This document provides an overview of a lecture on thyroid health. It begins with the speaker, Louis Cady, MD, disclosing commercial relationships and interests. It then outlines the structure of the lecture, which will cover thyroid basics, practical information, and conclusions. The document discusses conventional thyroid testing and its limitations. It also reviews factors that affect thyroid hormone production and conversion. Overall, the document introduces topics to be covered in the lecture regarding thyroid function and testing.
The Moral Imperative of Integrative Medicine - IMMH 2020Louis Cady, MD
IN this presentation, Dr. Cady reviews several of the handful of functional, integrative medicine techniques required for a holistic and comprehensive management of psychiatric issues. MTHFR, hormone balance, diagnosis and treating intestinal dysbiosis, need for trace elements, and hormones (including thyroid, testosterone and estradiol) are reviewed.
Thyroid, Adrenals, and Sex Steroids - A Balancing ActLouis Cady, MD
This was the second presentation gibven on MZarch 29, 2019 at the Manlove Psychiagtric Group and Brain Injury Institute spring conference in Rapid City, SD.
In this presentation, Dr. Cady carefully goes over the necessity of integrating and overview and awareness of hormones and their levels in the elucidation of what truly is going on with the patient.
This was an overview lecture only. Dr. Cady will be presenting a 16 hour CME program in Austin Texas on June 22 and 23 for the National Procedures Institute, and will explore all aspects of all relevant hormones and what can be done to manage and optimize them.
The integrative treatment of schizophrenia brazil 2019Louis Cady, MD
This is the English language version of Dr. Cady's presentation given at UNIP (Campus Paraiso - Sao Paulo, SP Brazil) for the 2019 Congresso de Saude Mental (Conference on Mental Health). It was delivered April 20, 2019.
This presentation also includes extra slides in the appendix that were not presented, and, unfortunately, these slides of the appendix have not been translated in the Portuguse version of this presentation.
In this presentation (Portuguese presentation will also be posted next), Dr. Cady briefly reviews the history of schizophrenia, the failure of the dopamine D2 receptor blockage as a universal cure-all in schizophrenia, and various holistic interventions which can strongly and positively impact symptoms of schizophrenia. Included in Dr. Cady's survey were the role of essential fatty acids, nutrient deficiencies (particularly B vitamins), the danger of overgrowth of candida , pharmacogenomic testing, MTHFR polymorphisms, and more.
It was an honor and a privilege to deliver this presentation in
São Paulo,.
For further information in Brazil on this topic, or to order a video/audio recording of the conference (in Portuguese),contact Luiz Dias of Laboratorio Great Plains in Brazil.
Natural Treatments for ADHD (TADH) in Sao Paulo, Brazil, for Laboratorio Grea...Louis Cady, MD
In this presentation, given at UNIP (Campus Paraiso - Sao Paulo, SP Brazo) for the 2019 Congresso de Saude Mental (Conference on Mental Health), Dr. Cady reviewed the prevalence, inheritability, and social ramifications of ADHD (TADH in Brazil). He specifically reviewed multiple holistic interventions, including limiting "electric screen time,"good quality diet with adequate amounts of essential fatty acids and critically important trace elements, and the use of pharmacogenomic testing as well as functional, integrative medicine testing, all to better characterize logical and reeasonmable points for holistic intervention.
This presentation was simultaneously translated into Portugue for the attendees, but unfortunately the slides were not available in translated form.
For further information in Brazil on this topic, or to order a video/audio recording of the conference (in Portuguese),contact Luiz Dias of Laboratorio Great Plains in Brazil.
Subtitle: The Moral Imperative of Integrative Medicine
This presentation, two hours in length, was delivered to the A4m MMI Audience in their Frontiers of Neurology - Module 3.
The following topics are reviewed:
- ADHD, Autism, Depression, Schizophrenia
- the impact of neuroinflammation on all of these.
- confounding factors and the ways to mitigate them: Omega6/Omega 3 imbalance in the Western diet, MTHFR polymorphism, the use of elemental lithium, the presence of intestinal dysbiosis and the role of gluten/dairy IgG Food allergies.
- pharmacogenomic testing
Medical Discussion of the Endocannabinoid SystemLouis Cady, MD
In this lecture, given in Evansville, IN, on April 22nd, Dr. Cady reviews the scientific rersearch on the endocannabinoid system and the rationale for appropriately using it as a nmodality to optimize the structure and function of the body. This is a NON-BRANDED presentationb, and deals ONLY with the "ECS."
In this Grand Rounds presentation, delivered to the Dept. of Psychiatry of the University of Cincinnati, Dr. Cady reviews the multiplicity of potential causes, as well as the multiplicity of pharmacological, psychological, and holistic interventions.
Among the topics covered are the following:
- the multidimensional matrix of causality posited to be relevant for schizophrenia
- the deficiency of the "dopamine hypothesis of schizophrenia and the overly simplistic mental model that has been programmed into at least two generations of practitioners
- the rationale for looking at other things besides "drugs" or "psych meds"
- an admonition to the practitioner to not forsake the origins of our profession where the dyadic relationship is honored; further, to be aware of how therapeutic impasses with schizophrenic patients may be frustrating to the practitioner and interfere with treatment;
- the relevant exploration and use of Vitamin D, omega e fatty acids, N-acetyl cysteine, gluten & casein free diets, *elemental* lithium, antifungals.
The Do It To Yourself Treatment of Depression - Webinar #3Louis Cady, MD
This is the third in a series of five webinars. The first was on staying alive by boosting your immunity during COVID 19. The second was on not screwing yourself up inside your head. This third one encompasses a romp through the peer reviewed medical literature looking for supplements and nutrients that you could use to self treat depression at home, CAREFULLY. Numerous cautions and warnings are included.
The driving impetus to this program is that many people - due to social isolation and their mental health care, or medical practitioners' offices being closed down - have not been able to get help or succeed in optimizing their treatment for depression. There are multiple useful nutrients for both depression and anxiety in nature's abundant pharmacopeia, and this webinar touches on just a few of them.
I hope you enjoy it.
The Moral Imperative of Integrative Medicine - IMMH 2020Louis Cady, MD
IN this presentation, Dr. Cady reviews several of the handful of functional, integrative medicine techniques required for a holistic and comprehensive management of psychiatric issues. MTHFR, hormone balance, diagnosis and treating intestinal dysbiosis, need for trace elements, and hormones (including thyroid, testosterone and estradiol) are reviewed.
Thyroid, Adrenals, and Sex Steroids - A Balancing ActLouis Cady, MD
This was the second presentation gibven on MZarch 29, 2019 at the Manlove Psychiagtric Group and Brain Injury Institute spring conference in Rapid City, SD.
In this presentation, Dr. Cady carefully goes over the necessity of integrating and overview and awareness of hormones and their levels in the elucidation of what truly is going on with the patient.
This was an overview lecture only. Dr. Cady will be presenting a 16 hour CME program in Austin Texas on June 22 and 23 for the National Procedures Institute, and will explore all aspects of all relevant hormones and what can be done to manage and optimize them.
The integrative treatment of schizophrenia brazil 2019Louis Cady, MD
This is the English language version of Dr. Cady's presentation given at UNIP (Campus Paraiso - Sao Paulo, SP Brazil) for the 2019 Congresso de Saude Mental (Conference on Mental Health). It was delivered April 20, 2019.
This presentation also includes extra slides in the appendix that were not presented, and, unfortunately, these slides of the appendix have not been translated in the Portuguse version of this presentation.
In this presentation (Portuguese presentation will also be posted next), Dr. Cady briefly reviews the history of schizophrenia, the failure of the dopamine D2 receptor blockage as a universal cure-all in schizophrenia, and various holistic interventions which can strongly and positively impact symptoms of schizophrenia. Included in Dr. Cady's survey were the role of essential fatty acids, nutrient deficiencies (particularly B vitamins), the danger of overgrowth of candida , pharmacogenomic testing, MTHFR polymorphisms, and more.
It was an honor and a privilege to deliver this presentation in
São Paulo,.
For further information in Brazil on this topic, or to order a video/audio recording of the conference (in Portuguese),contact Luiz Dias of Laboratorio Great Plains in Brazil.
Natural Treatments for ADHD (TADH) in Sao Paulo, Brazil, for Laboratorio Grea...Louis Cady, MD
In this presentation, given at UNIP (Campus Paraiso - Sao Paulo, SP Brazo) for the 2019 Congresso de Saude Mental (Conference on Mental Health), Dr. Cady reviewed the prevalence, inheritability, and social ramifications of ADHD (TADH in Brazil). He specifically reviewed multiple holistic interventions, including limiting "electric screen time,"good quality diet with adequate amounts of essential fatty acids and critically important trace elements, and the use of pharmacogenomic testing as well as functional, integrative medicine testing, all to better characterize logical and reeasonmable points for holistic intervention.
This presentation was simultaneously translated into Portugue for the attendees, but unfortunately the slides were not available in translated form.
For further information in Brazil on this topic, or to order a video/audio recording of the conference (in Portuguese),contact Luiz Dias of Laboratorio Great Plains in Brazil.
Subtitle: The Moral Imperative of Integrative Medicine
This presentation, two hours in length, was delivered to the A4m MMI Audience in their Frontiers of Neurology - Module 3.
The following topics are reviewed:
- ADHD, Autism, Depression, Schizophrenia
- the impact of neuroinflammation on all of these.
- confounding factors and the ways to mitigate them: Omega6/Omega 3 imbalance in the Western diet, MTHFR polymorphism, the use of elemental lithium, the presence of intestinal dysbiosis and the role of gluten/dairy IgG Food allergies.
- pharmacogenomic testing
Medical Discussion of the Endocannabinoid SystemLouis Cady, MD
In this lecture, given in Evansville, IN, on April 22nd, Dr. Cady reviews the scientific rersearch on the endocannabinoid system and the rationale for appropriately using it as a nmodality to optimize the structure and function of the body. This is a NON-BRANDED presentationb, and deals ONLY with the "ECS."
In this Grand Rounds presentation, delivered to the Dept. of Psychiatry of the University of Cincinnati, Dr. Cady reviews the multiplicity of potential causes, as well as the multiplicity of pharmacological, psychological, and holistic interventions.
Among the topics covered are the following:
- the multidimensional matrix of causality posited to be relevant for schizophrenia
- the deficiency of the "dopamine hypothesis of schizophrenia and the overly simplistic mental model that has been programmed into at least two generations of practitioners
- the rationale for looking at other things besides "drugs" or "psych meds"
- an admonition to the practitioner to not forsake the origins of our profession where the dyadic relationship is honored; further, to be aware of how therapeutic impasses with schizophrenic patients may be frustrating to the practitioner and interfere with treatment;
- the relevant exploration and use of Vitamin D, omega e fatty acids, N-acetyl cysteine, gluten & casein free diets, *elemental* lithium, antifungals.
The Do It To Yourself Treatment of Depression - Webinar #3Louis Cady, MD
This is the third in a series of five webinars. The first was on staying alive by boosting your immunity during COVID 19. The second was on not screwing yourself up inside your head. This third one encompasses a romp through the peer reviewed medical literature looking for supplements and nutrients that you could use to self treat depression at home, CAREFULLY. Numerous cautions and warnings are included.
The driving impetus to this program is that many people - due to social isolation and their mental health care, or medical practitioners' offices being closed down - have not been able to get help or succeed in optimizing their treatment for depression. There are multiple useful nutrients for both depression and anxiety in nature's abundant pharmacopeia, and this webinar touches on just a few of them.
I hope you enjoy it.
Introduction to Integrative Medicine for Mental HealthLouis Cady, MD
This is the first of three lectures that Dr. Cady will present in Sao Paulo, Brazil, for Laboratorio Great Plains. In it, he reviews key concepts of integrative medicine, functional testing, and a rational style of thinking through a patient's problems down to the fundamental level. IgG food allergies, depression, low testosterone, and nutrient deficiencies are all covered
This lecture was presented on March 29, 2019 in Rapid Citry, South Dakota, for the conference co-sponsored by the Manlove Psychiatric Group and the Brain Injury Center.
It reviews the uptick in diagnosis of ADHD, the raiontale for its concern, causative factors, and how it can be worked up holistically and in a balanced, not necessarily medication-oriented way.
Use of high dose fish oil, iron supplementation, and how to overrcome nutritional deficiencies are discussed.
This brief webinar, a gift to the local Jewish community and Temple Adath B'Nai Israel here in Evansville, IN, reviews the tradition of mindfulness and the interdigitation of Buddhist practices with some Jewish traditions. Dr. Cady reviews the downstream effects of stress, how meditation and mindfulness are useful tools and techniques, and actually how to practice it. Multiple references without being complicated or overdone are provided.
How to Transition from Allopathic to Integrated Practice - IMM Brazil 2015Louis Cady, MD
In this lecture, Dr. Cady compares and contrasts the significance differences, both conceptually and practically, between the conventional practice of medicine and a more rational, functional, integrated approach. Tactical concepts and didactic tools to make the transition are reviewed.
