Thyroid Hormones
Low thyroid levels/effects in the body cause cold extremities, weight gain, fatigue, need for
excessive sleep, high cholesterol, muscle aches and stiffness, reduced heart function, dry skin,
constipation, scalp and eyebrow hair loss, high blood pressure, depression, and mental
slowness. There are many other symptoms that can be seen in persons due to their unique
constitutions and their attempts to compensate for the low thyroid levels. Even mild
hypothyroidism increases one's risk of atherosclerosis and heart attacks.
Young persons up to age 25 have higher thyroid hormone levels than those over 25. Since we
begin to deteriorate around age 25, which level do you think is better for our health? After age 25
there is a steady decline in our thyroid hormone levels, our sensitivity to thyroid hormones, and
our own TSH-response to low thyroid levels.
Unfortunately, the medical profession is stuck with a false system of ideas regarding thyroid
insufficiency--thinking that all thyroid insufficiency is due to failure of the thyroid gland, and that
the pituitary hormone TSH (thyroid stimulating hormone) level always correctly indicates the
state of thyroid sufficiency throughout the body. Dr. Lindner calls this the belief in the
"Immaculate TSH". This belief is completely unjustified by the evidence, and is contrary to basic
principles of physiology. TSH is not a thyroid hormone. It is a secretion of the brain's pituitary
gland. It's a measure of a reaction of one part of the brain to the thyroid hormones secreted by
your thyroid gland or taken by mouth. TSH secretion is every bit a fallible as any other bodily
function. TSH production by the actions of the hypothalamus and pituitary gland is just as
likely to be defective as is the thyroid hormone production by the thyroid gland. Indeed, the
hypothalamus is a kind of grand central station of the brain, affected by many nerves,
neurotransmitters, biochemical disorders, etc. Because of the immaculate TSH doctrine, most
doctors check only a TSH level to "rule out" hypothyroidism and to monitor thyroid replacement.
Indeed some HMO's demand that doctors check only the TSH and not the actual free thyroid
hormone levels (for cost savings).
Conventional endocrinologists deny that there is such a thing as hypothalamic-pituitary
dysfunction without gross disease on an MRI scan, and they deny that free T4 and free T3 levels
in the low end of the laboratory's reference range can also cause hypothyroid symptoms and
poor health. They are mistaken. While many do know enough to check a free T4 level with the
TSH, they refuse to check the free T3 level, even though T3 is the active thyroid hormone! T4
is just a prohormone and must be converted into T3 to become active. Indeed, hypothalamic-
pituitary dysfunction with reduced TSH secretion is universal among aging adults (Carlé 2007).
The fact is that"central" thyroid insufficiency with low thyroid hormone levels within the reference
ranges is common and is a frequent contributor to depression, obesity, high cholesterol,
chronic fatigue, and fibromyalgia. These problems should all be considered as due to thyroid
insufficiency until proven otherwise. A doctor must always look at the free T4 and free T3 thyroid
hormone levels. He should consider them significant when both are below the mid-point of their
reference ranges in a symptomatic patient, and they certainly represent hypothyroidism when
both are in the lower third of their population ranges, regardless of the TSH.
It is even more inappropriate to rely on the TSH to adjust thyroid hormone dosing, as the TSH
may have been "wrong" to start with, and once-daily oral thyroid replacement produces unnatural
spikes in serum thyroid hormone levels that over-suppress the TSH for many hours. Actually, it
has been demonstrated that the TSH is of little use in adjusting thyroid hormone replacement. A
landmark study was done where four experienced thyroidologists adjusted levothyroxine (T4)
doses according to clinical criteria. The patients were then tested and it was found that the 95%-
inclusive range for the treatment TSH was from <0.01 to 20mIU/L. The free T3 level correlated
best with clinical euthyroidism. (Fraser, 1986). Such a study has never been repeated. All other
studies in the thyroid literature are based upon the assumption that a "normal" TSH means that
the patient is "euthyroid", even though many studies show that TSH-normalizing treatment
leaves many persons with residual signs and symptoms of thyroid insufficiency.(Saravan 2002,
Samuels 2007)
Doctors are wrong when they simply look at a lab report and declare that there's no thyroid
insufficiency because the TSH, the free T4 and/or free T3 are anywhere with the laboratory
reference ranges. In fact, a person with both free T4 and free T3 levels near the bottom of their
reference ranges can indicate severe hypothyroidism! Most doctors fail to understand that the
laboratory ranges are population ranges; they just tell us where the values of 95% of all
adults tested by that laboratory happen to fall. They do NOT represent the optimal range for
that person or for our species in general. With these broad ranges, you can only be judged to
be hypo or hyperthyroid if you're in the extreme lowest or highest 2.5% of the entire population. It
is a fact that far more than 2.5% of the population have sub-optimal thyroid levels, so the
reference ranges are excessively broadened towards the low end. Consider the tremendous
breadth of the reference ranges. For free T4 the range spans a factor of 3 from bottom to top, and
for free T3 a factor of 2. Can a person have the same health and quality of life if their thyroid
hormone levels drop to 1/2 or 1/3rd their previous level? Will a person not feel very different if
their thyroid hormone levels are doubled or tripled--yet still remain within the reference ranges?
