The Optimal Treatment for Hypothyroidism

Dr. Mark Starr shares his approach to treating an underactive thyroid

Mark Starr, MD
Mark Starr, MD

One of the leading experts on hormonal health, Mark Starr, MD, has shared his approach to optimal treatment for hypothyroidism. 

According to Mark Starr, MD, a board-certified pain specialist, the majority of patients he sees have mild to moderate adrenal deficiency, also known as adrenal insufficiency, that must be addressed before starting thyroid hormones. Adrenal insufficiency occurs when the adrenals do not produce enough of the hormones cortisol, aldosterone, or adrenocorticotropin (ACTH).

These hormones regulate many functions within the body including metabolism, stress, blood pressure, and maintaining the body's inflammatory response. There are two types of adrenal insufficiency – primary (also called Addison's disease) and secondary. Addison's disease is fairly rare, but secondary adrenal insufficiency is much more common. 

Treating Hypothyroidism and Adrenal Deficiency

Dr. Starr has found that proper treatment with iodine resolves many of the adrenal issues.

Dr. Starr always tests for autoimmune thyroiditis (TPO and thyroglobulin antibodies) during the first visit. Autoimmune thyroid problems are rapidly becoming epidemic. He has found that a majority of patients with antibodies do not tolerate iodine initially. He also uses different types of natural adrenal support products. Says Dr. Starr: "A few patients require low dose cortisol or prednisolone (adrenal steroids) to resolve their adrenal deficiency.

Those with antibodies also need compounded T4 and T3 synthetic thyroid. Desiccated thyroid is identical to our own thyroid (which the body is attacking) and causes the antibody levels to rise. These patients do not do well in the long run on desiccated thyroid."

According to Dr. Starr, Dr. Broda Barnes' long-term study of more than 2,000 patients over 30 years showed the adult dosage ranged from 2 to 5 grains of desiccated thyroid.

He also cites a study by the famous Dr. Jacques Hertoghe in the 1990s that included over 300 patients who were treated for about two years, and those patients requirements ranged from 2 to 5 grains. Says Dr. Starr: "My adult patients also need dosages in this range. Patients with prior heart attacks never should take more than 2 grains of thyroid. There are 38 mcg of T4 and 9 mcg of T3 per one grain of thyroid."

Dr. Starr reports that one patient he treated who had numerous symptoms was very disappointed when he told her she needed synthetic thyroid. Says Dr. Starr: "She asked if the goal of treatment was to be switched to desiccated thyroid. I told her the goal for all my patients is that they feel well. Optimal treatment means a resolution of hypothyroid symptoms."

Mark Starr, MD is author of "Type 2 Hypothyroidism" and founder of the 21st Century Medical practice in Paradise Valley, Arizona.


Email interview with Kent Holtorf, MD - December 2010