Okay, so this is Dr. Pati and we’re going to get our webinar started and today we’re going to talk about the ins and outs of thyroid use for men and women. This is a particularly important topic because of course many of us know that with all the stress and nutrient deficiencies we’re seeing. We’re obviously seeing a lot more thyroid dysfunction than usual and to just give you a little idea.
Our practice you know has 30% of people under the age of 25 and 30% of people above the age of 55, and pretty much 80-90% of our patients end up needing some kind of thyroid support. So and without it, the hormonal therapies and the other therapies we do would not have the kind of effect that we’ve seen.
So, I would actually say that out of all the things that I ended up putting into the practice – when I looked how to use thyroid, I would say that we’ve had the most effective leap in our treatments. So, let’s see here. So, you’ll have this particular webinar will be posted on MDPrescriptives website and everything around it.
So, it’s 6pm EST. So, I’d like everybody to just get comfortable and settle into your chair. Sit up straight and breathe, and let’s change our pH and go ahead forward with trying to figure out what we have to do for the thyroid. So, I always quote this quote from Carl Sagan which talks about:
“Science requiring a strange mating of two contradictory tendencies: a willingness to consider even the most bizarre idea, and at the same time, a harsh skepticism, requiring hard evidence to back up every claim.”
We come up against this concept every single time we hit something new and the reason why I mention thyroid as something new is because as you will see, every patient that I’m treating is on a combination of T4 and T3. Whereas 10 years ago when I started my practice, doctors in this area actually told our patients that, “If you go and get on T3, I’m not going to treat you anymore.”
That was a many endocrinologists that were here in the Orlando area and we’ve gone from that kind of reception for our patients to a willingness on the part of these physicians to accept that the patients actually got better on T3. Also we were able to provide data from New England Journal of Medicine and from Journal of Endocrinology that showed that patients did better on T4 and T3.
I have all that data in this webinar so you are free to use it and get the original articles so that you too will have something in your hand when you’re challenged about using T4 and T3. But with that kind of use of T3 which I’m going to show you today, we have had very good results and the categories that you see here especially cholesterol and cardiac dysfunction and things like that.
We’ve been able to get especially when you’re talking about antidepressants and the newer things that are on the market. You know new patients are coming in every day on things like Vyvanse, and Adderall, and Nuvigil, and all kinds of things for either energy or memory. It turns out that with the proper use of thyroid and nutrition and obviously, hormones – we’re able to get patients off of these meds.
Of all of them, the one that is the most effective is really to get the thyroid right and to be extremely aggressive with the T3 which you can do if you pay attention to the adrenals which is what I’m going to show you. So, the basis of the approach of course is the belief that underlying imbalances cause tiredness and sleeplessness and anxiety and depression and headaches, and general disease.
When you look at people with thyroid disease, you’re looking at people with muscle swelling, bone loss, nervous system issues, organ dysfunction. Plenty of studies to show that vascular dysfunction. So, we know that the thyroid hormone actually binds to all of these organs. We use a model as many of you seen to try to optimize the subconscious and conscious mind and the physical body.
Then to go ahead and optimize the host of hormones but what I’m going to show you today is that the thyroid is responsible for activating the testosterone and activating progesterone receptor and the cortisol receptor. So, it really goes hand in hand with any hormonal therapies. Just as important ends up being the specific nutrients that you need to activate it.
I’ve seen many people on testosterone. I’ll show you a case today. It had absolutely no effect until we added thyroid to the picture and then added the specific nutrients that were responsible for activating the thyroid. The second principle in a restorative approach is of course that you need to teach the patient to understand that you’re going to be looking for optimal values not normal values.
So, you’re going to be looking for fasting blood sugar of under 85 not over 85 because the mortality rate goes down when it’s under 85 by threefold. You’re going to be looking for a vitamin D of over 70 because the cancer rate goes down when it’s over 70 by 50%, and so does dementia and heart disease.
