An Interview With Glenn Rothfeld, MD

6. What about iodine supplementation, and use of herbs like kelp that contain high levels of iodine? Do you think they can help -- or hurt -- thyroid patients?

I sometimes use an iodine-tyrosine combination supplement, and I frequently have patients use kelp as part of a metabolism-boosting program. However, there is a "more-is-better" mentality in our culture generally, and it certainly affects people who use natural products. I often find patients who are taking too much iodine in the thought that it will boost their thyroid, and I don't recommend this. There are many unqualified nutritional advisers from the person who might be behind the counter at the Vitamin Shoppe to the massage therapist who advises her patients.

Unfortunately, the idea that "iodine is good for the thyroid" can be transmitted to the patient. Iodine is certainly necessary for good thyroid function. But, in today's world when table salt is iodized and fish is plentiful everywhere, it is unlikely that iodine deficiency is a major cause of thyroid dysfunction. And, too much iodine can unnecessarily stimulate a thyroid gland, leading to a worsening of tumors and overactive glands.

7. Why do you feel, as you state in the book, that synthetics are more stable that natural desiccated thyroid hormone replacement drugs?

First, let me say that I use a fair amount of natural desiccated thyroid, though my preferred therapy these days is time-released T3. Any natural product is subject to certain risks that synthetics are not. The clearest risk is the possibility that livestock is infected with a virus or other substance that will not be broken down in the processing of pills. Although there are no reports of mad cow disease being transmitted through the processing of drugs from livestock, the tiny possibility of some sort of infection exists, and thus I look for other possibilities. Also, an argument has long been made that there is less control of the exact amounts of hormone in the natural products, while a single-hormone product like thyroxine (T4) can have identical doses every time. This is less of an issue for me in prescribing medications. For one thing, our own thyroid glands are constantly changing their activity to respond to the internal and external environment, and we are not going to match that with a single-hormone synthetic product. Also, natural desiccated products contain a number of substances barely understood but probably having some significance to us (for instance, T2, T1, and T0 in tiny amounts).

8. What do you feel are some of the most promising avenues for thyroid patients in terms of alternative and complementary medicine?

I'm very interested in what is being termed "functional medicine". Most Of our current medical system is more "structural,” that is, we look for specific problems such as abnormal TSH, cysts and tumors, etc. Functional medicine looks at how our body systems function or malfunction, and there are a number of novel laboratory tests that are helpful. For instance, we measure adrenal function by serial saliva samples that can be collected at home, and show how the stress organ works throughout the 24 hour cycle.