From Here to Obscurity

Maybe you can remember it-a time when your energy and capacity were in sync with your life. Think back and recapture that sense of moving with relative ease through the world. Your energy flowed with the pace set by night and day. During the day, your physical and mental powers were at your service, while nighttime brought the restful sleep needed for energetic days-and the cycle repeated. You ate in proportion to your needs, without unexpected changes in weight. For the most part (heredity notwithstanding), your hair stayed where it belonged- on your head instead of the shower floor. If you are a woman, you experienced the normal ups and downs of life's cycles: puberty, menstruation, fertility, menopause. Aside from the normal changes in life, your outlook was generally positive.

Then slowly, over time, you began to lose step. A mix of symptoms, ranging from subtle to incapacitating, burden you. Now you are unable to keep up. You probably feel cold more often. You're the one who always needs to take a sweater to a restaurant in the summer. For many of you, seasonal and hormonal changes upset your internal rhythms and send your symptoms into overdrive. You feel drained of energy, and all you want to do is stay in bed, but a good night's sleep is just a dream. Insomnia and sudden wakings disrupt your sleep. Not only has your hair lost its luster, but it is brittle and falling out at the faintest touch. Your skin feels rough and dry. The area around your eyes looks puffy, and your voice has deepened or become gruffer. You get muscle cramps, and your reflexes are weak. Headaches, body aches/joint pain, low blood sugar, constipation and other digestive problems, severe PMS, unexplained weight gain-these symptoms may have cropped up.

If you are a woman, your periods might have become heavier and longer, or they have disappeared altogether. Then there are the emotional and mental effects. The color seems to have seeped out of your life, and your memory has slipped. You are no longer nearly as social as you once were, which adds to your sense of being out of step with the world. You are depressed (who wouldn't be?) and emotionally unsteady.

In short, you have symptoms of hypothyroidism.

Keeping Pace with Life's Change

Like a flawless dance partner, thyroid hormones are highly sensitive to changes in your ever-changing environment. They take the lead in setting the metabolic pace, helping you adapt to changes in temperature, stress, hormonal fluctuations, and other conditions.

When there are ample amounts of thyroid hormone doing the rounds, the body is more apt to respond in a realistic and healthy way to changes. When thyroid levels are low, the body Wslows down, lost in a fog of sensory stimuli that it cannot detect, much less respond to.

More scientifically speaking, researchers and clinicians know that the hormones produced by the thyroid, called T4 and T3, are architects of the body's ever-shifting metabolism. Metabolism is the use of oxygen and nutrients by cells to make energy. Generally, the higher your metabolism, the more energetic you feel (when metabolism's too high, you might feel “hyper”). When your metabolism flags, though, so does your physical and mental vigor.

The Hypothyroid Fog

Certainly, no single person has all of the symptoms described above. Each individual is unique. Chances are your suite of symptoms differs from another's. Yet underlying almost everyone's symptoms is what many weary patients describe as “brain fog”: Your energy is zapped, and with it you have lost your memory, your capacity to think clearly, the color in your life, your personality. As one of my patients described it, it feels as though someone stuffed cotton between your ears. You are essentially robbed of your inspiration, your passion, and your ability to live a full live.

When the hypothyroid fog sets in, the strong, vital internal metronome that once drove your life forward in sync with your life's distinctive melody-with all the high notes and low notes that went along with it-has been muted. The fog is not just a pervasive symptom; it is an apt metaphor for the state of hypothyroidism treatment today.

This fog has infiltrated the minds and lives of an estimated 27 million patients, yet only about 75 percent of people with a depleted thyroid are diagnosed, and many are not adequately treated.

What Doctors May Not Tell You … Because They Do Not Know

Much of what you read in this book will probably be new to you. You might assume that your doctor certainly would have tried this approach, or at least told you about it. The fact is that your doctor may not know about my approach-or any other that deviates from his or her knowledge. Too often, physicians follow the conventions of their field and never look to see what might work better. I developed this method based on what I learned in medical school and then what I learned from my patients. I observed them closely and studied what works, then adjusted therapy accordingly. Everything I do would be approved by the Food and Drug Administration, and there are many articles in well-regarded medical journals that support my concepts. However, in spite of the growing demand for new approaches and the groundswell of information supporting them, too few doctors seem to pay attention. As a result, most doctors hold close the three tenets of treatment for hypothyroidism that have left many patients suffering.

