Advanced Bio-identical Hormone

Replacement Therapy: Thyroid

S. Ali Mohamed, M.D.

Clinic for Graceful Aging, Houston
Chairman, A4M India, A4M Dubai
Hormones: Background

The central role of hormones in both the
human life cycle and the body are well
known

Their deficiency in youth and decline with
age, is also well known

Thyroid hormone is a classic example

Our discussion focuses on thyroid hormone
deficiencies, diagnosis and treatment
Hormones: Background

The rise and fall of hormone levels
throughout the human life cycle is well-
documented

We now know that “We age because our
hormones decline,” and not vice versa
Discussion
Hormones: Background

The Neuro-Endocrine Axis is the body’s
core system. It maintains internal
homeostasis and controls all bodily
functions

This Axis functions through the complex,
receptor-based inter-play of the Nervous
and Endocrine systems
Hormones: Background

Hormone replacement therapy, using
compounded, bio-identical hormones, is
now commonly performed in young and
aging adults

This is done in order to affect the Neuro-
Endocrine Axis
Hypothyroidism
Thyroid

Thyroid disease is present in 2-5% of all women

Thyroid disease is 1-2% of reproductive age
group women

Thyroid disease occurs as hyperthyroidism or
hypothyroidism

The most common is Thyroiditis, often post-
partum, resulting in hypo-thyroid symptoms seen
in 8-10% of new mothers
 Thyroid Hormone: “The Metabolic Hormone”

Affects:

Energy levels

Metabolism

Weight

Cholesterol levels
 Thyroid Hormone: “The Metabolic Hormone”

Fat metabolism

Body temperature

Cardiac & vascular function

Mental concentration

Hair, skin & nail growth

Immune system

etc.
Thyroid Hormones Flow Chart
Thyroid Function Tests

TSH

Total and Free T4

Total and free T3

T3 uptake

The Tragedy of TSH

Critical Free T3 (3.5-4.5 pg/ml)
 Acceptable Blood Levels (Female)
Hormone units range
IGF-1 NG/ML 260-290
TSH MIU/L <2
T3 free PG/DL 400-430
T4 Free NG/DL 1.3-1.8
Cortisol MCG/DL 10-15
SHBG NMOL/L 20-60
DHEA-S MCG/DL 200-250
FSH MIU/ML <20
Estradiol PG/ML 50-75
Progesterone NG/ML 10-20
Testosterone (TOTAL) NG/DL 40-70
Testosterone(FREE) PG/ML 6-8
Case History:
Post-partum Hypothyroidism

35 y/o female, 5’1”, 105 lbs.

C/c: cold sensitivity, mood swings, poor
sleep, skin dryness, loss of hair, hot flashes,
night sweats, menstrual cramps fluid
retention, brittle nails, irritability,
dyspareunia, weight gain

PMH: migraine, sinusitis

Meds: none
 Pre-Treatment Labs
Hormone units Pre-Rx
IGF-1 NG/ML 120
TSH MIU/L 13.89
T3 free PG/DL 237
T4 Free NG/DL 0.7
Cortisol MCG/DL 14.2
SHBG NMOL/L 73
DHEA MCG/DL 76
FSH MIU/ML 5.0
Estradiol PG/ML 133
Progesterone NG/ML 5.1
Testosterone (T) NG/DL 13
Testosterone(F) PG/ML 0.8
Testosterone % F 0.59
Rx

Thyroid: 2 grain (1:4) po, qam

Progesterone: 50 mg top., qhs

Testosterone: 1 mg top., qam

Diet : avoid refined carbs

Exercise: strengthening and aerobic

Stress reduction: Yoga/Tai Chi
 Pre & Post Rx Labs: PPH
Hormone units Pre-Rx Post-Rx
IGF-1 NG/ML 120 156
TSH MIU/L 13.89 7.16
T3 free PG/DL 237 289
T4 Free NG/DL 0.7 1.9
Cortisol MCG/DL 14.2 8.2
SHBG NMOL/L 73 43
DHEA MCG/DL 76 153
FSH MIU/ML 5.0 4.5
Estradiol PG/ML 133 49
Progesterone NG/ML 5.1 12.4
Testosterone (T) NG/DL 13 22
Testosterone(F) PG/ML 0.8 1.4
Testosterone % F 0.59 0.66
Clinical Progress

No cold sensitivity

Improved mood

Improved sleep

No skin dryness

Improved hair growth

No hot flashes

No night sweats

No menstrual cramps

No pain during intercourse
Case: Hypothyroidism

38 y/o female, 5’4”, 161 lbs.

