Know The Triggers!

One of the most common questions I get is…”How did I develop this autoimmune condition?”  Well…it's pretty much genetics and the environment.  It's a matter of what came first, the chicken or the egg?  We all know that genetically, you may be at risk for developing certain problems and/or conditions.  If your mom had a thyroid condition, if your grandmother had a thyroid condition, you probably have a thyroid condition too, so it's genetic.

Then there are environmental factors, one of them being chemicals such as cigarette smoke.  There are over 519 chemicals in cigarettes.  Here are just a few of them…
TSNAs:  Tobacco-specific N-nitrosamines (TSNAs) are known to be some of the most potent carcinogens present in smokeless tobacco, snuff and tobacco smoke.
Benzene: Benzene can be found in pesticides and gasoline. It is present in high levels in cigarette smoke and accounts for half of all human exposure to this hazardous chemical.
Pesticides: Pesticides are used on our lawns and gardens, and inhaled into our lungs via cigarette smoke.
Formaldehyde: Formaldehyde is a chemical used to preserve dead bodies and is responsible for some of the nose, throat and eye irritation smokers experience when breathing in cigarette smoke.

So chemicals in general can trigger an autoimmune response, like the latest chemical that's hit the news…BPA.  This is a very nasty chemical called bisphenol A.  It's used in a lot of plastics, and BPA is extremely bad for thyroid health;  it can trigger Hashimoto's Thyroiditis or autoimmune thyroid. 

One of the biggest triggers for an autoimmune thyroid is iodine.  When it comes to Hashimoto's autoimmune thyroid, iodine is probably THE BIGGEST trigger. 

You may be thinking that you've heard that iodine is "good" for the thyroid...or that it's in a lot of thyroid supplements.  Well, if you have an autoimmune disease (which 90% of hypothyroid sufferers do...), it's a different ballgame.  In the next blog, I will explain to you why...

In Health,

Dr. Daniel Boggs

Beckley, WV

For more information, or to schedule a consultation and case review, contact Dr. Boggs at (304) 255-4325, or email drdanboggs@gmail.com

Autoimmunity: The #1 Cause Of Hypothyroid in the U.S.

If you have been diagnosed as being hypothyroid, there is a 90% chance that the cause of your condition is not truly a dysfunctional thyroid.  Rather, it is a dysfunctional immune system.  The reason is because the #1 cause of low thyroid or hypothyroid in the United States is something called Hashimoto's thyroiditis or autoimmune thyroid.  It's an autoimmune condition and it means that your immune system is attacking your thyroid. 

An autoimmune condition is where your immune system is attacking a part of your body, and in your case, it is most likely attacking your thyroid gland.  Remember, your thyroid controls your body’s metabolism.  ALL OF IT!   You don’t have just a “thyroid” problem, you have an “immune” problem. Unfortunately, thyroid hormones do nothing for this autoimmune attack.  You will continue to lose more and more of your thyroid  by not addressing the cause.  It is a slow, progressive, downward slide.  You MUST heal the immune system, and thyroid hormones alone are not going to help accomplish this. 

There are two parts to your immune system, TH1 and TH2, and they should be in balance, kind of like a teeter-totter effect.  One should not be higher than the other.  If your immune system goes out of balance because of stress (physical, chemical or emotional), one system (TH1 or TH2) will become dominant and this will cause your immune system to attack your body.  There are specific blood tests for thyroid antibodies that can be run to determine if you are autoimmune and if one part of your immune system is dominant.

Now the problem with an autoimmune condition is it just doesn't attack one area of your body…for instance, your thyroid.  It can attack other areas of your body.  It can attack your pancreas, causing diabetes, or it can attack your gut -- your stomach lining, (causing IBS), or it can attack your joints (rheumatoid arthritis).  It can attack your entire body.  Often times, the attack on the thyroid is just the beginning.  

How do you know if you're autoimmune?  Specific to the thyroid, we would test for TPO and TGB antibodies, to see if you have an autoimmune thyroid or Hashimoto's thyroiditis, along with the immune panels to see if your TH1 and TH2 systems are imbalanced. But, the reality is…most people already know that they're autoimmune just from the fact that they may already suffer from a current autoimmune disorder, such as psoriasis, rheumatoid arthritis, ulcerative colitis, Sjogren's syndrome, scleroderma, and/or lupus.

