Hypothyroid Nation – Is this why Americans became obese, mentally unstable, and infertile?

(Guest article by Sue S.) The health of America has been transformed in the last generation. Obesity is rampant and causing terrible health sequelae. The number of USA adults on anti-depressants has skyrocketed, and children as young as 4yo are placed on some mind-altering medication. For those who wish to have a traditional family, fertility issues often unexpectedly arise. America used to be a vibrant nation which prided itself on its genetic diversity and health care system. How is it possible in one generation that things have changed so dramatically? What happened?

When epidemiologists examine clusters of symptoms in a population, they usually look for a broad link of causation. Why? If you have great numbers of people affected in a geographically defined area, there is usually some common factor. It has to be able to override individual DNA, and local epigenetics. It would have to provide universal exposure and exert a consistent influence to produce multi-generational changes. Is there a common link between obesity, mental health, and fertility? Yes, the thyroid gland.

What does the thyroid do?

The thyroid is a butterfly shaped endocrine gland on the front of the throat. It produces many hormones, but predominantly, T4 (storage form) and T3 (active form) of thyroid that have actions on all cells. Once produced, the hormones circulate through the blood stream to the body, and the brain. T3 penetrates the

membrane, and acts on the nucleus to change DNA transcription. It provides the energy catalyst necessary for all cells especially the function of muscles, including the heart as well as the gut smooth muscle. T3 acts on serotonin receptors to calm the brain. T4 is also found in the brain, and helps cognition and memory. T4 is primary for hair growth. Thyroid hormone interacts with progesterone (necessary to maintain pregnancy), and pregnenolone, considered protective hormones. It regulates the use, and excretion of cholesterol. Low thyroid leads to rises in cholesterol levels even without diet changes. https://articles.mercola.com/thyroid.aspx Its effects are ubiquitous.

How prevalent is hypothyroidism?

Although not listed in the top 10 public health concerns by CDC, hypothyroidism in the USA is widespread. In 2019, synthyroid (synthetic T4) is the number 2 prescribed medicine in the USA. In 2015, it was #1. On a USA map showing the top drug prescribed by state, synthyroid was the #1 prescription in over 30 states. Remember, these numbers are the people who have complained to their medical personnel and gotten lab work to warrant initiation of treatment.

This trend is not limited to the USA. Examine the sudden rising obesity rates world-wide, and you’ll find an alarming concurrent problem. “Hypothyroidism is one of the most common endocrinopathies worldwide, and its incidence is increasing rapidly.[3] It is frequently found to coexist with both type 1 and type 2 diabetes mellitus.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968713/ Something is going on.

How are thyroid problems diagnosed? The standard of care is to test for the pituitary hormone TSH- thyroid stimulating hormone. Theoretically, when tissue levels of T3 (active hormone) drop, a feedback loop causes the pituitary to release hormone (TSH) to urge the thyroid to make more. The average thyroid excretes about 100mcg of T4 (storage form), and 10mcg of T3 daily. Again, it is believed that if all ancillary systems function properly, and there are no deficits like low testosterone or iron deficiency anemia, the T4 will readily covert to T3. This is unfortunately not true. Trauma, emotional stress, inflammation, toxins, etc. have been shown to lower tissue conversion. These have little effect on the pituitary’s T3 levels, thus the body can be struggling, but the brain will not recognize the deficit. The pituitary has its own set of enzymes and can withstand a high toxin load without altering TSH. It follows then that NOT all hypothyroid individuals are diagnosed or are receiving medication. Why are so many Americans hypothyroid?

Location matters

Even though the use of iodized table salt greatly diminished the incidence of goiters, some areas are more prone to hypothyroid than others as certain states have mineral deficiencies in the soil. For instance, Michigan is low in selenium. This can also affect the mineral content of water. Either low selenium or iodine will cause hypothyroid.

Immune system assault

The American Thyroid Association writes that in the United States, the most common cause of hypothy-roidism is the autoimmune condition Hashimoto’s thyroiditis. (1) That means the condition is caused by inflammation. Generally speaking, inflammation is the immune system reacting to something that the body cannot tolerate. How is it with the genetic diversity of Americans’ ancestry, and the great differences among states’ weather, and topography, that this is happening to everyone? What is the common source of this reactive inflammation?

