Saturday, March 06, 2010 |
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Iodine and Bromine: My Test Results |
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By Diana Hsieh @ 8:00 PM   
A few weeks ago, I took the iodine loading test and bromine test from Hakala Labs. I've been meaning to report my results, as they were pretty surprising, but I've just been too busy. First though, let me tell you about the test.
The test requires that you take a 50 mg dose of Iodoral, then you collect your urine for 24 hours. You send the lab a sample of that urine, along with a report of the total amount of urine collected. The lab reports back your iodine and bromine levels in a few days. (You can test just for iodine, if you like.)
The test was relatively easy to do. You have to be at home for 24 hours to take the test -- unless you wish to carry your jug of urine in a cooler to the grocery store. (No? I didn't think so.) The jug of urine has to be refrigerated, so going to the bathroom requires some advance planning. Next time, to make the process easier, I'll likely set up the jug in a cooler in the bathroom. Of course, you have to make sure to remember to collect every last drop of your urine. (That's harder than it sounds.) Oh, and I discovered that my bladder had just slightly more capacity than the 16 ounce cup provided. (That was awkward!)
I had to stop taking my usual 20 mg per day dose of iodine for the two days before the test. The results were surprising: my digestion became sluggish almost immediately, and I felt like a bloated whale again for the first time in weeks. That disappeared shortly after I took the 50 mg dose of iodine for the test.
When I took the test, I'd been taking more than one milligram doses of iodine in the form of Iosol and Lugol's for 19 days, working my way from 1.8 mg to 24.7 mg. On average, I took nearly 19 mg per day.
So ... without further ado ... what were my results?
I excreted 46.2 mg of the 50 mg loading dose, over 90%. That's supposed to mean that I'm totally iodine sufficient.
That result made no sense whatsoever to me. Clearly, I have been iodine deficient, based on the remarkable improvements I've felt from supplementing with iodine. Yet I'd not been supplementing long enough to reach whole-body sufficiency, as that takes about 3 months of 50 mg of iodine per day. Plus, I felt the effects of just two days without iodine. So I can't be sufficient.
So what in the heck was going on? Here's what the lab report says:
If you excrete 90% or more, and are not taking iodine supplementation, this may be caused by:
1. A symporter defect in which iodine is absorbed but not taken into the cells properly.
2. An iodine organification problem where the iodine gets into the cell but does not attach to the lipid complex for activation.
3. Bromide may be interfering with the body's utilization of iodine. I'm not sure about the first two possibilities, but I did have my bromine levels checked. And I excreted 37.8 mg of bromine in that 24 hours. That's quite high: the upper normal value is 10 mg.
Dr. David Brownstein discusses bromine at some length in his book Iodine: Why You Need It, Why You Can't Live Without It. He writes:
The halides are a group of elements that share a similar size and shape. ... Fluoride, bromine, iodide, chloride and astatide make up this family. Iodine and chloride are the only halides that have therapeutic effects in the body. Bromide is a toxic element that has a chemical structure very similar to iodine. This similarity can cause bromine to bind to iodine receptors and possibly interfere with iodine transport in the body. Bromine is found in many food items such as bakery products, and some sodas, as well as many prescription items. In addition, bromine is found in many fire-retardant chemicals added to furniture, carpets, etc. Crops are sprayed with bromine as a fumigant for agriculture. When there is iodine deficiency present, bromine toxicity will be exacerbated. (Iodine, pg 82-3, citations omitted) What are the effects of bromine on a person?
Bromine intoxication (i.e., bromism) has been shown to cause delirium, psychomotor retardation, schizophrenia, and hallucination. Subjects who ingest enough bromide feel dull and apathetic and have difficulty concentrating. Bromide can also cause severe depression, headaches, and irritability. It is unclear how much bromide must be absorbed before symptoms of bromism become apparent. Recent research has demonstrated that symptoms of bromide toxicity can be present even with low
levels of bromide in the diet. (Iodine, pg 98, citations omitted) Dull and apathetic? Difficulty concentrating? Depression? Gee, that sounds familiar! Those symptoms definitely improved with high dose iodine for me.
Also, Dr. Brownstein reports that fluoride has similar harmful effects on thyroid function. When added to drinking water, it doesn't affect rates of dental cavities. I'm dubious of its benefits when used topically, e.g. in toothpaste. My teeth and gums were in terrible shape, despite using a prescription-strength fluoride toothpaste for some years. I've enjoyed huge improvements in dental health with eating paleo, plus supplementing with cod liver oil and butter oil -- without that high-fluoride toothpast. So fluoride for dental health seems overrated, at best.
Exposure to high levels of bromine and fluoride in modern society might be why many people seem to need so much iodine -- about 12 mg per day as a maintenance dose -- for optimal health.
Notably, I'm definitely not endorsing these claims about the effects of bromine and fluoride and their relationship to iodine as the gospel truth. While they seem to fit my own experience, I'm hardly qualified to judge the underlying scientific claims. (I hate being a layperson, particularly where my very capacity to live a meaningful life is at stake!)
So... supposing that bromine and fluoride toxicity is a genuine problem for me, what do I do?
Mostly, I take my daily dose of iodine, in the form of Iosol and Lugol's. I'm currently varying between 24 and 50 mg per day, somewhat at random. Dr. Brownstein's tests of his patients show that high-dose iodine supplementation enables the body to excrete bromine over the course of several months, until levels fall to normal. Fluoride seems to be excreted with iodine supplementation too, but more quickly. Happily, that supplementation is super-easy and super-cheap.
As an extra preventative measure, I've been trying to identify and eliminate sources of fluoride and bromine in my diet and environment. We bought an under-sink reverse osmosis system for our drinking water. That filters out everything -- including the natural fluoride in our water (2 ppm average), as well as pesticides, herbicides, and the like. I've stopped brushing with toothpaste with fluoride. (I use what I used as a kid: baking soda.) Tea apparently contains some fluoride, but I don't think the cup per day that I drink poses much of a problem.
