by Jeffrey Dach MD                        Buy Book

17 Hypothyroidism

Anna Ann Nicole Smith
Hypothyroidism, the Thyroflex and Reflex Time

Ann Nicole Smith

On February 8, 2007, Ann Nicole Smith apparently overdosed and died 5 minutes away from my office at the Seminole Indian Hard Rock Hotel, a new gambling casino on a nearby Indian reservation.  Anna Nicole's death was officially attributed to drug overdose. 

However, the autopsy report described a low thyroid condition called Hashimoto’s thyroid disease, a common condition causing low thyroid.(1)  Anna Nicole Smith was also said to be taking human growth hormone (HGH).(7)  Of course, this information wasn't mentioned in the autopsy report.  The obvious question is why was Ann Nicole taking Growth Hormone when she really needed thyroid medication?

Left Image: Ann Nicole Smith at the 2005 MTV Music Awards Courtesy of Wikipedia (47)(48)

Although mainstream medicine is staunchly opposed to HGH use by Aging Baby Boomers, the practice has caught the attention of some seniors groups,  and seems to be growing in spite of opposition by the Institute of Medicine and JAMA .(2)(3)(4)(5)(6)  As in the case of Anna Nicole, I propose that it's usually thyroid deficiency rather than growth hormone deficiency that is the more urgent problem.

Human Growth Hormone at Cenegenics

A few years ago in 2005, I spent a week doing a clinical fellowship at the Cenegenics Clinic in Las Vegas with Alan Mintz MD.(8)  The Cenegenics Clinic is devoted to Age Management Medicine.  You may have seen Dr. Alan Mintz when he appeared on CBS Television 60 Minutes to describe his clinic program and talk about the Age Management Medicine Protocols offered there.(9)  Sadly, Dr. Alan Mintz passed away June 3, 2007, a little less than a year after his interview on the 60 minutes CBS television show.(10

Alan Mintz Cenegenics Dr. Mintz had a background in radiology.  He was a visionary and a pioneer in his field, and he inspired many doctors, myself included, to make the plunge and embark on a new career in this exciting field of natural medicine and bio-identical hormones, and his presence will be greatly missed. 

Left Image: Alan Mintz Courtesy of the Las Vegas Review.(46)

I highly recommend Las Vegas Cenegenics as a world class medical clinic, with excellent doctors and support staff.  In this same CBS 60 minutes television interview, Alan Mintz disclosed that about 800 of the Cenegenics patients were using human growth hormone (HGH) based on a protocol for Adult Growth Hormone Deficiency.(11)  In addition, Dr. Mintz created an excellent and useful online medical library containing many articles relating to Aging and Hormones.(12)

Thyroid Hormone, The Missing Piece of the Puzzle

Various vitamin and hormone treatments such as HGH (human growth hormone), testosterone, DHEA, estrogen and progesterone are considered by aging baby boomers to have anti-aging properties.  However I would suggest that one need look no further than thyroid hormone, which is perhaps the quintessential anti-aging medication, since it changes the body composition, skin and hair quality, and produces a more youthful appearance after a few months of treatment.  In my experience these observed youthful changes are much more profound with thyroid hormone than any other treatment in patients with low thyroid.

Thyroxine Thyroid Hormone Chemical Structure Yet, many the large clinics involved in Age Management or so-called anti-aging medicine tend to be conservative when it comes to offering thyroid treatment.  They usually hesitate to give thyroid medication if the labs are normal, or if they do give thyroid hormone, it is usually Synthroid rather than natural dessicated thyroid hormone like Nature-Throid from Western Research (Now called RLC Labs owned by Rick Cox), or Armour.(13)(32)   

Left Image: Synthroid Courtesy of Wikipedia

Synthroid is a thyroid pill which contains only T4 (thyroxine), while the natural thyroid medication contains both T3 and T4, accounting for the better clinical results of the natural thyroid.(32)  Mainstream medical practice relies on the TSH test to determine when to treat with thyroid hormone (lab range 0.5 – 5.5) , so most people with low thyroid are missed by the medical system, and are not given thyroid hormone medication.

