Full text of DOI:10.1089/10762800152709750

Rx:RN
Holistic Management
of Thyroid Dysfunction
The Nurse’s Role
the thyroid hormones, thyroxine (T ),
4
ation exposure. Thyroid disorders may
also be caused by autoimmune condi-
tions, such as Graves’ disease and
Samten Williams, B.S.N., R.N.
the stored form of the hormone, and tri-
iodothyronine, (T ) the active form of
3 ,
the hormone. The subscript numbers
relate to the number of iodine molecules
Hashimoto’s thyroiditis. Family history
12
may be a factor
ypothyroidism, the most com-
mon form of thyroid disorder,
and some researchers
7–9
within each molecule of the hormone.
speculate that exposure to toxic sub-
stances in the environment may trigger an
autoimmune response.
affects one woman of ten over
The thyroid gland is self-regulated by a
complex system of negative feedback
loops that start with the secretion of thy-
rotropin-releasing hormone (TRH) in the
hypothalamus. Once released, TRH com-
municates with the pituitary gland to
release thyroid-stimulating hormone
(TSH). It is this hormone, TSH, that com-
municates with the thyroid gland to pro-
duce T . The hormone T is then produced
H
1,2
the age of 65.
This group of elders is
not the only cohort that is affected by
thyroid conditions. The 1999 United
States Census estimate, which is the lat-
est information available to date, indi-
cates that 5.40 million American men
and women in the general population
The Challenge of Diagnosing
Thyroid Dysfunction
Confirming a diagnosis of hypothy-
roidism is a challenging process because
the standard test used to check thyroid
function, the TSH test, is not sensitive
enough to diagnose many borderline suf-
ferers.
Denis St. J. O’Reilly, a consultant clini-
cal biochemist in the department of clini-
cal biochemistry and clinic for thyroid
diseases, at the Royal Infirmary, Glasgow,
Scotland, has 20 years of research and
clinical experience working with patients
who have thyroid disorders. Addressing
the chaos in the medical community
regarding the diagnosis of hypothy-
roidism, Dr. St. J. O’Reilly calls for a
reassessment of thyroid-function tests.
This reassessment is needed for the fol-
lowing reasons:
3
are treated for thyroid dysfunction. In
addition, an estimated 13–20 million
Americans may not know that they have
4
3
from T
by the removal of an iodine
4
4–6
8,9
thyroid conditions.
molecule. These thyroid hormones are
responsible for cellular metabolism
throughout the entire body.
People who suffer from thyroid dys-
function need health care providers who
have a sophisticated understanding of
the testing, diagnosis, and treatment of
thyroid disorders. Conventionally, via
assessment, education, and communica-
tion, nursing has served as a bridge
between physicians and patients. This
nursing role is crucial now; it is the front
line of defense against a rise in thyroid
dysfunction in the United States.
Common thyroid disorders include
hyperthyroidism and hypothyroidism.
Caused by an overproduction of thyroid
hormones, hyperthyroidism causes over-
activity of body metabolism. Signs of an
overac tive thyroid may include an
enlarged thyroid gland, generalized ner-
vousness, weak muscles, weight loss,
moist skin, hair loss, palpitations, heat
intolerance, dyspnea, increased gastroin-
10
testional motility, insomnia, and fatigue.
The Thyroid in
Health and Dysfunction
The most prevalent form of thyroid
dysfunction, hypothyroidism, results
from an inadequate production of thy-
roid hormone. Symptoms of an underac-
tive thyroid may include puffiness in the
hands and face, weight gain, a hoarse
voice, dry skin, chronic constipation,
depression, intolerance to cold, memory
loss, muscle aches, bradycardia, and gen-
(1) Changes in thyroxine and triiodothy-
ronine levels during periods of sys-
temic illness are not well-understood.
(2) False-positive and false-negative
results can occur and should be consid-
ered when interpreting TSH levels.
The thyroid gland is the only tissue in
the body that can absorb iodine, an ele-
ment that is vital to hormonal chain
reactions. Absorbed through a normal
component of many foods, especially
sea vegetables, iodized salt, thyroid
medications, and supplements, iodine is
combined with an amino acid, tyrosine,
to form the basic building block that will
become the thyroid hormones. This ele-
ment/protein combination converts into
(3) The secretion of TSH, or lack thereof,
is influenced by many factors other
than negative feedback inhibition by
11
12
eralized fatigue.
thyroxine or triiodothyronine.
