Thursday, June 19, 2014

The Oft-Ignored Link Between Mental Illness and Hypothyroid Disease

Overview of the thyroid system (See Wikipedia:...
Overview of the thyroid system (See Wikipedia:Thyroid). To discuss image, please see Talk:Human body diagrams (Photo credit: Wikipedia)

By Kelly Brogan, M.D.
Meet your mitochondria.1 With a laundry list of responsibilities ranging from creating energy to determining the time of a cell's death, mitochondria have increasingly become the focus of chronic disease research.2
The keeper of our mitochondria is our thyroid hormone.3 This is why, when thyroid hormone is deficient or poorly functioning, patients experience an array of symptoms, including fatigue, constipation, hair loss, depression, foggy thinking, cold body temperature, low metabolism, and muscle aches.
How much of what we call "mental illness" is actually thyroid-driven? In my experience, a vast majority, and certainly enough of a subset to warrant a more sophisticated appreciation for proper diagnosis and treatment in these patients.

To Reverse Pathology, You Need a Whole Mind-Body Approach

Thyroid health is so much more than pumping out a hormonal product – it is a sophisticated conversation between the brain, gland, hormones, and the receiving cells and tissues.
This circuitry is at the mercy of yet another hormone, cortisol,4 produced by your adrenal glands, signaled by your brain.
This is why hypothyroidism can also look like anxiety, palpitations, insomnia, and sweating, and why one person may feel restored on thyroid hormone and another decimated.
Once we ask about the state of adrenal function, we have to dig a step deeper and ask what is taxing the adrenals. From this point of inquiry, we are typically talking about gut, diet, and environmental immune provocation.
This is the model of medicine that prizes root-causes, considerations like gluten enteropathy, sugar imbalance, fluoride toxicity, and iodine deficiency as potential drivers of thyroid hypofunction. The many lifestyle and environmental factors that can influence this relationship are prime examples of the web-like, whole mind-body approach that medicine must take in an effort to truly reverse pathology.

Underdiagnoses and Mistreatment

When patients are tested for thyroid pathology, typically at their own request, they are often confronted with "reference range" rejection – physicians staring at numbers instead of the suffering humans before them.
Reference ranges that bracket your lab results are based on unscreened and clinically unassessed populations (many were active hypothyroid patients), never calibrated for diagnostic practice. Doctors are trained to look at a brain hormone – TSH – as an absolute indicator of whether or not a patient is living in a glandular hormonal deficiency state.
Dysfunction of the endocrine system at large is totally ignored by this metric that "diagnoses" only the lowest 2.5 percent of those in a given reference range, as hypothyroid, without looking at the whole picture of their hormone activity. There is also neglect for the significance of antibodies as a relevant indicator of endocrine/immune dynamics, and consideration of autoimmune drivers.
For those who do receive the label of hypothyroid, they remain obliquely objectified by their lab work as their doctors use synthetic T4 – Synthroid – to attempt to move their TSH within range, more often leaving them symptomatic but "treated" because of poor conversion to active thyroid hormone (T3) and suppression of natural T3 production because of their now lower TSH.
When patients are denied appropriate hormonal treatment, it can be a slippery slope to medications for their remaining symptoms, and one category of medications in particular – psychiatric.

The Psychiatric Slide

Psychiatry is often positioned to slap Band-Aids on the festering unwashed wounds of the population. When these patients are told that they are "fine" or "treated" but they continue to feel unwell, they are sent to a psychiatrist, or started on psychotropics by a nonspecialist. Are many psych patients actual thyroid patients?
The literature seems to suggest as much, particularly in pregnant women. An important premise, however, is that there is likely gross underdiagnosis taking place in the literature secondary to use of a single metric TSH. We will see the significance of thyroid autoantibodies in various psychiatric diagnosis.
This reflects what functional medicine and naturopathy have claimed for years – that immune dysregulation is the key factor in thyroid hypofunction, and may predate actual change in hormone production by up to seven years.5 The role of thyroid in brain health has been the subject of speculation for over a century. As noted in a 1949 paper in the British Medical Journal:6
"[Since] 1888 the Committee of the Clinical society of London reported on the mental changes observed in over 100 cases of Myxoedema and noted the general retardation, sluggishness and slowness of apprehension, which was associated with insanity in the form of melancholia, chronic mania and dementia."
Another study published in the journal Encephale7 in 2004 notes several actions of thyroid hormone on your brain:
"Thyroid hormones receptors are predominantly present in cerebral cortex, amygdala, plexus choroideus and structures of adult neurogenesis: hippocampus and olfactory bulb. Thyroid hormones modify expression of genes encoding myelin, neurotrophins, and proteins involved in intracellular signaling pathways. They have also neuroprotective and vasodilatory effects."

