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- Herausgeber: Hammersmith Health Books
- Kategorie: Ratgeber
- Sprache: Englisch
Hypothyroidism is one of the commonest yet the worst treated condition in Western medicine. Why? Because today's doctor only treats blood tests, not patients, even though patients may have all the classic signs and symptoms – tired, cold, thinning hair, low mood, high cholesterol. Dr Myhill, supported by Craig Robinson, shows us what those signs and symptoms are, all stemming from the metabolism running slow, and what the problems with diagnostic blood tests are that mean they cannot be relied on in isolation. Advocating lifestyle measures, iodine and natural glandulars (NGs), where found to be necessary, the authors also show us the consequences of untreated hypothyroidism at every stage of life and why it is so important to take remedying the problem safely into your own hands if your doctor can't give you the support you need.
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Veröffentlichungsjahr: 2023
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Contents
About the Authors
Dr Sarah Myhillmb bs qualified in medicine (with Honours) from Middlesex Hospital Medical School in 1981 and has since focused tirelessly on identifying and treating the underlying causes of health problems, especially the ‘diseases of civilisation’ with which we are beset in the West. She has worked in the NHS and private practice and for 17 years was the Honorary Secretary of the British Society for Ecological Medicine, which focuses on the causes of disease and treating through diet, supplements and avoiding toxic stress. She helps to run and lectures at the Society’s training courses and also lectures regularly on organophosphate poisoning, the problems of silicone, and chronic fatigue syndrome. Visit her website at www.drmyhill.co.uk
Craig Robinsonma took a first in Mathematics at Oxford University in 1985. He then joined Price Waterhouse and qualified as a Chartered Accountant in 1988, after which he worked as a lecturer in the private sector, and also in the City of London, primarily in Financial Sector Regulation roles. Craig first met Sarah in 2001, as a patient for the treatment of his ME, and since then they have developed a professional working relationship, where he helps with the maintenance of www.drmyhill.co.uk, the moderating of Dr Myhill’s Facebook groups and other ad hoc projects, as well as with the editing and writing of her books.
Stylistic note: Use of the first person singular in this book refers to me, Dr Sarah Myhill. One can assume that the medicine and biochemistry are mine, as edited by Craig Robinson and that the classical and mathematical references are Craig’s.
Dedication
SM: To Dr Gordon Skinner, Consultant Virologist and pioneer in the treatment of the underactive thyroid. He was hounded to his death by the General Medical Council because he dared to prescribe natural desiccated thyroid to patients who were clinically hypothyroid despite ‘normal’ blood tests. The fact that he restored the health of thousands of people was of no interest to the medical establishment.
CR: For Louise, my hairdresser, friend and an all-round lovely human being. Louise first started cutting my hair around 25 years ago, when I was very ill with ME, and bedridden. She would come into my bedroom, and I would roll from side to side while she leant over and half-sat on the bed to cut my hair. This simple act made me feel human. Years later I asked her whether she was at all nervous about coming into a strange man’s bedroom to which she replied, in typical fashion: ‘You were the one who should have been worried – I had the scissors!’
Preface
According to the capabilities of the reader, books have their own destiny.
Robert Burton (8 February 1577 – 25 January 1640), English writer and fellow of Oxford University, best known for his encyclopaedic book The Anatomy of Melancholy1
If what Robert Burton said is true, then it would seem that the destiny of this book is in safe hands. The fact that you are here, dear reader, taking charge of your own health, with an enquiring mind, is good news for you, and also, if Burton is to be believed, good news for this book.
Though the chapter titles in the Contents list for this book are mostly clear, we give readers a bit more detail here about what to expect in each:
Introduction: Do it yourself because your doctor won’t – this describes why this book is necessary and introduces the thyroid glandPart I: The practical – provides the Tools of the Trade for looking after your thyroid health, including:° Chapter 1: Are you hypothyroid? Poor energy delivery symptoms and signs (including chronic fatigue syndrome, myxoedema madness* and poor viiiimmunity); thyroid-specific symptoms (metabolic, sleep, oedema, skin, hair and nails, bones, constipation, ‘signs’ (pulse, blood pressure and core temperature)); other clues (family history, other autoimmune conditions, gradual decline); and triggers.
° Chapter 2: Blood tests for underactive thyroid – The stengths and weaknesses of such and what other information is needed.
