All posts by leslieboswell

I am the mother of a darling five-year old little girl living with Down syndrome. We found out on her two-month well check that she might have DS. While the diagnosis took a little adjusting to, we have enjoyed a full and happy life with our precious girl.

Navigating Healthcare for the Special Needs Parent



I just love double meaning acronyms. My true feelings, I would say, are spot on for the way the subtitle reads. What the acronyms actually mean are: 5FU is a chemo agent 5-fluorouracil. MTHFR is methylenetetrahydrofolate reductase. SOC is the ever-beloved standard of care.

The way these all tie together is that when you have the MTHFR genetic defect or any other condition that affects the enzyme folate metabolism activity, such as hypothyroidism, that essentially means that your body is not going to process folic acid, which then leads to having children with special needs, psychiatric symptoms, and all the trickle-down effects of folate deficiency; including cancer, to name a few. I have glazed over MTHFR through my years of thyroid advocacy with the thought of if you can keep your thyroid levels where they need to be, it is less of an issue. I did learn in the work done by Dr. Christiansen and Dr. Lynch that when you are hypothyroid, your enzyme that processes folic acid doesn’t function optimally. Here is a link to their great work.

So, essentially, if you do address folate deficiency and not address hypothyroidism, are you still in the same boat? The role of MTHFR in special needs kids is high and being proposed as the turning point when a child becomes vaccine injured and develops autism. It hinders the body’s ability to detox.

The conventional use of large doses of folic acid (5 mg/day) has become obsolete. Regular doses of folic acid (100–200 μg) can be tolerated in the general population but should be abandoned in the presence of MTHFR mutations, as the biochemical/genetic background of the patient precludes a correct supply of 5-MTHF, the active compound. A physiological dose of 5-MTHF (800 μg) bypasses the MTHFR block and is suggested to be an effective treatment for these couples. Moreover, it avoids potential adverse effects of the UMFA syndrome, which is suspected of causing immune dysfunction and other adverse pathological effects such as cancer (especially colorectal and prostate).”

I have continued to think that thyroid is also a fuel to that fire. My main point kind of coming from pics parents would share of their babies before that dreaded vaccine that changed their world, and I see symptoms of hypothyroidism; puffy cheeks, depressed nasal bridge, enlarged tongue, and/or an eye that turns outward.

The SOC for newborn screening is lacking and our system for notifying docs of failing the newborn screening is lacking and too many babies are getting missed for that hypothyroid diagnosis at birth. It took me a process over four years to get my children’s newborn screening results from the State, and they were not released to me until the State’s legal counsel approved the release. Come to find out, my daughter was recommended for a second screening. After some tree shaking, I had procured her diagnosis on my own through her cardiologist that she was, in fact, hypothyroid at three months of age. She was not diagnosed with Down syndrome until the age of two months. My pediatrician at that time was very lax on everything. I first learned she had a heart murmur from a local iridologist who saw it in her eyes. When I learned of the high rate of heart defects in Down syndrome, I called and got her in to a pediatrician cardiologist. She had fluid around her heart which he said could be caused by the thyroid. I begged to test. This was more than my gut could reconcile. I had already approached her pediatrician about my concerns of symptoms of hypothyroidism. They were written off because those were the same markers for Down syndrome. I had read that untreated could lead to irreversible mental retardation. My pediatrician reassured me that she passed the newborn screening, and she was okay. When her labs did show she was hypothyroid by an elevated TSH, this same pediatrician also wanted to wait four months to treat for when the visiting endocrinologist came to town. I was not cool with that, so I switched pediatricians and procured treatment for her right away.

I guess my point for trailing off is that these standards of care had already led me to feel a lack of confidence that the SOC that docs are under the obligation to practice under were nowhere in line with a happy and healthy baby.

My other experience with the standard of care comes from my court reporting days of sitting in a medical malpractice deposition and the opposing attorney asking the question of the doc, “Did you follow the standard of care?” Doc’s answer, “No.” Attorney, “Why not?” So the bottom line is that if the doctor does not follow the suboptimal standards, they subject themselves to a medical malpractice suit and possible licensure discipline. I do have an expectation, as I am sure we all do, that our doctors act prudently and responsibly. So does prudent mean not thinking on their own and stay within the shortcomings of SOC, or does it mean they will do their own thinking and look at the patient individually and make adjustments where needed? Interestingly, in the guidelines for newborn screening for hypothyroidism, there is a catch phrase that puts the onus on the physician that they should not forego their clinical judgment and that the testing could be inaccurate.

I had been feeling terrible for about a year. Stress levels out of this world. I got some labs. I had found it easier and cheaper to procure my own labs. I enjoyed the freedom of being able to get the labs I wanted without fighting with my doctors and causing discord because doctors can face disciplines for ordering tests outside of the SOC. I have found great healthcare with a naturopathic physician from a state that has prescribing privileges because they have different guidelines to follow which are more conducive to better health and well-being.