Dipping Hormones and Depression

In the case of depression, there is much dispute as to the significance of hypothyroidism in presentations of classical and treatment resistant cases. Estimates of "subclinical hypothyroidism" (where free hormones are low, but TSH is normal) are up to 52 percent in the resistant population,8 which is demonstrative of the importance of looking beyond TSH.
The specific suppression of free T3 levels in depressed patients has been evaluated in several studies including those which specifically identified poor conversion of T4 to T3 in depressed women who were less likely to improve with standard medication treatments.9, 10 In 10 years after initial hospital admission, those with evidence of thyroid dysfunction through a stimulation test (TRH) were significantly more likely to relapse.11 Antibodies to thyroid tissue are also present in 20 percent of depressed patients,12 as compared to 5-10 percent of the general population.

If All Else Fails, Add Some Thyroid

In both bipolar and unipolar depression, there have been six randomized, placebo-controlled trials conducted wherein thyroid hormone was used as an augmentation to an incompletely effective antidepressant (tricyclic) and found to be effective, particularly in women. In the STAR*D report,13 the largest and most expensive trial ever conducted on antidepressant treatments, T3 was found to result in remission in 24.7 percent of patients.

Predicting Postpartum?

Perhaps the best studied population when it comes to the predictive role of thyroid abnormalities, pregnant and postpartum women deserve the most vigilant screening. Of 31 inpatient women with a diagnosis of postpartum psychosis,14 19 percent had detectable thyroid autoantibodies and 67 percent of these women developed thyroid dysfunction by six months as compared to 20 percent in the controls.  TSH at delivery has been shown to be a predictor of postpartum depression at six months postpartum.15, 16, 17 Even in the setting of "normal" TSH levels, thyroid autoantibodies are predictive of postpartum depression and anger18, 19 including in prospective trials.20, 21
Risks of hypothyroidism include adverse pregnancy outcomes such as hemorrhage, preeclampsia, fetal cardiac rhythm anomalies, and labor abnormalities.22 Thyroid antibodies, once again, represent a significant risk factor, not just for psychiatric pathology but for tripled odds of miscarriage and double of preterm birth.23 Importantly, in one randomized, placebo-controlled trial,24 supplementation with 200 micrograms (mcg) of selenium during pregnancy reduced antibody activity and improved hormone parameters likely owing to selenium's antioxidant properties in thyroid tissue.

