Friction. Clap your hands, stomp your feet, or give them a mini-massage. But you already know that one, so consider…

Yoga. Lie on your back with legs against wall, perpendicular to the floor for as long as comfortable. When leg muscles relax, blood vessels open up and circulation improves.

Aerobic exercise. Take a walk, ride a bike, or do jumping jacks—anything that makes you work up a sweat.

Still feeling frosty? Consider thermal bio-feedback, a natural therapy that trains patients to warm their hands and feet in about 20 sessions. For a referral, talk to your care provider or go to bcia.org.

How to Shake Off a Chill The Saturday Evening Post

Dorrie

St. Augustine, Florida

Rest easy. Your body is able to turn the prescription drug Synthroid into the T3 hormone that you need.

A healthy thyroid gland produces the right amount of T3 (triiodothyronine) and T4 (thyroxine or tetraiodothyronine) to control the body’s rate of energy use. Doctors prescribe a synthetic version of T4 called levothyroxine (Synthroid, Levoxyl) when the gland is underactive or removed because of thyroid cancer or Graves’ disease, the most common cause of hyperthyroidism in the United States.

“The body converts, or makes, T3 from T4,” explains Dr. Jeffrey Garber, chief of endocrinology at Harvard Vanguard Medical Associates. “In fact, a 2008 study from Georgetown University Medical Center in Washington, D.C., reports normal T3 levels in those taking levothyroxine therapy.”

Thyroid Pills The Saturday Evening Post

“It ruined everything—career, social life, relationships, because I was tired all the time,” Rotherham recalls. With lab results in hand and determined to find an answer, he began researching the Internet for clues. “One thing that kept surfacing was hormone imbalance,” Rotherham found.

The search also introduced him to an Indianapolis physician, noted for success in treating “difficult” cases, who conducted more extensive lab tests that finally revealed a diagnosis—underactive thyroid. Immediately placed on thyroid supplements, Rotherham soon noticed a difference.

“Within a couple of weeks, I felt worlds better,” says Rotherham, now 49, who recently launched his own business. “I went from being literally flat on my back, achy and tired, to being highly functional.”

Rotherham is among the approximately 27 million Americans living with overactive or underactive thyroid, according to the American Academy of Clinical Endocrinologists (AACE). Unfortunately, like Mark Rotherham, many go undiagnosed until something goes terribly awry, at times wreaking havoc on one’s quality of life.

Think of the thyroid as your body’s thermostat. Functioning normally, this butterfly-shaped gland, which sits just below your voice box, releases just the right amount of hormones to regulate your body’s metabolism and keep things running smoothly. However, if the thermostat is turned up too high, the thyroid becomes overactive—a condition called hyperthyroidism. You may feel revved up, overheated, and anxious and notice unexplained weight loss. In contrast, if the thermostat is turned down too low, the thyroid becomes underactive—a disorder called hypothyroidism—and fails to provide enough hormones to meet the body’s demands. As a result, your body slows down, leading to a wide range of ubiquitous symptoms. Of the two, hypothyroidism is the more common—and the more insidious.

Dialing down

The reason hypothyroidism is missed so often is threefold: Doctors don’t always screen for thyroid dysfunction; patients may not know to ask about it; and the symptoms are common to many other conditions.

While some people with hypothyroidism note changes, others overlook symptoms, because they seldom develop overnight and are often subtle. Hypothyroidism is notorious for mimicking changes often associated with aging, such as fatigue and intolerance to cold.

Over time, people may discover that the gland swells 
(see Neck Check) and their eyebrows begin to disappear. Additionally, hypothyroidism decreases sweating and causes slowing of your most vital systems: the heart, the lungs, and the gastrointestinal tract. Patients may experience shortness of breath when exercising, and many develop sleep apnea. Worst of all, hypothyroidism can cause high blood pressure and raise blood levels of cholesterol, two of the biggest aging culprits in America. Identifying the thyroid disorder is crucial, because in rare cases, hypothyroidism can lead to coma or even death. For all of these reasons, I encourage both 
patients and their doctors to have a conversation about hypothyroidism. When left untreated, the complications 
can shave years off your life.

Gauging your risk

Women are especially vulnerable: According to the AACE, hypothyroidism is up to 8 times more common in women than men. But all of us need to pay attention to our thyroids as we age, because underactive thyroid becomes much more common in older adults. By age 60, as many as 17 percent of women and 9 percent of men have an underactive thyroid.

Smoking; exposure to secondhand smoke or large amounts of radiation during childhood or cancer treatments of the head, neck or chest; and some prescription medications (such as the heart drug amiodarone and long-term use of mood-stabilizing lithium) can cause hypothyroidism.