God had guided me to a panel of labs that included a homocysteine level. My homocysteine level was 36 µmol/L (optimal is 5-7 µmol/L)!! The upper end of the range was 15. My thyroid hormone levels were extremely high, yielding above 4 ng/dL for free T4 (optimal levels are 1.0-1.5) and over 7 pg/mL for free T3 (optimal levels are 3.5-4.5). Of course, the TSH looked normal at 1.8 µIU/L.

My next big dose of standard of care also comes from my recent experience of a diagnosis of cancer. My GI doctor who performed the colonoscopy called me up at 11:00 on a Friday (office closes at noon) and says, “You have cancer and you need chemo ASAP.” I had questions, of course. The main one being what stage cancer I had. His reply was, “We need a pelvic MRI to determine that.” My thought was, “Okay. Order one.” He told me the standard of care is chemo and he needed to know ASAP if I wanted my chemo to be done in Lubbock or Midland. I called him back 20 minutes later because I was more interested in surgery. I had reconciled I would probably end up with a colostomy bag. He never returned my call.

My nurse practitioner referred me to a local surgical group. They sent me their newest and greenest doctor. Not much skill is needed to relay, “The standard of care is the Nigro protocol of chemo.” The standards squashed any desire I had as a patient on what course of treatment I wanted. He did not order scans. They did, however, schedule me an appointment with an oncologist. Before I received my appointment date, I had made contact with the Cancer Treatment Centers of America. My appointment with the local oncologist was still not for another week following my return from Arizona. They flew me out and performed an extensive workup for three days. I finally had answers. I had a staging. I was told I had Stage 2 anal cancer. This was a continuation of my previous HPV driven vulvar cancer. That staging was Stage 0. Surgery has proved me well on that and my comfort level was still high with the surgical option. I was again reminded that the SOC was chemo and radiation.

The highly skilled surgeon at CTCA (far superior to what I had back home) performed a really gentle and thorough exam and determined that to do surgery, they would have to take the vaginal wall and basically skin graft the area. My goal was to preserve all my female parts. So on to the oncologist’s recommendation I went. The recommendation was two rounds of chemo and six weeks of radiation. The side effects of the radiation will still hold quite a bit of damage to my female parts. Many women who have undergone this regimen have spent a number of years undergoing reconstructive surgery to overcome the devastating effects of radiation. These women who I am now included with are not given the choice of surgery initially but have to undergo the 44-year-old chemo protocol and radiation. It’s hard to believe that cancer treatments have not advanced at all in a half a century. The reply being “because they work so well.” Big Pharma maintains a chokehold on doctors and their ability to think for themselves through the standards of care.

I continue to be strangled by the ever-beloved SOC.
Despite my thoughts of a healthy thyroid equals healthy folate levels, my thoughts didn’t matter. My health was in a pickle. I also had a vitamin D level at 29 ng/mL (optimal is 80 -100 ng/mL) . I had an extreme pain in my anal/vaginal area to the point of debilitating and my energy level was zero. I had to do something. I don’t usually call in favors, but I was desperate. I had resolved my elevated thyroid but didn’t feel any improvement. So I hit up my friend who is also a naturopathic physician. She was most concerned about the homocysteine level. I repeated my thyroid labs and checked antibodies. They were looking great. I turned those around lickety-split by taking desiccated thyroid at ½ grain for a couple weeks to suppress the pituitary and then adding another ½ grain to total 1 grain and working on my vitamin D levels.

Of course, in my narrow-mindedness, I didn’t know what in the world to do with an elevated homocysteine level. I had glazed over that equation for many years. Erica made some recommendations for an optimized B complex and optimized folate. I had never had the 23 and Me test to determine my MTHFR status. I knew it was likely I had an MTHFR mutation or some other condition affecting the folate metabolism between having a brother with Tourette’s, a father with alcoholism, and a child with Down syndrome. I had lost a good 50 pounds and was shriveling into nothing. Despite my attempts for better health, my foot cracked while on vacation, and I still felt rotten. Keeping up with a new business, a normally developing 12-year-old son, and a 10-year-old fireball little girl with Down syndrome, and marriage, I was still on the bottom side of stress with no conceivable way to get on top of it. I reran my labs after working on my B vitamin levels and folate. I had gotten my homocysteine down to 15!! Vitamin D was at 59 now, and thyroid was stable. It was too little, too late. I still had cancer and still didn’t have a choice in my treatments.

