I decided that I could create a newsletter dedicated to connecting integrative MDs and NDs.  It started in 1983 with a small readership and was just 8 pages formatted with a typewriter and printed by photographing it.  We did get a few advertisers.  But it did grow incrementally.  By 1984 it was 32 pages, something between a newsletter and a magazine.  Many more doctors and consumers subscribed and more advertisers participated. The naysayers who thought there would be no publication in a year were wrong.  Each year the Townsend Letter for Doctors, now just Townsend Letter, drew a larger reading audience and more advertisers.  The writing covered the spectrum of natural medicine, diagnosis, treatment, herbology, homeopathy, vitamins and nutraceuticals, energy medicine, acupuncture, and alternative treatment practices.  We covered the politics of natural medicine as well as the ins-and-out of how doctors practice day-to-day.  

     Of course, in the 1990s other journals began to appear and in the late part of the 1990s the internet began to be active in publishing at first on websites and then searchable on Google.  The Townsend Letter has matured and our publication is no longer unrefereed writing; we require our authors to provide evidence-based reports documenting integrative medicine.  However, we still give the reader a birds-eye view of how doctors practice “in the trenches.”  We serve as a forum for doctors who want to share their insights into how to diagnose and treat.  I review the article content of the Townsend Letter to be sure authors are providing legitimate and substantiated content.  That doesn’t mean that I offer everything in my clinical practice that is published in the magazine.  But I do keep an eye out for authors who misrepresent the intent of work by other doctors and researchers.  

     You can enjoy the writing of the Townsend Letter as a print magazine, e-magazine, or sample some of the content that is published each month on the website:  www.townsendletter.com.  And if you do become my patient you will have the opportunity to read current and past issues at each visit.

Jonathan Collin, MD

     A hypothyroid patient typically experiences fatigue, a lack of stamina, a need to rest following any effort, and depressed mood.  Physically it is not unusal to have cold hands and feet, swelling in the extremities, coarse drying of the skin, thining of the hair, fragile fingernails and toenails, muscle pain with activity, and fullness in the neck.  Mentally there can be less sharp mental acuity, decreased memory, even brain fog, and low grade cognitive dysfunction.  Younger women can experience missed periods and fail to achieve an easy pregnancy and are subject to harsher menstruation pain and bleeding. On physical exam, the doctor’s use of the reflex hammer will demonstrate a weakened Achille’s tendon reflex as well as an oral temperature measurement well below 98.6F.  A greater degree of swelling is seen in the more severe case with “myedema” present not just in the extremities but trunk and face.  Loss of eyebrow hair is not unusual.  Woman are more prone to experience episodes of breast soreness.  Hypothyroidism can be underlying depression even when other physical symptoms are not present.

     A patient experiencing a number of the aforementioned symptoms has a high likelihood of having hypothyroidism and the normal TSH should not rule out the diagnosis.  Other thyroid blood tests deserve to be tested including the “free” (unbound) T3 and free T4 as well thyroid antibody studies.  Although most phsicians do not offer urine testing of thyroid hormones, a 24-hour urine measurement sometimes reveals hypothyroidism when the blood test is normal.  If all tests come out normal but the symptoms and signs appear to fit the diagnosis of hypothyroidism, the doctor could treat with low-dose thyroid to determine if there would be symptomatic improvement.  Such treatment can be monitored with further testing.  

     Thyroid treatment need not be a prescription of synthetic thyroid hormones such as Synthroid (levothyroxine) and Cytomel (lio-thyronine).  Natural thyroid hormone replacement such as Naturethroid or Armour thyroid can be employed.  Additionally some patients respond well to the use of so-called “glandular” thyroid manufactured from animal thyroid glands but lacking hormone.  Additionally thyroid treatment may benefit from the use of amino acid treatment such as with tyrosine and phenylalanine.  The thyroid is also dependent on adequate iodine which may need supplementation.  Trace minerals including selenium, zinc, and copper supplementation may also be beneficial.  For sensitive patients homeopathic thyroid support may be necessary.