Improve Thyroid Health Lesson and Certification
Lesson Goal
To introduce and familiarize Members with the using Iodine and Basal Body Temperature to improve Thyroid Health and earn the Cureality Improve Thyroid Health Proficiency Award.
Learn the Essentials
Iodine: Essential trace mineral for thyroid health
Iodine is essential for health. Just as deficiency in vitamin C will lead to teeth falling out, open sores over the body, and eventually death, i.e., scurvy, so will iodine deficiency lead to disease. Simply meeting the Recommended Daily Allowance (RDA) of 150 mcg per day will keep goiter (enlarged thyroid from lack of iodine) from developing and maintain thyroid hormone production at a “normal” level for the majority of people. Because Americans increasingly avoid use of iodized salt, more people are developing iodine deficiency.
The connection between goiter and iodine deficiency established in 1916 led to the introduction of iodized salt in 1924 with FDA advice to use more salt. This led to health issues from excessive salt consumption in susceptible individuals observed in the latter half of the 20th century, followed by advice to reduce salt and sodium exposure. Fast-forward to the 21st century and many health-conscious people proudly declare their assiduous avoidance of salt, especially iodized table salt. Others have turned to alternative preparations of sodium chloride, such as sea salt (very little iodine content), Kosher salt (no iodine), and potassium chloride-based salt substitutes (no iodine). As a result, iodine deficiency and goiters are making a comeback.
If iodine is unavailable to the thyroid gland, production of thyroid hormones, T3 and T4 (the “3” and “4” referring to the number of iodine atoms per molecule of T3 and T4), begins to suffer, production drops, hypothyroidism ensues. Iodine deficiency over time leads to a thyroid gland that enlarges, or “hypertrophies,” an attempt to overcompensate by growing larger and better able to extract the little iodine available from the body. However, it is not necessary to have a goiter for thyroid dysfunction to develop.
Athletes and persons engaged in heavy physical effort lose considerably more iodine than other people through perspiration, increasing need for iodine. Vegetarians also have substantially greater likelihood of iodine deficiency than omnivorous people.
What is not clear is just how much iodine we all need for optimal health. Does alleviating goiter also mean that thyroid function is optimized? Goiter may simply represent the grossly visible manifestation of hypothyroidism. Is there an intake of iodine that can further improve thyroid function, even after goiter is reversed or suppressed?
To further complicate the situation, what is the quantity of iodine required in the presence of now ubiquitous environmental blockers of thyroid function and iodine, such as bromine (pesticides like polychlorinated biphenyls (PCBs), flame retardants like polybrominateddiphenyl ethers, brominated pool water); bisphenol A (from polycarbonate plastics, plastics with recycling code 7, microwaveable plastic, and the resin lining of canned foods); perchlorates (fertilizers, explosives in fireworks)?
All of these substances have been shown to block thyroid action; having sufficient iodine helps prevent these chemicals from entering thyroid tissue. How should this factor into our decisions on dose of iodine?
Simply adhering to the RDA of 150 mcg per day for adults or thereabouts is likely just enough for most people. Note that many multivitamins or multi-minerals contain the RDA for iodine. Obtaining iodine through the use of iodized salt is both unreliable and unhealthy, since salt increases blood pressure in the susceptible, causes fluid retention, and can accelerate osteoporosis. Iodine in salt is also inconsistent, poorly absorbed, and volatile (evaporating from the container within weeks of opening).
If there is any indication of hypothyroidism, then strong consideration should be given to an increase in iodine intake to the 500-1000 mcg (microgram, not milligram) per day range, preferably from an iodine supplement such as kelp tablets, a form that approximates the natural, ocean-derived source. Iodine is also available from health food stores as potassium iodide drops, capsules, and tablets. Also, note that there may be a mild increase in TSH for several months after iodine is initiated, only to drift back down over time.
Thyroid testing can suggest iodine deficiency by the pattern of a low free T4, e.g., at or below the “reference range,” along with a slightly-higher–than-optimal TSH of 2.5 mIU/L or greater. This is usually corrected after 3-6 months of iodine replacement if iodine deficiency is the cause, especially if any thyroid enlargement is present.