Three Flaws in the Conventional Approach to Hypothyroidism

In my view, there are three serious flaws with the conventional approach to hypothyroidism:

1. Conventional medicine bases diagnosis on a test that does not detect all patients. The only certain way to diagnose hypothyroidism is with a trial of thyroid that is fine-tuned to patient response.

2. Mainstream doctors endorse only one treatment: the synthetic thyroid hormone T4. If you continue to feel poorly, most doctors will tell you that your symptoms have another cause, because “you are on a thyroid medicine and your test numbers are good.” They seldom make use of other highly effective options: T3 and natural thyroid extract.

3. When it is employed, T3 is rarely used in the right proportion. In more than two decades of treating hypothyroidism, I have seen these mistakes over and over in patients who come to me looking for confirmation that their symptoms have a cause, and looking for a way to end years of misery. As a result, I've come to see hypothyroidism in a different light than my conventional colleagues do.

Why I Wrote This Book

It may seem simple and obvious to treat patients as individuals and to use all of the therapeutic tools available. But my approach, though rooted in common sense and the best of today's clinical knowledge, is virtually unknown by the vast majority of hypothyroid patients and their clinicians. That's why I felt compelled to write What Your Doctor May Not Tell You About Hypothyroidism.

This book was written for the individuals who are looking for a simple, clinically safe, and patient-proven way to end their symptoms. For the first time in any book, you will find a description of how hypothyroidism affects individuals- women and men-at every life stage. You'll also find how my treatment helps where others have failed, both in my words and in the words of my patients.

This book was written for the millions of people whose symptoms have been dismissed by other doctors because their lab tests were “normal”-and who were misdiagnosed and treated, often unnecessarily, for other conditions with potentially harmful drugs. All the while their hypothyroidism and its symptoms continue untreated, contributing to fatigue, weight gain, and potentially dangerous heart problems-to name just a few. This book will give you hope that your symptoms are not all in your head. You are not doomed to a lifetime of thyroid symptoms because there is an approach that works for you-and for the millions of others like you.

Last but not least, I wrote this book for open-minded physicians who have sensed that the conventional approach may work for some patients, but not for all, and are looking for a new tactic. Herein you will find the clinical rationale behind my approach, and a clear step-by-step outline of my strategy. My unique 2 percent T3 solution has allowed me to help thousands of patients. It is my hope that it will give doctors the tools to effectively treat millions more.

Keeping Up With The Times

Importantly, thyroid rhythms change over time with our bodies' metabolic needs. Our bodies and environments are in constant flux. It is the job of the thyroid and related endocrine (hormonal) system to be exquisitely sensitive to changes in the body's internal and external environment and to help our bodies keep a metabolic balance that accommodates these changes.

As the body's needs change, so does its need for thyroid hormone. The challenge is finding a good match and continually fine-tuning treatment to changing rhythms. I am honored that my patients' health is the most convincing testimony to this alternative approach. Michelle is one example.

The term “slow motion” is the last one Michelle would use to describe herself. She is a fit and glowing mother of three children and the director/teacher of a thriving yoga center. But those are the words she used to describe her life before discovering yoga and receiving my thyroid treatment.

When she first came to see me at the age of thirty-nine, Michelle was overweight and mentally foggy, and she suffered from insomnia. Her face was swollen, and she had terrible acne. In our first input session, Michelle traced her symptoms back to her teenage years-as so many of my patients do! She remembered often feeling lethargic and depressed. She was formally diagnosed as hypothyroid at the age of eighteen based on a high level of thyroid-stimulating hormone (TSH).

By the time she was thirty, Michelle was diagnosed with Hashimoto's autoimmune thyroiditis, the most common cause of hypothyroidism. Severe headaches had led her to neurologists who identified a venous stricture in her brain. Another neurologist diagnosed epilepsy; she subsequently experienced a toxic reaction to antiseizure medications. Just a few in a long, long decade of “worse and worse stories,” culminating in the prospect of a brain surgery, thyroidectomy (removal of the thyroid gland), and exploratory surgery on her colon.