I've not been able to identify many clear sources of bromine in my diet or environment. It's in hair dye, and I've dyed my hair continuously for the past few years. (That's now stopped, at least temporarily.) I don't eat bread any longer, and I've never drunk Mountain Dew or other sodas. My father never used bromine in our swimming pool when I was a kid. I don't know whether it might be in our carpets or my clothing, but if so, I can't do much about that. I could switch to organic vegetables, but I'd like to avoid that hassle and expense, if possible. (But I hope to grow plentiful vegetables in my own garden this summer!)
I do wonder -- as a super-sketchy hypothesis -- whether my own fat stores might have been a major source of bromine. Bromine seems to be stored in fat tissue. Perhaps I'd accumulated it from various sources over the years, then retained it in fat tissue due to insufficient iodine intake. Losing about fifteen pounds over the course of six months in 2008 on a paleo diet might have released a good amount of bromine into active circulation in my body. Due to my super-low iodine intake at the time, I couldn't excrete it. Instead, it took the place of iodine in my body, and that interfered with thyroid function. Notably, I had low-grade symptoms of hypothyroidism before I switched to a paleo diet, so I'm sure that was in my future, but perhaps the bromine contributed to my hard crash this past fall. Mostly though... I have no clue!
In any case, I plan to repeat the iodine and bromine test in a few months. Hopefully, I'll see lower levels of bromine excretion and greater iodine uptake.Labels: Health, Personal, Thyroid
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Thyroid Update: Do Labs Mean Much? |
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By Diana Hsieh @ 8:00 AM
I'm starting to think that thyroid lab values mean very little, at least in some cases.
I got my latest thyroid labs on Thursday:
- TSH = 3.24 (above 2.5 is hypothyroid, goal to be 1.0)
- Free T3 = 2.6 (normal range 2.0-4.4, goal to be high in that range)
- Free T4 = 1.0 (normal range .82 to 1.77, goal to be in the middle of that range)
That's not what I expected!
Basically, these lab values are the same, if not slightly worse, than they were when I was originally diagnosed as hypothyroid in November. Back then, I was pretty much a senile corpse, but the labs indicated only very mild hypothyroidism.
Now I'm doing pretty darn well, thanks to desiccated thyroid and iodine, as I reported in this blog post.
I still have some symptoms -- I'm still cold, my cholesterol is still high, my skin is terribly dry, and I'm not quite at full strength for weightlifting. Overall though, I'd have to say that I feel pretty darn fabulous.
Yet... the labs are the same. So basically, I've gone from night to day on the inside, yet my lab values haven't budged. At least in my case, my thyroid lab values don't correlate with my well-being in the slightest!
Why would that be? Speaking purely as a well-read layperson, I suspect that many of my worst hypothyroid symptoms were due to the inability of my body to make proper use of its own thyroid hormones, likely due to iodine deficiency. In this good article on the reliability of conventional thyroid tests, Dr. Briffa writes:
Another reason why TSH may not reflect true thyroid status relates to the fact that the brain and peripheral tissues (outside the brain) can sense thyroid hormone levels different. Imagine, for a moment, that the tissues in the periphery are somewhat resistant or 'numb' to the effects of thyroid hormones (in a way similar to the situation when tissues become resistant to insulin). But let's imagine there is no such problem in the brain. Then what can happen is the brain thinks there's enough thyroid hormone around, while the rest of the body is in fact deficient in thyroid hormone and therefore exhibiting the symptoms and signs of hypothyroidism. That's the "type 2 hypothyroidism" that Dr. Mark Starr discussed in his book Hypothyroidism Type 2.
Of course, my labs and symptoms indicate some "type 1 hypothyroidism" too, meaning that I'm not producing enough thyroid hormone. Perhaps my thyroid will fully recover with more iodine supplementation, but I'm not holding my breath. For now, my doctor has raised my medication from 1.0 to 1.5 grains of desiccated thyroid, with another thyroid blood panel scheduled for eight weeks. Hopefully, that extra half grain will be all that I need to feel completely fabulous!Labels: Personal, Thyroid
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Saturday, February 13, 2010 |
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Health-O-Rama |
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By Diana Hsieh @ 2:00 PM
I'm delighted to report that Kelly Elmore has seen some remarkable improvement on desiccated thyroid and iodine. Here's her before post and after post. Lady Baker is also doing better on iodine alone, as she reports in her before post and after post. Hooray to feeling better!
Dr. Davis writes about heart health and magnesium deficiency. Here's an older post on the same topic from Dr. Eades. It's also worth considering whether you're getting the right amounts of potassium. And selenium. And everything else.
Jimmy Moore put together a great post on Whole Foods' new program to promote low-fat, high-carb eating. He's right to be critical of the program, but I don't plan to boycott Whole Foods, as some others are doing. Whatever his errors on diet, John Mackie has earned my respect for his free-market opposition to Obamacare. Plus, Whole Foods doesn't plan to change its product offerings. If it does, then I'll shop elsewhere.Labels: Health, Link-O-Rama, Thyroid
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Saturday, February 06, 2010 |
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Body Temperature: Personal Results |
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By Diana Hsieh @ 3:00 PM
As a followup to my general discussion of thyroid function and body temperatures, I thought I'd report my own personal findings.
Since late December, I've taken my temperature three to four times per day with this basal thermometer. For greater accuracy, I don't take my temperatures for a half hour before or after eating or drinking, nor after exercise. I try to avoid breathing through my mouth (as of often do, as I have narrow nasal passages) for a while beforehand. I record the value and the time in the spreadsheet, then I calculate the average and the range each day.
During that time, my temperatures haven't changed much. That's not surprising. Even though I've seen a dramatic improvement in my other hypothyroid symptoms after starting high-dose iodine and desiccated thyroid in mid-January, I still feel cold -- not just in my hands and feet but in my innermost guts -- most of the time. Some other symptoms, like dry skin, as as bad as ever.
So let's get to the numbers. From December 21st to February 5th, my average temperature has been 96.76°F. The median is 96.85°F. The standard deviation is .69°F. The range is 4.40°F.
