The paper reads as follows (quote): “Between 5% and 7% of all older adults in the US report severe financial strain, defined as substantial difficulty meeting monthly needs.1 Severe financial strain among older adults is associated with lower medication adherence,2 which may negatively affect recovery for older adults following an acute myocardial infarction (AMI).** However, the relationships between financial strain and AMI outcomes for older adults have not been evaluated.
In this cohort study, we hypothesized severe financial strain would be associated with elevated mortality risk following an AMI.”
It continues: “After adjustment, severe financial strain was associated with a 61% increase in 180-day mortality risk compared with those with no strain. Moderate financial strain was not associated with mortality (HR, 1.04; 95% CI, 0.78-1.39). Feb 21, 2022″.
** My “take’ on this conundrum is that it has nothing to do with the patient’s failing to take pills: please see an explanation of the increased mortality in the text box, below.
BOTTOM LINE MESSAGE
When you have a heart attack, the shock, worry and stress of thinking about what has happened to your body is enough to raise your Cortisol.
High cortisol reduces Thyroid3 production inside all the cells in your body.
Most people feel Lucky and privileged, to have survived a heart attack; they are relieved and looking forward to full recovery, especially since the doctors who “saved them” seem to be doing an excellent job.
However if they have anything else to worry about (? the will, job, cash flow, kids ?), the total stress can raise cortisol production high enough to reduce the Thyroid3 in all the cells of the body to almost zero. Thus they go into Intracellular Hypothyroidism (IH).
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SHOULD OUR THYROID HORMONE TEST RANGES BE REVIEWED?
Currently, our “system” says that to figure out whether a person’s thyroid balance is satisfactory in terms of keeping our cells working at maximum efficiency, all we need to check is the Thyroid Stimulating Hormone (TSH). However TSH is a signal sent by the pituitary gland, to tell the thyroid how much T4 to make: the pituitary is merely ordering Thyroxine, to satisfy itself.
TSH HAS NOTHING TO DO WITH THE REST OF THE BODY!
There’s no point in this, if “normal” ranges aren’t accurate!
WHAT OUR MEDICAL SYSTEM IGNORES
Since Free T3 is rarely, and reverse T3 never, measured by family physicians and endocrinologists, they are unaware of the state of thyroid hormonal balance in the cells and organs. The body has no way of expressing its state of satisfaction with the availability of T3 within the cells. Therefore we don’t have a dedicated test for thyroid balance, other than FT3 /rT3, which Allopathic physicians it seems, have never heard of. However I just saw an excellent paper by Dr. Begonia Ruiz Nunez, a researcher in Holland – the first note recommending T3/rT3 I have seen on the web – she uses rT3/T3, but the diagnostic technique is essentially the same.
However we can differentiate between true and intracellular hyperthyroidism ourselves, with minimum civil disobedience: let’s look at Free T3 and reverse T3 results and figure it out!
METABOLISM OF THYROXINE, THE “T4” HORMONE
T4 is converted preferentially to T3 rather than rT3 (a small amount of rT3 is naturally produced).However, while TSH and FT4 are only minimally affected when Cortisol output rises due to fasting or any other stress, [1,2] T3 production falls and reverse T3 production is boosted. Therefore serum FT3 is reduced to a minimum, while rT3 increases.
Logical clinical conclusions when FT3 falls in response to stress
If rT3 goes up when T3 goes down, calculating the T3/rT3 and the ratio will provide a snapshot of the degree of abnormal processing of T4 to rT3. Functional/metabolic medicine practitioners have been utilizing this simple method to assess the state of intracellular Triiodothyronine for decades and it has been observed that hypothyroid symptoms occur when the FT3/rT3 ratio is less than 20.0. We differentiate this Metabolic aberration from true Hypothyroidism, applying a new diagnostic term: “Intracellular Hypothyroidism”. **
While Hypothyroid symptoms usually indicate a reduction of Thyroxine production (true hypothyroidism), the TSH and T4 are normal in 20%, or more, of people complaining of hypothyroidism symptoms. When this is so, the diagnosis of intracellular hypothyroidism is missed if FreeT3 and reverse T3 are not tested. Thyroxine (excellent treatment for true hypothyroidism) is empirically prescribed, but the symptoms continue. The result is confusion on the part of the physician and frustration on the part of the patient.