Mark Starr and Type Two Hypothyroidism

A few months after meeting with Alan Mintz, M.D. at the Cenegenics clinic, I attended a medical meeting of the ICIM (Integrative and Complementary Medicine) in Grand Rapids Michigan.  At this meeting, I spoke with Mark Starr, M.D. who presented his approach to diagnosis and treatment of the low thyroid condition, which he calls Type Two Hypothyroidism.(14)

MArk Starr MD Mark Starr's lecture and his book on the same topic were a real eye opener for me because he claimed that while 30% of the population are low thyroid, they are ignored and go untreated by mainstream medicine. These unfortunate souls drag themselves from doctor to doctor with labels such as chronic fibromyalgia, and chronic fatigue, and suffer from hair loss, constipation, depression and a host of other symptoms described by Dr. Jacob Teitelbaum.(15)  Dr. Starr explained why thyroid blood tests such as the TSH are unreliable.   Dr. Starr instead relies on old fashioned clinical judgment to decide when to treat with thyroid hormone and how much thyroid medication to give. (16)(17)(18

Left Image: Courtesy of Mark Starr MD (14)

Enter The Thyroflex Machine

One of the tried and true clinical parameters of thyroid function is the delayed Achilles reflex time which the old time docs used routinely for practical management of low thyroid before the blood tests were devised.  Checking the Achilles reflex is still accepted and used by mainstream medicine today as an indicator of thyroid function.(19)(20)(21)(22)(23)(24).

Achilles Tendon jeffrey dach mdI was therefore really excited to meet Drs. Konrad Kail and Daryl Turner at their booth at the American Academy of Anti-Aging Medicine Meeting in 2005.(25)(26)(27)(28)  Drs. Kail and Turner  developed the Thyroflex instrument, a reflex hammer connected to a laptop computer which measures reflex time in milliseconds.(27

Left Image: Achilles Tendon Courtesy of Wikipedia

They do not routinely use the Achilles Tendon reflex though.  Instead, they decided to use the Brachio-Radialis muscle of the forearm, a more convenient way to illicit the reflex while the patient is seated in a comfortable chair. A delayed reflex time is the finding which indicates low thyroid.

They found excellent correlation between reflex time and thyroid function as measured by basal metabolic rate in patients before and after treatment with natural thyroid. Their study found a predictive Value of a Positive Test = 0.95 and a Predictive Value of a Negative Test= 0.017, which I thought was quite good.(29)(30)

Our Thyroflex Experience

We are proud to be the first medical clinic in Florida to offer this noninvasive Thyroflex test which really represents the best modern medicine has to offer, while at the same time validating the original knowledge of early thyroid clinical practice. After using the Thyroflex machine for about one year, we have found it to be especially useful in those cases in which the TSH is paradoxically low even though the patient is low thyroid. Note: a low TSH indicates high thyroid function, while a high TSH indicates low thyroid function. Many people are confused by this.

JAcob Teitelbaum MD This paradoxically low TSH is called hypothalamic dysfunction, and Jacob Teitelbaum MD sees this frequently in his chronic fatigue patients.(31)  Since in these cases the TSH is usually below 3, no mainstream doctor would be willing to give thyroid hormone treatment to these unfortunate souls.  With the confidence of a delayed reflex time on a Thyroflex test, we can feel comfortable giving these people the badly needed thyroid, and the results have been astounding.

Left Image: Courtesy of Jacob Teitelbaum MD (15)(16)

Our approach to diagnosis of low thyroid uses a lengthy questionnaire which goes over 70 symptoms of low thyroid (listed below), a complete thyroid blood panel including TSH, free T3 and free T4, and a physical examination which includes measurement of reflex time with the Thyroflex. Also included is a basal body temperature chart filled out by the patient at home.

