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Hypothryoidism- Heart problems, ischemia,depression

arizona1
1 Recommendation

This is from the doctor I work with for my CFS. I just happened to find this article while "researching"
It sheds some very interesting light on heart issues and hypothyroidism.

Kathi


Hypothyroidism
The Tragic and Invisible Epidemic of Thyroid Disease


© Dr Jacob Teitelbaum MD


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For over a decade, research by Jacob Teitelbaum M.D. author of the best-selling book "From Fatigued to Fantastic!"1 has shown that hypothyroidism, like most other illnesses that affect predominantly women, has been dramatically under diagnosed.2 3 The American Academy of Clinical Endocrinologists (AACE), the nation's largest organization of thyroid specialists, has now confirmed this. After a recent meeting, the normal range for thyroid tests was dramatically narrowed. As noted in the AACE press release:
"Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range. Now AACE encourages doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.0. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now."

"The prevalence of undiagnosed thyroid disease in the United States is shockingly high - particularly since it is a condition that is easy to diagnose and treat," said Hossein Gharib, MD, FACE, and president of AACE. "The new TSH range from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health - such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression."4

Now, 6 months after the new directives have been given, doctors are still largely unaware of these new lab guidelines for diagnosis and treatment. Even the major labs doing thyroid testing have not bothered to change the now incorrect normal ranges for both diagnosis and treatment of thyroid disorders.

The normal range for thyroid hormone levels in the past have been based on statistical norms (called 2 standard deviations). This means that out of every 100 people, those with the 2 highest and lowest scores are considered abnormal and everyone else is defined as normal. That means if a problem affects over 2% of the population( and as many as 24% of women over 60 are hypothyroid5 and 12% of the population have abnormal antibodies attacking their thyroid6 ), then our testing system will still miss most of them. In addition, our testing system does not take biological individuality into account. To translate how poorly this "2%" system works, consider this. If we applied it to getting you a pair of shoes, any size between a 4 and 13 would be "medically normal." If a man got a size 5 shoe or a woman a size 12, the doctor would say the shoe size they were given is "normal" and there is nothing wrong with it!

This increased the number of Americans with Thyroid illness from 13 million to approximately 27 million. Unfortunately, over 13 million Americans with thyroid disease remains undiagnosed4, and the majority of those receiving treatment are not being dosed appropriately5 6. Doctors do not know that they have not been adequately trained in the proper diagnosis or treatment of hypothyroidism, and the cost in human life and devastating illness is enormous. What makes this especially tragic is how easy treatment is if doctors were given the correct information. Even the major laboratories continue to give erroneous normal ranges for the tests, simply because they're not aware of the guidelines of the AACE or the information put out by their National Association of Clinical Biochemistry.

WHAT IS THE COST OF MISSING HYPOTHYROIDISM?


Over 30,000 preventable deaths/year from heart attacks. Women with untreated hypothyroidism are more than twice as likely to have a heart attack. A study in the prestigious Annals of Internal Medicine noted that hypothyroidism "contributed to 60 percent of cases of myocardial infarction [heart attacks] among women affected by subclinical [even mild] hypothyroidism". It contributed more to causing heart attacks in these patients than smoking, elevated cholesterol, high blood pressure, or diabetes!7. Another new study supports this showing that Subclinical hypothyroidism was associated with a 2.6-fold increased prevalence of ischemic heart disease.7a
Over 4600 miscarriages/yr after 15 weeks of pregnancy-countless more before. Six percent of miscarriages are associated with hypothyroidism. Undiagnosed hypothyroidism is also associated with infertility. In moderate to severely hypothyroid mothers, the baby was also over 6 times as likely to die soon after being born.8
Learning disabilities- Children born to hypothyroid mothers have a lower IQ (average of 7 points). They are almost 4 times as likely to have an IQ under 85 and over twice as likely to have learning difficulties resulting in their having to repeat a grade.9
Hypothyroidism contributes to millions being unnecessarily disabled. Over 6 million Americans have Fibromyalgia and tens of millions more have chronic muscle pain. Undiagnosed or inadequately treated thyroid disorders contribute to these unnecessarily disabling conditions1 2 3 . Our initial understanding of this was elucidated by Dr. Janet Travell, who was the white house physician for President Kennedy-who suffered from excruciating back pain.10 Dr. Teitelbaum's recently published research shows that 91% of these patients can improve with proper treatment-especially including thyroid hormone.2
Hypothyroidism is a major cause of gaining and being unable to lose weight. It causes fatigue, dry hair, coarse skin, depression, and “brain fog” as well. Americans are currently treating hypothyroidism, which is often confused as being depression, with Prozac! This is an even bigger problem in the elderly who are being misdiagnosed with depression or Alzheimer's/ senility when what they have is hypothyroidism.
What makes this situation especially tragic is that, given the proper information, hypothyroidism is incredibly easy and inexpensive to diagnose and treat. Instead, because of lack of awareness on the part of physicians, Americans unnecessarily suffer with a major public health disaster.