Here's the chart of temperature over time (click to enlarge):
Here's the chart of frequency of temperature values (click to enlarge):
As you can see, my temperature mostly ranges from 96.0°F to 97.2°F. That encompasses 68% of the readings (i.e. 101 of 148) -- meaning two standard deviations.
My low was 93.92°F on January 29th. I was sitting at my computer, on a heated pad, under a fleece blanket. I began taking my temperature as I felt myself growing colder and colder. When it got that low, I just couldn't do anything but sit. Then, as it began to rise back to 96°F, I began to feel better. Notably, that was after a few days of terrible stress over a friendship. That's reflected in the wild temperatures I got around that time in the first chart. (Perhaps my adrenal glands were going haywire.) Since then I've made a concerted effort to chill out relax.
I hope to see a rise in body temperature -- and to feel a warm glow in my belly -- if my doctor increases my dose of desiccated thyroid from 1.0 to 1.5 grains with my next round of labs later this month.
Update: I forgot to mention something. When I ate the Standard American Diet, I felt mildly cold most of the time, not just in my hands and feet but in my core. My temperatures were also low, albeit not as low as they are now. When I began eating paleo, I was amazed to feel so much warmer. I didn't need the seat warmer in my car and my office; I wore lighter clothing around the house during the winter. It was fantastic! The only time I would feel cold was after I'd been fasting for about 20 hours or more. That's one reason why I'm pretty sure that I was mildly hypothyroid before I began eating paleo, even though my TSH was in the official normal range. (I'll say more about that in another post, however.)Labels: Health, Thyroid
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Thyroid and Body Temperatures |
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By Diana Hsieh @ 2:00 PM
One difficulty of diagnosing and treating hypothyroidism is that many of the standard symptoms are highly variable between individuals, not well-correlated with lab values, difficult to measure, and not unique to hypothyroidism. Doh!
One useful measure seems to be low body temperature. Janie Bowthorpe of Stop the Thyroid Madness has a whole page on body temperature. She writes:
Generally, the average temperature of an adult with a healthy thyroid and a healthy metabolism is 98.6 degrees Fahrenheit or 37.0 degrees Celsius, and that occurs around mid-afternoon or 3 pm. So if you take your mid-afternoon temp and find it in low 98's or even in the 97's, you have been given a strong clue that you may be hypothyroid. And a few report their mid-afternoon temp being in the 96's. BRRRR.
Another temperature clue is to take it before you rise from your bed in the morning. Dr. Broda Barnes, a doctor who paid attention to clinical presentation and prescribed Armour, found that a healthy before-rising morning basal temp should be between 97.8 - 98.2. If it's higher, you may be hyperthyroid, and if it's lower, you are most likely hypothyroid. He also recommended under-the-arm temperature testing, but patients have found oral to be just as effective.
Additionally, once you are on natural desiccated thyroid like Armour, and are consistently raising your doses, you will see your temps climb to healthy levels with increasing feel-good symptoms to match. In many patients, reaching 98.6 can happen before you are even on your optimal amount of Armour.
Janie also thinks that fluctuating temperatures can be a sign of adrenal fatigue. That's a controversial diagnosis, but given the abysmal failure of the standard treatment of T4-only medication for so many people, I'm inclined to side with Janie's experience.
Dr. Davis also recommends using body temperature in the diagnosis and treatment of hypothyroidism. He writes:
Is there an at-home test you can do to gauge thyroid status?
Yes. Measure your temperature.
Unlike a snake or alligator that relies on the sun or its surroundings to regulate body temperature, you and I can internally regulate temperature. The hypothalamus-pituitary-thyroid glands are the organs involved in thermoregulation, body temperature regulation. While the system can break down anywhere in the sequence, as well as in other organs (e.g., adrenal), the thyroid is the weak link in the chain.
Thus, temperature assessment can serve as a useful gauge of thyroid adequacy. Unfortunately, temperature measurement as a reflection of thyroid function has not been well explored in clinical studies. It has also been subject to a good deal of unscientific discussions. He recommends taking an oral basal temperature -- meaning as soon as you wake up, before you get out of bed or do anything. What temperature are you looking for?
Though there are scant data on the distribution of oral temperatures correlated to thyroid function, we find that the often-suggested cutoff of 97.6 degrees Fahrenheit, or 36.4 C, seems to track well with symptoms and thyroid laboratory evaluation (TSH, free T3, and free T4). In other words, oral temp < 97.6 F correlates well with symptoms of fatigue, cold hands and feet, mental fogginess, along with high LDL cholesterol, all corrected or improved with thyroid replacement and return of temperature to 97.6 F. Of course, hypothyroidism is not equivalent to low body temperature -- any more than it's equivalent to high TSH. It's just one sign among many symptoms and signs. And I think it's a potentially useful sign.
However, I do have some questions about body temperature, some of which Richard Nikoley touched on in this post.
First, what's the optimal range of body temperature? How much does it vary between persons?
It's easy enough to determine average temperature in a population: just take a slew of temperatures. Determining optimal temperature is a whole new ball of wax -- particularly if many people suffer from undiagnosed hypothyroidism! Plus, the optimal body temperature of a person eating a high-carb vegetarian diet might differ markedly from a person eating a high-fat paleo diet. Similarly, the sedentary person might have a different optimal temperature than the avid crossfitter, marathoner, or weightlifter. And perhaps genetic origins matter too: Inuits might differ from Polynesians. Moreover, perhaps individuals with very similar backgrounds and lifestyles vary in their optimal temperature due to random features of their biology.
In short, knowing the average body temperatures and standard deviations of seemingly healthy people is a far cry from knowing your own optimal body temperature.
Here's the standard view of normal body temperatures from WebMD:
Most people think of a "normal" body temperature as an oral temperature of 98.6F. This is an average of normal body temperatures. Your temperature may actually be 1°F (0.6°C) or more above or below 98.6F. Also, your normal body temperature changes by as much as 1°F (0.6°C) throughout the day, depending on how active you are and the time of day. Body temperature is very sensitive to hormone levels and may be higher or lower when a woman is ovulating or having her menstrual period. They also indicate that an oral temperature of less than 96F indicates low body temperature. (I've had plenty of temperatures below 96.0 lately, but I'll post on that separately.)
