Hypothyroidism and Hyperparathyroidism

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Information Resources / Additional Information and Links to Scientific Studies

  1. Wikipedia gives a clear explanation of hypothyroidism. Most standard medical websites provide an incomplete explanation for patients that suspect a subclinical thyroid imbalance, or have been diagnosed with either sublclinical or clinical hypothyroidism. In this disease, or health imbalance, patient understanding is the key to correcting the endocrine imbalance and the associated health problems. Goto http://en.wikipedia.org/wiki/Hypothyroidism
  2. A 1995 landmark study entitled the Colorado thyroid disease prevalence study indicated that abnormally high levels of TSH exists in about 10 percent of the population, and abnormally low levels of TSH exists in over 2 percent. The study also noted that among patients in a large cross-sectional study of 25,862 persons attending health fairs, that over 40 percent that were taking thyroid medications still had abnormal TSH levels. One measure of associated health problems was conducted, lipid imbalance, and this was highly correlated with abnormal TSH levels. The results of this large study indicate that nearly 13 percent of a normal midwestern population may have a subclinical thyroid disorder or a poorly treated clinical disorder. The time to integrate Complementary Medicine into the treatment protocol and take a holistic approach to restoration of health has come, yet standard medicine still is resisting this logical and conservative approach to treatment: http://www.ncbi.nlm.nih.gov/pubmed/10695693
  3. A 2008 multicenter study, led by the endocrinologist Dr. Vijay Panicker at Sir Charles Gardner Hospital, in Nedlands, Australia, and published in the Journnal of Clinical Endocrinology and Metabolism, showed that perhaps 16 percent of the human population has a genetic variation that decreases conversion of thyroid hormone T4 to the active T3 in the brain, and that this subset of patients showed poor response to synthetic T4 treatment with hypothyroidism concerning psychological symptoms. The recommendation of these experts, and guidelines now in Europe and Australia was to use a combination of natural T3 and T4 hormone therapy in many patients to insure better overall outcomes. Unfortunately, the American Thyroid Association in 2014 decided to omit the use of combination T3/T4 in its guidelines, creating much controversy in the field: http://press.endocrine.org/doi/abs/10.1210/jc.2008-1301
  4. A 2006 study at the esteemed Mayo Clinic showed that a high percentage of patient taking greater than a 125 mcg dose of levothyroxine, or synthetic T4, had abnormal levels, or fluctuating levels, of their TSH, while those taking less than 125 mcg had a high percentage where TSH levels were normal or stable. Obviously, the maintaining of better natural thyroid function, and attention to the various factors that could affect T4 levels, could result in more patients having to take smaller dosages of synthetic T4, and thus better overall health. This revealed here at the website of the American Thyroid Association: http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-7-issue-4/vol-7-issue-4-p-10-11/
  5. The subject of genetic variations affecting thyroid function and disease is fully explored by Dr. Vijay Panicker in this study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219766/
  6. A 2013 randomized controlled human clinical trial comparing natural desiccated thyroid extract (Amour Thyroid) to synthetic T4 drugs (levothyroxine and synthroid), at Walter Reed National Military Medical Center, in Bethesda, Maryland, noted that no significant differences were noted between the randomized groups of patients in terms of symptoms and neurocognitive measurements, but that about half of the participants expressed preference for the natural desiccated thyroid extract: http://www.ncbi.nlm.nih.gov/pubmed/23539727
  7. A broad study of the general population in France in 2004 found that among patients not already diagnosed with thyroid disease that the prevalence of abnormal TSH was very high, indicating an alarming percentage of the population in industrialized society now experiencing a subclinical thyroid imbalance, with a significant percentage associated with deficient iodine levels and other environmental factors. Undiagnosed subclinical hypothyroidism in the female population age 45-60 was over 11 percent: http://www.ncbi.nlm.nih.gov/pubmed/15731735