Another way that people will know if they're autoimmune is that their symptoms may wax and wane.  Symptoms that wax and wane are a sure sign that you are most likely suffering from an autoimmune condition.

The third way to know if a patient's autoimmune is that they will come in with a basket of supplements--I mean a truck-load.  I've had people bring in so many bottles of supplements it wasn't funny.  In many cases, the supplements that they are taking were actually making them worse! 

Number four…their life fell apart after they got sick.  That's how they know they're autoimmune.  They've been to 12 or 15 or 20 different doctors and they have a stack of medical records sky-high, all because it's an undiagnosed autoimmune condition. 

They may develop an autoimmune condition following a pregnancy.  Usually, women are TH2 dominant in the third trimester and TH1 dominant postpartum. 

And finally, as I've mentioned, there's positive testing via the immune panels and TPO and TGB antibodies.  You see, your immune system is designed to protect you.  When your immune system runs amuck, it starts attacking different parts of your body. It's important to know that once you realize you have an autoimmune condition, you need to get checked, and you need to manage that autoimmune condition.

Dr. Daniel Boggs

For more information, visit www.wvthyroidrelief.com

"Does A Normal TSH Mean That Your Thyroid Is Healthy?

Happy "hump day"!  Today, I want to discuss something that I see very frequently in my clinic.  Oftentimes, a patient will come in to see me because they have various symptoms of hypothyroidism and they'll say "my doctor has been checking my TSH and it's normal".  How could this be?

Well, it's pretty simple.  TSH is just ONE marker.  There are many different markers that should be tested in a person with chronic thyroid symptoms.  For most people, all that's tested is TSH and MAYBE T4, while the rest of the panel is ignored.  In order to discover what's really going on with the thyroid, we must have a complete picture of the thyroid function.

This would include (at a minimum):

• - Thyroid Stimulating Hormone: the message sent from the pituitary gland to the thyroid to "kick start" the gland
• Free T3: this is the biologically active form of thyroid hormone, meaning, this is the form you body can use.  Only 7% of the hormone made in the thyroid gland is T3
• Free T4:  93% of the hormone made by the thyroid gland is T4.  This has to be converted into T3 for the body to be able to use it.  This conversion takes place in the liver, GI tract and peripheral tissues.  So, even if the thyroid is functioning properly, if there is a conversion problem, you can have thyroid symptoms.  Measuring TSH will not tell us if there is a problem with the conversion of T4-T3
• Thyroid Antibodies:  this is check to see if there is an autoimmune attack on the thyroid.  We will discuss autoimmunity in the next few posts.  By some estimates, 90% of hypothyroidism is caused by an autoimmune condition.  The only way to know for sure if there is an autoimmune condition, like Hashimoto's thyroiditis, is to test for thyroid antibodies.  This test is rarely done because it doesn't influence the typical medical treatment.
• Reverse T3:  A form of T3 your body cannot use
• Free Thyroxine Index (FTI):  a measure of how much T4 is available
• Resin T3 Uptake:  measures the unsaturated binding sites on thyroid proteins

There are also additional tests to consider.  It is very important to test a patient's blood glucose, liver markers, adrenal function, food sensitivities, GI function, etc.  The reason is because the thyroid interacts with every organ and system of the body. 

Remember...it ALL matters...your nervous system, your hormones, GI system, etc. Everything is tied to your thyroid function!

In the coming weeks, I will help to put the pieces of this puzzle together.  I think it would be helpful to give you an understanding of how the thyroid works, so we'll cover that in the next post.

In the meantime, please visit www.wvthyroidrelief.com for more information.  And, as always, you can reach me at drb@drdanboggs.com or (304)255-4325 if you'd like to schedule a consultation. 

"My Lab Tests Are Normal, But I Still Have The Same Thyroid Symptoms. What Gives?"

Here's a scenario that I see daily in my clinic:  A patient comes in complaining of various thyroid related symptoms.  She may have fatigue, thinning hair, depression, inability to lose weight, or some other hypothyroid symptom.  After reviewing the patient's case, I discover that the patient has had her thyroid tested and her TSH is within the "normal" laboratory range of .35 - 5.0.  Without fail, this patient is frustrated and confused.  If they TSH is normal,  why do the symptoms persist?

Well, there are several reasons for this.  The first reason that I want to discuss is "laboratory ranges" versus "functional ranges".

