ARTICLES AND INTERVIEWS

ASK THE EXPERTS

 Questions and Answers as they appear on
Mary Shomon's website Thyroid-Info
under "Ask The Experts"

QUESTION
Are cysts in the thyroid normal?-- Mary Shomon

DRS. RICHARD AND KARILEE SHAMES ANSWER
Generally a person with autoimmune (Hashimoto's ) thyroiditis, multiple cysts in various parts of the thyroid gland pose no threat whatsoever, and should simply be monitored periodically. The best treatment for the nodules seems to be optimal treatment of the thyroid condition, and optimal reduction of its symptoms.

Many practitioners feel that nodules and sometimes cysts, both byproducts of the autoimmune process, are best handled by what is called TSH suppression. This means that the patient takes enough medicine so that the TSH level is at the very low end of the normal range, or just below. Without much stimulation of the thyroid gland (because TSH levels are low and therefore not stimulating the gland) it has a chance to be somewhat quiescent, getting a rest and begin to repair itself. (August, 2002)

(Important note: All thyroid nodules should be evaluated and treated by your physician.)

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-cysts.htm

QUESTION
Why do thyroid patients lose hair, and is there anything that you suggest can be done?-- Mary Shomon

DRS. RICHARD AND KARILEE SHAMES ANSWER
It is widely believed that thyroid sufferers lose hair due to decreased metabolism in the scalp follicles, resulting in early release of the shaft, root and all. sometimes the hair becomes just too brittle, and there is a great deal of loss from split ends and breakage. As you know, thyroid is intimately involved with hair function, witness that early graying and loss of outer eyebrows, is a cardinal sign of low thyroid in oneself or in the family.

As far as what can be done, the first and primary step is to restore full normal thyroid function. Consider that in general the body's wisdom directs it to conserve energy when possible, from nonessential areas, shunting repair and regeneration power to those functions considered more essential. Another mechanism is that when thyroid function is low, intestinal absorption and utilization of vitamins, minerals, and other nutritional cofactors is compromised also. Not only are there not enough of the raw materials available, but the enzymes and sometimes temperature required for optimal chemical reactions is lessened.

As to restoring full function, don't be misled into utilizing the TSH test alone as a terrific barometer of full restored function. This one laboratory determination is in no way up to that important task, regardless of what you may have been told by your doctor or HMO. A great many thyroid sufferers need more thyroid hormone replacement than most current endocrinologists are comfortable with giving.

We have seen people whose hair loss is only finally reversed, after years of unsuccessful treatments, with a fairly high dose of thyroid medicine, resulting in a very low TSH. Sometimes it is a mixture of thyroid pills (T3, T4, and/or natural all combined) that eventually does the trick.

In addition, we recommend a rich vitamin, mineral, amino acid, and essential fatty acid replacement program. These four categories need to be well represented, using high quality products to restore and regenerate normal scalp function via optimizing thyroid metabolism. No other mechanism in the body has eight separate layers of biochemical control as does thyroid, each requiring specific vitamins, minerals, and other cofactors that would allow a full recovery of function. (July, 2002)

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-hairloss.htm

Still "FEELING FAT, FUZZY OR FRAZZLED?"...(Despite Thyroid Care?)
Multi-gland imbalance is largely an unsuspected condition. Even when suspected, it is frequently undiagnosed. When it is diagnosed, it often goes untreated. When it is treated, it is seldom treated optimally.

If you would like to hear more about when our new book FELLING FAT, FUZZY, OR FRAZZLED? becomes available, and how to get a copy, send an email to keepmepostedtp@feelingfff.com  [You should receive a confirmation email within 2 hours. If not, please contact webmaster@feelingfff.com ]. You will be notified in Spring '05 of publication.

QUESTION
Please explain what happens to your body to cause underactive thyroid.-- Mary Shomon

DRS. RICHARD AND KARILEE SHAMES ANSWER
Although low thyroid can be caused by a variety of maladies, by far the most common cause of simple hypothyroidism is an immune system attack against the thyroid-hormone forming tissue (thyroxine hormone assembly apparatus of the thyroid gland).The reason for this seemingly bizarre occurrence of our immune system attacking a part of ourselves is not entirely clear. It can be the result in part of trauma or infection damaging the thyroid gland, and the immune system attacking the damaged area as if it were a foreign invader.