1 From Fatigued to Fantastic! (Avery/Penguin Putnam 2001;1st edition 1995). Jacob Teitelbaum M.D.
2 Teitelbaum JE, Bird B, Greenfield RM ,Weiss A., Muenz L, Gould L. Effective Treatment of CFS and Fibromyalgia. A Randomized, Double-blind, Placebo-controlled, Intent to Treat Study. The Journal of Chronic Fatigue Syndrome. Volume 8(2), 2001,pg3-28.
3 Teitelbaum J, Bird B. Effective Treatment of Severe Chronic Fatigue: A Report of a Series of 64 Patients. J Musculoskeletal Pain 1995; 3 (4):91-110.
4 Press release on AACE web site: http://www.aace.com/pub/tam2003/press.php
5 Canaris GJ ,et al.The Colorado Thyroid Disease Prevalence Study :Archives of Internal Medicine, Feb 28,2000 p526-534.
6 National Assn of Clinical Biochemistry web site. http://www.nacb.org/lmpg/thyroid_LMPG_PDF.stm p31-46
7 HAK AS,Subclinical Hypothyroidism is an independent Risk Factor for Atherosclerosis and MI in Elderly Women. Annals of Internal Medicine 2000;132:p270-278.
7a J Clin Endocrinol Metab 2004;89:3365-3370
8 Allan WC,et al. Maternal Thyroid Deficiency and Pregnancy Complications; Implications for population Screening. J Medical Screening.2000 .Pg127-130
9 Haddow JE,et al. Maternal Thyroid Deficiency During Pregnancy and Subsequent Neuropsychological Development of the Child. New England Journal Of Medicine 1999:P549-555.
10 Travell J, Simons DG, Simons L: Perpetuating Factors. Chapter 4. In: Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams and Wilkins, Baltimore MD,




Archived columns by Dr Jacob Teitelbaum MD



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on Hypothyroidism

Dr. Teitelbaum is a board certified internist and director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, where he sees CFS/Fibromyalgia/Chronic pain patients from all over the world ...more

Explore topics in this discussion:

Cancer Surgery Trazodone Pregnancy Chronic fatigue syndrome Levothyroxine Anxiety Acne Prozac Fibromyalgia Infertility Thyroid cancer Osteoporosis Xanax Heart disease Dizziness Hyperthyroidism Ativan Synthroid Pain Atherosclerosis Heart attack Depression Mental health Cortef Hypothyroidism Diarrhea

20 replies

Starbait

No I haven't lost any of the weight yet they are still trying to regulate the meds and having a hard time doing so. The reason that I say that the "finally" found out what was wrong was because the whole time I was telling them to check my thyroid. They are the ones that felt it was a mental health issue and I felt it went with your article about the elderly. I now also have heart damage due to their lack of knowledge. But in all fairness it's my body and I should have gone to another doctor had I thought that I was not getting the care I should have been, had I have been in a normal frame of mind anyway. Thank you for responding to me. I do look forward to loosing the weight soon so I can feel like myself again. sherry

arizona1

How frustrating to have gone through so much before you were diagnosed!!!! Doctors are just practicing medicine the best they can..... some better than others. Fortunately for you , at least it was discovered . Good health to you. Are you able to lose some of the weight you gained????