Then two events changed her life: yoga and effective thyroid treatment. With yoga, Michelle immediately felt the mental fog lift, and she slept better-the beginning of her road to wellness. “The other part of the equation was Dr. Blanchard,” she says, whom she discovered through the Web site of Mary J. Shomon, thyroid patient advocate and published educator, at www.thyroid-info.com.

As is customary, I took a complete history. Based on Michelle's symptoms, my recommendation was a combination of natural thyroid extract (Armour) and levothyroxine (Synthroid), also known as T4. My aim with Michelle was to replace the missing thyroid hormone in physiologic doses-that is, a dosage to restore a healthy balance of thyroid hormones. A short trial with my regimen quickly uncovered a problem: skin irritations and outbreaks. Many people with Hashimoto's thyroiditis have multiple immunologic problems, including allergies.

The skin problems cleared up when I switched Michelle to a dye-free dosage form of Synthoid. “Other doctors would have sent me to a dermatologist,” says Michelle. Michelle relies on me to keep the chemistry in balance, and she balances out with yoga. Together we make a good team. Because our bodies are constantly changing, I encourage all of my patients to stay tuned to changes in their symptoms and to let me know about them so that I can make the necessary dosage adjustments. “For me, the first things to go are my digestive system, sleep patterns, and mental clarity,” Michelle says. “I'm sensitive to even slight changes,” which she takes as warnings for a change in dosage.

Over the course of six months, Michelle went from a woman not living up to her potential to a woman embracing and acting on her abilities. The impact on her family, her marriage, and her professional life has been enormous. Today she is symptom-free and able to live her life fully.

Many of my patients have learned to take their symptoms seriously and insist that their doctors do the same. I encourage my patients to be active partners in their treatment. It is my hope that this book will instill a similar sense of confidence and empowerment in my readers-to give them the confidence to trust their feelings and to persist in finding a doctor who gives them the same level of respect.

Most doctors would probably have never given Michelle thyroid treatment, because her tests were normal. If she had followed the recommendations of various specialists, she may have been misdiagnosed and ended up with unneeded treatments, a shunt in her brain or a double bowel resection, while her hypothyroidism persisted, untreated or poorly treated with 100 percent T4.

As this and many other cases show, what you don't know about hypothyroidism can hurt you. This is a critical lesson that we'll explore in more detail throughout this book, so that you will have the knowledge to seek out an accurate diagnosis and the treatment you need.

Diagnosis

What Doctors May Not Tell You about Diagnosis

The American Academy of Clinical Endocrinologists (AACE) is the governing body for endocrinologists, the doctors who specialize in hormone problems like hypothyroidism. Over the past two years, they have twice revised the ranges considered normal for thyroid function. Basically, they continue to expand the lab test range for the TSH to include more patients with hypothyroidism. According to a 2003 AACE press release, “The prevalence of undiagnosed thyroid disease is shockingly high, particularly since it is a condition that is easy to diagnose and treat.”

It's great that doctors are being encouraged to test more often and to heighten their awareness of hypothyroidism. The unfortunate fact is that diagnoses will continue to be missed by most physicians when they base it solely on their recommended “easy to diagnose” testing method, rather than on how the patient feels.

TSH Tests: The Good, the Bad, and the Irrelevant As far as tests go, the TSH is a very accurate (in labese, “sensitive”) test for what it is designed to measure: thyroid-stimulating hormone. Doctors can feel confident that it will do what it should. The problem is how the results are used.

Depending on the laboratory, most physicians suspect hypothyroidism if the TSH levels are above the normal range. This range is based on guidelines from the AACE and other governing organizations. TSH levels that are higher than a certain level indicate hypothyroidism. TSH levels below a certain level are considered normal or, when even lower, hyperthyroid.