I learned that leucovorin (folinic acid) was being used in numerous chemo protocols. I asked my oncologist if I could add that to my regimen. Her reply was, “No. That is not the standard of care.” She won’t even run a dang homocysteine level!! Her response to the numerous abstracts I presented on the connection between HPV driven cancers and MTHFR was that it didn’t apply to me because these were third world countries and we have been fortifying our cereals and flours since the ‘70s. (The same timeline as the introduction of the TSH test for hypothyroidism, the Nigro chemotherapy protocol, and the increases in diseases such as autism and fibromyalgia and chronic fatigue syndrome to name a few.)

Here I am half a country away from home and my usual health care providers, and I am going to have to procure follow up on my own. Luckily, there is a LabCorp down the road from my hotel. I will continue to run my own labs to ensure I don’t get lost to the SOC if my advocacy attempts continue to fail. Ordering your own labs is easy and cheap. It just irks me that I can’t get a simple lab added to the weekly labs they are drawing to monitor a condition that feeds cancer and exacerbates side effects of chemo. Super delighted to have this subclavian port jabbing through my throat so I won’t have to be repeatedly poked with a needle so I can grab an Uber to go up the street to be…poked with another needle.

This is the link where order my own labs.

I had also requested half doses of chemo at twice the frequency because my body is so sensitive to treatments of any sort in general. Since that is not the standard, my request was shot down. After the fact of experiencing side effects unusually hard, I came across this information. I wish I would have known this before and I might have advocated a little harder for myself. Now it has been determined that they will only give me a half dose for my next round of chemo. While this focuses on methotrexate, the severity of side effects I am experiencing is identical. I knew my gut was talking really strongly, but to read that I can have a 36 percent increase in oral mucositis symptoms and a 34 percent slower recovery of platelet counts kind of took my breath away. I have battled those two side effects and others pretty hardcore.

“The retrospective analysis involved 220 bone-marrow transplant patients who received methotrexate, an antifolate drug used as standard therapy for preventing graft-vs-host disease, a common complication of marrow transplantation. In analyzing the patients’ stored DNA, Ulrich and colleagues found that those with the lowest activity of a key folate-metabolizing enzyme (called methylenetetrahydrofolate reductase, or MTHFR) suffered the highest degree of toxicity and treatment complications.

Side effects of methotrexate include oral mucositis and delayed blood-platelet recovery. Oral mucositis is characterized by a painful inflammation of the tissues lining the mouth, throat and gastrointestinal tract; delayed platelet recovery can interfere with blood clotting and require expensive platelet transfusions.
Patients with two copies of the MTHFR variant had less than half the rate of folate-enzyme activity as compared to those with only one copy of the mutation, resulting in a 36 percent increase in oral mucositis symptoms and a 34 percent slower recovery of platelet counts. This is the first study of its kind to show the impact of this genetic variant on drug response.”

“Oral mucositis is one of the worst side effects of marrow transplantation from the patient’s perspective because it interferes with their eating, drinking, talking, and sometimes even breathing. It also increases the risk of infection as well as the cost and duration of the hospital stay,” said Ulrich, an assistant member of the Hutchinson Center’s Public Health Sciences Division and a research assistant professor of epidemiology at the UW.
In addition to preventing graft-vs.-host-disease in marrow-transplant patients, methotrexate is used to treat certain cancers and, in lower doses, immune diseases such as rheumatoid arthritis. The drug works by temporarily interfering with the body’s use of folic acid, a nutrient needed for cell growth.

The reason patients with the MTHFR gene mutation suffer more severe side effects of antifolate chemotherapy, Ulrich hypothesizes, is because their bodies lack the adequate folate necessary to produce nucleotides — a key component of the DNA-repair machinery. Patients with variations in the MTHFR gene, in the future, may be candidates for more customized therapy, from altered dosages to alternative drugs.”

“We know that every patient reacts somewhat differently to the drugs they’re given and, until recently, our ability to understand how a patient will react has been very limited, based on characteristics like age and body weight,” Ulrich said. “Now, with our increasing understanding of genetics, we can better predict how patients will process a drug and thus provide the appropriate dose for that patient. Ultimately this will allow us to tailor our drug dosages to reduce toxicity, or side effects, and increase effectiveness.”

I will continue to advocate for leucovorin as a result of coming across this.

“5-FU is continuously degrading via the pyrimidine degradation pathways
To enhance the inactivation of TS, we increase the concentration of methylene-THF by dosing with leucovorin at the same time as 5-FU.”
3. More complex activation of chemotherapeutic for tissue-targeted intervention:
Capecitabine is a pyrimidine nucleotide derivative that undergoes a three-step conversion to the 5-FU: dealkylation, deamination, phosphorylase
This produces a steady supply of 5-FU, and tends to occur more in tumor tissue.””