There you go with the optimal T3. So, T3 range on most labs right now is somewhere between 230 or 2.3 and 4.5 or 450 depending upon what you’re using as your denominator. But we know that if you look at the endocrine society and you look at many of the labs which have started to change this, you’ll start to see ranges of 230-680. We try to look for optimal ranges above the 400.
Now if you have a patient who’s sitting at 350 and she’s saying, “Doctor, I have good energy, good mental clarity, good memory focus. My metabolism’s great. I’m feeling great.” Three-fifty it is! She probably has good receptors, sight function and good nutrients, and you can stop there.
But the other thing to realize is that while we’re getting people repleted especially for energy, it’s important to realize that the more mental and physical activities they have – the more nutrition and hormonal deficiencies they have. So when you’ve got somebody who’s in their twenties and they’ve got lots of hormones and nutrients, no problem.
You’ve got somebody in their forties and they’re depleted, these activities end up hampering and decreasing the speed at which we can get people well. As we see people, we start with a Symptom Chart initially and we always do the hormonal testing and the physical exam. You really don’t want to be thinking of giving somebody a thyroid replacement and we haven’t cleared the cardiac system and the lungs, and everything.
So, we do a very thorough physical exam on every patient that we’re giving any kind of treatment to every year, and also of course, a written plan of action. Although the standard of care is to see patients for thyroid adjustments every three months. When a patient comes to you because they’re feeling lousy, they’re not really interested in being told, “Take this thyroid and I’ll see you in three months.”
So, it’s very reassuring to them when you say, “Look I want you to start this thyroid and increase it as stated. I’ll see you in four weeks and if you’re not feeling well in four weeks, we’ll keep increasing it.” I’ve used this four-week interval for changes for the last eight to nine years with no issue in terms of over-correction.
You aim for a restoration period of 3-6 months. Most people are feeling well within three months. We have a symptom approach to hormonal therapy so there’s particular symptoms that are related to different hormones. The ones that we look at for thyroid symptoms are going to be.
The most common ones which are: fatigue, decreased memory and mental clarity, lower mood and depression, lower motivation. A third of patients have weight gain. I had a patient today say, “Well, I don’t have any weight gain because my thyroid’s still raw.” Yes, the thyroid is usually. Weight gain is precedent in a third of people but not in two-thirds. Muscle pain from swelling, swelling in general, loss of outer eyebrows, coldness, constipation, palpitations.
We ask people to rate these on a scale of 1-10 telling them that it would serve as a baseline and every four weeks when we see them that we’re going to go ahead and you know, allow them to give themselves different ratings so that they know where they are. So and then other things one sees are things like cholesterol, elevation and swelling.
The thing to remember is that the symptoms that I mentioned that were in the black are actually things that you don’t see in everybody. These you see in a third of patients. Then of course, we try to measure hormones but I’d like to point out that when we measure hormones, we’re really measuring a piece of the puzzle.
So, if you look at this diagram. This is actually an example for thyroid not insulin. This slide is incorrect there but if you look at the thyroid receptor or the T3 receptor. It has multiple pieces to the puzzle. There’s selenium, iodine, and B vitamins that are needed. You need the T3. You need a pH above 7.0. You need a receptor site that’s functional.
So when we measure T3, we’re getting the piece of the picture but the full picture is only seen when you pay attention to the clinical symptom that the patient is presenting with such as tiredness or loss of hair, things like that. So we’re not able to measure receptor site function unless we look at function, body temperature, things like that.
So, the thyroid hormone as I already mentioned to you works with all the other ones and it is really one of the most important metabolic hormones that there is. It declines in everyone somewhere around a 40% decline by age 40; 50% decline by age 50. If you have more nutritional deficiencies; if you have more stress or more exposure to electromagnetic fields – than the decline is sharper.