Thyroid conditions may also occur in
pregnant women or in newborns, or as a
result of cancer, or as a side-effect of radi-
Jacob Teitelbaum, M.D., director of the
Annapolis Research Center for Effective
Fibromyalgia Syndrome/Chronic Fatigue
384

GJ 7/6 360-393 11/15/01 1:55 PM Page 385
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
385
“I would like to see nurses on the
forefront of people advocating for patients.”
Syndrome Therapies, Annapolis, Mary-
land, agrees with this last concern of Mr.
Louise Hay’s Affirmations for Patients With Thyroid Conditions
St. J. O’Reilly’s. Sharing a clinical scenario
from his practice with patients who have
myalgia, Dr. Teitelbaum says that, when
hypothyroidism is caused by suppressed
activity of the hypothalamus, the results
Problem
Probable cause
New thought pattern
Thyroid dysfunction
Humiliation; a feeling of
“I never get to do what I
want to do. When is it
going to be my turn?”
“I move beyond old limitations and
now allow myself to express freely
and creatively.”
11
of a TSH test can be normal.
Richard Shames, M.D., on the adjunct
faculty of Florida Atlantic University,
and Karilee Halo Shames, R.N., Ph.D.,
an assistant professor of Nursing at
Florida Atlantic University, are doc-
tor/nurse, husband/wife, holistic health
experts in the field of thyroid disorders.
Their book and copy on their Web site
(see box entitled Web Sites) describe
their “Thyroid Power” program and
they provide physician and nurse con-
sultations for people with thyroid prob-
Goiter
Hatred for having something “I am the power and authority in my
inflicted upon oneself; being
a victim; feeling thwarted in
life; and feeling unfulfilled
life. I am free to be me.”
Hyperthyroidism
Hypothyroidism
Rage at being left out
of things
“I am at the center of life and I
approve of myself and all that I see.”
Giving up; feeling
hopelessly stifled
“I create a new life with new rules
that totally support me.”
Adapted from ref. 17.
The Role of Nursing
13,14
lems.
can I do to get my doctor to listen to me
and not just look at the lab results?’”
says Richard.
The minimum amount of testing that
the Shames’ think is needed before a
patient can be told, “it does not look
like low thyroid [hormone] is causing
your symptoms” include a TSH test, a
The Shames’ also recommend against
relying too heavily on just the TSH test
for determining a course of treatment.
Karilee says: “Generally, doctors treat
patients by telling them that this one tiny
little test tells everything. This test doesn’t
even tell if there are antibodies present,
which is a huge clue in letting people
know if there is an autoimmune process
going on.”
One arm of nursing’s role in the thyroid
dysfunction “epidemic” is helping physi-
cians and patients understand testing and
treatment protocols better. The other arm
of nursing care in this epidemic is advoca-
cy.
“We start with the premise that, at the
present time, we do not have a health care
system. We have a sick care system. What
we need in order to have a real health
care system is for people to advocate for
themselves,” says Karilee. She continues:
basal temperature test, and a T
with total T , T uptake, free thyroxine
panel
4
4
3
index, T total, and antiperoxidase anti-
3
13
In their work with patients who have
thyroid conditions, the Shames’ rely on
“four pillars of diagnosis”: (1) symp-
toms: (2) laboratory tests; (3) related ill-
body.
In August 2001, the Food and Drug
Administration approved a home-test
kit for measuring TSH levels. Because
many experts regard the TSH test as an
unreliable measurement, especially
when used alone, such products raise
concern about quality care. The potential
for inaccurate diagnosing with the use
of home-test kits is another reason, and
opportunity, for nurses to assume a
leading role in the public health profile
And I would like to see nurses on the
f oref ront o f p eople advocating f or
patients. This is where nursing, especially
ho li st ic nur s ing, can re ally s hine.
Medicine is more focused on the curing,
the elimination of symptoms, and treating
disease. Nursing is supposed to be taking
care of the whole rest of the spectrum
from high-level wellness to critical illness.
Yet, somehow, many nurses find them-
14
nesses; and (4) and family history.
“When you look at the whole picture,
you get a better sense of what is going on
with the whole person. We believe that
doctors are mostly ‘treating the lab tests’
and not the person,” says Karilee. “We
do consults with people across the coun-
try and every day people say the same
thing: ‘My doctor is not listening. What
15
of thyroid care.