Hypermania Hyperthyroid

In a recent review entitled "Gender differences in thyroid system function: relevance to bipolar disorder and its treatment,"25 the authors discuss high prevalence of subclinical hypothyroidism in female bipolar patients with a focus on rapid cycling illness, resistant to treatment. Lithium, considered a gold-standard mood-stabilizer, interferes with thyroid hormone secretion, and may induce or unmask underlying pathology.
A randomized, placebo controlled trial26 of T4 treatment in bipolar depression showed improvement that was limited, statistically, by high rates of placebo response, and likely the same conversion limitations of using T4 as opposed to a T3 containing preparation. A rational extension of this finding was demonstrated in two studies that found elevated T3 in manic bipolar patients, one noting that patients with bipolar mania relative to controls were 2.55 times as likely to have abnormal free hormone levels.27,28
Feeling like a mental patient? Look out for these offenders. The establishment of a relationship between suboptimal thyroid function and symptoms of mental illness tells us that appropriate and comprehensive screening is vital in this population. It also leads us to ask, why is the thyroid flagging, and what can we do about it. High on my list of causative offenders are:
  • Birth control pills:29 The synthetic hormones in this pharmaceutical product increase thyroid hormone binding globulin, effectively lowering available thyroid hormone even without perturbing lab values.
  • Gluten:30 In addition to its direct effects on the brain through opioid compounds, indirect effects through autoimmune and cytokine stimulation, gluten drives at least two pathologies – celiac and Hashimoto's – that are significantly associated with depression and other mental illnesses. The prevalence and causative role of gluten in Hashimoto's Disease (thyroid autoimmunity) has been established.31 The role of gluten in brain health is of increasing interest, and in celiac patients with thyroid autoantibodies, depression and panic disorder risk is greatly increased.32
  • Fluoride:33 Historically, fluoride was used, even in the milligram range, to suppress thyroid function in hyperthyroid patients. It interferes with multiple aspects of thyroid tissue integrity, hormone activation, and displacement of iodine, a critical and essential mineral for thyroid function.
  • Endocrine disruptors:34 From exposure in utero, 35 industrial and agricultural chemicals such as phthalates, flame retardants, and PCBs are pervasive toxicants that interfere with the hypothalamic pituitary adrenal signaling, stimulating the immune system and derailing hormones.

Summary of Recommendations

For all of the reasons listed above, my top recommendations for anyone experiencing symptoms of mood disturbance are to:
  • Clean up your local environment: from personal care products to cleaning agents, water, air, and electromagnetic fields
  • Clean up your diet: eliminate gluten, dairy, GMOs (soy, corn, and vegetable oils), and sugar
  • Clean up your mind: initiate a meditation practice to heal your adrenals and promote anti-inflammatory signaling.
In my article, "Thyroid Dysfunction and Treatment," I explore these interventions a bit further. The thyroid is a canary in the coalmine. In our fast-paced, technology-smothered, nutrient-depleted, and toxicant-replete lifestyles, your thyroid gland may be the first to come under siege. Recognize the profound significance of treating a thyroid condition with psychotropic medications, and choose to go to the root of the problem, first.

About the Author

Dr. Brogan is boarded in Psychiatry/Psychosomatic Medicine/Reproductive Psychiatry and Integrative Holistic Medicine, and practices Functional Medicine, a root-cause approach to illness as a manifestation of multiple-interrelated systems. After studying Cognitive Neuroscience at M.I.T., and receiving her M.D. from Cornell University, she completed her residency and fellowship at Bellevue/NYU.
She is one of the only physicians with perinatal psychiatric training who takes a holistic evidence-based approach in the care of patients with a focus on environmental medicine and nutrition. She is also a mom of two, and an active supporter of women's birth experience, rights to birth empowerment, and limiting of unnecessary interventions which is a natural extension of her experience analyzing safety data and true informed consent around medical practice. She is the Medical Director for Fearless Parent, and an advisory board member for and Pathways to Family Wellness. She practices in NYC and is on faculty at NYU/Bellevue.

Unleashing Histories Mysteries, Part 2, The Knights Templar; Foundation Continued

(Original text : Eight Pointed Cross of the Sc...
(Original text : Eight Pointed Cross of the Scottish Knights Templar, author SKT1314, source URL (Photo credit: Wikipedia)

Unfolding Histories Mysteries part 2.  Here we start on the next part of our foundation that will lead to yet bigger mysteries we will unfold.  This section on the Knights Templar will be needed for further background as we move closer to our modern day.

  Again, you do not have to agree with the information in the video above or the rest of the information we will be putting up about the Templar's, it's just part of the background and foundation you are going to need for the rest of the story coming.  This particular video however shows you the skills and gives you some idea of the wealth that the Knights Templar achieved during their rein.

Now this video gives you the biggest clue as to where we are heading with our stories but no it isn't about the possibility of that treasure being in Nova Scotia or the curse of Oak Island.  It does tie in, but it's not the main story at all.

This is the painting or picture that was discussed in the video for those who want to get a better look at it.  What is important to learn here in this section of unfolding histories mysteries is the secret hidden codes that are all around us everywhere.  When you understand what to look for, it's amazing what turns up and gives you more clues as to where to look next.