Hormone disrupting chemicals are in the food/drink, and all our personal care products-

06/2019 USA Today reported that we consume the equivalent of a credit card in plastics weekly. Researchers at the University of Newcastle, Australia found we are consuming about 2000 pieces of plastic per week from regular drinking water, either from the tap or in a bottle. The study, No Plastic in Nature: Assessing Plastic Ingestion from Nature to People, was commissioned by the WWF (World Wildlife Federation). Their findings show we consume 21 grams a month, or over 250 grams a year. How is this acceptable?

Although some plastics have been banned from use in baby bottles, etc. due to their hormonal effects, the danger is often hidden. Aluminum drink cans are lined with plastic. Milk, and fruit juices given to children are all in plastic containers. Tests of bottled water revealed that just unscrewing the lid can drop particles inside. https://www.usatoday.com/story/news/nation/2019/06/12/plastic-youre-eating-credit-cards-worth-plastic-each-week/1437150001/

There are other chemical exposures through various health/beauty products. Oxybenzone is added to body care products, and sunscreens as it helps them penetrate the skin. Oxybenzone and its metabolites, the intermediary chemicals made as the body breaks it down, are linked to allergies, cell damage, and hormone disruption. It is used in >500 brands of sunscreens, and hundreds of items like lip products, anti-aging creams, conditioner, and female fragrances. Not only does it drop testosterone levels in men, it also disrupts estradiol, one form of estrogen. The sunscreen and beauty industry insist the concern over risks are over blown, and that since they have FDA approval, it is safe. Some dermatologists also support its use, but many vehemently disagree such as this group: https://www.ewg.org/news/testimony-official-correspondence

In addition to these health issues, there are environmental concerns with sunscreens. Since it is frequently worn by people who engage in water activities, it can contaminate bodies of water. Wastewater treatment doesn’t adequately remove it. Oxybenzone has even been linked to viral outbreaks in coral reefs per Danovaro, et. al., Environmental Health Perspectives, 2008. https:/plottpalmtree.miiduu.com/arbonne-company-mislead-information-alternatives-egplottpalmtrees-com It was even reported by Time Magazine. https://time.com/4080985/sunscreen-coral-reefs/

On March 21, 2008, the CDC published a study of 2,500 Americans aged 6yo and up, where they assayed urine for the ingredient oxybenzone. The study revealed that 97% of respondents are contaminated with high levels of oxybenzone. Women and girls had higher levels than males. This is particularly disturbing since another study published on 3/20/08 revealed this chemical was linked to low birth weight in baby girls whose mothers are exposed while pregnant. https://www.ewg.org/news/testimony-official-correspondence/cdc-americans-carry-body-burden-toxic-sunscreen-chemical

Food supplies fare no better.

Pesticides are used so universally that it has shown up in water/ plant samples in remote locales. The effects are cumulative. Despite efforts to regulate factory farming practices, livestock still account for 70% of the total antibiotics used in the USA. Trying to restrict exposure through vegan diets may be futile as it has been shown by the University of Minnesota that plants grown in fields fertilized by manure from factory farms also contained antibiotics. https://www.growfood.tech/2018/08/22/warning-antibiotics-fed-to-animals-are-absorbed-by-plants-fed-with-manure/

The case against soy

In the last 30 years much has been made about cutting fats out of the diet. Butter, lard, and beef tallow were demonized as the causes of heart disease. They were replaced by margarine, and other soy-based products as the low fat/unsaturated fat diets became the standard. Did it help? We have not seen the promised drop in obesity, diabetes, or heart disease. Why not? “Unsaturated oils block thyroid hormone secretion, its movement in the circulatory system, and the response of tissues to the hormone. When the thyroid hormone is deficient, the body is generally exposed to increased levels of estrogen.” https://traditionalcookingschool.com/health-and-nutrition/foods-making-thyroid-sick/

