European endocrinologists think about and treat thyroid dysfunction much differently than most American physicians. In the US, we are trained to order TSH, T3, and T4 blood levels and treat the numbers. Dr. Ridha Arem who is a Board Certified endocrinologist at Baylor and author of The Thyroid Solution discusses the flaws in this approach.


The thyroid is coined the great masquerader as patients may present with as many as seventy symptoms but the tests are normal. The thyroid is called the master gland for good reason. Read pages 382-383 of Dr. Ralph Golan’s outstanding book called Optimal Wellness for the multitudinous symptoms of an underactive thyroid and how the thyroid affects virtually every bodily system.


And patients, being biochemically unique, manifest symptoms in what at first blush, appears to be confusing. With an underactive thyroid, some women have very heavy menses, others very light. Some patients sleep all the time, others are tired but wired and unable to sleep.


In longevity medicine we are trained that with aging all of our organs (heart, lungs…..) and glands (ovaries, testicles, thyroid) are shrinking. We are also losing one pound of muscle a year. Think about it.


European testing is much broader in scope including TSH, T3, T4, Free T3, Free T4, FTI, Reverse T3, DHEA-S, Fasting Cortisol, body temperature, Antithyroperoxidase Antiboidies, Antithyroglobulin Antibodies…In the final analysis even if the numbers are normal, the European physicians ponder two questions. How do we know the thyroid hormone is slipping into the receptor site, and how do we know if it then crosses the cellular membrane. Ask different questions, and get different answers. The European patient is treated if symptomatic, despite test numbers. Please know that we are in our fifth generation of thyroid testing, each time saying, aha we got it right this time.


By history, patients have been in psychiatric hospitals who really needed thyroid hormone. Please understand, they probably needed psychotropic medication as well. But great psychiatrists know that if you add T3 to an antidepressant, results often improve dramatically. Recall historically, that in the l920s, we thought rheumatoid arthritis was a psychiatric disorder and then cortisone was discovered.


Let’s talk treatment. The most common form of underactive thyroid is HAIT – get ready for doctor talk – Hashimoto’s Autoimmune Thyroiditis. This diagnosis shall be made only via ordering thyroid antibody levels. Which means, your producing thyroid hormones, but the body is not recognizing them or able to utilize them. The T4/T3 protocol works well for HAIT. Read The Thyroid Solution for further enlightenment. If you have HAIT, and natural thyroid in the form of Armour or some variation thereof is prescribed, the body shall interpret that as your own natural thyroid and reject it. This is the time we must prescribe synthetic hormones. It happens. You see, Armour Thyroid, which is considered natural thyroid, is made from dessicated pig thyroid. Since the guinea pig is biochemically very similar to humans, it is rejected.


If we are treating subclinical hypothyroidism (the tests are normal but you are the poster person for underactive thyroid) or regular everyday hypothyroidism, not autoimmune hypothyroidism, patients do better on synthetic thyroid. Some do better or Synthroid (brand name), some do better on Levoxyl or Levothyroid (generic names). Adding T3, brand name Cytomel (or sustained released T3 compounded by a pharmacist) is usually, if not always, necessary.


Excuse the biochemistry, but this is vital. There are different kinds of thyroid, just as there are 400 something kinds of cherries. There is T1, T2, T3, T4. The natural thyroid preparation like Armour, contains all the different kinds of thyroid.


Now this next biochemical tidbit is vitally important. The job of T4 is to be converted to T3, the real powerhouse in thyroid land. Sounds easy enough, but the conversion of T4 to T3 requires about 50 things like Zinc, Copper, Selenium, Essential Fatty Acids, hormones (which are changing with aging). You can appreciate this is not a one size fits all 10 to l5 minute consultation. And please appreciate that our American white flour, white sugar, white fat, and white salt diet is nutritionally inadequate.


Perhaps we should rename the information age as the stimulus overinclusion age. Try as I might, this was the most difficult hormone to explain, rightfully so. Dr. Ridha Arem’s incredible book The Thyroid Solution estimates that approximately l3 million Americans are being undertreated. Medical studies also show that ADD/ADHD children and adults have a high incidence of untreated thyroid! Are we prescribing Ritalin, when it is thyroid that is required? Read the studies, and let’s continue to think outside the box.


As an aside, Newsweek reported recently that Vitamin A is immunoenhancing. Serendipitously, I revisited my study notes from the l970s, and reread that the FDA said Vitamin A was NOT advantageous immunologically. The point, if we wait for full concensus, we are three decades too late.