° Chapter 3: Before you start a trial of thyroid glandular (natural desiccated thyroid) – All the other interventions, especially diet and supplements, that need to be in place before you try out natural thyroid supplementation.
° Chapter 4: The adrenal gearbox – Symptoms, diagnosis and management of adrenal fatigue.
° Chapter 5: How to trial thyroid glandular (natural desiccated thyroid) – Starting low, building slowly and finding your personal ‘sweet spot’.
° Chapter 6: How and why we become hypothyroid – The possible causes of primary and secondary hypothyroidism, including autoimmunity, environmental factors and nutritional deficiencies.
° Chapter 7: What happens if the diagnosis of hypothyroidism is missed – This chapter is a bit scary, itemising accelerated ageing and degeneration, dementia, heart disease and cancer, so it ends with some light relief!
° Chapter 8: Thyroid myths – This arms you to face discouragement from health professionals about taking charge of your thyroid yourself.
° Chapter 9: How we starve, destroy and poison the the thyroid – Helps understanding of the ways in which modern life damages the thyroid and how we can limit that damage.
° Chapter 10: The hypothyroid child – Another scary chapter detailing the consequences for growth and development of mother (during pregnancy) and child being hypothyroid.
° Chapter 11: The hypothyroid female – Underactive thyroid is much more common in those with female hormones; this chapter explains why and what particular action to take.
° Chapter 12: Thyrotoxicosis – Addresses the much rarer issue of overactive thyroid and possible causes.
° Chapter 13: Iodine – How much iodine is it desirable and safe to supplement and ixwhat other uses does iodine have in the body?
Much of the Appendices is repeated from our other books, though with a particular focus on the underactive thyroid, so that this book can be self-contained and provide all you need. That said, readers will find references to our other books for more detail on the why and how of the paleo-ketogenic diet, understanding and fighting infection, pregnancy and child development, and a comprehensive picture of ecological medicine, including numerous case histories.
Returning to Robert Burton and his tome The Anatomy of Melancholy, this, had the original title The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it. In Three Maine Partitions with their several Sections, Members, and Subsections. Philosophically, Medicinally, Historically, Opened and Cut Up. (By the way, this is not the longest book title ever – that ‘honour’ belongs to The Historical Development of the Heart from Its Formation From … In all, the title contains 3777 words and over 26,000 characters. But we [Craig!] digress(es).) The title was long, but the thrust of what Burton suggested can easily be distilled down to:
Diet rectifiedSleep and waking rectifiedExercise rectifiedAir rectifiedMirth, music and merrymaking.The reader will notice, in due course, that these principles are very similar to the Groundhog regimes described in the Appendices, but do not hurry there yet – there is much reading to be done first! x
203
References
1. Burton R. The Anatomy of Melancholy. First published 1621. www.gutenberg.org/files/10800/10800-h/10800-h.htm
2. Humphry GM. Report of a Committee of the Clinical Society Of London. J Anat Physiol 1886; 20(Pt3): 546-547. www.ncbi.nlm.nih.gov/pmc/articles/PMC1288618/
3. Asher R. Myxoedematous madness. Br Med J 1949; 2(4627): 555–562. doi: doi.org/10.1136/bmj.2.4627.555 www.bmj.com/content/2/4627/555
*Historical note on ‘Myxoedema madness’: The Committee on Myxoedema of the Clinical Society of London issued the first report (1886) that described the development of ‘delusions and hallucinations’ in almost half of hypothyroid patients.2 Sixty years later, in 1949, Asher et al re-examined this relationship in 14 patients who had psychosis and clinical evidence of hypothyroidism. The patients received thyroid hormone supplements, with nine patients achieving full recovery.3 Asher labelled this association ‘myxoedema madness’, which later was renamed ‘myxoedema psychosis’ (MP).
Introduction
Do it yourself because your doctor won’t
My experience, flowing from four decades of clinical medicine and consultations with thousands of patients, has shown me that the best person to effect a cure is the sufferer. No-one is better motivated or better positioned to put in place the interventions which allow healing and recovery. This will not happen with conventional Western medicine because patients have been disempowered by doctors. They believe in pills for all ills. But most physicians and pharmacists are more interested in profits than patients. Big Pharma’s mantra is ‘A patient cured is a customer lost’.