  8. Such studies as this, in 2004, by Health Canada, in Ottawa, Canada, Environmental Research Division, have found that the accumulative effects of industrial halides (e.g. fluoride, chloride, bromide) and halogens (fluorine, chlorine, bromine) in the environment, which compete with the halide iodine, are proven to disrupt thyroid hormone production, as well as cause neurotoxicity that may affect the thyroid regulation at the hypothalamus. These chemicals, many of which are now banned but still prevalent in the environment, not breaking down, but some of which continue to be used at alarming levels, such as PBDE (polybrominated diphenyl ethers), in flame retardants, pesticides and other products, are now found in toxic accumulative levels in aging humans everywhere, and even in wildlife in areas as remote as the arctic: http://www.ncbi.nlm.nih.gov/pubmed/15369322
  9. A 2009 study at Boston University Medical Center found that a number of common environmental pollutants, including PCBs, PBDEs, perchlorates, bisphenol-A in soft plastics, pesticides and dioxins, may cause of contribute to thyroid dysfunction in a variety of biochemical ways: http://www.ncbi.nlm.nih.gov/pubmed/19942155
  10. A 2014 study at the Federal University of Rio de Janeiro, and the Federal University of Sao Paolo, in Brazil, shows that glyphosate, the main chemical in RoundUp and other organophosphate herbicides that are ubiquitous in the environment in the last decade with the massive promotion of Monsanto GMO crops matched to glyphosate herbicides, causes significant dysfunction in the thyroid metabolism, and in fact can mimic hypothyroidism. This study showed that glyphosate could inhibit conversion of T4 to T3 thyroid hormone, via mechanisms affecting the liver and the pituitary deiodinase enzymes (DIO): http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2014.ED.2.SAT-0361
  11. A medical textbook (DeGroot et al) conservatively outlines the many factors, including medications and environmental chemicals, as well as behavioral patters and cognitive patterns of stress that are proven to alter the TSH expression and circulating levels, as well as the peripheral conversion of thyroid hormone types: http://www.ncbi.nlm.nih.gov/pubmed/25905415
  12. Dr. John R. Lee, a pioneer in the use of bio-identical hormones, is well represented with hypothyroid information at: http://virginiahopkinstestkits.com/thyroidarticle.html
  13. A 2013 randomized controlled human clinical trial of progesterone therapy to treat hypothyroidism, at the the University of British Columbia School of Medicine, and Vancouver Coastal Health Research Institute, found that progesterone caused a significant free T4 thyroxine increase in patients with hypothyroidism, demonstrating that Dr. John R. Lee was indeed correct in his research findings: http://www.ncbi.nlm.nih.gov/pubmed/23252963
  14. A 2006 study at the University of Gottingen Medical School in Germany found that common environmental chemicals used in sunscreen are accumulating in our drinking water and causing potential hormonal imbalances similar to hypothyroidism: http://www.endocrine-abstracts.org/ea/0011/ea0011oc60.htm
  15. A 2010 study at the University of Exeter and the Peninsula Medical School, in Exeter, and the University of Plymouth, in the UK, found a strong association between perfluorooctanoic acid (PFOA) levels in the body and thyroid disease, gathered from a large amount of data primarily from the U.S. National Health and Nutrition Examination Survey. PFOA (C8) is a chemical developed by Dupont Chemical and 3M and widely used in non-stick cookware (e.g. Teflon) for decades despite knowledge of health risks, eventually subjected to a phasing out of production between 2002 and 2015. Numerous lawsuits have presented strong evidence that PFOA is accumulative in the environment and the body, and is associated with cancers, inflammatory bowel disease, thyroid disease, high cholesterol and pregnancy induced hypertension(eclampsia): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866686/
  16. A 1999 meta-analysis of published scientific studies by the University of California Neuropsychiatric Institute in Los Angeles found that the drug Lithium, used to treat depression and bipolar disorders, interfered with thyroid metabolism and increases the incidence of both overt and subclinical hypothyroidism, and that subclinical hypothyroidism is associated with neuropsychiatric symptoms. Lithium is now available without prescription and will be heavily promoted for profit, but a low dose of lithium orotate has been used for a century without problems. To achieve maximum effect, medical doctors utilized a different form of lithium in a high dosage to treat depression in the past, dramatically increasing available serotonin in the brain: http://www.ncbi.nlm.nih.gov/pubmed/10221287
  17. A 2005 study of the effects of hypothyroidism found that when thyroid hormone in circulation (thyroxine or T4) was reduced, this created a deficiency of the important cellular antioxidant and detoxifier, glutathione, in the red blood cells, which would increase cardiovascular risk, risk of anemia, and risk of leukemia: http://www.ncbi.nlm.nih.gov/pubmed/15801865
