Adrenal Dysfunction

The adrenal glands secrete hormones such as cortisol, estrogen, and testosterone that are essential to health and vitality and significantly affect total body function. After mid-life, the adrenal glands gradually become the major endogenous source of sex hormones in both men and women. Intense or prolonged physical or emotional stress commonly associated with modern lifestyles or chronic illness can lead to Adrenal Fatigue, which is an important contributing factor in health conditions ranging from allergies to obesity.

Anti-inflammatory and anti-oxidant adrenal hormones like cortisol help to minimize allergic and negative reactions, such as cancer and autoimmune disorders. These hormones closely affect the utilization of carbohydrates and fats, the conversion of fats and proteins into energy, and cardiovascular and gastrointestinal function. Proper adrenal support is essential to complete the hormonal pathway to optimal health, and includes proper nutrition, getting plenty of sleep, regular moderate exercise, stress management, slowing down to regain a proper perspective on life, and replacement of deficient hormones.

Thyroid Hormone Therapy

Symptoms of hypothyroidism (low levels of thyroid hormone) include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slowed metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.

Although both T4 (thyroxine, an inactive form that is converted to T3 in other areas of the body) and T3 (triiodothyronine, the active form) are secreted by the normal thyroid gland, many hypothyroid patients are treated only with levothyroxine (synthetic T4). Some hypothyroid patients remain symptomatic, and T3 may also be required for optimal thyroid replacement therapy. However, the only commercially available form of T3 is synthetic liothyronine sodium in an immediate release formulation which is rapidly absorbed, and may result in higher than normal T3 concentrations throughout the body causing serious side effects, including heart palpitations. Research indicates there is a need for sustained-release T3 preparations in order to avoid adverse effects.

A randomized, double-blind, crossover study found inclusion of T3 in thyroid hormone replacement improved cognitive performance, mood, physical status, and neuropsychological function in hypothyroid patients. Two-thirds of patients preferred T4 plus T3, and tended to be less depressed than after treatment with T4 alone. Patients and their physicians may wish to consider the use of sustained-release T3 in the treatment of hypothyroidism, particularly when the response to levothyroxine (T4) has not been complete.

J Endocrinol Invest 2002 Feb;25(2):106-9
Levothyroxine therapy and serum free thyroxine and free triiodothyronine concentrations.
Click here to access the PubMed abstract of this article.

N Engl J Med 1999 Feb 11;340(6):424-9
Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.
Click here to access the PubMed abstract of this article.

Many patients have tried synthetic thyroid hormones, such as levothyroxine and liothyronine, and have found that Natural Thyroid is the only form that works adequately for them, reporting that they simply do not feel as well when they take levothyroxine alone or with liothyronine.

Certain forms and strengths of Natural Thyroid are available only through compounding pharmacies. In addition, we can blend T4 and T3 pure powders in a specific ratio by prescription.

Commercially available tablets contain fillers and excipients that may not be tolerated by all patients. When we compound customized dosages, we have the ability to omit any problem-causing inactive ingredients and substitute non-reactive fillers. We welcome your questions and the opportunity to help your patients.

Thyroid Therapy: Essential for Hormone Balance

More than half of all people affected by thyroid disease are unaware of their condition. Thyroid disorders affect far more women than men, and the risk increases with age. While both men and women experience stress and exposure to environmental toxins, women are more vulnerable to thyroid imbalances due to hormonal changes throughout their lifetime (puberty, birth control pills, pregnancy, menopause, HRT). Many symptoms of hypothyroidism and menopause overlap. While hormone replacement therapy often focuses on estrogens, progesterone, DHEA and testosterone, optimal hormone balance cannot be achieved without correcting thyroid hormone imbalances.

Thyroid hormone (T4; thyroxine) is produced by the thyroid gland in response to the release of thyroid-stimulating hormone (TSH) from the pituitary gland. T4 is converted in other parts of the body to T3 (triiodothyronine), the form of thyroid hormone that cells use most effectively. Thyroid hormone helps the body convert food into energy, regulates body temperature, and impacts reproduction and many other hormonal functions. In hypothyroidism (underactive thyroid), either the thyroid’s ability to make and release T4 or the body’s ability to convert T4 to T3 becomes compromised often showing up in the form of elevated TSH. When thyroid hormones are not available in the proper form and amount, many bodily functions are disrupted. For example, thyroid imbalance has a profound effect on cardiovascular fitness because thyroid hormone helps control heart rate and blood pressure. Under hypothyroid conditions, the heart rate can slow substantially, arrhythmias may develop, and blood pressure may fall significantly. Hypothyroidism also weakens muscles including the diaphragm; as a result, breathing can become less efficient. Snoring may start or become worse. With impaired respiration and reduced availability of oxygen, muscles do not strengthen in response to exercise and stamina does not improve. Fatigue is extremely common, and muscles and joints may ache.