Hemp Oil: What Can It Do For You? Lebanon, TN 04 06 2018Louis Cady, MD
In this presentation, Dr. Cady reviews the peer-reviewed medical literature for the endocannibinoid system, the concept of endocannibinoid deficiency syndrome (now well established), and citations dealing with the multiplicity of health conditions for which a full spectrum hemp oil should be considered as a reasonable supportive strategy. The difference between the generic "CBD Oil" that is available at health food stores compared to the Zilis products is touched on. The Zilis products appear to have better absorbability, faster onset of action, and scientific studies elucidating the true duration of action of CBD levels in blood serum.
This presentation was given to a very appreciative audience at the Friendship Church in Lebanon, TN (a suburb of Nashville).
Natural Treatments for ADHD - December 7th, 2016 - Saint Marys HospitalLouis Cady, MD
This lecture, presented December 7th, 2016 for the Parent Support Group for children with ADHD and Sensory Processing Disorders, was presented at Saint Marys Hospital in Evansville, Indiana. In this one hour presentation, Dr. Cady broke down some of the alternative treatments for ADHD, grounded in the peer-reviewed literature, that do not involve the prescription of typical psychiatric medication for ADHD. He emphasized, natural, holistic treatments to treat deficiencies and restore balance of nutrients and specific essential fatty acids.
Integrating the Functional, Psychodynamic, and Immunologic Matrix: New Advent...Louis Cady, MD
In this presentation (here represented in English before translation) Dr. Cady deconstructs the curious and sometimes perplexing manifestations of delayed sensitivity food allergy testing, supporting it with citations from the peer-reviewed medical literature and extensive bibliographic references. The importance of understanding the potential immunologic contribution to a patient's mental state is reviewed.
Optimized Aging with Nutritional & Weight Management TechniquesLouis Cady, MD
In this lecture, presented on August 15, 2014 for the USI Mid-America institute on Aging, Dr. Cady covered the under appreciated physiology of micronutrients and deficiency syndrome, the concept of the "Triage Theory of Aging" from Dr. Bruce Ames, and reviewed the literature on nutritional supplementation. This covered carotenoids, peer-reviewed studies on carotenoids and mortality, peer-reviewed studies on carotenoids and risk of breast cancer, peer review articles on lipid preoccupation, antioxidants, and the chances of survival in the institutionalized elderly, Raman spectroscopy as a marker of antioxidant nutritional deficiency, the explosion of obesity in our population in the US, and optimal antiaging strategies. The "Seven Secrets of Optimizing Body Composition" was reviewed at the end. References are attached.
Zoned, Stoned And Blown Pain Psych R X And C D Cady At OliverLouis Cady, MD
Review by Louis B. Cady, MD (Cady Wellness Institute) of the interdigitation between psychiatric disorders, chemical dependency and issues in treatment and recovery. This presentation reviews the enormous intertwinement between untreated ADHD and the development and maintenance of substance use and chemical dependency, examining both biological and psychodynamic influences. It concludes with tips from the recovery community and recommendations on how treatment teams can collaborate with each other.
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:Louis Cady, MD
Drs Cady and Gabhart of the Cady Wellness Institute deliver a "command performance" at the Kannise Hair Salon in Owensboro - apparently a hotbed interest site for information pertaining to thyroid dysfunction in women. (Hair stylists hear about it all the time!). This was a fun example of staff at CWI "taking it on the road" out to our communities to educate the lay public on topics of self-empowerment.
New Adventures in Food Allergy Testing! 09 21 2013Louis Cady, MD
This is the second of four CME lectures delivered by Dr. Cady at the 4rth Annual Integrated Medicine For Mental Health Conference in Chicago, IL at McCormick Place, September 21, 2013. In it, he traces the development of the concept of "non-atopic" food allergies and the inflammatory mechanisms behind through which food to which patients have become sensitized can harm them.
A review of the medical literature, from headaches, to depression to ADHD, to brain inflammation in autism is traced to these IgG mediated food sensitivities.
At the end of this presentation, the viewer will have a much greater appreciation of the fact that children, adolescents, and adults, can have SEVERE food sensitivities that do not necessarily turn up "positive" on scratch testing or RAST testing.
The scientific literature, quoted right up to the day before the conference started, is extensive and well sourced.
Any practicing physician, and certainly any interested patient(s) should familiarize himself or herself with this content.
We live in an era of medication, but what else can we do to improve mental health? Are we excessively prescribing, can we approach medicine in a more holistic way?
Dr. Cady returned to IMMH in Orange County to deliver this talk on September 28, 2017. This is his fifth presentation on this topic to the Integrated Medicine and Mental Health conference.
In this presentation, Dr. Cady reviews common misconceptions about the evaluation of the thyroid axis, dosing concerns, actual studies on patients and real-world clinical data. A large appendix and reference is included at this end of this presentation for things which were not able to be covered in the time allotted. These include the role of thyroid hormone on cognition, the role of thyroid hormone in head injury, and an exploration of the role of thyroid hormone in possibly preventing, and possibly actually treating Alzheimer's disease (as one of MANY targeted pharmaceutical, nutraceutical and integrative modalities.)
Hormones and Mental Health - Thyroid and Testosterone.pptxLouis Cady, MD
In this presentation for the Psychiatry Redefined program, Dr.
Cady breaks down and deconstructs the accepted, unthinking, "practice guideline based" notions of thyroid and tesotsterone, with there seemingly "normal" levels and dosing, versus what the actual peer reviewed medical literature says. In this presentation, do use of all forms of thyroid, and all forms of testosterone are reviewed. The idiocy of "T4 only treatment" is covered. The use of T4, T3, a combination of T4 and T3, and all of the porcine and compounded products is review.
In terms of testosterone, dr. Katie reviews the concept of "do you want to be optimal or do you want to be normal." He notes that it is "normal" for oil in cars to deteriorate and break down with age. It's also "normal" for men's and women's testosterone (as well as thyroid) to go down with age. The question is, "do we want to do anything about it?"
Logical ways of intervening in both the thyroid and female and male gonadal axes are covered. There is scrupulous attention paid to the thyroid hormone pathways, and the relevance of reverse T3 versus free T3. Similarly, in terms of women, the downstream effect of estradiol coming from testosterone is also reviewed.
Introduction to Integrative Medicine for Mental HealthLouis Cady, MD
This is the first of three lectures that Dr. Cady will present in Sao Paulo, Brazil, for Laboratorio Great Plains. In it, he reviews key concepts of integrative medicine, functional testing, and a rational style of thinking through a patient's problems down to the fundamental level. IgG food allergies, depression, low testosterone, and nutrient deficiencies are all covered
This lecture was presented on March 29, 2019 in Rapid Citry, South Dakota, for the conference co-sponsored by the Manlove Psychiatric Group and the Brain Injury Center.
It reviews the uptick in diagnosis of ADHD, the raiontale for its concern, causative factors, and how it can be worked up holistically and in a balanced, not necessarily medication-oriented way.
Use of high dose fish oil, iron supplementation, and how to overrcome nutritional deficiencies are discussed.
This brief webinar, a gift to the local Jewish community and Temple Adath B'Nai Israel here in Evansville, IN, reviews the tradition of mindfulness and the interdigitation of Buddhist practices with some Jewish traditions. Dr. Cady reviews the downstream effects of stress, how meditation and mindfulness are useful tools and techniques, and actually how to practice it. Multiple references without being complicated or overdone are provided.
How to Transition from Allopathic to Integrated Practice - IMM Brazil 2015Louis Cady, MD
In this lecture, Dr. Cady compares and contrasts the significance differences, both conceptually and practically, between the conventional practice of medicine and a more rational, functional, integrated approach. Tactical concepts and didactic tools to make the transition are reviewed.
Hemp Oil: What Can It Do For You? Lebanon, TN 04 06 2018Louis Cady, MD
In this presentation, Dr. Cady reviews the peer-reviewed medical literature for the endocannibinoid system, the concept of endocannibinoid deficiency syndrome (now well established), and citations dealing with the multiplicity of health conditions for which a full spectrum hemp oil should be considered as a reasonable supportive strategy. The difference between the generic "CBD Oil" that is available at health food stores compared to the Zilis products is touched on. The Zilis products appear to have better absorbability, faster onset of action, and scientific studies elucidating the true duration of action of CBD levels in blood serum.
This presentation was given to a very appreciative audience at the Friendship Church in Lebanon, TN (a suburb of Nashville).
Natural Treatments for ADHD - December 7th, 2016 - Saint Marys HospitalLouis Cady, MD
This lecture, presented December 7th, 2016 for the Parent Support Group for children with ADHD and Sensory Processing Disorders, was presented at Saint Marys Hospital in Evansville, Indiana. In this one hour presentation, Dr. Cady broke down some of the alternative treatments for ADHD, grounded in the peer-reviewed literature, that do not involve the prescription of typical psychiatric medication for ADHD. He emphasized, natural, holistic treatments to treat deficiencies and restore balance of nutrients and specific essential fatty acids.
Integrating the Functional, Psychodynamic, and Immunologic Matrix: New Advent...Louis Cady, MD
In this presentation (here represented in English before translation) Dr. Cady deconstructs the curious and sometimes perplexing manifestations of delayed sensitivity food allergy testing, supporting it with citations from the peer-reviewed medical literature and extensive bibliographic references. The importance of understanding the potential immunologic contribution to a patient's mental state is reviewed.
Optimized Aging with Nutritional & Weight Management TechniquesLouis Cady, MD
In this lecture, presented on August 15, 2014 for the USI Mid-America institute on Aging, Dr. Cady covered the under appreciated physiology of micronutrients and deficiency syndrome, the concept of the "Triage Theory of Aging" from Dr. Bruce Ames, and reviewed the literature on nutritional supplementation. This covered carotenoids, peer-reviewed studies on carotenoids and mortality, peer-reviewed studies on carotenoids and risk of breast cancer, peer review articles on lipid preoccupation, antioxidants, and the chances of survival in the institutionalized elderly, Raman spectroscopy as a marker of antioxidant nutritional deficiency, the explosion of obesity in our population in the US, and optimal antiaging strategies. The "Seven Secrets of Optimizing Body Composition" was reviewed at the end. References are attached.
Zoned, Stoned And Blown Pain Psych R X And C D Cady At OliverLouis Cady, MD
Review by Louis B. Cady, MD (Cady Wellness Institute) of the interdigitation between psychiatric disorders, chemical dependency and issues in treatment and recovery. This presentation reviews the enormous intertwinement between untreated ADHD and the development and maintenance of substance use and chemical dependency, examining both biological and psychodynamic influences. It concludes with tips from the recovery community and recommendations on how treatment teams can collaborate with each other.
Two Docs Talk: Drs. Cady & Gabhart Take it On the Road:Louis Cady, MD
Drs Cady and Gabhart of the Cady Wellness Institute deliver a "command performance" at the Kannise Hair Salon in Owensboro - apparently a hotbed interest site for information pertaining to thyroid dysfunction in women. (Hair stylists hear about it all the time!). This was a fun example of staff at CWI "taking it on the road" out to our communities to educate the lay public on topics of self-empowerment.
New Adventures in Food Allergy Testing! 09 21 2013Louis Cady, MD
This is the second of four CME lectures delivered by Dr. Cady at the 4rth Annual Integrated Medicine For Mental Health Conference in Chicago, IL at McCormick Place, September 21, 2013. In it, he traces the development of the concept of "non-atopic" food allergies and the inflammatory mechanisms behind through which food to which patients have become sensitized can harm them.
A review of the medical literature, from headaches, to depression to ADHD, to brain inflammation in autism is traced to these IgG mediated food sensitivities.
At the end of this presentation, the viewer will have a much greater appreciation of the fact that children, adolescents, and adults, can have SEVERE food sensitivities that do not necessarily turn up "positive" on scratch testing or RAST testing.
The scientific literature, quoted right up to the day before the conference started, is extensive and well sourced.
Any practicing physician, and certainly any interested patient(s) should familiarize himself or herself with this content.
We live in an era of medication, but what else can we do to improve mental health? Are we excessively prescribing, can we approach medicine in a more holistic way?
Dr. Cady returned to IMMH in Orange County to deliver this talk on September 28, 2017. This is his fifth presentation on this topic to the Integrated Medicine and Mental Health conference.
In this presentation, Dr. Cady reviews common misconceptions about the evaluation of the thyroid axis, dosing concerns, actual studies on patients and real-world clinical data. A large appendix and reference is included at this end of this presentation for things which were not able to be covered in the time allotted. These include the role of thyroid hormone on cognition, the role of thyroid hormone in head injury, and an exploration of the role of thyroid hormone in possibly preventing, and possibly actually treating Alzheimer's disease (as one of MANY targeted pharmaceutical, nutraceutical and integrative modalities.)