There is also good evidence to suggest that much of the problem is related to increasing pollution in the air, food, and water, hormone-disrupting chemicals which confuse the body's response.

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-hypo.htm

QUESTION
What sorts of things -- medicine, supplements, mind and body approaches -- can be done for a flagging libido?-- Mary Shomon

DRS. RICHARD AND KARILEE SHAMES ANSWER
This can indeed be a difficult area, perhaps one of the least talked-about and most distressing aspects of low thyroid conditions. because in addition to having the same complex biochemical aspects that the more purely physical ailments have, there is often now even more emotional overlay to cope with. Keep in mind that emotional overlay with a thyroid sufferer is in part due to the compromised brain function that somehow is linked to memory loss, depression, and anxiety. These brain difficulties are known to be a direct result of the lack of proper brain stimulation by thyroid hormone. We consider this challenge to be one that begs for creative solutions, as well as the optimal medication and supplementation.

First of all, if low libido is affecting your life, once again make sure that your thyroid correction is as exactly right for you as possible. You may need a different brand of thyroxine, you may need T-3 added to your thyroxine regime, you may do better on natural thyroid hormone. If you are already on natural thyroid, you could benefit from adding synthetic T-3 and/or T-4 added. For some people, an excellent way to accomplish this is with the synthetic combo called Thyrolar. This fixed combination does not serve everyone well, and many do better with two different pill bottles, one of T-3 and one of T-4, so as to get a more personalized ration of the two. If you are on natural thyroid and it is working reasonably well, you still might benefit from changing brands of natural thyroid. In addition to Armour, there is Naturethroid, Westroid, the new Bio-Throid, and the old standby Proloid.

In addition to these medication possibilities, make sure your vitamin intake is strong. That means: a high quality multivitamin and multimineral (not from discount drug store); plenty of extra antioxidants, which help with inflammation of the gland through eliminating free radicals; extra amino acids, generally a couple of grams a day of mixed high-quality aminos; to ensure entry of thyroid hormone into the cells, take a full dose of Omega 3, 6, and 9 fatty acids. This means adding to your fish or flax oils some primrose or borage oil.

We suggest doing everything possible to balance your life, including meditation, exercise, stress-reduction maneuvers, counseling with the opportunity for safe emotional discharge, and simply taking time off to do nothing in particular. This program, with the last suggestions in particular, can be highly effective in freeing up creativity, or sexual energy, that has been hidden or locked inside.

As we have detailed in our book THYROID POWER, there are many other loving actions one can take with oneself and one's partner to overcome this challenge. An energy-compromised person must guard her energy carefully, making decisions about where to spend it just as one must when considering financial expenditures. When one person has this condition, the couple must work together diligently to protect their energetic investment, often necessitating a thoughtful decision-making process that honors the needs of the unit. This kind of teamwork becomes even more critical when caring for children, aging parents, or in highly demanding work situations.

The actual day-to-day spark can be more forthcoming if the non-affected partner can contribute to re-establishing more energy flow through supportive behavior, including massaging sore muscles, reminding the affected person to exercise, eat properly, take the assorted supplements mentioned, eat nutritionally-charged foods that work to enhance energy (less and less sugar and junk food, more low-fat protein and less carbs).

The partner can lovingly remind the affected person of his or her needs without coming across as demanding or blaming. This can, under the right circumstances, become an interesting challenge for the pair. It seems to require the pursuit of romance much like the playful seduction applied in the earlier courting days of the relationship. While this can be perceived as a burden to tired working couples or parents of young children, it is a challenge worthy of the time and space needed to maintain harmony. If a person is not in a committed relationship, she or he must be even more protective of oneself and ones energy, in order to create the possibility of a more balanced life. The truth is, this is a big challenge, and one must make very wise decisions about where to spend time and commitment. (July, 2002)

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-sexdrive.htm

Still "FEELING FAT, FUZZY OR FRAZZLED?"...(Despite Thyroid Care?)
Multi-gland imbalance is largely an unsuspected condition. Even when suspected, it is frequently undiagnosed. When it is diagnosed, it often goes untreated. When it is treated, it is seldom treated optimally.