I can see her qualms when I recommended surgery or chemo sensitivity testing. I mean, those are pretty big requests. I am at CTCA because they pride themselves on the Mother Standard and choices. And they do provide a nice standard offering things such as Qigong energy sessions, acupuncture, nutrition, organic farm, and a naturopathic physician. But at the end of the day, no matter where you are, Big Pharma dictated standards control the day. I hate to bash CTCA too much. Their care far exceeds what we have at home, and I would and have hoped on their train in a heartbeat with every ounce of gratitude I have. But I am irked I can’t get a homocysteine level or leucovorin. A suboptimally elevated homocysterine is a guide for me that I do not have optimal folate metabolism. It is a cheap, easy, and effective means of monitoring the end result of folate metabolism.

I was able to get her to order one set of thyroid labs. I was appreciative of the shaking that ensued in the naturopathic doctor when I brought up my homocysteine level to him to begin with. I would much rather be able to address this with an injection of leucovorin as there is a limit to just how many pills a person can swallow in a day. I had to titrate up to my folate dose and with every period of “falling off the wagon,” I find myself having to watch for anxieties that come with just jumping in full steam.

I want to end this diatribe to not lose my point I want to make: Mommas of special needs kiddos; Our stress is real. We wear it like a badge comparing it to the soldiers on the front lines of war. We know it is real. We feel it. We live it. But when you look up and you are on the underside of stress, it is too late. We don’t eat. We don’t sleep. If we are lucky, we still have a marriage that is intact, hanging by a thread. We are malnourished. We are tired. We are heartbroken. We redefine stress. Not even sure there is even a word that describes what we go through. We endure judgement. We have to be the doctors when we should just get to be mommas. Most of us are not of the fabric to be doctors and shouldn’t be expected to, though we are guilt riddled when we miss things the doctors should have caught. We endure snide remarks and looks from family and friends because if we do it well enough, the behaviors of our children are just because we are bad parents and not because they have special needs. We are continually in PTSD mode. We can’t continue like this. We have to rally and pull ourselves together. We have to stop and get our own labs, the ones that will keep us alive and not the ones limited to Big Pharma’s SOC. We have to take care of ourselves.

I drew the lucky straw, the one where I can be away from my kids and family and work for six weeks. I am one of a few that can take a short period of time and rehab myself if you can consider cancer treatments rehab. Most of us don’t fall into that category. My prayers are with you endlessly that you somehow find a way. Do something now before it is too late. God has spared me. Worst case scenario, I will get my initial request of surgery. That is pretty damn lucky. I sure didn’t give God much to work with. While my tumor may only be 2mm away from the vaginal wall, to God it is a foot. Give Him something to work with better than I did. When they performed an EUS, my staging jumped up to a Stage iiic.

We have to stop and take a break from being the educator, the doctor, the advocate and keep ourselves alive.
If you or anyone you know has had an abnormal pap smear, I encourage you/they request and push for anal paps. The percentages are too high for those affected and it can be caught early.
Leslie Boswell 2018 ©

Order Your Own Labs

Mother, Child, Butterfly image

Order Your Own Labs if Your Physician Won’t order them.

Recommended Lab Panels:

Down Syndrome Support Blog Recommended Thyroid and Adrenal Labs,

Stop the Thyroid Madness – Recommended Labs (great guide for ordering your own tests),

Recommended Labs by Erica Peirson, N.D. –


Online Labs:

Life Extension,


Direct Labs,


There are even more than this.



23andMe –



Questions to Ask When Interviewing a New Thyroid Doctor

Mother, Child, Butterfly image

Questions to Ask When Interviewing a New Thyroid Doctor


Do you test Free T3 and Reverse T3 along with TSH and Free T4?
Most desired answer:
Yes. I understand the importance.

Do you look at the ratio between Free T3 and Reverse T3?
Most desired answer:
Yes. I want to know how much active T3 is available.

Do you look within the ranges, or do you take symptoms and placement within the ranges into consideration when interpreting labs and making treatment recommendations?
Most desired answer:
Yes. I like to see the Free T4 at midrange and the Free T3 in the upper part of the range.

Do you take into consideration the American Academy of Clinical Endocrinologist’s recommendation that the upper level of the TSH range should be lowered to 3?
Most desired answer:
Well, of course.

Do you always consider a low TSH as being hyperthyroid or do take pituitary function into consideration?
Most desired answer:
I always look to see if the Free T3 is elevated when determining if a
patient is hyperthyroid.

Do you test for all antibodies? TgAb (Hashimoto’s), TPO (Hashimoto’s), and TSI (Graves’.)
Most desired answer:
Of course.

Do you perform saliva cortisol?
Most desired answer:
Yes. I understand that it provides the measurement of cortisol that is free floating and available for use. I also like to know where the levels are throughout the day.

