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ADVERTORIAL Do you have an BY KENNETH N. WOLINER, M.D., A.B.F.M. Optimal Thyroid? “I have tried every diet known to man (or moms) these last few years – to no avail.” Alyson continued to tell me her story. “For example, this past summer, my best friend flew me to their home in Sonoma for an entire month. We ate nothing but organic everything, lean protein, I drank 150 ounce-plus of water a day and did a high intensity workout every morning mixing up interval training with boot camp at her gym. In exactly 30 days – I lost a grand total of THREE pounds. I didn’t even lose the initial ‘water weight’ everyone else loses.” I empathized, “It’s hard to stay motivated with minimal results.” “I’m willing to starve myself, if that would work. I even did two rounds of hCG. My wallet’s lighter, but that’s about it.” “The FDA recently published a website, www.fda.gov/hcgdiet, detailing how hCG diet products are illegal, and how restrictive diets such as that one can cause electrolyte disturbances, an irregular heartbeat and are potentially fatal.” I continued, “But looking at your diet history, I don’t think the problem is one of eating too much.” “Dr. Woliner, what else could it be? I have a friend that blew up taking Abilify for her depression, and another while on Actos for diabetes, but I’m not on any medications.” “It’s true that many drugs have weight gain as a common side effect [1]. But there are other causes of weight gain. With your other symptoms of cold intolerance, fatigue, and constipation, I’m thinking that you have an untreated thyroid condition [2].” “I begged my other doctors to treat me for that, but they all said no.” “Some doctors focus too much on lab tests without considering the patient’s history and physical exam findings [3]. Thyroid hormone resistance is more common than people realize.” Alyson sat with a puzzled look on her face. “So, even if these doctors said my tests were normal, I might still have a thyroid problem? [4]” “The word ‘normal’ has many meanings. There is a difference between ‘common’ and ‘optimal’ [5]. Rather than using a range that includes people who are overweight and being treated for high cholesterol and other conditions, perhaps it would be better to use narrower ranges of persons who feel ‘dandy’ [6].” “Does anyone even use that word anymore?” “My practice is built on patient-to-patient referrals. Just liking my bedside manner is not enough to convince your friends to see me. You have to glow. So yes, I do plan on making you feel dandy.” After finishing Alyson’s physical exam, my staff used our Korr indirect calorimetry machine to measure her metabolic rate [7]. “You’re at ‘minus 20%’. That’s one of slowest metabolism’s I’ve ever seen!” “How do we fix that?” “I use a holistic approach that combines behavior changes, diet, exercise, supplements, and of course medications [8,9]. I prefer to use T3 based drugs as they have been shown to cause significantly more weight loss than T4 drugs such as Synthroid alone [10].” As I ramped up Alyson’s dose of thyroid medication, her fatigue and other symptoms began to resolve. To be on the safe side, I periodically rechecked her EKG and bone density, which remained normal [11]. “Dr. Woliner, your scale says I only lost 49 pounds, but at home, naked, I’m down 51!” “ Thyroid hormone resistance is more common than people realize. “ REFERENCES: [1] Singh T. Aripiprazole-induced weight gain. Psychiatry (Edgmont). 2005 Jun;2(6):19. [2] de Moura Souza A, Sichieri R. Association between serum TSH concentration within the normal range and adiposity. Eur J Endocrinol. 2011 Jul;165(1):11-5. [3] Kalra S, Khandelwal SK. Why are our hypothyroid patients unhappy? Is tissue hypothyroidism the answer? Indian J Endocrinol Metab. 2011 Jul;15(Suppl 2):S95-8. [4] Dickey RA, Wartofsky L, Feld S. Optimal thyrotropin level: normal ranges and reference intervals are not equivalent. Thyroid. 2005 Sep;15(9):1035-9. [5] Gurnell M, Halsall DJ, Chatterjee VK. What should be done when thyroid function tests do not make sense? Clin Endocrinol (Oxf). 2011 Jun;74(6):673-8. [6] Shomon M. The Optimal Treatment for Hypothyroidism – Interview with Dr. Ken Woliner. http://thyroid.about.com. January 10, 2011. [7] Kim B. Thyroid hormone as a determinant of energy expenditure and the basal metabolic rate. Thyroid. 2008 Feb;18(2):141-4. [8] Singh P, et al. The impact of yoga upon female patients suffering from hypothyroidism. Complement Ther Clin Pract. 2011 Aug;17(3):132-4. [9] Schomburg L. Treating Hashimoto’s thyroiditis with selenium: no risks, just benefits? Thyroid. 2011 May;21(5):563-4. [10] Celi FS, et al. Metabolic effects of liothyronine therapy in hypothyroidism: a randomized, double-blind, crossover trial of liothyronine versus levothyroxine. J Clin Endocrinol Metab. 2011 Nov; 96(11): 3466-74. [11] Ricken R, et al. Long-term treatment with supraphysiological doses of thyroid hormone in affective disorders - effects on bone mineral density. J Affect Disord. 2012 Jan;136(1-2):e89-94. Dr. Kenneth Woliner is a board-certified family medicine physician in private practice in Boca Raton. He can be reached at: Holistic Family Medicine; 9325 Glades Road, #104, Boca Raton, FL 3343 ~ 561-314-0950 the PARKLANDER knw6@cornell.edu ; www.holisticfamilymed.com 89
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