C/c: breast tenderness, fluid retention, weight
gain, depression, lethargy, hair loss, low libido,
menstrual cramps, menstrual irregularity, anxiety,
polyuria, incontinence, dyspareunia, constipation,
cold sensitivity, mental haziness

PMH: hypothyroid since 1998, nullipara

Medications: Levoxyl, BCP
 Pre-Rx Labs
Hormone units Pre-Rx
IGF-1 NG/ML 102
TSH MIU/L 61.16
T3 free PG/DL 232
T4 Free NG/DL 0.5
Cortisol MCG/DL 24.0
SHBG NMOL/L 78
DHEA MCG/DL 100
FSH MIU/ML 5.0
Estradiol PG/ML 128
Progesterone NG/ML <0.5
Testosterone (T) NG/DL 23
Testosterone(F) PG/ML 4.7
Testosterone % F 2.03
Rx

Thyroid: 2 grains (1:2) po, qam

Thyroid: 2 grains (1:2) po, qpm

Progesterone cr. 150 mg top., qhs

Nutraceuticals

Exercise, nutrition, stress control
 Pre & Post Rx Labs
Hormone units Pre-Rx Post-Rx
IGF-1 NG/ML 102 135
TSH MIU/L 61.16 24.72
T3 free PG/DL 232 334
T4 Free NG/DL 0.5 1.2
Cortisol MCG/DL 24.0 13.7
SHBG NMOL/L 78 42
DHEA MCG/DL 100 125
FSH MIU/ML 5.0 4.9
Estradiol PG/ML 128 77
Progesterone NG/ML <0.5 2.1
Testosterone (T) NG/DL 23 57
Testosterone(F) PG/ML 4.7 17.4
Testosterone % F 2.03 3.01
Clinical Progress

Improved energy

Improved mood

Better sleep

Decreased hair loss

Decreased cold sensitivity

Weight loss

No constipation
 Analysis

Case# 1: T3/T4, 2gr (1:4), po, qam

Case# 2: T3/T4, 2gr (1:2), po, bid

Thyroid releases 80 mcg T4 & 4 mcg T3 daily in the
blood stream

T3:T4 is 1:4 in nature because T3 is 4 times more
potent than T4

T4 crosses BBB, therefore necessary

Decreased 5’-deiodinase with age, therefore have to
alter the ratio and more T3 is given in case #2 in
ratio 1:2
Thyroid Calculations

Total potency is calculated in terms of T4

T3 is 4 times more potent than T4

T3:T4 (1:4) = 9 mcg : 38 mcg = 1 grain

9 mcg T3 = 36 mcg T4

38 mcg T4 = 38 mcg T4

So 1 grain (1:4) = 74 mcg T4 in potency
Thyroid Calculations

T3:T4,(1:2) =12.5 mcg : 25 mcg=1 grain

T3, 12.5 mcg = 50 mcg T4 in potency

T4, 25 mcg = 25 mcg T4 in potency

1 grain (1:2) = 75 mcg T4 in potency

So 1 grain (1:2)=1 grain (1:4) in T4 potency

Thyroid

Many physicians using BIHRT still
prescribe Armor thyroid

This is a pig product and not bio-identical

We do not recommend this practice
 Conclusion

Diagnosis of Hypothyroidism should be
based on the free T3 level, not TSH

Treatment should be with compounded,
bio-identical T3 and T4

The T3-T4 ratio should be altered by age
group: 1:4 for under 40 and 1:2 for over 40