Hormones and Mental Health - Thyroid and Testosterone.pptxLouis Cady, MD
In this presentation for the Psychiatry Redefined program, Dr.
Cady breaks down and deconstructs the accepted, unthinking, "practice guideline based" notions of thyroid and tesotsterone, with there seemingly "normal" levels and dosing, versus what the actual peer reviewed medical literature says. In this presentation, do use of all forms of thyroid, and all forms of testosterone are reviewed. The idiocy of "T4 only treatment" is covered. The use of T4, T3, a combination of T4 and T3, and all of the porcine and compounded products is review.
In terms of testosterone, dr. Katie reviews the concept of "do you want to be optimal or do you want to be normal." He notes that it is "normal" for oil in cars to deteriorate and break down with age. It's also "normal" for men's and women's testosterone (as well as thyroid) to go down with age. The question is, "do we want to do anything about it?"
Logical ways of intervening in both the thyroid and female and male gonadal axes are covered. There is scrupulous attention paid to the thyroid hormone pathways, and the relevance of reverse T3 versus free T3. Similarly, in terms of women, the downstream effect of estradiol coming from testosterone is also reviewed.
This is the 2016 version of Dr. Cady's fundamental lecture on the thyroid and its hormone replacement, particularly as it pertains to mental health as well as medical health.
This is the first of four CME lectures delivered by Dr. Cady at the 4rth Annual Integrated Medicine For Mental Health Conference in Chicago, IL at McCormick Place, September 21, 2013. In it, he deconstructs the facts and fallacies surrounding the thyroid axis, what should be measured, why it's important, and what happens to patients with suboptimal thyroid status.
The scientific literature, quoted right up to the day before the conference started, is extensive and well sourced.
Any practicing physician, and certainly any interested patient(s) should familiarize himself or herself with this content.
Thyroid On My Mind - IMMH, San Antonio 2014Louis Cady, MD
In this lecture, the 2nd of 4 delivered at the Integrated Medicine and Mental Health Conference in San Antonio, TX, Dr. Cady carefully reviews the literature regarding thyroid status and optimization. Multiple citations from the peer-reviewed medical literature are referenced and cited. At the conclusion of viewing this presentation, the viewer should be able to recognize the absolute fallacy of checking just TSH, and recognize the necessity of looking at the entire thyroid axis in terms of diagnosis and treatment. Relevant in depression and cognition are reviewed.
This is the second of three lectures Dr. Cady presented in San Diego at the Integrated Medicine and Mental Health Conference, on September 19, 2015. This lecture reviews common variances in practice from some of the professional societies and sets them in clear contrast to the peer reviewed medical literature, taken on balance. The use of alternative forms of therapy besides levothyroxine (Synthroid ® ) are reviewed: Armour, Westhroid, Naturethroid, and T3 or liothyronine (Cytomel ®). Decreased coronary risk factors with a decrease in TSH, showing adequately treated subclinical hypothyroidism, is reviewed. Need for iodine discussed.
This is the second of five lectures given by Dr. Cady in Santa Fe, NM for the 2012 IMMH conference. It covers the need to identify the hormonal deficiencies of a patient, and ways to remediate them.
Hormones, Cognition, and Mood Changes in Older AdultsLouis Cady, MD
HORMONES, COGNITION AND MOOD CHANGES IN OLDER ADULTS. This is Dr. Cady's lecture from the Age Management Medical Group meeting in las Vegas, NV, PRESENTED 12 2 2012.
2 & 3 together hormones, allopathic psychiatryLouis Cady, MD
Dr. Cady's update lecture for World Link Medical - August 17, 2012. Topics: use of hormones in functional medicine (and psychiatry) as well as "pedal to the metal" allopathic psychiatry.
These are the final two lectures given by Dr. Cady in Salt Lake City, UT on June 1, 2012. The first lecture deals with the use of hormones in traditional psychiatry and medicine, as supported by the peer reviewed literature. The second lecture, which is in this slide deck "back to back" with the first one, is on what Dr. Cady refers to as "Pedal to the Metal Allopathic Psychiatry." That is - using medications with finesse and, when indicated, with forcefulness. Functional and integrated medicine does not mean sitting around eating fruits, nuts, and flakes, but rather using the best techniques and tools that we have available to us from all fields of medicine (including traditional, classical allopathic medicine).
The Integrative Treatment of Depression, Schizophrenia & Autism - IMMH 2015Louis Cady, MD
This is the first of three lectures given by Dr. Cady at the 6th annual Integrative Medicine and Mental Health Conference in San Diego, on September 18, 2015. In it, Dr. Cady deconstructs the contributing factors to either exacerbating or causing a diagnosable mental disorder. The use of understanding the pathophysiology of the entire body, and not just firing antidepressants and other psychotropic drugs blindly into the patient without thinking, is clearly reviewed.
Thyroid and critical illness
Non Thyroidal Illness Syndrome (NTIS)
Sick Euthyroid Syndrome
Euthyroid Sick Syndrome (ESS)
Low T3 Syndrome
NTIS, formerly known as euthyroid sick syndrome, often occurs in patients who have severe, prolonged critical illness and is essentially a laboratory abnormality to be monitored.
By Usama Ragab Youssif
Killer Drugs and the Supplement Hall of FameLouis Cady, MD
In the fourth and final lecture of his series at the IMMH Conference in Chicago, IL at McCormick Place, September 22, 2013, Dr. Cady covers the "for sure" interactions to watch out for between specific drugs and their common points of interaction.
After examining those potentially toxic interaction, he continues into a review of peer-reviewed evidence for the appropriate, thoughtful, and precise use of specific supplements in a targeted approach. The role of good basic antioxidant protection is discussed, as is the need for B-vitamins, Omega 3 fatty acids, and several others.
This lecture on the relevance of hormonal optimization in mental health, was presented by Dr. Cady in Salt Lake City, UT at the 2012 Medical Seminar Series coordinated by World Link Medical.
The Physician In Spite of Himself (returns!) -San Antonio 2014Louis Cady, MD
In this first of four lectures delivered at the IMMH Conference in San Antonio, Texas - September 19, 2014 - Dr. Cady touches on themes from last year's presentation and introduces fun and exciting new ways to look at function medicine. This year's talk heavily emphasizes the role of nutritional supplementation in supporting the structure and function of the human body. Updates from clinical cases encountered last year are also covered. General topics in this presentation include:
- the importance of evaluating and balancing the thyroid axis
- the importance of sex steroids and DHEA
- the importance of antioxidants, mineral, multivitamins, and essential fatty acids in optimal health
- the need to clearly identify, articulate, and treat the differences between something that is a pure "psychiatric" condition and the covert masqueraders which may actually represent undiagnosed and untreated physiological/medical conditions until addressed.
Scratching Your Head Psychiatry: Practicing OUTSIDE of the Allopathic BoxLouis Cady, MD
In this first lecture of his 5-lecture series for IMMH in Santa Fe, NM, Dr. Cady reviews the absolute need to get the biological basis right in confusing and confounding cases. Using real patient stories, he illustrates the blending of functional testing, food allergy testing, and hormonal interventions.
SEND IN THE SHRINKS - 2009 Oliver CME seminarLouis Cady, MD
This one was fun.
I was invited by Dr. Randalll Oliver, MD, Founder of the Oliver Heachache and Pain Clinic in Evansville, to present to an audience of primary care practitioners about how to use pysychiatric mediations ("psychopharmacology") in clinical practice.
Along the way, I covered, ADHD and treatments, depression, anxiety, erectile dysfunction, hypoadrenia, and even touched on hypothyroidism. Although this presentation was in 2009, all of the drugs covered are stills in use, and, at times.... stupidly.
This presentation deconstructs the intricacies of selecting and antidepressant, particularly in the SSRI class.
What is the nature of QUALITY in medicine -for ASQ 11 14 2023.pptLouis Cady, MD
In this presentation, Dr. Cady deconstructs the tensions and stressors on both patients and health care providers in today's system.
This presentation reviews checklists foe liminating mistakes, the actual number of mistakes that are being made in medical practice, and what patients and their loved ones can do for self protection.
This isn't a "bash the doctor" presentation. It's a thoughtful, careful exploration of stresses and ramifications to the current US healthcare system.
This was a Grand Rounds program for St. Marys Hospital (now Ascension St. Vincent) in Evansville delivered on April 2, 2014. It is uploaded to my slideshare site as a public service to patients and mental health practitioners.
We are actually no longer using TMS at Cady Wellness, having transitioned to the attempting maximum stabilization of our patients with nutraceuticals, hormones, and the latest advance in psychopharmacology. This includes intramuscularly administered ketamine, which has been transformative in many of our patients.
The Moral Imperative of Integrative Medicine 2022.pptLouis Cady, MD
Presented to Psychiatry Redefined Meeting - September 10, 2022
Three cases are reviewed - two with MTHFR deficiencies and pharmcotherapy challenges; one case with schizophrenia solidly treated with clozapine but also with additional antidepressant (vortioxetine) and functional, integrative medicine techniques.
CORONOFOBIA - Passos práticos para equilibrar as defesas do corpo e da menteLouis Cady, MD
Esta palestra, apresentada em 29 de maio de 2021 para o Congresso de Medicina Integrativa para a Saúde Mental 2020, promovido pelo Laboratório Great Plains no Brasil, enfocou coisas simples e de bom senso que os pacientes (e seus médicos) podem fazer para se manter seguros e viver durante o Pandemia do covid.
Os seguintes conceitos holísticos foram revisados:
- sono adequado e por que é tão importante;
- o uso de melatonina, cientificamente validada como tendo atividade antiviral (referências citadas);
- a importância de diminuir o estresse e técnicas para fazê-lo;
- a necessidade de "comer frutas e vegetais" como sua mãe e sua avó ensinaram devido à ingestão de carotenóides e antioxidantes ((referências citadas);
- o uso adequado de suplementos vitamínicos / nutricionais (referências citadas).
O foco desta apresentação não foram medidas heróicas para salvar vidas na unidade de terapia intensiva para pacientes gravemente enfermos com COVID, mas, sim, técnicas de bom senso, práticas, baratas e (em alguns casos) GRATUITAS para melhorar você e seus pacientes 'saúde e resistência às doenças.
THE MORAL IMPERATIVE OF INTEGRATIVE MEDICINE - O IMPERATIVO MORAL DA MEDICINA...Louis Cady, MD
Neste programa, o Dr. Cady baseia-se em uma série de casos clínicos para ilustrar a necessidade absoluta e moral do tratamento de precisão de nossos pacientes com todas as ferramentas disponíveis para uso por meio da medicina integrativa.
O uso de testes de polimorfismo MTHFR, testes convencionais e laboratoriais e testes farmacogenômicos foram revisados.
Os casos apresentados ilustram a trágica dificuldade de um menino com deficiência de MTHFR que estava prestes a desviar sua vida; um paciente esquizofrênico com vários problemas de medicina funcional que precisavam ser resolvidos (levedura, glúten, sensibilidade alimentar de IgG); uma estudante universitária a quem foi dito "não há nada de errado com você; seus laboratórios estão bem", embora ela tenha manifestado todos os sintomas relevantes de hipotireoidismo; e um CEO do sexo masculino de 42 anos que estava "tão cansado que parecia morrer" e que, na verdade, estava funcionalmente com pouco testosterona. O último caso revisado foi de um adorável garotinho que tinha autismo e foi recuperado por meio de uma abordagem focada e intensa de medicina integrativa.
Dr. Cady deconstructs some the medical literature about the use of nutrients - and the evidence of what happens in the presence of their insufficiency. Everything for decreased viral replication to decrease brain shrinkage is covered. The role of antioxidant and carotenoids, measured by the Pharmanex Biophotonic Scanner, is reviewed.
Please note - there is no representation that any nutrient or supplement can treat, prevent, mitigate, or cure any medical condition. It does seem, however, upon reflecting on the medical literature, that there seems to be a lot of evidence for therapeutic effect in the presence of good levels of nutrient, and harm to patients if they have insufficient levels.
Webinar 5: Designing Your Future: WHAT'S COMING NEXT?Louis Cady, MD
In this capstone webinar presentation, closing out Dr. Cady's series on dealing with COVID 19, he turns his attention to a nunmber of interesting thems:
- what's the REAL case fatality rate of COVID 19
- How is it likely that society will reopen?
- What's going to happen in education and medicine?
- What's going to happen when the robots and AI arrive?
- What's the future going to be out 500 years?
HOW TO SAVE MONEY ON YOUR HEALTHCARE: An Integrative Medicine ApproachLouis Cady, MD
In this webinar, the fourth in a series of five from Dr. Louis Cady and the Cady Wellness Institute, we focus on the actual dollars and cents of health care expenditures, and the societal and PERSONAL costs of poor health maintenance behavior. We examine the essentially passive US medical system, that would rather drug a symptom than fix the underlying problem.