Do you test iron by checking ferritin as well?
Most desired answer:
Yes. I also realize the vast range and prefer to see a ferritin more around 60-80 rather than a low normal.

Most often, you will know by this point how well you will be able to work with a prospective doctor. If it looks promising, you can follow with these questions about treatment:


How do you treat hypothyroidism? Using synthetic T4 only, T3/T4 mix, desiccated thyroid, or straight T3?
Most desired answer:
I prefer desiccated thyroid and will make adjustments with T3 depending on the balance of the levels and reverse T3 status.

How do you treat low iron?
Most desired answer:
Natural iron.

How do you treat a high reverse T3?
Most desired answer:
By testing saliva cortisol and tending to iron deficiency.

Do you adjust thyroid treatment dose according to Free T3 levels or TSH? If the TSH goes low and the free T3 is below midrange, will you increase dose?
Most desired answer:
I adjust dose according to Free T3 level.

Do you titrate dosing?
Most desired answer:
Yes. I start out in 15 mg increments for children and increase every two weeks until the target dose (according to the prescribing instructions) is achieved and hold there for six weeks and retest.


Do you use desiccated thyroid for treatment of antibodies?
Most desired answer:
Yes. I will dose to where the Free T3 is in the upper quarter of the range to suppress the thyroid to calm the antibodies.

Do you have dietary recommendations for antibodies?
Most desired answer:
Yes. I believe gluten free can help decrease thyroid antibodies.

What other treatments do you use for treating antibodies?
Most desired answer:
(Other antibody treatments include diet, IVIG, others).

Do you prescribe LDN for antibodies?
Most desired answer:
Yes, if desiccated thyroid and diet have not been able to get antibodies down.

Don’t be too discouraged if your doctor does not answer verbatim to the most desired answer. These are answers we would get in a dream world. The main place to start with any doctor is the appropriate tests. Things can be pieced together after that.

Hope this is handy when it comes to interviewing a prospective doctor.

How to Find a Good Physician


Finding a Good Doctor

 Finding a good thyroid doctor can be quite challenging. Here are some lists I have put together for you. I have also included a Stop the Thyroid Madness link on how to find a good doctor. There are some great tips in there.

A good starting point is checking the Dollars for Docs list to see how much money a prospective doctor may have received from pharmaceutical companies. I found the two endocrinologists I clashed with most locally on this list.

Dollars for Docs

Stop the Thyroid Madness

Naturopathic Doctor – Erica Peirson, ND

Thyroid Change Patient-Recommended Doctors

Thyroid friendly doctors (must be a member of this Yahoo Natural Thyroid Hormones group)

Mary Shomon’s list

NatureThroid doctors

Thyroid Info doctors

Generation Rescue

MedMAPS doctors
Clinician directory

DAN doctors

© Leslie Boswell 2014

Purpose and Disclaimer

Purpose and Disclaimer for

The purpose of this group is to share experiences to help educate parents about thyroid and adrenal testing and treatment options in order to facilitate the strongest of communications with our physicians regarding testing and treatment.

Leslie’s Thyroid and Adrenal Support does not claim to diagnose, treat, or cure any kind of disease. The information provided is for learning and educational purposes only; hopefully, between you and your doctor together.  The information learned here should be used as a launching pad to a deeper learning.

© Leslie Boswell 2014

Thyroid Research Links

Mother, Child, Butterfly imageThyroid Research Links

Prevalence of Iron Deficiency in Down Syndrome

Newborn Screening Fails to Identify Hypothyroidism in Down Syndrome

T21 Causes Persistent Hypothyroidism


Fetal Brain Development as a Result of Thyroid

Neonatal Thyroid Function


Down Syndrome and Thyroid


Feingold, ADHD and Thyroid


Stop the Thyroid Madness Medical Research


Cardiovascular and Thyroid


Down Syndrome and Thyroid


Perinatal Asphyxia and Thyroid


Thyroid Hormone Regulates the Expression of the Sonic Hedgehog Signaling Pathway


Thyroid Hormone Regulates Oxytocin Gene


Thyroid Hormones Serotonin


Thyroid Hormone necessary for response to SSRI


Regulation of Gene Expression by Thyroid


Thyroid Functions of Neonates in Down Syndrome


Dosing Thyroid Medication by TSH


Skeletal Development and Thyroid!po=19.1406


Salivary Cortisol in Children

Recommended Thyroid and Adrenal Labs


Recommended Thyroid and Adrenal Labs

These are the routine labs that have been helpful for myself and my family for a decent outlook on thyroid function and adrenal glands.  There is a limited amount of blood we can get out of our children, and we don’t want more blood ordered than is available. 


TSH, Free T4, Free T3, Reverse T3.  It is good to also rule out antibodies with TgAb (Hashimoto’s), TPO (Hashimoto’s), and TSI (Graves.) The antibodies tests may be bumped to another set of labs if it is hard to get an order for this many labs.


