Jane Sadler, M.D., a physician at Baylor Scott & White Medical Center in Dallas, Texas, talks about low thyroid hormone levels and how some patients can benefit from a surprising treatment.
Interview conducted by Ivanhoe Broadcast News in March 2017.
Cheryl before she found you she didn’t know what was wrong, she was fatigued, she was tired and it forced her to retire early. She couldn’t figure it out, is that uncommon with issues of thyroid, it takes a long time to figure it out?
Dr. Sadler: Sometimes it takes a long time for the patient to actually come to the doctor. Once the patient is under our care we’ll screen for thyroid disorders generally beginning at age thirty and up.
Is it because people think I’m tired and they just think they need to eat better or get more sleep, things like that?
Dr. Sadler: For people like Cheryl they’ve tried every other venue. Perhaps they’ve been to homeopathic or naturopathic doctors or they’ve been to other physicians or they’ve even been treated with different types of thyroid hormone. They are still really, really tired and they come over sometimes here just for a second opinion. It’s not unusual for patients to seek second opinions with different doctors when they don’t feel good after they’ve sought help and treatment.
Is this uncommon or is this common?
Dr. Sadler: It’s common, it’s very common especially in family practice because many times we get patients that come from other physicians or maybe our patients leave and go to other doctors because whatever we’re doing isn’t meeting their needs.
Tell me a little bit about her story because she told us she saw a lot of different doctors before she met you and got on the right track.
Dr. Sadler: Honestly I was lucky with Cheryl, we hit it off right away and I was able to diagnose, manage and treat her hypothyroidism in a way that best fit her lifestyle and her chemistry.
What did you do for her that perhaps other physicians didn’t?
Dr. Sadler: I agreed to try nature thyroid or armour thyroid which is a desiccated pig thyroid. Which some people considered to be more natural as opposed to synthetic thyroid.
When you say the armour, the pig thyroid versus the natural what are we talking about here, is this substance or what is it?
Dr. Sadler: It’s actually ground up pig thyroid and pig thyroid gland. What you’re getting is in some cases kind of a hodgepodge of thyroid hormone both T3 and T4. To explain, so T3 is made from T4. T3 hormone is the active form of thyroid, this thyroid hormone T3 however has a short half-life so it’s in the body and it’s out of the body quick. We had to figure out that perfect balance for Cheryl.
You’re balancing between two hormones is that what you’re saying?
Dr. Sadler: Really it’s the same hormone but the T4 is broken down to the T3. But the T3 is the active form of the thyroid and that’s the one that some people really feel like it makes them feel better. It’s having a little bit more of that free T3 available in their body.
When she’s taking her medication is that what she’s taking?
Dr. Sadler: When Cheryl is taking her medication Cheryl is taking a combination of T3 and T4 hormone. What’s happening is she is getting the active thyroid hormone in addition to the precursor of the active thyroid hormone. She’s kind of getting that immediate released thyroid in addition to a longer acting degree of that thyroid or a compound of that thyroid that’s eventually going to break down over time and become the active thyroid hormone that her body will use.
Is that something that you came up with for her that perhaps some of the other doctors weren’t?
Dr. Sadler: The only reason I chose it is because Cheryl had exhausted all other avenues of treatment with thyroid. For her I elected to go with the more natural thyroid or the pig thyroid or what some people call the borsine thyroid in order to see if I could better meet her needs.
And did you?
Dr. Sadler: She is genuinely happy, she is so pleased with the treatment it’s rewarding. I will emphasize that I have to monitor Cheryl’s levels of thyroid much more closely than I would somebody on a synthetic thyroid hormone replacement.
Why?
Dr. Sadler: The synthetic thyroid hormone, Synthroid, is actually the same molecule as our natural thyroid. When we lose our natural thyroid Synthroid which is the name brand for levothyroxine is a manufactured hormone that is equivalent, bio equivalent to our body’s own natural thyroid. For a lot of physicians we see that as the more natural thyroid hormone.
But?
Dr. Sadler: In Cheryl’s case it didn’t make her feel any better at all. It just didn’t help her. I was moved to try her on the pig thyroid in order to determine if I could be of better benefit for her health, because otherwise she and I weren’t on the same level of care.
I read an article in the New York Times, what’s the news in there, is the news that thyroid issues are overlooked sometimes and it takes a while for physicians to kind of figure it out or there are different treatments or options that maybe some doctors are not aware of? What did you get out of that article in terms of what we’re talking about?
Dr. Sadler: Yes. The article that came from New York Times was interesting because it is the flavor of what the patient brings to me about their thyroid. They feel like much of their exhaustion, much of their fatigue, their lack of motivation, their depression is all related to the thyroid. My disagreement with the article is that the thyroid hormone deficiency is a little over rated.
