“Insidious Hypothyroidism” is pandemic. To prevent it, the following supplements are recommended — Collagen, Vitamin D3, α-GPC, Shell Ginger, Omega 3 Unsaturated Fatty Acid, Selenium, zinc, manganese, vitamin B.

You may suffer from one of the 4 types of “Insidious Hypothyroidism” — “Hidden Hypothyroidism”, “Overlooked Hypothyroidism”, “Subclinical Hypothyroidism”, and “Estrogenic Hypothyroidism”.

It was 1986 when I traveled in Ethiopia, I saw a lot of women who had goiter (a swelling of the neck or larynx resulting from enlargement of the thyroid gland). Probably it was due to lack of iodine from seaweed because Ethiopia doesn’t have sea. Since then I have been intrigued by thyroid problems. And recently I realized that really many people are suffering from thyroid problems insidiously.

1) What is Insidious Hypothyroidism?

In last 30 years, the body temperature especially of female has often been found to be lowered to less than or equal to 36°Celsius (96.8°Fahrenheit). The lower body temperature is the source of many kinds of diseases.

Common to these people are fatigue, sluggishness, depression, constipation, increased sensitivity to cold, slow pulse, poor concentration, forgetfulness, memory lapses, dry skin, hair loss, coarse hair, brittle nails, a puffy face, unexplained weight gain, joint pain and stiffness, muscle weakness, enlargement of the tongue, excessive or prolonged menstrual bleeding, erectile dysfunction, and so on. They are having some of these symptoms at the same time.

These modern malaise symptoms are often caused by decreased function of the thyroid. Usually doctors check TSH (Thyroid-Stimulating Hormone), T3 (Triiodothyronine), and T4 (Tetraiodothyronine or Thyroxine). And often three of them are “Within Normal Range”. Therefore doctors think the patients are free from thyroid problems.

T3, T4 and rT3 are the three types of thyroid hormones. T3 has stronger activity to that of T4. rT3 is the mirror image isomer of T3 and “r” indicates reverse. Its function is almost zero compared with that of T3. Thus, we consider T3 as the main thyroid hormone. But in normal blood analysis, rT3 is regarded as the same as T3, and the analysis comes up as T3, because ordinary check cannot distinguish rT3 from T3. Consequently the check reports “T3 + rT3” as total T3. So, even if “T3 + rT3” consists of “10% T3 + 90% rT3”, the result shows that the patient’s T3 is “Within Normal Range”.
But if rT3 is 90%, the thyroid function is very weak. Routine test, however, does not examine rT3. Moreover, TSH also comes to be normal in some cases. And doctors say to you, “Your thyroid function is OK”.

In addition, in some people even though T3, T4 and TSH levels are really normal, they might be suffering from chronic thyroiditis (Hashimoto’s disease), or contrary to it, Graves’ disease (hyperthyroidism), which can be detected after conducting tests for TgAb (anti-thyroglobulin antibody) and TPOAb (anti-thyroid peroxidase antibody). In other words, even if there are pathological lesions in the thyroid gland, the thyroid hormone levels seem to be maintained, masking the underlying problems. These two antibodies test are not carried out in ordinary, other than at the thyroid specialist clinics. So, if you have any suspicions about your thyroid, I recommend you to always consult the specialists and have these antibodies test done.

I call these medical conditions as “Hidden Hypothyroidism“. Females with family history of thyroid problems are most likely to get it. But it even occurs in male.

A male patient with psoriasis came to me. He was using a disposable hot patch in mid-summer. As a precaution, I recommended him to carry out echo and get his thyroid functions checked by a thyroid specialist.
The result showed his TSH slightly higher than the normal value, a symptom of mild Hashimoto’s disease, for which medications are not usually prescribed.
Psoriasis and Hashimoto’s disease are not directly related to each other. But he had been under observation of dermatologists for 10 years and the dermatologists didn’t notice that he was suffering from Hashimoto’s disease. Hypothyroidism is likely to be missed like this.

As hypothyroidism is relatively more common in women compared to that of men, it might be easily overlooked in men. So, there might be the more cases of “Overlooked Hypothyroidism” than women. In men, laryngeal prominence (the so-called Adam’s apple) is significant to that of women. Thus, the thyroid enlargement might have been mistaken for Adam’s apple in an unexpectedly high rate.