My job as a physician is to supply the Rules of the Game and the Tools of the Trade to allow patients to find their own path to recovery. From the symptoms, signs and tests, we – the patient and me – together establish the underlying mechanisms which, if uncorrected, progress to pathological disease. This is proper, scientific, logical medicine which goes under various names: naturopathic, ecological, functional. This is not an alternative medicine – it is the Real McCoy.*
xiiWe do not have enough trained therapists to correctly diagnose and manage the tsunami of people who are being failed by ‘conventional’ medicine. Conventional medicine may provide the short-term relief of symptom-suppressing medication, and the short-term reassurance that ‘something is being done’, but it fails to address the underlying causes. The inevitable result is a progression of the underlying pathology, so that we have more chronically sick and dysfunctional adults and children than ever before.
I learned about the inadequacies of modern medicine through working with thousands of patients with chronic fatigue syndrome and myalgic encephalitis. Conventional medicine had and still has little to offer these pathologically fatigued patients. The correct treatment seems so obvious now, but when I first started talking about energy delivery mechanisms in the 1980s, I was considered unhinged. When this progressed to putting my ideas into the public arena in an online website,† I was attacked by mainstream doctors for such heretical ideas and subjected to endless investigation by the UK’s General Medical Council (GMC). This was despite not a single complaint from a patient, not a single patient worsening as a result of my treatments, and not a single patient being put at risk of harm. A revealing comment arising from an FOIA (Freedom of Information) search came from the GMC’s own barrister Mr Tom Kark: ‘The problem with the Myhill cases is that all the patients are improved and none will give witness statements against her.’
The current ‘football match’ score is Myhill 38, GMC nil.‡ In other words, there have been 38 GMC investigations concluded against me and all have found in my favour. My most recent GMC hearing was in Oct 2020, which I again won. Interested xiiireaders can learn more from my website.1 At that point I relinquished my registration with the GMC because that gave me the clinical freedom to speak my mind without the bore of yet another investigation. What is so interesting is that I have continued to practise as a Naturopathic Physician but have been no less effective because I find the Tools of the Trade are available without doctors’ prescription. They can all be found in Nature’s pantry.
What to expect from this book
The thyroid gland is a vital part of energy delivery mechanisms. The underactive thyroid is now so common that it needs to be considered in the treatment of any chronic condition. Conventional medicine routinely misdiagnoses such cases and thereby delays diagnosis. Worse, when the diagnosis is made by physicians like myself, then conventional doctors obstruct, mislead and frighten patients into stopping their healing treatment.
What this book is: It describes how we can all effectively and safely diagnose and treat our own underactive thyroid to reverse current pathology, improve quality of life and prevent future pathology.What this book is not: It is not a textbook. There will, however, be a fair smattering of supporting medical papers and references, all listed at the end of the book, by chapter. The reader can choose to look them up or just to plough on, safe in the knowledge that ‘they are there’.In essence this book is the path to living well and to your full potential. You have to do it yourself because your doctor will not do it for you.
Just do it!
Introducing the thyroid gland
Perhaps before we end this introduction, we should say a little about the thyroid gland itself. The word ‘thyroid’ is derived from the Latin ‘thyreoidea’ which can be traced back to the Ancient Greek word θυρεοειδής, meaning ‘shield-like/shield-shaped’. The shape and location of the thyroid gland can be seen in Figure 1.
In the course of this book you will find out what it does, what may make it become xivunderactive and why that is important. Also how to spot for yourself if yours or a loved one’s is under-performing, as most doctors today rely solely on blood tests and thereby miss many diagnoses, and how to support your thyroid back to health.
Figure 1: Position of thyroid in the neck
References
1.www.drmyhill.co.uk/wiki/Press_Release_re_my_Non_Compliance_Hearing_-_MPTS_-_Myhill_vs_GMC_Sept_28_to_Oct_1_2020
* There are many contenders as to the derivation of the phrase ‘the real McCoy’. Here are four:
1. Perhaps the McCoy is derived from Mackay, referring to Messrs Mackay of Edinburgh, who distilled a fine whisky from 1856 onwards and who, from 1870, promoted it as 'the real MacKay'
2. The expression could have derived from the name of the branch of the MacKay family from Reay, Scotland, that is, 'the Reay Mackay'.