This vexing situation is easily avoided by estimating free T3 and reverse T3 levels, to derive the T3/rT3 ratio, which reliably differentiates between true and Intracellular Hypothyroidism (IH). IH is easily and safely treated with Sustained Release Triiodothyronine, the symptoms subside and the patient is happy.
** A.K.A. Low T3 Syndrome, Nonthyroidal Illness Syndrome, Euthyroid Sick Syndrome and Functional Hypothyroidism.
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Chronic fatigue syndrome (CFS) is a heterogeneous disease, of unknown cause. CFS symptoms resemble a hypothyroid state, secondary to chronic inflammation. We studied 98 CFS patients and 99 age- and sex-matched controls, measuring parameters of thyroid function, (metabolic) inflammation, gut wall integrity and nutrients influencing thyroid function and/or inflammation. CFS patients exhibited: Similar TSH, Lower free T3 (FT3), Lower total thyroxine (TT4), Lower total T3 (TT3), Lower %TT3 (4.7%), Lower activity of deiodinases, Lower secretory capacity of the thyroid gland (14.9%) and Lower 24-h urinary iodine (27.6%).
The % of reverse T3 (rT3) was higher (13.3%), among the patients. FT3 below the normal range, consistent with the “low T3 syndrome,” was found in 16/98 Chronic Fatigue Syndrome patients vs. 7/99 controls.
We also found evidence of low-grade metabolic inflammation (Ferritin & HDL-C). FT3, TT3, TT4, and rT3 correlated positively with HSCRP in both CFS patients and controls.
TT3 and TT4 were positively related to HSCRP in controls. Low T3, and the shift from T3 to rT3, may reflect more depressed tissue T3 levels.
The findings in chronic fatigue syndrome patients agree with studies suggesting a hypometabolic state. They resemble “non-thyroidal illness syndrome”, a.k.a. “low T3 syndrome” (I prefer to call it “intracellular hypothyroidism”), experienced by a subgroup of hypothyroid patients receiving T4 monotherapy. Our study needs confirmation by others: trials with T3 and iodide supplements might be indicated.
Keywords: chronic fatigue syndrome, thyroid, “low T3 syndrome”, triiodothyronine, reverse triiodothyronine, urinary iodine, inflammation, high-sensitive C-reactive protein
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An old friend, who is an avid and successful vegetable gardener, is passionate about mushrooms, especially chanterelles (Fig. 2), which abound in the woods of Ontario and are easily found, if you know what to look for. So successful is he in the chanterelle hunt, that he is able to augment his income (a bit) by selling them to knowledgeable restaurants. 2023 was a bumper year, for chanterelles and my friend, while keeping himself amply supplied, sold his surplus for more than $1,000.
In July however he found a small red spot, which began just above his elbow and spread around the arm.
Soon he became ill and progressively, so weak that he was admitted to a hospital. Eventually, a blood test showed Lyme Disease and he was started on a course of antibiotics. He is now improving, though very slowly.
My friend’s experience led me to a web search on Lyme disease and being me, I began the search by entering “Lyme disease T3” into Google. Lo and behold, the following appeared on my handheld screen: “The inflammatory cytokines that are produced in Lyme disease impact thyroid hormone signalling. This means thyroid stimulating hormone (TSH) may decline. The conversion of T4 to T3 (the active thyroid hormone) can be reduced, leading to fatigue and low energy levels. Additionally, reverse T3 can become elevated. June 2. 2023.”
