“Low iron and hypothyroidism may be significant contributors to ADHD”

Is your son unable to pay attention to details or easily distracted? Does he fidget and squirm, or seem hyperactive? Does your daughter have difficulty following through with instructions in school or at home? Perhaps she seems not to listen even when spoken to? Do you know an adult with these symptoms? These problems can occur in any healthy person, but they can also be symptoms of Attention Deficit/Hyperactivity Disorder (ADHD). If these problems become troubling enough, a doctor or teacher may recommend that your child (self, or spouse…) get medically evaluated and treated. Once the diagnosis of ADHD (previously known only as ADD, or Attention Deficit Disorder) is made, stimulant medications are usually prescribed to help the patient focus. While stimulant medications can aid in controlling symptoms, they have many potential side effects.

  According to WebMD.com, one of the most common stimulant medications for ADHD has the following potential side effects: loss of appetite, weight loss, dry mouth, stomach pain, nausea, vomiting, dizziness, headache, diarrhea, fever, agitation, mood swings, depression, abnormal thoughts, outbursts of words/sounds, chest pain, fainting, irregular heartbeat, seizures, extreme tiredness, blurred vision, slurred speech, confusion, and allergic reactions leading to rash, itching, swelling, and trouble breathing. Pretty scary.

  There are also “non-stimulating” drugs for ADHD, but they don’t appear to be much safer. WebMD.com’s list of side effects includes: vomiting, constipation, fatigue, dizziness, insomnia, mood changes, weight loss, fast or irregular heartbeat, fainting, heart attack, stroke and more.

  Fortunately, most children do not suffer severe side effects from ADHD medications. Some even do fairly well and are able to function better at home and school. But are these medicines the best way to treat ADHD? No one is certain, but sincerely I doubt it.

  I believe that the best way to address most medical conditions is to look for and treat the underlying causes of the problem. In the case of ADHD, I am certain that this condition is not caused by a deficiency of prescription drugs – stimulant or otherwise. According to MayoClinic.com, ADHD may be caused by several factors including: altered brain function; genetics; past exposure to environmental toxins, tobacco or drugs; or, food additives. Unfortunately, except for food additives, most of these potential causes are not reversible and these theories have not lead to new treatment breakthroughs.

  At the same time, we are ignoring two common and treatable medical conditions that may be significant contributors to ADHD: low iron and hypothyroidism (low thyroid). In fact, several recent studies have shown a strong correlation between low iron levels and ADHD. For example, researchers in India studying children with newly diagnosed ADHD concluded, “Serum ferritin (a measure of iron levels) was found to be significantly lower in children with ADHD.”

  Another study published in the Archives of Pediatric and Adolescent Medicine concluded, “…low iron stores contribute to ADHD and that ADHD children may benefit from iron supplementation…” Other studies have had similar findings, verifying a strong tendency for children with ADHD to have diminished iron levels. It appears very likely that low iron contributes to at least some cases of ADHD.

  Although evidence connecting ADHD to hypothyroidism is not as strong as that linking ADHD to low iron, it is still compelling. At first glance this connection may seem unlikely since low thyroid is well known to cause sluggishness and low energy. However, some of history’s top thyroid experts were able to see through this paradox and recognize that hypothyroidism can also cause hyperactivity. Back in 1915, the “father of endocrinology,” Eugene Hertoghe, MD, stated that in certain hypothyroid children, “there is an extreme turbulence, with (a tendency) to throw down and break everything” (The Practitioner Jan. 1915). Hertoghe’s “turbulence” certainly sounds like today’s hyperactivity. Dr. Borda Barnes, who had a Ph.D. in thyroid physiology as well as an MD, was even more explicit in describing what he called “paradoxical” effects of mild thyroid deficiencies on children. In his book, “Hypothyroidism: the Unsuspected Illness,” Barnes described two boys who were “hyperactive and restless” until their thyroid deficiencies were treated.

  Recent science has begun to corroborate the insights of these thyroid pioneers. In 2007, a study in The Journal of Clinical Endocrinology reported that low thyroid levels in blood tests were associated with ADHD symptoms. Even more recently, research published in the Journal of Affective Disorders found a connection between ADHD-related conditions and mild hypothyroidism. Based on medical history and emerging science, I believe that before giving potentially toxic medications to patients who show signs of ADHD, doctors should carefully screen them for iron deficiency and hypothyroidism. These conditions are common, important, and highly treatable and they may play a major role in ADHD. It is usually safer and more effective to treat the underlying causes of health problems instead of just treating the symptoms, so please make sure that your child or loved one with ADHD is carefully checked for low iron and hypothyroidism -- and treated when necessary.

Michael E. Doyle, MD is a Board Certified Family Physician whose practice combines conventional and alternative medicine, including nutrition and natural hormones. Dr. Doyle has a practice in Stamford and can be reached at 203.324.4747 or through his website at GoToDrDoyle.com.

References used in this article:
Archives of Pediatric & Adolescent Medicine 2004 Dec; 158(12):1113-5
Indian Pediatrics 2010 Nov 7;47(11):955-8. Epub 2010 Mar 15
Journal of Clinical Endicronology (Oxf) 2007. June:66(6):890-8
Journal of Affective Disorders 2010 Feb; 121(1-2):184-8. Epub 2009 Jun 28