However, even the standard number of 98.6 is controversial. Here's a report from Harvard Medical School:
The 98.6° F "normal" benchmark for body temperature comes to us from Dr. Carl Wunderlich, a 19th-century German physician who collected and analyzed over a million armpit temperatures for 25,000 patients. Some of Wunderlich's observations have stood up over time, but his definition of normal has been debunked, says the April issue of the Harvard Health Letter. A study published years ago in the Journal of the American Medical Association found the average normal temperature for adults to be 98.2°, not 98.6°, and replaced the 100.4° fever mark with fever thresholds based on the time of day.
Now, researchers at Winthrop University Hospital in Mineola, N.Y., have found support for another temperature truism doctors have long recognized: Older people have lower temperatures. In a study of 150 older people with an average age of about 81, they found that the average temperature never reached 98.6°. These findings suggest that even when older people are ill, their body temperature may not reach levels that people recognize as fever. On the other hand, body temperatures that are too low (about 95°) can also be a sign of illness.
The bottom line is that individual variations in body temperature should be taken into account, reports the Harvard Health Letter. Ideally, you and your doctor should have enough temperature measurements at various times of day to establish a baseline for you. Short of this, recognize that 98.6° isn't the benchmark that we've long believed it to be. So perhaps the best way to know your own optimal body temperature would be to record a series of body temperatures when you feel well with a good-quality thermometer. I wish I'd done that a year ago.
Second, how can a person get precise and accurate measurements of body temperature?
That's a harder problem than you might think! The article "Temperature measurement in paediatrics has an excellent discussion of the problems with the various methods of measurement. (I'm omitting the citations, as well as some material relevant only to children. You can find that in the article.)
Rectal thermometry: Rectal thermometry has traditionally been considered the gold standard for temperature measurement, but some studies have revealed limitations of this method. Rectal temperatures are slow to change in relation to changing core temperature, and they have been shown to stay elevated well after the patient's core temperature has begun to fall, and vice versa. Rectal readings are affected by the depth of a measurement, conditions affecting local blood flow and the presence of stool. Rectal perforation has been described, and without proper sterilization techniques, rectal thermometry has the capacity to spread contaminants that are commonly found in stool.
Axillary thermometry: While axillary [armpit] temperature is easy to measure (compared with oral or rectal measurements), it has been found to be an inaccurate estimate of core temperature in children. This type of measurement relies on the thermometer remaining directly in place over the axillary artery, and it is largely influenced by environmental conditions.
Oral thermometry: The sublingual site is easily accessible and reflects the temperature of the lingual arteries. However, oral temperature is easily influenced by the recent ingestion of food or drink and mouth breathing. Oral thermometry relies on the mouth remaining sealed, with the tongue depressed for 3 to 4 min ... The only good news is that (high-quality, properly-functioning) digital thermometers are as accurate as mercury thermometers.
As I said to Richard Nikoley when he e-mailed me that link: "I suppose that the most accurate method is the coroner's liver temp, but I think I'd rather avoid that!"
As for my own body temperatures, I've posted that separately: Body Temperature: Personal Results.Labels: Health, Thyroid
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Questions on Hypothyrodism |
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By Diana Hsieh @ 9:00 AM
Dr. Eades has graciously agreed to write up a post on thyroid and iodine. Here's what he says at the end of his most recent post:
I've been so busy lately that I haven't posted a lot, but that doesn't mean I haven't been thinking about posting. I've got a number of things I've been wanting to write about that I plan to have up as soon as the Colpo deal is finished. I want to add my two cents worth on a bunch of the problems some Paleo dieters seem to develop. And I've got a post cooking on the thyroid and iodine. One on fructose, and one on saturated fat. Plus the analysis of the next stupid study that will inevitably pop up and seize the imagination of the mainstream media types who will shout it from the rooftops. Hooray! I'll definitely owe him the sous vide meatball that I promised him. Then again, he might prefer if I wrote up a post on how to make them. (I have no idea... but here's a hint.)
I know that I've been all gushy for Dr. Eades of late... but he deserves it! Dr. Eades -- as well as Dr. Davis and others -- have been extremely generous in their blogging. I've benefited so much from their medical experience -- not just in my abstract understanding of the relevant science but in my rubber-meets-the-road well-being. They've earned my respect and my gratitude in spades.
Now to the real point of this post. In requesting a post on thyroid problems, I sent Dr. Eades the following questions as fodder. I have my own preliminary views and suppositions about some of them, but I'm very interested in his answers. Here they are, with links added:
- Why did you choose to put your patients on desiccated thyroid rather than T4-only meds?
- What do you think of using synthetic T4 plus T3 rather than desiccated thyroid? (Kurt Harris claims that synthetic hormones are exactly identical to those in porcine thyroid, and that the addition of T3 is the sole reason why people do better on porcine thyroid than T4-only meds.)
- What do you think of the claim that a person can be hypothyroid despite basically normal lab results? What do you think about the concept of "Type 2 Hypothyroidism"?
- Do you recommend dosing based on symptoms -- or by TSH?
- Why do you think that hypothyroidism is so prevalent today? Why do you suspect that it affects more women than men?
- What do you think of the standard view that any dose of iodine above a few hundred micrograms is dangerous, even potentially a cause of hypothyroidism? What is a standard safe dose? Is high-dose iodine dangerous for some people?
- If a person suspects that they might be hypothyroid, what do you recommend that they do? Might iodine alone make a difference -- or stave off full-blown hypothyroidism?
- Do you think that a low-carb diet can somehow cause, reveal, exacerbate, or otherwise affect a thyroid problem? (Matt Stone claims that, as do others. [See the PaNu smackdown.]
- Do you think that adrenal fatigue is a genuine problem for some hypothyroid people? If so, what do you recommend doing to treat it?
- What sources do you recommend that people read if they have been diagnosed with or suspect they have hypothyroidism?