3. Perhaps it was the Kid McCoy (Norman Selby, 1872-1940), American welterweight boxing champion, who gave us this phrase. The story goes that a drunk challenged Selby to a fight to prove that he was McCoy and not one of the many lesser boxers trading under the same name. After being knocked down, the drunk mumbled, 'Yes, that's the real McCoy'.
4. Or maybe it was named after one Elijah McCoy, the Canadian inventor educated in Scotland, who invented an automatic lubricating cup which allowed trains to travel without the delays that were erstwhile necessary in order to add oil to the axles and bearings. Elijah’s invention spawned many copies, all inferior to the original and so he patented the design in 1872.
† My website – www.drmyhill.co.uk – currently (as of September 2022) has had in excess of 24 million hits. I think it is a classic example of the Streisand Effect: this is a phenomenon that occurs when an attempt to hide, remove or censor information has the unintended consequence of increasing awareness of that information, often via the Internet. It is named after American singer, Barbra Streisand, whose attempt to suppress the California Coastal Records Project photograph of her residence in Malibu, California, taken to document California coastal erosion, inadvertently drew greater attention to it in 2003. So, by trying to put me out of action, the GMC drew attention to me, and people visited my site in their droves!
‡Sporting aside: The highest score in an English Football League match is 13-0 and that has been achieved three times. The first such occasion was on 6 January 1934 when Stockport County beat Halifax Town 13-0 in a Third Division (North) fixture. The Scottish Football Cup can do better – Arbroath beat Bon Accord 36–0 on 12 September 1885. But my 38-0 thrashing of the GMC outstrips them all; Craig has even had a polo shirt made up for me, with my GMC score emblazoned across the chest!
Part I
The practical
Chapter 1
Are you hypothyroid?
The symptoms and signs of an underactive thyroid
Listen to the patient, they will tell you the diagnosis
Sir William Osler
With respect to medical disorders, 90% of the diagnosis comes from the patient’s history. Tests are helpful but, on their own, cannot be relied on. This is particularly true for managing the underactive thyroid and adjusting the dose of any replacement hormones. Understanding why symptoms arise is the starting point for proper diagnosis and management because we use symptoms to monitor the dose and timing. We need the full picture.*
The thyroid is a vital part of energy delivery mechanisms. I use the car analogy. For full function we need the right fuel in the tank (a paleo-ketogenic diet), the mitochondrial 4engine (see Chapter 3, a microcosm of our book Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis – it’s mitochondria not hypochondria) together with the control mechanisms of the thyroid accelerator pedal and the adrenal gearbox. The symptoms of the underactive thyroid are split into those that apply to poor energy delivery mechanisms and those that are specific to the thyroid. This distinction is important because to treat those general symptoms of poor energy delivery may well need attention to diet, gut function and mitochondrial and adrenal issues before one can effectively employ thyroid support.
Table 1.1: General symptoms of the underactive thyroid (which equally apply to poor diet and poor mitochondrial and adrenal function)
Table 1.2: Symptoms more specific to the thyroid
MechanismSymptomNotesFluid retention and oedemaPuffy faceCompare current looks with old photographs Large tongueYou may see indentations from where teeth lie against the tongue Obstructive sleep apnoea, perhaps with snoringBecause the tissues of the throat are swollen, and this constricts the airways Voice changesThe vocal cords are puffy Swollen, puffy legs, most obvious in the ankles at the end of the dayA cause of ‘non-pitting oedema’ Problems with ‘trapped nerves’ e.g. carpal tunnel syndrome, sciaticaSwollen tissues squash nervesPoor fat burningKetogenic hypoglycaemia – on a PK diet you need thyroid hormones to burn fat; if low, then fat burning is done with adrenalin and this gives all the symptoms of low blood sugarThe symptoms of low blood sugar are not due to low blood sugar but to the adrenalin (and other hormonal) pumped out in response to low blood sugar Gaining weight despite being on a keto diet – this may point to hypothyroidismYou need thyroid hormones to burn fatSleep disturbancePoor quality, unrefreshing sleepThis is well recognised in hypothyroidism but the mechanism is uncertain. It may be