Let's first discuss the laboratory ranges:  Whenever you have a lab test done, the clinician will compare your results to a "normal" range.  The common laboratory range is figured by taking a bell curve analysis of the results of all the people that came through a lab during a particular time period.  The problem with this is that many of the people analyzed are sick and even already taking medication.  So, the ranges are very broad to account for these patients.  This means your results are actually being scrutinized and compared to a sick population.  This does not give us a good idea of how you are functioning compared what the optimum level is for your body.  We call this broad range the "laboratory range" or "pathological range".

Now, compare that to the Functional Range:  Fortunately, several groups have done significant research and worked to come up with an ideal "functional range" that tells us what lab values would be normal for a body that is functioning optimally.  (Some of these groups are The Endocrine Society, Dr. Harry Eidenier, and Balancing Body Chemistry) These ranges are based only on a study of healthy individuals without disease/pathology and who are not taking medication.  Functional medicine practitioners like myself utilize this functional range so that we can detect "subclinical" dysfunctions and help support these problems before they progress into pathological processes.   Functional ranges are much narrower compared to the laboratory ranges.

By comparison, the laboratory range for Thyroid Stimulating Hormone (TSH) is .35 - 5.0.  The optimum functional range is 1.8 - 3.0.  

Again, the laboratory ranges that most doctor's compare your lab markers to are far too broad.   It's likely that a patient's family practitioner only ordered one thyroid test, which is TSH.  If you are "lucky", maybe he has ordered a couple more, like a T4 marker.  From your Doctor's perspective, if your TSH level is within that very wide lab range of .35 -5.0, you're normal.   There's nothing wrong with you!  But - and this is a HUGE "but" - the OPTIMAL LEVEL (or "functional level) for TSH is 1.8 to 3.0.  So you could still be "normal" in the medical doctor's eyes but abnormal when we consider what the optimum thyroid function is.

It's only when the TSH range is above 5.0 that the medical doctor will put you on a thyroid hormone such as Synthroid or the generic, levothyroxine.  And really, that's all the intervention that is normally offered.  

So, if you're TSH level is , say 3.8, your doctor will say that you are in the normal range and you don't even need medication.  Even though you may still have all the thyroid symptoms:  extreme fatigue, hair falling out, weight gain, etc....you're NORMAL!

Well, you and I both know you are not "normal".  If you were, you wouldn't still be suffering from these symptoms.  The problem is that if you are outside of the optimum range of 1.8 - 3.0., you to have a whole host of thyroid symptoms.

In summary, one reason that you may have normal labs but still have thyroid symptoms is that most doctors compare your values to a "normal" range that is far too broad.  Often times by taking a more critical look at your labs, we are able to see why you have the symptoms you are experiencing.

In the next segment, I will explain why you can still have symptoms even though you are taking medication and your TSH is in the optimum range.  

Dr. Daniel Boggs

Beckley, WV

For questions, or to schedule a consultation, call (304)255-4325 or email drb@drdanboggs.com

An introduction To Thyroid Dysfunction

Welcome!  I'd like to thank you for taking the time to visit this blog.  If you are suffering with a thyroid disorder, I believe that you will find the information on this blog to be very helpful.  My goal is to give you, the thyroid sufferer, insight into how the thyroid works, why it malfunctions, and why the traditional medical approach fails so many people.  I am going to explain to you how functional medicine practitioners, such as myself, support patients with thyroid conditions.  And I'm going to tell you THE KEY up front:  You don't just have a problem with your thyroid.  You have a sick, broke down, malfunctioning body and THAT is what is causing your thyroid to malfunction.

So, with that...let's get started...

More than 20 million Americans are affected by thyroid disorders. That's 1 in 13 people, and there are millions more who have undiagnosed thyroid problems.

Why are these numbers so high? And why do so many people who are affected by thyroid disorders still have the same symptoms even while taking medication? Well, after extensive research and study into thyroid disorders, it became very evident to me how poorly diagnosed and supported thyroid conditions are. The truth is that the thyroid is one of the most misunderstood and mismanaged areas in all of medicine.