“Thyroid enlargement in rats and humans, especially children and women, fed with soya beans has been known for half a century,” according to Theodore Kay at Kyoto University in Japan. In 1988, he tried to discover the amount of iodine necessary to prevent this in those consuming soy. He found that even though small amounts of iodine could help enlargement, it didn’t stop pathological changes to the gland due to soy. https://www.integrativehealthcare.org/mt/soy-and-hypothyroidism/

“Although scientists have known for many years that soy is goitrogenic, it was only recently that they were able to pinpoint the actual thyroid-depressing compounds. Researchers at the US Toxicological Laboratory in Arkansas found that the thyroid-depressing substances are isoflavones, the estrogen-like compounds… This discovery came as a shock to the soy industry, which has heavily promoted these phytoestrogens as beneficial…that are supposed to protect us from heart disease, cancer, osteoporosis and the discomforts of menopause. Yet in normal women consuming sufficient iodine, just 30g of roasted soybeans daily, containing about 38mg isoflavones, were found to depress thyroid function–less than the amount in two glasses of soy milk, two servings of tofu, or a handful of roasted soy nuts. “ https://www.westonaprice.org/health-topics/soy-alert/soy-the-dark-side-of-americas-favorite-health-food/

In 2002, the National Institute of Environmental Health Sciences (NIEHS) reported that soy phyto-estrogens gave estrogenic effects equal to or lower than doses of DES estrogen. Diethylstilbestrol, a synthetic estrogen, was administered to pregnant women between 1940’s-1971. It was discovered the daughters of these women were more prone to cervical cancer, and it was discontinued. Maternal consumption of soy products also transfers estrogenic hormone disruptors to the baby while pregnant as well as being passed through breast milk. https://www.westonaprice.org/health-topics/soy-alert/why-babies-should-not-be-fed-soy/

Soy based baby formula was advertised as being better than breast milk. Research shows this is not true, and in fact, it has harmful effects. Children fed soy formula were more likely to develop autoimmune thyroid diseases like Hashimotos. (2) Additionally, infants who are diagnosed hypothyroid should not use soy products as it’s proven to block synthroid medication absorption. Lack of thyroid can cause abnormal brain development. https://www.medicinenet.com/script/main/art.asp?articlekey=161646

How important is hypothyroid screening for babies? Many states include a thyroid lab on their newborn testing panels. Approximately 3000-4000 babies/year are born in the USA with hypothyroid.

There has been a drop in the age of menarche with many young girls hitting puberty now at 10yo. It is theorized to be due to phyto-estrogens in the food/environment. Some anecdotal reports demonstrate that children (M and F) fed soy-based formula are more likely to exhibit not only physical problems like thyroid disorders, asthma and irritable bowel syndrome, but also extremes in emotional behavior and depression.

The vegan movement adopted soy as the go-to milk and meat replacement. Pro vegan websites dispute these findings and present their own studies to disprove any negative effects. There may be other players on the field as Ag Business also wants to promote a highly profitable product. Soy advocates point to Asia as a region that consumes large amounts of soy as tofu without harmful effects. Despite the claims by advocates, soy is not used as a staple. Consumption of soy is actually fairly low: China- 10 grams or 2 teaspoons per day; Japan- 50 grams or ¼ cup per day. It is also almost always fermented. https://www.westonaprice.org/health-topics/soy-alert/soy-the-dark-side-of-americas-favorite-health-food/

Soy represents a huge chunk of USDA exports with USA sales at $59 billion in 2018. Who raises soyabeans? Brazil’s Ag business is #1 with 56% of all soy exported, and the USA is #2 with 29% of exports. Most of today’s soy is heavily genetically engineered and is being managed by the large seed and ag companies. Until recent events, soyabeans had steadily increased in value for several consecutive years. That’s a lot of cash. http://www.worldstopexports.com/soya-beans-exports-country/

How are all these hormone disrupting factors affecting our physiology? A theory: disruption of normal thyroid function can, in and of itself, be linked to obesity, mental health, and fertility problems, and this universal effect might be caused by these hormone disruptors in our environment, and food. I am not an epidemiologist nor do I have knowledge of any study demonstrating a direct link to current national hypothyroid levels and these substances. Statisticians often caution: correlation doesn’t ensure causation…agreed. But if there is no effect, why are we seeing the high numbers of auto-immune hypothyroid patients throughout all age groups? There is support for this theory.