The fact that all "normal" values are not ideal is evidenced many different studies have
shown clear benefits to having T4 and T3 levels within the upper third of the reference
ranges. These benefits include lower cholesterol levels, reduced weight, reduced tendency to
form blood clots, reduced risk of atherosclerosis, and alleviation of depression. Adults with
hypothyroid symptoms but "low normal" free hormone levels often respond very well to adequate
thyroid supplementation (Skinner, 2000). The only reference ranges that will be of help in
thyroidology and in endocrinology in general will be those based upon a study of perfectly
healthy, vigorous 20-25 year olds.
However, even the free serum FT3 and FT4 levels cannot tell the whole story. Human physiology
is much more complicated than that. There are many mechanisms by which relative resistance
to thyroid hormones can occur. In the best tradition of clinical medicine, a physician should
prescribe thyroid hormones for persons whose symptoms, physical signs, and/or blood
tests indicate that they may have inadequate thyroid hormone effects for optimal health and
quality of life. Symptoms that suggest thyroid insufficiency include fatigue, cold extremities,
weight gain, muscle aches, poor memory, and depression. Low thyroid levels also cause high
cholesterol levels. All such patients deserve a trial of thyroid optimization. If they do not need the
thyroid supplementation, they will feel no better, or may feel worse from boosting their thyroid
levels. Thyroid optimization for those who need it improves mood, energy, and alertness and
improves many parameters of health.
There is a great deal of irrational fear among physicians about optimizing hormone levels,
especially thyroid levels. Most doctors are afraid to prescribe any thyroid hormone to someone
whose TSH level is within the laboratory reference range—even to people with obvious
symptoms of hypothyroidism and relatively low free T4 and T3 levels. They think that the TSH is
always right, so that if they give any additional thyroid hormone to that person they will cause
hyperthyroidism with bone loss, cardiac abnormalities, and muscle loss. However, a low or
undetectable TSH on thyroid replacement therapy does not equal hyperthyroidism. They
would have to give grossly excessive doses of thyroid hormone to produce hyperthyroidism and
all its associated problems. Muscle loss occurs only with free T4 and T3 levels that are 2 or
more times greater than the upper limit of the reference range such as occurs in Grave’s
disease (Riis 2005). Increased bone loss with higher thyroid levels occurs only in persons who
are already in a bone-losing state, because thyroid hormones increase all metabolic activities in
the body. So if you're losing bone you will lose it faster when your thyroid levels are raised. Such
is the case with postmenopausal women who are not on estrogen (Appetecchia 2005). Bone
loss with TSH-suppressive thyroid therapy is not seen in most men or in younger
premenopausal women because they are not losing bone to start with. The problem of bone
less should be addressed by restoring the sex hormones and Vit. D, not with keeping
someone's thyroid hormone levels low! Cardiac abnormalities like a thickened heart wall and
slow diastolic relaxation occur only when TSH levels are completely suppressed by excessive
T4 replacement, and usually people with these cardiac changes are also uncomfortable and
have a poor exercise tolerance. Reducing the T4 dose to a TSH level that is still below the
reference range eliminates the cardiac changes and the symptoms (Mercuro 2000). Atrial
fibrillation (a rapid, irregular heartbeat) will occur only in susceptible persons, and can be
triggered by higher thyroid hormone levels within the reference ranges. It is usually reversible.
The fear of causing atrial fibrillation in susceptible persons is not a sufficient reason to
withhold thyroid hormone supplementation from all the persons who would benefit.
