Thyroid for Dummies (34 page)

The muscles of a person with subclinical hypothyroidism show abnormal energy metabolism that leads to early fatigue; this is also corrected with thyroid hormone. The ability of blood vessels to open up to allow more blood flow is also impaired. This fact is further evidence of the need for treatment, particularly before the condition worsens.

Exercising with hyperthyroidism

If you have hyperthyroidism, your heart rate and the amount of blood pumped per heartbeat are both elevated when you are resting, but they do not respond to exercise in a normal fashion. After normal thyroid function is achieved through treatment, these abnormalities disappear.

Careful study of the hearts of people with hyperthyroidism shows that their resting heart rates are abnormally high, as are the frequent occurrences of abnormal heart rhythms. The size of the heart is increased as a result of abnormal thickening of the heart muscle.

With exercise, the hyperthyroid heart cannot increase its workload in the same way as a normal heart. The result is that someone with hyperthyroidism cannot exercise as long as he or she used to, and his or her peak level of exercise is reduced. This fact is true even in subclinical hyperthyroidism, where the TSH is suppressed below the normal range but the free T4 remains normal. When the beta-blocker drug propranolol is given to slow the heart rate, the person often feels an improvement in exercise capacity (although one of the possible side effects of beta-blockers is fatigue).

An older person with hyperthyroidism needs to be especially careful with exercise because older people have an increased risk of heart failure, and may experience abnormal heart rhythms (which may not improve even when the hyperthyroidism is brought under control). Chest pain can get worse as hyperthyroidism continues.

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energy to perform the same amount of work as healthy muscle. As a result, the muscle is fatigued much earlier.

Meeting your minimal exercise needs

While you are recovering from hypothyroidism or hyperthyroidism, you often can’t do much exercise and certainly not the amount necessary for good health. After you are cured, however, you want to get up to speed.

You want to do two types of exercise:

ߜ
Aerobic exercise:
To improve heart and lung function, and raise your healthy HDL-cholesterol level.

ߜ
Anaerobic exercise:
To strengthen muscles and increase stamina.

Any exercise that gets your heart beating faster for a sustained period is aerobic exercise. Doctors used to recommend a formula for determining the ideal heart rate during exercise: Subtract your age from 220, and your ideal heart rate is 60–75 per cent of that number. Now we know that many people can sustain aerobic exercise at higher heart rates. Perhaps the best way to know whether you’re meeting your exercise goal is to rank the activity like this: ߜ Very, very light

ߜ Very light

ߜ Fairly light

ߜ Somewhat hard

ߜ Very hard

ߜ Very, very hard

If you stay at the level of ‘somewhat hard’ while you get into shape, you are doing the right amount of aerobic exercise.

Aim to sustain aerobic exercise for 20 to 30 minutes every day. Despite the normal loss of exercise capacity with ageing, doing this amount helps you maximise what you have and may add significant time to your life.

Don’t forget to do muscle strengthening exercises as well. Using light weights of 10–15 pounds, three times a week, try three or four different exercises to work your arms and legs and strengthen your back.

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Introducing Leptin: The New

Hormone on the Block

Leptin,
which was first described in 1994, has an important role in normal thyroid function. A hormone made in fat cells, leptin plays a major role in regulating body weight. As your body fat goes up, the leptin in your body increases, as it’s made in fat cells.

When fasting, a person has a fall in T3 and TSH. This fall may result from a reduction in leptin levels as fat stores decline over time. In the future, the use of leptin may help to promote increased weight loss in obese individuals.

This section explains the brief history of our knowledge of leptin and what we know so far about its relationship with thyroid hormone.

Understanding the functions of leptin

A certain strain of obese rats has a genetic mutation that means they can’t make leptin. When these rats are given leptin, they reduce their food intake, lose weight, and bounce around with increased energy levels. The same thing happens when leptin is given to normal-weight mice – they lose fat mass.

Not surprisingly, scientists then looked for leptin in human beings and discovered it, hailing the gene that codes for it in our DNA as the obesity gene.

Unfortunately, giving humans injections of leptin doesn’t lead to substantial weight loss.

Human obesity is not usually the result of a genetic mutation in the leptin gene. However, several families do have a mutation of the leptin gene that leads to severe obesity at a young age. This gene is a recessive trait, meaning that family members with only one abnormal leptin gene instead of two do not show the disease. When people with the disease are given leptin, they experience significant weight loss and the reversal of metabolic abnormalities.

Further studies show that leptin is doing more than just signalling the body that it has too much fat. When researchers compare body-fat percentages and leptin levels in women and men, women are found to have leptin levels that are as much as two to three times higher than in men. But even though women typically have more fat mass than men, this factor does not fully explain the difference. Scientists now know that the female sex hormone, oestrogen, stimulates leptin production, while the male sex hormone, testosterone, suppresses leptin.

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Researchers also know that girls go into puberty when they reach a certain weight. Puberty begins when a hormone from the hypothalamus, a part of the brain, is made for the first time. This hormone is called
gonadotrophin-releasing hormone (GnRH)
. What signals the release of GnRH? You’ve guessed it – leptin is now known to trigger puberty as it provides a sure sign that the fat mass is sufficient for puberty to begin.

Interacting with thyroid hormone

Leptin also interacts with several other hormones in the body, especially insulin, which appears to have an important place in regulating leptin secretion. Leptin interacts with the adrenal glands and growth hormone as well.

Because thyroid hormone increases the metabolic rate and increases body temperature, researchers thought that leptin (which also regulates metabolism and body temperature) might interact with thyroid hormone.

