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Dr. David Derry Answers Reader Questions
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Index of Q&As with Dr. David Derry



Topic: Asthma and Thyroid Hormones

A Reader Writes:

I am writing to see if you have any advice for me. Two years ago the doctor found a knot on my neck. I went and had a thyroid blood test and everything was normal. Then I had a ultrasound and scan done. Came back that it was a solid cold nodule. They said that it could be cancer and I needed a fine needle biopsy down. It was fine.

I went to a endocrinologist.

She didn't like the report and wanted to have it removed. I went to an ent doctor and he put me on thyroid medicine to try and shrink it. Four months nothing happened. I was scheduled for surgery and one and half weeks before I broke out on my neck just where the nodule was. They said it was shingles.

The doctor said maybe this was meant to be and not have the surgery. I was asked by my family doctor to go to another ent doctor. He just watches it and has did one more fnb on it. It has grown to at least 2cm in size. I have pain in my neck and down in my shoulder. I am always short of breath so they did test and said I must have asthma. I know I don't because I have a son with asthma and I have never had wheezing or an attack. I could sleep 24hr/7, no energy, gained weight, muscle aches and pain, no sex drive, always in a terrible mood, the list goes on and on. They say nothing is wrong. I had to find a new family doctor because of insurance. She said that the knot seemed too big and ask if I would go to an ENT she knows. I said yes but I am scared to go I don't know anything about him and don't know who to believe anymore. I just hate feeling like this. My mom started losing her eyebrows then her hair for the last 4 years. She goes to the dermatologist to get shots all the time. Has a lot of the same problems as I do but they say her blood test is fine also. Is there anything you can tell me that might help.

David Derry Responds:

Dear Patient

From your mother's problems you mentioned, it sounds like she is low thyroid. I have discussed hair and eyebrow loss in another answer on hair loss. Clinically you are low thyroid. What is interesting to me is your question about asthma. You said your physicians did some tests and thought it was asthma. I would like to discuss my thoughts on why your physicians might have been correct.

In the mid 1980s I had a chronic asthma patient who developed an inflammation of his thyroid. After consultation with an endocrinologist he was put on Eltroxine (T4). One day when the patient came in later he mentioned that the thyroid treatment improved his asthma considerably. At the same time, my office receptionist had severe asthma since the age 12 requiring constant medications and multiple hospital visits. She knew about the results on this patient, she asked if she could try thyroid as well. I started her on 180 mg of desiccated thyroid and within a month raised her to 250 mg. This was in about 1986. She has been free of asthma symptoms since then. She still takes some medication occasionally but has not been in hospital for asthma since.

Encouraged by these results, I proceeded to work my way through all of my chronic asthma patients. At the time there were 22 severe asthmatics who came into my office on a regular basis for asthma attacks. Some came into the office once a month (or more often when in trouble) and some twice a year. Over about a 2-3 year period I gradually put all of them on desiccated thyroid. All patients improved tremendously. I would not say all of them were completely cured but the improvement was striking. Two things followed from this. By 1990 all asthma patients were on thyroid and thus from 1990 to 2002, I did not see another acute asthma attack in my office and none of these 22 patients came in for their asthma. The other slightly embarrassing problem was for a few months my waiting room became quite slow because of the absence of these asthma patients. From there I went on to learn what other benefits thyroid medication might have.

So it is my impression asthma is a low thyroid problem which can be better controlled and dealt with by thyroid treatment. Two patient who have been on these doses of thyroid for more than 15 years have had bone density tests show their bone density was completely normal. Prednisone (cortisone) used for acute severe asthma attacks has more serious potential for causing bone problems. Thyroid treatment, especially with supplementary iodine (Lugol's one drop daily) does not alter bone density short term or long term.

The only literature I can find on asthma and thyroid hormone was from the early part of the last century when many physicians found thyroid improved asthma. One 1911 study in a large Paris asthma clinic found thyroid treatment effective treatment for asthma.(1) However, adrenaline was discovered at the same time. Consequently all severe asthma patients went on daily injections of adrenaline for many years. The potential for using thyroid to help asthma was gradually forgotten. There was a study in 1968 in which they used growth hormone and thyroid to treat asthmatic children. They attributed the improvement to the growth hormone not the thyroid. (2) It has been noted repeatedly that asthma incidence is increasing in all age groups. I feel this is the result of a lower intake of iodine occurring in many families from decrease consumption of table salt. (3-6) The lower intake of iodine tends to make thyroid glands work poorly and cause hypothyroidism and thus increase the chances of asthma in those who are susceptible.