However, the most common culprit in the U.S. is autoimmune dysfunction, when the body’s immune cells start to attack thyroid tissue like it’s a foreign invader. As 
a result, the thyroid gland stops producing hormones the 
way it’s supposed to. Genetics likely play a role; we know 
that people with a personal or family history of autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, 
and psoriasis, among others are at higher risk for hypothyroidism. Researchers are close to discovering which gene types might make us more susceptible to autoimmune thyroid problems. In those who are genetically susceptible, certain environmental factors, such as iodine in our diet, are thought to trigger the autoimmune attack on the thyroid.

Thyroid checkup

If you are worried about your thyroid hormone levels, a simple blood test can help you and your doctor reach a diagnosis. The American Thyroid Association recommends that all adults over the age of 35 undergo thyroid screening; however, there is no firm consensus on mass screening. It’s especially important for people with high cholesterol to ask about having their thyroid levels checked: Many people aren’t screened for thyroid levels and could potentially have hypothyroidism. The good news is that doctors now have a very sensitive “thyroid stimulating hormone” (TSH) test that allows us to diagnose thyroid disorders much earlier—even before symptoms appear. Higher than normal TSH levels can reveal whether your thyroid function is in danger, even if your actual thyroid hormone levels are normal.

If your thyroid blood tests come back sub-par or abnormal, the most common treatment option for hypothyroidism is synthetic thyroid hormone replacements. These oral medications help restore hormone levels that shift your internal thermostat and metabolism back to normal. Evidence suggests that people who take thyroid hormone replacements should do so on an empty stomach. Additionally, certain medications, supplements, and foods may affect your ability to absorb thyroid pills. Talk to your doctor about your present medication regimen to gauge if there is an interaction. For example, generally it’s best to wait about four hours after taking thyroid medication to consume soy and high-fiber products, iron and calcium supplements, antacids that contain aluminium or magnesium, and certain prescription medications such as cholestyramine (Questran). Ultimately, monitoring thyroid hormone levels will determine if there is an absorption problem.

The role of prevention

Even if you’re not a candidate for thyroid hormone medications, dietary changes may help you protect the health of your thyroid. Because both too much and too little iodine can cause hypothyroidism, it’s important to be aware of foods that contain iodine and how they may affect your thyroid. Iodine deficiency is rare in the U.S. because it is added to our table salt. Eating excessive amounts of certain raw vegetables such as brussels sprouts, cabbage, cauliflower, corn, and kale should be avoided because they contain enzymes that can drive down thyroid function. But don’t think I’m telling you not to eat your vegetables—cooking them for just a few minutes deactivates those enzymes and makes them nutritious for your whole body.

In general, to protect the cells in your thyroid and your entire body, I recommend foods rich in:


• Antioxidants (blueberries, cherries, tomatoes, squash,
 bell peppers)

• Omega-3 fatty acids (walnuts, salmon)

• B vitamins (whole grains, fresh vegetables)

Vitamin D is another critical micronutrient that is 
getting a lot of attention for its role in autoimmune disease. We know that up to 70 percent of Americans aren’t getting enough vitamin D and that inadequate levels could put you at higher risk for autoimmune disorders, such as rheumatoid arthritis and multiple sclerosis. Vitamin D also plays a supportive role for the parathyroid glands, four smaller glands located on the larger thyroid, that closely monitor and regulate calcium levels in our blood and bones. One of the best ways to get your daily dose of D is just 10-20 minutes of sunshine each day. Sardines, dark leafy greens, and fortified dairy products are also important sources. I recommend at least 800 international units (IUs) daily for most adults and 1000 IUs for adults over 70.

In addition to warding off problems within the thyroid and autoimmune disease, keeping your vitamin D levels up will also help fight off flu and several forms of cancer.

The key to keeping the thyroid healthy is paying attention to your own body. All too often, we accept that certain changes, such as sluggishness and depression, are just a natural part of the aging process. But hypothyroidism is the secret culprit behind these unexplained symptoms for millions of Americans. When we simply accept weight gain, low exercise tolerance, and mental cloudiness without questioning the cause, we’re risking serious harm to our bodies.

After his hypothyroidism went undiagnosed for a decade, Mark Rotherham is back on his feet.

You can find more information on diagnosing and treating thyroid disease from our exclusive interview with Dr. Jeffrey R. Garber.

Post Investigates: Thyroid Disease The Saturday Evening Post

Millions of Americans are living with an overactive or underactive thyroid, according to the American Association of Clinical Endocrinologists (AACE). Unfortunately, many go undiagnosed until something goes terrible awry, at times wreaking havoc on one’s quality of life. In this Web exclusive interview, we offer information about diagnosing and treating thyroid disease from Dr. Jeffrey R. Garber, immediate past president of the AACE, chief of endocrinology at Harvard Vanguard Medical Associates, and associate professor of medicine at Harvard Medical School to accompany the Jul/Aug 2010 Post Investigates feature: “Thyroid: A Secret Culprit,” by Dr. Mehmet Oz.