Great attention is paid on not shaming the patient or the doctors as they exist in the current system. Both groups "do not know what they do not know." Confirmation bias is rampant.
This webinar points the way to living a more vital, energetic life, with a minimum of cost, grief, and misery.
HOW TO COPE WITH THE PSYCHOLOGICAL IMPACT OF COVID 19 AND SOCIAL DISTANCINGis...Louis Cady, MD
In this presentation, Dr. Cady will review:
- What did Sparky learn about not being an emotional support animal?
- "Do it to yourself psychotherapy." Learn the following:
- What are the wrong - and the RIGHT ways of any sort of "behavioral therapy"?
- How to use a journal to think RATIONALLY and “get out of your head.”
- How to get out of your HEAD and into your LIFE.
- We'll cover all 10 of David Burns’ cognitive distortions, customized and gift-wrapped for dealing with COVID 19.
- We will cover actionable examples of how to reprogram yourself.
We will review What are the 3 P's of Positive Psychology and Learned Optimism?
The Cady 5 "5P’s” and “How to shrink yourself."
Can we find the GOOD in COVID?
This presentation is meant to be provocative and to challenge you mentally, intellectually, and emotionally. Some of the great thinkers and exemplars of human performance and possibility are featured.
BOOSTING YOUR IMMUNITY During the COVID 19 PandemicLouis Cady, MD
In this presentation, presented as a live webinar on Monday, April 27th, Dr. Louis Cady of the Cady Wellness Institute reviewed practical, common-sense things that can be done to boost your immunity, with documentation from the peer-reviewed medical literature. Dr. Cady also reviews supplements and nutrients that are established in the peer-reviewed medical literature as having antiviral capabilities. These include Vitamins C,D, and E, Zinc, carotenoids and antioxidants, probiotics, the reishi mushroom, elderberry, cannabidiol (CBD - not marijuana or weed!).
Points presented are scrupulously documented from the medical literature. This presentation does not guarantee or represent that using ANY of these nutrients will "keep you from getting infected or dying" from COVID 19. They are presented for your thoughtful consideration.
Tratamento holistica de ezschizophrenia - São Paulo, Brazil April 20, 2019Louis Cady, MD
Esta é a versão em inglês da apresentação do Dr. Cady feita na UNIP (Campus Paraiso - São Paulo, SP Brasil) para o Congresso de Saúde Mental de 2019 (Conferência sobre Saúde Mental). Foi entregue em 20 de abril de 2019.
Nesta apresentação, o Dr. Cady analisa brevemente a história da esquizofrenia, a falha do bloqueio do receptor de dopamina D2 como uma cura universal na esquizofrenia, e várias intervenções holísticas que podem impactar forte e positivamente os sintomas da esquizofrenia. Incluídos na pesquisa do Dr. Cady estavam o papel dos ácidos graxos essenciais, deficiências nutricionais (particularmente vitaminas do complexo B), o perigo de supercrescimento da cândida, testes farmacogenômicos, polimorfismos da MTHFR e muito mais.
Foi uma honra e um privilégio entregar esta apresentação em
São Paulo.
Para mais informações no Brasil sobre este tema, ou para solicitar uma gravação em vídeo / áudio da conferência, entre em contato com Luiz Dias do Laboratório Grandes Planícies no Brasil.
Slides, até o apêndice, são traduzidos por Luiz Dias.
Natural Treatments for ADHD - April 11, 2018Louis Cady, MD
This presentation will be delivered April 11, 2018 on recorded webinar for the Autism Global Conference. It was my pleasure to prepare and present this lecture (in webinar form), outlining a coherent philosophy of finding biological underpinnings that can cause or contribute to, or exacerbate, mental dysfunction. In the case of this presentation, the question is "How much of ADHD symptomatology is caused by a lack of a good medication, or, rather, lack of a coherent strategy for finding and fixing underlying biological abnormalities?"
Those biological abnormalities in this presentation include MTHFR polymorphisms, COMT polymorphisms, elemental deficiencies (lithium, magnesium, zinc, iron, and copper), essential fatty acid deficiencies, the confound of high fructose corn syrup, and many others.
Rational strategies for nutraceutical intervention are reviewed.
THE ENDOCANNABINOID SYSTEM - Cady Wellness InstituteLouis Cady, MD
This lecture, presented on February 2, 2018 at the Cady Wellness Institute in Newburgh, IN, represented Dr. Cady's review of the current peer-reviewed medical literature current as of that morning. The concepts of "endocannabinoids" vs. "phytocannabinoids" were reviewed. Themes in the medical literature were explored, including the relationship of the endocannabinoid system and CB! and CB2 receptors to modulate hippocampal neurogenesis, cause apoptosis in breast cancer cells, and many other interesting correlations. A careful review of legal vs illegal options for obtaining plant phytocannabinoids in the state of Indiana was emphasized.
A abordagem da Medicina Integrativa para o Tratamento da EsquizofreniaLouis Cady, MD
This is the presentation that Dr. Cady gave in São Paulo, Brazil, in October of 2017 on the integrtive treatment of schizophrenia. The one in English is already posted. My thanks to Luiz Dias, of Laboratorio Great Plans in Brazil, for his impeccable translation.
Endocannabinoid System - Literature ReviewLouis Cady, MD
In this brief review of the literature, Dr. Louis Cady of the Cady Wellness Institute reviews the endocannabinoid system and the role it plays in bridging the connection between mind and body, modulating anxiety, inflammation, memory and other physiological processes. Nothing in this presentation suggests that any of the products mentioned are appropriate for the treatment, remediation, cure, or prevention of any disease or illness. It does appear, however, that this natural, indwelling, genetically passed down endocannabinoid system may have major implications for holistic physicians and health care practitioners, and for the patients that they serve.
The Integrative Medicine Treatment of SchizophreniaLouis Cady, MD
This is the third of three lectures that Dr. Cady did in Sao Paulo, Brazil, for Laboratorio Great Plains. Dr. Cady dispenses with the "Dopamine hypothesis of schizophrenia" quickly, and notes that the most powerful drug for schizophrenia, clozapine, is actually only a weak blocker at that receptor. Using the concepts of Dale Bredesen, MD, Dr. Cady advances the idea that there is no "one magic bullet" approach to the treatment of schizophrenia, but that, rather, multiple possibile causes of schizophrenia exist, multiple nutritional laboratory values exist, multiple other physiological perturbations exist (including gluten sensitivyt), and that the thoughtful practitioner's approach should be to attempt to identify, integrate, and address all possible causes and exacerbating influences on the causes, and treatments of schizophrenia. Obviously, this is not a comprehensive treatment on the subject - which would take days - but does scratch the surface at other ways to look at schizophrenia and approach its treatment.
This is the second of three lectures Dr. Cady gave in Brazil. This is an update his previous thyroid talk, focusing more particularly on mental effects and the assessment of thyroid axes, and thyroid use, in mental healthj
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
9. [ http://www.umm.edu/patiented/articles/how_serious_hypothyroidism_000038_6.htm -
accessed August 2015 and 08 20 2016]
• “Thyrotropin (Thyroid-Stimulating Hormone or
TSH). Measuring TSH is the most sensitive
indicator of hypothyroidism.” (hunh?!) –
accessed 9/5/2011
• “…blood tests for measuring levels of TSH and
free thyroxine (T4) are the only definitive way to
diagnose hypothyroidism” – 10/6/2012
Louis B. Cady, MD
10. Louis B. Cady, MD
http://umm.edu/health/medical/ency/articles/t
hyroid-function-tests accessed 7/31/2017
11. Factors for production of
thyroid hormones:
• Iron, iodine, tyrosine, Zn,
Se, E, B2, B3, B6, C, D
Factors affecting T4 to
REVERSE T3 (RT3):
• STRESS, trauma, low
calorie diet,
inflammation, toxins,
infections,
liver/kidney dysfxn,
certain Rx
Factors that INHIBIT proper T4
production:
• STRESS
• Infection, trauma, radiation, Rx
• Fluoride
• Toxins: pesticides, Hb, Cd, Pb
• Celiac disease
T4 T3 requires Se and Zinc!
T4
Factors that improve cellular
sensitivity to thyroid hormones:
• Vitamin A
• Exercise
• Zinc
12. • “Iron deficiency impairs thyroid hormone
synthesis by reducing activity of heme-
dependent thyroid peroxidase.”
• Zimmermann MB, Kohle J.
Thyroid. 2002 Oct;12 (10):867-78
–Subclinical
hypothyroidism assoc.
with Fe deficiency.
• Nekrasova TSA, 2013 Kloin Med
(Mosk).2013; 91 (9):29-33.
– Fe deficiency assoc with Thyroid
microsomal antibody levels.
• Wang YP et al. J Formos Med Assoc.
2014 Mar;113(3):155-60.
– Fe salts + T4 worked best.
• Ravanbod M et al. Am J Med. 2013
May;126(5):420-4.
Consider IRON deficiency
135 citations search on “iron deficiency
hypothyroidism” as of 6/19/2017
13. “the foot soldier” “the evil twin”
Selenium
required!
FEEDBACK
INHIBITION
CORTISOL
80% of T4 to T3
converted in the liver
Iodine
required
(65% of T4)
14. Conventional medical practice:
- Only TSH is typically considered.
- You get T4 if you’re lucky.
- Ill-considered: “T7”, Total T4, Total T3, %T3 uptake
- You DON’T get Free T3 or Rev T3
? ?
Louis B. Cady, MD
?
15. What are the TYPES of hypothyroidism
(from the top down)?
• Tertiary hypothyroidism – deficiency in
hypothalamus – not enough TRH
• Secondary hypothyroidism –pituitary
isn’t kicking out enough TSH “your
thyroid labs are ‘just fine’”
• PRIMARY hypothyroidism – where
thyroid gland can’t make thyroid
hormone
• This is the only one that high TSH is good
for diagnosing!!
• Low TSH
• Low TSH
Your doc is
happy!!
• HIGH TSH
(finally!)
Louis B. Cady, MD
16. Functional Thyroid Deficiency:
FOUR MAIN CAUSES
• Over time the amount of thyroid hormone
decreases secondary to a decreased
production by the gland (primary)
• Decreased conversion of T4 to T3
(secondary)
• Less effectiveness at the receptor sites
causing low thyroid symptoms in spite of
“normal” blood levels (tertiary)
• ELEVATION OF REVERSE T3.
17. Review of all hypothyroid patients in a private
practice in Belgium between May 1984 and July1997
• 24 hour urine Free T3 correlates better with clinical
status of hypothyroid patients, and even better than
T4 by RIA.
• Conclusions: In this study symptoms of
hypothyroidism correlate best with 24 h
urine free T3 Baisier WV et al. 2000, Vol. 10, No. 2 , Pages 105-113
18. Key review article!
[Schroeder AC et al. Front Encorinol (Lausanne). 2014;5:40.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978256/ )
• Thyroid hormones effect on
brain relates to balance of T4
and T3.
• Thyroid receptor alpha1 =
70-80% of all TR expression
in adult vertebrate brain.
Louis B. Cady, MD
19. Who cares
about T3??
Effectively:
- These genes make THR alpha
- THR Alpha is a nuclear receptor for tri-
iodothyronine [T3].
- “[This receptor] has been
shown to mediate the
biological activities of
thyroid hormone.”
- This is where thyroid
(T3) works – AT THE
TISSUE LEVEL.
- (NOT TSH. NOT T4.) Source: Gene ID: 7067, updated 9-Jul-2017
20. “Euthyroid sick syndrome”
• Stages:
• EARLY:
• Normal TSH, Normal T4, but LOWER T3
• LATE:
• T4 also goes down
• Pro-inflammatory cytokines promote this
via direct activity on the thyroid gland, as
well as by inhibition of peripheral response
for conversion of T4 to T3, especially in
the liver.
Papanicolaou DA. Euthyroid sick syndrome and the role of
cytokines. Rev Endocr Metab Disord 1(1-2):43-48, 2000.
21. Clinical vignette – July 19, 2018 – “Euthyroid sick”
• 37 year old Family NP. Eyebrows began thinning at 33.
Fatigued. Not depressed. On supplements.
• Not on thyroid. Told her thyroid is “fine.”
• TFT’s
• TSH 1.17 {0.36 – 4.94}
• Free T4 1.04 {0.7 – 1.48}
• Free T3 3.3 {2.0 – 4.4}
• Reverse T3 20.1 {9.2 – 24.1}
• Thyroglobulin Ab <1.0 {0 – 0.9}
• Thyroid Peroxidase 12 {0 – 34}
• PHYSICAL EXAM:
• Delayed relaxation phase for biceps, triceps, brachioradialis, and
patellar muscle stretch reflex. (Achilles’ tendon not done).
Thinned out eyebrows.
• TREATMENT:
• Liothyronine working up to 5 MICROgrams three times daily.