Keep in mind that, if hypothyroidism or goiter is present, iodine intake may need to be individualized by your healthcare provider. Rarely, someone with hypothyroidism or goiter will develop abnormal thyroid responses to iodine. This occurs because of iodine deficiency present before correction distorts thyroid function; adding iodine can actually worsen the situation temporarily. Iodine replacement may therefore be best undertaken alongside monitoring of thyroid function by you and your health care provider. Alternatively, some people have success by increasing the dose of iodine gradually, e.g., starting at the RDA of 150 mcg per day, building up by 50-100 mcg increments gradually over 6 months until the desired dose, e.g., 500 mcg per day, is achieved. Anyone with a history of Hashimoto’s thyroiditis, Graves disease, thyroid cancer or thyroid nodules should also supplement iodine only under supervision of a knowledgeable healthcare provider (though, sadly, knowledgeable healthcare providers aware of all the issues surrounding iodine are quite rare).
Unfortunately, dose-escalating studies for iodine that track thyroid function have not been thoroughly explored. If the RDA for iodine of 150 mcg yields some improvement of thyroid measures, would 300 mcg, 600, 900, even 10,000 mcg further improve thyroid function or other aspects of health? Sadly, sufficient study has not yet been done to answer these questions.
Should we take a lesson from the Japanese, who, through their dietary reliance on seaweed (e.g., kelp, kombu, nori, etc.) and abundant seafood, have iodine intakes 30- to 100-fold higher (5,280-13,800 mcg per day) without excessive thyroid disease and reduced incidence of fibrocystic breast disease and breast cancer (Patrick 2008)? This is also unclear, though it suggests that much higher intakes of iodine are, for the majority, safe. It may even be preferable.
Do-it-yourself-at-home thyroid test: Basal body temperature
The regulation of body temperature - thermoregulation - is a reflection of the body’s capacity to adapt to the external environment and maintain body temperature within a narrow range. Deviations from the narrow range of body temperature suggest disruption of internal control. If it weren’t for our ability to regulate body temperature, we’d have to lie in the sun like snakes and crocodiles to control body temperature.
Should thermoregulation go haywire due to external influences that overwhelm it, trouble results. Anyone who has experienced a fever of 104º F or hypothermia from cold exposure knows that just a few degrees in either direction is distinctly unpleasant, even life-threatening.
What is normal body temperature? Recent analyses, as well as a comprehensive review of temperature data from studies from 1935 to the present, suggest that normal oral temperature ranges from 96.3º F/35.7º C to 99.9º/37.7º C. This differs from the 98.6º F/37.0º C often quoted as normal, a relic of 19th century observations on human temperatures.
Body temperature also undergoes a predictable circadian rhythm, with highest temperature of the daily 24-hour cycle at around 8 pm, lowest at around 4 am. It is the temperature low that is most reflective of thyroid status.
There is no question that the thyroid gland and thyroid hormones, T3 and T4, play a crucial role in temperature regulation. A principal sign of advanced hypothyroidism (high TSH, low thyroid hormone levels) is low body temperature, while hyperthyroidism (low TSH, high thyroid hormone levels) is associated with increased body temperatures. When can low temperature be attributed to hypothyroidism and not other causes? There are frustratingly few data that explore this relationship. While there is no dispute that low temperatures can accompany hypothyroidism, it is not clear how reliable an indicator it is, since the relationship has not been studied in a formal manner. In anecdotal experience in many clinical practices, however, low body temperature is commonly used to identify hypothyroidism.
We have used first-upon-arising oral temperatures in the Cureality program and they can indeed be useful. At a practical level, any first a.m. temperature (immediately upon arising) consistently less than 97.3º F or 36.0º C is suggestive of hypothyroidism; the lower the temperature, the more likely it represents hypothyroidism. A temperature of 94.7° F, for instance, is more strongly suggestive of hypothyroidism than a temperature of 97.1° F.