In this case of the patient with psoriasis, if T3 and T4 levels were normal, specialists would call it as “Subclinical Hypothyroidism“. Since TSH is very sensitive, the anomaly comes first to this hormone. This condition is pretty much popular, estimated to be 4% to 10% of the general population, and it is confirmed that the prevalence rate will be higher and will exceed 20% for elderly people. Regarding the necessity of treatment of “Subclinical Hypothyroidism”, there are guidelines, and doctors decide whether to treat or not by prescribed drugs based on the guidelines. In most cases, patients kept under observation and only in case of pregnant women or those women who try to have a baby, the treatment begins immediately.

We may have higher cases of Hidden Hypothyroidism, Overlooked Hypothyroidism, and Subclinical Hypothyroidism than we think.

If you are feeling depression or unexplained melancholia, you might be suffering from thyroid problems. So, better meet a thyroid specialist before moving to psychiatry and psychosomatic medicine. If you are diagnosed with Subclinical Hypothyroidism or mild Hashimoto’s disease or you are in border region of normal value, doctors tell you, ‘You don’t need any treatment now. Let’s see’.
Similarly, even if you have abnormal TgAb and TPOAb values but normal T3 and T4, then it is thought you don’t need any treatments. And probably your medical insurance doesn’t cover if you want to check more the slightest change in thyroid hormones. So, in order to get rid of the depressive mental symptoms, you may reluctantly go for psychiatric and psychosomatic medicine. But, of course, the antidepressants are never effective, because your problems are from thyroid, not mental. And doctors increase the dose of the drugs more and more and you will become intoxicated by the drugs themselves, and finally you would suffer from true psychosis by unnecessary drugs.

I saw this tragic case often.

2) Many factors attribute to insidious hypothyroidism.

In the United States, iodine has been added to salt. However, as too much of salt intake leads to high blood pressure, health conscious people tend to limit the salt intake, which in return leads to iodine deficiency.
Furthermore, fluorine is added for disinfection in tap water. Fluorine, belonging to the same halogen group, interferes with the absorption of iodine in body, causing further iodine deficiency. And generally American people don’t take sea weeds that contain lot of iodine. Thus, if you live in the United States, and do not eat sea foods, you might be at a risk of iodine deficiency.

Although being a vegetarian is generally good for health, if you like too much salad of cruciferous vegetables such as cauliflower, broccoli, cabbage, brussels sprouts etc., be cautions. These vegetables contain “Goitrogens” that interfere with iodine uptake in the thyroid gland. “Goiter” refers to the abnormal enlargement of the thyroid gland.

And because indole-3-carbinol, which is found at relatively high levels in cruciferous vegetables, is said to be effective to prevent breast cancer and prostate cancer (and lupus), some health conscious people eat these vegetables too much without knowing the danger of the adverse effect against the thyroid.

And people think any soy products are healthy. But if soy is not fermented, it can be hazardous to the thyroid, if taken too much. Many mothers feed soy milk to babies who have allergies to normal milk. Please search for “Soy Thyroid” in Google. You would read, drinking soy milk sometimes is good for health but when it comes to everyday, it might be dangerous.

In addition to this indiscreet soy intake, some people are taking vitamin C supplement too much. Recently, I saw a young girl nibbling on vitamin C tablets with crunching sound as if she was eating a cookie. This is very dangerous. In my 38 years of experience as a general physician, I understand vitamin C is certainly an important vitamin. However, it has been found recently that excess intake might lead to serious problems. Excess intake of vitamin C supplement lowers zinc and manganese level. And it inhibits the uptake of inorganic selenium. Zinc, manganese, and selenium are essential for the thyroid. So, if possible it is better to get vitamin C from food source rather than taking supplements recklessly.
Zinc is required for healthy T3 receptors in your cells so even if you have enough T3, it won’t work optimally if you are deficient in Zinc.

Manganese is a vital component of the antioxidant enzyme called “MnSOD” (manganese-dependent superoxide dismutase). On liver cell membranes most T4 convert to T3, and there MnSOD is required to reduce oxidant stress.