TIBC, serum iron, ferritin, and % saturation.  Pernicious anemia: serum B-12, MMA, folate.

General: CBC, CMP

Adrenal function: 24-hour Saliva Cortisol (see below)

For adults, looking at sex hormones could be important too: Estrogen, Progesterone, and Testosterone.

I also like to refer to The Down Syndrome Treatment Center of Oregon’s list of labs.  I wouldn’t limit this list to Down syndrome.  I feel it is a great list for us all.


Stop the Thyroid Madness has an excellent list of recommended labs.



If it is questionable whether your kiddo can spit into a tube, you can practice spitting to see if and how much saliva you can get.  You could also check with the lab and see if the sample drawn by a bulb syringe could be used.  Smelling a lemon can help produce saliva.  There are pediatric collections kits listed below as well as a good spit test.

NeuroScience Adrenal Tests (doctor must order these tests)

NeuroAdrenal Basic 9028 (Cortisol x4, DHEA, Epinephrine, Norepinephrine, Dopamine, Serotonin, Glycine, GABA, Glutamate, PEA, Histamine) Basic

NeuroAdrenal Essential 9094 (Epinephrine, Norepinephrine, Dopamine, Serotonin, GABA, Glutamate, PEA, Cortisol x4) Essential

 Adrenal Rhythm 7000 ( Cortisol x4) Rhythm


Here are some avenues to get a saliva cortisol test without going through your doctor.

Cotton:  MyMedLab’s *Sabre* cortisol saliva kits come with the cotton swab ones, but it has to be the Sabre ones.

Cotton:  MyMedLab carries others as well. It’s a 6-sample test, which would mean waking your child up twice during the night.


Cotton: DirectLabs has a 4-sample one from MetaMatrix which is the cotton one, too.

Spit:  MyMedLab spit, four times a day.

© Leslie Boswell 2014 



Vitamin D, Gene Regulation, and Thyroid

Vitamin D, Gene Regulation, and the Thyroid

 There is much ado about vitamin D these days and the fallout physically from being vitamin D deficient.  Vitamin D deficiencies are high among the special needs kids’ population, as well as the hypothyroid population.

I am very thrilled to read the Vitamin D Council’s blog regarding a new study that finds that vitamin D helps regulate three genes involved in autism.  These genes, as you will read in the blog, relate to regulation of the serotonin synthesis.   This discovery is considered to be “groundbreaking.”  I am deeply saddened that the equation that the thyroid hormone also plays into causing vitamin D deficiency, as well as these other “mysteries,” such as low oxytocin levels in children with autism, has been ignored.  I have included various studies to show these physiological functions relating back to the thyroid hormone of these “groundbreaking” “mysteries.”

Here are a few excerpts from their blog.

“The authors also solved some of the mysteries surrounding autism. One mystery is why autistic individuals have low levels of serotonin in their brain but elevated serotonin levels in their peripheral blood. The authors discovered that there are two genes involved in turning tryptophan into serotonin, a central gene and a peripheral gene.

Vitamin D up-regulates the central serotonin gene and down-regulates the peripheral serotonin gene. That may explain why autistic kids have elevated blood serotonin but decreased brain serotonin when their vitamin D levels are low. To date, many studies of vitamin D levels in autism show autistic kids are vitamin D deficient.”

“Drs Patrick and Ames may have solved another mystery of autism: why autistic children have low levels of oxytocin. Oxytocin is a hormone that does a lot of things, such as promote socialization. The authors explain that oxytocin is also directly controlled by vitamin D. If children are deficient in vitamin D, they will also have low levels of oxytocin.”

You can read entirety of the New Study Finds Vitamin D Regulates Three Genes Involved in Autism, Vitamin D Council’s blog, yourself here.

 Vitamin D hormone regulates serotonin synthesis. Part 1: relevance for autism.

Patrick RP1, Ames BN.

Author information

1Nutrition and Metabolism Center, Children’s Hospital Oakland Research Institute, Oakland, California, USA.


“Serotonin and vitamin D have been proposed to play a role in autism; however, no causal mechanism has been established. Here, we present evidence that vitamin D hormone (calcitriol) activates the transcription of the serotonin-synthesizing gene tryptophan hydroxylase 2 (TPH2) in the brain at a vitamin D response element (VDRE) and represses the transcription of TPH1 in tissues outside the blood-brain barrier at a distinct VDRE. The proposed mechanism explains 4 major characteristics associated with autism: the low concentrations of serotonin in the brain and its elevated concentrations in tissues outside the blood-brain barrier; the low concentrations of the vitamin D hormone precursor 25-hydroxyvitamin D [25(OH)D3]; the high male prevalence of autism; and the presence of maternal antibodies against fetal brain tissue. Two peptide hormones, oxytocin and vasopressin, are also associated with autism and genes encoding the oxytocin-neurophysin I preproprotein, the oxytocin receptor, and the arginine vasopressin receptor contain VDREs for activation. Supplementation with vitamin D and tryptophan is a practical and affordable solution to help prevent autism and possibly ameliorate some symptoms of the disorder.-Patrick, R. P., Ames, B. N. Vitamin D hormone regulates serotonin synthesis. Part 1: relevance for autism.”