in part sleep disturbance due to ketogenic hypoglycaemia Being an owl (drop off to sleep late, wake late) and so feeling ‘jet-lagged’There are at least three groups of hormones for quality sleep and correct diurnal rhythm – melatonin, TSH and T4/T3. Light inhibits melatonin production, dark stimulates such. Melatonin stimulates the pituitary and so TSH spikes at midnight. Then T4 spikes at 4:00 am, T3 at 5:00 am, which stimulates the production of adrenal hormones that wake you up 8Proximal myopathy – that is, symmetrical weakness of ‘proximal’ (upper) and/or lower limbsThis may present with difficulty climbing hills or stairs, trouble getting out of the bath or off the floor or even up from a chair… or getting on to a horse! Press-ups become impossibleOften misdiagnosed as lack of fitnessPoor energy delivery plus oedema of the gut?ConstipationConstipation is often an early symptom to improve once the underactive thyroid has been corrected. I am not sure of the mechanism of this but it is probably a combination of poor energy delivery, being cold and oedema of the gutUncertainHeadachesAgain, I am not sure of the mechanism of this but clinically, headaches often settleTable 1.3: Signs of poor energy delivery mechanisms (the combined effects of poor diet and poor mitochondrial, thyroid and adrenal function) – useful for diagnosing and monitoring
SymptomMechanismNotesLow core temperature – that is, below 36.6ºC (97.88ºF)Poor energy deliveryMonitoring core temperature is helpful to get the dose of thyroid and adrenal supplements right – see Chapter 4Low blood pressure – that is, below 110/70 mm HgPoor energy delivery to the heart so it cannot beat powerfullyThis may well be masked by the adrenalin of metabolic syndrome (a pre-diabetic condition) or ketogenic hypoglycaemiaSlow pulse – that is, less that 70 bpm in a non-athleteThe thyroid is largely responsible for the resting pulse rateA normal person, not in athletic training, should have a resting pulse of 70-75 bpm. Again, this may be masked by adrenalin as above 9Table 1.4: Medical history of the underactive thyroid – useful for suspecting the diagnosis
WhatWhyNotesBeing femaleTaking the Pill and HRT are major risk factors for the underactive thyroidWomen with CFS/ME outnumber men by at least 4:1 – see www.meresearch.org.uk/ sex-differences-in-mecfs and paper by Baha Arafah, 2001, which has the telling conclusion: ‘In women with hypothyroidism treated with thyroxine, estrogen therapy may increase the need for thyroxine.’1Family historyThyroid problems run in familiesPossibly genetic2 but families have the same diet, environmental and infectious exposures. Genetic risk does not mean that there is nothing that can be doneOther autoimmune conditionsAutoimmunity runs in families2Again, possibly genetic but, again, families have the same diet, environmental and infectious exposuresGradual decline into ill healthThe thyroid may be slowly destroyed by autoimmunity, micronutrient deficiency, toxins, radiation…All the above symptoms are ascribed by doctors to age, stress, menopause, etc so patients are dismissed without proper clinical consideration. This is further reason to do it yourself …and prescription medicationsLithium,3 amiodarone4 and beta blockers5 have been clearly linked but there are probably many othersTriggers: Be aware of the increased risk if any of the following are in your medical history1. vaccinesThese are good at triggering autoimmune diseaseSee the list of 31 studies below that demonstrate that vaccines can trigger autoimmune responses. For a more recent report, specific to thyroid function, see Vera-Lastra et al’s 2021 report62. menopauseProgesterone increases the efficacy of thyroid hormonesThe menopause may unmask underlying hypothyroidism. In consequence many women have been wrongly prescribed progesterone (when the underactive thyroid diagnosis has been missed) and this is dangerous medicine as progesterone is carcinogenic 103. viral infectionMay present with an overactive thyroid and this progresses to an underactive thyroid, typically in women aged 40-50 triggered in summer and early autumnSo called sub-acute thyroiditis (SAT) – for example, there is evidence of SAT being preceded by upper respiratory tract infection, of elevated viral antibody levels, and of both seasonal and geographical clustering of cases74. whiplash injuryA good friend and osteopath has noticed this associationThis is biologically plausible as there may well be soft tissue injury in the neckHaving established the clinical picture suggesting an underactive thyroid, then we can do laboratory tests to support that suggestion.