386
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
A direct care nurse has to communicate to
a patient’s physician the need for further testing.
welfare, helping patients with health
advocacy issues.
complementary resources without a doc-
tor’s diagnosis or prescription. He says:
“Now, I do not know about in the hospi-
tals, if nurses can start suggesting nutri-
tional items but, outside of the hospital,
they certainly can. A lot of thyroid treat-
ment that works really well is nonprescrip-
tion: vitamins, minerals, herbal medicines,
homeopathy, glandulars, and essential
fatty acids. The thyroid gland seems to
function more optimally when the patient
is [given supplements] with essential fatty
acids with mixed amino acids.”
For patients who are interested in tak-
ing over-the-counter thyroid glandulars, a
nurse can recommend a regimen of two
to four doses per day along with a multi-
vitamin. Other dietary recommendations
for patients with low thyroid hormone
levels include:
Organizations
American Thyroid Association
6066 Leesburg Pike, Suite 650
Falls Church, VA 22041
Phone: (703) 998-8890
Fax: (703) 998-8893
This is a huge gap in health care, Kar-
ilee says, because there are millions more
people laboring under the burden of
chronic, everyday discomfort and disease
than there are people needing critical or
near-death care.
Richard adds: “Nurses can take a little
more medical history than the doctors
have time to do or have the interest to do.”
He recommends thorough questioning
regarding family history of thyroid and
related diseases. If a patient complains of
fatigue, depression, and weight gain, he
recommends asking if the patient has ever
considered a diagnosis of hypothyroidism.
In short, when multisystems are affected
and the clinical picture is convoluted,
Richard advises “think thyroid.”
Advanced practice nurses have direct
control over ordering thyroid tests. A
direct care nurse, however, has to com-
municate to a patient’s physician the need
for further testing. In that circumstance,
Karilee advises that a nurse can say to a
physician something like, “I notice that
this patient has a number of diverse
symptoms, all possibly suggesting a thy-
roid illness. Do you think it would be
worth doing thyroid testing? I know that
we checked the TSH. I wonder if another
test might give us a little more clarity in
terms of whether this person is struggling
with an autoimmune response.”
Web site: www.thyroid.org
This association promotes scientific and
public understanding of the biology of the
thyroid gland and its disorders to improve
methods for prevention, diagnosis, and
management of thyroid dysfunction.
Thyroid Foundation of America
350 Ruth Sleeper Hall—RSL 350
350 Parkman Street
Boston, MA 02114
Phone: (617) 726-8500, inside the
Boston area
(800) 832-8321, outside Boston area
Fax: (617) 726-4136
e-mail: tfa@clark.net
Web site: www.clark.net/pub/tfa/
This organization offers educational
outreach and networking to providers and
consumers regarding issues concerning
thyroid disease education and management.
• Eat breakfast because doing so sets a
metabolic tone for the day.
• Lower fat intake.
• Limit cruciferous vegetables to one
serving or less each day.
• Eat only well cooked soy products in
13
one serving or less each day.
The Thyroid Society of America
7515 South Main Street, Suite 545
Houston, TX 77030
The nursing perspective of helping
someone boost his or her health is a very
different perspective than the perspective
of diagnosing or treating a disease. In addi-
tion, introducing these nursing interven-
tions earlier in the disease process can
spare a patient agony later on, says Karilee.
Phone: (800) THYROID
e-mail: help@the-thyroid-society.org
Web site: www.the-thyroid-society.org/
This organization offers educational
materials, public health alerts, research
opportunities, and a quarterly newsletter,
The Thyroid Connection
Metaphysical Considerations
Richard also says that nurses can lead
patients who look sluggish, sound slug-
gish, and complain of being cold and con-
stipated all of the time to alternative and
selves trapped in a tiny little corner down
at the end called critical care and death.
That leaves no one guarding the public
The endocrine system lies symmetri-
cally in and along the midline of the
body. Because this is also where the

ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
387
Afirmations on thyroid conditions
may assist nurses as they energetically guide
patients with thyroid conditions to empowerment.
chakra of intuitive knowing), we stress the
throat chakra. Given the myriad number of
variables, and consequences, associated
chakra system is, the endocrine and
chakra systems are metaphysically
related.