Thyroid Hormone Regulates the Oxytocin Gene.


Adan RA, et al. Show all

Adan RA, Cox JJ, van Kats JP, Burbach JP.


J Biol Chem. 1992 Feb 25;267(6):3771-7.



“Endocrine factors involved in the transcriptional regulation of the oxytocin (OT) gene were investigated in heterologous expression systems. Plasmids having a 5′-flanking region of the rat OT gene (-363/+16) or the human OT gene (-382/+41) cloned in front of the firefly luciferase gene were co-transfected with an expression vector for the rat thyroid hormone receptor alpha in P19 embryonal carcinoma (EC) cells. Thyroid hormone (T3) stimulated the activity of the rat and human OT promoters about 10-fold. In MCF-7 breast tumor cells transfected with the human OT promoter-luciferase fusion gene, T3 stimulation through endogenous thyroid hormone receptors was about 5-fold. Co-transfection experiments in P19EC cells using 5′ deletion mutants of the rat OT gene showed that thyroid hormone responsiveness was located in two regions, one located between nucleotides -195 and -172, the other between nucleotides -172 and -148. Each region accounted for about 3-fold T3 stimulation. Gel retardation analysis using extracts from HeLa cells over-producing the c-erbA/TR alpha protein showed specific binding to the -172/-148 element, while no binding occurred on the -195/-172 element. The -172/-148 element which contains the imperfect estrogen response element, GGTGACCTTGACC, has inverted as well as direct repeats of the TGACC motif. Mutagenesis of TGACC motifs separately reduced thyroid hormone responsiveness by about 50%. However, simultaneous mutation of two TGACC motifs abolished the responsiveness to T3 completely. There was no cooperativity between the activated thyroid hormone and estrogen receptors in transfected MCF-7 cells nor in thyroid hormone receptor and estrogen receptor co-transfected P19EC cells. Negative interactions between these two receptors were observed and gel retardation assays showed interaction between the two receptors proteins. It was shown in an in vivo experiment that treatment of rats with thyroid hormone increased hypothalamic OT mRNA levels, the pituitary OT content, as well as OT levels in blood. The results reveal thyroid hormone as a physiological regulator of OT gene expression, which stimulates OT promoter activity directly through interaction with a thyroid hormone-response element in the OT gene.”


1371278 [PubMed – indexed for MEDLINE]

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Vitamin D and Autoimmune Thyroid Diseases.


Kivity S, et al. Show all

Kivity S, Agmon-Levin N, Zisappl M, Shapira Y, Nagy EV, Dankó K, Szekanecz Z, Langevitz P, Shoenfeld Y.


Cell Mol Immunol. 2011 May;8(3):243-7. doi: 10.1038/cmi.2010.73. Epub 2011 Jan 31.




“The role of vitamin D as an immune modulator has been emphasized in recent years, and low levels of the hormone were observed in several autoimmune diseases including multiple sclerosis and systemic lupus erythematosus. Vitamin D mediates its effect though binding to vitamin D receptor (VDR), and activation of VDR-responsive genes. While VDR gene polymorphism was found to associate with autoimmune thyroid diseases (AITDs), few studies examined levels of vitamin D in these patients and those that did yielded conflicting results. We therefore undertook to evaluate the levels of vitamin D in patients with AITDs compared to patients with non-AITDs and healthy controls. Serum vitamin D (25-OH) levels were measured in 50 patients with AITDs, 42 patients with non-AITDs and 98 healthy subjects, utilizing the LIAISON chemiluminescence immunoassay (DiaSorin, Saluggia, Italy). Vitamin D deficiency was designated at levels lower than 10 ng/ml. Antithyroid antibodies, thyroid functions and demographic parameters were evaluated in all patients. The prevalence of vitamin D deficiency was significantly higher in patients with AITDs compared with healthy individuals (72% versus 30.6%; P<0.001), as well as in patients with Hashimoto’s thyroiditis compared to patients with non-AITDs (79% versus 52%; P<0.05). Vitamin D deficiency also correlated to the presence of antithyroid antibodies (P=0.01) and abnormal thyroid function tests (P=0.059). Significantly low levels of vitamin D were documented in patients with AITDs that were related to the presence of anti thyroid antibodies and abnormal thyroid function tests, suggesting the involvement of vitamin D in the pathogenesis of AITDs and the advisability of supplementation.


