Dr Jonathan Collin, publisher and editor-in-chief of Townsend Letter, titled his "Letter from the Publisher" for the January 2011 issue, "Criminalizing Doctors Who Diagnose Hypothyroidism." Ending his letter, Dr. Collin lauds Dr. Alan R. Gaby's new textbook, Nutritional Medicine, which has an 8-page chapter on hypothyroidism that develops scientific arguments supporting a diagnosis of low thyroid when routine blood tests of a patient "read" normal.
Steady Townsend Letter readers are familiar with Dr. Gaby's "Literature Review and Commentary" column and his editorials – both long-running features in this national monthly, whose cover advertizes it as "The Examiner of Alternative Medicine."
I've been researching and writing about hypothyroidism for more than a year. Exactly a year ago, I published a column, "Dr. Raphael Kellman on the Need for TRH Testing for Low Thyroid" (Townsend Letter, April 2010). In that column, Dr. Kellman, an holistic internist in Manhattan, claimed that Americans are dealing with an epidemic of low thyroid disease, which commonly used tests, he says, often fail to detect.
Dr. Kellman also stated that he has evaluated some 13,000 patients over 15 years for low thyroid with a test that fell out of vogue after most physicians switched to the TSH and T3 and T4 assays. It is the TRH stimulation test. (TRH stands for thyrotropin releasing hormone, secreted by the hypothalamus gland in the brain.) In my April 2010 column on Dr. Kellman, I neglected to credit him with arranging some 10 years ago for a chemical company to produce TRH for this test.
I reached Dr. Gaby by phone, explained that I was about to write another column about hypothyroidism, and he kindly e-mailed me a copy of an article he published in 2004; that article, he said, served as the basis for his chapter on low thyroid in Nutritional Medicine.1 My research on hypothyroidism lately has latched on to environmental pollutants, particularly endocrine disrupters. Dr. Gaby's 2004 article and the chapter in his book (published in November 2010) both "discuss the concept of toxins interfering with the action of thyroid hormone."2
Endocrine disruptors, simplistically defined, are synthetic chemicals absorbed into the body which afterward mimic or block hormones. They can alter normal hormone levels, halt or stimulate the production of hormones, or change the way hormones travel through the body, affecting the functions that these hormones control. Many pesticides and plasticizers are suspected endocrine disruptors.
Americans are at risk today of exposure to some 3000 synthetic chemicals produced in high volume annually. These chemicals are routinely detected in air, drinking water, and food. They abound in building materials, many consumer goods, cosmetics, household products, medications, and motor fuels. Hazardous waste sites are full of them.
Measurable quantities of several of these chemicals have been traced in the blood and urine of nearly all Americans. They're also traceable in human breast milk and in the blood in umbilical cords in newborn infants. Less than 20% of these chemicals have been tested as potential causes of neurodevelopmental toxicity. At least 1000 chemicals known to be neurotoxic in animals have never been investigated for their effects in humans.
At Dr. Kellman's invitation, I attended a scientific workshop with him, "Exploring the Environmental Causes of Autism and Learning Disabilities," presented by the Mount Sinai Children's Environmental Health Center at the New York Academy of Medicine, December 8, 2010.
(In passing, I should mention that Irving Selikoff, MD, a pioneer of environmental and occupational medicine, "created" the Division of Environmental and Occupational Medicine at the Mount Sinai School of Medicine, directing this division from 1966 to 1985. Dr. Selikoff died in 1992, but the Mount Sinai Children's Environmental Health Center reflects his influence.)
On January 21, 2011, Dr. Kellman made a presentation before the Autism Research Institute in Dallas, Texas, on "The Thyroid-Autism Connection: The Role of Endocrine Disrupters." As usual, Dr. Kellman emphasized the use of the TRH stimulation test in definitively diagnosing low thyroid. (The Autism Research Institute is a think tank, which invites doctors it regards as autism experts to speak before it.) Anyone who would like to read Dr. Kellman's presentation can obtain a copy by phoning his office: 212-717-1118.
Dr. Kellman on Low Thyroid and Several Issues Involving Women's Health
I'll close this column with quotations and adaptations from articles on menopause and hair loss accessible on Dr. Kellman's website, Practicing the Medicine of Tomorrow (http://raphaelkellmanmd.com).
Menopause. Menopause is a change in life, not a disease. Our focus on this natural change as a disease and on drugs that can make quick alterations have led to the widespread use of unnatural synthetic hormones in a vain attempt to suppress menopausal symptoms. ...
Menopause is widely considered a sign of aging. It is not a sign of aging, but if the effects of menopause are severe, it can appear to be so. ...