  18. A 2008 study at the Norwegian University of Science and Technology found that there was a 40% increased risk of cardiovascular death over 8.3 years with women who had a high TSH (thyrotropin) level, but not with men. The connection was not clear, and the authors did not advocate treating with synthetic thyroid hormone, but did suggest that thyroid health and general health should be addressed in these conditions: http://www.theheart.org/article/860257.do
  19. A 1992 study investigating the relationship of hyperparathyroidism and hypothyroidism found that 95% of laboratory animals with induced high levels of TSH developed hyperparathyroid state in 12 weeks: http://www3.interscience.wiley.com/
  20. A 2002 study by experts at the Henry Ford Hospital, in Detroit, Michigan, U.S.A. found that incidence of primary hyperparathyroidism has increased dramatically since the disease was first described in the 1940s, especially in developed countries in America and Europe, and most cases now are asymptomatic. These experts deduced from study that an increased incidence of the hormone Vitamin D is highly associated with these changes: http://www.ncbi.nlm.nih.gov/pubmed/12412781
  21. A 2000 study by experts at the Henry Ford Hospital, in Detroit, Michigan, U.S.A. found that the size of the adenoma, or gland enlargement, was a major determinant of disease severity, and that studies around the world indicate that a hormone Vitamin D deficiency is inversely related to the size of the adenoma. Sub-optimal hormone Vitamin D status may be the key factor: http://www.ncbi.nlm.nih.gov/pubmed/10720039
  22. A 2007 explanation of the increasing incidence of secondary hyperparathyroidism is presented by experts at the University of Oviedo, in Spain. Here, we see that kidney dysfunction and poor hormone Vitamin D metabolism are both key causes, with the inability to properly secrete phosphorous by the kidney quickly leading to hyperstimulation of the parathyroids and abnormal growth of parathyroid tissue, especially in the presence of a hormone Vitamin D deficiency. We may also surmise that even if the parathyroids are removed, that this underlying problem will stimulate the thyroid glands to again create tissues that produce excess parathyroid hormone over time: http://ckj.oxfordjournals.org/content/1/suppl_1/i2.full
  23. A 2012 report from experts at the University of Tennessee School of Medicine, in Memphis, Tennessee, U.S.A. notes that with increased study of the protein growth factor FGF-23 (fibroblast growth factor) that this may be the key mechanism involved in the cycle of dysfunction that causes secondary hyperparathyroidism, and may be mainly responsible for the deficiency of hormone Vitamin D. While this prompts standard medicine to look for an allopathic approach to pharmaceutically inhibit FGF-23, it is easy to see that a more holistic restoration of this metabolic feedback cycle of homeostasis is preferable: http://www.ncbi.nlm.nih.gov/pubmed/22421513
  24. A landmark 2011 study at the University of Catania Medical School, in Italy, and Cardiff University, in the UK, showed that even with standard treatment with synthetic T4 levothyroxine, that optimal thyroid homeostasis is not achieved in about a fifth of patients: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148220/
  25. A 2010 study at the Peking University School of Medicine, in Beijing, China, showed that the herbs Astragalus and Angelica sinesis (Huang qi and Dang gui), long used to treat chronic renal disease in Complementary Medicine, act partially by modulating expression of FGF-23 and 5 key enzymes in animal studies: http://www.ncbi.nlm.nih.gov/pubmed/20195958
  26. A 2010 study at Dundee University found that mild primary hyperparathyroidism eventually causes an increased risk of overall mortality and comorbidity (related diseases) that is similar to more severe hyperparathyroidism. Standard medicine has no effective and appropriate treatment, and partial parathyroidectomy produces hormonal imbalance and symptoms where there were none. Complementary Medicine offers that chance to treat mild hyperparathryroidism with a comprehensive protocol: http://www.ncbi.nlm.nih.gov/pubmed/20039887
  27. A 2014 release of the official U.S. FDA guidelines for synthetic T4, called levothyroxine or synthroid, shows that this commonly prescribed medication needs to be carefully monitored for dosage, comes with a number of warnings concerning long-term use and contraindications with various health problems, including cardiac pathology and adrenal insufficiency, and comes with a warning of significant adverse effects, usually with long-term use: http://www.drugs.com/pro/levothyroxine.html
  28. Scientific study in China in 1997 has proven that acupuncture exerts significant beneficial effects on the hypothalamus: http://www.wellspringintegrative.com/acup_pit.htm