Why is that?  There is an saying that "when you are a hammer, all you see are nails".  Most doctors look at the thyroid gland as an independent structure and disregard the "cross talk" and dependence that it has with the rest of the body.  *Remember:  You don't just have a problem with your thyroid. You have a sick, broke down, malfunctioning body and THAT is what is causing your thyroid to malfunction. *


You see, there is a complicated web of physiological and neurological pathways that cause your body to work properly. Everything is connected...everything matters. Every cell i your body has thyroid receptors and depends upon thyroid hormones to function properly. Also, your thyroid is not a "stand alone" gland. Your hormones, digestion, blood sugar, adrenal function, nervous system...all these things (and more) have a relationship with your thyroid gland.  Malfunction of any of these areas can affect your thyroid.  And vice versa...malfunction of the thyroid will affect all these areas as well.  This is what we are going to discuss throughout this blog.

For today, lets have a discussion about how the thyroid works. (keep in mind that this is a vastly oversimplified explanation for the purposes of this blog).

It all starts in the brain.  

The hypothalamus releases Thyrotropin Releasing Hormone (TRH) which stimulates the pituitary gland to release Thyroid Stimulating Hormone (TSH).  TSH then activates an enzyme in the thyroid gland called Thyroid Peroxidase (TPO), to attach iodine molecules to thyroglobulins. 

This activity leads to the production of the 2 primary thyroid hormones: Thyroxine (T4) and Triidothyronine (T3). 93% of what is produced is T4 and only 7% is T3.  Why is this important? Because T4 is inactive. It cannot be used by the body unless it is converted into T3. 

Since T4 needs to be converted to T3, these hormones are released into the blood stream attached to a protein called Thyroid Binding Globulin (TBG). TBG carries the thyroid hormones all over the body. Most of it goes to the liver, and the rest to the gut and other tissues.

Remember how we said that T4 has to be converted to T3? Much of this conversion (about 60%) takes place in the liver. Another 20% of the conversion occurs in the gut, and the other 20% in other peripheral tissues throughout the body. This is important because you can have a conversion problem due to malfunctioning of these tissues, and it can cause you to have thyroid symptoms.

Once this conversion takes place, we call this "Active T3". The active T3 goes back into the blood stream as free T3 (FT3_, because now it is not bound to the TBG transporter. Then FT3 travels in the blood stream until it attaches to a cell’s thyroid receptor (remember, every cell has thyroid receptors)...which brings it inside the cell, where it creates interactions with DNA in the cell nucleus influencing cell metabolism. This hormone interaction with the cell is the key to healthy thyroid function.

That may be a lot to digest right now, but as I add to this blog, you may want to use the above information as a reference.

So, what happens when this system breaks down? Well, depending on what type of malfunction you have, you will become symptomatic.  You will have symptoms of hypothyroidism, hyperthyroidism, or both.

Hypothyroidism is a condition where the body lacks sufficient thyroid hormones. Since the main purpose of the thyroid is to "run the body's metabolism", it is logical that people with this condition will have symptoms associated with a slow metabolism

Symptoms of hypothyroidism:
- Feeling fatigued, tired, sluggish
- Cold feet and/or hands
- Requiring excessive amounts of sleep to function
- Gaining weight easily or having difficulty losing weight
- Difficult or infrequent bowel movements
- Depression
- Lack of motivation
- Morning headaches that wear off as the day progresses
- Thinning hair or excessive hair falling out
- Dryness of the skin and/or scalp
- Mental sluggishness

Hyperthyroidism is the term to describe an over production of thyroid hormones. This condition is less common, but it can precede a slowing down of the thyroid.

Symptoms of hyperthyroidism:
- Heart palpitations
- Inward trembling
- Increased pulse, even at rest
- Being nervous/emotional
- Insomnia
- Night sweats
- Difficulty gaining weight

It is very common for people to have symptoms of both hypo- and hyperthyroidism. If that is the case, you may have an auto-immune attack on your thyroid, such as Hashimoto's Thyroiditis. As a matter of fact, by some estimates, autoimmunity accounts for up to 90% of hypothyroidism cases. This is a major problem because autoimmunity is NOT a thyroid problem. It is an immune system problem, and simply giving a patient thyroid hormones is doing to do very little to help the individual. This is where an overall functional approach is important.

At this point, we briefly discussed how the thyroid works and what happens when it malfunctions.  Check back in several days for my next post:

"Why Do I Still Have Thyroid Symptoms Even Though I'm On Medication And My Labs Are Normal?"

Dr. Daniel Boggs

www.wvthyroidrelief.com

drb@drdanboggs.com

To schedule a consultation, or to attend one of our free Thyroid Workshops, call (304) 255-4325.