These days we’re seeing dysfunctional thyroid in people by the age of 20 because of stress and nutritional deficiencies. This is where we’re noticing there was a study that recently came out showing that about 25% of students in the colleges around the country are actually using some kind of medication for focus and concentration.
Which most of the ones that have come into us have been able to correct just by measuring and correcting the nutritional deficiencies and asking them to eliminate some of the electromagnetic field exposures that they have. So, I show this slide just for us to have a little conversation about TSH which is normally secreted by the pituitary gland and which is of course, the normal measurement that we see coming through the door for an evaluation of thyroid.
I always measure the TSH so that we can speak to other doctors when we need to look at the same things but at the end of the day, the TSH is actually measuring and indicating circulating T4 much more than circulating T3. It turns out that circulating T4 is inactive. So, the potency of T3 is multiples greater than T4, and it is the hormone especially the prefraction that the body has receptor sites for.
I show you this picture with reversed T3 because that is the monkey wrench. If you have a monodeiodination of T3 and a loss of T3 receptor and you don’t have good function. So when I’m looking at the thyroid, I’m looking at multiple things. I’m looking at the level of T4, the level of T3, the reverse T3, and the TSH, and also the thyroid antibodies.
The reason why the thyroid antibodies are relevant is that if you have them, you’re able to reverse them by using plant-based diets that eliminate animal products which create autoimmunity. Also as you start treating, it is amazing how quickly those thyroid antibodies can actually reverse.
It also gives you a wider threshold for treatment because as you may know in the endocrine literature shows that if you have a thyroid antibody – then your threshold for treating should be a lot looser and I’ll show you some data actually behind that. So, the optimal free T3 is going to be above 450 but the picture always trumps.
If you look at even in pregnancy, they’ve shown that the upper limit of reference range with a normal T4 has actually been associated with adverse outcome. So they recommend that when we’re correcting women in pregnancy that we keep the T4 in the upper part of the range. I have a lot of patients who actually come to me in pregnancy for keeping their T3 and T4 in a good place.
Because we know that cognition in offspring and neurological development can be affected by it, I’m very careful about monitoring this every month because mostly the endocrinologists and the obstetricians are not going to be looking at that. It’s an interesting scenario because often the endocrinologists are telling the OBs, “You manage it,” and the OBGYN is like, “You manage it.”
So at the end of the day if you’re the one giving the thyroid, you may end up managing it. What I do is I look at thyroid levels in these patients every month and I try to keep those T3 in the top part of the range. So, we talked about the fact that thyroid dysfunction is common these days because of the electromagnetic fields and electromagnetic fields directly affect the thyroid because it’s the most sensitive organ to radiation.
We also have a number of other things. For example, the absence of iodine, the replacement of bromine for iodine, or the fluoride that we have in our drinks, the processed foods. Obviously, you may have heard patients coming in, coming in and telling you that, “Well, I’ve read that I shouldn’t eat broccoli and cauliflower and I shouldn’t eat soy products because they can decrease thyroid activity.”
If you look carefully at those studies, you’ll find that the studies were done in people who are eating lots of soy and soy cheese and soy milk, and soy everything. So, moderation is what I tell these patients. I’ve never seen a problem with people eating any of these things in moderation but excess is where you see it and obviously, we know that stress is a big factor and nutrient deficiencies.
The agricultural studies, the USDA published a few years ago showed a 60% reduction in our minerals and minerals are needed for the thyroid. So, that’s over 50 years. So, we’re seeing thyroid deficiency much earlier in literally in younger people just correcting the nutrient deficiencies [indiscernible] [18:05].
The thyroid has a lot of effects on the body. It has effects on cellular metabolism. It activates brain and neurological function. It is a major contractile support for the cardiac system. It actually stimulates osteoblastic support of the bone. I am not worried about overcorrecting the TSH because it turns out the T3 and T4 are osteoblastic stimulators.