The above book can be downloaded for free from our Slideshare site.  You can sign up for a free membership in order to get the free download.  You never have to use the site again, but there is a lot of great stuff on there, so we would recommend keeping the free status.  The book was written in 1842.  It's hard to say if they had better access to information at that period or if the access to knowledge is better now.  How much has been lost for one reason or another?  How much has been gained through other areas of science and investigation?

  Our next area will go to Christopher Columbus and this is where some real twists and turns are going to take place.  It is here that everything you thought you knew, well, maybe you did and maybe you didn't.  Part 3 is sure to start changing your views on a lot of history.

Gloucester, VA Illegal Procurement By Utilities Department In Progress?

English: Deere construction equipment in Suffo...
English: Deere construction equipment in Suffolk,VA, photo by William John Grimes. (Photo credit: Wikipedia)
Just another fine example of how well Gloucester County, Va. follows Commonwealth of Virginia law; or not?
On June 15, 2014 I sent the following in an email to the Gloucester County Purchasing Director, Public Utilities Director, County Administrator and Board of Supervisors:
The process thus far to purchase a new mini excavator for the Utilities Department does not allow for competitive bidding.  The Invitation for Bids that was recently published specifies a specific manufacturer (John Deere) and a specific model (60G).  This is the same as sole source procurement, which in the instance of purchasing a mini excavator, is likely not applicable.  There are numerous mini excavator manufacturers who are just as reputable and offer machines, warranties and service that are comparable to John Deere’s.  If there is something specific about the requested item that makes it the only machine that can do a specific task; a description of such should have been included in the procurement notice.      
Do safety issues, excessive maintenance costs, or an excessive amount of hours on an existing machine justify this purchase or is this a new addition to the inventory?  If the latter is the case; is this purchase absolutely necessary at this time?  Is an enclosed cab or canopy option being considered?  Enclosed cab machines utilized in utility work environments increase safety risks due to the amount of work performed in close proximity to people, utilities, traffic and other machines.  Closed cab machines have a tendency to be utilized by employees as a heater or air conditioner which, among other negative things, increases fuel and maintenance costs. 
Based on professional experience and research; the John Deere 60 series mini excavator is just an enhanced version of the John Deere 50 series machines and is considered by many to be an odd ball machine.  Odd in that certain parts which make up the machines uniqueness are only specific to that machine.  The 60 series machines are several thousand pounds heavier than all other comparable machines and often require additional licensing and other transportation related expense increases.  JD-50 series machines outsell JD-60 series machines by a rather large margin.  Combined; these facts suggest an enhanced likelihood of higher maintenance and repair costs and longer down times from waiting on repair parts.  The JD-60 and JD-50 series machines are work horses and are primarily used in high paced production environments of at least 40 hours per week for 40 or more weeks out of the year.  Most contractors purchase the 50 series machines primarily because of cost differences.  Both John Deere machines are more than capable of fulfilling the Utilities Department’s needs, but the 60G is about $10,000 more expensive to purchase and costs more to operate, transport and maintain. 
Unless there is a specific reason why the Utilities Department requires something unique only to the John Deere 60G, the normal transparent procurement process should be followed and all authorized vendors should be allowed to submit bids.
Kenneth E. Hogge, Sr.
Thus far I have received the following response from the Purchasing Director:
“Mr. Hogge
Thank you for your email.
The present bid that we have advertised seeking prices for a John Deere 60 G Excavator is being sought as a brand name without substitution due to the Utility departments desire for this specific equipment.  It is my understanding that Mr. Schlesinger communicated with you regarding this issue and indicated that this specific equipment was desired by his department because of their review of comparable machines.
I do not agree with your assertion that our present solicitation does not allow for competitive bidding and the procurement method is the same as a sole source purchase. Rather, the solicitation is being offered as a proprietary purchase which allows any John Deere dealer to competitively bid on it.  I trust this will be the case because we have had past procurement programs for John Deere equipment that have garnered multiple bids.