Selenium is a vital component of the antioxidant enzyme “glutathione peroxidase” that has 8 isozymes. And 4 of the isozymes have selenium. Therefore to reduce H2O2 selenium plays a pivotal role. And selenium is essential to the 3 important enzymes to activate and deactivate T4 — iodothyronine de-iodinases, types I, II, and III (known as IDI, IDII, and IDIII). All of these enzymes require selenium to function.

Humans and chimpanzees cannot make vitamin C in their liver as they lack gulonolactone oxidase. However, other mammals such as dogs, cats, lions etc. can synthesize vitamin C in their liver by this enzyme. That’s why we don’t see a lion eating oranges. As we cannot synthesize vitamin C inherently, we compensate it from the food sources.
If vitamin C is so important, why did humans and chimpanzees lose the ability to synthesize vitamin C in the body? From the evolutionary point of view, they should still have been equipped with it. Because the more evolved species should have the more perfect physiological functions. Some scientists feel that this is one of the defects of Darwin’s theory of evolution.

But if excess vitamin C might give negative influence to the development of intelligence, we could understand why humans and chimpanzees have thrown away the genes encoding gulonolactose enzyme. If too much vitamin C interferes with absorption of the vital minerals such as zinc, manganese, and selenium, it hinders the thyroid gland from proper functioning and consequently the brain would not develop fully.

Both the soy products and supplements of vitamin C, looking like a healthy combination at first glance, probably affect the thyroid gland adversely if taken excessively, resulting in lowered function of the thyroid gland.

3) Estrogenic Hypothyroidism

And ” Estrogen Dominance” complicates the problem of thyroid problems. If you are on hormone replacement therapy to alleviate your menopausal syndrome, sometimes estrogen is given slightly more than necessary because of insufficient medical follow-up. This extra estrogen increases the Thyroxine-Binding Globulin (TBG). TBG absorbs thyroid hormone flowing freely in bloodstream as it is a protein that can bind to thyroid hormone even in normal condition. This decreases the functional thyroid hormones in body. In this case, even if your thyroid function itself is OK, you would suffer from hypothyroidism.

And now our modern world itself has become “Estrogen Dominant” due to endocrine disrupters, or environmental hormones. One of the typical instances is dioxin. This is a very troublesome substance that is produced when burning vinyl chloride or vinylidene chloride which is used anywhere and once it is taken into the body it hardly goes out. Previously it was thought that the influence of dioxin is related only to the occurrence of cancer and neonatal malformation. But the subsequent studies have elucidated that this evil substance also acts like estrogen. It works in units of picogram(=10-12g). Rather difficult for us to grasp this so minute unit. But image of one droplet of dropper in the 50 meter pool makes us understand easily the relationship of this substance and our environment.
However, environmental hormone is not only dioxin, but it is also contained in insecticides, industrial wastes, automobile exhaust gases, soaps and shampoos, nail polish, paints of furniture and building materials. Moreover, most of it shows estrogenic effects in units of one trillionth to one billionth gram. In other words, we live in the ocean of estrogen from childhood, or more precisely, we are exposed to excessive estrogen from the time of fetus.

In addition, estrogen enters our body from foods. Please check especially beef. If the cow is brought up by being fed hormones, the beef might contain much estrogen.

And obesity causes “Estrogen Dominance”. We are living in “Obesogenic Society”. Too much sugar intake, too much fat consumption, less mobility by cars, sedentary lifestyle in front of computer are big factors of “Obese Genesis”. Now we have more fat cells, exactly speaking, white adipose (fat) cells than before. In the white adipose cells androstenedione is converted to estrogen (androstenedione–> estrone–> estradiol–> estriol).
Consequently both women and men are confronting increased Thyroxine-Binding Globulin (TBG), which may cause very mild hypothyroidism with apparently normal level of T3 and T4.

And if your liver function is weak due to excess intake of alcohol, or fatty liver, estrogen cannot be well metabolized in the liver. This induces “Estrogen Dominance”, too, in our body.