The evidence base for the relationship between immune responses and vaccinations
Here is a list of medical papers showing the link between allergic and autoimmune responses and vaccinations:
Shoenfeld & Aron-Maor 2000.8Nossal, 2000.9Shoenfeld, Aron-Maor and Sherer, 1996.10Cohen & Shoenfeld, 1996.11Rogerson & Nye, 1990.12Haschulla et al, 1990.13Biasi et al, 1993.14Biasi et al, 1994.15Gross et al, 1995.16Cathebras et al, 1996.17Maillefert et al, 1999.18Grasland et al, 1998.19Pope et al, 1998.20Tudela, Marti & Bonanl, 1992.2111Finielz & Lam-Kam-Sang, 1998.22Guiseriz, 1996.23Mamoux & Dumont, 1994.24Grezard, et al, 1996.25Weibel & Bemor, 1996.26Ray et al, 1997.27Howson & Fineberg, 1992.28Howson et al, 1992.29Mitchell et al, 1998.30Mitchell et al, 2000.31Nussinovitch, Harel & Varsano, 1995.32Thurairajan et al, 1997.33Maillefert et al, 2000.34Adachi, D`Alessio and Ericsson, 2000.35Older et al, 1999.36Kennedy, 1999.37Hogenesch et al, 1999.38Finally, it is biologically plausible that the Covid-19 vaccines will switch on autoimmunity. 12
References
1. Arafah BM. Increased Need for Thyroxine in Women with Hypothyroidism during Estrogen Therapy. N Engl J Med 2001; 344:1743-1749. www.nejm.org/doi/10.1056/NEJM200106073442302
2. Panicker V. Genetics of Thyroid Function and Disease. Clin Biochem Rev 2011; 32(4): 165–175. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219766/
3. Surks M. Lithium and the Thyroid. www.uptodate.com/contents/lithium-and-the-thyroid?search=lithium%20and%20the%20thyroid&source=search_result&se-lectedTitle=1~150&usage_type=default&display_rank=1 (Accessed 1 July 2022) 204
4. Keh-Chuan L. Amiodarone-induced thyroid disorders: a clinical review. BMJ: Postgraduate Medical Journal 2000; 76(893): 133-140. doi.org/10.1136/pmj.76.893.133
5. Bax ND, Lennard MS, Tucker GT. Effect of beta blockers on thyroid hormone. Br Med J 1980; 281(6250): 1283. doi: 10.1136/bmj.281.6250.1283
6. Vera-Lastra O, Navarro Ao, Dominguez MPC. Two Cases of Graves’ Disease Following SARS-CoV-2 Vaccination: An Autoimmune/Inflammatory Syndrome Induced by Adjuvants. Thyroid 2021; 31(9): 1436-1439. doi: 10.1089/thy.2021.0142 https://pubmed.ncbi.nlm.nih.gov/33858208/
7. Nishihara E, Ohye H, Amino N, et al. Clinical Characteristics of 852 Patients with Subacute Thyroiditis before Treatment. Internal Medicine 2008; 47(8): 725-729. doi.org/10.2169/internalmedicine.47.0740 www.jstage.jst.go.jp/article/internalmedicine/47/8/47_8_725/_article
8. Shoenfeld Y, Aron-Maor A. Vaccination and autoimmunity. Vaccinosis: A dangerous liaison? J Autoimun 2000; 14(1): 1-10. doi: 10.1006/jaut.1999.0346
9. Nossal GJV. Vaccination and autoimmunity. JAI 2000; 14: 15-22.
10. Shoenfeld Y, Aron-Maor A, Sherer Y. Vaccination as an additional player in the mosaic of autoimmunity. Clin Exp Rheumatol 2000; 18(2): `181-184. PMID: 10812488
11. Cohen AD, Shoenfeld Y. Vaccine-induced autoimmunity. J Autoimmun 1996; 9(6): 699-703. doi: 10.1006/jaut.1996.0091 11A. Rogerson SJ, Nye FJ. Hepatitis B vaccine associated with erythema nodosum and polyarthritis. Br Med J 1990; 301: 345. doi: https://doi.org/10.1136/bmj.301.6747.345
12. Haschulla E, Houvenagel E, Mingui A, Vincent G, Laine A. Reactive arthritis after hepatitis B vaccination. J Rheumatol 1990; 17: 1250-1251.