I almost fell off my chair: that such a perspicacious (if slightly inaccurate) statement would appear as a first response from Google is mind-boggling! It means that someone, somewhere, is beginning to think about peripheral thyroid hormone metabolism and if we are lucky, the medical establishment will finally begin to consider it seriously.
So let’s discuss Lyme disease
Lyme disease is caused by a germ called Borrelia Burgdorferi (Fig 2), which looks like the syphilis germ, Treponema pallidum, in that it is a “spirochete”. It is long and narrow, for a bacterium (20 – 30 µm long and 0.2 – 0.3 µm wide), “curly and wiggly” and completely colourless – to see it under a microscope, you have to view it on a “dark field”, as shown in the graphic from Wikipedia, in figure 1. Worldwide, there are 15 species of Borrelia, of which 5 cause Lyme Disease.
Borrelia Burgdorferi, under a dark-field microscope (Wikipedia)
Borrelia Burgdorferi is passed to humans by the bite of ticks and lice (Fig. 3). Its presence in our blood can be identified in the laboratory by immunity testing (not by looking for it under a microscope).
An adult deer tick
Usually, the tick bite is painless and isn’t noticed by the unfortunate recipient until a red spot appears somewhere on the skin, 3 days to a week (or more) after the bite. Classically, the area around the bite looks like a “bull’s-eye” (Fig. 4), with a red spot in the middle, a surrounding circle of normal -looking skin and a red circle of 6 inches or more, outside of that (figure 4). However it isn’t always that obvious: there might be a simple, small red spot such as one would get from any insect bite, or maybe a rash, or an irregular red area. The inflamed area usually lasts between 3 and 5 weeks and other red spots may develop.
A “bull’s-eye” rash, typical of Lyme disease (James Gathany, 2007).
Symptoms
Symptoms begin sometime later, usually with headaches and neck stiffness, other rashes, odd aches and pains, fever, fatigue, numb and tingly areas and even “brain fog”. The affected person may become really ill and the problem can last a long time: years, in some cases.
The symptom lists below comes partly from the two references, mentioned below:
In the acute phase, there is some combination of:
Headache, fever, fatigue and neck stiffness, in the acute phase
Muscle pain and joint pain, often affecting the large joints (e.g. knees)
Nerve pain, numbness, and tingling in the hands or feet
Facial paralysis, with a drooping appearance and loss of muscle tone in the face
Heart palpitations, irregular heartbeat, dizziness, shortness of breath
Brain fog, short-term memory problems and changes in vision
In chronic cases, the history may include:
Severe headaches
Arthritis, with pain and swelling of joints
Heart abnormalities
Mental disorders, including depression
Cognitive impairment: confusion, short-term memory loss, and brain fog
Numbness in the extremities, from Peripheral Neuropathy.
Caveat
(1) A discussion of Lyme disease itself is not my main purpose here: for greater detail about the illness, please see an excellent “layman’s” dissertation on the subject, by Mary Shomon, at health central, https://www.healthcentral.com/article/lyme-disease-and-your-thyroid .
(2) Lyme disease is like long Covid in two ways – the fatigue is similar and its effects can persist for an extraordinarily long time. Lyme disease doesn’t become chronic in every case, but for those who are affected, it represents a major problem. So much so that, like “Long Covid”, there is a name for it. The term is “Post–Treatment Lyme Disease Syndrome,“or “PTLDS” (I’m tempted to call it “Long Lyme”, a nickname which my Trinidadian friends would find amusing, because in Trinidad, “Lyme” means “hang-out, drink rum, and chat”).
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ONCE UPON A TIME, THERE WERE TWO CHIMPANZEES. They were twins: one was smart and the other, not so very.
On their third birthday each was given a toolbox, with a big-handled screwdriver, pliers, a hammer, a saw, a crowbar and a large knife.