Nowadays, in our “Estrogen Dominant” world, we may suffer from very mild hypothyroidism without noticing. About 1 in 20 people may be suffering from this Estrogenic Hypothyroidism despite thyroid hormones themselves being fully secreted.

4) Problem of how to interpret blood analysis.

For example, your blood test result for FT4 shows a value of 0.81 ng/ml. Reference value for FT4 is 0.80 to 1.6 ng/ml. In this case, 0.81 is within the reference value, and your thyroid function is regarded as normal. However, if the result is 0.79, as it falls short of reference value, this case is treated as hypothyroidism. Where on earth is so much difference between 0.79 and 0.81? Depending on the physical condition of the body, the numbers might fluctuate between 0.79 and 0.81 in the same person. These kinds of factors are not considered at all during inspections as just the numbers are considered.
As a result, thyroid function seems to be apparently normal and if your mood is heavy and depressive, doctors recommend you to go for psychosomatic medicine or psychiatry. This can be disastrous in particular if it is diagnosed as depression. Many doctors like to prescribe anti-depressants (as it increases the revenue) , but it ruins the patient’s life.

Even in your 50’s, 60’s, as far as you are healthy, you can recover from most of the fatigue after good sleep. However, if you suddenly start feeling abnormal fatigue when you wake up after a good sleep, please consider the possibility of hypothyroidism.

Please measure your body temperature every morning after you get off your bed. You can use an ordinary thermometer. The cut off temperature should be 36.2°Celsius (97.16°Fahrenheit) in armpit. If your thermometer shows less than 36 degrees, there is a high possibility of hypothyroidism. (Please pay attention. Use at least two thermometers for measurement as even two thermometers bought from the same place at the same time may differ by as much as 0.5 degrees.)

ALP↓+ Cholesterol↑ ≒ Hypothyroidism ?
Another easy way to find a decrease in your thyroid function. In medical examination a routine blood test is carried out to check liver function and cholesterol. The resulting values of ALP and cholesterol level can be used for analysis.

ALP (alkaline phosphatase); It shows abnormal values when abnormalities of gall bladder / bile duct/ liver system, bone metabolism etc. occur. In many cases, attention is urged when it is higher than normal value, comments such as requiring precise examination of the liver and the gall bladder or bone following general medical examination. However, when it shows a low value, it is easy to be neglected. Because, except zinc or magnesium deficiency (e.g. alcoholism), ALP shows lower values only when you are suffering from “hypothyroidism”, or “hereditary hypophosphatasia”. The latter is a very rare disease that occurs only to about one in 100,000 people.

Cholesterol ; Hypothyroidism reduces the synthesis of bile acids from cholesterol in the liver. This results in increased blood cholesterol.

If the decrease in ALP level and rise in cholesterol level happen at the same time, it will be smart to visit a clinic keeping hypothyroidism in mind and get it scrutinized.

Here we take a specific case:

45 Years old Woman
ALP 87U/L (reference value: 104-338)
Total Cholesterol 272mg/ dl (reference value: 150-219)
HDL Cholesterol 125mg/dl (reference value: 40 to 90)

Main complaints of this patient are obesity, serious forgetfulness, fatigue, and hair loss. Doctor seemed indifferent to thyroid gland. Thus the thyroid hormone test was not done. As other numerical values were normal, she had been recommended to take anti-hyperlipidemic agents based on above test results. Since the symptoms did not go away, she went to another hospital and found out that she was suffering from mild Hashimoto’s disease.

Everyone should look again at the blood test result of medical examination taken last year. And if “ALP ↓+ Cholesterol ↑” with fatigue, sluggishness, constipation, slow pulse, poor concentration, obese even after exercising, puffy face, missing eyebrows, stiff hair, dry skin, ED (male), menstruation irregularities (female), you might have considerable probability of hypothyroidism.

If you took statin drugs such as pravastatin, simvastatin, atorvastatin, fluvastatin, etc. to reduce cholesterol before you check your thyroid function, it would make the problem much worse. Because the side effects of statin drugs include muscle weakness and memory lapses. Then, you and your doctors cannot know which is the true cause for these symptoms, hypothyroidism or side effect of statin.