Even when doctors do prescribe thyroid hormone, they usually prescribe only the prohormone
T4 (Synthroid®, Levoxyl®). It must be converted to T3 to become active. They give T4 in low
doses that just "normalize" the TSH to any value within the reference range. The result is an
almost universal undertreatment of thyroid insufficiency because the hypothalamic-pituitary
axis is more easily suppressed by oral thyroid hormones than it is by the normal continuous T4
and T3 secretion by the normal thyroid gland. Once-daily oral thyroid replacement produces a
large spike in serum levels and this over-suppresses the TSH for more than 24 hours. With the
usual TSH-normalizing T4 therapy, free T3 levels remain relatively low (Escobar-Morreale 1996).
Often they are lower than before the T4 therapy was started leaving a patient more hypothyroid
than before therapy! Also, when the TSH is reduced by thyroid replacement, so is T4-to-T3
conversion reduced throughout the body. (Kabadi 2006) Some conventional thyroid specialists
are aware of this and do recommend giving enough T4 to push the TSH to the bottom of the
reference range or a bit lower and to push the FT4 to at or above the top of its reference range,
but most doctors are unaware of this, causing them to undertreat most of their patients.
The thyroid gland produces both T4 and T3, so it makes sense to supply both hormones in
adequate amounts to produce all the benefits of thyroid sufficiency. Providing a substantial
amount of T3 assures that the patient will get some benefit, even from low doses. Armour®
thyroid is dessicated porcine thyroid gland and it contains the prohormone, T4, and the active
hormone, T3. It has a safety and efficacy track record spanning many decades. It is produced
using the latest technologies to assure consistent T3 and T4 content in every tablet. It provides
other hormones and nutrients from the thyroid gland (calcitonin, T2, iodine, etc.). When we
decide to take over the function of the thyroid gland by supplying thyroid hormone orally, we have
to replace everything that our thyroid glands make. We need to supply both T4 and T3 in order to
restore adequate/optimal thyroid hormone effects throughout the body. Every symptomatic
person deserves a trial of gradually increasing doses of dessicated thyroid hormone to see if
this will eliminate the symptoms without causing any signs or symptom of excess dosing.
The Immaculate TSH doctrine is causing tremendous damage to patients and to the
reputation of the medical profession. One day, this TSH-based delusional system will be
abandoned and physicians will go back to treating the patient first, and the free T4 and T3 levels
second.
To see the evidence for yourself, read Dr. Lindner's thyroid hormone abstracts.
Low thyroid levels/effects in the body cause cold extremities, weight gain, fatigue, need for
excessive sleep, high cholesterol, muscle aches and stiffness, reduced heart function, dry skin,
constipation, scalp and eyebrow hair loss, high blood pressure, depression, and mental
slowness. There are many other symptoms that can be seen in persons due to their unique
constitutions and their attempts to compensate for the low thyroid levels. Even mild
hypothyroidism increases one's risk of atherosclerosis and heart attacks.
Young persons up to age 25 have higher thyroid hormone levels than those over 25. Since we
begin to deteriorate around age 25, which level do you think is better for our health? After age 25
there is a steady decline in our thyroid hormone levels, our sensitivity to thyroid hormones, and
our own TSH-response to low thyroid levels.
Unfortunately, the medical profession is stuck with a false system of ideas regarding thyroid
insufficiency--thinking that all thyroid insufficiency is due to failure of the thyroid gland, and that
the pituitary hormone TSH (thyroid stimulating hormone) level always correctly indicates the
state of thyroid sufficiency throughout the body. Dr. Lindner calls this the belief in the
"Immaculate TSH". This belief is completely unjustified by the evidence, and is contrary to basic
principles of physiology. TSH is not a thyroid hormone. It is a secretion of the brain's pituitary
gland. It's a measure of a reaction of one part of the brain to the thyroid hormones secreted by
your thyroid gland or taken by mouth. TSH secretion is every bit a fallible as any other bodily
function. TSH production by the actions of the hypothalamus and pituitary gland is just as
likely to be defective as is the thyroid hormone production by the thyroid gland. Indeed, the
hypothalamus is a kind of grand central station of the brain, affected by many nerves,
neurotransmitters, biochemical disorders, etc. Because of the immaculate TSH doctrine, most
doctors check only a TSH level to "rule out" hypothyroidism and to monitor thyroid replacement.
Indeed some HMO's demand that doctors check only the TSH and not the actual free thyroid
hormone levels (for cost savings).