People with hypothyroidism have an increased risk of kidney disease, and chronic kidney disease can affect the production and breakdown of thyroid hormones. When thyroid hormone levels drop, the liver no longer functions properly and produces excess cholesterol, fatty acids, and triglycerides, which increase the risk of heart disease. Hypothyroidism is the second leading cause of high cholesterol, after diet. High cholesterol may also increase the risk of Alzheimer’s disease, and severe hypothyroidism can cause symptoms similar to those of Alzheimer’s disease.

Hashimoto’s disease is the most common cause of hypothyroidism in the United States. This autoimmune disease causes inflammation that often leads to an underactive thyroid gland. It primarily affects middle-aged women, but also can occur in men and children. Hashimoto’s typically progresses slowly over years and causes chronic thyroid damage, leading to a drop in thyroid hormone levels. Without treatment, signs, and symptoms gradually become more severe and the thyroid gland may become enlarged (goiter).

Treatment of Hashimoto’s disease with thyroid hormone replacement is usually effective. Some Hashimoto’s patients are not able to properly and efficiently convert T4 to T3. Stress is a common cause of low T4 to T3 conversion, and under stressful situations, T4 may be converted to reverse T3 (R-T3) instead of T3. R-T3 is an inactive molecule related to T3, but without any physiological activity. Therefore, combination T4/T3 therapy may be needed. Vitamin D deficiency has been reported to be prevalent in several autoimmune diseases including Hashimoto’s thyroiditis, and vitamin D supplementation should be considered.

As people age, they often experience changes in thyroid physiology and function. In some cases, there may be a reduction in thyroid iodine uptake, and less free thyroxine and free triiodothyronine production. T4 may convert to R-T3. Testing is needed to determine the problem and the most appropriate treatment.

The original form of thyroid hormone replacement was Desiccated Thyroid Extract (DTE) from the thyroid glands of animals which contained both T4 and T3; this was the only available treatment for hypothyroidism for almost 50 years. Levothyroxine sodium (synthetic T4) has replaced DTE as the most common treatment for primary hypothyroidism.

Despite apparently adequate replacement therapy with levothyroxine, some hypothyroid patients remain symptomatic. Studies suggest that therapy with levothyroxine alone does not ensure normal thyroid hormone levels in all tissues and that a combination of levothyroxine and T3 may be required for optimal thyroid replacement therapy. Patients with specific genetic polymorphisms that affect thyroid hormone transport may benefit from combination T4/T3 therapy, and those who continue to have thyroid symptoms despite having normal TSH levels may benefit from a trial of T3 in addition to T4 medication.

However, the only commercially available form of T3 is immediate release liothyronine sodium which is rapidly absorbed and metabolized, requires multiple daily doses, and can cause serious side effects including heart palpitations. Research indicates there is a need for sustained-release T3 preparations.

Benefits of Compounding

Some patients feel best when taking medications that do not contain excipients such as lactose, corn starch, and gluten, which represent some of the most common food sensitivities in people with Hashimoto’s. Ingesting even small portions can exacerbate symptoms. In some cases, removing these substances from medications and diet may reverse the formation of thyroid antibodies.

Natural DTE products are only available in a standard physiologic ratio. Compounding enables physicians to prescribe thyroid hormone therapy in a custom T4:T3 ratio when needed, and to order T3 as a sustained-release preparation to avoid cardiovascular side effects associated with immediate-release liothyronine.

Eur J Endocrinol. 2017 Dec;177(6):R287-R296.
THERAPY OF ENDOCRINE DISEASE: T4 + T3 combination therapy: is there a true effect?
Click here to access the PubMed abstract of this article.

Clin Endocrinol (Oxf). 2014 Nov;81(5):633-41.
Defending plasma T3 is a biological priority
Click here to access the PubMed abstract of this article.

Int J Nephrol. 2014; Article ID 520281.
Thyroid Disorders and Chronic Kidney Disease
Click here to access the PubMed abstract of this article.

Climacteric. 2014 Jun;17(3):225-34.
Thyroid and menopause
Click here to access the PubMed abstract of this article.

Nat Rev Endocrinol. 2014 Mar;10(3):164-74.
Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism
Click here to access the PubMed abstract of this article.

Thyroid. 2011 Aug;21(8):891-6.
Relative vitamin D insufficiency in Hashimoto’s thyroiditis
Click here to access the PubMed abstract of this article.

J Obstet Gynaecol. 2007 Jul;27(5):503-505.
Can thyroid dysfunction explicate severe menopausal symptoms?
Click here to access the PubMed abstract of this article.

