HYPOTHYROIDISM AND DEPRESSION – DR RIDHA AREM
Over 20 years ago, I used to prescribe thyroxine only to my hypothyroid patients because that’s what I was taught to do, and I realised very quickly that most of them, the majority of them, they continued to complain of lingering symptoms of low grade depression, anxiety, cognitive symptoms, and fatigue. At the same time, when I saw a patient who was taking Armour Thyroid I tried to switch that patient from Armour to thyroxine obviously, and I was facing many unhappy patients and I didn’t understanding what I was doing.But that prompted me really to do a lot of thinking about this matter and having been trained by one of the discoverers of T3 back in ‘51/52, I realised that there was a rule for T3 in the management of patients with hypothyroidism. So I put together protocols etc; coincidentally, the publication of the first edition of the Thyroid Solution in ‘99 coincided with the first peer reviewed paper on T4 T3, which showed some mental benefit when patients receive T4+T3 versus T4. The study was really not very well But that prompted me really to do a lot of thinking about this matter and having been trained by one of the discoverers of T3 back in ‘51/52, I realised that there was a rule for T3 in the management of patients with hypothyroidism. So I put together protocols etc; coincidentally, the publication of the first edition of the Thyroid Solution in ‘99 coincided with the first peer reviewed paper on T4 T3, which showed some mental benefit when patients receive T4+T3 versus T4. The study was really not very well done, since then there were 11 studies that were published. Some of them did not show any benefit and that’s what introduced this controversy the traditional medicine and the current teaching now is that T43 in traditional medicine. T43 is naturally helpful, but in fact when used appropriately, T43 therapy should be the future in the treatment of hypothyroidism. I’m going to review very briefly how the thyroid system works. The thyroid gland produces two thyroid hormones, T4 and T3, as you see on a daily basis approximately 6-8 micrograms of T3 are produced by the gland, all the T4 is produced by the thyroid gland 80-90 micrograms and 80% of the T3 derives from the conversion via the five prime from T4 to T3 and that will provide the system with about 20-24 micrograms of T3 on a daily basis. So as you see, if the gland is not working properly there will be a deficit in T3; if in addition the T4 to T3 conversion in the system is not perfect, then there would be an additional hypothyroidism in our hypothyroid patients. And you are all familiar with the feedback mechanism, whereby the thyroid hormone affects the TSH secretion and that’s why TSH continues to be the standard diagnostic test for hypothyroidism. Now you can get hypothyroidism as a result of a hypothalamic or pituitary problem such as a tumour or hypophysitis for example, an autoimmune attack on the pituitary gland which is actually increasingly recognised as a concurrence with Hashimoto’s Thyroiditis so it’s not uncommon to see a patient with primary hypothyroidism having a combination of the two deficits as a result of the pituitary and the thyroid at the same time. If the gland is the problem, that’s primary thyroid failure, the most common condition is Hashimoto’s Thyroiditis which is the an autoimmune disorder, it’s the most common cause of hypothyroidism. To purchase this entire lecture series, click here.
Jul
06,
2015