CHAPTER 1:
THE HISTORY AND EVOLUTION
OF THYROID HORMONE
REPLACEMENT
“Beware of false knowledge; it is more
dangerous than ignorance.”
~ George Bernard Shaw
Fatigue. Depression. Brain fog. Muscle and joint aches. Weight gain. Cold hands and feet. Sleep problems. Low sex drive. Hair loss. Elevated cholesterol. Do any of these symptoms sound familiar? They are actually some of the most common health complaints that plague us today. And billions of dollars – and countless hours – are spent seeking effective treatments and solutions.
The media bombards us with advertisements for products, procedures, plans, nutraceuticals, and pharmaceuticals, all designed to address these issues separately. Pillows, mattresses, sound machines, and more supplements and pills promise to put us to sleep. Energy drinks, triple espressos, and pricey drugs promise to wake us up and keep us awake. “Experts” hawk overpriced miracle supplements, diet programs, and exercise fads to help us lose weight.
And let’s not forget the widely-prescribed – and highly profitable – statin drugs to lower cholesterol. (More than a few internists over the years have told me that high cholesterol is so prevalent that “statins should be added to the water supply!”)
Wouldn’t it be amazing if we could find an easier way to fix these symptoms by identifying the root cause and using that information to create an inexpensive and effective solution?
That’s why, after decades in medical practice, I am passionate about encouraging practitioners and patients to revisit the metabolic control center of the body – the thyroid gland– to understand why these symptoms are so rampant and learn how to resolve them efficiently!
THE FUNCTION OF THYROID HORMONE
The thyroid gland produces thyroid hormones, whose function is to regulate the metabolic rates of all mammals, including humans. A healthy human or animal thyroid gland produces several hormones, but two are key: thyroxine and triiodothyronine.
The majority of thyroid hormone produced is thyroxine, abbreviated as T4, to indicate that it contains four atoms of iodine. Some consider T4 to be a precursor or storage hormone, and allegedly it has no functional role apart from being converted in the body to T3, which contains only three atoms of iodine. T3 is considered the “active” form of thyroid hormone, and its job is to help activate or drive the various functions within every cell, tissue, gland, and organ system in the body. As noted, most of the T3 in the body is derived from converting T4 into T3, but some T3 is produced and released by a functioning thyroid gland. I’m not entirely convinced that T4 is not an active hormone in the cells, but this is all just theory and is, therefore, not crucial to this discussion.
To help people understand the role of these thyroid hormones, I like to describe them as the “operating system” of the human computer. Your computer needs the “Windows” operating system to run programs like Word or Excel. Similarly, in the body, we require sufficient and functional levels of thyroid hormones as our operating system so that all our individual “programs” – like respiration, digestion, cognition, and such – can run. When we don’t have enough thyroid hormone function – a condition known as hypothyroidism – it’s like trying to run your computer with a corrupted operating system. Programs get glitchy and don’t work well or at all. Instead, your computer body becomes sluggish.
With hypothyroidism, everything slows down, and all our physiologic processes don’t work smoothly. The result? Typically, people who are hypothyroid experience fatigue, depression, brain fog, muscle and joint aches, weight gain, cold hands and feet, sleep problems, low sex drive, hair loss, and elevated cholesterol…and many other symptoms. Again…sound familiar?
There is an effective way to address these issues. But that knowledge has been relegated to the past for the most part. Why, you ask? Perhaps it’s because so many people and corporations (pharmaceutical and non-pharmaceutical) make money selling promises and solutions, and they have a vested interest in keeping it that way. (Ka-ching!)
