Thyroid Book Table of Contents Copy
Updated May 8, 2024
Thyroid Program
Front Cover: Thyroid Algorithm A
TOC
Publishers
Dedication
Disclaimer
Testimonials: Deb, Sharon, Kristin, Susan, Rob
Ch 0: Introduction edit
Ch 1: Use the Algorithm Right Away edit
Ch 2: Forms of Thyroid Medication edit
Ch 3: Essential Concepts: T4, T3, RT3 edit
Ch 4: TSH: A Failed Measure, and its replacement RT3
Ch 5: Thyroid Medication Adjustment
Ch 6: True Stories
Ch 7: Other Important Measures
Ch 8: Other Important Connections
Ch 9: Healing the Thyroid
Ch 10: Working with your Prescirber
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Ch 1: Essential Hormones: T4, T3, RT3
- This Thyroid Algorithm A (TAA) demonstrates 27 different Scenarios involving the permutations of three values specific thyroid measures, This addtiional precision, if it applies, provides a better understanding of individual thyroid function and need than using just one measure. Thyroid Algorithm A It suggests 9 different responses to these 27 scenarios, giving more flexibility and potential precision on understanding individual thyroid functioning.
- There are three main thyroid hormones: T4, T3 and Reverse T3 (RT3).
- T4 is only made by the thyroid gland
- T3 and RT3 are made by most cells of the body
- For each cell, T3 is the gas and RT3 is the brake.
- All three can and should be measured with every thyroid measurement
- T4 and T3 are available as mediations; RT3 is made from T4.
- No medication regime can match natural thyroid function, but sometimes there is no choice but to use thyroid medication for short- or long-term therapy.
- This TAA, when it applies, should improve satisfaction with thyroid interpretations (and therapies if applied as well). However there will remain a percentage of patients where the Total levels of hormones and Binding Globulins are required to best understand thyroid function, and often extend outside of the thyroid to the liver, adrenals, sex hormones, sugar/metabolic system and others.
- The TAA does not consider Binding Globulins and Total levels of T3 and T4, nor the concepts of T1, T1, and amino acids. These topics are saved for the companion book, Thyroid Ideas. The use of Total Levels of T4 and T3 will be used in a pending Algorithm B. After B is formulated, we will add to Algorithm A the criteria for whether Algorithm A or Algorithm B will best apply.
Ch 2: The Duel between TSH and RT3
- TSH is made by the pituitary and is not made by the thyroid
- TSH therefore reflects pituitary function, not thyroid function
- The pituitary can make its own T3 so it may not reflect what’s happening in the rest of the body
- Reverse T3 (RT3) is made by most cells of the body from T4
- RT3 is a better reflection of bodily need and function, similar to how HgA1c is used for diabetics
- RT3 also is affected by cortisol and adrenal function. By raising RT3, Cortisol “applies the brake”.
- In conventional medicine TSH is the primary biomarker for thyroid function.
- In holistic medicine, RT3 is the primary biomarker used to assess bodily need for thyroid hormone(s).
- In holistic medicine, TSH is not used for adjustment but optionally to check pituitary function.
- If only T4 is prescribed, there are only 3 options for adjustment: go up, go down, or stay the same.
- If T4 and T3 are prescribed, there are 9 options for adjustment, giving more opportunity to match bodily need.
- There are two main sources of thyroid hormone: pig and synthetic.
- T4 and T3 are both available as pork-sourced and synthetic
- The requirements for T4 and T3 vary from patient to patient. Therefore a pre-fabricated combination product, even when “naturally” sourced from pig, may not meet an individual’s short-term or long-term need.
- Most patients will need two forms of thyroid medication to optimally adjust thyroid.
- See the Table for the current available forms of thyroid hormone
Ferritin
Minerals: Magnesium, Selenium, Zinc (Iodine later)
Water-Soluble Vitamins: B’s and C
Omega-3 Oils
Fat-Soluble Vitamins: A, D, E, K
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Chapter 1: Essential Concepts: T4, T3, RT3
“A kid working at a MacDonald’s counter can be shown how to adjust thyroid medicine better than this”
— an anonymous philosopher
Important Points:
- Many thyroid patients are dissatisfied with their thyroid care–you can take control!
- There are three main thyroid hormones: T4, T3 and Reverse T3 (RT3).
- T4 is only made by the thyroid gland
- T3 and RT3 are made by most cells of the body
- For each cell, T3 is the gas and RT3 is the brake.
- All three can and should be measured with every thyroid measurement
- T4 and T3 are available as mediations; RT3 is made from T4.
- No medication regime can match natural thyroid function, but sometimes there is no choice but to use thyroid medication for short- or long-term therapy.
This book will focus on essential thyroid therapy. While this method is backed by long-standing quality science, those details will be saved for later chapters and books.
The reason that I am writing this book, despite there being so many already, is that I formulated a “Thyroid Algorithm” several years ago after my frustration with my mother-in-law’s thyroid care. I will save the story for a later chapter, but the degree of suffering that I witnessed, not only in her case, but so many, got me angry enough to engage a philosopher who came up with the statement above. Anyone can do it!
Since then, I have been teaching my patients to apply the Thyroid Algorithm, not only to feel better, but to know why and how to do it. I teach my patients to fish, at least those who want to…
I have chosen the word “Therapy” for the title, rather than “Treatment” or “Therapeutics”. All would have worked but for me the connotation of Therapy implies healing, rather than managing or curing. Our thyroid system can heal, even after resection or radiation. The thyroid gland is a small part of the thyroid-iodine-adrenal system. When thyroid medication is sub-optimally adjusted, it stresses other systems and ultimately becomes chronic due to the ripple effects. For most patients, the pattern has been brewing for a decade or more before the thyroid is addressed, in part due to incomplete testing and sub-optimal treatment strategy.
To heal well, the best approach is more comprehensive and therefore more holistic. Indeed, while we will focus on the logic of thyroid assessment and medication adjustment, it will all work better and deeper if this approach is a part of a multi-dimensional approach. The Holistic approach includes at the least: breath, sleep, water, food, movement, purpose, and stress management.
It is estimated that more than 50% of thyroid patients are dissatisfied with their thyroid status. The usual complaints are insufficient energy or stamina, a feeling of thickness, stiffness, slowness, coldness that can affect the hair, skin, joints, bowels, immune system, and brain. If you are reading this book then you have probably figured out that a Primary Care Provider or an Endocrinologist who only orders two or three thyroid labs is not going to be of any help. This is because the tests are incomplete and there are only three ways to go with T4 medication– up, down, or same. I’m excited to finally put this all down in a book to share with you!