We have not seen bone loss in people that are on thyroid. They actually build bone and if you look at the data, you can see that osteoblastic stimulation is one of T4’s activities. Menstrual cycle regulation. I can’t tell you how many patients with infertility. We have given low doses like 30-60 mg of Armour too with a little bit of minerals. We’ve had faster cycles and fertility restored.
So, it’s a very powerful therapy. It also activates all other hormone receptors, therefore hormone restoration can start with thyroid as long as the adrenals are strong. The major symptoms we talked about: low energy, low mental clarity, low focus/concentration, depression, low mood, low motivation. Things that help us to associate with the normal aging.
So, when you look at normal aging or what we consider normal aging really by the age of 50, the thyroid function has gone from a 100% to 50%. If you get down to the ten percentile, the lab will tell you that you’re low on thyroid but if you’re in the 50th percentile – you’re still feeling all these symptoms.
A third of people will feel weight gain, drier hair, drier skin, colder hands, colder feet, hair loss, constipation, LDL elevation, loss of outer eyebrows – but you’re being told you’re normal. So, this is the patient who’s come in telling you, “I think I have a thyroid problem.” The patient always knows. “I have all these symptoms. I looked them up online.”
One of the common sites you’ll see your patients go to is stopthethyroidmadness.com, which actually happens to be a pretty informative website that a lot of my patients have looked at before even coming here. “And my TSH is normal so I’m being told that I’m fine and my thyroid doesn’t have a problem.” But I just pointed out to you that the TSH is reflecting T4 which doesn’t have any activity and we’re looking at normal ranges.
So, this is the patient who could really benefit from just a try of thyroid. We also know of course that low thyroid is associated with cardiovascular disease and high cholesterol and low cardiac function, delay in diastolic relaxation. These are the patients coming in with swelling and pooling. That just something like 50 mcg of T4 regardless of the TSH would give you a correction of the cardiac parameters.
I’m showing a little bit of the data just to point out that there are a lot of major associated conditions associated with your thyroid being even 30-40% lower than it should be including: infertility, chronic fatigue syndrome, fibromyalgia. These patients in the last two categories end up needing a lot more thyroid when you’re replacing them. Their receptor sites seem to be down regulated, congestive heart failure.
I can’t tell you how many patients’ ejection fractions have improved just using thyroid, and bone loss and osteoporosis. I mentioned that their osteoblastic stimulators. Dementia and low cognition of offspring we talked about and with the pregnancy. So, there’s a lot of associated conditions and you could say that these are the indications that the free T3 is less than 450.
Really the clinical picture trumps because of the fact that you’ve got a lot more factors than just the T3. The other part is if you look at this study that was published in 2002, it actually proves that although we have population-based reference ranges, the test results for an individual person is very narrow.
That means that it’s so narrow that each individual needs to be interpreted according to their own range which since we usually don’t have baselines for free T3, we wouldn’t know that. That is why I come back to this picture which this one’s actually correct showing you that the measurement is going to measure the T3. It will not tell you about receptor site function or the pH of the tissue or whether anything else is around.
The other thing I want to help you with here is to show you in 2005 what was published in the Journal of Clinical Endocrinology & Metabolism. It was a joint statement from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. Their statements are that:
“The potential benefits of early detection and treatment of subclinical thyroid dysfunction significantly outweigh the potential side-effects that could result from early, diagnosis and therapy.”
This is for those people who are getting hammered for treating people that don’t have laws outside the normal range.
“We also strongly agree with an aggressive approach to case-finding in patients presenting with symptoms and signs that suggest the possibility of thyroid dysfunction.”
So, this is a nice statement. They actually also go on to say that:
“They believe that it will be necessary for clinicians and patients to consider each individual’s unique situation in determining the need for testing and for treatment.”
So this gives us a lot of leeway to try to correct people clinically. I always recommend using T3 and T4. I told you that I would show you some data that would support that. One of the things you should remember is that there’s many forms of thyroid that you can use and many combinations to use for T3 and T4.
