Tertiary (Iodine and Omega 3 fatty acids) Decreased rate of conversion of T4 into T3 (the active hormone) (Selenium – Stress, Delivery, Liver dysfunction) Thyroid Resistance: increased cellular resistance to the hormones (a. Vitamin A, D and Zinc b. Low Cortisol, Iron the body developing antibodies to its own hormones (auto- immune disease) Graves and Hashimoto's Thyroiditis

TYRANY of TSH A TSH test is a fraction of the overall thyroid picture. * TSH is NOT a thyroid hormone. It is a pituitary hormone from which doctors have to guess the quality of your thyroid hormones. * It can only diagnose “primary” hypothyroidism, NOT other types of hypothyroidism. * Many times, the hypothalamus-pituitary axis does not function efficiently, and the TSH level does not change exactly as T3 and T4 levels change. Dysfunction of this hypothalamus-pituitary axis can cause “secondary or pituitary” and “tertiary or hypothalamic” hypothyroidism. * Just because TSH level is “normal” does not mean that one does not have an underactive or hypothyroid condition. * T3 medications and TSH

RECOMMENDED LAB TESTS: TSH Free T4 (FT4) Free T3 (FT3) Reverse T3 (RT3) Thyroglobulin level and Thyroid Antibody tests - Thyroglobulin antibody and - Microsomal TPO or Peroxidase antibodies) AM Cortisol level Iron level These tests are important not only for diagnosis but also to decide what type of thyroid treatment to utilize for each individual.

Pitfalls to Avoid While Interpreting Thyroid Function Tests: Normal Does Not Mean OPTIMUM Total T4 Level: ______________________________ 11.5 4.5 NOT Feeling WELL Syndrome TSH is a test of the Pituitary Gland for interpreting Thyroid Function Low TSH does not always mean Hyperthyroidism T4 is not an active Thyroid hormone T4 – T3 rT3

How I interpret Lab Results: 1.2 - 0.8 = 0.4 0.4 / 1 * 100 = 25% T3 4.2 – 2.3 = 1.9 3.4 – 2.3 = 1.1 1.1 / 1.9 * 100 = 58% RT3 25 – 8 = 17 43 – 8 = 35 35/17*100 = 206% Desirable lab levels: T4 50 % T3 60-70% RT3 Less than 30%

70 year old female was treated with Levothyroxine 50mcg for over 10 years. Fatigue Body Ache Weakness Back Pain Multiple Joint Pain Weight gain of 4lbs in 3 months Diabetes

Pitfalls to Avoid While Interpreting Thyroid Function Tests: 1. One must keep in mind that laboratory tests only represent a snapshot of thyroid function at the time that the blood sample was obtained. 2. Only a small fraction of T4 circulates in the “free” or unbound state. Approximately 99.9% of T4 in the circulation is bound to serum proteins, including thyroxine- binding globulin (TBG), thyroxine-binding prealbumin, albumin, and lipoproteins.[9,10] About 99.7% of T3 is bound to its carrier protein, transthyretin. Alterations in serum levels of these binding proteins will alter the total levels of the thyroid hormones in serum. Autoimmune thyroid disease is common in western populations, and represents the most common cause of thyroid dysfunction in the United States.[14,15] Graves' disease and Hashimoto's thyroiditis are 2 forms of autoimmune thyroid disease that have different manifestations.

Treating Hypothyroidism * Glandular Thyroid Medicines Armor Thyroid, NatureThroid, Westhroid (T4, T3, T2, Calcitonin) Compounded Thyroid Medicines * T4/T3 combinations * Sustained release T3 Iodine Nutritional Supplements