Leptin is now known to help regulate the part of the brain that releases thyrotrophin-releasing hormone (TRH), and to regulate the release of thyroid-stimulating hormone (TSH). When a person fasts, both their thyroid hormone and leptin concentrations fall. If leptin is given to the fasting individual, their TSH and the T4 hormone return to normal.

On the other hand, thyroid hormone also controls leptin production to some extent. In animals without thyroids, leptin concentration is increased, but when thyroid hormone is replaced, leptin levels are suppressed. Understanding of the role of leptin is at an early stage and its full role in thyroid disease is still not clear; stay tuned.

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Chapter 16

Helping Yourself: Herbs

and Homeopathy

In This Chapter

ᮣ Using complementary medicine

ᮣ Finding a therapist

ᮣ Treating thyroid problems with herbs

ᮣ Combating thyroid problems with homeopathic remedies Complementary medicine is now mainstream, and most supermarkets and pharmacies sell homeopathic and herbal remedies, not just health food shops. Many orthodox doctors now suggest complementary remedies to their patients, such as glucosamine sulphate for arthritis and St John’s wort for depression. Few suggest remedies to help thyroid problems, however. This reason is primarily because research has not yet looked into their effectiveness. But lack of evidence of effectiveness is not the same as evidence of lack of efficacy. Mostly, the research is unavailable because it’s not worth anyone’s while to fund it. As a result, many remedies traditionally used to treat thyroid problems are based on years of anecdotal evidence of their benefit, rather than scientific studies. The use of some remedies is also based on common sense, in that they are good sources of iodine, or have a calming action.

Although herbal remedies are not yet available on the National Health Service (NHS), you can obtain an NHS prescription for homeopathic remedies, assuming that you consult an NHS general practitioner (GP) who is trained in this method. The NHS also funds five homeopathic hospitals in the United Kingdom.

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Finding a Reputable Practitioner

A variety of healers practise herbal medicine and/or homeopathy including homeopaths, naturopaths, chiropractors, osteopaths, herbalists, dentists, acupuncturists, and even GPs. Experience and training vary widely, however, and selecting a therapist who carries professional indemnity insurance is important. To find an accredited medical herbalist, contact the National Institute of Medical Herbalists at www.nimh.org.uk. You can also search www.irch.org, the International Register of Consultant Herbalists and Homeopaths.

You are entitled to homeopathic treatment on the NHS, and if your doctor decides that it’s appropriate, he can refer you to an NHS doctor at one of the five NHS homeopathic hospitals, or at an NHS homeopathic clinic. If your doctor refuses to refer you, ask him to discuss their reasons and to explain why they do not feel the treatment is appropriate. You can then request a second opinion. The British Homeopathic Association publish a useful guide called ‘How to get Homeopathic Treatment on the NHS’, which you can request by phone on 0870 444 3950, Email: [email protected] or by visiting www.trusthomeopathy.org, the Association’s Web site.

Homeopathic remedies prescribed by a medically trained homeopathic doctor on a normal NHS prescription form are dispensed at homeopathic pharmacies for the usual prescription charge or exemptions. You can also consult a private homeopathic practitioner. To find an accredited homeopath visit www.

trusthomeopathy.org, the Web site of the Faculty of Homeopathy.

You can also search www.irch.org, the Web site ofthe International Register of Consultant Herbalists and Homeopaths.

If you decide to consult a complementary practitioner, ask them the following questions before committing yourself to an appointment: ߜ Where did you study?

ߜ What are your qualifications?

ߜ What is your experience in treating thyroid problems?

ߜ What does treatment consist of?

ߜ What benefits can I expect from your treatment?

ߜ How long does your treatment last?

ߜ How much does it cost?

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with a pharmacist for any interactions between the conventional drugs you are taking and any herbal remedies your therapist suggests you start taking.

Digging into Medicinal Herbs

Herbal medicine uses different parts of different plants – leaves, roots, bark, sap, fruit, seeds, or flowers – for medicinal purposes. Herbs are either eaten in their natural form, or dried and ground to produce a powder that’s made into a watery infusion (tea or
tisane
), an alcoholic solution (
tincture
), or packed as raw powder into tablets/capsules. Increasingly, active ingredients are extracted using a solvent, which is then removed to produce a more concentrated extract used to make tablets or capsules.

Solid extracts are described according to their concentration so that, for example, a 10:1 extract means ten parts (for example 10 grams) of raw herb was used to make one part (in this example 1 gram) of final extract. Although it seems logical that more concentrated herbal extracts have a more powerful action, this is not always the case. Sometimes, active ingredients evaporate away, so in fact the final concentrate is actually weaker. Because of this, you find selecting a standardised preparation, where possible, is better.

Standardisation means that each batch provides a standardised or consistent amount of selected active ingredients, and brings the same benefit.

Herbs used to treat thyroid problems generally fall into one of four main groups and either:

ߜ Help to normalise body functions, and help you adapt to different situations (and are known as
adaptogens
)

ߜ Are good sources of iodine

ߜ Have a calming action

ߜ Or, have an anti-inflammatory action

Medical herbalists often use one or more of the following herbs to treat thyroid problems. They are best used under medical supervision only.

Bladderwrack

Despite its name, bladderwrack (
Fucus vesiculosus)
is not for those with problems with their waterworks. Bladderwrack is a form of kelp seaweed that is named after its bulbous floatation devices. A rich source of iodine, 22_031727 ch16.qxp 9/6/06 10:47 PM Page 200