Specifically, as of February 2003, the AACE encourages doctors to treat patients who test outside the boundaries of a target TSH level of 0.3 to 3.4 uU/ml. Mary J. Shomon, hypothyroid patient advocate, author of Living Well with Hypothyroidism and editor of the highly informative Web site www.thyroid-info.com, encapsulates the situation like this:

Until November 2002, people who had clear symptoms of thyroid disease, but were in the normal range on the TSH scale, were considered “euthyroid” or normal by almost all endocrinologists and practitioners, and were not diagnosed at all, much less easily diagnosed. People who had family histories of thyroid disease, symptoms (including enlarged thyroid, goiter, nodules, etc.), but whose TSH tests were in the low or high end of normal were routinely denied treatment or told that their problems were the result of depression and given antidepressants. This has gone on for decades, as conventional medicine has relied on the TSH test-often to the exclusion of clinical evidence, symptoms, and medical observation- to make a diagnosis. I would not consider this evidence of “easy to diagnose,” particularly from the perspective of the millions of patients who have suffered with undiagnosed thyroid disease, not to mention the suffering that resulted from being misdiagnosed with a host of mental or physical ailments by their doctors and prescribed various drugs, hormones, and other inappropriate treatments.

I use the TSH as a more individualized marker for the success of treatment, but not as the sole basis for diagnosis. Indeed, many of my patients can cite their “personal” TSH-the level where they feel best. But as I mentioned, in some patients the test is completely irrelevant.

The TSH “normal” range is determined by measuring TSH levels in large numbers of “normal” individuals. Plotting these results on a graph gives a bell-shaped curve. By statistical formulas, a few percentage points on the shoulder of the curve on each side are chopped off, giving the “normal” range. It is important to note that a lab result represents a range, not an absolute.

In addition, the normal range for thyroid function is very broad, as far as ranges go. Many confirmed cases of hypothyroidism were not diagnosed sooner simply because the individuals' tests were normal-even when patients didn't feel normal.

The question in my mind is always this:At what TSH level do my patients feel best? My measure of success is my patient's well-being,not his or her test numbers.

The Tragic Consequences of Undiagnosed Hypothyroidism As Michelle's case showed all too clearly, having symptoms of hypothyroidism with a normal TSH result sends many patients off on the convoluted path of medical specialists.

If you were depressed, you were probably referred to a psychiatrist. Aches and pains: a rheumatologist. Migraines? A neurologist. Extreme fatigue: a psychologist, allergist. Constipation?

Gastroenterologist. Hypothyroidism is rarely on the radar of these specialists, who by definition focus on the body system that they know best. You might have managed to get some symptom relief, but with the underlying cause persisting, new and potentially life-threatening problems are bound to crop up.

Consider Jackie. At age fifty-one she had lost the better part of her vital adult life to undiagnosed hypothyroidism:

Depending on the symptom, the specialist would recommend a treatment in that area. I had swelling in my feet and tarsal tunnel syndrome, and the podiatrist wanted to operate on me. The orthopedist said I had sympathetic dystrophy. An ear, nose, and throat specialist told me I had TMJ.

I went from doctor to doctor. Depression landed me with three different antidepressants. I do have antithyroid antibodies, but they weren't even measured until I finally “proved” myself to an endocrinologist with a TSH of 6.0! If only the problem ended with an accurate diagnosis.

Treatment

What Doctors May Not Tell You about Treatment

Doctors will tell you that treatment is also straightforward. The missing thyroid hormone is replaced in pill form, usually as a pure synthetic form of T4 called levothyroxine. Once the body has the hormone it needs, you should feel well.

What they will not tell you is that, with this single-minded treatment plan, patients are inadequately treated, even when measured by the conventional TSH test. According to the Colorado Thyroid Disease Prevalence Study of more than 25,000 people, reported in the February 2000 issue of the Archives of Internal Medicine, in spite of treatment, TSH levels were abnormal in 40 percent of those who were hypothyroid.

In the first large-scale quality-of-life survey of hypothyroid patients (710 patients), conducted by Mary J. Shomon, 50 percent reported that they are not satisfied with their treatment. (Read more at www.thyroid.about.com.)