The smart Chimp opened his toolbox and found that he could use the tools, lifting stones to find delicious worms, getting termites from their nests, opening walnuts, cutting coconuts, peeling oranges, squeezing things and generally making life easier for himself. He kept the toolbox in a dry spot inside a cave, took it with him everywhere and used the tools often, always cleaning and returning them to the box after use.
The un-smart brother loved his toolbox because it was the first birthday present that he could remember, but he never opened it and often left it out in the rain.
When they were about 10 years old, somehow they each, on the same day, got caught in a cage set by a trapper: he made his traps with auto-locking doors which only opened with a special key, but he put the hinges on the inside of the doors, due to his carpenteric dyslexia.
The smart Chimp noticed, with amusement, that his screwdriver would fit the screws which held the hinges. He sat for a while, giggling: then he opened his box and got his screwdriver out.
Still giggling, he disconnected the door with his screwdriver, put the ‘driver back into the box and walked out, taking the toolbox with him, as usual.
He tried to set his brother free, but the cage was made of steel and he couldn’t bend the bars, or break the lock, with the crowbar. He would have passed the screwdriver to his brother, but the spaces between the bars were too narrow to let its big handle through. Eventually he gave up trying.
The smart Chimp took his toolbox back to his cave and lived happily ever after, using his tools often and keeping them oiled and in good condition.
The unsmart Chimp was sold to a zoo, where he died at 33 from Alzheimer’s disease.
Q: WHAT’S THE POINT OF THIS STORY ?
A: Due to hormone loss, we humans don’t permanently maintain perfect control over our functions: loss of our hormonal “tools”may be natural, but keeping them has benefits.
Kept healthy by our hormonal tools, we are fine up to age 25, but then our hormone production falls, at a rate of about 1% per year: by age 80 most of our hormone production is gone.
Thus the efficiency of our metabolic management systems declines, slowly, but continuously and relentlessly. All our operating systems eventually become “skewed” to a greater or lesser degree, depending on how our individual internal organs respond to reduced hormone levels.
Each individual, male or female, responds to hormonal loss with his or her own pattern of symptoms, depending on the individual organ’s sensitivity to lowered hormone availability. There may be hair loss, weight gain, recurrent acne, dry skin, brittle finger nails, allergies, high blood pressure, diabetes, autoimmune diseases, psycho-cognitive change, cancer, neurological disease like Alzheimer’s and Parkinson’s, MS or other problems. Even our immune systems lose potency, so that we become more liable to infections.
Stress
In addition stress, endemic to our modern lifestyle, can trigger suppression of thyroid function as an energy-saving manoeuvre. When this happens all systems lose efficiency, because all our systems need Thyroid 3 to function normally: the muscles (including heart muscles) weaken and ache, the metabolic rate falls and we gain weight, cognitive loss leads to loss of self-confidence and anxiety. Fuzzy thinking, brain fog and depression ensue.
While most people begin their disabilities at 26 (or earlier), many appear to be unaffected until much later. There is such a wide spectrum of “aging” effects that the majority are able to “carry on as usual” and the ones who fall by the wayside early in life are regarded as poor eaters, unhealthy due to bad habits or simply “unlucky”. Nevertheless one thing is clear: no-one escapes the trap into which we are born and our slide, down the razorblade which is life, whether fast or slow, is inevitable.
As we age, most of the parameters by which our health professionals measure us remain stable and reasonably constant until some major system fails: tests for the function of the heart, blood vessels, kidneys, liver, lungs, intestines, endocrine glands, brain, bones etc remain sufficiently stable that hardly anyone shows obvious deterioration.
In the opinion of Functional / Metabolic Medicine professionals, our progressive loss of hormone production with aging, though naturally occurring and 100% pervasive, is a disease. Deviations from perfect health are ill-effects of aberrant hormonal balance, which can be monitored and corrected easily and safely. Therefore, to anyone who has the pertinent information, natural aging due to hormone loss is modifiable, if not truly curable.