So, I wouldn’t get too committed to using one kind or the other because there’s those people who will do better on bio-identical Levothyroxine and Liothyronines such as Synthroid and Cytomel and those who would do better on a natural desiccated thyroid forms like Armour or Westhroid or Naturethroid, or one of those.
I always ask people to take it on an empty stomach and not eat or drink for 30-60 minutes. The bottle will say four hours. That becomes complicated and difficult and the compliance rates goes down. Most of the absorption takes place within the first hour. So if your patient can put it next to their bedside, swig it with a glass of water, and roll back over. Within 30-60 minutes they’re usually in a pretty good place.
There’s specific nutrients critical to thyroid function which I’ve mentioned to you and we’ll go over in a little bit more and that the fraction that’s active is the T3, but this is the data. I’m just showing you rather quickly that show the T3 and T4 are more effective than T4 alone. This is a study where they actually clinically measured that change by replacing 50 mcg of T4 with 12.5 mcg of T3.
This was published in the endocrinology literature showing that although a professional organization continues to recommend T4 alone, they’ve actually found a gene polymorphism in patients who did not respond to T4 at all. They say clinicians could consider adding T3 as a therapeutic trial in selected patients because you can’t really measure that polymorphism in everybody unless you want to spend $1700.
Another study in the endocrinology literature. This was a randomized controlled trial showing a clear preference for treatment that featured higher levels of T3 versus T4 alone. Another study published in New England Journal of Medicine in 1999 showing that 30% of patients were significantly better after treatment with T4 plus T3. That’s the result of that.
So, why is it that T3 causes so much fear? Why is it that an endocrinologist generally stay away from T3 and tell their patients that Cytomel and Liothyronine are dangerous? The most important thing to realize here is that T3 especially Cytomel which is an immediate release, if you order it in that way, is one of the most potent powerful forms of thyroid that you will ever give somebody.
The peak is within 1-2 hours. That’s actually why I tell people that are on Cytomel, in the morning when you get your blood drawn, come in for your lab review – hold the Cytomel. Because the Cytomel will peak in two hours and you’ll end up with an abnormal result that’s sky-high and within two more hours, it will drop back down. So, I usually tell them to hold the Cytomel.
Well, what is the fear of it? The fear of it is that it actually will increase the metabolic rate. If you increase the metabolic rate and increase the cardiac system in somebody who has low adrenals and magnesium deficiency, which everybody with low adrenals is going to have magnesium deficiency – you’re going to have cardiac palpitations, anxiety and heart rate variabilities.
So, the most important thing here is to monitor and see where the adrenals are. If you have strong adrenals and your morning DHEA-S is above the 200 range and you’ve given enough magnesium or you’ve measured the magnesium, you can give T3 without a problem. That’s one of the things I learnt early in the practice when I started to see that when adrenals were low, giving T3 was difficult.
All forms of thyroid right now on the market are bio-identical and there’s many different forms. I hear people talking about always go with brand, always go with brand because the generic is up and down but it just turns out that whether you look at the brand or you look at the generic, there is anywhere from a 9-25% variation whether it’s generic or brand.
So, I wouldn’t worry too much about that. There are a couple different forms. I’m going to tell you about Physiologic Thyroid. It was basically named Physiologic Thyroid because it was mixed with T4 and T3 ratio 3.3:1, and that is the ratio at which the body produces thyroid. So, for example, if you wrote for PTA 76 from a compounding pharmacy – the first thing you should know is that all of these are slow-release. They’re all slow-release.
Why would you want to use a slow-release? You would use a slow-release in somebody who you suspect has adrenal insufficiency. If they do not have adrenal insufficiency, slow-release is going to give you a slower and less pronounced effect in general. So, if I suspected adrenal insufficiency when I’m starting somebody on something.