T4 Is a Misleading Treatment Option

T4 is one of two major active hormones produced by the thyroid gland; the other is T3. (There are others as well, which are discussed in the book.) For many years, doctors used natural thyroid extract, made from animal thyroid, to treat hypothyroidism. Then pharmaceutical research found a way to reproduce pure T4 synthetically. Today it is the mainstay of treatment for hypothyroidism.

Synthetic T4 comes under the brand names of Levoxyl, Unithroid, Synthroid, and Levothroid. It is true that T4 often works beautifully for a short period, or if patients are lucky, longer. But symptoms commonly creep back, while blood tests remain normal. Now the patient is in double trouble. At this point, many doctors argue that the original diagnosis was incorrect, bringing the frustrated (and symptom-plagued) patient back to square one. Many of these patients end up at my door. The medical profession casts a jaundiced eye on any plan that departs from this single-minded strategy.

The Body Needs More Than T4.

T4 is just one of several known hormones produced by the thyroid gland. The thyroid also makes T3 (the more active hormone) and purportedly inactive hormones such as the T1s and T2s. So why do most doctors tell you that you only need T4? Medical doctrine has it that T4 converts to T3 in the body's tissues. Doctors are taught that if T4 converts to T3 and other Ts, then there's no reason to replace thyroid hormones other than T4.

It is my strong belief, and that of a growing number of other clinicians, that many factors can cause clinical hypothyroidism, not just inadequate production of T4.

The thyroid itself produces T3, albeit in much smaller quantities than T4. Some researchers assert that certain organ tissues, like those in the brain, need the thyroid-direct form of T3 to function, not just the T3 made by conversion in the tissue. As a result, based on theory and my experience with thousands of patients, I strongly believe that people with hypothyroidism also need T3 treatment and probably the other Ts as well.

But T3 has many detractors. They point to studies showing that T3 is not effective. That it can cause palpitations (racing heartbeat). They say that it doesn't last long in the body, making it necessary to take multiple inconvenient doses.

The 2 Percent Solution

The 2 Percent Solution: A Solution Based On What Works In Patients

It is true. The correct dosing of T3 is important in order to achieve effectiveness and to avoid side effects. Having prescribed T3 in one form or another for more than fifteen years, I have arrived at a dose that reflects the natural balance of hormones in a healthy thyroid system-what I term a physiologic balance. I call it the 2 percent solution.

Thousands of Patients Can't Be Wrong

The 2 percent solution is based on treating thousands of patients in my practice who were suffering on T4 alone. It's the result of years of fine-tuning treatment to arrive at a physiologic dose of T3 and T4. Over time, I began to see a pattern of success: Patients responded beautifully when the dose proportion was 2 percent T3 and 98 percent T4.

This 98:2 proportion can be achieved with either synthetic hormones (using a time-release capsule for T3) or natural thyroid extract.

Many of my patients respond wonderfully to this proportion with natural desiccated thyroid extract (Armour). Armour contains roughly 80 percent T4 and 20 percent T3. By adding the right amount of synthetic T4, I arrive at the natural physiologic balance.

Of course, there will always be a small number of patients who do fine on 100 percent synthetic T4. And I am very happy to continue prescribing it. But for the majority of patients who don't do well on T4, there's immense relief in having a new therapeutic option that works.

The improvements with this combination have been called lifesaving by my patients because of the many ways they experience relief: Years of fatigue lift. Skin moistens. Depression disappears. Headaches evaporate. After years of debilitation, my patients can function wholly again.

Consider again the case of Jackie. When we left her earlier, she was shuttling from specialist to specialist: I'd heard about Dr. Blanchard from Mary Shomon's Web site at About.com. So I wrote him a letter telling him my story, and he agreed to see me. He put me on a time-release form of T3 with T4, and I couldn't believe it. Within two days the fog had lifted. There is no way to describe it-to me it was a miracle. I guess I'm lucky in the sense that hypothyroidism is a disease that can improve quickly when you have the right treatment. I consider myself lucky to have gotten better-and to have been given the right tool to keep myself well.

The Hypothyroid Challenge

Keeping Up With Life's Changes: The Hypothyroid Challenge

The thyroid is an instrument of change. As the master of the body's metabolism, the healthy thyroid helps the body adapt without much fuss to minute-by-minute, climate-driven, seasonal, and life-stage changes. As you read this, your thyroid is busy at work helping you adjust to changes in temperature, stress levels, the food you ate for lunch.