22. Caloric Deprivation and Non-
Thyroidal Illness Causes Low T3
• “The effects of the low T3 syndrome at the tissue level
are in many instances comparable to those seen in
hypothyroidism.”
• “These effects are considered to constitute a beneficial
adaptive mechanism in situations in which the
organism is endangered.”
Hennemann G, Docter R, Krenning EP. Causes and effects of the low T3 syndrome during
caloric deprivation and non-thyroidal illness: an overview. Acta Med Austriaca. 1988;15(1):42-
45.
23. Why Reverse T3?
•Hibernating bears can:
–Lower temperature 9 – 11
degrees Farenheit
–Reduce their metabolism by 75%
–Drop heart rate from 55 to 9 bpm
•Rev T3 thought to “hibernate”
humans
Louis B. Cady, MD
24. What causes elevation in Rev T3?
• High Cortisol (emotional stress) or high copper
•Nutritional starvation
• Heavy metal toxicity – mercury, lead,
cadmium*
• Selenium or Zinc deficiency*
•And high dose of thyroxine
(T4) – a “pro-hormone”
–iatrogenic!)
*Integrative tip: hair analysis is an inexpensive and effective screen. Also
RBC-Selenium and RBC Zinc.
Louis B. Cady, MD
25. And you can’t tell by “looking”
• Patients with biochemically severe hypothyroidism
may present with only mild clinical manifestations
• Some patients with moderate changes in thyroid
hormones may present with severe signs of tissue
hypothyroidism.
Meier C, Trittibach P, Guglielmetti M, et al. Serum thyroid stimulating hormone in
assessment of severity of tissue hypothyroidism in patients with overt primary thyroid
failure: cross sectional survey. BMJ. 2003 Feb 8;326(7384):311-312.
26. Per HDRS – 17, remission in:
15.9% on Li
24.7% on T3
Per QIDS-SR16, remission in:
13.2% on Li
24.7% for T3 *
* Fava & Covino: Augmentation/Combination Therapy in STAR*D Trial, Medscape Psychiatry
LEVEL III RESULTS:
Louis B. Cady, MD
27. For resistant depression:
“The best-documented augmentation
strategies involve inexpensive medicines
(e.g., lithium or thyroid hormones) and
response, if it occurs, is often within 2
weeks.”
- Kaplan & Sadock’s Comprehensive Textbook of
Psychiatry, 2004 (Chapter 14, Mood Disorders)
Louis B. Cady, MD
28. WHERE ARE WE IN THE LITERATURE?
THYROID
Louis B. Cady, MD
31. Some recent citations…
• “Paucity of treatment options for bipolar disorder.” “Many
clues suggesting that T3 could augment and accelerate
treatment response [with lithium and antidepressants].”
• Parmentier T et al. J Affect Disord. 2018 Mar 15;229:410-414.
• “Backing into the future: pharmacological approaches to the
management of resistant depression” (failure of two
antidepressants)= Rx with atypical antipsychotics, lithium,
T3 (triiodothyronine). Ketamine. Anti-inflammatory agents.
Pramipexole (dopamine agonist).
• Psychol Med. 2017 Nov;47(15):2569-2577.
33. European Neuropsychopharmacology Jun;28(6):752-760.
• Multicenter study of the European Group for the
Study of Resistant Depression
• 1410 patients – MDD patients with and without
thyroid disease
• Point prevalence – 13.2% of patients had
hypothyroidism.
• “In conclusion, our analyses suggest that abnormal
thyroid function, especially hypothyroidism, is linked
to depression severity and associated with distinct
psychopathologic features of depression.”
• However – treatment recommendation was NOT
thyroid replacement but other meds, including
antipsychotics, mood stabilizers, and pregabalin. (?!?!?!)
35. Does treatment with thyroid hormone cause
any of the following? Why or why not?
• Osteoporosis
• Tachycardia
• Atrial fibrillation
• Cardiac dysfunction
• Metabolic changes
36. The CAUSE of hyperthyroidism is critical
“Hyperthyroidism is associated with increased
morbidity and mortality from cardiovascular
disease.”
“whether the risk of cardiovascular disease is
related to the etiology of the hyperthyroidism
is unknown.”
“This article will focus on patients with Graves
disease, toxic adenoma and toxic multinodular
goiter, and will compare risks associated with
these diseases.”
Biondi B et al. Nat Rev
Endocrin6:431-443 (2010)
37. Kelly, T. An examination of myth: a favorable
cardiovascular risk-benefit analysis of high-dose thyroid
for affective disorders. J Affect Disord. 2015 May
15;177:49-58
CONCLUSION:
The cardiovascular risks of HDT appear
to be low. HDT is at least as safe as or
safer than many psychiatric medications.
It is effective and well tolerated.
CONCLUSION:
High circulating levels of thyroid
hormone is not the cause of the
sequelae of hyperthyroidism. The
reluctance to using high dose thyroid is
unwarranted.
Kelly, T et al. Elevated levels of circulating thyroid
hormone do not cause the medical sequelae of
hyperthyroidism.
Prog Neuropsychopharmacol Biol Psychiatry. 2016 Jun
11;71:1-6.
39. Mild Thyroid Disease May Raise
Cardiac Risk
• Subclinical hypothyroidism is linked with a more-than-
twofold increase in heart attack risk among women
aged 55 and older, according to a recent study from
the Netherlands.
• Mild thyroid disease is in the same ballpark as well-
established cardiac risk factors like high cholesterol and
smoking.
• It does tip the balance toward recommending thyroid
replacement therapy, which is a relatively benign
treatment to your patients who have this common
condition.
Hak EA, Pols H, Visser TJ, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and
myocardial infarction in elderly women: The Rotterdam Study. Ann Intern Med. 2000;132:270-278.
40. Subclinical Hypothyroidism Is an Independent Risk
Factor for Atherosclerosis and Myocardial Infarction
in Elderly Women: The Rotterdam Study
•Conclusion: Subclinical hypothyroidism
is a strong indicator of risk for
atherosclerosis and myocardial
infarction in elderly women.
Hak EA, Pols H, Visser TJ, et al. Subclinical hypothyroidism is an independent risk factor for
atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann Intern
Med. 2000;132:270-278.
41. More on HEART DISEASE risk
(2006)
• Medline search from 1966- April 2005
• 14 observational studies met criteria
• Subclinical hypothyroidism (elevated TSH,
normal T4) increased odds ratio of CHD
to 2.38 (CI 1.53-3.69) after adjusting for risk
factors
Subclinical hypothyroidism and the risk of coronary heart
disease: a meta-analysis. Rodondi N et al. Amer. Jour
of Med. July 2006, 119, 541-551. (meta-analysis)
42. “What is the association of hypothyroidism
with risks of cardiovascular events?” (2017)
• 55 cohort studies with 1,898,314 patients reviewed.
• Hypothyroid patients, compared to euthyroid patients
had
• Higher risk of ischemic heart disease - RR of 1.13
• MI (RR of 1.15)
• All cause mortality – RR 1.25
• Cardiac mortality - RR 1.96
• Cardiac disease patients with hypothyroidism
compared to euthyroid group had RR of 2.22
for all cause mortality
Ning Y et al. What is the association of hypothyroidism with risks of
cardiovascular events and mortality? A meta-analysis of 55 cohort studies
involving 1,898,314 participants. BMC Med 2017 Feb2;15(1):21
43. A favorable risk-benefit analysis of high dose thyroid
for treatment of bipolar disorders with regard to
osteoporosis.
• CONCLUSION:
•“High dose thyroid does not appear
to be a significant risk factor for
osteoporosis while other widely
employed psychiatric medications do
pose a risk.”
Kelly T. J Affect Disord. 2014 Sep;166:353 -8.
44. NOW – let’s look at the mental health
literature
45. 63 patients with “subclinical hypothyroidism”
HAM-D and MADRS scales with serum TSH Free T4, free T3
TPO AB and Tg-AB levels
“This study suggests the importance of a psychiatric
evaluation in patients affected by subclinical
hypothyroidism.”
Prevalence of depressive symptoms in this
population was 63.5%
Hunh?
Louis B. Cady, MD
48. “Optimal intervention required
knowledge of thyroid pathology and
attention to the possibility of subtle
thyroid dysfunction in patients with
affective disorders. “
49. Best augmenting strategies available:
- Lithium
- Thyroid hormone
- Anti-anxiety medications
- Atypical antipsychotics.
Louis B. Cady, MD
50. Aim: Evaluate relationship of subclinical hypothyroidism and cognition in the
elderly.
- 337 outpatients; {177 = men; 160 = women}
“Patients with subclinical hypothyroidism had a probability about
2 times greater (RR = 2.028, p<0.05) of developing cognitive
impairment.”
MMSE scores were SIGNIFICANTLY lower in subclinical
hypothyroid patients compared to euthyroid (p<0.03)
51. Aim: Evaluate relationship of subclinical hypothyroidism and serum TSH and
cognition in the elderly. (TSH & Free T4 measured – NOT Free T3)
CONCLUSION:
Low TSH is associated with poorer performance on an
executive function test in middle-aged adults without overt thyroid
dysfunction.
Cross-sectional analysis of Brazilian Longitudinal Study of
Adult Health. N = 10,362. Mean age: 49.5 +/- 7.4 years.
- Exclusions: >/= 65 years of age, overt thyroid dysfunction,
neurologic disease, Asian or indigenous people
Szief C et al. Psychoneuroendocrinol. 2018 Jan;87:152-
158.
52. An opposing view:
•“Thus, any abnormal thyroid function tests
in psychiatric patients should be viewed
with skepticism. Given the fact that thyroid
function test abnormalities seen in non-
thyroidal illness usually resolve
spontaneously, treatment is generally
unnecessary, and may even be potentially
harmful.”
• Dicerman AL, Barnhill JW. Abnormal thyroid
function tests in psychiatric patients: a red
herring? Am J Psychiatry. 2012
Feb;169(2):127-33
53. • Early 20’s college student
• Weight gain, fatigue, brain fog
• Saw “numerous” MD’s asking for help
• Told “nothing is wrong with your thyroid; your
labs are fine.”
(permission granted to use photos & data)
Louis B. Cady, MD
55. Depressed mood 100%
Reduced energy: 97%3
Fatigue or loss of energy: 94%94%2
Impaired concentration: 84%3
Tiredness: 73%1
Hypersomnia: 10%–16%4 (Insomnia)
Useful Target Symptoms in Major
Depression
1. Tylee et al. Int Clin Psychopharmacol 1999;14:139-151. 2. Maurice-Tison et al. Br J Gen Pract
1998;48:1245-1246. 3. Baker et al. Comp Psychiatry 1971;12:354-65. 4. Horwath et al. J Affect
Disord 1992;26:117-25. 5. Reynolds and Kupfer. Sleep 1987;10:199-215.
Louis B. Cady, MD
56. A FEW common symptoms of hypothyroidism
(adapted from multiple sources)
• Depression, fatigue
• Concentration problems
• Poor cognitive
performance
• Lack of motivation
• Reduced libido
• Psychosis – “myxedema
madness”
• Exacerbation of bipolar
symptoms
• Cold intolerance
• Weight gain
• Slowed relaxation
phase of DTR’s
• Brittle hair/fingernails
• Decreasing eyebrows
• HIGH blood pressure
• Constipation
Louis B. Cady, MD
57. “Data supporting associations of subclinical
thyroid disease with symptoms or adverse
clinical outcomes or benefits of treatment are
few.” (JAMA 2004)
Louis B. Cady, MD
58. Subclinical hypothyroidism in
the US– what’s the latest?
As of August 6, 2015• Synthesis: treat only those with TSH >10
– Hennessey JV Espaillat R. Diagnosis and management of Subclinical
Hypothyroidism in Elderly Adults: A Review of the Literature. J
Am Geriatr Soc. 2015 Jul 22. epub ahead of print
• Synthesis: SCH [TSH >/= 4.5- 19.99] associated with hip and
other fractures.
– Blum MR et al. Subclinical thyroid dysfunction and fracture risk: a meta-
analysis. JAMA. 2015 May 26;3(20):2055-65.
• Synthesis: Treatment of SCH [TSH 4-11] improved risk of
coronary heart dz risks. “Direct evidence on the benefits
and harms of screening remains unavailable.”
– Rugge JB et al. Screening for and treatment of thyroid dysfunction: An
evidence review for the US. Rockville (MD) Agency for Healthcare Research
and Quality (IS);2014 Oct. Report No. 15-05217-EF-1.
59. Dr. Imre Zs-Nagy, MD – one more time!
Archives of Gerontology and Geriatrics, Volume 48, Issue 3, May-June 2009, 271-275
"[The] gerontological elite has instead sought to
obfuscate the facts ... the reason for this is
nothing less than an abject fear ... to avert their
loss of control, power, prestige, and position in
the multi-billion dollar industry of gerontological
medicine.”