Web Sites
Drs. Richard and Karilee Shames
www.thyroidpower.com
This Web site features information
about the Shames’ program, Thyroid
POWER: 10 Steps to Total Health.
The seven major chakras are located
along the midline from the sacrum, known
as the first chakra, to the crown of the head,
known as the seventh chakra. These
ascending numbers parallel an ascending
consciousness. Whereas the root chakra is
concerned with survival issues, the seventh
chakra is concerned with universal, or cos-
mic consciousness and the unity of every-
thing. Chakras in between the first and the
seventh chakras correspond to the awaken-
with making even daily decisions, it is easy
to see why the throat chakra and thyroid
gland are overworked.
16
A prolonged disruption of this chakra
can result in any number of clinical dys-
functions, including addiction. In the words
of writer Jule Klotter, “[w]ithout the balance
and joined power of head and heart, the
will lacks a leader to follow; so, it goes out
in search of something to pledge its energy
MyThyroid.com
www.mythyroid.com
This site, maintained by Daniel J. Drucker,
M.D., division of endocrinology, University
of Toronto, Canada, University Health
Network, Toronto General Hospital,
provides extensive resources for many
categories of thyroid conditions, including
direct hyperlinks to scientific literature.
16
to, taking the form of an addiction.”
16
ing stages along this ascending path.
Louise Hay, a well-known spiritual
teacher and author based in Carlsbad, Cal-
ifornia, is another healer who has worked
extensively on the metaphysical levels of
disease manifestation. Her affirmations on
thyroid conditions (see box entitled Louise
Hay’s Affirmations for Patients With Thy-
roid Conditions), may assist nurses as
they energetically guide patients with thy-
roid conditions from the powerless, or vic-
The fifth chakra, like the thyroid
itself, is located at the base of the throat.
This chakra has to do with decision-
making issues of choice and with speak-
About.com on Thyroid Care
http://thyroid.about.com/cs/keythy
roidsites/
Mary Shomon is the guide on this
“about.com” site. It is is an excellent
resource for every aspect of thyroid care.
16
ing truth. Karilee says: “It is probably
no coincidence that the thyroid is locat-
ed at the base of the neck, our center for
self-expression and speaking our truth.
So many of us are challenged by this at
this particular time in our evolution.”
Because a majority of patients with thy-
roid problems are women, Karilee adds
that “ [i]t is a very important message
that, in order to be whole and healthy, we
must speak out. We must tell our truth.
We must actualize ourselves and fully
express [ourselves]. Each one of us is a
special light in the world. We have made
a commitment, an obligation, and I
believe, we made a promise when we
came here to express that light in our own
special way[s]. Only then, will the world
function as it needs to and be fulfilled.”
Whenever we struggle to align the heart
(the fourth chakra) with the mind (the sixth
17
tim, stance into one of empowerment.
V i a t h e i r 1 0 - s t e p p r o g r a m , t h e
Shames’ also look at the multiple layers
of thyroid disease. As they put it, “[w]e
take it one layer at a time so that, first,
we look at some of the physical issues
and then, when that is resolved, the
patients move more into some of the
mental, emotional, and spiritual issues.
The physical issues can be quite complex
even though these issues may look very
simple. They are quite complex because
everything is connected to everything
else. We try to help people understand
that they may have to do one system at a
time and that is OK.”
Higher Rates of Mortality
18
A 10-year cohort study in Great
Britain demonstrates that subclinical
levels of hyperthyroidism are associat-
ed with increased incidences of death
from all causes, especially mortality
attributed to circulatory and cardiac
diseases.
Comorbidity factors appear to be
involved with the diagnosis of hypothy-
roidism. This disease, in coexistence with a
variety of other diseases, increases the sever-
ity of these other illnesses. For instance,

388
ALTERNATIVE & COMPLEMENTARY THERAPIES—DECEMBER 2001
Nurses can play a major education and
intervention role in stemming the tide of losses,
both tangible and intangible, associated with thyroid disease.
I. Nutr Perspect 23(3):7, 9–11, 2000.
A startling example from the Shames’
practice shows that thyroid disorders can
kill patients. A new client came to their
office the day after her baby died. Suffer-
ing from hypothyroidism, the woman
was utterly exhausted in the daytime and
she fell asleep. The baby wandered off,
fell into water behind the family’s home
and drowned. “Here is an example of
what can happen when you have low thy-
roid [hormone levels] and you cannot
meet the demands of your life. It is a
havoc that most people do not even think
about. When some people go on ram-
pages, especially the women who kill
their babies, I wonder, how much of that
could be thyroid [related]? There is no
one looking at that,” says Karilee.