Numerous toxins, including plastics such as Bisphenol-A, pesticides, mercury, and flame retardants such as PBDE, are shown to block tissue thyroid receptors and reduce T4 to T3 conversion with resultant low tissue levels of thyroid that are not detected by standard blood tests (126-134,283)…. Thus, the D1(hormone converting storage T4 to active T3) in the body is suppressed by toxins, pesticides, and plastics at levels that are hundreds to thousands times lower than required to suppress the D2 (hormone converting T4 to T3) in the pituitary. This is proving to be a major problem for the population in general; levels of plastics and other toxins commonly found in individuals (toxins that are considered “normal” exposure) result in reduced levels of T3 in all tissues with the exception of the pituitary, which is resistant to the effect of toxins. Because the pituitary is relatively unaffected, the reduced tissue thyroid levels are not detected by standard TSH testing.” https://www.nahypothyroidism.org/deiodinases/#toxins

*Disclaimer– Seek the counsel of licensed professionals for any health issues. None of the information here is a recommendation for any kind of treatment or supplementation. Any thyroid medication requires a prescription and should be used judiciously under the direct supervision of a medical professional.

Obesity, and its complications of diabetes and hypertension

We have record numbers of people who are morbidly obese, and many more who can’t seem to lose weight no matter how much they diet. The UK is now second world-wide to the USA in numbers and severity of morbidly obese population. The old advice isn’t working. Change your eating habits and just exercise… right? The physiology of fat may be far more complicated than it seems.

Thyroid hormone regulates the basal metabolic rate- how many calories you burn while at rest. This includes body temperature (as directed by the hypothalamus), normal functions like digestion, circulation, respiration, and cellular repair. Thyroid also governs the laying down of fat through other hormones like leptin. Hypothyroid state turns down the basic rate. While it’s true that eating massive calories will put weight on, eating less doesn’t necessarily cause a loss of weight or turn up the basal metabolic rate (BMR).

Hypothyroid itself is associated with poor sleep. Additionally, overweight individuals often suffer sleep apnea, which hinders weight loss. These individuals are not only fatigued, but under oxygenated as they struggle to go to work, etc. It puts them at great risk for cardiac complications.

Hypothyroid also sabotages exercise as skeletal muscles need thyroid to function properly. The hypothyroid person who is overweight is caught in a cycle. These people will experience fatigue post exercise, and poor recovery, so losing weight by “just moving around” doesn’t often work.

For those who struggle through the diets, and are able to lose weight, they often gain all of it back, and sometimes even more. T3 (active hormone) is greatly reduced in these people, and RT3 (reverse T3) rises. The body sees itself as if in starvation mode resulting in a metabolic rate drop of 25% compared to those who haven’t lost weight. (3) This is equal to about 500-600 kcal/day that the person would have to reduce their intake to maintain the loss. Horrifying examples of this are the former winners of the TV show Biggest Loser. (4) https://doi.org/10.1002/oby.21538

Thyroid, obestity, and diabetes- Low thyroid hormone leads to insulin resistance as does consumption of high sugar foods. Prolonged insulin resistance leads to Type II diabetes. This is one of the most frequent complications of obesity. Weight loss can decrease insulin resistance as can administering thyroid hormone to the hypothyroid patient since the two are inter-related. “Thyroid hormones have a significant effect on glucose metabolism and the development of insulin resistance. In hyperthyroidism, impaired glucose tolerance may be the result of mainly hepatic insulin resistance, whereas in hypothyroidism the available data suggests that the insulin resistance of peripheral tissues prevails. “ https://www.ncbi.nlm.nih.gov/pubmed/24549605/