Prof. Dr. Imre Zs.-Nagy, MD - part of the gerontology movement for four
decades; founder and Editor-in-Chief of the Archives of Gerontology and
Geriatrics
60. How much subclinical hypothyroidism?
• 4 – 8.5% of US population (for TSH> 5.1!!)
• Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T4 and
thyroid autoantibodies in the United States population (1988–1994):
National Health and Nutrition Examination Survey (NHANES III) J Clin
Endocrinol Metab. 2002;87:489–99.
• Canaris GJ, Manowitz NR, Mayor G, et al. The Colorado Thyroid
Disease Prevalence Study. Arch Int Med. 2000;160:526–3
• UK study (2011): 8% of women over 50 and men
over 65 have under-active thyroid and 100,000 could
benefit from treatment
• BBC News 2011 - January 24
Louis B. Cady, MD
62. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN
COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THYROID
DYSFUNCTION CASE FINDING. [Hennessy JV. Endoc Pract. 2016 Feb;22(2):262-70
We recommend that thyroid dysfunction should be
frequently considered as a potential etiology for
many of the nonspecific complaints that physicians
face daily. The application and success of safe and
effective interventions are dependent on an
accurate diagnosis. We, therefore, advocate for an
aggressive case-finding approach, based on
identifying those persons most likely to have thyroid
disease that will benefit from its treatment.
63. This is it in a nutshell…
1. 70% of older patient with TSH > than 4.5 mIU/L were within their age-
specific reference range.
2. From the “Conclusion” statement: “TSH distribution progressively shifts
toward higher concentrations with age. The prevalence of SCH
may be significantly overestimated unless an age-specific range for
TSH is used.”
64. “But the doctor told me my thyroid was fine.”
• Can be “wnl” but suboptimal.
• TSH frequently only thing checked.
• Nothing known about Free T4 or Free T3.
• Free T4 can be converted to Reverse T3 under
stress (cortisol)
• Free T4 can be underconverted to T3 (Se def).
• Can have normal levels (or slightly elevated
levels) of everything and have auto-immune
thyroid disease.
Louis B. Cady, MD
65. Definition of “normal labs”:
“When your lab
values are as
crappy as
everyone else’s.”
- Neal Rouzier, MD
(World Link Medical Seminar II –
Spring 2011)
Louis B. Cady, MD
66. So what are people
doing out there?
What does the literature say?
Louis B. Cady, MD
67. “Subtle deficits in specific cognitive domains
(primarily working memory and executive function)
likely exist in subclinical hypothyroidism and
thyrotoxicosis, but these are unlike to cause major
problems in most patients.” (Endocrinol Metab Clin
North Am. 2014 Jun)
“Patients with mild thyroid disease and significant
distress related to mood or cognition most likely
(??) have independent diagnoses that should be
evaluated and treated separately.”
68. So what does the American Association of Clinical
Endocrinologists (ACEE) say?
• “The upper limit of TSH should remain
at 4.5 mIU/L, rather than 3.0-3.5 as
some other organizations have suggested.”
• “Routine T4 treatment for patients with TSH
between 4.5 and 10mIU/L is not
warranted.”
–https://www.aace.com/files/final-file-hypo-
guidelines.pdf
• Garber JR et al. CLINICAL PRACTICE GUIDELINES FOR HYPOTHYROIDISM
IN ADULTS. In: Endocrine Practice vol 18, No. 6 – November/December
2012. Accessed July 22, 2018.
69. Lab values – one more time…”4.5” is where the American
Assn. of Clin. Endocrinologists wants the highest level of TSH
TSH = 0.45 4.12 source: % =
(2.5th% 97.5th% NHANES III
4.5 is the
upper limit
they want –
this is at c.
the 99th%
Louis B. Cady, MD
70. 70 patients- ages 18-65 years of age. w/ primary hypothyroidism on stable T4 for 6
months.
Randomized to either dessicated thyroid extract (DTE) or T4 for 16 months, then
crossed over for another 16 months.
RESULTS:
- “No differences in symptoms” and neurocognitive measures.
BUT:
- DTE patients lost 3 lbs!
- 48.6% of patients (n=34) PREFERRED DTE.
- Those patients preferring DTE lost 4 lbs during the DTE treatment and
subjective symptoms were all significantly better while
taking DTE as per general health questionnaire-12 and
thyroid symptom questionnaire.
71. “Conclusions”:
- DTE therapy did not result in a significant improvement in quality of life; however,
DTE caused modest weight loss and nearly half (46.8%) of the study patients
expressed preference for DTE over L-T4.
DTE therapy may be relevant for some
hypothyroid patients.” [Can you believe it????]
72. Dx:
•TSH
•Free T4
•Free T3
•Reverse T3
• If indicated:
• Anti-thyroid antibodies (anti-
TPO)
• Anti-thyroglobulin antibodies
• Thyrotropin receptor antibodies
(TRAb’s)
• We typically do not do:
• Total T4, Total T3, or thyroid
reuptake
Test! Test! Test!
73. Thyroid “by the numbers.”
1. Review this lecture.
2. Go get good training. (Neal Rouzier, MD)
3. PSYCHIATRISTS! Acknowledge that “T3 augmentation” is in your
literature and it is your RIGHT TO PRACTICE IT. (Consider “HDT”!)
4. Therapists/other practitioners: wake up! Don’t fall into trap of “blaming”
the functionally hypothyroid patient. REFER!
5. Start LOW.
6. Go SLOW.
7. Test test test test test.
• MUST GET BASELINE (which typically hasn’t been done).
• If you are unsure or nervous, TEST.
• MONITOR THE THERAPY.
8. Explain “Goldilocks and the Three Bears” to your patients and start
LOW, giving them some flexibility.
74. Useful aphorisms to remember
•It’s difficult to be euthymic without being
euthyroid.
•Depression can start in the NECK.
•John Earl Shoaff: “The difference between
success and failure is about a half dozen
things.”
75. Framework:
• Decide where in the literature you want to be.
• Do you want to practice the way things “used
to be” or do you want to practice evidence
based medicine?
–[or just blindly listen to the specialty societies
who parrot from the past?]
• Do you want your patient to be “normal” or
“optimal”?
• And can you live with yourself and your
decision?
Louis B. Cady, MD
76. RX: You MUST Know This
Transthyretin = carrier protein)
• Terasaki, T. and Pardridge, W.M.: Stereospecificity of
triiodothyronine transport into brain, liver, and salivary gland: role
of carrier- and plasma protein-mediated transport. Endocrinology,
121(3):1185-1191, 1987.
• http://www.kingpharm.com/uploads/pdf_inserts/Cytomel_PI.pdf.
• Mooradian, A.D.: Blood-brain transport of triiodothyronine is
reduced in aged rats. Mech. Ageing Dev., 52(2-3):141-147, 1990.
• Cheng, L.Y., Outterbridge, L.V., Covatta, N.D., et al.: Film
autoradiography identifies unique features of [125I]3,3'5'-
(reverse) triiodothyronine transport from blood to brain. J.
Neurophysiol., 72(1):380-391, 1994.
• Rudas, P. and Bartha, T.: Thyroxine and triiodothyronine uptake
by the brain of chickens. Acta Vet. Hung, 41(3-4):395-408, 1993.
Or: The idiocy of T4 only thyroid treatment…
77. • Generally practice
guidelines and policy
statements are effective,
BUT…MANY people do not
respond to treatment.
• Clinicians face the
conundrum either
following the guidelines
(which are ineffective), or
ethically prescribing
alternatie (and effective)
Tx.
Pritchard, EK. Reducing the scope of
guidelines and policy statements in
hypothyroidism. Journal of
Othomolecular Medicine. Volume
28, Number 2, 2013.
78. • Per paper:
• Current guidelines are based on (a) suppression of
evidence that other scientific disciplines would
routinely accept.
• Alternative treatments, which are supported by
decades of research and practice, should not be
ignored.
• Response to prescribed treatment is as high as 1.7
million people in the US (90% of whom are women)
• Practicing “per guidelines” keeps patients suffering
from ongoing symptoms of hypothyroidism.
• Patients showing clear benefits on treatment
demonstrate that suffering is not necessary.
Pritchard, EK. Reducing the scope of guidelines and policy statements in hypothyroidism.
Journal of Othomolecular Medicine. Volume 28, Number 2, 2013.
79. Rx:
• Synthroid ® (levothyroxine)
• Cytomel ® (Tri-iodothyronine – “T3”)
• Instant release (cheap!)
• Compounded in SR capsule (easier
dosing)
• Armour® thyroid (brand or generic) =
T4 + T3
• NP Thyroid (cheapest & is excellent)
Naturethroid & Westhroid = T4 + T3 –
better tolerated in some
• OR Compounded dessicated thyroid
80. Consider T3 ONLY use…
• T3 raises T3 levels.
• T3 does NOT raise Reverse T3 levels
• (but T4 does).
• T3 (liothyronine) is generic and CHEAP.
• It can be microdosed and then spread out to
twice daily to three times daily.
• It can be converted to an SR preparation by a
compounding pharmacy. Example – 5
MICROgrams T3 three times daily becomes
15 MICROgrams SR T3 daily, (compounded).
81. TREAT WITH T3 AND T4
• Raising T3 levels to optimal will improve
symptoms
• Raising T3 level by itself cannot be
accomplished with just T4 alone
• (you will also elevate Reverse T3)
• A combination of T4 & T3 is frequently
required in order to optimize T3
• Desiccated thyroid is typically drug of
choice for combined treatment.
82. • Compounded, “DESICCATED” thyroid – still
porcine, but better absorbed secondary to no
binders like tabs
• Avoid Compounded synthetic T4 & T3(non-
desiccated) unless for religious reasons = not
porcine = not as efficacious
• Compounded T4 & T3(non-desiccated) not
absorbed as well as the desiccated compounded
form of T4 & T3
• Desiccated is premixed at 9ug T3 & 38ug T4-
concentration cannot be changed as it is pre-
blended together before distribution
• Also contains T1 & T2
83. The “roll your own” model of
thyroid dosing perspective
• T4 (levothyroxine)
PLUS
T3 (Liothyronine)
• Can ADD “T3” to conventional dosing regimen if
indicated.
• In rare cases, compounded porcine thyroid (T4 &
T3 at fixed dosage) PLUS additional T3.
84. Non-desiccated (REGULAR)
compounded T4 & T3
• Not premixed as is desiccated
• Can combine in any concentration
• T4 is mixed with T3 by the pharmacist to any
combination that is requested
• It is not premixed to 9ug & 38ug as is desiccated
thyroid
• Not as well absorbed=not recommended
• Not porcine; useful for religious preferences
85. Natural Thyroid = Desiccated thyroid
HOW TO DOSE IT
•Comes in ¼, ½ grain, 1 grain, 2 grains, 3
grains
•Initiate with 1 grain dose typically (Rouzier)
• Start with ¼ or ½ grain increments (Cady)
• Tell ‘em “Goldilocks”
•Increase by 1/2 to 1 grain increments per
month
•Monitor lab tests and symptoms monthly
until stable
86. Desiccated thyroid =
NP Thyroid = Armour Thyroid = = Westhroid =
Naturethroid = compounded dessicated thyroid
• T4 and T3 (FIXED RATIO) and T1 and T2
• Porcine not bovine
Porcine ¼ grain ½ grain 1 grain 2 grains 3 grains
Porcine = 15 mg 30 mg 60 mg 120 mg 180 mg
T4 25 ug 50 ug 100 ug 200 ug 300 ug
T3 6 ug 12 ug 25 ug 48 ug 72 ug
Contents and balance of T4: T3
88. Watch out for Reverse T3!
•It has the same effect
on humans that it
does on bears.
Louis B. Cady, MD
89. “Sit down before fact as a little child,
- Thomas H. Huxley
Louis B. Cady, MD
be prepared to give up
every preconceived notion,
follow humbly wherever …
nature leads,
or you shall learn nothing.”
90. Louis B. Cady, MD
Cady Wellness Institute
4727 Rosebud Lane – Suite F
Newburgh, IN 47630 USA
Office (812) 429-0772
info@cadywellness.com
www.facebook.com/cadywellness
Twitter: @LouisCadyMD
www.slideshare.net/lcadymd
www.cadywellness.com
92. Must have iodine to make T4!
Source: Office of Dietary Supplements, NIH accessed 8/11/2013
http://ods.od.nih.gov/factsheets/Iodine-QuickFacts/
93. Sources/locations of deficiency:
• Chlorinated or fluorinated drinking water
• Not using iodized salt
• Consumption of NaCL in processed foods
• Consumption of soy & “goitrogens” - cabbage,
broccoli, cauliflower and Brussels sprouts
• Being pregnant
• People living with iodine deficient soils &
eating local foods
Louis B. Cady, MD
94. North America 85%
South America 76%
Asia 76%
Africa 74%
Europe 72%
Australia 55%
% Mineral depletion from the soil during the
past 100 years, by continent
Source: UN Earth Summit Report 1992
95. - Selenium is one of the factors that may affect the risk of
cognitive decline. In selenium deficiency the brain remains
selenium replete the longest suggesting that Se plays an
important role in brain functions.
