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