* When ALP is higher than normal range, you should check not only the liver and the gallbladder but also the bone. ALP has 6 isozymes (ALP1~ALP6), and if ALP3 is too high, you may suffer from hyperthyroidism or hyperparathyroidism. Please do visit thyroid and parathyroid specialists.

5) Treatment of Insidious Hypothyroidism

If your doctor tells you to take medical drugs such as Levothyroxine(Thyradin) , please take it, because your thyroid function has already got reduced very much. This is not insidious. Rather overt, and without medication your health is in jeopardy.

If your doctor says to you, “You don’t need any treatment now. Let’s see”. But you suffer from fatigue without any reasons, serious constipation, chilling, high cholesterol level, slow pulse, poor concentration, forgetfulness, obese, coarse hair, increased gray hair, irregular menstruation (female), ED (male), depression, etc., take the following supplements ;

a) α-GPC (L-Alpha glycerylphosphorylcholine)
This is one of choline derivatives mainly contained in the brain and the retina. This substance passes through the blood brain barrier and increases the neurotransmitter acetylcholine. It also encourages the secretion of growth hormone. Growth hormone promotes the conversion of T4 to T3 in the various tissues such as liver, bone, muscle, etc. Since T3 has the strongest effect, this conversion is very important.
As it is contained very much in mother milk, as you can see, it is a very safe substance. So, this is a supplement to take. In addition, it has been confirmed that α-GPC also increases memory and cognitive ability.

b) Fermented Leaves of Shall Ginger
Shell Ginger (Alpinia zerumbet), which is a perennial plant of the ginger family. But Shell Ginger is not the same as ordinary ginger.
In Japan Shell Ginger grows especially in Okinawa where its climate is subtropical. In detail, please read ; http://en.drmakise.com/shellginger/
For thyroid problems, Ferulic Acid (FA) in shell ginger is very important. FA prevents deterioration of thyroid function

c) Vitamin D
This vitamin is initially taken into the body as some cholesterol (7 – dehydrocholesterol) from diet. Ultraviolet rays convert it into vitamin D3 on the skin.
And in the liver it is metabolized to 25-hydroxyvitamin D3, and finally in the kidney it becomes 1,25-dihydroxyvitamin D3. This last form of vitamin D3 exerts its work. It is estimated that a lot of people lack vitamin D3 nowadays.
Lack of D3 influences the secretion of TSH from the front lobe of the pituitary gland adversely. And insufficient vitamin D itself disturbs immune system and reduces the function of the thyroid gland.

d) Omega 3 Unsaturated Fatty Acid
Flaxseed Oil, Perilla Oil, Sacha Inch Oil contain lot of Omega 3 Unsaturated Fatty Acid, α-linolenic acid, from which benign eicosanoids are metabolized. In detail, please read

Benign eicosanoids are very important to cure inflammation. Hashomoto’s thyroiditis is inflammation as you see the suffix – “itis” which means inflammation. Hepatitis, Colitis, Appendicitis, Pancreatitis, Encephalitis, —.
Contrary to α-linolenic acid, linoleic acid is eventually metabolized to malignant eicosanoids that aggravate inflammation. Safflower Oil, Sunflower Oil, Sesame Oil, Soybean Oil, Corn Oil, Cottonseed Oil, Peanut Oil, Wheat Germ Oil, Evening Primrose Oil, Grape Seed Oil contain lot of linoleic acid. That’s why you should not take these oils too much.
Although Fish Oil contains Omega 3 Unsaturated Fatty Acid a lot, if it is from fish from deep sea, please be careful of its quality. Because bad ones may contain noxious heavy metals that cause thyroid problem.

e) Selenium is also very important. And its supplement is cheap. But be careful not to take it too much. Zinc and manganese are the same. Essential, but not too much intake.
In Japan, I don’t recommend my patients to take them from supplements, because usually Japanese cuisine has enough of them. But I don’t know how about in foreign countries. It depends upon the soil where the materials grow. I heard that Brazilian nuts contain lot of selenium. So, if you are living in Brazil, you may not need to take selenium supplement.

f) Collagen
Thyroid hormones are produced in the follicular epithelial cells of the thyroid gland.
Sufficient collagen is necessary to let these cells work properly.

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