1/3 of Americans consume at least one sugary drink or soda per day. High sugar intake negatively impacts the thyroid. Sodas shifted in the 1980’s from sugarcane-based syrups to high fructose corn syrup (HFCS). It is now found as the primary sweetener in all kinds of food and drink. Although corn lobbyists will insist there is no evidence it causes any health risks, medical practitioners might disagree as HFCS goes straight to the liver for metabolizing. “A study conducted by Princeton University found that rats that were fed HFCS gained fat 300% more quickly than those fed an equal (or slightly larger) dose of fruit-derived sugar.” http://www.youralternativedoctor.com/5-health-dangers-of-high-fructose-corn-syrup-hfcs/

The second condition paired with obesity is hypertension (HTN)- While it is true that excessive weight increases the load on the heart, and thus raises the blood pressure, hypothyroid alone can cause HTN. If a person is hypothyroid, when the body tries to compensate, it produces too much noradrenalin, which raises BP. If it continues long enough, it can involve aldosterone too. (5,6)

The Journal of Hypertension, Kosis et al. evaluated 100 patients recently diagnosed for hypothyroidism in a cohort study. During a 24-hour period, the hypothyroid patients consistently had higher overall systolic blood pressure readings, and more variability than the controls. The fear of doctors or “white-coat” hypertension was increased in patients with hypothyroidism.

Can thyroid medication help this? Yes. A report in 2002 American Heart Journal (Dernellis J and Panaretou M) showed that not only was hypertension completely reversed in 50% of the patients by thyroid replacement therapy, but that arterial stiffness was decreased in all patients.

Mental health issues and cognition

The T4/T3 effects don’t stop out in the body; they are essential within the brain as well. T4 helps memory.

Both affect the pituitary, a master gland for the regulation of all hormones. Thyroid hormones also help with learning, and general reasoning.

Panic Attacks – T3 acts on serotonin and catecholamines in the brain. T3 acts to keep the brain calm similarly to the effects of SSRIs. It follows that low thyroid is linked to panic attacks. (7)

ADD, etc.– Otherwise healthy preschoolers who had TSH levels (thyroid stimulating hormone) in the high normal range were found to have lower cognitive function. (High TSH guarantees low thyroid function.) If they had both high TSH and low free T4 values, they had ADHD symptoms. For those in the highest of the TSH values, there were statistically significant differences. Could it be there are kids who are getting Ritalin for ADD or ADHD that are really hypothyroid instead? (8)

Bipolar disorder– Can hypothyroid contribute to bipolar? A 2002 study found a high prevalence of Hashimoto’s antibodies in the bipolar group over the control. (9) This means these patients are likely to experience both the hypo, and hyper thyroid states. Supplementing Hashimoto’s patients with appropriate doses of hormone, lowers the stress on the thyroid. Additionally, T3 has been explored as a treatment for bipolar.

In a retrospective chart review of 125 patients with bipolar II disorder, and 34 patients with bipolar disorder NOS, T3 was found to give significant clinical relief. These bipolar patients had failed symptom control after trying on average 14 medications. Using a range of doses between 13mcg-188mcg on individual patients, the average dose of 90mcg produced marked improvement in 84%, with 33% experiencing a full remission. Coincidence? One patient who had gotten better on T3, was temporarily switched back to T4 only, and the symptoms returned. When the patient went back to the T3, the symptoms again resolved. (10)

Depression– Funded by the NIH, the Star*D Report is the largest trial to date (4000 patients) comparing different anti-depressants’ effectiveness. As an option on the protocol, they included T3 as Cytomel. It was revealed that of the patients who do have benefits from the anti-depressant meds, 50% will still relapse within a year. 66% of patients either fail to respond, or have severe side-effects causing them to dis-continue the med. When they tried T3 with these patients, T3 was shown to be 50% more effective than the others even when <50mcg (the optimum dose) was used. https://www.researchgate.net/publication/5614758_The_STARD_study_Treating_depression_in_the_real_world

The American fertility rate has dropped dramatically in the last 30 years

According to CDC, the number of U. S. births in 2017 was 3.85 million, a decrease of 2% from 2016. It is the lowest number in 30 years. CDC estimated approximately 12% of U.S. women aged 15 to 44 years have difficulty getting pregnant or carrying a pregnancy to term. Although this may be skewed in part to factors like increased maternal age as 20% of women now have their first child after age 35, studies of thyroid hormone levels in cases of infertility demonstrate a trend for both men and women.