I may start with a slow-release but eventually move over to something that is more intermediate-release like a Armour Thyroid or a Naturethroid, and then eventually possibly Cytomel if I need it but the thing to remember here is that the slow-releases are generally not covered by insurances. So patients are very happy when you move them from the Physiological Thyroid slow-release generally into an Armour/Synthroid/Cytomel combination.
The 76 mcg is going to have 33 of T4 and 10 of T3 which is the 3.3:1 ratio. You can see that 33 plus 10 is not 76. It’s 43. So, why is it called PTA 76? And that’s because it’s physiologically equivalent to 76 mcg of Synthroid. You’ll see when you go up this chart. You know every often when I’m starting somebody and I’m concerned about their tolerance, I’ll start somebody on a PTA 19 slow-release (SR) and tell them, “Every two weeks I want you to increase until the next dose.”
So, go from 19 to 38 to three of them, to four of them, and move them up. Once I get to a T4 dose of alone to 66-100 which is PTA 152 or 228, I’ll start to alter the T3 to T4 ratio because as you get higher and higher on the T4 – you have more reverse T3 which is a blocking agent and that’s not what we want. I’ll show you an example.
I find that you have a better result when the T3 ratio is closer to 1:1. So, very often I’ll have a patient on PTA 76 mcg which is 33 T4SR, 10 T3SR and I’ll give them an extra 10 mcg of T3 alone. I’ll ask them to start the 76 and at day ten, add 10 of the T3 and at day 20, add another 10. Then they’ll be finally at about a 1:1 ratio and people will do better at a 1:1 ratio than they will at a 3.3:1 ratio in general.
When we talk about the desiccated natural sources of thyroid, all of them contain T4, T3, T2, T1 in different ratios. They’re measured in milligrams (mg) but the actual amount of T4 and T3 are measured in micrograms (mcg). So, for example, when we have Armour Thyroid 60 mg, we have 38 mcg of T4 and 9 mcg of T3.
There’s lots of brands on the market. There’s a generic natural desiccated thyroid that’s a little newer on the market called Acella. Just to know this is very similar to all the others and Armour also but it’s got a bunch of things in it but so does Armour. Armour Thyroid which is made by Forest Pharmaceuticals. I use this a lot because it’s available and most pharmacies are carrying it.
If you look at the added ingredients in the bottom line of other ingredients, it really isn’t too great. It comes in a fourth of a grain which is 15 mg. What I’ll do in patients where I’m concerned about starting, all the thyroid is going to be released as an intermediate T3. So, it’s not quite as powerful as the Cytomel and not quite as weak as a slow-release.
If I have enough magnesium onboard, I’ll start them on Armour Thyroid 15 mg. which is a fourth of a grain and again ask them every week to go up by a fourth of a grain up to 60-75 mg. Then I have them come back in four weeks and they do their blood pressure, their heart rate, and make sure they’re not having any other symptoms. Then start taking them towards 90 mg. Once they get to 90 mg,, I generally start to add Cytomel especially if they have enough magnesium.
So, the corresponding doses if you look. The Armour of 60 I told you was a 38:9 ratio. I like to think of it as a 40:10 because it’s so much easier to think about it that way. Naturethroid has similar ratio. I already mentioned to you that’s about equivalent to PTA 76. So just equivalency is important when you’re changing doses.
I might write something like a PTA SR 19 mcg or Armour Thyroid 15 mg, or Synthroid 25 mcg and ask the patient to start there and keep moving it up every week or two up to four weeks. If you start them on Cytomel, you have to make sure the adrenals are fine and there’s enough magnesium onboard.
So I already mentioned to you that slow-releases are order if you suspect adrenal insufficiency which means they have a long history of stress or fatigue or panic attacks, palpitations, muscle cramps, inflammation. You have to make sure that the DHEA-S is above 100 before you start any kind of thyroid and that you don’t have a low morning cortisol.
The other thing I do to be careful is slow down the dosing while I’m adding iodine. So, if I’m adding iodine, I won’t increase the thyroid at the same time because iodine has a profound effect on it. So I don’t give them at the same time. Many patients will need to be dose adjusted downwards after iodine is added and as the stress reduces.