If you would like to hear more about when our new book FELLING FAT, FUZZY, OR FRAZZLED? becomes available, and how to get a copy, send an email to keepmepostedtp@feelingfff.com  [You should receive a confirmation email within 2 hours. If not, please contact webmaster@feelingfff.com ]. You will be notified in Spring '05 of publication.

DRS. RICHARD AND KARILEE SHAMES ANSWER
It is my professional opinion that natural thyroid products are excellent choices for many thyroid sufferers. Some people do better on these dessicated animal gland medicines than they would ever do on any brand or combination of synthetics. Other people do fine on the synthetics, in fact, some do better on synthetics than they would on natural thyroid. There is no one best medicine for everybody; people's metabolisms are just too different.

Regarding stability and uniformity of dose, the synthetic medicines do not have a corner on the market in this area. Several times over the years, the Synthroid company has been called to task for nonconformity and nonreliability of dosage strength. More recently, Levoxyl tablets have faced the same charge, and had to be recalled. This suggests to me that stability and uniformity is an issue with any and all thyroid products, both the prescription type and over the counter variety.

Considering the tremendous benefit to some patients that natural thyroid products provide, the uniformity of potency may well be a minor issue. It has certainly been a smokescreen for the prescription drug companies to further denigrate the natural products. What we believe is that a medicine that words really well, be it Armour thyroid, Naturethroid, or BioThroid, may well be preferable compared to any possibly more precisely-dosed amount of a synthetic medicine that doesn't work all that well in your body.

What we recommend is that with any thyroid medicine, be it prescription synthetic, prescription natural, or a totally over the counter regimen, is to realize that optimal dosing is a moving target - an ongoing process. Keep well aware of your symptoms and your basal temperatures, along with periodic blood tests, and let them in combo be your guide as to whether you need a midcourse correction toward more or less intervention. As we've always said, optimal health is an ongoing process, not a destination.

Bottom line - if you try natural thyroid and do well with it, the variability of dose per pill should not pose any significant problem. If you would like to try natural thyroid because you are not doing that well on synthetic, don't for a moment let the dose-variability issue stand in your way. (July, 2002)

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-stable.htm

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-t4t3.htm

QUESTION
What type of tests should I have to see if I have hypothyroidism, and do I need to see a special doctor, or can I see my general practitioner?

DRS. RICHARD AND KARILEE SHAMES ANSWER
Let us answer the second part of this question first. Thyroid tests can be ordered and interpreted by several different kinds of doctors. Almost any GP, internist, or family physician would be an appropriate choice for initiating a thyroid evaluation. Some people seek out or are referred to an endocrinology specialist if their situation seems more complex or more difficult than simple low thyroid.

Keep in mind that endocrinology specialists are among the most conservative, often less than enthusiastic about trying something new and different. They are also often overburdened with life-threatening diabetes cases, and may not have the time to give thyroid the attention you would like.

We believe that having an open-minded, curious, and thyroid-friendly MD or nurse practitioner, or physician assistant, or any other practitioner allowed to order tests and prescribe medicine, can work fine as long as you become activated and articulate in directing your own care.

As for tests, a standard thyroid panel of TSH and Free T4 should be augmented with additional tests of Free T3 and thyroid antibodies. If you are already on medicine, and are doing the tests to determine the optimal dosage, you can drop the Free T4 and the antibodies and simply ask for a TSH and a Total T3 (the Free T3 is best used for making a diagnosis rather than for determining treatment).