Hugs,
Kathi

Starbait

I'm 43 and live in California. 3 Years ago I was working 10 hour days 6 days a week. One day I woke up and I felt awful and called in sick. I went to the doctor and he gave me a note for work for 3 days. At the end of the 3 days I wasn't any better but worse. Movement and sounds made me jump and they startled me. I was extreamly nervous, very shaky like I had been fighting all day in a screaming match or something, so I went back to the doctor and he told me I needed to go to mental health I was having a nervous breakdown and that I could not return to my job. I didn't go to mental health like he told me to but instead stayed home where the symptoms became worse. I was unable to ride in a car unless I read a book. The cars that went by were shocking to my senses. I started gaining weight at an alarming rate. I lived with my mom and she is a diabetic so I ate the same diet she did yet I gained 70 lbs in 6 months. all the while going to the doctor with other symptoms, my hair was falling out, I developed dry skin, acne. boils, chest pains, high blood pressure, depression, my bones hurt all the time, my good cholesterol was low, I thought I was loosing my mind, I wasn't having my period every month missing them sometimes 2-3 months at a time, however I miscarride several times during this time, I was having trouble sleeping, my throat felt like it was being squeezed, sometimes I would forget where I was or how I got there, I would go to the doctor and not remember what happened while I was there or remember what happened during tests. The symptoms go on and on the bottom line in over the course of a 1.5 yrs I kept telling the doctor there was something was wrong I was still gaining weight at an alarming rate. Low and behold they finally discover my thyroid doesn't work at all and I have gained a total of 136lbs while they messed around telling me I needed to go to mental health and that if I didn't they would have to call them because they felt I was having a nervous breakdown! I am still trying to get my meds regulated which is taking way to long (1 yr). BUT now that I'm on synthroid (150 mcg) for now, most of my symptoms have disappeared.

tlmagraw2

Scarlettsmommy,

Thyroid issues are present in my family as well. My mother had a thyroidectomy for Grave's Disease and my father was hypothyroid.

After everything was over with my mother told me I was a lot worse than she ever was.

I remember saying to someone (doc or one of the nurses I work with) they need to do something before I have a heart attack.....how long can a heart beat at this rate (180-200/minute from January to June) and not be damaged or stop completely? They calculated my EF at close to 80% when the Echo was done. Luckily, I have no damage.

The high heart rate, dizziness, tremors, diarrhea stools, loosing 10 pounds/day (yes, really!), protruding eyes, choking on food, hair loss (by the handful), not sleeping more than 2 hours a night, migraine headaches that nothing would take away, skin changes, nail changes--no fun. People who saw me everyday would ask what was wrong and tell me "you look terrible." The worst thing of all was repeatedly telling the doctor only to have him pat me on the back, tell me all was well and giving me a prescription for Ativan or Xanax (whichever one he felt like writing that day) and Trazodone so I could sleep at night. I should have collapsed on the floor of my bedroom sooner because that is when he listened for the first time and we did the Holter and Echo.

Teri

Patybluetx

Awww Kathi, I feel the love :D. Thanks!
((HUGS))
Martha

TexRose

I have Hashimoto's and Graves. It has been a bugger getting me regulated. My TSH can be .095 and I feel great or it can be 12.0 (terrible) The last three TSH readings have been in the 7-8 range. (Too High) I go from .112 (levothyroxine) to .125 on Synthroid..then .137 then .150....I am getting horrid side effects from the thyroid meds yet nothing is bringing the TSH down. My DL picture of 4 years ago looks like I was in the Graves's state yet no one detected this at that time. I see a new female doctor in October. There is good web site about this. About.com/thyroid. Mary S. is the owner of this site and has written 2-3 books on Thyroid disease.

arizona1

Scarlettsmommy, can you be more specific about your thyroid storm??? Tell us more, if you can. Those of us that struggle with thyroid need to help others that are not being diagnosed!!!

Kathi

scarlettsmommy

I had a thyroid storm in conjunction with my MI - this was a first for both the cardiologist and endocrinologist - I remember their faces in the ER and they were quite shocked. Although I wasn't. I lived with heart palps and wooziness for over a year and a half... all the time I was told there was nothing wrong and "I was depressed" over multiple deaths in my family.

I have to say, Thyroid problems run on my mother's side of the family all the way to great aunts - every single female, including my mother - whom I believe, now, was undiagnosed (I won't get started on her doctor)...

It's an extra test or two to check off on the blood work sheet, make sure you get it done!!

Thank you for posting this article...

arizona1

Patybluetx, I thought of you when posting this article, especially how it relates to miscarriages and pregnancy. I am glad you noted this article, I was hoping you would. Thyroid problems run in families. I can see why everyone is concerned for you.