If you have weak adrenals, then this is the regimen that I use before I put the thyroid onboard which is a high dose of magnesium 400-800 mg either in the form of glycinate orally. Or if they have diarrhea and are dose-limited by diarrhea, we use magnesium oil transdermally which can be acquired from ancient minerals, and omega3. Then add progesterone, testosterone or DHEA and finally, thyroid which is slow-release or a Natural glandular.
This is just an example of somebody who a 45-year old woman with an energy of three, panic attacks and insomnia. You already know because of the very low energy that this is not just a thyroid issue but this is most likely related to adrenals. So you start progesterone and interestingly enough, this is that patient that I’ve shown you in another webinar where the patient ends up with the exact opposite reaction to progesterone.
A panic attack, heart racing, no sleep, and nervous. Of course, this is what we would call possibly a paradoxical reaction to progesterone. This is a patient with severe adrenal insufficiency. So this is not a patient that you would ever give thyroid to in the beginning. You’d start them with exactly the regimen we’ve talked about which is high dose of magnesium, omega and DHEA, and sublingual progesterone.
If you have a patient that you start on thyroid and they have palpitations, you not only increase the magnesium but you could consider COQ10, Ribose and, L-carnitine. I use these in patients who I have consistent problems in the cardiac system and if I have that, I may also get echo looking for diastolic function.
We increase the dose upwards until symptoms are relieved. I want to talk to you about this patient because I want to make a point about reverse T3. So, this is a 45-year old patient who has thyroid problems, who’s doing very well on your PTA 228 which is 100 mcg of T4 and 33 mcg of T3.
She’s on progesterone, multivitamin, fish oil, bone formula and then over two months. She’s been fine. This is a patient of mine who several years ago, she was absolutely fine. Then she came in and reported that over a few months, her energy had dropped to 5 out of 10. She’d gained some weight. She was foggy. She was depressed. She was started on an antidepressant. She was cold. Extremely obvious that the thyroid she was on was not working for her.
So it was either that the T3 was too low or that the minerals were too low. Something was up. So when you have a ratio of a hundred mcg of T4 to 33 of T3, you have to consider the possibility that you’re taking T4 and dumping it into T3. As a matter of fact, when we measure, if you look at the very bottom gradient which is the reverse T3 – she was at 360. You want the reverse T3 to be under 220.
If you look at the free T3 gradient, you’ll see that that was actually decent. It was at 3.3. It had gone up significantly but she was in a bad spot because the reverse T3 binds the T3 and blocks it. So, in this patient, you could add more T3 or you could just bump the T4 down. Usually when we bump the T4 down, the patient looks at you like you’re crazy. They’re like, “Oh, I thought I needed more thyroid.”
Once they understand this, this patient actually I just bumped the T4 down to 75 mcg and she recovered on that. So, I usually measure labs at the six-month mark and if I have problems, I’ll measure it at three months. So, this is a 45-year old male on PLO cream of 75 mg of testosterone. This man came in reporting a low sex drive. His sex drive had improved from a two to a five over a 3-4 month period on the PLO 75 mg.
He had come in from another practice. His energy level recovered from a three to a ten but we’re still not at the 8/9 we’re looking for. His testosterone level had gone from 370 to 750. His bioavailable was fine. I don’t have it on the chart but you would expect that he would be fine. When we looked at his T3, it was in a lower part of the range.
As I was mentioning to you, the T3 and the thyroid actually activate the testosterone. His DHEA-S was perfect. His adrenals were at 330. In the morning, we expect the battery to be fully charged and in a male, you’re looking for a number of 3-400. So his adrenals are strong. He’s a good candidate for thyroid.