I doubt that Dr. Eades can answer all those questions in a single blog post, but I hope that he addresses some of them.Labels: Health, Thyroid
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Saturday, January 30, 2010 |
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Thyroid Update: Desiccated Thyroid and Iodine |
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By Diana Hsieh @ 5:00 PM
After months of being lethargic, confused, fat, pained, and cold from my hypothyroidism, I'm finally on the mend! Although I'm not yet 100%, the turn-around was remarkable. Within just a few days, my worst symptoms of mental fog and lethargy were alleviated by rejecting the conventional treatment of synthetic T4 (e.g. Synthroid, levothyroxine) in favor of desiccated porcine thyroid plus high-dose iodine.
(Desiccated thyroid is dried pig thyroid; it contains the full range of natural hormones produced by the thyroid, not just T4. High-dose iodine means supplementing with 12.5 to 50 milligrams per day.)
When I was diagnosed as hypothyroid in early November, my TSH was only 3.23. That's barely abnormal, but I was suffering from most of the standard symptoms of hypothyroidism. (TSH above 2.5 suggests hypothyroidism.) My doctor put me on 50 micrograms of Synthroid, a synthetic version of the T4 hormone. Two months later, in early January, my TSH was down to 2.28, but my symptoms were somewhat worse. Also, my Free T3 and Free T4 were the same, still on the low end of the middle range.
Undoubtedly, I could have increased my Synthroid, eventually reducing my TSH to my doctor's target of around 1.0. Would I have felt any better at that point? Based on my experience on the drug for those two months -- when my lab values improved but my symptoms worsened -- I strongly suspect not. Instead, if I'd stayed on Synthroid, I likely would have been mentally and physically disabled for the rest of my life.
I'm not exaggerating. During those two months, I was unable to work, travel, or pursue any substantive projects. My weekly trip to the grocery store exhausted me, and I often couldn't muster the energy to slowly walk around the pastures with Conrad. My IQ felt about 20 points lower; I could only think at a very surface level. I was most definitely not flourishing. My mind and body seemed to be slowly shutting down.
Sadly, that's not an uncommon response to the standard regimen of T4-only medication. TSH might fall to normal levels, but the many debilitating symptoms of hypothyroidism remain. From what I've read in countless forums, too many doctors seem concerned only to treat the problem of high TSH, not the underlying problem of hypothyroidism. In particular, many doctors seem to ignore the fact that the body might not effectively convert the storage hormone T4 into the active hormone T3 -- or that tissues might not effectively use T3. Many patients on synthetic T4 medication complain to their doctor about their persistently raging hypothyroid symptoms, only to be summarily dismissed. After all, if the TSH is normal, all those classic hypothyroid symptoms simply must be due to something other than a poorly functioning thyroid -- like aging or poor diet or even hysteria. Or so they claim. (Such doctors equate hypothyroidism with elevated TSH, just as analytic philosophers equate concepts with definitions.)
The consequences of that mis-treatment are tragic. People suffer the degradation of living as a quasi-corpse for years and decades, unless they discover desiccated thyroid. (Or, in some cases, they suffer unless they find a way to return to desiccated thyroid, after some new doctor switched them from it to synthetic T4, often against their express wishes.) It's heartbreaking to read these stories. I know that, without dedicated and tenacious people like Janie Bowthorpe of Stop the Thyroid Madness, I could have suffered the same fate. Instead, I got off pretty easy with only two months of living as a semi-corpse on Synthroid.
At the time of my diagnosis of hypothyroidism in early November, I was aware that Synthroid might not work for me. However, given that I developed my hypothyroidism at the very height of a government-induced shortage of desiccated thyroid, I was willing to try it. Well, I got my answer by early January: Synthroid didn't do squat for me, except lower my TSH.
Happily, my excellent family practice doctor, Dr. Heble, was willing to switch me to one grain of desiccated thyroid, to see whether that might help. (One grain is the standard starting dose for desiccated thyroid, but it was an increase for me, based on this conversion chart.) By that time, I'd found a local source: Wise Compounding Pharmacy.
Just as I was making that switch from Synthroid to desiccated thyroid, I also began taking high-dose iodine, plus selenium. As I indicated in my first post on my hypothyroidism, I suspected that I might be deficient in iodine for three reasons.
- Seafood is the primary natural dietary source of iodine, but I hated it until my mid-20s, and even now, I don't eat more than a serving per week.
- Nearby oceans supply the soil of the east and west costs with iodine, but I've lived in the "goiter belt" for the last decade.
- Then, perhaps tipping me over the edge, I switched from iodized salt to (low-iodine) sea salt when I began eating paleo in the summer of 2009.
(I'll say more on what I suspect about the origins of my hypothyroidism in another post, including its relationship to my lacto-paleo diet.)
Back in early December, I began cautiously supplementing with 150 micrograms of "Liqui-Kelp," gradually increasing that to 600 micrograms over the next month. (150 micrograms is the government's recommended daily allowance.) I never felt any positive results from doing that. However, during that time, I was reading about much, much higher doses of iodine -- between 12.5 and 50 milligrams -- as sometimes necessary for whole-body health, including improving thyroid function.
I was intrigued by that, but also very wary. Most doctors will say that milligram doses of iodine are dangerous. However, the claims of danger seem to be sketchy, seemingly based on poor-quality epidemiological studies. Plus, most people seem to be able to handle those milligram doses just fine, and many people see remarkable improvement on them. Also, from what I read in some standard medical sources, a person with a physically intact thyroid can handle that much iodine, but a person with a damaged thyroid (e.g. partly removed in surgery) will be unable to tolerate it. Also, some people with Hashimoto's do great on iodine, but others don't tolerate it well. So, with much trepidation, I decided to try milligram doses of iodine.
On Monday, January 11th, I began taking Iosol and Lugol's, working my way up to about 16 milligrams by the end of the week -- over 100 times the government's RDA. I also began supplementing with 100 to 200 micrograms of selenium each day. (Selenium is essential for thyroid health, you probably don't want to take iodine without it, and you definitely don't want to take more than 400 micrograms per day. That upper limit seems well-established.)