  29. A 2011 study in Russia followed 27 women diagnosed with subclinical hypothyroidism to see if periodic short courses of acupuncture focused on thyroid function could benefit. The study found that not only were symptoms relieved, but that TSH levels were normalized, and quality of life was significantly improved. These short courses of focused acupuncture stimulation are a valuable part of a more comprehensive protocol with CIM/TCM:http://www.ncbi.nlm.nih.gov/pubmed/22165143
  30. A 1993 study at the Shanghai Research Institute of Acupuncture and Meridian followed 71 cases of patients with Hashimoto's thyroiditis, which almost always reverts to a chronic hypothyroid state, and found that short course of moxibustion stimulation consistently reduced thyroid antibody levels, and modulated immune responses, showing that addition of moxibustion in the treatment protocol could potentially benefit patients significantly:http://www.ncbi.nlm.nih.gov/pubmed/8501952
  31. A 2014 meta-review of all published studies of Chinese Herbal Medicine to treat subacute thyroiditis found only 21 small studies published, but a consistent finding of benefit when this treatment is integrated with standard care, improving symptoms, reducing relapse rate, and alleviating adverse effects of the standard therapy with synthetic hormones. No contraindicating adverse effects were noted: http://www.ncbi.nlm.nih.gov/pubmed/24992749
  32. A 2006 review of parathyroidectomy versus partial removal and minimally invasive techniques showed that outcomes were similar, with calcium and parathyroid hormone levels normalizing at 3 months (Rush University Medical Center, Chicago): http://www.sciencedirect.com/
  33. A study of the long-term effects of synthetic thyroid medication, levothyroxine, in 2008 at the University Federico II Dept. of Intenal Medicine and Cardiovascular Sciences, shows association with impaired heart function and arterial hardening that explains complaints of fatigue: http://www.ncbi.nlm.nih.gov/pubmed/18445676
  34. Reports of long-term side effects of synthetic thyroid medication to the FDA: http://www.ehealthme.com/q/levothyroxine+sodium-side-effects
  35. A 1993 randomized controlled human study at Karl Franzens University School of Medicine, in Austria, found that treatment with iodine solution was almost identical in effect with prescription of synthetic thyroid hormone, or levothyroxine, to reduce endemic thyroid goiter, ore excess growth: http://www.ncbi.nlm.nih.gov/pubmed/7900936
  36. A 1999 randomized controlled human study at Ernst-Moritz-Arndt University of Greifswald, in Munich, Germany, found that the safety of iodine therapy for patients with both endemic thyroid goiter, and patients with autoimmune thyroiditis, or Hashimoto's disease, was both safe and effective, and that a combination of low-dose synthetic thyroid hormone, or levothyroxine, combined with iodine solution had an advantage regarding the low risk of immunological reactions to therapy. This study of 209 patients found that high-dose iodine solution resulted in antibody reactions in 14.8 percent of the patients with toxic nodular goiter, but only 5 percent when a lower dose of iodine solution was used. No pathological antibody-levels at all were found in patients where synthetic T4 and iodine solution were combined. Of the patients with mildly increased antibody levels during iodine therapy, only 4 of 22 increased further with therapy. Hypothyroid disturbances were not observed in any patients. The conclusions of these experts was that potential antibody reactions with high-dose iodine solution in therapy had no clinical importance at all. This study showed definitively that treatment with Lugol's Iodine solution, or Iodoral, is safe, but should be monitored and initial treatment should try a low-dose solution. The study also found that the treatment with low-dose solution combined with levothyroxine is safe. Subsequent studies identified a small percentage of patients with an inherited tendency to iodine overstimulation creating and antibody response, and that this was reversed by decreasing or stopping the iodine therapy: http://www.ncbi.nlm.nih.gov/pubmed/10603730
  37. Inflammatory mediators such as interleukin-6 have been found to play an important role in the pathogenesis of hypothyroidism, and immune dysfunction as well as physiological stress and hormonal imbalance increase the chance that chronic inflammation will play a part in the disease: http://www.annals.org/content/128/2/127.abstract
  38. A 2007 review of comorbidities with celiac disease, at Singleton Hospital, Swansea, United Kingdom, found that autoimmune disorders occurred at a higher rate in patients with celiac disease than the general population, especially Hashimoto's thyroiditis, as well as inflammatory bowel disease (IBD), diabetes type 1, and autoimmune liver diseases, although the reasons for this are still poorly understood: http://www.ncbi.nlm.nih.gov/pubmed/18056028