Thyroid activates testosterone and the chances are his nutrition is not in the right place and he doesn’t have the specific minerals to activate the thyroid or the testosterone. So we put him on 50 mcg of Levothyroxine which is bio-identical T4. We put him on 5 mcg of Liothyronine and asked him to increase it every week up to 15 mcg.
We put him on Essentials 5 in 1 which has specifically 400 mcg of selenium, which we know that selenium is a critical part of the deiodinase enzyme and 50 mg of zinc, and all of the other specific nutrients that are needed for thyroid activation. You’ve got to put people on minerals and minerals with the right kind and the right dosing. It also has the iodine and the chromium and so on. So, he ended up on that.
At week eight, he had improved up to an eight which still there’s room for improvement. I would go ahead and add five more of Cytomel and then in seven days go straight to 25 mcg. The benefit of going to 25 mcg for a patient is that the 25 mcg tablet is actually covered by insurance much better than 5 mcg. It’s much cheaper for them.
So, if you can get them to a 25 or even for people who are on 12.5 as prescribed to 25, and tell them to take half a tablet. Their copay is a lot lower for that. But this makes the point as to the importance not only of activating other hormones with thyroid which I’ve seen over and over and over in my practice, but also the nutrition.
This is what we know. Zinc is an essential part of Estradiol and testosterone. Cobalt is needed for estrogen function. Chromium is a part of progesterone function. We know that there’s plenty of studies showing that iodine and selenium are required for the T4 to T3 conversion. Zinc. This was published in the nutrition literature and JAMA.
So, we’re really talking about good sources showing us that we need specific minerals for thyroid activation. There’s also plenty of data. We know that thyroid has the highest selenium content and in patients with antibodies, selenium supplementation alone decreases anti-thyroid antibody levels and improves the structure of the thyroid gland.
We also know that selenium significantly decreases the percentage of postpartum thyroiditis and hypothyroidism, and that in Graves’ disease, people are recovering more rapidly. The dose that’s recommended is between 200-400 mcg. The Essentials 5 in 1 has 400 mcg. Interestingly, the Daily Two which is half the B vitamin doses but only two pills rather than four pills – still has 400 mcg of selenium and 35 mg of zinc.
So, it actually still has all the activators for the thyroid in it at full dose. Our nutrition program isn’t based just on supplements. It’s really based on food and supplements and measurement. Measurement. I’m using Spectracell right now for measurement and I can tell you that it’s a powerful tool to motivate people because these are the kind of deficiencies we start to see when we measure.
A perfect example would be this lady. You know you’ll always have the patient who you’ve got on things and they’re not really having a good result. They’re using you know their multivitamins that they’ve chosen wisely and we never try to discourage people necessarily from completely getting off of something they’ve chosen.
This is the perfect example of a patient I saw very early in the practice who just three months into the therapy was on thyroid and progesterone and was taking her pills, and really had a pretty minimum effect on energy level. No effect on memory. Some effect on mood. Barely an effect on weight. This again is a classic example of somebody who as soon as we put them on corrective doses of in the Essentials, they started to really improve.
The energy level improved. The memory, the mood, and the weight. These are before and afters. So, I think that I’ve gotten to the point where I am going to wrap this up because I’d like to make sure that I can take your questions. I’m going to start taking questions right now. Somehow I’m not getting a good transmission so I’m not seeing questions.
I know there’s a question up here somewhere but one thing you should realize is that all of our webinars are posted to the new MDPrescriptives website. The website actually changed and turned over last week and some of the webinars aren’t there but this webinar will be there. I also want to tell you that on May 15th in Orlando, I will be giving a full-day workshop on the adrenals, the thyroid, estrogen, progesterone, testosterone, and basically presenting 15-20 cases on hormonal therapies.
That’ll be May 15th and the information is on both Sajune’s and MDPrescriptives website. I really appreciate all of you joining us this evening. I’m sorry I can’t take questions because it looks like the transmission of the questions aren’t working today. But if you have questions, then please email me at email@example.com and I wish you the best evening ever. Thank you very much.