We know that by tracing radioactive thyroid hormone injected into animals shows the hormone concentrates in the aveoli of the lungs. These are the lower air sacs that we have to exchange oxygen with. Also for a good 100 years iodine preparations have been used on chronic chest problems and asthmatics. Iodine is excreted in the lung mucus. In fact iodine in excreted in all mucous secretions such as the mouth(saliva) stomach, bowels, cervix, and lungs. The iodine in the mucous likely helps to kill any bacteria or viruses. Thus both iodine and thyroid hormone are involved in lung physiology. For example most, if not all, sleep apnea patients are fixed with adequate doses of thyroid. Chronic obstructive lung disease (COPD) also is helped by thyroid hormone treatment.

The amount of iodine in the lung mucus possibly explains the paradox that the Japanese who are amongst the heaviest smokers in the world also have one the lowest lung cancer rates. It is likely the high levels of iodine in their blood is excreted in the lung mucus. This iodine then by apoptosis (natural cell death)could be killing off any abnormal cells as they develop that are caused by the cigarette carcinogens. In addition iodine reacts directly with carcinogens and chemical to render them inactive. (7) The Japanese have had an average dietary iodine intake of about 10 mg for many centuries. If the level of iodine intake is above 2-3 mg daily then the thyroid gland becomes saturated within two weeks and does not take iodine up anymore. Thus the most of the iodine can then go to the other parts of the body to carry out iodine's mulitple important functions. The most important of these is relataed to killing off of pre-cancerous abnormal cells. Our intake of iodine as laid down by the WHO is around 15-200 micrograms. This is about one tenth the needed dose to saturate the thyroid gland. So most iodine or a large part of the dietary iodine in Westerners goes to the thyroid gland. This leaves less than optimal amounts going to the rest of the body.

The origin of your problem may be low iodine intake over a long period. But your breathing problems could easily be a mild asthma from your hypothyroidism. This means if you were treated adequately for you thyroid problem all your symptoms would go as well as your breathing problem.

Having said all that, my inclination - from what you have told me - is to have the lump removed.

I hope this helps you handle your problem.

David

References

1. Levy,L. and de Rothschild,H.. Asthme endocritique. In: Endocrinologie. Nouvelles etudes sur la physiopathologie du corps thyroide et des autres glandes endocrines, edited by L. Levy and H. Rothschild, Paris: 1911, p. 325-391.

2. Collipp P.J.. Short asthmatic children and human growth hormone. Evaluation of albumin-bound growth hormone. Clin Pediat (Phila) 7:659-664, 1968.

3. Thomson, C.D. Colls, A.J. Conaglen, J.V., M. Macormack, M. Stiles, and J. Mann Iodine status of New Zealand residents as assessed by urinary iodide excretion and thyroid hormones. British Journal of Nutrition 78, 901-912 1997.

4. Lee,R., Bradley,R., Dwyer, J., Lee,S.L. Two much versus too little: The implications of current iodine intake in the United States. Nutritional reviews. 57, 177-181. 1999. page 178

5. Hollowell,J.G., Staehling,N.W., Hannon,W.H. et al. Iodine nutrition in the United States. Trends and public health implications: Iodine excretion data from national health and nutrition examination surveys I and III (1971-1974 and 1988-1994). J Clin Endocrinol Metab 83:3401-3408, 21998.

6. Kamala Guttikonda, Cheryl A Travers, Peter R Lewis and Steven Boyages Iodine deficiency in urban primary school children: a cross-sectional analysis. MJA 2003; 179 (7): 346-348

7. Derry,DM Breast cancer and iodine, Trafford Publishing Victoria Canada, 2001.



About Dr. Derry:

Dr. Derry is no longer practicing medicine.

These answers are personal opinions. Please discuss any ideas you get with your physician.

Born in 1937, I am at the cutting edge of the war baby boom. With one exception the baby boomers tend to do what I do in large numbers about ten years later. The exception was that after finishing my internship at the Toronto General Hospital in 1963, as I had planned, I started a PhD in biochemistry at the Montreal Neurological Institute at McGill University in Montreal. After completing my PhD, I was hired by the Department of Pharmacology at the University of Toronto to teach and do research. Within a short time I became a Medical Research Council Scholar, which meant the Medical Research Council of Canada paid my salary to do research. Domestic rearrangements suddenly placed five children between the ages of 5 and 9 under my care. I abandoned my research career and took all five children, a new wife and dog out west to Victoria British Columbia.

My aim in 30 years of General Practice (an honor and a privilege) was to learn carefully and persistently how to listen to the patient. This is the one area of medical research that has gone almost totally un-examined. Sir William Osler, who I feel was the greatest physician of all time, said: if you listen to the patient they will usually give you the diagnosis and if you listen even more carefully they will likely indicate the best treatment for them. Gradually with the help of multiple self-development courses over the years I learned to listen by just getting my ego out of the way. From my patients I learned everything. Because of the arrival of effective treatments with potential side-effects, in 1945 the out-dated Hippocratic oath of “do no harm” was replaced with a new principle of ethical patient care namely “Consider first the well-being of the patient.” Combining extensive medical-literature reading with what I learned daily from patients clarified which approaches and treatments assured the “well-being of the patient.”

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