  39. Gastrointestinal dysfunction associated with gluten malabsorption and celiac disease has long been linked to hypothyroidism, especially Hashimoto's. In 2012, researchers at Sapienza University of Rome, Italy, found that patients with Hashimoto's thyroiditis who experienced atypical celiac disease showed the need for a significantly higher dose of the synthetic T4 hormone levothyroxine, attributed to malabsorption of the medication: http://www.ncbi.nlm.nih.gov/pubmed/22238404
  40. A 2010 study at Istanbul University in Turkey found a significant correlation between diabetes, autoimmune thyroid disease and celiac disease, with 15.4% of children with insulin dependent diabetes (an autoimmune disorder), also testing positive for the antibodies that confirm Hashimoto's thyroiditis: http://www.ncbi.nlm.nih.gov/pubmed/20931425
  41. A 2015 study at King Saud University, in the Kingdom of Saudi Arabia, showed that CoQ10 was an effective adjunct treatment for induced myopathy, a condition seen in 60-80 percent of patients with chronic hypothyroidism, and relative to the severity and duration of the disease. Here, the study group was induced with myopathy with the use of statin drugs for high cholesterol, which many hypothyroid patients are prescribed because thyroid imbalance is tied to metabolic syndrome and poor regulation of lipid cholesterols: http://www.ncbi.nlm.nih.gov/pubmed/25366571
  42. A high percentage of the U.S. population in areas of the country have been found to be iodine deficient, and iodine has been a safe and broadly prescribed treatment for various hypothyroid conditions for more than a century. The benefits revealed in scientific studies are broad, and this 2010 study at Leipzig University in Germany reveals that iodine supplementation may prevent peripheral thyroid dysfunction, mutations of the thyroid stimulating hormone receptor, and slow the development of clinicially relevant thyroid diseases, including Hashimoto's thyroiditis, an autoimmune disorder:http://www.ncbi.nlm.nih.gov/pubmed/21035537
  43. To see the effects of fluoride consumption, a halogen that competes with iodine absorption, along with bromides, and may limit iodine in the body, refer to this website of the fluoride action network:http://www.fluoridealert.org/health/
  44. Research as far back as 1997, at the University of Brussels, in Belgium, showed in animal studies that a moderate dose of iodine/iodide supplement normalized thyroid hormone production, thyroid stimulating hormone (TSH) level, and thyroperoxidase (TPO), which is the enzyme needed to control the rate of transfer of iodine to form thyroid hormone in the gland. The findings showed that a small dose, as is commonly seen in many supplements these days, had no effect: http://www.ncbi.nlm.nih.gov/pubmed/9296378
  45. Research in 2005 at Cardiff University School of Medicine in Great Britain found that sufficient iodide levels in the body inhibit the mutations of thyroid stimulating hormone receptors (TSHR), which are the main mechanism of pathology in Hashimoto's thyroiditis, and in adenomas and multi-nodular goiter. Thus, periodic supplementation with Iodoral, when warranted, may prevent these diseases from occurrring: http://www.ncbi.nlm.nih.gov/pubmed/15691889
  46. A 2010 metaanalysis of scientific studies of selenium supplementation in cases of Hashimoto's thyroiditis found that patients supplementing for 3 months had significantly lowered thyroid peroxidase antibodies (TPOab) and significant improvement in symptoms: http://www.ncbi.nlm.nih.gov/pubmed/20883174
  47. A study in 2003 at University College Dublin, in Ireland, found that many scientific studies demonstrated a link between breast cancer and a variety of thyroid disorders, increasing belief that an iodine deficiency, as well as a selenium deficiency is a potent contributor to the pathogenesis of breast cancer. Iodine and iodide are heavily stored in both breast and thyroid tissues, and exert significant antioxidant effects. In the thyroid, iodine is an integral part of thyroid hormone formation. The role of iodine in breast tissue appears to be limited to antioxidant protection. Large studies have also shown that populations with a higher iodine intake in the diet, such as Japan, have much lower incidence of breast cancer. There is some unclear evidence implicating excess iodine and iodide with supplmentation to decreased antioxidant protection, though, and professional guidance is always recommended. A small percentage of the population also has an inherited allele, with genetic predisposition, for excess iodine to trigger temporary hyperthyroid reaction, which is easily reversed with discontinuation or reduction in dosage: http://www.ncbi.nlm.nih.gov/pubmed/12927031