Conventional endocrinologists deny that there is such a thing as hypothalamic-pituitary
dysfunction without gross disease on an MRI scan, and they deny that free T4 and free T3 levels
in the low end of the laboratory's reference range can also cause hypothyroid symptoms and
poor health. They are mistaken. While many do know enough to check a free T4 level with the
TSH, they refuse to check the free T3 level, even though T3 is the active thyroid hormone! T4
is just a prohormone and must be converted into T3 to become active. Indeed, hypothalamic-
pituitary dysfunction with reduced TSH secretion is universal among aging adults (Carlé 2007).
The fact is that"central" thyroid insufficiency with low thyroid hormone levels within the reference
ranges is common and is a frequent contributor to depression, obesity, high cholesterol,
chronic fatigue, and fibromyalgia. These problems should all be considered as due to thyroid
insufficiency until proven otherwise. A doctor must always look at the free T4 and free T3 thyroid
hormone levels. He should consider them significant when both are below the mid-point of their
reference ranges in a symptomatic patient, and they certainly represent hypothyroidism when
both are in the lower third of their population ranges, regardless of the TSH.
It is even more inappropriate to rely on the TSH to adjust thyroid hormone dosing, as the TSH
may have been "wrong" to start with, and once-daily oral thyroid replacement produces unnatural
spikes in serum thyroid hormone levels that over-suppress the TSH for many hours. Actually, it
has been demonstrated that the TSH is of little use in adjusting thyroid hormone replacement. A
landmark study was done where four experienced thyroidologists adjusted levothyroxine (T4)
doses according to clinical criteria. The patients were then tested and it was found that the 95%-
inclusive range for the treatment TSH was from <0.01 to 20mIU/L. The free T3 level correlated
best with clinical euthyroidism. (Fraser, 1986). Such a study has never been repeated. All other
studies in the thyroid literature are based upon the assumption that a "normal" TSH means that
the patient is "euthyroid", even though many studies show that TSH-normalizing treatment
leaves many persons with residual signs and symptoms of thyroid insufficiency.(Saravan 2002,
Samuels 2007)
Doctors are wrong when they simply look at a lab report and declare that there's no thyroid
insufficiency because the TSH, the free T4 and/or free T3 are anywhere with the laboratory
reference ranges. In fact, a person with both free T4 and free T3 levels near the bottom of their
reference ranges can indicate severe hypothyroidism! Most doctors fail to understand that the
laboratory ranges are population ranges; they just tell us where the values of 95% of all
adults tested by that laboratory happen to fall. They do NOT represent the optimal range for
that person or for our species in general. With these broad ranges, you can only be judged to
be hypo or hyperthyroid if you're in the extreme lowest or highest 2.5% of the entire population. It
is a fact that far more than 2.5% of the population have sub-optimal thyroid levels, so the
reference ranges are excessively broadened towards the low end. Consider the tremendous
breadth of the reference ranges. For free T4 the range spans a factor of 3 from bottom to top, and
for free T3 a factor of 2. Can a person have the same health and quality of life if their thyroid
hormone levels drop to 1/2 or 1/3rd their previous level? Will a person not feel very different if
their thyroid hormone levels are doubled or tripled--yet still remain within the reference ranges?
The fact that all "normal" values are not ideal is evidenced many different studies have
shown clear benefits to having T4 and T3 levels within the upper third of the reference
ranges. These benefits include lower cholesterol levels, reduced weight, reduced tendency to
form blood clots, reduced risk of atherosclerosis, and alleviation of depression. Adults with
hypothyroid symptoms but "low normal" free hormone levels often respond very well to adequate
thyroid supplementation (Skinner, 2000). The only reference ranges that will be of help in
thyroidology and in endocrinology in general will be those based upon a study of perfectly
healthy, vigorous 20-25 year olds.
However, even the free serum FT3 and FT4 levels cannot tell the whole story. Human physiology
is much more complicated than that. There are many mechanisms by which relative resistance
to thyroid hormones can occur. In the best tradition of clinical medicine, a physician should
prescribe thyroid hormones for persons whose symptoms, physical signs, and/or blood
tests indicate that they may have inadequate thyroid hormone effects for optimal health and
quality of life. Symptoms that suggest thyroid insufficiency include fatigue, cold extremities,
weight gain, muscle aches, poor memory, and depression. Low thyroid levels also cause high
cholesterol levels. All such patients deserve a trial of thyroid optimization. If they do not need the
thyroid supplementation, they will feel no better, or may feel worse from boosting their thyroid
levels. Thyroid optimization for those who need it improves mood, energy, and alertness and
improves many parameters of health.