7. Online document at: http://thyroid.about.
com/library/weekly/aa030300a.htm2001.
8 . O n l i n e d o c u m e n t a t : h t t p : / / m y .
webmd.com/content/asset/adam_test_thry
rotropin 1999.
9. Teitelbaum, J. From Fatigued to Fantastic. New
York: Avery, 2001.
10. Online document at: www.aarda.org/
page19ahtml 2001.
11. Online document at: http://thyroid-rip
ken.med.jhu.edu/info-hypo.html 1998.
12. St. J. O’Reilly, D. Thyroid function tests—
time for a reassessment: Review. Br Med J
320(7245):1332–1334, 2000.
13. Shames, R., Shames, K.H. Thyroid POWER:
10 Steps to Total Health. New York: Harper
Resource, 2001.
Recommended Reading
Thyroid POWER: 10 Steps to Total Health
By Richard Shames, M.D., and Karilee
Halo Shames, R.N., Ph.D.
New York, HarperResource, 2001
From Fatigued to Fantastic
By Jacob Teitelbaum, M.D.
New York, Avery, 2001
someone with a diagnosis of hypothy-
roidism and a related glandular condition,
such as diabetes, can experience more com-
plications and earlier death than someone
without this dual diagnosis. In such cases,
Richard says, “[t]he thyroid medicines do
not work as well and you need more of the
diabetes medicine.” In addition, utilization
of insulin is compromised when a person
does not have the energy to exercise.
14. Online doc ument at: www. thyr oi d
power.com
As the thyroid epidemic continues to
grow, nurses from the bedside to advanced
practice settings can play a major education
and intervention role in stemming the tide
of losses, both tangible and intangible,
15. Torassa, U. When “normal feels lousy.” San
Francisco Chronicle, August 19, 2001, p. B3.
16. Klotter, J. Nourishing the energy body.
To w ns en d Le t t er for Do ct o r s & Pa t ie nt s
175/176:56–62, 1998.
Low thyroid hormone conditions make
an impact on the ability of the body to
maintain and repair cells in a nonglandu-
lar disorder such as osteoarthritis. Often,
when people with mild-to-moderate
arthritis symptoms have their thyroids
checked, receive treatment, and get their
thyroids under control, it turns out that
they did not have a mild or moderate
arthritis after all, says Richard, noting,
“[t]hat happens in my practice a lot; it
happens in other doctors’ practices.”
He adds: “What we are hoping to tell
nurses about is the need for heightened
awareness, a greater lookout, for con-
comitant low thyroid [hormone levels] as
an easily treatable cofactor that worsens
mortality and morbidity unnecessarily.”
17. Hay, L. Heal Your Body. Carlsbad, CA, Hay
House, Inc., 1988.
18. Parle, J., et al. Prediction of all-cause and
cardiovascular mortality in elderly people from
one low serum thyrotropin result: A 10-year
cohort study. Lancet 358(9285) 861–865, 2001.
associated with thyroid disease.
n
References
1. Online document at: www.mccg.org/
adulthealth/endocrine/stats/asp.
2. Online document at: www.viahealth.org/
disease/endocrinology.stats.htm July 2, 2001.
3 . O n l i n e d o c u m e n t a t w w w . a l l
thyroid.org/docs/mi/thy_statistics.html
4. Canaris, G.J., Manowitz, N.R., Mayor, G., Ridg-
way, E.C. The Colorado Thyroid Disease Preva-
lence Study. Arch Intern Med 160;526–534, 2000.
5. Ditkoff, B.A., Lo Gerfo, R. The Thyroid Guide.
New York: HarperPerennial/ HarperCollins,
2000.
Samten Williams, B.S.N., R.N., is a nurse,
writer, consultant, and public speaker, in pri-
vate practice in Ashland, Oregon.
To order reprints of this article, write to or call:
Karen Ballen, ALTERNATIVE & COMPLE-
MENTARY THERAPIES, Mary Ann Liebert,
Inc., 2 Madison Avenue, Larchmont, NY 10538-
1961, (914) 834-3100.
6. Moss J. Hypothyroidism—the unsuspected
illness or the most misunderstood illness? Part