Hugs,
Kathi

Patybluetx

WOW thanks for the info ladies! My mom had thyroidism (I'm not sure what kind, I think it was hyper) and they had her whole thyroid gland removed, and my baby sis is having some thyroid issues too (poor little thing has all sorts of issues), so she's constantly having me check my thyroid gland function.

arizona1

Teri, I cannot do low normal either. If you read above, we are shooting for 60-80% normal. I presently am at
20% normal. I do armour thyroid which has both T3 and T4 in it. I could not take synthroid because I can't conert T4. Also, we are checking the T4 in CFS, rather than the TSH. The TSH is totally useless in CFS because of the hypothalmic-pituitary axis imbalance. Your doctor sounds like she is listening and that is absolutely essential. Even though you are having your ups and downs, it seems to be working with your physician. That is wonderful!!!

Kathi

.

tlmagraw2

Kathi,

I do not like low normal.....I feel so much better when my levels are solidly in the middle.

I have actuallly been battling--and it has felt like a war has been going on inside me--hyperthyroidism again since May (this after ablation with Iodine 131). Have been off Synthroid for 6 weeks and my TSH has gone from 0.26 to 80, I feel so much better than I did. We are going to reintroduce the Synthroid at a much decreased dose and slowly adjust it. The doctor and I both know that I will need more, but she wants to slowly increase which I am thrilled about.

arizona1

Joy, you really had to fight for yourself. Fortunately you got to an internist that could help you. I hope things are going well with balancing your thyroid.

Kathi

arizona1

Thanks for your input Teri!!

Kathi

arizona1

*******The tests for the thyroid hormone are T3 & T4. The test that give you how much homone is available to your body to use is the FreeT4 & Free T3. FreeT4 is long term storage, FreeT3 is what you use now and gives you energy besides other things. Problems arise when your body does not convert FreeT4 to FreeT3 when you need it.

Sandy is absolutely correct on this!!! This is the problem in CFS that I experience. A normal TSH, but the thyroid does not respond. There is a problem with the hypothalamus-pituitary axis in all CFS/Fibro cases.

I do not convert T4 to active T3, as Sandy mentioned above. Mine goes into reverse T3 instead, which is totally useless. This does my body absolutely no good.

My MD brother has finally learned to go on symptoms and not tests! This created a problem for awhile and sibling rivalry was at it's height. Afterall, he was the doctor and who was I to challenge what he had learned in medical school. BUT I persevered and we are on the other side of this now.

*******So, narrow the range, but don't forget to correlate numbers with what is on a clinical exam and what a patient is saying. Also educate not only the Endocrinologists, but family docs as they are the ones who have to write those referrals to specialists.

Sandy is right again. That is why Dr. T says endocrinologists are 20 years behind the times. Doctors rank even further down. Go on symptoms!!

Can you imagine how hard it is to get better when no one knows how to get you better. You end up being more medical savy than most professionals and is why you must research for docs that will understand and listen. They don't come easy. However, some are teachable, as they say. It takes work to get yourself better and relying on what a physician says may not be the best way to accomplish the task.

Hypothyroid people are very medication sensitive according to the American Academy of Endocrinologists. Mmmm do any of you suffer like I do with this problem???

Teri says
****** I spent 6 months telling a doctor my thyroid was not functioning the way it needed to be and it needed further testing, to keep me quiet he would do the thyroid panel and the values would be within the range suggested in this article--the low end, but normal; it was after a holter monitor

For me low normal is not good enough. I must be at
60-80% to function. We are currently trying to get my T4 levels up because they are in a low normal range and I still do not feel good.

Joy says
****** she had renegade cells

Joy, I can just imagine what you went through. Vascillating between highs and lows with your thyroid.
Unbelievable.

Kathi

Joy3032

Interesting ...I had thyroid cancer when I was a teen and had total removal (so we thought). I was placed on thyroid replacement therapy. Had my ups and downs with weight and anxiety and malaise back and forth. Tests showed shifts in the thyroid numbers, but all within the "normal numbers". When I was in my mid 40's and an office nurse, I complained that I thought it was a thyroid problem I was having. The doctor finally sent me to an internist who had a thyroid scan done. I asked him why as there was no thyroid to scan. Nevertheless, I went ahead with the scan and the tech who was a friend of mine said the doctor (radiologist) has to see this. On the screen in the area of my chin were green areas which were alive with the radioactive isotope. The radiologist called them renegade cells that travel after the thyroid surgery and at will become active and produce the hormone.