Also regarding treatment, if you are taking just thyroxine alone (Synthroid, Levoxyl, Levothroid, or Unithroid) as a single medicine by itself, and you are not doing as well as you'd like, you might consider also running a Reverse T3 to see if your T4 to T3 conversion process has gone awry. (August, 2002)

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-testsdocs.htm

QUESTION
My doctor is using my Basal Body temperature as a guide to determine if I've met my optimum thyroid medication level. I take my temperature under my arm first thing upon waking for 3 days in a row and write it down. I have read recently that this is much more accurate than the blood tests (target range being 97.8 to 98.2), so why don't other doctors use this method? I had never heard of using he basal temperature until I went to this doctor.

As a side note to you, my basal temperature for the 3 days ranged from 95.8 to 96.8, though my TSH level at my last doctor was in the normal range (that doctor has been "fired" by me). Since that TSH test my thyroid meds have been increased by my new doctor, and my BBT is still low.

I would like to hear another doctor's opinion on the BBT method of testing...

DRS. RICHARD AND KARILEE SHAMES ANSWER
There is considerable evidence that current tests both for the diagnosis of hypothyroidism and for the management of a case under treatment are tests that lack sensitivity and accuracy. Faced with this situation, in my medical practice and in my second opinion telephone coaching sessions with patientsof other practitioners, I absolutely insist on basal temperatures being part of the equation.

For people who are wondering if their health problems are due totally or in part to an underactive thyroid, basal temperature testing is not the only diagnostic maneuver that I use, but it is one additional piece of data along with symptoms, family history, related conditions, and signs of abnormality upon physical examination. For those who have already been diagnosed with hypothyroidism, the basal temperature test is an additional piece of observational measurement that helps determine whether a person is on the right medicine and / or the right dose, along with considering the response to medication, physical signs ( especially ankle reflexes and skin temperature), and blood test results.

In other words, the doctor who is suggesting that you use the thermometer testing maneuver you described in your question is doing what I would consider a very proper medical maneuver, if indeed that doctor is also considering the other factors I have mentioned. Your information saying that basal temperature testing is "much more accurate than the blood tests" should be taken with a grain of salt. Like many things, the statement is true for some people, but not true for everyone.

Therefore, a prudent practitioner and a prudent consumer, will use as many different clues and pieces of information as possible to help make the sometimes difficult decision about whether or not to treat a health problem as a low thyroid issue or , if already being treated, whether or not to add or change medication or supplements.

Here is a good example: I generally find out on a first conversation with a potential thyroid sufferer what is their present percent of total optimal function that they currently enjoy. Some people say to me, "Dr. Shames, I'm glad I can talk to you on the phone from across the country because I'm only feeling 20% of my prior self, but my doctor says my TSH test is normal, so they are not going to do anything further."

This is a person who should be following their basal temperature, rather than their TSH. Most likely their basal temperature will still be low, suggesting a need for further medicine, and I endorse people going along with that suggestion regardless of TSH levels.

You asked why other doctors don't use this method. I believe it's because many of them have not read the 1970s book, Hypothyroidism: The Unsuspected Illness, by Broda Barnes MD. In this compelling volume, Dr. Barnes, the granddaddy of the thyroid field, put his many decades of experience into a succinct and easily-digestible form. It was here that the basal temperature test was first explained in proper detail, with the proper rationale and research. From your question, it is clear to me that you did not proceed along the exact lines that Dr. Barnes would have most recommended.

He recommended that you do the morning temperature sampling for ten days in a row, not just for three. Menstruating women should start this ten-day period on the third day of their cycle. It is best to use a basal thermometer, which is more accurate than a regular oral thermometer. Currently most folks are able to locate non-mercury thermometers, which we recommend as more friendly to the environment. This kind of basal thermometer is actually more accurate for this purpose than any digital electronic thermometer. Dr. Barnes also suggests that the thermometer not be used orally, but instead used under the arm, with the person lying quietly in bed, and the arm comfortably at the side. The temperature is taken upon awakening, before rising up out of bed for any reason.

Dr. Barnes felt that this test was a check on the most basic function of the thyroid gland: its ability to regulate the metabolic furnace of the body, and to control temperature. An average of ten days is a very useful indication, therefore, of one's overall thyroid status, and in many people it may well be more accurate than the blood tests. Temperature testing, however, is not infallable, and - like any other test - should never be used alone to rule in or rule out a thyroid condition, or to dictate therapy. This is simply a good piece of information that should be used wisely. I use it with every one of my patients who will do the test, and I recommend to other practitioners to do the same. It would be a welcome addition to many doctor's thyroid management regimen.