Unfortunately however, errors are built into our current healthcare system: hormonal balance, a measurable parameter affecting the function of all organs, is ignored: deteriorating test results are labeled “age-related”, considered “natural and normal for age” and relegated to the “interesting, but unimportant” file. Stress, that potently evil bugbear which causes most of our disabilities, is not treated, as it should be, as a hazard requiring hormonal and metabolic investigation.
Let’s think about the hormones we lose with aging:
– DHEA, the precursor for Testosterone, Progesterone, Oestradiol, Cortisol and a host of microhormones which keep our parts working – all our cells, including heart, brain and thyroid cells, need it to maintain perfect function, but in Canada DHEA is on the “dangerous drugs” list and doctors do not test for it. It is available, by prescription, from compounding pharmacies; but rare is the doctor who will prescribe it. – Testosterone: quite aside from the well-known “low T” difficulties in the male, “low T” (women’s normal = 20-30 picomoles/Litre) is a huge problem for women. “Low T” is often found in young females (I had a patient aged 23 with zero testosterone). ZERO “T” is easily and safely treated with DHEA, or Testosterone cream, but hardly any doctors test for it. – Progesterone: it rules the menstrual cycle, prevents PMDD, promotes sleep, counteracts fat-making Oestrogens, prevents heart dysrhythmia and converts to Allopregnanolone. Progesterone Deficiency is the usual cause of dysmenorrhoea and premenstrual dysphoria, but most practitioners don’t even think of it. – Allopregnanolone: the darling of neuropsychiatry, it prevents and treats depression and is essential for memory, sleep, and brain maintenance/brain repair. Allopregnanolone deficiency is the main reason for depression, especially postpartum, but there’s no available test to check its level. – Oestradiol: as the main female hormone, it maintains women’s “parts”, keeps the skin young and makes bones stronger, is essential for the libido in both genders and like testosterone, boosts self-confidence and the sense of well-being; but mainstream medicine strongly recommends against prescribing it. – Thyroid hormone: The thyroid hormonal system isn’t tested accurately because TSH, the pituitary gland’s trigger for T4 production, is the only thyroid test we use, although it speaks only of the pituitary’s need for T4 and has nothing to do with the body as a whole. 1) The so-called “normal range” of T3, the efficiency accelerator, is ridiculously wide: a low level indicates restricted production and reduced cellular efficiency, but doctors are specifically instructed by their “bosses” not to do the test (the ministry of health went to extraordinary lengths, to devise and advertise a list of tests which must not be done because doing them increases the cost of healthcare: do click on the list, to see the instruction for thyroid hormones) and it is hardly ever measured! (please click on this link and go to number 7, which reads, “Don’t screen for thyroid dysfunction in asymptomatic non-pregnant adults”). 2) Reverse T3, the sensitive marker for reduced whole-body efficiency, is never measured, again because the central controlling body of the medical profession in Canada specifically instructs doctors not to test for it.
Item #7, quoted above, goes on to say “Treating subclinical hypothyroidism (TSH ~4-10 IU/L and normal T3/T4) showed no benefits in any patient-oriented outcome such as mortality or cardiovascular disease, fatigue, weight, depression, cognitive function or quality of life” – that obviously specious statement, “fake news” generated solely to reduce costs (to heck with clinical judgement!), was copied and pasted from the website of “Choosing Wisely Canada”. 3) Anticancer drugs which work by blocking T3 are often prescribed without monitoring the effect on thyroid function, even though they are known to suppress it.
“Normal Aging”
None of this is news.
The progressive loss of all these hormones is accepted as “normal for age”. The ill-effects of hormone deficiency are viewed as inevitable, due to “normal aging” and we are told to “live with it”: no one seems to consider the obvious possibility that we’ll die from it!
Heavy Metal poisoning
Mainstream doctors don’t test for vitamins and minerals, excepting Electrolytes, Vit B12, Iron, Calcium, Magnesium and Phosphorus.