You had a really good point there.
Dr. Sadler: The thyroid hormone replacement in many cases is so over rated. One of the most common complaints I get from women is that they’re fatigued, they’re overweight, that they can’t concentrate and it’s all because of their thyroid imbalance. Well it’s really not in most cases. In most cases women have a calamity of other issues going on and the thyroid is not the cause of all the commotion. Then it’s many women however, the thyroid is a contributing cause or factor to their lack of energy, their lack of sex drive, their weight gain and their overall fatigue and depression. For that subset of women the thyroid hormone replacement can make a difference. The type of thyroid hormone replacement can make ever a bigger difference.
And that’s what we have here with Cheryl.
Dr. Sadler: And that’s what we have here. But that’s not with every woman.
Generally speaking let’s say because of what women are reading or whatever, they say I’m tired, I have no energy, I’m depressed. And you’re saying that they’re reading enough stuff that they’re jumping to conclusions is that what it is? Or are some doctors jumping to conclusion?
Dr. Sadler: I think because doctors don’t have all the answers that many times we jump to the thyroid hormone as being part of the solution. In some cases it is the solution to better health, feeling good, being less tired, and helping with weight loss. In most cases the thyroid replacement will be a disappointing factor in part of their medical management because it’s not going to fulfill all those needs, the physical needs of women believe that it will make.
Unless they have a true deficiency in the hormone.
Dr. Sadler: If a woman has a true deficiency in the thyroid hormone or even a sub-clinical deficiency which means she has a low thyroid but she’s not yet feeling it, then replacement of thyroid hormone generally helps a woman feel a little bit better. We’ve used thyroid hormone in treatment, low levels, in treatments for depression in the past so we do know that it does help women with some of the energy and lack of drive and motivation they have. In women with true thyroid deficiency meaning the blood test tells me the TSH which is the most sensitive test for thyroid deficiency, the TSH tells me that their thyroid is low. That they need thyroid replacement because their body is going to run in to problems with heart failure, osteoporosis, low heart rate, dry skin, dry mouth, all kinds of medical issues that will need to be addressed at one time. If it’s not addressed early enough in the course of their life then they’re led on a path of disability down the road. Identifying the low thyroid early is really important.
I did a story not too long ago; it was one of these hormone replacement clinics. Somehow in the course of all this hormone replacement therapy the side effect was people losing weight. The clinician was putting a lot of focus on the thyroid and I don’t know if this was abnormal or her angle. What do you think about it, is there a trend and is this something that people should be aware of that there’s a lot of people prescribing thyroid hormone replacement as a solution that may be not called for or is there a different way of reading your blood test?
Dr. Sadler: It’s funny you asked. Today I had a patient who came from a hormone center and I was reviewing her medications and she was on sixty five micrograms of pig thyroid. I looked at her thyroid level and I said, was this your thyroid level before you started the pig thyroid or after. And she said, well before I started the pig thyroid. Well what was interesting is her thyroid level was actually kind of on the higher side of normal and she had been put on sixty five micrograms of pig thyroid. I had her stop it. Too much thyroid hormone is going to lead to fast heart rate, osteoporosis, what we call atrial fibrillation, which an irregular heart rate, it can lead to heart failure even. It is so important for clinicians to be responsible in prescribing thyroid hormone. Thyroid hormone is not intended for weight loss. Thyroid hormone has very little effect in depression. Thyroid hormone needs to be prescribed to the appropriate patient with clinically low thyroid levels.
Cheryl said because we said was there an eureka moment, you took the drug and like bingo. She said, no it wasn’t like that, she said it was gradual. And that’s what you’re saying right. It’s not a miracle cure.
Dr. Sadler: We can choose to treat patients within a range of thyroid replacement at which we give them maybe a little bit more and keep their thyroid on the high/normal level and maybe they feel a little bit better. We have to be careful and responsible that we don’t give them too much because if we go past our boundaries then we give patients problems. That’s iatrogenic, that’s not good clinical practice. We need to be responsible providers.
Overall in this amazing business on replacement therapy which men and women are spending thousand, million, billions of dollars every year, are you saying it’s over rated?
Dr. Sadler: The thyroid is over rated as a general cause for fatigue, malaise, weight gain, depression, but there is a subset of patients that have true clinical hypothyroidism that the only way to know that is with the ultra-sensitive TSH which is the thyroid stimulating hormone that comes from the pituitary gland at the brain. It is the most sensitive test for thyroid hormone. Not the T3, not the T4. When your clinician measures your thyroid gland it’s important to look at the ultrasensitive TSH level.
What is the thyroid, what does it do, why is it important within the body?