THE CLASSIC APPROACH TO DIAGNOSING
HYPOTHYROIDISM: IDENTIFYING LOW
METABOLISM
Going back to the early 20th century, the knowledge of how to diagnose and treat hypothyroidism started with physicians who had a basic knowledge of the natural function of thyroid hormone in the human body. Those were the days when doctors touched patients instead of focusing primarily on their electronic medical records iPads. A physician took a detailed history, asking about symptoms like fatigue, weight gain, cold intolerance, hair loss, depression, and brain fog. A physical examination was also essential. The physician would test reflexes, note a patient’s weight and blood pressure, assess the dryness of the skin, evaluate for hair loss, look for puffiness around the eyes and in the hands and feet, and take basal temperatures. After a detailed discussion, careful evaluation of clinical signs, and knowledge of normal human physiology, doctors could make a clinical diagnosis of low metabolism due to thyroid dysfunction and determine that hypothyroidism was the root cause of their patient’s symptoms.
This classic approach to diagnosing hypothyroidism served generations of patients and physicians for the first half of the 20th century.
THE CLASSIC APPROACH TO TREATING
HYPOTHYROIDISM: CLINICAL WELLNESS AS A
GOAL
Since thyroid hormone controls each individual’s metabolic rate, it was concluded that thyroid function was inadequate when clinical signs suggested a low metabolic rate. To improve those patients' health, their physicians logically sought to treat them with thyroid hormone replacement, i.e., replacing what was clearly missing based on their physical assessment of their patient. And the goal of treatment was to normalize the metabolism of the individual being treated and relieve all the symptoms of hypothyroidism that were present in each patient.
This was accomplished by starting the patient on a low dose of thyroid hormone replacement. After prescribing a starting dose, the physician carefully adjusted that dose upward – a process called “titration” – until most or all of the patient’s symptoms were resolved, without unwanted side effects from overmedication. Back in those days, the dose was usually given three times a day, as many patients found that the efficacy of each dose waned after about 8 to 10 hours.
The dose that relieved the most symptoms and caused no adverse effects was considered the “optimal” dose for each patient. Since the optimal dose of thyroid hormone for each patient varied significantly, a “one size fits all” approach was not recommended. Instead, doctors titrated each patient’s dose to find the optimal dose.
Later, as blood tests became available around the 1950s, some doctors added a serum cholesterol level as an indirect measure of thyroid function that could help confirm their diagnosis. They knew back then that thyroid function, to a large extent, determined cholesterol levels. When thyroid function was low, cholesterol was usually elevated. And once doctors found the optimal dose of thyroid, they would measure cholesterol again to ensure it had also normalized, which confirmed to them that their dose was indeed adequate.
The bottom line is this: For many decades, physicians – using good old-fashioned logic and reasoning – looked for signs and symptoms of low metabolism and hypothyroidism in order to make a diagnosis. They treated patients with thyroid hormone replacement until hypothyroidism symptoms were safely and satisfactorily resolved and patients felt well! (These patients didn’t require a pharmacy full of drugs to treat multiple symptoms. Imagine that!)
THE CLASSIC THYROID HORMONE
REPLACEMENT DRUG: ARMOUR THYROID
Thyroid hormone replacement underwent an evolution starting in the late 1800s, when early pioneers like G.R. Murray started administering injections of sheep thyroid extract – which contained natural forms of both T4 and T3 – to their patients.
Doctors soon discovered that oral preparations of animal thyroid extract were also effective, making cumbersome and expensive injections obsolete. The science evolved, and it turned out that porcine (pig) thyroid was even more effective. It was also very inexpensive, as the thyroid glands of pigs were a readily available and otherwise useless by-product of the meat packing industry. The glands were dried (desiccated) into a powder and processed into pills that became a very inexpensive and effective treatment for hypothyroid patients.
Enter Armour and Company, which in 1900 was the largest meat packing company in America. With a near monopoly on porcine thyroid glands, they began manufacturing Armour Thyroid and became the dominant manufacturer of natural desiccated thyroid – also known as NDT – for decades. Over the years, Armour Thyroid went through various owners, but the name stuck. Since the launch of Armour, other brands of NDT – including Westhroid, Nature-Throid, WP Thyroid, and, most recently, NP Thyroid – came onto the...