As a side note, when the Purchasing Department received the requisition for this equipment, it also included a recommendation to acquire the machine from an existing national purchasing cooperative.  Certainly this would have been an option; however, I decided to initiate our own competitive bid for the excavator in anticipation of receiving a lower price than the cooperative and especially to determine if there was any local source that could bid on the equipment.  Obviously, the answer to this strategy will not be known until the bid due date of Monday, June 23rd.
I am unable to respond to the other issues in your email regarding the Utility Department's justification for the use of this excavator.  Responses to these inquiries rest with the operational requirements of Public Utilities and I am quite sure that Mr. Schlesinger would be willing to discuss them with you.
Our bid opening for the excavator is at 2:00 PM onJune 23rd and we will post a tabulation of the bids on our website shortly after that time.”
Bill Lindsey
Section 2.2-4300, paragraph C of the Code of Virginiastates in part;
that all procurement procedures be conducted in a fair and impartial manner with avoidance of any impropriety or appearance of impropriety, that all qualified vendors have access to public business and that no offeror be arbitrarily or capriciously excluded, it is the intent of the General Assembly that competition be sought to the maximum feasible degree, that procurement procedures involve openness and administrative efficiency, that individual public bodies enjoy broad flexibility in fashioning details of such competition, that the rules governing contract awards be made clear in advance of the competition, that specifications reflect the procurement needs of the purchasing body rather than being drawn to favor a particular vendor”
In his response, Mr. Lindsey stated,
the solicitation is being offered as a proprietary purchase which allows any John Deere dealer to competitively bid on it.”
A proprietary purchase is a purchase in which the specifications or requirements describe a product or service that is only available from one manufacturer or vendor, and which does not permit an equivalent product to be supplied. 
There are no specifications or requirements contained in the Invitation for Bids to support a purchase under the proprietary purchase title.  John Deere bidding against John Deere with respect to an excavator does not demonstrate competition as most heavy equipment dealers are assigned designated sales areas.  This will not necessarily prevent responses from multiple John Deere dealerships however it is still John Deere bidding against John Deere?
The Utilities Department is purchasing a piece of equipment of which type is manufactured and sold by numerous companies such as Case, John Deere, Caterpillar, Kamatsu, New Holland, Kubota, Yanmar, etc.  The exclusion of all companies except John Deere in the procurement process clearly violates Commonwealth law and the spirit for which the law was written.    
Commonwealth of Virginia law requiring all procurement procedures to be conducted in a fair and impartial manner with avoidance of any impropriety or appearance of impropriety has been completely ignored again inGloucester County.  So has the part of the law that requires that specifications reflect the procurement needs of the purchasing body rather than being drawn to favor a particular vendor.  
Manipulation of procurement processes seems to have become a normal way of conducting business in Gloucester County.  This unethical and transparency restricted way of purchasing goods and services is not what the tax payers expect nor is it what the General Assembly intended when the procurement laws were written.
Kenneth E. Hogge, Sr.
Gloucester Point
At around 5:00 PM on June 16, 2014 I submitted the following FOIA request to Ms. Lewis.
Please provide electronic copies of documentation reflecting the evaluation process utilized in determining which make and model excavator is required to fulfill the mission of the Gloucester County Public Utilities Department. 
On June 18, 2014 I received a response from Ms. Lewis indicating she will contact the departments concerned before being out of the office on the 19th and 20th and will provide a response to my request on June 23, 2014.  June 23rd is the date all bids on providing the excavator are to be in and opened.  Seems like stall tactics to me.

Our Notes:  You just have to love the way some people think they can just get away with doing whatever they think they want to without any consequences to their actions.  The question really does exist however if there will in fact be any consequences other than the department getting exactly what they want no matter what the state code says?  

  We have to ask the question;  is a kickback part of this plan?  Did a John Deer salesman teach the county how to ask for a specific product and get away with somehow bypassing state codes by doing this little trick?  It's a fair question that deserves to be asked.  Someone has to watch every area of the county government these days as there sure seems to be a lot of funny tricks going on everywhere. 

  Yet a further question is why does the department even need this?  If there is a lot of work to be done, maybe it's cheaper to rent what you need?  If not, then what about contracting the work out?  Who else is going to be using this machine?