Dr. Sadler: The thyroid gland is super important for the body. It controls or regulates metabolism. It helps us in balancing hormones between the brain and of course the thyroid gland, that it controls the heart rate, it can control muscle tone. It can control absorption of certain minerals in to the body. It controls energy, it helps control our brain metabolism which is very important and also can affect our skin. Having the thyroid balanced within our system effects everything.
Where is it?
Dr. Sadler: The thyroid gland is located in the neck, it’s bi-lobular which means that it has two lobes and you can actually function normally with just one lobe of the thyroid gland. There’s a feedback loop between the brain and the thyroid and the bloodstream that allows the body to naturally control our thyroid. In some cases where tumors or viruses can affect the thyroid gland or tumors can affect the brain or infections, the feedback loop gets interrupted. Those are the cases in which the thyroid levels in the body can be disrupted.
Right now what is the thyroid doing for you?
Dr. Sadler: My thyroid gland is working very well right now. What it’s doing is its controlling my metabolism, it’s allowing me to think clearly, to speak clearly. It controls a lot of my skin tone, the moisture in my body, the moisture in my skin. It prevents my skin from drying out. It affects my heart rate; it allows me to regulate my heart rate in a way that is appropriate in times of stress but also resting heart rate. It makes sure that my heart stays at a regular pace as well as rate.
It almost sounds like a thinking organ of sorts, so it’s really tied in with what’s going on in the brain.
Dr. Sadler: That’s right. The thyroid is tied in with the brain. I would say it’s a living, breathing organism but it doesn’t have lungs, but it is a big part of our entire system. I have seen low thyroid to the level where the patient was almost comatose with so low on thyroid. I’ve seen a gentleman that used to be our music writer who could no longer even write his name and could hardly speak because his thyroid was so low. The critically low thyroid can be a critically important physical case that needs urgent medical attention. In America we don’t see that so much but we do see it among the underserved and we see it in other countries. Also the thyroid gland is very important in pregnant women because pregnant women with low thyroid can have babies that have a form of dwarfism called cretinism. For that reason we need to monitor our ladies with pregnancy to make sure number one, they don’t have a thyroid disorder and number two that thyroid is monitored closely because they generally need a little bit more thyroid hormone on board during pregnancy because their metabolism really picks up.
Does the thyroid sort of distribute the hormone sort of as needed? What triggers the action of the thyroid?
Dr. Sadler: As soon as the thyroid levels in our blood stream start dropping the brain receives that signal in the pituitary gland. The thyroid stimulating hormone starts acting up and so it will increase to tell the thyroid gland to release more necessary hormone to the body. When the thyroid level is too high the pituitary gland will kind of shut down and say you don’t need any more. The thyroid stimulating hormone will decrease.
The pituitary gland is where?
Dr. Sadler: In the brain, in the celature of the brain.
Is it wired directly to the thyroid?
Dr. Sadler: It is chemically wired to the thyroid. My father actually developed the surgery to remove the thyroid tumors. He had them do it the way that the pharaohs removed the brain tissue; he went through the nose in to the celature, through the celature to take out the thyroid gland. He developed it at MD Anderson. He was Chief of Endocrinology there for twenty five. He worked a lot with the surgeons. He was their first endocrinologist and their first one to study endocrine tumors.
Is that where you get your interest in endocrinology?
Dr. Sadler: Actually I’m very weak in endocrinology, I’m embarrassed to say.
But family practice.
Dr. Sadler: My mother is a family doctor and I love my family practice
What else?
Dr. Sadler: About the thyroid gland, what can I tell you. I’ve had women come to me who have been to many doctors and they bring this book that’s this thick and it’s all about the thyroid. They lay on the table, they say, okay it’s all about my thyroid and I want to talk about it. I’ll look at them and I’ll look at the book and I just say, you know let’s talk about it. I just listen to them. I will tell you in many situations what the thyroid hormone replacement will do for you is over rated unless you’re in a third world country or you are near comatose because your thyroid level is too low.
Dr. Sadler: I had a patient at the Hope Clinic, he could hardly walk, and he was stumbling. He used to write all the music for the church, he couldn’t even write his name he was so low in thyroid.
Does this effect men as well as women?
Dr. Sadler: Yes and I know we concentrated on women but it happens to men too. So men get hypothyroidism.
This is not just about women?
Dr. Sadler: The two cases I’ve seen of severe hypothyroidism have been in male patients. It may be because men are less likely to seek routine medical care with a medical provider. One was near comatose and one could hardly walk and could hardly speak because his thyroid was so low. Having a low thyroid is not just a benign disease; it can be a critical disease. It’s important for people to seek out routine care with a good medical provider on a regular basis.
END OF INTERVIEW
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