- Results from this study: “Low Se status is a risk factor for
cognitive decline even after taking into account vascular
risk factors.”
Louis B. Cady, MD
96. SELENIUM DEFICIENCY in FASEB:
• “Adaptive dysfunction of
selenoproteins from the
perspective of the ‘triage’
theory: why modest
selenium deficiency may
increase risk of
diseases of aging.”
Foundation of American Societies for
Experimental Biology
McCann, J, Ames BM. FASEB J.
2011 Jun;25(6):1793-814.
Louis B. Cady, MD
97. As of August 20, 2016
• “Low selenium status is associated with increased risk of thyroid
disease. Increased selenium intake may reduce the risk in
areas of low selenium intake.”
• Wu Q et al. Low population selenium status is associated with increased prevalence of
thyroid disease. J Clin Endocrinol Metab. 2015 Nov;100 (11):4037-47.
• “We demonstrated …the beneficial effects obtained by
selenomethionine treatment on patients affected by subclinical
hypothyroidism.”
• Nordio M. Combined treatment with myo-inositol and selenium ensures euthryoidism in
subclinical hypothyroidism patients with autoimmune thyroiditis. J Thyroid Res.
2013;2013:424163
Louis B. Cady, MD
99. Prange’s postulates. A historical
retrospective…
• 1963 case where hyperthyroid patient became toxic
when imipramine was introduced.
• Preclinical theories:
• thyroid hormone enhances noradrenergic
receptor sensitivity
• Perhaps modest amounts of T3 might
accelerate imipramine’s antidepressant
activity without producing toxicity.
Prange AJ. Paroxysmal auricular tachycardia apparently resulting from
combined thyroid-imipramine treatment. Am J Psychiatry 119:994-995, 1963.
Louis B. Cady, MD
100. Prange proceeds…
•Placebo controlled study of 20
depressed (but non-refractory)
patients, a more rapid onset of
antidepressant action was observed in
the imipramine-T3 group vs. placebo.
Prange AJ, et al. Enhancement of imipramine antidepressant activity by thyroid
hormone. Am J Psychiatry 126:457-469, 1969.
Louis B. Cady, MD
102. Thyroid augmentation known to be useful in
refractory depression
• 292 patients and eight studies aggregated.
• (Medline data base 1966 – May 1995.)
• Patient treated with T3 augmentation – twice as like
to respond as controls
• (RR 2.09; 95% confidence interval)
• Improvements in depression scores were moderately
large (effect size 0.62, P<0.001)
Louis B. Cady, MD
Aronson R et al. Triiodothyronine augmentation in the treatment of refractory
depression. A meta-analysis. Arch Gen Psychiatry. 1996 Sep;53(9):842-8.
103. 5HT joins NE
• 2002 - New findings:
• Thyroid hormones increase 5HT neurotransmission in
the cortex by increasing 5HT2 sensitivity, and by
reducing 5HT1A autoreception sensitivity in the
raphe
• Changes in gene expression of brain and
neurotrophins thought to be responsible.
Bauer M et al. Thyroid hormones, serotonin and mood of synergy and
significance in the adult brain, Mol Psychiatry 7:140-156, 2002.
104. • Cognition
• Head injury recovery
• Alzheimer’s disease prevention
Other areas of interest advertised in
lecture synopsis
Louis B. Cady, MD
105. Cognition: maternal low thyroid and ADHD in
kids
• Known impact of thyroid hormone deficiency in
pregnancy can affect ADHD symptoms in children
• “Generation R” Study in Rotterdam
• 4,997 eligible mother-child pairs studies (with data on
maternal thyroid levels) identified
• Of these, 3,873 visited a Generation R research center for
assessments.
• “Maternal hypothyroxinemia (n-127) in early
pregnancy was associated with higher scores for
ADHD symptoms in children at 8 years of age”
independent of confounding factors.
• Modesto T et al. JAMA Pediatr. 2015
Sep;169(9):838-45.
106. Impact of mild maternal thyroid hormone deficiency in
pregnancy – the Generation R Study
• Congenital hypothyroidism known to cause
irreversible brain damage.
• Before 12-14 weeks of gestation, maternal thyroid
hormone serves as the only source of thyroid
hormone for the fetus.
• T3 is generated locally from maternal T4 in the fetal brain
before mid-gestation.
• Iodine deficiency and thyroid autoimmune disorders
known as two of the main causes of thyroid
deficiency.
• Ghassabian A et al. Best Practice and Research Clinical
Endocrinology & Metabolism 28 (2014) 221 – 232
107. Results of Generation R study (cont)
• 3,659 maternal child pairs evaluated in this analysis.
– Higher results of maternal free T4 in early pregnancy predicted a
lower risk of expressive language delay in their children at 2 ½
years.
–“Severe hypothyroxinaemia:
• predicted a higher likelihood of expressive language delay in
children at 1 ½ and 2 ½ years of age.
• Also predicted a higher risk of non-verbal delay at 2 ½ years.
• Ghassabian A et al. Best Practice and Research Clinical Endocrinology & Metbaolism 28 (2014)
221 – 232
Louis B. Cady, MD
108. Multiple studies
• “Thyroid hormone regulates neurogenesis in the developing
and adult brain across different vertebrate species.”
• Gothie JD et al. Mol Cell Endocrinol. 2017 May 22.
• The development of infant visual attention is related to thyroid
hormone during early prenatal period.
• Bell MA et al. Am J Clin Nutr. 2016 Sept
• Thyroid dysfunction known to occur in autism spectrum
disorder and may be related to a blocking folate receptor
autoantibody
• Frye RE et al. J Neuroendocrinol. 2017 Mar; 29 (3)
Louis B. Cady, MD
109. Experimental induction of hypothyroidism during
early postnatal stages in rats.
• Hypothyroidism induces at 21 days of age using
propyl—2-thiouracil .
• Results:
– “hypothyroidism triggers a significant dysfunction in
learning and memory processes.
– “The cognitive impairment was correlated with a reduction
in hippocampal plasticity and depression.
– Also, decreased glucose utilization and increased oxidative
stress observed.
– Hypothyroidism in young rat model alters numerous
functions at the level of the hippocampus.
• Salazr P et a. Biochim Biophys Acta. 2017 April;1863(4):870-883.
Louis B. Cady, MD
110. Other studies in children
• Endocrine-disrupting chemicals (EDC’s) and perturb
normal levels of hormones required for normal neural
circuit development.
– Three ubiquitous endocrine disruptors studied
[polychlorinated biphenyls, polybrominated diphenyl
esters, and bisphenol A.]
– Impact of these disrupts goes beyond relative
hypothyroidism and affect memory, cognition, and social
behavior.
– Pinson A et al. Andrology. 2016 Jul;4(4):706-22
Louis B. Cady, MD
111. Thyroid hormone and aging
• Known correlation between increase in TSH during
ageing.
• Unclear if this is a normal adaptive response associated
with senescence or an actual mild thyroid dysfunction.
• Several meta-analyses showed a direct link between
subclinical hypothyroidism and cardiovascular events
(younger than 65) and cognitive impairment (in those
under 75 years of age.)
• Pasqualetti G et al. Recent Pat Endocr Metab Immune Drug Discov. 2016
(10(1):4 – 10
Louis B. Cady, MD
112. “Thyroid function and neuropsychological status
in older adults.”
• “Cross sectional associations between serum
thyroid hormone concentrations and several
neuropsychological function domains among men
and women aged 55 – 74 years” were reported.
• Findings:
– Higher thyroid hormone levels associated with improved
visuospatial function, as well as tasks of memory and
learning.
• Shrestha S et al. Physiol Behav. 2016 Oct 1; 164(Pt A):34-9
Louis B. Cady, MD
113. Thyroid hormone and its function on health status, mood,
and cognition in T4 treated subjects
• Cross sectional study of 132 otherwise health
hypothyroid subjects who received levothyroxine
replacement therapy.
– Generally, not much difference in health status, mood or
cognitive status.
– However, on the Iowa Gambling Task (which mimics real
life decision-making), subjects with low-normal TSH “made
more advantageous decisions than those with high-normal
TSH levels.”
– “Decision making – which encompasses many executive
functions, may be affected.”
• Samuel MH et al. Thyroid. 2016 Sep;26(9):1173-84.
Louis B. Cady, MD
114. Thyroid hormone: influences on mood and
cognition in adults (the need for a “happy
medium”)
• “Treatment of over thyroid dysfunction largely resolves
associated disturbances in mood and cognitive
dysfunction.”
• “However, in the setting of overt hypothyroidism subtle
detrimental effects on cognition may not be full reversed.”
• “Subclinical HYPERthyroidism and higher Free
Thyroxine ( Free T4) within the normal range have also
been associated with poorer cognitive outcomes.”
• Ritchie M, Yeap BB. Maturitas. 2015 Jun;81(2):266-75.
Louis B. Cady, MD
115. Prevalence of thyroid dysfunction and its impact
on cognition in older Mexican adults (SADEM
study)
• 1750 participants evaluated via interviews, TSH, and Free T4 levels.
• TSH of 0.4 – 4 was considered euthyroid.
• Over hypothyroidism = TSH>4.8
• Overt hyperthyroidism – TSH <0.3 IU/L
• Results:
• Overall estimated prevalence of thyroid dysfunction in Mexican
population was 23.7%.
• 15.4% we were classified as subclinical hypothyroidism.
• Thyroid dysfunction and cognitive impairment was most evident
in overt hypothyroidism [OR=1.261]
• Juarez-Decillo T et al. J. Endocrinol Invest. 2017 Mar 25.
Louis B. Cady, MD
116. TSH and cognition in older people (negative
study)
• 335 home-dwelling older people (>/= 75 yoa)
• Cognitive performance evaluated using the
Consortium to Establish a Registry of Alzheimer’s
Disease battery (CERA-nb)
– APO E4 genotype also defined.
– Subjects divided into quartiles by TSH.
• “Our results do not support the notion that higher
TSH concentrations, not even in the range of
subclinical hypothyroidism, would adversely affect
cognition among older people.”
– Ojala AK et al. Age Ageing. 2016 Jan;45(1):155-7
Louis B. Cady, MD
117. Thyroid hormones are associated with longitudinal
cognitive change in urban adult population (positive study)
• 1466 of 1602 participants was analytic sample size.
• Adults ages 30 – 64 years at baseline visit.
• Follow-up between first and second visit ranged from <1
to 8 years
• “In sum, higher baseline thyroid stimulating hormone
was associated with faster cognitive decline over
time among urban US adults, specifically in domains of
working memory and visuospatial and/or
visuoconstruction abilities.” Beydoun MA et al. Neurobiol Aging.
2015 Nov; 36(11):3056-3066.
Louis B. Cady, MD
118. Effects of Thyroxine as Compared with
Thyroxine plus Triiodothyronine in Patients
with Hypothyroidism
Bunevious R et al. N. Engl Journal of Medicine 1999 Feb 11:340(6):424-9.
• 33 hypothyroid patients treated in two phases
• Phase 1 – treated with usual dose of T4.
• Phase 2 – 50 MICROgrams of T4 was removed from dosing
and 12.5ug T3 put in its place.
• Post treatment with T3:
• 17 treated patients improved their scores on cognitive
performance and mood states.
• 10/15 patients were significantly better on T4 + T3 for the
visual analogue scales on wellness.
• “…this finding suggests a specific effect of the
triiodothyronine normally secreted by the thyroid
gland.”
119. Effects of Thyroxine as Compared with
Thyroxine plus Triiodothyronine in Patients
with Hypothyroidism
Bunevious R et al. N. Engl Journal of Medicine 1999 Feb 11:340(6):424-9.
• 20/33 preferred T4 plus T3
• Felt they had more energy, improved
concentration and “just felt better overall.”
• 11 had no preference
• Only 2 preferred T4 only.
•Conclusions:
• “Treatment with thyroxine plus
triiodothyronine improved the quality of
life for most patients.”
121. Head injury considerations in children
• Hypopituitarism: 5 – 7% prevalence in children
following TBI. (includes low TSH)
• “The effect of hormonal replacement in patient
recovery is important enough to consider baseline
screening and reassessment between 6 and 12
months after TBI.”
• Cassano-Sancho P. Arch Dis Child. 2017 Jun; 102(6):572-
577
Louis B. Cady, MD
122. Evaluation of pituitary function for extended
periods s/p TBI
• 24 children s/p TBI evaluated.
• Mean age 9.5 (+/- 3.1) years
• Follow-up times were 29.4 (+/-9.8) months.
• TSH, Free T4, Free T3, IGF-1, sodium, FSH, LH, E2 in girls, Total
testosterone in both girls and boys
• No children found with hormonal deficiencies.