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-basaltemp.htm

QUESTION
Are saliva or urine tests for thyroid disease accurate? -- Mary Shomon


DRS. RICHARD AND KARILEE SHAMES ANSWER
It is our contention that the saliva tests for thyroid are not yet as reliable as the saliva tests for female or adrenal hormone levels. The technology is more recent, and the technical problems are still being worked out to the satisfaction of careful practitioners.

Any new tests are worth a try as part of your overall diagnostic regimen, which should also include appropriate blood testing (insist on the Total T-3 test and not TSH being the primary indicator), regular basal temperature testing, and close monitoring of changing symptoms.

The urine tests, on the other hand, have a longer history of reliability and effectiveness. This is especially true if the tests are done at high-quality laboratories such as Vitamin Diagnostics in Cliffwood Beach, New Jersey, or especially the Broda Barnes Foundation in Trumbull, Connecticut. We have seen people whose blood tests were reported normal by top-name conventional laboratories only to finally obtain the diagnosis and treatment they have long needed when the hypothyroidism finally showed up on the urine tests.

In summary, we recommend the urine testing if a simple blood test shows normal and you have significant symptoms, low basal temperature, family history, or associated illnesses. (July, 2002)

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-saliva&urinetests.htm

Still "FEELING FAT, FUZZY OR FRAZZLED?"...(Despite Thyroid Care?)
Multi-gland imbalance is largely an unsuspected condition. Even when suspected, it is frequently undiagnosed. When it is diagnosed, it often goes untreated. When it is treated, it is seldom treated optimally.

If you would like to hear more about when our new book FELLING FAT, FUZZY, OR FRAZZLED? becomes available, and how to get a copy, send an email to keepmepostedtp@feelingfff.com  [You should receive a confirmation email within 2 hours. If not, please contact webmaster@feelingfff.com ]. You will be notified in Spring '05 of publication.

QUESTION
What is the percentage of men versus women with thyroid deficiencies?

DRS. RICHARD AND KARILEE SHAMES ANSWER
According to studies, which present varying statistics, out of every 10 thyroid sufferers, approximately 7 to 8 are female. It appears that this difference is related to the fact that thyroid conditions are autoimmune in nature for the most part, and that women tend to have more autoimmune illness. The reason might be related to the more complex reproductive system, and continuous hormonal and inflammatory changes during monthly cycling. (August, 2002)

As it appears on Mary Shomon's Website Thyroid-Info under "Ask the Experts"
http://www.thyroid-info.com/articles/shames-gender.htm

Still "FEELING FAT, FUZZY OR FRAZZLED?"...(Despite Thyroid Care?)
Multi-gland imbalance is largely an unsuspected condition. Even when suspected, it is frequently undiagnosed. When it is diagnosed, it often goes untreated. When it is treated, it is seldom treated optimally.

If you would like to hear more about when our new book FEELING FAT, FUZZY, OR FRAZZLED? becomes available, and how to get a copy, send an email to keepmepostedtp@feelingfff.com  [You should receive a confirmation email within 2 hours. If not, please contact webmaster@feelingfff.com ]. You will be notified in Spring '05 of publication.

 Questions and Answers as they appear on
Mary Shomon's website Thyroid-Info
under "Ask The Experts"

Harper Collins, 2001

Harper Collins, 2002

THIS WEBSITE VIEWED BEST IN FRAMES-
IF YOU ARE NOT IN FRAMES-CLICK HERE!

l HOME l CARTOONS l OUR PURPOSE l COACHING l TESTIMONIALS l FAQ'S l AGREEMENT FORM l THYROID POWER l BUY THE BOOK l REVIEWS l BIOS l  SELF-TEST l  ARTICLES l RESOURCES l EVENTS l MORE PRODUCTS l CONTACT l SPECIALS l THYROID TESTING GUIDELINES lSHAMESHEALTH.COM