(Note: I don't have any special reason for doing both types of iodine, except my own confusion. Lugol's -- or the tablet form Iodoral -- seems to be the preferred form, as it contains both iodine and potassium iodide. From what I've read, different tissues prefer those different forms. Iosol contains only iodine. The milligrams of iodine per drop for J.Crowe's Lugol's Solution is here.)
On Tuesday of that week, I began feeling better: I was able to run some errands, then attend Ari Armstrong's "Liberty in the Books" economics discussion group. That amazed me, as doing both would have been impossible just a week before. Then, on Wednesday, I switched to the desiccated thyroid. Over the next few days, I felt amazingly better. My brain fog lifted, and my lethargy disappeared. I could think again! I could concentrate! I danced around the house, singing silly songs! I wanted to exercise again! I had energy to burn! Life was good again!
Most amazingly, within just a few days on the milligram doses of iodine, a 16-month bout of totally mysterious amenorrhea came to an end. (Sorry, TMI, I know... but it's important.) I was totally floored; I never expected that kind of result, not so fast! By way of background, the problem started after I went off the birth control pill in October of 2008. My doctor did a battery of tests over the summer, but nothing seemed wrong, except that my estrogen levels were very low -- like menopausal. Initially, we thought the problem was just that my reproductive system went dormant with the shock of going off the pill after about fifteen years of nearly continuous use. Once the hypothyroidism cropped up, my doctor wondered whether there might be some connection. Hypothyroidism is known to cause menstrual problems, albeit usually causing too-heavy periods. Now I wonder what my iodine deficiency did to my estrogen levels, if that's what happened. (Oh, and I'm not the only one.)
Never in my life have I experienced such a dramatic turn-around in my health, mind, and mood as I experienced that week on iodine and desiccated thyroid. If I weren't a intransigent atheist, I would describe it as a miracle. That's what it felt like: I got my life back -- I got myself back -- in the span of just a few days.
However, I had an epistemic problem. Although I knew that the improvement began before I switched to desiccated thyroid, I wanted to sort out how much was due to the iodine supplementation versus the desiccated thyroid. So after three days on desiccated thyroid, I switched back to my old 50 microgram dose of Synthroid. I stayed on that for about five days -- enough time to allow the T3 of the desiccated thyroid to fully clear from my system.
During that time on iodine plus Synthroid, I definitely felt a decline in my energy and mental function, although I was still significantly better than when on Synthroid alone. I was eager to get back to the desiccated thyroid, and I perked up again when I switched back to it. Interestingly, I'm going without iodine today and tomorrow, to prepare for an iodine loading test on Monday. I'm definitely feeling a fuzzy-headed today, perhaps due to that lack of iodine intake.
Overall, I would say that I was functioning at about 50% while Synthroid, at about 75% while on Synthroid plus iodine, and now I'm at about 90% with desiccated thyroid plus iodine.
Oddly, my symptoms are not all better. Instead, my body's response has been somewhat mixed. My brain fog is gone, and my powers of memory and concentration are much better. I have tons more energy, such that I'm able to put in a day's work. Overall, my mental function and energy levels should be about 10% better, I think. I've stopped gaining weight, but I've not yet lost any weight. My digestion is definitely better: I'm not chronically bloated, and I'm able to skip a meal without disaster. My carpal tunnel is somewhat better, but still bothering me somewhat. However, my body temperatures are still quite low, averaging about 96.5 F. My skin is still terribly dry.
I'm also able to exercise -- but wowee, I am so out of shape! I'd been increasing sedentary for the last few months, such that I barely moved in December. Now I can exercise, but my muscles are shaky and then sore from even mild weightlifting. Also, I used to be unable to exert enough energy to get winded, but now my wind is the major limiting factor when I row on our rowing machine. That's good!
Also, my goiter -- the nodule in my thyroid -- seems to have shrunk considerably. Before, I could feel a squishy spot on my neck, and I could see a slight bulge in the mirror. Now that's all gone. I'll have an ultrasound recheck in late March, and I expect good results from that.
I'm going to have another thyroid lab panel done in early March, and I expect that I'll be increasing my desiccated thyroid dose to 1.5 grains then. Also, as I mentioned, I'm taking an iodine loading test on Monday. I'll be very curious to see my results; I expect that I'm still iodine deficient, and that I can and ought to increase my daily dose, perhaps up to 50 milligrams per day for a few months. Paul -- who has been supplementing with just the RDA of 150 micrograms for the past few weeks -- will be taking his test when he can, likely next weekend. I'll be very curious to compare my results with his.
I've come to wonder whether iodine might be like Vitamin D -- in the sense that the miniscule amounts recommended by the government might be sufficient to ward off obvious illness -- rickets, in the case of Vitamin D and goiter, in the case of iodine. Yet a much higher dose might be optimal. I'm definitely not recommending everyone start taking large doses of iodine. However, if you're suffering from the symptoms of hypothyroidism, you might investigate iodine. And for everyone else, I recommend that you make sure that you obtain the recommended 150 micrograms per day.
Mostly though, I'd like to see some solid research and writing on the subject. While I've learned a great deal from the sources I've read, I've been frustrated by the inconsistent quality thereof. I'm not competent to dig up and read the primary sources in the medical literature: I'm purely a consumer of secondary sources. That makes me exceedingly nervous, as I know just how inaccurate secondary sources can be!
I have serious reservations about the scientific judgment of some of the sources I've read on iodine and hypothyroidism -- even though I often found them fascinating and helpful. For example, Dr. David Brownstein wrote a fascinating little book on iodine -- Iodine: Why You Need It, Why You Can't Live Without It. (He's also the author of Overcoming Thyroid Disorders.) His collection of articles on iodine (often co-authored) looked good too... until I got to the belligerent argument for young-earth creationism. Seriously. I don't think that Brownstein is lying about the tests he's done and the results he's gotten, particularly given that others have reported similar results. Yet I simply cannot trust the medical judgment of someone who appeals to the Flood (!!) and Satan (!!) to explain why the soils of some inland areas are deficient in iodine.