My renegade cells were sometimes active and sometimes dormant which caused the fluxuation in the thyroid activity. In the past ten years I have had two strengths of thyroid Rx'd for me and I take one why I feel like my thyroid activity is low and one when I feel I am overstimulated. This comes from years of testing and trial and error. This seems to work for me.

Joy

tlmagraw2

Here is my problem with giving ranges of normal, and this is from personal experience. It is difficult to convince a doctor that you are actually experiencing symptoms of either hypo or hyper when they rely on numbers and forget to correlate what they see on a clinical exam with the numbers in front of them and what patients are saying. I spent 6 months telling a doctor my thyroid was not functioning the way it needed to be and it needed further testing, to keep me quiet he would do the thyroid panel and the values would be within the range suggested in this article--the low end, but normal; it was after a holter monitor and echo, both of which I had to beg for that he started putting the whole picture together. My hands were tied because I needed a piece of paper from this doc to get to the doc who could actually treat what was happening.

When my TSH is 0.50 I have hyperthyroid symptoms (I'm told this should not be, but it is): heart rate in 120's, tremors, numbness, personality changes, and heat intolerance. By the time my TSH is 0.30 my heart rate is even higher, tremors are more obvious (docs request a different nurse to help with procedures, that is how bad they are), rapid weight loss, personality changes are so bad I don't even like myself, and it feels like the middle of a hazy, hot and humid August in my body! Each time my TSH has been 0.30 (or less)-0.50 range, I've been placed on short term disability; the first time for three months (and my TSH was <the lowest value available to the lab that drew it).

So, narrow the range, but don't forget to correlate numbers with what is on a clinical exam and what a patient is saying. Also educate not only the Endocrinologists, but family docs as they are the ones who have to write those referrals to specialists.

Teri

SandyW

One other thing, the TSH test is actually testing your Putitary gland. It stands for "Thyroid Stimulating Hormone".

Basically it is asking the Putitary if it is sending the signals to the Thyroid gland to product or cutback on thyroid hormon production. So how does that tell you if your Thyroid gland is responding? It dose not!

The tests for the thyroid horman are T3 & T4. The test that give you how much homone is available to your body to use is the FreeT4 & Free T3. FreeT4 is long term storage, FreeT3 is what you use now and gives you engery besides other things. Problems arise when your body does not convert FreeT4 to FreeT3 when you need it.

Antibody test for the thyroid are used to see if you have an actual thyroid diease such as Graves (hyperthyroid) or Hashimos ( hypothyroid)

Some reachers think Graves and Hashimoto are the same diease, just opossit end of the scale.

Most GP are so uneducated about thyroid diease it is sad. It gets very hard to fight the medical establishment time and time again. I would love to get in on research that covers some of this. But being in Canada is very limited as you usually have to live near the teaching hospital or in a Major City Center to qualify.

Thanks for bringing this up Kathi, I really do think FM and CFS and Thyroid are all the same illness.... Definately it is hormonal based, at least from my prespective. This is just my opinion and I know other may not aggree with me, that's fine, I could be wrong... But I dont' think so.

I've had FM since 1981, but it has dissappeared for long lengths of time when I was balance hormonally. Now if only I could find that "Magic Balance" or "Sweet Spot" as others have refered to it.

Cheers Sandy W (PS: use any into I post if it will help). Cheers Sandy W

arizona1

I sent this article off to Dr. T asking if there were any updates. Perhaps he can respond to what you mention in your post?????? Thanks for sharing your information. It is so important!!!!

Knowledge is power......
Kathi

SandyW

The elevated cholesterol was what caused my CABG operation. I don't have high blood pressure, the opposite, low blood pressure.

The article is good, however I do not agree on one point. If you have Hashimoto, it is NOT easily controled. I wish it was....

I swing back and forth from hypo & hyper and you have to adjust your meds accordingly. But any change in the medication, takes about 6 weeks to level out. I can go for 8 months at a good blance and then all of a sudden my system messes me up. My TPO count orginally was 1,400 (range <32). Once on thyroid meds I finally got it down to 360 or so. Once I got on Cortef (HC) I managed to get it down to 152. Antibodies are nasty when their attacking your body....

The article is right when it comes to being underdiagnosed! I've had it since I think I was born. I had every doctor I ever when to test me for thyroid. All I ever got was "Normal". Years later I got copies of all my test, and I was not normal. He really did not understand what a normal level should have been.

Kathi, thanks for trying to spread the word!!!
Cheers Sandy W

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