The standard laboratory tests for diagnosing Thyroid Dysfunction are:

The Non-Conventional methods for diagnosing hypothyroidism include:

NOTE:  Download a Temperature Graph to use in recording Basal Body Temperature  Excel format PDF format

Basal Body Temperature: There are two schools of thought regarding Basal Body Temperature. The traditional school of thought developed by Dr. Broda Barnes advises taking the temperatures first thing in the morning. The newer school of thought developed by Dr. Dennis Wilson advises taking the temperature at intervals during the day. I often ask patients to do it both ways.

Dr. Broda Barnes method:

1. Obtain a basal thermometer. It is important to use a mercury thermometer and not a digital thermometer. Shake it down and put it by your bedside when you go to sleep.

2. Upon awakening and before arising place the thermometer in your axilla, (armpit) for 10 minutes. Do this for five days in a row.

3. In women, the temperature should be taken starting on the second day of menstruation. In mid cycle there is a typical rise in temperature with ovulation. In post-menopausal women and men the time of the month does not matter.

4. A normal temperature is considered to be between 97.8-98.2 degrees Fahrenheit. Temperatures below this range may suggest underactivity of the thyroid.

Dr. Bruce Rind's method:

1. Use a basal thermometer. It is important to use a specialized digital thermometer.

2. The temperature is taken under the tongue, not in the axilla. The temperature is taken 3 times per day for 3 consecutive days.

3. The first temperature is taken 3 hours after arising.

4. The second temperature is taken 3 hours after the first temperature.

5. The third temperature is taken 3 hours after the second temperature. Do a daily average of the 3 temperatures taken.

6. Menstruating women should avoid taking the temperatures in mid cycle when they are ovulating.

Body temperature as a means of diagnosing under-activity of the thyroid is controversial. It should be used in the context of a patient history, physical exam and laboratory testing.

A second method for looking at Thyroid Function that is outside mainstream medical practice is The 24 Hour Urine Collection for Free T3 and Free T4. This is the test favored by the Belgian Endocrinologist Dr. Thierry Hertoghe. He argues that a 24-hour collection gives a more accurate picture of the person’s thyroid hormone production than a spot serum measurement.

When I am evaluating a person for thyroid dysfunction I prefer to do all the tests in order to get the most complete picture possible. Remember, testing combined with history and physical exam is needed to make a diagnosis.

There are several issues regarding treatment of functional hypothyroidism.

• We need to establish whether there is an adequate production of T4 from the thyroid gland.

• We need to establish whether T4, (the pro-hormone), is being converted to T3, (the active hormone), in the thyroid and in the peripheral tissues.

• We need to establish whether there is tissue resistance to adequate amounts of thyroid hormone. This last idea is mostly speculation. Many physicians suspect that there can be thyroid hormone resistance just as there can be insulin resistance, (a pre-diabetic state).

Factors that may lead to Functional Hypothyroidism include:

1. Nutritional Deficiencies

1. Deficiencies in Vitamins; A, B2, E

2. Deficiencies in Trace Minerals; Iodine, Iron, Copper, Zinc, Selenium

3. Deficiencies in Essential Fatty Acids, (this is my speculation)

4. Protein/Calorie Malnutrition

5. Deficiencies in metabolic intermediates; NADH

2. Medications can inhibit thyroid production, reduce conversion of T3 to T4.  The dominant metabolic abnormality that can do this is Insulin Resistance.  Insulin resistance and its treatment can be reviewed in the Functional Basis of Health and Healing section.

3. Hormonal deficiencies may impair the conversion of T4 to T3. This is observed when the DHEA level is low. DHEA can be low for many reasons including Aging, Stress and Insulin Resistance. Dr. Bruce Rind describes a situation of functional Adrenal Insufficiency. This can account for a failure of the Basal Body Temperature to respond to thyroid supplementation.

4. Excess ingestion of certain foods may inhibit thyroid hormone production:  Cauliflower, Soy Products, High Protein Diets, and Excessive Iodine ingestion.

5. Medications can inhibit thyroid production, reduce conversion of T3 to T4, and  produce a relative resistance to thyroid hormone. This list includes but is not  limited to lithium, beta-blockers, anti-thyroid medications, antidepressants, antiseizure medications, anticoagulants, antiarrythmic agents and anti-inflammatory drugs.

6. Certain herbal products can inhibit thyroid function; Lithospermum, Lycopus, Melissa and some flavonoids.

7. Toxic agents that can adversely affect thyroid function are alcohol, tobacco, cadmium, mercury, cyanides, thiocyanates, phenols, coal derived pollutants, carbontetracholride, pesticides, herbicides, organochlorines.

8. Chronic Diseases involving other organs; Liver, Kidney, GI, Cardiovascular, Immune System, Rheumatologic, Neoplastic.

This list is daunting, but consideration of these issues may be important in dealing with a person with a refractory problem.

Thyroid Hormone Treatment Strategies:

The Conventional Medicine approach uses a synthetic T4. For many people this is perfectly adequate.

The advocates of the Dr. Broda Barnes method think that the animal glandular extract is a better form of replacement. They argue that the products in the extract provide a balanced supplementation that is more like our own natural glandular production. Many people feel better, (more energetic), with this form of supplementation. There is no objective evidence in the medical literature that one form is better than another.

Dr. Wilson’s approach is entirely different. He argues that the problem is the over- production of a product called reverse T3. Excess Reverse T3 blocks the thyroid receptors and inhibits production of Regular T3. He uses escalating doses of Slow-Release T3 to shut down the person’s own thyroid production and to reduce and halt the production of Reverse T3. He then tapers the Slow-Release T3 and allows the person’s own thyroid production to take over. His approach is intriguing. It has been beneficial for many patients. It has m ade other patients very ill.  It's safety is not well-established.  It is unproven by any scientific observational process. It is difficult for patients to adhere to the regimen. It is not a technique I recommend.

Dr. Bruce Rind has studied this issue and come to some interesting conclusions. He has observed that patients with the problem of “Low Metabolism” have a dominant symptom of fatigue and general low energy. They have difficulty accomplishing the daily activities of their lives. There are many possible causes for this phenomenon including chronic infections, intoxications, chronic stress, endocrine disorders and other chronic diseases. He believes that these underlying problems can create thyroid and or adrenal dysfunction or insufficiency. He has observe differences in patient history, physical exam and laboratory testing based on whether the individual has a problem that is predominately thyroid, adrenal or mixed. Most importantly, he has observed that patients with functional adrenal insufficiency do not respond to thyroid hormone either clinically or in terms of an improvement of their Basal Body Temperature. This has led him to a therapeutic process that addresses this sub group of patients. I believe his approach has merit and utilize it when managing patients with a “Low Metabolism” syndrome. Dr. Rind’s website is www.drrind.com.

Therapy must be individualized.  Monitoring on a regular basis is essential.

Functional Thyroid Hormone Therapy should be done with consideration of the interaction with other Endocrine Function such as Adrenal Function, (Cortisone & DHEA), and Pituitary Function, (Growth Hormone).  Please review these issues in the other chapters of this section.  


Practitioner Profile
 Dr. Warren Ross