In treating thousands of patients over the years, I've seen that symptoms peak and wane with seasonal, metabolic, and hormonal shifts, and sometimes these changes are great enough to warrant a change in treatment. It's not unusual for symptoms to return when the seasons change-or for new symptoms to appear when patients enter different life stages.

Childhood. The body's constant growth puts an exceptionally high demand on the metabolic and hormonal systems. Symptoms and signs of hypothyroidism such as short stature, irritability, difficulty in concentrating, and/or ADD can be either easily ignored or misdiagnosed, leading to the prescribing of potentially dangerous medications. If symptoms point to hypothyroidism and tests are normal, I would recommend a trial of thyroid medication. This is safer and more “diagnostic” than administering mood-altering drugs or such agents as Ritalin.

Puberty. Shifting hormones can wreak havoc on a thyroid- deprived endocrine system. Are the symptoms of PMS-constipation/diarrhea, cold intolerance, headaches, cramps-due to normal hormonal fluctuations or hypothyroidism? If there is a family history, I certainly consider a trial of thyroid replacement, especially when over-the-counter medications fail.

Infertility. Inability to conceive, miscarriage, and pregnancy complications may be a woman's first indication of hypothyroidism. It may cause anovulation (failure to ovulate), short luteal phase (the time between ovulation and onset of menstrual flow), and other problems. The demands for thyroid hormone during the time of conception are higher than normal, so patients with border-line/ low thyroid function may have problems conceiving.

For women already diagnosed with hypothyroidism, as well as those suspecting it due to infertility, I recommend trials of thyroid replacement and close monitoring.

Pregnancy. Pregnancy causes a sudden rise in thyroid hormone needs, as much is diverted to the maturing embryo.

If a patient's symptoms have been well controlled on thyroid medication and she suddenly experiences symptoms, a thyroid checkup is in order. Undertreated hypothyroidism can result in a learning problem, or even a lower IQ, in the child later. I tune thyroid levels to my patients' symptoms rather than the TSH.

Menopause. The change in life creates a hormonal roller coaster. The educated woman will know that estrogen replacement is often considered a panacea for menopausal symptoms; that it is important to clarify whether symptoms are due to hypothyroidism or estrogen depletion; and that a carefully individualized regimen of estrogen, thyroid, progesterone, and possibly other hormones is required to achieve a healthy balance during this time.

Advanced age. At a certain point, as with other body systems, the thyroid begins to slow down. An estimated 20 percent of women over the age of sixty have hypothyroidism.

I discuss hormonal changes and examine symptoms closely with patients who may need extra supplementation at the time when their body's natural supply wanes.

Weight gain is often blamed on thyroid deficiency, which may be the case. But unfortunately, the remedy is not always thyroid replacement. Close attention to diet, especially one that synchronizes with natural metabolic rhythms, is most effective.

Seasonal changes. In addition to hormonal shifts, seasonal changes impose variations in response to treatment and may trigger changes in the emotional and physical health of my patients. These observations make perfect sense considering the role of thyroid hormones in regulating metabolism.

My Own Story

I started my career as an endocrinologist with the same doctrinaire approach to hypothyroidism as my colleagues. I performed the TSH test when symptoms indicated, and treated only when the tests indicated an abnormality. My break from medical orthodoxy began in 1985, when a young female patient came to see me with an article from a popular health magazine. That article claimed that symptoms of premenstrual syndrome are due to thyroid deficiency, a concept that is still unaccepted by conventional doctors.

I never treated that patient because her TSH tests for hypothyroidism were negative-and I was not ready to defy medical convention yet. But the experience was eye-opening. Little did I know then that this one patient would come to represent a turning point in my professional life, and in the lives of thousands of men and women I have since successfully treated for hypothyroidism. Over the next few years, I began tentatively treating patients whose TSH tests indicated borderline hypothyroidism, and I was surprised by the positive response. The successes I experienced gave me the courage to extend my clinical reach to individuals with symptoms strongly suggestive of hypothyroidism, irrespective of their TSH results.