Followers of the experience of Dr. Broda Barnes adhere to his original belief that axillary (armpit) temperatures are the preferred method to assess body temperature. However, of the various ways to measure body temperature, axillary is the least reliable and the one most prone to inaccuracy. More so than other methods, axillary temperatures are subject to external ambient temperature, amount of clothing worn, sweating, whether right or left arm is used (since there is variation of up to 2.0° F degrees from right to left), the amount of cutaneous (skin) dilation or constriction of blood vessels. Axillary temperatures track internal (rectal) temperature poorly, with wide variation in the day-to-day and minute-to-minute fluctuations of temperature, and especially
marked divergence from rectal temperature in morning (temperature nadir) and evening (temperature peak) hours, with as much as 1.8-2.7º F/1.0-1.5º C variation within several minutes. Axillary temperatures are therefore too variable and unreliable for use in assessing thyroid status and should not be used.
Despite its uncertainties, temperature is still a useful tool to identify hypothyroidism, particularly when laboratory values like TSH, free T3, and free T4 are borderline or equivocal, or when symptoms are unusual or atypical. Low temperature may suggest low thyroid status even when all other measures, including TSH, are normal, but this is on more shaky ground scientifically. Temperature can also be useful to follow trends over time to gauge the adequacy of thyroid replacement.
There are several lessons to keep in mind if we are to use temperature to assess our body’s capacity for thermoregulation and thyroid status: - Normal immediately-upon-arising oral temperature is 97.3º F or 36.0º C.
- Oral temperatures are best used as a gauge of thyroid status alongside symptom assessment and thyroid laboratory evaluation that includes TSH, free T3, free T4, and perhaps reverse T3.
- Oral temperatures only should be used (unless internal temperatures are available). Oral temperatures track most truly to internal temperatures. Axillary temperatures do not track with internal temperatures and are subject to unacceptable variation and should not be used.
- Oral temperatures should be assessed immediately upon awakening without drinking water or other liquids or eating any food; alcoholic beverages should be avoided the evening prior. Temperature should not be assessed during calorie restriction, fasting, or a period of substantial sleep deprivation.
- The temperature nadir (bottom) usually occurs between 3 am and 6 am. If oral temperature is taken upon awakening at, say, 8 a.m., it will be higher than the true nadir. Waking temperatures later than 6 a.m. can be adjusted to the “6 a.m. equivalent” by subtracting 0.18° F/0.1° C for every hour after 6 a.m.
- Menstruating females should take oral temperatures during the first 7 days after beginning menstrual bleeding during the follicular phase, the phase that does not show the exaggerated increase in temperature triggered by ovulation or progesterone.
Temperature represents a simple means to gauge metabolic rate and thereby thyroid status. It is another measure like blood pressure or blood sugar, a simple assessment you can perform on your own and track over time.
Key to minimizing disruption of thyroid health: Seize control of grains and sugars: The Cureality Diet
A cornerstone of the Cureality Diet, an absolute requirement for seizing full control over health, is to eliminate wheat products in all their forms—all breads, breakfast cereals, buns, bagels, pretzels, crackers, pancakes, waffles, muffins, pizza, etc., along with elimination of corn, oats, and sugars.
A connection between celiac disease (destruction of the small intestine due to the gluten protein of wheat) and various autoimmune diseases, including Hashimoto’s thyroiditis, has been established. An association with antibodies against the gliadin protein in wheat in people without celiac disease has also been established, with over 50% of people with Hashimoto’s thyroiditis demonstrating positive antigliadin antibodies. Note that the wheat protein, gliadin, has been implicated as the cause for abnormal intestinal leakiness, as well, the process that likely underlies many autoimmune conditions, including that involving the thyroid gland.
Although the gliadin protein in wheat likely is among the triggers of autoimmune thyroid inflammation, it is not clear how much improvement most people can expect in thyroid function with wheat/gluten/gliadin elimination, as the studies have not yet been performed. Efforts to monitor thyroid function are therefore recommended, especially if you are taking thyroid hormone replacement (e.g., levothyroxine, Armour thyroid, etc.) |