Although we know that an overload of Lead, Mercury and many other metals can be deleterious, tests for metal poisoning are almost never done and chelation treatment for metal overload is regarded as “quackery”.
Age 5-15: teach hormone information and awareness courses in high school, to improve basic knowledge of the subject among the general population.
Age 15-25: the family physician asks each patient, at age 15, to fill out a “wellness assessment questionnaire” and orders a short list of tests, most of which are inexpensive and easily available. The questionnaire and tests are repeated at age 20 and 25: if and when symptoms of aging and hormone loss begin, the tests are repeated and the results are discussed with the patient.
Age 25-35: The wellness questionnaire and tests are repeated every 3 years: the onset of symptoms, an abnormal test result, or the individual’s concern triggers a brief explanation by the family doctor and referral to a Health Education Professional (a well-paid paramedic, or nurse), who reviews all aspects of hormonal balance, to ensure the patient’s understanding of the diagnosis and possible therapy, then the person returns to the MD to discuss a plan for management and possible prescription.
If the person needs, and is ready to start (necessarily lifelong) hormone restoration, they request a trial of therapy. This request is a mandatory prerequisite to prescription: refusal of advice, or postponement of surveillance and/or therapy, is the individual’s prerogative: healthcare professionals document the refusal, under signature; but accept refusals without question or consequence.
FAQ
Q: WHAT’S THE POINT OF ALL THIS? A: To reduce and delay essential-system deterioration due to hormone deficiency. [1]
Q: WON’T IT BE EXPENSIVE? A: it is a lot cheaper to prevent disability, than to cure it. [2]
Q: HOW CAN WE AVOID OVERTREATMENT? A: Repeated tests show the effect of therapy and hormone doses are adjusted ad hoc.
Q: WHAT ABOUT HORMONE – DEPENDENT CANCER, LIKE HER-2 BREAST CANCER? A1: These cancers need the hormones to grow, but are not caused by human hormones (horse hormones do encourage breast-cancer in humans). A2: Maintainance of DHEA, Melatonin, Progesterone, CoQ10, NAC, MTHF, Magnesium etc. deters cancer formation [4]
Q: PEOPLE WITH PCOS HAVE HIGH DHEA – WILL YOU CAUSE PCOS, BY INCREASING DHEA? A: PCOS is associated with high DHEA, Testosterone, LEAP2, LH, and Cortisol, while estrogen is reduced: these changes are produced by PCOS, not vice versa. [5]
Q: SUPPOSE TESTOSTERONE PRODUCES A PROSTATE CANCER? A1: That idea is wrong. Testosterone opposes Prostate Ca formation & low Testosterone promotes it. A2: The Mayo Clinic still says that P Ca should be treated by blocking T, [9], but DHEA, or Testosterone, prevents Prostate cancer and can be used as a treatment, in some cases. [6,7,8].
Q: DON’T HORMONES PREVENT PREGNANCY? A: Artificial hormones in birth control pills do, normally cycling Human hormones don’t. [10]
Q: AMD IS ASSOCIATED WITH HYPERTHYROIDISM – CAN Thyroid Hormone MAKE YOU BLIND? A: There is a link between hyperthyroidism and AMD, not with prescription of T4. Some unknown factor must cause both conditions: how, and why, would an essential hormone ruin vision? [11]
Q: WHAT ABOUT THYROID CANCER? A: The story is the same as for other hormone-sensitive tumours: the cancer cells need thyroid hormone to grow, but Thyroid Hormone does not cause the cancer.
For brevity, only a few are listed. Many more are available through NCBI.
(1) The “multiple hormone deficiency” theory of aging: is human senescence caused mainly by multiple hormone deficiencies? T Hertoghe1 Ann N Y Acad Sci 2005 Dec;1057:448-65. doi: 10.1196/annals.1322.035. https://pubmed.ncbi.nlm.nih.gov/16399912/
(2) The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary (Book)