A Trial of Low Dose Thyroid is Very Safe

Once it has been determined that thyroid hormone is likely to be beneficial, a trial of low dose Nature-Throid from RLC labs (Western Research) is given with a small half grain tablet every other day, while a log book is kept by the patient describing any changes in energy or other symptoms.  Any symptoms of thyroid excess such as palpitations, feeling of warmth, anxiety or insomnia are noted in the log book.  After 8 days, the log book is reviewed to determine if the thyroid was of benefit. In addition, Iodine supplementation with Iodoral is routinely given as described in a previous article on Iodine and Breast Cancer Prevention.(45

We have found that monitoring symptoms by recording any changes in a log book, as well as small half grain gradual increments in thyroid dosage makes this program very safe.  In the event the patient experiences palpitations, they are instructed to hold any further thyroid medication and inform the physician.  For more information, visit my web site thyroid page.

Articles with Related Interest:

The Thyroid Nodule Epidemic

Questioning New Armour Thyroid Pills

The Unreliable TSH Lab Test

Book Review: Stop the Thyroid Madness

Hunt Study Shows Thyroid Meds Prevent Heart Attacks

Saving Tim Russert and George Carlin with Thryoid Pills

Reasons Why Thyroid Testing can be Unreliable

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie Florida 33314

Links and References

Anna Nicole Smith Autopsy Released, Coroner: Ex-Playmate died from accidental sedative overdose.

Aging Baby Boomers turn to hormone, Some doctors concerned about growing 'off-label' use of drug Sabin Russell, Chronicle Staff Writer, Monday, November 17, 2003 San Francisco Chronicle
HGH (Human Growth Hormone) HGH and effects on aging - An exciting discovery made about 15 years ago has linked the aging process to declining levels of certain hormones.

Provision or Distribution of Growth Hormone for "Antiaging", COMMENTARY Clinical and Legal Issues. Thomas T. Perls, MD, MPH; Neal R. Reisman, MD, JD; S. Jay Olshansky, PhD. JAMA. Oct 26 2005;294:2086-2090.  Full Text PDF.

Provision or Distribution of Growth Hormone for "Antiaging", COMMENTARY Clinical and Legal Issues. Thomas T. Perls, MD, MPH; Neal R. Reisman, MD, JD; S. Jay Olshansky, PhD. JAMA. Oct 26 2005;294:2086-2090. Abstract.

Institute of Medicine web site

What Anna Nicole Smith Was Shooting? The dead starlet's autopsy revealed that she was injecting human growth hormone to counter the effects of aging and promote weight loss. Does that work? Inside the HGH boom—and the backlash. By Lynn Waddell and Arian Campo-Flores,  Newsweek Web Exclusive Mar 28, 2007

Cenegenics Medical Institute, 851 S Rampart Blvd Ste 210, Las Vegas, NV 89145-4886, Phone: (702) 240-4200, Toll Free 866.953.1510

60 Minutes. Aging In The 21st Century, Steve Kroft Reports On The New Field Of Anti-Aging Medicine, Aug. 20. 2006

ALAN MINTZ M.D. Alan P. Mintz, M.D., cofounder and CEO of Cenegenics Medical Institute, passed away June 3, 2007, as a result of a brain hemorrhage. He was 69 years old. Born in Chicago, Alan was a graduate of the University of Chicago and earned a doctor of medicine degree from the University of Illinois - School of Medicine. He served as a physician in the U.S. Navy, prior to postgraduate training in radiology.

Guidelines for the Diagnosis and Treatment of Adult Growth Hormone Deficiency
Background. Cenegenics Foundation.

Online Cenegenics Medical Library offered via nonprofit Cenegenics Education and Research Foundation.