N Engl J Med. 1999 Feb 11;340(6):424-9.
Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism
Click here to access the PubMed abstract of this article.

Hashimoto’s: The Root Cause and Hashimoto’s Protocol
by Isabel Wentz, Pharm.D.

Low Thyroid Function and Infertility

Unexplained infertility (UI), defined as the inability to conceive after 12 months of unprotected intercourse with no diagnosed cause, affects 10% to 30% of infertile couples. An improved understanding of the mechanisms underlying UI could lead to less invasive and less costly treatment strategies. Abnormalities in thyroid function and hyperprolactinemia are well-known causes of infertility.

Hypothyroidism causes very irregular menstrual cycles, which interfere with ovulation and conception. In a recent Harvard Medical School study, women with unexplained infertility had significantly higher TSH levels than controls, and more than a quarter of the women with UI showed signs of hypothyroidism.

Hypothyroidism may not be diagnosed until a person has a TSH level of 4.5 or 5. However, a TSH level of 2.5 indicates a person at risk of hypothyroidism who might be experiencing some early symptoms, according to Pouneh Fazeli, MD, a neuroendocrinologist with Massachusetts General Hospital and an assistant professor at Harvard Medical School. To see if a slightly underperforming thyroid gland could affect fertility, Fazeli and her colleagues reviewed the cases of 187 couples with unexplained infertility and 52 couples in which the men had an extremely low sperm count, using them as a control group. Nearly 27 percent of women in the unexplained infertility group had a TSH level in the high-normal range of 2.5 or greater, compared with 13.5 percent of the women in the male-factor infertility group.

However, the study did not prove a cause-and-effect link, but rather an association. “What we don’t know is whether giving someone in this situation thyroid hormone will actually improve time to conception. That’s really the critical next step,” said Fazeli, Future research may determine whether giving women supplements to boost their thyroid hormone levels will make a difference.

Doctors already test for thyroid levels in pregnant women and treat them as necessary, said Dr. Tomer Singer, Director of Reproductive Endocrinology at Lenox Hill Hospital in New York City. “We pretty much implement treating patients with thyroid supplements when they have TSH greater than 2.5 because we know during pregnancy it’s been shown by several studies that the baby’s brain development can be affected if the patient hasn’t been treated for hypothyroidism,” said Singer, who wasn’t involved with the study. “This is along the same lines,” he said. “Now, patients who are trying to conceive should be treated, and if they’re not treated, that in and of itself can be a contributing infertility cause.”

J Clin Endocrinol Metab. 2018 Feb 1;103(2):632-639.
Higher TSH Levels Within the Normal Range Are Associated With Unexplained Infertility
Click here to access the PubMed abstract of this article.

Chronic Fatigue Syndrome (CFS, Chronic Fatigue and Immuno-Deficiency Syndrome, CFIDS) and Fibromyalgia (FM, formerly called fibrositis) may manifest as hypothalamic, pituitary, and immune dysfunction.

A study in the Annals of Allergy, Asthma and Immunology [2000 Jun;84(6):639-40] demonstrated that supplementation with NADH for one month resulted in significant improvement, and other studies have shown some minimal improvement with magnesium.

Ann Allergy Asthma Immunol. 1999 Feb;82(2):185-91
Therapeutic effects of oral NADH on the symptoms of patients with chronic fatigue syndrome.
Click here to access the PubMed abstract of this article.

The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all, CFIDS/FM patients. T4 (levothyroxine) preparations are often ineffective for CFIDS/FM patients. A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable. T3 works the best for many of these patients, but Cytomel, a very short acting T3 available at retail pharmacies, is also a poor choice because the varying blood levels cause problems such as heart palpitations. Compounded, sustained-release T3 may be the best treatment. However, standard blood tests may lead one to dose incorrectly and not obtain significant benefits. Ultimately, it is the expertise and dosing of the T3 or T4/T3 combinations and the makeup of the medications that determines the success of treatment.

Natural Therapies for CFIDS/FM: Proper nutritional supplements, proteins, and hormones can protect and enhance the immune system. Antioxidants may also be beneficial because free radicals play a role in causing damage to the immune system.

Vitamin B-12 levels are often low in patients with CFIDS/FM. A malfunctioning thyroid or adrenal gland can decrease the ability of the body to absorb and utilize vitamin B-12. Vitamin B-12 is necessary for a healthy nervous system; it has been known for many years that depression and fatigue can be caused by low B-12 levels.

D-ribose significantly reduced clinical symptoms in patients suffering from fibromyalgia and chronic fatigue syndrome, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30%.

J Altern Complement Med. 2006 Nov;12(9):857-62
The use of D-ribose in chronic fatigue syndrome and fibromyalgia: a pilot study.
Click here to access the PubMed abstract of this article.