"Sub-laboratory" hypothyroidism and the empirical use of Armour® Thyroid

Alternative Medicine Review, June, 2004 by Alan R. Gaby

Reactive Hypoglycemia/ Dysinsulinism

Barnes reported that the common, though controversial, disorder of blood-glucose regulation referred to as "reactive hypoglycemia," "hypoglycemia," or "dysinsulinism" often improves after empirical treatment with desiccated thyroid. (7) Case 2 is an extreme example of the many patients seen by this author in whom treatment with thyroid hormone improved the symptoms of reactive hypoglycemia.

Case 2.

A 23-year-old woman presented
with the chief complaint of fainting when
she did not eat every 2-3 hours. She sought
medical treatment after being stopped by
a policeman for speeding, while racing to
the nearest store to purchase food. She
collapsed while waiting for the ticket to
be issued, and had to pay not only for
speeding, but also for the ambulance and
hospital evaluation. The review of systems
was positive for intolerance to the cold.
Physical examination revealed a delayed
return on the Achilles' tendon reflex (ATR)
test and mild dryness and coarseness of the
skin. Thyroid-function tests were normal.
Based on her history, a presumptive diagnosis
of reactive hypoglycemia was made.
The patient was treated with 30 mg Armour
thyroid daily and within two weeks she was
able to fast for up to eight hours without
experiencing any significant problems.

Although thyroid hormone has not been systematically studied as a treatment for hypoglycemia, circumstantial evidence suggests it is involved in glucose homeostasis. In a study of healthy volunteers made hypoglycemic by administration of insulin, the mean serum concentration of T3 increased significantly within 45 minutes after the insulin injection. (8) Other research has shown thyroid hormone stimulates the synthesis of glucose through the process of gluconeogenesis. (9,10) Taken together, these findings suggest that thyroid hormone plays a role in the metabolic adaptation to hypoglycemia.

Ear, Nose, and Throat Disorders

Forman observed in 1934 that vasomotor rhinitis and, to a lesser extent, allergic rhinitis are often associated with clinical evidence of hypothyroidism, and that treatment with thyroid hormone relieves the symptoms in some cases. (11) He commented that the nasal mucosa of patients with vasomotor rhinitis frequently has a myxedematous appearance. In 1956, Hollender reported on 126 patients seen in his otolaryngology practice who had a low basal metabolic rate and were treated with levothyroxine. The response rates were as follows: vasomotor rhinitis (68%), postnasal discharge (68%), hearing loss and/or tinnitus (69%), lymphoid hyperplasia of the pharynx (51%), and headache (57%). (12) Others have also reported treatment with thyroid hormone can ameliorate various otolaryngological problems; (13,14) however, some investigators have failed to observe any benefit from this treatment. (15) Withers reported in 1974 that treatment with thyroid hormone frequently enhances the response to allergy-desensitization therapy. (16)

Menstrual Disorders and Infertility

Conventional texts mention infertility, menorrhagia, and oligomenorrhea as common disorders associated with hypothyroidism. There is evidence these problems also may occur in association with sub-laboratory hypothyroidism (Case 3). In a study of 150 women with longstanding (> 2 years) infertility due to anovulation or luteal insufficiency, 13.3 percent were found to have hypothyroidism. (17) In most of the cases of hypothyroidism, standard tests of thyroid function were normal, and the TRH-stimulation test was needed to establish the diagnosis. After treatment with levothyroxine (50 mcg daily), luteal function improved and two of the 20 women became pregnant. This author knows of several women with longstanding infertility and normal thyroid-function tests who have become pregnant after treatment with desiccated thyroid.