Similarly, while I was super-intrigued by what I read in Dr. Mark Starr's book Hypothyroidism Type 2, I was dismayed to read on his web site that he practices homeopathy and "energetic medicine." I just can't regard that as anything better than mystical quackery. The only bright side is that nothing in the book seems to depend on -- or even hint at -- those views, so perhaps that's all separate from his views on hypothyroidism. However, once again, I simply can't trust his medical judgment.
My basic approach is to take whatever seems grounded in good empirical science from these folks, then then integrate it with my own experience and reliable reports from others. Happily, I can strongly recommend one very practical book on hypothyroidism, namely Janie Bowthorpe's Stop the Thyroid Madness. Mary Shomon's book Living Well with Hypothyroidism also has some helpful suggestions, particularly for dealing with doctors unwilling to prescribe desiccated thyroid. And I've often found myself searching the archives of various Yahoo Groups, particularly Coalition for Natural Desiccated Thyroid, Natural Thyroid Hormones, and Iodine.
Also, I have some hope for Dr. Broda Barnes' 1976 book Hypothyroidism: The Unsuspected Illness, but I'll reserve judgment until that arrives from Amazon.
Mostly, I'm just desperate for a good, juicy blog post from Dr. Eades on the subject of hypothyroidism, desiccated thyroid, and iodine supplementation. He's probably the only doctor (along with his excellent wife, MD) whose judgment I can fully trust on this topic. He's got the deep knowledge of the relevant biology; he's got the years of experience treating patients with hypothyroidism; and he's got a good working epistemology.
Happily, Dr. Eades dropped some useful hints in the comments of a blog post on Oprah's weight gain. He recommends an iodine loading test, plus Iodoral (12.5 to 50 milligrams) for people who are deficient. And he always used desiccated thyroid for his patients, not synthetic T4. I was so relieved to read that, as I felt like I was leaping about in the dark, particularly on the iodine.
So ... Dr. Eades ... will you write that blog post on iodine that you promised in those comments? Pretty please... with a deliciously tender sous vide meatball on top?Labels: Health, Personal, Thyroid
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Saturday, January 02, 2010 |
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Another Thyroid Update |
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By Diana Hsieh @ 12:00 PM
Blah. I suppose that it's time for another update on my hypothyroidism.
It's not going terribly well. For the moment, I'm doing somewhat better only because I've learned how to best limit my activities, so that I don't completely exhaust myself. That means doing very little, unfortunately. If I'm feeling well, I can work for about three hours each day -- maybe. Yet even then I'm pretty fuzzy-headed all the time. My powers of concentration and memory are pretty pathetic. I routinely forget what I'm supposed to be doing unless I write it down and keep it in sight. I wake up from eight hours of deep sleep like I just got four. That's how I feel all day.
For example, when preparing dinner last week, I was puzzled by the fact that I didn't seem to have any vegetables. They weren't on our plates, nor on the stove. "Oh well," I thought, "we have enough food." Then I wandered to the stove to stir the turkey stock I was making. I noticed something funny in stirring it, but only when I spooned up a small red potato did I remember that I'd put them in the stock to cook for dinner. (I don't make potatoes often, but they are an occasional treat for Paul.) Paul then joked that I'm like the man in Memento. He asked me not to take his picture and write "enemy" on it. That was damn funny... but not entirely inapt. At times, I've thought to myself, "Oh, so this is what it feels like to go senile."
Unfortunately, it's all-too-easy for me to overdo it, then render myself completely incapable of doing anything. Any kind of exercise -- even just ten minutes on the rowing machine -- kills me. This week, I was completely unable to muster the energy to work for two full days because I wore myself out on Tuesday. What did I do? I had a friend over for an informal brunch, a guy came to the house to replace my cracked windshield on my car, and then I went into town to run some errands, mostly just buying groceries at Whole Foods and Costco. That killed me for all of Wednesday -- much to my dismay and surprise.
On the plus side, I've found that instead of my normal feelings of too-exited overload in social gatherings, the company of friends energizes me into feeling pretty normal. So although I'm not keen on doing anything, I'm trying to be a bit more social than usual.
Also, I'm still gaining weight, even though I'm eating little. I can't fast or even skip a meal. My temperatures are steady around 96.5. And my skin is unbearably dry and itchy. However, I'm happy to report that I haven't had any problems with depression in the past few weeks. I think that limiting my activities has prevented those awful lows. That's huge, I must say. I can tolerate almost anything -- but not that.
Overall, I'm not really better than when I went on the Synthroid back in November. I might even be somewhat worse.
I'm hopeful, however. I've found a local compounding pharmacy able to provide me with dessicated thyroid, so I'm going to switch to that as soon as I get my thyroid hormones tested on January 5th.Labels: Health, Personal, Thyroid
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Saturday, November 28, 2009 |
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Thyroid Update |
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By Diana Hsieh @ 8:00 AM
Last Tuesday, my thyroid nodule was repeatedly poked for a biopsy. (My neck wasn't happy about that, I must admit!) The biopsy went fine, and results weren't so bad.
Initially, the pathologist's reading was basically, "maybe cancer, maybe not." That wasn't terribly helpful! The odds were very good that the nodule wasn't cancer. Yet that couldn't be ruled out, based on the mere look of the cells. The standard of care in such cases is to remove the nodule, along with the half the thyroid. Then the pathologist can perform the much easier task of examining a whole slice of tissue to determine whether it's composed of evil mutant cells or not. I wasn't too enthused about that, as you might imagine: I'm eager to get back to work. ("Good news, you didn't need the surgery! Now enjoy your weeks of recovery to full strength!")
Happily, we were able to get a second reading from a pathologist specializing in cytopathology. He's reasonably confident that the nodule is merely benign goiter, so we plan to simply do a recheck ultrasound in six months.
I'm not sure if the nodule and the hypothyroidism are related. However, I'm leaning toward the hypothesis that iodine deficiency might be the underlying cause, as discussed by Dr. Davis in this helpful article.
As for my hypothyroidism, I'm not feeling quite as bad as I was a few weeks ago, but I'm not feeling terribly well. I'm lethargic; I tire easily. I'm having trouble concentrating -- or even remembering what I said five minutes ago. My body temperatures are still low, and I'm cold. I'm still gaining weight. My carpal tunnel is still bothering me. I've not had the depression of a few weeks ago, thankfully. I'm definitely doing a bit better -- but only a bit. I'll have been on the Synthroid for three weeks as of Tuesday, so I'm going to speak to my doctor about increasing my dose -- if not switching to dessicated thyroid.