Menopausal symptoms are related to a decline in certain hormones, for instance: estrogen, progesterone, testosterone, and DHEA ... Additionally thyroid hormones can also be low during menopause. Restoration of the proper balance of hormones is what is needed in order for a woman during menopause to feel like herself again.
In their menopausal years, women frequently begin to exhibit thyroid dysfunction...
Often, a thyroid abnormality is contributing, and masquerading as a menopause problem. … Also, an adrenal problem may masquerade as a menopausal problem. ...
The adrenals produce numerous hormones, including estrogen progesterone, DHEA, and testosterone ... I've alleviated many menopausal symptoms by evaluating adrenal function and frequently just using compounds such as DHEA. ...
I believe that every menopausal woman must be addressed individually. Ideally, it is best to get a blood test and saliva test to measure hormone levels. … Additionally, a full adrenal evaluation is necessary ...
Most women develop a progesterone deficiency even before they develop an estrogen deficiency. This can occur even before perimenopause, but certainly the decline becomes significant as women get closer to menopause. Symptoms of progesterone deficiency include premenstrual discomfort, hot flashes, night sweats, decreased sense of well being and depression, and a decreased ability to concentrate and focus. Progesterone in general could help women feel better physically and mentally.
I use only bio-identical hormone replacement therapy. Bio-identicals are far gentler and safer ... They may even be protective against cancer. ...
Some women require the use of bio identical hormones. Some can be helped with phytoestrogens and by balancing the adrenal gland. Others do not have an estrogen issue at all; their symptoms may be due to a low thyroid. Clearly, one needs to see a physician who has a broad view of health, one who is not quick to use even bio identical hormones.
Hair Loss. Although most people believe hair loss is generally a man's issue, the fact is that as many as two-thirds of all women experience hair loss as some point. Forty percent of women have visible hair loss by the time they are forty, according to the American Academy of Dermatology.
The medical profession pays little attention to the issue of women and hair loss, and most doctors don't take complaints of hair loss in women seriously.
Hair loss in women can be devastating for self image and emotional well being. Even hair thinning can make a woman feel unattractive, stressed and depressed. To make matters worse, doctors usually have no explanation and little to offer for this devastating problem.
Worst of all, many women are told hair loss is just part of the aging process. This is farthest from the truth. Hair loss in women can be stopped and reversed ...
Hypothyroidism or Low Thyroid is one of the most common causes of hair loss in women. Frequently, this goes undetected because the routine test thyroid blood test (TSH, T4, T3) often fail to detect the problem ...
Hypothyroidism is more common in women. The balance between estrogen and progesterone can have an indirect effect on the thyroid. High estrogen levels in proportion to progesterone levels can suppress thyroid function.
Stress can result in high levels of cortisol, which suppress thyroid function. [Stress] can also lead to low DHEA, which can make one more susceptible to hypothyroidism. Frequently, when a low thyroid causes hair loss, women have other thyroid-related symptoms as well ...
How demoralizing it is for women with hypothyroid-related hair loss when this condition is also associated with weight gain asnd fatigue - frequent low thyroid symptoms. But most troubling and frustrating is when women go from doctor to doctor and none give them an explanation or adequate treatment.
A Case History
I'll call the patient 'Janet.' Since she was 35, 'Janet' had been losing hair, gaining weight, yet eating very little and feeling tired. She went to her doctor suspecting that there might be something wrong with her thyroid, but her doctor told her that her thyroid blood tests were normal. Instead, her doctor suggested that her symptoms were likely due to stress and told her to go on a diet.
Janet felt humiliated but didn't give up on her search to find out what was wrong. When she came to see me, I did the more sensitive TRH Stimulation Test. Sure enough we detected a low thyroid. With natural thyroid hormone, the addition of biotin, silica in liquid form, iron, and selenium, 'Janet's' hair loss stopped. Then her hair re-grew, and her energy dramatically improved.
1. Gaby AR, Sub-laboratory hypothyroidism and the empirical use of Armour thyroid. Altern Med Rev. 2004;9(2).
2. Gaby AR. Personal communication, January 11, 2011.
Marcus A. Cohen's "baptism" in the whirlpools of medical politics dates to 1984, when he served as government and media liaison for patients under alternative cancer therapy. Subsequently, he has advocated broadening plausible treatment options for patients unresponsive to conventional care. A Townsend Letter columnist since 2004, he has reported and commented on a wide range of health-care topics; he is also the author of a paperback, Lyme Disease Update, published by the Lyme Disease Association in 2004.