Over time, I also began exploring unorthodox uses of available treatments-all approved, but some only rarely used, such as T3 in combination with T4. Through observation of my patients, the seasonal and hormonal patterns I described above began to emerge.

I have refined my approach over the past decade. The result is a system rooted in several simple ideas that were conceived by observation, pursued by intuition, and proved by cautious, empirical treatment of thousands of my patients.

First and foremost, I listen to patients' symptoms, not necessarily the lab results. As I've explained, the patient's presentation is more telling than any test. I routinely use a combination of the two to make clinical decisions.

Second, I balance thyroid levels by administering “physiologic” doses of hormones according to the 2 percent solution. Not only is hypothyroidism often underdiagnosed, but even after diagnosis it's usually poorly treated. As stated earlier, my therapeutic aim is to reproduce the body's normal balance of T3 and T4 through physiologic (not pharmacologic) doses of these two hormones-doses that reflect an individual's body in health. In my experience, that proportion is 2 percent T3 and 98 percent T4. This solution has worked for many thousands of my patients.

However, it often requires more than one visit to achieve the right balance. In the following chapters, you will discover the medical rationale behind T4/T3 treatment, scenarios where different treatments are successfully used, and how to broach the subject of this effective but unconventional treatment with your own doctor.

People are dynamic beings and thyroid needs change. So should treatment. It is imperative to tune thyroid levels to changing life rhythms. Some people can hum along for years taking the same prescription with no problem but then, suddenly, with a change in conditions, symptoms flare up. Puberty, pregnancy, menopause, seasonal changes, times of great physical or emotional stress-all can throw hormones off balance. I will help you to understand why certain milestones in the life cycle disrupt hormonal rhythms and how to recognize these changes in yourself, and I will give you some pointers for discussing with your doctor the need for adjustments.

Reduce weight with a solid nutritional and exercise plan. Many people with hypothyroidism are aware of difficulties in losing excess weight. A slower metabolism, lower energy levels, and depression-these are symptoms of hypothyroidism that conspire to add pounds. Because you're using less energy, you do need fewer calories than people with normal thyroid function.

But that's only when your thyroid is functioning on low. Thyroid hormone replacement will not solve weight problems-it will only level the playing field so that you have the energy to exercise and take more active control over your diet. In some cases, hypothyroidism contributes to hypoglycemia and indirectly promotes weight gain. Timing meals and exercise to take advantage of the body's daily natural metabolic rhythms- combined with appropriate doses of T4 and T3-improves the odds of weight loss. Readers will learn a metabolism-enhancing weight-loss program, which includes a weeklong meal plan with low-fat, thyroid-friendly foods (yes, there are some foods that you should avoid!).

In general, a good diet is all that is needed to provide adequate nutritional support for people with hypothyroidism. But people with hypothyroidism may consider taking certain supplements in conservative measure.

Holistic and alternative treatments that can help stabilize hormonal fluctuations, manage stress, and regulate mind-body imbalances include meditation, yoga, homeopathy, and body work (e.g., massage). Though not integral to my approach, I do support patients who feel better when they try safe alternative approaches.

There is no cure for hypothyroidism. Achieving a balance with hypothyroidism is a lifelong process, a process based on self-awareness and devotion to continuing health.

It is my hope that this book will cast a new, hopeful light on your condition, that it will expose obstacles in your path to health and reveal ways for you to reclaim a steady, healthy rhythm in your life-one that allows you to move easily and energetically in your ever-changing world. In the following chapters, I will show you how and why your body has lost its balance and give you specific and practical guidelines that have proved effective for thousands of my patients. I am not offering any absolute answers. Each of you is unique, with a unique rhythm all your own. I hope you will gain a renewed sensitivity to your body's unique symptoms and a vocabulary for speaking convincingly with your physician to get the help you need to live your life to its fullest.

Copyright © 2004 by Ken Blanchard, M.D. and Marietta Abrams Brill

About the Author

Ken Blanchard, M.D., Ph.D., lives in Newton, Massachusetts, with his wife and children.

Marietta Abrams Brill has been a health writer for nearly 20 years and has written several health books.