Dr. Jeffrey GarberCourtesy AACE

Post: Who should be tested? Should it be part of a routine annual physical?
Dr. Garber: Thyroid testing was not part of President Bush Sr.’s annual physical. If you remember, his hyperthyroidism was diagnosed after he had problems breathing while jogging. Today, the American Thyroid Association recommends screening every five years, starting at age 35. Universal screening is not felt to be cost effective, but most experts would recommend testing women over 60, those with symptoms, and then targeted subgroups such as smokers or those with a personal or family history that includes autoimmune conditions.

Having symptoms of thyroid disease does not mean one has it. Making a diagnosis solely based on symptoms can be inordinately difficult. However, the diagnosis becomes straightforward by testing for it. People should target themselves based on symptoms. If you are aware of thyroid conditions and believe you are experiencing enough symptoms, it is easy for a doctor to justify testing.

In addition, doctors should target patients on the basis of other risk factors. For example, I would check someone who comes to my office saying “I feel perfectly well” if I felt a lump in their thyroid or there was a compelling history. Thyroid disease is very easy to overlook.

Post: Hypothyroidism seems to be frequently in the headlines. Any reason why?
Dr. Garber: I think we live in an era in which people are seeking holistic approaches—sometimes in a good sense, and sometimes in a way that they can get exploited, in my view. Thyroid disease lends itself to an approach by some practitioners that is generally symptom-based. The idea that a constellation of symptoms dictates a diagnosis, despite the lack of conventional proof, is where the tension comes in.

“What Your Doctor Won’t Tell You” is a great headline. What people don’t read about is the downside of taking thyroid hormone products. It is not a free ride. My major concern is the risk of over-treatment. The second concern is that by treating symptoms without a certain diagnosis, a doctor will overlook another important fact or condition. Hypothyroidism can masquerade as depression, but depression can masquerade as hypothyroidism, for example.

Then there is the cost of medicine and the cost of testing. I would never argue with someone who says they feel a certain way, but the data doesn’t support that treating marginal disease necessarily leads to benefit. If a person has borderline thyroid stimulating hormone (TSH) levels and no symptoms or compelling medical reason, such as planning a pregnancy, treatment may not be called for. If people are borderline and symptomatic, of course, try to treat it. But give it a limited time. Don’t just commit people to medicine and put them at risk for being over-medicated or being subject to costs and missing other possible reasons for what they are feeling. Fatigue is the 21st century complaint. We’ve got a lot of reasons to be tired besides our thyroid.

Thyroid drug analogs, or copies of thyroid hormone, are also being mentioned in the press. As recently as March 11, 2010, the New England Journal of Medicine featured a follow-up article on the subject. The concept is to design a thyroid hormone analog that has the benefits of, say, inducing weight loss or lowering cholesterol, but not the drawback of stimulating the heart.

Post: How far away is this concept from actual reality?
Dr. Garber: It was pretty far away until March 11. These researchers demonstrated that one particular analog did not affect the heart, and did lower cholesterol.

Another drug analog was studied in heart disease patients. Many lost weight, but 60 percent to 70 percent of the patients dropped out of the study because they felt lousy. Since the study was not designed to analyze weight loss, researchers couldn’t do a good job of finding out whether people ate less because they had a lousy appetite, which is a terrible way to lose weight, as opposed to eating less because their appetite isn’t as high.

Post: Is there a better test for thyroid hormone levels on the horizon?
Dr. Garber: Not at present. The current discussion is whether we need to take a new look at what is considered the normal range for TSH levels, depending on the situation. Data show that some TSH levels we now consider elevated—in the elderly—may not represent hypothyroidism. And, on the other hand, new guidelines are definitely going to set a lower TSH of approximately 2.5 as the upper normal in the first trimester of pregnancy.

Post: What is the link between thyroid hormone and heart attack and heart disease?
Dr. Garber: If you are profoundly hypothyroid, you often become hypertensive and hypercholesterolemic. As a result, your vessels become constricted as well. Hyperthyroidism affects the heart mostly through rhythm disturbances characterized by fast heart rates including atrial fibrillation and sinus tachycardia.

Post: Are there other new developments you would like to mention?
Dr. Garber: A recent discovery suggests there is a subgroup of people with a certain genotype that are more likely to feel better on a T3-T4 combination therapy. We are not at the point that we are going to start doing genetic testing on people, but the study found that certain people with a certain genotype were more likely to feel better on combination therapy. From a hot, new, and conceptual point of view, the discovery may provide yet another role for genetic testing.

Resources:

Click here for more information from the American Association of Clinical Endocrinologists and to find an endocrinologist near you.

Click here for an excerpt from “The Harvard Medical School Guide to Overcoming Thyroid Problems” by Dr. Jeffrey R. Garber, published by McGraw-Hill.

Thyroid Disease: A Post Web Exclusive The Saturday Evening Post

What Happened to Armour Thyroid? The Saturday Evening Post