  48. A 2014 randomized controlled human clinical trial of the addition of N-acetyl cysteine (NAC) to the protocol to treat subclinical hypothyroid illness associated with peripheral dysfunction of thyroid hormone conversion, and excess T4 to rT3, found that this simple supplement was effective to prevent or treat this condition. These researchers noted that this syndrome is associated with heart attack and cardiac dysfunction, and that oxidative stress is also associated, implying that these issues can be treated with CIM/TCM as well: http://www.ncbi.nlm.nih.gov/pubmed/25148231
  49. A 2014 report from the U.S. AHRQ and the U.S. Preventive Services Task Force found that subclinical hypothyroidism was highly associated with cardiovascular and metabolic disease, but that standard treatment for this disorder, limited to synthetic thyroid hormone treatment, did not prevent these disease consequences. The task force stated that screening for subclinical hypothyroidism did not show clear benefits at this time, but certainly failed to acknowledge that effective treatment for subclinical hypothyroidism involves an holistic approach with Complementary and Integrative Medicine (CIM), which can both restore thyroid and adrenal homeostasis and prevent cardiovascular and metabolic disease: http://www.ncbi.nlm.nih.gov/pubmed/25927133
  50. Dr. John R. Lee, a pioneer in the use of bio-identical hormones, is well represented with hypothyroid information at http://virginiahopkinstestkits.com/thyroidarticle.html
  51. The Holtorf Medical Group, Inc. of Foster City, California, provides excellent resource on the internet with information that is valuable to modern Complementary care. http://holtorfmed.reachlocal.net/article_info.php?articles_id=2#12
  52. Many overlooked health problems are attributed to, or associated with, subclinical hypothyroid syndromes. This multicenter study based at the University of Athens Medical School, in Greece, shows that studies indicate a strong association between these subclinical hypothyroid syndromes and neutropenia, and immune deficiency syndrome associated with chronic allergic hypersensitivity: http://www.ncbi.nlm.nih.gov/pubmed/26061308
  53. A 2015 study at the Chinese Academy of Medical Sciences, in Beijing, China, showed that subclinical thyroid disease presents a clear and significant increased risk of cardiovascular disease and mortality:http://www.ncbi.nlm.nih.gov/pubmed/26052725
  54. Subclinical hypothyroid syndromes are highly associated with lipid imbalance, yet this is widely overlooked, as is the controversial conclusion that synthetic thyroid hormone taken long-term may contribute to this imbalance in lipid metabolism: http://www.ncbi.nlm.nih.gov/pubmed/26031143
  55. A randomized controlled human clinical study showed that the combination of subclinical hypothyroidism and the hormone Vitamin D deficiency was a direct cause or contributor to heart disease and left ventricular diastolic dysfunction via dysregulation of calcium metabolism and induction of inflammatory activity: http://www.ncbi.nlm.nih.gov/pubmed/25960009
  56. A randomized controlled human clinical study at Capital Medical University, in Beijing, China, showed that both subclinical hypothyroidism and clinical hypothyroid disease significantly increased cardiovascular risk, and that markers of high homocysteine and insulin resistance were linked to this risk, and caused by the hypothyroid dysfunction: http://www.ncbi.nlm.nih.gov/pubmed/25938439
  57. A 2015 study at the Acibadem University School of Medicine, in Istanbul, Turkey shows a clear relationship between increased fatty tissues surrounding the heart and subclinical hypothyroidism:http://www.ncbi.nlm.nih.gov/pubmed/26023309
  58. A 2015 study at Shanghai Jiao Tong University School of Medicine, in Shanghai, China, found that in a study of patients with chronic hepatitis that prevalence of subclinical hypothyroidism was highly predictive of fatty liver disease: http://www.ncbi.nlm.nih.gov/pubmed/25974331
  59. A 2015 study at the Federal University of the State in Rio de Janeiro, Brazil, showed that chronic use of antiretroviral medications in the treatment and prevention of HIV/AIDS is associated with a high risk of acquiring subclinical hypothyroidism, and recommends therapies to restore immune function with Complementary and Integrative Medicine: http://www.ncbi.nlm.nih.gov/pubmed/25993673
  60. A 2011 study of patients diagnosed with subclinical hypothryoidism in Russia concluded that a large majority of patients received significant benefits from short courses of acupuncture administered every 3-4 months, with improved Quality of Life measures and improvement in symptoms: http://www.ncbi.nlm.nih.gov/pubmed/?term=subclinical+hypothyroidism+acupuncture

NOTE: medical experts have stated for many years: "long-term use of high-dose inhaled corticosteroid therapy has potential to cause systemic side effects – impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitiary-adrenal-axis suppression, measured by serum or urine cortisol decrease correlates with the occurrence of systemic side effects of high-dose inhaled corticosteroids."