A 2017 study conducted at Harvard Medical School by Dr. Pounch Fazeli, neuroendocrinologist, discovered that more than a quarter of the women who had unexplained infertility also had thyroid levels at low-normal values. In a meta-analysis, it was found that the presence of thyroid autoantibodies, even while having a normal thyroid level, increased the risk of miscarriage or pre-term birth 180-390%. https://www.ncbi.nlm.nih.gov/pubmed/21558126

A study published in the journal Human Reproduction Update, showed severe declines in sperm quality and sperm count in Western cultures. In less than 40 years, North American, European, Australian, and

New Zealand men showed a 52.4 % decline in sperm concentration, and a 59.3% decline in total sperm count. https://www.scientificamerican.com/article/sperm-count-dropping-in-western-world/

Low thyroid is associated with low testosterone in both men, and women. Testosterone helps with more than lean muscle development. If hypothyroid, the body will steal pregnenolone (a precursor) to make hormones, thus depleting sex hormones. It has been found that males with either diabetes or insulin resistance have testosterone levels in the low or low-normal range. This low sex hormone further depresses Deiodinase 1 (which coverts inactive T4 to active T3 in the body), causing decreased T3 hormones out in the tissues. This adds to weight gain and problems losing weight. Deceptively many laboratories have lowered the testosterone values to reflect this overall drop in levels, thus maintaining the majority results at 95% https://www.nahypothyroidism.org/deiodinases/

What is the answer?

Due to the prevalence of hypothyroid in the USA, it may be prudent for anyone being treated for the problems mentioned above to have an endocrine workup with full thyroid panels to rule out any possible underlying hypothyroid issues. If there are concomitant issues like diabetes, adjusting the thyroid level provides a more solid platform for rebuilding health. Consult your treating health care personnel.

Do your own research into natural substances that are anti-oxidants like glutathione that detoxes the liver. Research thoroughly the far-reaching benefits of vitamin C. A study was conducted on 28 women and 3 men with hypothyroid. They took their thyroid med in water containing 500mg of vitamin C. Blood work showed improvements in their TSH, free T4 and T3. Researchers concluded it might be helpful for patients to take their medication with the vitamin C, because of these positive anti-oxidative effects. (11)

Review the works of Dr. F. Klenner, and Dr. Abram Hoffer. Search for the best quality supplements. I have used the liposomal delivery system for these nutrients and believe it can be extremely beneficial. (Non-sponsored.)

Reducing thyroid inflammation is key. “Selenium supplementation has been shown to reduce anti-thyroid peroxidase antibodies and anti-thyroglobulin antibodies in patients with autoimmune thyroiditis. Selenium has been shown to increase the level of glutathione peroxidase, which contains selenocysteine. Both Withania somnifera (Ashwaganda) and Commiphora mukul have been shown to improve hypothyroidism by elevating T3 levels and increasing T3:T4 ratios through peripheral metabolic pathways. “ https://restorativemedicine.org/journal/extra-thyroidal-factors-impacting-thyroid-hormone-homeostasis-a-review/

We cannot eliminate the outside contaminants in all food, etc., but we can research products more thoroughly to eliminate as many sources of bad chemicals/hormone disruptors as possible. Carefully choose things going into or on your body.

You might sort through all the beauty products, and sunscreens for oxybenzone to keep exposure under the allowable levels. Consider changing your storage habits- use glass containers for left overs, juices, etc. to minimize plastic consumption. Based on your water supply, you might purchase a water filter for your home so that your baths/showers as well as drinking water are clean and free of residual chemicals/ pharmaceuticals.

Examine clothing choices as the skin’s contact with either synthetics or cleaning products can be a source of immune irritation. 100% wool products have enormous advantages. For warmer temps, try natural fibers like flax, hemp, or organic cotton. Linen is excellent as it doesn’t hold static electricity, is very hydroscopic (absorbs and releases water easily) and hypo-allergenic. In Japan, convalescent homes that use linen sheets for bed-ridden patients have very little skin breakdown.