• Conclusion was that some pituitary dysfunction may present in the
late period, “therefore, all cases should be followed up at
outpatient clinics for a longer period”
• Aylanc H, et al. J Neurosci Rural Pract. 2016 Oct-Dec;7(4):537-543
Louis B. Cady, MD
123. TBI in childhood research
• The more severe the trauma, the greater the
risk of progressive reduction in long-term
serum TSH.
• Heather N et al. Clin Endocrinol (Oxf). 2016
Mar;84(3):465-7.
Louis B. Cady, MD
124. Thyroid hormone treatment activates protective
pathways following neuronal injury
• TBI in rats showed to be associated with reduction in T4 and T3.
• A single dose of levothyroxine (T4) one hour post-injury, increased
serum T4 and NORMALIZED serum T3 levels.
• Expression of genes important for thyroid actin in the brain
(MCT8 and Type 2 deiodinase) diminished after injury but were
partially restored with T4 treatment.
• The findings from both in vitro and in vivo studies support a role of
thyroid hormone in activating pathways important for neuronal
protection and promotion of neuronal recovery after injury.
• Li J et al. Mol Cell Endocrinol. 2017 Sep 5;452:120-130.
Louis B. Cady, MD
125. Emerging pharmacotherapy for treatment of TBI
– targeting hypopituitarism and inflammation
• Large body of evidence suggests that TBI may
adversely affect pituitary function – both acutely
and chronically.
• The time interval between injury and effect “is one
of the major factors responsible for variations in
the prevalence of hypopituitarism reported.”
• “euthyroid sick” syndrome reviewed
– Paterniti I et al. Expert Opin Emerg Drugs.
2015;20(4):583-96.
Louis B. Cady, MD
126. “Thyroid hormone in the frontier of cell
protection, survival and functional recovery”
• Thyroid hormones exerts important actions on
cellular energy metabolism.
• Enhances homeostatic potential including
antioxidant, antiapoptotic, anti-inflammatory and
cell proliferation responses.
• Psych uses:
– Reduce cognitive side effects of lithium
– Improves response to ECT in bipolar patients.
• Videla LA et al. Expert Rev Mol Med. 2015 May 25;17:e10.
Louis B. Cady, MD
127. Somatotropic and thyroid hormones in the
acute phase of subarachnoid haemorrhage.
• Complicated hospital course was associated
with a deeper fall in TSH and T3
concentrations.
• “Low concentrations of TSH and T3 were
connected to worse SAH [subarachnoid
haemorrhage] grade and poor outcome.”
–Implications for treatment? No conclusions
given.
–Zetterling M et al. Acta Neurochir (Wien). 2013
Nov;155(11):2053-62.
128. Exogenous T3 administration provides
neuroprotection in a murine model of traumatic brain
injury.
• Thyroid hormones noted to be decreased in patients with
brain jury.
• Controlled cortical impact injury (CCI) [widely used
experimentally] was used in adult male mice.
• Tx with T3 (1/2 MICROgrams/100 grams body weight IP)
one hour after TBI resulted in a significant improvement in
motor and cognitive recovery after CCI.
• 24 hours after brain trauma, T3 treated mice showed
significantly lower number of apoptotic neurons.
• T3 significantly enhanced post-TBI expression of BDNF
and GDNF compared to control vehicle.
– Crupi R et al. Pharmacol Res. 2013 Apr;70(1):80-9.
129. Multiple hormonal derangements seen as determinant
of cognitive decline in older men
• Thyroid, cortisol, and anobolic hormones [DHEA-S,
testosterone, and IGF-1] noted to decline with age.
• Frailty related to consequences of cognitive
impairment and cognitive decline.
• Correlation with changes of thyroid hormone and
anabolic hormones in older men was found.
– Maggio M et al. J Nutr Health Aging. 2012 Jan;16(1):40-
54.
Louis B. Cady, MD
130. THE ROLE OF THYROID HORMONE
Prevention/attenuation of Alzheimer’s
disease?
Louis B. Cady, MD
131. Thyroid hormone levels an in-vivo
Alzheimer’s disease pathologies
• Study evaluated TSH with two AD specific biomarkers
(cerebral amyloid beta burden and glucose metabolism.
– 148 individuals
– PET scan, T3, Free T3, Free T4 and TSH levels measured.
– Al patients were clinically euthyroid. But…
• Independent negative associations were found
between serum fT4 levels and global cerebral Aβ
deposition after controlling for the effects of age,
gender, and the apolipoprotein E ε4 (APOEε4)
genotype. (no other thyroid hormones showed a
relationship)
– Choi HJ et al. Alzheimers Res Ther. 2017 Aug 17;9(1):64.
Louis B. Cady, MD
132. Effects of Thyroid Hormones and their Metabolites on Learning and
Memory in Normal and Pathological Conditions.
• “The available literature suggests that both classical and
non-classical thyroid hormones act as neuroprotective
agents in the brain areas related to learning and memory.
Their role in these areas supports the idea that they may be
involved in the development of Alzheimer's disease.”
• CONCLUSION: Thyroid hormones produce significant
neurological effects, act as neuroprotective agents and
might be considered as future diagnostic and therapeutic
tools for Alzheimer's disease.
• Accorroni A et al. Curr Drug Metab. 2017;18(3):225-236.
Louis B. Cady, MD
133. • “…levothyroxine replacement therapy with vitamin
E supplementation may ameliorate cognitive deficit
in PTU-induced hypothyroidism [experimental
model of hypothyroidism] through the decrease of
oxidative stress status.”
• Note: BOTH were used.
• Pan T, et al. Endocrine. 2013 Apr;43(2):434-9.
134. Thyroid hormone prevents cognitive deficit
in a mouse model of Alzheimer's disease.
• Study examined feasibility of using T4 as a
therapeutic agent of Alzheimer’s disease.
• Mice injected IP with amyloid beta-peptide to produce
AD animal model.
• IP injection of levothyroxine prevented their
cognitive impairment and improved their memory
function.
• Fu AL et al. Neuropharmacology. 2010 Mar-Apr;58(4-
5):722-9.
Louis B. Cady, MD
135. Selenium and selenoproteins in health and disease.
• Selenoproteins – involved in redox regulation of intracellular
signaling, redox homeostasis, and thyroid hormone
metabolism.
• Reduced expression of selenoproteins directly linked to thyroid
hormone metabolism defects (specifically – deficiency of deodinases)
• Selenoprotein deficiencies have been linked to some forms of
cancer, Alzheimer’s disease, cardiovascular disease, and life
span.
• Papp LV et al. Antioxid Redox Signal. 2010 Apr 1;12(7):793-5.
Louis B. Cady, MD
136. And now – more research and
reading is in your future!
• This review has merely scratched the surface of
all of these topics.
• My thanks to everyone who attended my lecture
at IMMH 2017 (Orange County) and my best
wishes for the future!
Louis B. Cady, MD
139. PGC-1 alpha is T3 receptor in brain
• PGC-1 is rapidly regulated and is a direct target
of T3 – both in vivo and in cell culture.
• PGC-1 alpha then coactivates liganded thyroid
hormone receptors
• Autoregulatory feed-forward loop of PGC-1 alpha
activation upon T3 treatment is noted.
• Wulf A et al. T3-mediated expression of PGC-1 alpha via a
far upstream located thyroid hormone response element.
Mol Cell Endocrinol. 2008 Jun 11;287(102):90 – 5.
•
140. Aim: evaluate biological factors assoc. with suicide attempts in
naturalistic sample
439 patients with major depression, bipolar and psychotic
disorders consecutively assessed in the ER of an Italian Hospital
(Jan 2008-Dec 2009)
Suicide attempters were 2.27 times less likely to
have higher Free T3 values than non-attempters (odds
ratio = 0.44; 95% CI; p=0.01) (prolactin level differences failed to
reach significance)
141. The Beneficial Effect of L-Thyroxine on Cardiovascular Risk
Factors, Endothelial Function, and Quality of Life in Subclinical
Hypothyroidism: Randomized, Crossover Trial
• SCH treated by L-thyroxine leads to a significant
improvement in CV risk factor and symptoms of
tiredness.
• The CV risk factor reduction is related to the
increased level of free T4 concentration.
• (only T4 level checked – not T3.)
Razvi S et al. J Clin Endocrinol Metab. 2007 May;92(5):1715-23.
142. Thyroid Hormone Treatment of Congestive Heart
Failure
• Recent work has characterized the beneficial effects of thyroid
hormone on cardiovascular hemodynamics
• … administration of thyroid hormone has been shown to increase
cardiac inotropy and to lower systemic vascular resistance.
• Patients with advanced heart failure after coronary artery bypass
surgery and post myocardial infarction have altered thyroid
hormone metabolism with low serum triiodothyronine (T3) levels.
The decrease in serum T3 levels occurs primarily as a result of a
decrease in conversion of tetraiodothyronine (T4) to T3 … causing
low T3 or nonthyroidal illness syndrome
• Coupling the potential benefits of thyroid hormone to enhance
cardiac performance with the inherently low serum levels of T3, a
heart failure treatment regimen that includes thyroid hormone
replacement in a carefully monitored setting seems rational.
Klein I, Ojamaa K. Thyroid hormone treatment of congestive heart failure. Am J Cardiol. 1998
Feb 15;81(4):490-491.
143. Louis B. Cady, MD
“subclinical hypothyroidism bipolar disorder” 1/28/2018
43 citations
• “Thyroid abnormalities occur frequently in patients with BD regardless of
treatment.” [Lambert CG et al. Bipolar Disord. 2016 May;18(3):247-60]
• Patients with SCH had poorer performance than patients without SCH in
measures of verbal memory, attention, language, and executive functions.
[Martino DJ, et al. Subclinical hypothyroidism and neurocognitive
functioning in bipolar disorder. J Psychiatr Res. 2015 Feb;61:166-7]
• “There is no significant association between hypothyroidism and bipolar
disorder.” Menon B. Hypothyroidism and bipolar affective disorder: is
there a connection. Indian J. Psychol Med. 2014 Apr;36(2):125-8
• Hypothyroidism, either overt or more commonly subclinical, appears to the
commonest abnormality found in bipolar disorder. Chakrabarti S. Thyroid
functions and bipolar affective disorder. J Thyroid Res. 2011;2011;
2011:306367.
144. Louis B. Cady, MD
“subclinical hypothyroidism bipolar disorder” 1/28/2018
43 citations
• Study of 84 lithium treated patients with bipolar disorder vs. 65
gender/age matched controls.
• TSH & Free T4 drawn +USG exam of thyroid
• Mean TSH and thyroid volume significantly higher in the
lithium group
• 16.7% of lithium group had hypothyroidism vs. 10.8%
in control group
• Prevelance rate for goiter – 47.6%
• USG pathology – 83.3%
• Conclusion: “You can’t tell by looking at the blood tests.”
Kumn TO et al. Thyroid function and ultrasonography abnormalities in Lithium-treated
bipolar patients: a cross sectional study with healthy controls. Noro Psiklyatr Ars. 2017
Jun;54(2):108-115
145. As of August 21, 2016
NEW LITERATURE – AUGUST 2016 – “Association between serum
thyrotopin levels and mortality among euthyroid adults in the
United States. [Inoue K et al. Thyroid. 2016 Aug 18 [Epub ahead of print]
• Population – NHANES III study . N = 12,584 adults>/= 20 years of
age.
• Associations between TSH tertiles (high, medium, and low)
and mortalities (all cause, cardiovascular and cancer)
• Mean followup = 19.1 years with 3,395 deaths.
• Increase risk of all-cause mortality found in high normal TSH
compared to medium normal TSH group. ( Low normal
compared to medium also had higher all cause mortality).
• “This study indicated that the normal range of TSH levels may
require reevaluation.”
Louis B. Cady, MD
146. More studies
• 24.2% of an adult female population in Puerto
Rico = hypothyroid
• Vonzales-Rodriguez LA, et al. Thyroid dysfunction in an adult female
population: A population-based study of Latin American Vertebral
Osteoporosis Study (LAVOS) - Puerto Rico site. P R Health Sci J.
2013 Jun; 32(2):57-62.
Louis B. Cady, MD
147. A Low-Normal Free Triiodothyronine Level Is Associated with
Adverse Prognosis in Euthyroid Patients with Heart Failure
Receiving Cardiac Resynchronization Therapy (2017)
• Evaluate: whether or not free triiodothyronine (fT3) is
related to response to cardiac resynchronization
therapy (CRT)
• Patients with fT3 < 3.00 pmol/L had a significantly
higher overall mortality than those with fT3 ≥ 3.00
pmol/L (P = 0.027).
• A lower-normal fT3 level is correlated with a worse
cardiac function and adverse prognosis in euthyroid
patients with HF after CRT implantation.
Chen YY et al. Int Heart J. 2017 Dec 12;56(6):908-914