There is a great deal of irrational fear among physicians about optimizing hormone levels,
especially thyroid levels. Most doctors are afraid to prescribe any thyroid hormone to someone
whose TSH level is within the laboratory reference range—even to people with obvious
symptoms of hypothyroidism and relatively low free T4 and T3 levels. They think that the TSH is
always right, so that if they give any additional thyroid hormone to that person they will cause
hyperthyroidism with bone loss, cardiac abnormalities, and muscle loss. However, a low or
undetectable TSH on thyroid replacement therapy does not equal hyperthyroidism. They
would have to give grossly excessive doses of thyroid hormone to produce hyperthyroidism and
all its associated problems. Muscle loss occurs only with free T4 and T3 levels that are 2 or
more times greater than the upper limit of the reference range such as occurs in Grave’s
disease (Riis 2005). Increased bone loss with higher thyroid levels occurs only in persons who
are already in a bone-losing state, because thyroid hormones increase all metabolic activities in
the body. So if you're losing bone you will lose it faster when your thyroid levels are raised. Such
is the case with postmenopausal women who are not on estrogen (Appetecchia 2005). Bone
loss with TSH-suppressive thyroid therapy is not seen in most men or in younger
premenopausal women because they are not losing bone to start with. The problem of bone
less should be addressed by restoring the sex hormones and Vit. D, not with keeping
someone's thyroid hormone levels low! Cardiac abnormalities like a thickened heart wall and
slow diastolic relaxation occur only when TSH levels are completely suppressed by excessive
T4 replacement, and usually people with these cardiac changes are also uncomfortable and
have a poor exercise tolerance. Reducing the T4 dose to a TSH level that is still below the
reference range eliminates the cardiac changes and the symptoms (Mercuro 2000). Atrial
fibrillation (a rapid, irregular heartbeat) will occur only in susceptible persons, and can be
triggered by higher thyroid hormone levels within the reference ranges. It is usually reversible.
The fear of causing atrial fibrillation in susceptible persons is not a sufficient reason to
withhold thyroid hormone supplementation from all the persons who would benefit.
Even when doctors do prescribe thyroid hormone, they usually prescribe only the prohormone
T4 (Synthroid®, Levoxyl®). It must be converted to T3 to become active. They give T4 in low
doses that just "normalize" the TSH to any value within the reference range. The result is an
almost universal undertreatment of thyroid insufficiency because the hypothalamic-pituitary
axis is more easily suppressed by oral thyroid hormones than it is by the normal continuous T4
and T3 secretion by the normal thyroid gland. Once-daily oral thyroid replacement produces a
large spike in serum levels and this over-suppresses the TSH for more than 24 hours. With the
usual TSH-normalizing T4 therapy, free T3 levels remain relatively low (Escobar-Morreale 1996).
Often they are lower than before the T4 therapy was started leaving a patient more hypothyroid
than before therapy! Also, when the TSH is reduced by thyroid replacement, so is T4-to-T3
conversion reduced throughout the body. (Kabadi 2006) Some conventional thyroid specialists
are aware of this and do recommend giving enough T4 to push the TSH to the bottom of the
reference range or a bit lower and to push the FT4 to at or above the top of its reference range,
but most doctors are unaware of this, causing them to undertreat most of their patients.
The thyroid gland produces both T4 and T3, so it makes sense to supply both hormones in
adequate amounts to produce all the benefits of thyroid sufficiency. Providing a substantial
amount of T3 assures that the patient will get some benefit, even from low doses. Armour®
thyroid is dessicated porcine thyroid gland and it contains the prohormone, T4, and the active
hormone, T3. It has a safety and efficacy track record spanning many decades. It is produced
using the latest technologies to assure consistent T3 and T4 content in every tablet. It provides
other hormones and nutrients from the thyroid gland (calcitonin, T2, iodine, etc.). When we
decide to take over the function of the thyroid gland by supplying thyroid hormone orally, we have
to replace everything that our thyroid glands make. We need to supply both T4 and T3 in order to
restore adequate/optimal thyroid hormone effects throughout the body. Every symptomatic
person deserves a trial of gradually increasing doses of dessicated thyroid hormone to see if
this will eliminate the symptoms without causing any signs or symptom of excess dosing.
The Immaculate TSH doctrine is causing tremendous damage to patients and to the
reputation of the medical profession. One day, this TSH-based delusional system will be
abandoned and physicians will go back to treating the patient first, and the free T4 and T3 levels
second.
To see the evidence for yourself, read Dr. Lindner's thyroid hormone abstracts.
For Health and Quality of Life
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