So for now, I'm still on a reduced schedule. My primary concern is to keep churning out new episodes of Explore Atlas Shrugged. You should consider anything else to be an unexpected bonus.Labels: Health, Personal, Thyroid
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Saturday, November 21, 2009 |
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Hypothyroidism: Lethargic, Fat, Pained, and Cold |
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By Diana Hsieh @ 8:00 AM
The past few weeks have been a drag for me. I've just not been feeling right. I've been lethargic, even somewhat depressed. Based on those and other symptoms, I suspected thyroid problems. I was right. I've been diagnosed with mild hypothyroidism, plus a two-centimeter thyroid nodule.
My symptoms seem to have started in a clear way in early September, then accelerated hugely in early November. In short...
- I've been generally lethargic, with far less energy than usual. I used to have tons of energy, since my change in diet last July. I would run up hills during six-hour hikes for fun. I would do jumping squats while waiting for meat to grill. I needed my daily workouts to burn off steam. That changed this fall. I didn't want to work out or exert myself. In late September, I was very easily worn out by the hiking that Paul and I did with my father. I didn't want to run around outside with Conrad.
- I've gained weight. Much to my dismay, I've gained about eight pounds in eight weeks, despite eating in a way that should have kept my weight steady. (I feel enormous: it's awful.) Also, I found myself unable to fast: I've needed regular inputs of food to keep myself going or I would crash. The last time I tried fasting, I crashed hard around 23 hours. I was shaky and ill, with a blood sugar of only 54. My attempts to raise it by exercise were totally fruitless. Also, my digestive system hasn't been working right: it protests if I do so much as skip a single meal. (I won't inflict the specifics on you.)
- I've lost muscle power. At OCON in early July, I was able to leg press 320 pounds. In mid-September, I was down to 210. By late October, I was down to 150. Given the slow-burn-type workouts I was doing this fall, my power should have been increasing, not declining rapidly.
- I've been cold, cold, cold. Last winter, I was remarkably warm and toasty, thanks to my change in diet. This fall, I was freezing. My temperatures -- tested with a good basal thermometer -- have been in the 96s. Only rarely have I gotten into the 97s, and then only in the bottom half. (I have been in the upper half of the 95s, much to my astonishment.)
- I suddenly developed severe carpal tunnel problems in early October, even though my desk is set up the same as ever. I've also had mysterious aches in my left elbow and neck for the past two months that never seemed to go away.
- I've been depressed on occasion without cause. In general, I've felt deeply unmotivated and emotionally flat. I just don't care: I've lost my too-hot passions. I've also had some bizarre bouts of utterly inexplicable and pathetic misery -- like crying because the interior of my car stank like solvent for about two minutes after the mechanic returned it to me. Seriously, that's just dumb.
- I've had difficulty concentrating. My productivity has declined hugely over the past few weeks, to the point where I'm barely able to do my one Atlas Shrugged podcast per week.
Strangely, apart from the depression and the carpal tunnel, these symptoms made me feel like I was back to eating loads of carbs and other junk. In fact, I've been eating as paleo-ish as ever. For many weeks, I just assumed that I was being lazy, gluttonous, and weak-willed. Despite all that I know, I found it remarkably easy to blame and flog myself.
However, as I became more depressed and flat, I realized that something was seriously amiss. Thanks to some excellent hints and prodding from Monica Hughes, I realized that so much of what I was feeling matched the standard symptoms of hypothyroidism. Oh, and I should mention that I've had problems sleeping (very unusual for me), my cholesterol has been rising (despite no change in diet), and I could feel a lump on my neck where my thyroid is. Also, I've got a solid family history of thyroid problems.
My doctor agreed to do a thyroid blood panel before I saw her on November 10th. (That was good; I hate doing results over the phone.) That bloodwork showed an elevated (and rising) TSH of 3.23, as well as somewhat low free T3 and T4. That, in addition to my symptoms, suggested early hypothyroidism.
So I'm now on a fairly low dose of Synthroid, i.e. synthetic T4. That medication takes a few weeks to take full effect, so we'll likely need to gradually adjust my dose based on my symptoms and lab values over the next year. (The aim is to get my TSH down to about 1.) I would have preferred desiccated thyroid over T4, as many people report far better results, due to getting the full range of thyroid hormones. However, thanks to the regulatory overlords at the FDA, that's been nearly impossible to obtain in the US for the past few months. If I'm not happy with the Synthroid, then I'll make the effort to obtain desiccated thyroid from overseas.
On the 17th, I had an ultrasound of my thyroid. The lump I felt on my neck turned out to be a two centimeter nodule. Frustratingly, it's not clear whether -- and in what way -- the hypothyroidism and the nodule are related. I wonder whether the underlying cause might be iodine deficiency, particularly given that I don't consume much iodized salt. (Dr. Davis, the Heart Scan Doc, has written quite a bit on this problem.) However, I'm pretty thoroughly confused by all that I've read on iodine and thyroid. I think I ought to supplement, but I fear doing more damage to my thyroid. (I'm now eating a bit of sea vegetable every day for its iodine content, but I'm not sure that's the right thing to do.)
I'm scheduled for an aspiration of my thyroid nodule on Monday. That should be an easy procedure. The nodule is not likely composed of evil mutant cancer cells, but it's worth checking. Plus, I figure that I ought to get whatever medical care I can before Obama can ration everything based on collective cost savings.
For the moment, I'm feeling somewhat better. Granted, I'm still lethargic, fat, pained, and cold. Life still sucks. However, life sucks less than it did a few weeks ago. Right now, I count that as a win.
My plan is to keep myself relatively quiet through this Thanksgiving week, then try to get back to work in earnest in the first week of December. November feels like a lost month for me, and I hate that. Hopefully, December will be a month of happy frolicking for me.Labels: Health, Personal, Thyroid
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