13. Biasi D, De Sandre G, Bambara LM, Carletto A, Caramaschi P, Zanoni G, Tridente G. A new case of reactive arthritis after hepatitis B vaccination. Clin Exp Rheumatol 1993; 11(2): 215. PMID: 8508565
14. Biasi D, Carletto A, Caramaschi P, Frigo A, Pacor ML, Bezzi D, Bambara LM. Rheumatological manifestations following hepatitis B vaccination. A report of 2 clinical cases (article in Italian). Recenti Prog Med 1994; 85(9): 438-440. PMID: 7938876
15. Gross K. Combe C, Kruger K, Schattenkirschner M. Arthritis after hepatitis B vaccination. Report of three cases. Scand J Rheumatol 1995; 24: 50-52. doi: 10.3109/03009749509095156.
16. Cathebras P, Cartry O, Lafage-Proust MH, et al. Arthritis, hypercalcemia and lytic bone lesions after hepatitis B vaccination. J Rheumatol 1996; 23: 558-560.
17. Maillefert JF, Sibilia J, Toussirot E, et al. Rheumatic disorders developed after hepatitis B vaccination. Rheumatology 1999; 38: 978-983. doi: 10.1093/rheumatology/38.10.978.
18. Grasland A, Le Maitre F, Pouchot J, et al. Adult-onset Still’s disease after hepatitis A and B vaccination (article in French). Rev Med Interne 1998; 19(2): 134-136. doi: 10.1016/s0248-8663(97)83425-x 205
19. Pope JE, Stevens A, Howson W, Bell DA. The development of rheumatoid arthritis after recombinant hepatitis B vaccination. J Reumatol 1998; 25(9): 1687-1693. PMID: 9733447
20. Tudela P, Marti S, Bonanl J. Systemic lupus erythematosus and vaccination against hepatitis B. Nephron 1992; 62(2): 236. doi: 10.1159/000187043
21. Finielz P, Lam-Kam-Sang LF. Systemic lupus erythematosus and thrombocytopenic purpura in two members of the same family. Nephrol Dial Transplant 1998; 13: 2420-2421.
22. Guiseriz J. Systemic lupus erythematosus following hepatitis B vaccine. Nephron 1996; 74: 441.
23. Mamoux V, Dumont C. Lupus erythemateux dissemine et vaccination contre l’hepatite B. Arch Pediatr 1994; 1: 307-308.
24. Grezard P, Chafi M, Philippot V, Perrot H, Faisant M. Cutaneoius lupus erythematosus and buccal aphthosis after hepatitis B vaccination in a 6-year-old child. Ann Dermatol Venereol 1996; 123: 657-659.
25. Weibel RE, Bemor DE. Chronic arthropathy and musculoskeletal symptoms associated with rubella vaccines. A review of 124 claims submitted to the National Vaccine Injury Compensation Program. Arthritis Rheum 1996; 39: 1529-1534.
26. Ray P, Black S, Shinefield H, et al. Risk of chronic arthropathy among women after rubella vaccination. Vaccine Safety Datalink Team. JAMA 1997; 278: 551-556.
27. Howson CP, Fineberg HV. Adverse events following pertussis and rubella vaccines. Summary of a report of the Institute of Medicine. JAMA 1992; 267; 392-396.
28. Howson CP, Katz M, Johnston RB Jr, Fineberg HV. Chronic arthritis after rubella vaccination. Clin Infect Dis 1992; 15: 307-312.
29. Mitchell LA, Tingle AJ, MacWilliam L, Horne C, Keown P, Gaur LK, Nepom GT. HLA-DR class II associations with rubella vaccine-induced joint manifestations. J Infect Dis 1998; 177: 5-12.
30. Mitchell LA, Tingle AJ, Grace M, Middleton P, Chalmers AC. Rubella virus vaccine associated arthropathy in postpartum immunized women: influence of preimmunization serologic status on development of joint manifestations. J Rheumatol 2000; 27: 418-423.
31. Nussinovitch M, Harel L, Varsano I. Arthritis after mumps and measles vaccination. Arch Dis Child 1995; 72: 348-349.
32. Thurairajan G, Hope-Ross MW, Situnayake RD, Murray PI. Polyarthropathy, orbital myositis and posterior scleritis: an unusual adverse reaction to influenza vaccine. Br J Rheumatol 1997; 36: 120-123.
33. Maillefert JF, Tonolli-Serabian I, Cherasse A, et al. Arthritis following combined vaccine against diphtheria, polyomyelitis and tetanus toxoid. Clin Exp Rheumatol 2000; 18: 255-256.