Linen may offer some protection to the wearer from gamma radiation. Flax plants removed from radiation contaminated areas showed very little exposure. Consumption of the seeds is beneficial to the immune system. A study at the Pearlman School of Medicine (Univ. of PA.) demonstrated that mice fed flax had resistance to the effects of even lethal doses of radiation. The flax-fed mice not only survived, but were remarkably healthy with heavier body weights, and minimal inflammation of the lungs. “The purpose of this study was to find a way for cancer patients to survive radiation”. https://naturalsociety.com/flax-seeds-protect-repair-radiation/#ixzz5wjbUDi6F

We need to be aware of contaminants in our environment, and their potential effect on our bodies and those of our loved ones. Everyone is free to make their own choices. Forewarned is forearmed.

These websites have been a wealth of well documented information: http://www.tiredthyroid.com by Barbara Lougheed https://www.nahypothyroidism.org Run by health care professionals. https://hypothyroidmom.com by Dana Trentini

I do not know them personally, but appreciate their work. Many of the studies cited here were taken from their excellent information. I receive no compensation in any way from them, or anyone else.

1) Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by The American Association of Clinical Endocrinologists and The American Thyroid Association. Endocr Pract. 2012;18(No.6):989-1028.

2) Fort, P., et al. “Breast and soy-formula feedings in early infancy and the prevalence of autoimmune thyroid disease in children.” Journal of the American College of Nutrition 9.2 (1990): 164-167.

3) Leibel, R.L., Hirsch, J. Diminished energy requirements in reduced-obese patients. Metabolism. 1984 Feb;33(2):164-70.

4) Persistent metabolic adaptations 6 years after the biggest loser competition; E. Fothergill, J.Guo, L. Howard, J.Kerns, et.al. 02 May 2016

5) Fommei, Enza, and Giorgio Iervasi. “The role of thyroid hormone in blood pressure homeostasis: evidence from short-term hypothyroidism in humans.”

6) Journal of Clinical Endocrinology & Metabolism 87.5 (2002): 1996-2000. Mordi, Ify, and Nikolaos Tzemos. “Subclinical hypothyroidism as a cause of resistant hypertension.” Cardiovascular Endocrinology 1.2 (2012): 31-32.

7) Kikuchi, Mitsuru, et al. “Relationship between anxiety and thyroid function in patients with panic disorder.” Progress in Neuro-Psychopharmacology and Biological Psychiatry 29.1 (2005): 77-81.

8) Alvarez-Pedrerol, M. Ribas-Fito, N., Torrent, M., Julvez, J., Ferrer, C., Sunyer, J. TSH concentration within the normal range is associated with cognitive function and ADHD symptoms in healthy preschoolers. Clinical Endocrinology 2007;66(6):890-898.

9) Kupka, R.W., Nolen, W.A., Post, R.M., McElroy, S.L., Altshuler, L.L., Denicoff, K.D., Frye, M.A., Keck, P.E. Jr, Leverich, G.S., Rush, A.J., Suppes, T., Pollio, C., Drexhage, H.A. High Rate of Autoimmune Thyroiditis in Bipolar Disorder: Lack of Association With Lithium Exposure. Biological Psychiatry 2002 Feb 15;51(4):305-11.

10) Kelly, T., Lieberman, D, The Use of Triiodothyronine as an Augmentation Agent in the Treatment-Resistant Bipolar II and Bipolar Disorder NOS. J Affect Disord. 2009 Aug 11;116(3):222-6. Epub 2009 Feb 11.

11) Jubiz W, Ramirez M. Effect of vitamin C on the absorption of levothyroxine in patients with hypothyroidism and gastritis. Journal of Clinical Endocrinology and Metabolism 2014 Jun;99(6):E1031-4. Doi: 10.1210/jc.2013-4360 https://www.ncbi.nlm.nih.gov/pubmed/24601693

Biographical info

Sue – Semi-curmudgeon, gleefully long-married, retired, Christian woman. Worn many hats: farmer, teacher, author, medical care worker. Spent >10 years overseas. My goal is to inform others about topics that I am interested in and have thoroughly researched, so that they can be informed and make appropriate choices.