Lecture 7, September 10th - Dr

1INTEGRATED CLINICAL STUDIES – SEPTEMBER 8TH, 2008 DR. MICHAEL FRIEDMAN – THYROID AND ADRENAL LECTURE 7 TSH may increase when supplementing with iodine. Don’t worry, this is temporary. LV and KI convert T4 to T3 with 5’ diiodinase (Selenium and Zn = cofactors, also for thyroid peroxidase) TPO levels decrease with selenium (in Graves) Even pituitary, adipose tissue converts T4 to T3. Why is t3 not measured Reverse T3 is increased in times of stress. Slows down to preserve energy and metabolic rate. Will feel tired after loved one dies, military cadet training… If rT3 too high for too long, helpful to give T3 to eliminate rT3. T3 is the main test that Dr. Friedman orders. But will still treat if body temperature is low. Hashimotos and Graves: antibodies to thyroid peroxidase (TPO). One way of decreasing antibodies = Se (500700mcg/day) Maybe 1500mcg /day for Goldenrod for kidney problems: helps thyroid hormone conversion. Cortisol inhibits conversion of T4/T3 Low cortisol inhibits action of T3 on receptor site. (glycyrrhizic acid: increases cortisol, sarsparilla extract too Low cortisol? Person DOES NOT SWEAT. ESS: in emergency room situation. Get increase in rT3 IL-6 increased in times of infection, also inhibits T4-T3. Chronic infection in Epstein-Barr, CFS. Reset temp: iodine, blue flag, guggul, kelp, T2… Increases temperature again. Exercise also a great way to increase temperature. Decreased T3 function, seratonin levels go down (effect on MAOI) => depression! GH decreases too: see person at low metabolic rate, cold, low BP, Fibromyalgia? Increase metabolic rate! FIQ: Fibromyalgia impact questionnaire T3 and osteoporosis? One study found that total suppression of TSH caused more hip fractures in post-menopausal women. Supplement with 10,000 IU Vitamin D, other bone minerals T3 contraindications: Severe adrenal insufficiency: no cortisol – need this! Can increase with licorice When thyroid goes down, adrenal function goes down. Low metabolism (CFS), given heparin to thin blood. Blood so thick and sluggish, body can’t function well. Taking BCP? Lower levels of free hormones of T3/T4. Estrogen dominance can indirectly cause thyroid low function. Androgens will decrease levels of Thyroid binding hormone, more free hormone. WT3 therapy: just give until patient’s temperature gets back to normal. Study: N=11: when temperature was 98.6 (3 measurements per day, morning/afternoon/evening, take average over 3 days) The treatment used here was T3 ADRENAL LECTURE Adrenal glands = nerve tissue Chronically nervous/stressed? Repercussions on adrenal function. Primary: adrenal Secondary: pituitary Tertiary: hypothalamus ICS SEPTEMBER 10TH, 2008 – PAGE 1

Adrenal insufficiency: Very rarely seen by endocrinologists (MDs) What we see as AI, isn’t from their point of view. Secondary: pituitary problems. Pain behind eyes? This is unlikely. Will see many different organs affected, severe symptoms. IL-6 increases with age, inhibits conversion of T4 to T3. Hypothyroid? Adrenals will be affected. 3 phases of adrenal dysfunction: Alarm, resistance, exhaustion Long term excessive exercise: eg. Marathon runners (chronic) Hyperadrenocorticism Immune suppression occurs in chronic stress Can have bone loss Dysglycemia with chronic stress Body hair: low testosterone, but get androgen production, conversion to testosterone get hair and acne Aromatase converts testosterone to estrogen = estrogen dominance = less free T3 Stress decreases HCL secretion Melatonin and DHEA oppose high cortisol Ashwaganda: adaptogenic, but also nervine (calming, relaxing) Rauwolfia: helps with anxiety, calms people down, decreases catecholamines in brain. Exhaustion: tend to have hypoglycemia in this stage Nutraceuticals: can also give chromium, will be helpful DHEA: can’t give in Canada. Licorice: tonic. Good to give in adrenal exhaustion. CFS related to Epstein barr virus. Hep C as IV treatment. Low body temperature? Adrenal and thyroid support. (Magnesium citrate: only getting 15% of elemental magnesium) 1:1 = 1g : 1mL Licorice solid extract: a ‘goop’ that you take with a spoon. Wise woman herbals makes one. Case Study: low adrenal function Mustache was d/t DHEA. Best lab test for cortisol: doesn’t do much testing. More symptom based. Low body temperature and tired? Treat adrenals and thyroid. Tonic herbs!!! Salivary tests useful, not perfect. Also blood, urine. Cancer treated with adrenal/thyroid support Normal BP? Will give small amount of licorice extract (1/8 tsp) Tinctures in notes are 1:4 Contact Dr. Friedman: 1-800Can ask questions about anything related to endocrinology.

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