Nature-Throid from RLC labs Western Research, Western Research Laboratories
2404 West 12th Street, suite #4 - Tempe, Arizona - 85281, Toll-Free: 1-877-797-7997

Type Two Hypothyroidism Book by Mark Starr. This is an astonishing book revealing the cause and successful treatment for the plague of illnesses affecting western civilization; including obesity, heart attacks, depression, diabetes, strokes, headaches, chronic fatigue, and many more. In Dr. Starr's description Type 2 Hypothyroidism, he presents overwhelming evidence showing a majority of Americans suffer this illness, which is due to environmental and hereditary factors. Laboratory testing used to diagnose hypothyroidism is completely inadequate, and current treatment for hypothyroidism is ineffective.

Hypothyroidism, The Tragic and Invisible Epidemic of Thyroid Disease. Dr Jacob Teitelbaum MD

Jacob Teitelbaum MD Chronic Fatigue Web Site

Optimum Diagnosis and Treatment of Hypothyroidism With Free T3 and Free T4 Levels

Major Revision of Hypothyroid Diagnosis Guidelines, 

Achilles Tendon Reflex Time

Med Klin. 1970 Nov 6;65(45):1973-82. [Validity of Achilles tendon reflex measurement during thyroid gland function disorders][Article in German] Gillich KH, Krüskemper HL, Stendel A.

Probl Endokrinol (Mosk). 1982 Jan-Feb;28(1):34-8. [Reflexometry as a supplementary study method in thyroid hypofunction][Article in Russian] Gaĭdina GA, Matveeva LS, Lazareva SP.
A correlation was established between the time of the Achilles reflex and the biochemical characteristics of thyroid function (total thyroxin and triiodothyronine levels, thyroxin-binding capacity of the blood serum proteins, the basal TTH level) in patients with grave and moderately expressed hypothyroidism.

J Assoc Physicians India. 1990 Mar;38(3):201-3. Ankle reflex photomotogram in thyroid dysfunctions.Khurana AK, Sinha RS, Ghorai BK, Bihari N.

Aust Fam Physician. 1976 May;5(4):550-9, 561. A screening test for thyroid function.Goodman E.  The Achilles tendon reflex half relaxation time measurement (ART) has been used by many physicians both as a diagnostic test and for the assessment of progress in thyroid gland malfunction.

Minerva Med. 1976 Oct 27;67(51):3325-34. [Achilles reflexogram and hemodynamic parameters in the evaluation of thyroid function]Franco G, Malamani T.

 Probl Endokrinol (Mosk). 1987 May-Jun;33(3):6-9. [Changes in the duration of the Achilles reflex in euthyroid goiter in children][Article in Russian]Gaĭdina GA, Alekseeva RM, Bobrovskaia TA, Lazareva SP. Changes in the duration of the Achilles reflex were studied in subclinical disturbances of thyroid function. A significant conformity of the levels of TSH, T3, T4 to the duration of the Achilles reflex was shown.

Konrad Kail, P.A., N.D. Director. Southwest College Research Institute. Tempe, AZ (602) 363-9237 Associate Professor of Naturopathic Medicine; Special Consultant for External Research Affairs; BS, University of Houston, 1974; BS, Baylor College of Medicine, 1976; ND, National College of Naturopathic Medicine, 1983.

Curriculum Vitae for Dr. Konrad Kail  

Thyroflex, Nitek Web Site, Daryl Turner

A4M, American Academy of Anti-Aging Medicine


Predictability of Brachioradialis Reflexometry, Thyroflex, Nitek

Managing Subclinical Hypothyroid Using Resting Metabolic Rate and Brachioradialis Reflexometry
Konrad Kail, N.D.1, Robert F. Waters, Ph.D., Thyroflex, Nitek

From the Townsend Letter for Doctors & Patients, October 2002. Highly Effective Treatment of Fibromyalgia and Chronic Fatigue Syndrome: Results of a Placebo Controlled Study and How to Apply the Protocol, by Jacob Teitelbaum, MD

Armour Thyroid Web Site

Summary List of Symptoms of Hypothyroidism , Armour web site

Hypothyroidism Risk/Symptoms Checklist, Help in Diagnosis and Finetuning Your Treatment By Mary Shomon,, December 22, 2003

Do You Have Signs of Hypothyroidism or Thyroid Hormone Resistance? Dr. John C. Lowe

Lowe, J.C., Reichman, A., & Yellin, J.: The process of change with T3 therapy for euthyroid fibromyalgia: a double-blind placebo-controlled crossover study. Clin. Bull. Myofascial Ther., 2(2/3):91-124, 1997.