21278761 [PubMed – indexed for MEDLINE]

Full text: Nature Publishing Group

Thyroid hormones, serotonin and mood: of synergy and significance in the adult brain.


Bauer M, et al. Show all

Bauer M, Heinz A, Whybrow PC.


Mol Psychiatry. 2002;7(2):140-56.



“The use of thyroid hormones as an effective adjunct treatment for affective disorders has been studied over the past three decades and has been confirmed repeatedly. Interaction of the thyroid and monoamine neurotransmitter systems has been suggested as a potential underlying mechanism of action. While catecholamine and thyroid interrelationships have been reviewed in detail, the serotonin system has been relatively neglected. Thus, the goal of this article is to review the literature on the relationships between thyroid hormones and the brain serotonin (5-HT) system, limited to studies in adult humans and adult animals. In humans, neuroendocrine challenge studies in hypothyroid patients have shown a reduced 5-HT responsiveness that is reversible with thyroid replacement therapy. In adult animals with experimentally-induced hypothyroid states, increased 5-HT turnover in the brainstem is consistently reported while decreased cortical 5-HT concentrations and 5-HT2A receptor density are less frequently observed. In the majority of studies, the effects of thyroid hormone administration in animals with experimentally-induced hypothyroid states include an increase in cortical 5-HT concentrations and a desensitization of autoinhibitory 5-HT1A receptors in the raphe area, resulting in disinhibition of cortical and hippocampal 5-HT release. Furthermore, there is some indication that thyroid hormones may increase cortical 5-HT2 receptor sensitivity. In conclusion, there is robust evidence, particularly from animal studies, that the thyroid economy has a modulating impact on the brain serotonin system. Thus it is postulated that one mechanism, among others, through which exogenous thyroid hormones may exert their modulatory effects in affective illness is via an increase in serotonergic neurotransmission, specifically by reducing the sensitivity of 5-HT1A autoreceptors in the raphe area, and by increasing 5-HT2 receptor sensitivity.”


11840307 [PubMed – indexed for MEDLINE]

Free full text: Nature Publishing Group

Understanding TSH, T4, and T3

Understanding TSH, T4, and T3

It can be difficult to wrap your head around how the different hormones TSH, T4, and T3 function.  The TSH (thyroid stimulating hormone) is a pituitary hormone.  This stands for thyroid stimulating hormone.  It is a signal that comes from the pituitary gland to tell the thyroid that there is not enough active thyroid hormone in the cells and that it needs to kick some more thyroid hormone out.  The T4 (thyroxin) is the thyroid storage hormone.  The body in a perfect state of health has to convert the T4 hormone into the active thyroid hormone T3 (triiodothyronine).  The cells of the body receive this active T3 hormone through receptors.

One way I like to look at it is to correlate it to a light switch, a light fixture, and actual lighting that you have in front of your face to see an object.  The light switch is the TSH.  The light fixture is the T4.  The light in front of you is the T3.  When looking at thyroid function by means of a TSH test, you are merely looking at the light switch to see if it is turned in the on position.  When you measure the storage thyroid hormone T4 (Free T4 test), you are looking at the light fixture to make sure there is a light bulb in there.  When you measure the active thyroid hormone (Free T3 test), you are assessing whether or not you have light to see by.  If you don’t have enough light to see by, that would be referred to as having hypothyroid symptoms.

There are numerous reasons why the TSH is iffy in testing thyroid function.  In this post, I will only address a correlation as to determining dosage of thyroid treatment in regards to the “light source.”  Say that you determine that you have faulty lighting and you just don’t have enough light to see by, and so you provide an external source of lighting such as a skylight or other window.  This would be like taking thyroid hormone replacement.  If you have enough light to see by, you are not prompted to go flip the switch to turn the light bulb on.  The same kind of goes with thyroid replacement.  When the cells of the body are receiving the active thyroid hormone, the feedback loop has no need to tell the pituitary gland to tell the thyroid to produce more hormones.  Therefore, we see a drop in the TSH level.  Doctors are trained to perceive this is being hyperthyroid and are prompted to reduce the dosage, then throwing the body back into hypothyroidism.  When only TSH and Free T4 levels are tested, the main function of the thyroid is left out, the T3 levels.  This is the same as looking at a light switch or a light fixture to tell you whether you have enough light to see by.  Proper testing for a complete picture of thyroid function should contain the lab tests TSH, Free T4, Free T3, and a Reverse T3.  The ratio between Free T3 and Reverse T3 will help you to know how much active thyroid hormone T3 is getting received by the cells in your body.

Understanding TSH, T4, and T3        © Leslie Boswell 2014