34. Adachi JA, D`Alessio FR, Ericsson CD. Reactive arthritis associated with typhoid vaccination in travellers: report of two cases with negative HLA-B27. J Travel Med 2000; 7: 35-36. 206
35. Older SA, Battafarano DF, Enzenauer RJ, Krieg AM. Can immunization precipitate connective tissue disease? Report of five cases of systemic lupus erythematosus and review of the literature. Sem Arthritis Rheum 1999; 29: 131-139.
36. Kennedy JR. Reactive arthritis: the result of an anti-idiotypic immune response to a bacterial lipopolysaccharide antigen where the idiotype has the immunological appearance of a synovial antigen. Med Hypotheses 2000; 54: 723-725.
37. Hogenesch H, Azcona-Olivera J, Scott-Montcrieff C, Snyder PW, Glickman LT. Vaccineinduced autoimmunity in the dog. Adv Med Vet 1999; 41: 733-747.
38. Akinosoglou K, Tzivaki I, Marangos M. Covid-19 vaccine and autoimmunity: Awakening the sleeping dragon. Clin Immunol 2021; 226: 108721. doi: 10.1016/j.clim.2021.108721
*Astronomical aside: One has to look very carefully to arrive at the full picture. As an analogy, consider Polaris, the North or Pole Star, so called because its current position is less than a degree away from the north celestial pole. The Ancients thought this to be the (single) brightest star in the constellation Ursa Minor, and as such it is designated Alpha Ursae Minoris. In fact, Polaris is a triple star system (three stars all orbiting each other), composed of the primary, a yellow supergiant designated Polaris Aa, in orbit with a smaller companion, Polaris Ab and then this pair is in a wider orbit with Polaris B. At one time there were thought to be two more widely separated components—Polaris C and Polaris D – but these have been shown not to be physically associated with the Polaris system. All this took time, effort, a lot of mathematics, many different methods of astronomical investigation, such as observation by the naked eye, observation through a variety of telescopes, the use of variable radial velocity calculations, and the determination of some very clever people – things had to be ruled in and things had to be ruled out. The same principles apply to diagnosing hypothyroidism – one has to look at lots of different factors, be determined and not rely on a single measure. Relying on such a single measure was the mistake the Ancients made with Polaris – their eyes saw one bright star and so they thought there was one bright star. Wrong! Conventional doctors see ‘normal’ blood test result(s) and so the patient does not ‘have a thyroid problem’. (Often) wrong!
†Footnote: A ‘poikilotherm’ is an organism (such as a frog) with a variable body temperature that tends to fluctuate with, and is similar to or slightly higher than, the temperature of its environment.
‡ The words ‘attractive’ and ‘beauty’ may seem unusual terms to find in a description of the symptoms and signs of illness, but I use these because they are universally ‘understood’, not in any ‘judgemental’ or ‘discriminatory’ way. The fact is that we ‘look different’ when we are ill, and evolution has ‘taught’ us to recognise these outward signs of illness as ‘unattractive’ – dark circles under the eyes, for example. Many of my most ill patients have become, as they have got better, the most attractive human beings.
Chapter 2
Blood tests for the underactive thyroid
Blood tests for the underactive thyroid have become the only route by which doctors generally are prepared to diagnose and monitor hypothyroidism, just as naked eye observation was the only way the Ancients (incorrectly) determined the nature of Polaris. In consequence, the diagnosis is often missed or delayed. Just as bad, replacement therapy may be inadequate because simply relying on blood tests means that under-dosing is common. Late diagnosis and under-dosing consign the patient to years of misery together with the increased risk of major pathology (see Chapter 9). I suspect one reason is intellectual idleness: it is so much quicker and easier to diagnose a condition with a fleeting and unthinking look at a piece of paper rather than take a proper medical history, as detailed in Chapter 1 – less work for doctors, which means that patients can be shovelled through the system in two instead of 20 minutes. Jolly good for out-patient vital statistics.*
Big Pharma too loves patients to be under-dosed because this leads to more pathology, more prescriptions and more profits. This has ‘worked’ very well for Big Pharma – as of 14end-2020, the total global pharmaceutical market was valued at about US$1.27 trillion, having made striking increases from its 2001 valuation of US$390 billion.1