Useful Links

Thyroid Page on Jeffrey DACh MD web site

Stop the Thyroid MAdness, devoted to natural thyroid medication rather than synthroid

Broda Barnes Institute

Mark Starr MD Pain Clinic

Richard L. Shames, M.D.THYROID  POWER

Living Well With Chronic Fatigue Syndrome & Fibromyalgia, Mary Shomon, patient advocate.

By Mary Shomon Thyroid Disease Guide Thyroid

William McK. Jefferies, M.D. (Retired) Web Page,  Dr. Jefferies has retired from active medical practice. (Honorary) Professor, Division of Endocrinology and Metabolism University of Virginia School of Medicine Charlottesville, Virginia

Breast Cancer Prevention and Iodine Supplementation by Jeffrey Dach MD

Jan. 22, 2006 Las Vegas Review-Journal IN DEPTH: Hormone therapy: CENEGENICS: Photo of Alan Mintz 

Ann Nicole Smith Wikipedia Photo. American actress Anna Nicole Smith in the red carpet for 2005 MTV Video Music Awards

Anna Nicole Smith, Luna Park, Sydney. Toby Forage Anna died on February 8, 2007.

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      Checklist of Common Symptoms of Low Thyroid:

____Weight gain
____Puffy face
____Loss or thinning of eyebrows
____Cold intolerance
____Low sex drive
____Abdominal bloating
____Cold hands or feet
____Dry or thinning hair
____Joint or muscle pain
____Thickening of the skin
____Thin, brittle fingernails

Longer List of Commonly Reported Symptoms of Hypothyroidism

1. Dry skin
2. Thick, scaling skin
3. Coarse skin
4. Fineness of hair
5. Dry, coarse, brittle hair
6. Sparse eyebrows, especially outer ends
7. Hair loss
8. Brittle nails
9. Dry ridges down nails
10. Cold skin
11. Swelling of face (edema)
12. Swelling around the eyes (edema)
13. Swelling of eyelids (edema)
14. Nonpitting edema of ankles
15. Fluid accumulation in abdomen (ascites)
16. Thick tongue
17. Swelling of ankles 18. Paleness of skin 19. Paleness of lips
20. Bluish or purplish coloration of skin, nail beds, lips
21. Weight gain unexplainably
22. Hoarseness
23. Low basal & activity level temperature
24. Protrusion of one or both eyeballs (exophthalmos)
25. Slow speech
26. Slow pulse rate despite low physical fitness
27. Slow thinking
28. Sluggish movement 29. Slow relaxation phase of the knee or ankle reflex
30. Listless, dull look to eyes
31. Wasting of tongue
32. Nervousness
33. Rapid heart rate with weak force of contraction
34. Slow heart rate despite low aerobic fitness
35. Pounding heart beat
36. Cardiac enlargement on x-ray
37. Indistinct or faint heart tones
38. Low QRS voltage on ECG
39. Long-normal intervals on ECG
40. Fluid around heart (pericardial effusion)
41. Changes at the back of the eye (at fundus oculi)

Financial Disclosure:  I have no financial interest in any of the products, nutritional supplements, or books mentioned here.

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The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician -- patient relationship.  Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur.  Finally, the material produced by myself may be reproduced for personal use, provided that appropriate credit is given

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(c) Copyright 2007-2009 Jeffrey Dach MD All Rights reserved. This article may be copied or reproduced on the internet without permision provided a link and credit is given.

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie Florida 33314