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Fibromyalgia, Hypothyroidism,
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Dr. Lowe How to Prepare Patient-to-Patient Fibromyalgia Research Foundation
The Metabolic Treatment
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 Question: My doctor prescribed Armour Thyroid hoping it would work better than the Synthroid I had taken for years. Within a couple of weeks, my energy was up and I generally felt better. But I had to stop taking it because my skin itched all over. The itching started several days after I started taking the Armour. My doctor switched me back to Synthroid. The itching stopped, but within a couple of weeks, I was as miserable as I've always been on Synthroid. She switched me back to Armour, thinking that my itching had been coincidental, but the itching started again, so I'm now on Synthroid again and miserable again. Any advice? Dr. Lowe: Your experience in switching back and forth from Synthroid to Armour is consistent to my observations of many patients. They are miserable on Synthroid (or other brands of T4), but although they improve remarkably on Armour, they itch or have other allergic symptoms. I've confirmed that the itching and other symptoms on Armour are allergy-based by having the patients go through a simple test. I have them take 25 mg to 50 mg of Benadryl while still using Armour. If the itching or other symptoms stop within thirty-minutes to an hour, then most likely, the patient is having an allergic reaction, probably to some of the binders or fillers, such as cornstarch. Further confirmation that the itching is an allergic reaction comes from the patient beginning to itch again after the antihistamine effects of Benadryl to wear off. When patients have reported to me that they've had allergic reactions to Armour, I've recommended that they ask their prescribing clinicians to switch them to Nature-Throid. This product, produced and marketed by RLC Labs, is different from other prescription desiccated thyroid products. The difference is that it contains binding ingredients that are hypoallergenic, such as microcrystalline cellulose. Patients who have switched to Nature-Throid have maintained the benefits they got from switching from Synthroid to Armour, but in addition, they've freed themselves from their allergic reactions to Armour. April 4, 2009 Dr. Lowe: The product is available through the following website: http://www.thyroidscience.us/Ordering/howtoorder.htm. The website was set up to provide access to the product until it is more widely available. The study report your nurse practitioner read would have to be the one that was published little more than a week ago: http://www.thyroidscience.com/studies/lowe.2009/lowe.hsf.3.22.09.htm. The full text of the report is available free as a pdf. A prescription isn't necessary, but in using the product, I hope you'll work closely with your nurse practitioner. I wish you the best possible outcome from your use of Hypo Support Formula, or "HSF" as we refer to it.
October 15, 2008 Dr. Lowe: I’m sorry you have two hormonal disorders to deal with. Some symptoms of hypothyroidism overlap with some of diabetes. The overlap can confuse the patient and his or her clinician. It may not be clear at all which of the two conditions they need to address to relieve the patient’s symptoms. Sometimes, of course, they must address both conditions. You said your doctor just recently diagnosed your diabetes. Because of this, I assume your diabetes is uncontrolled. If so, you may have symptoms attributable to the diabetes. Despite that, some of your symptoms are most likely caused by under-treatment for your hypothyroidism. I say this because the 1 grain of Nature-Throid you’re taking is too low to provide optimal benefits to most hypothyroid patients. Endocrinologists long ago made the TSH the be-all-and-end-all for deciding hypothyroid patients’ thyroid hormone dosages. Before this costly mistake of the endocrinology specialty, patients used higher—and more effective—dosages of thyroid hormone. When they used desiccated thyroid, as you are, effective doses for most patients ranged from 2 grains up to 4 grains.[1][2] If you’re like most patients, then, your effective daily dose will be higher than the 1 grain you're now taking. That will also be your safe dose. I say this emphatically for one reason—it is not safe for clinicians to under-treat hypothyroid patients with thyroid hormone, as most conventional clinicians do nowadays. Of course, it’s important for you to control your diabetes. You hopefully have surviving insulin-secreting beta cells in your pancreas. If so, you stand a good chance of safely controlling your diabetes by avoiding anti-diabetic drugs. You can mostly likely do this through diet, exercise, and natural medicine treatments. (Comprehensive information on the natural medicine approach to diabetes is in the 3rd edition of the Textbook of Natural Medicine.[3] I highly recommend this book to all diabetic patients and clinicians who treat them.) It will serve you well to go all out in using these methods. If using them controls you diabetes, you can, as I said, avoid anti-diabetic drugs, all of which risk giving you other medical problems. In general with diabetes, the aim is to maintain a normal blood sugar curve. It’s especially important to control the height of your blood sugar rise after eating. This is important because the peak level, if too high, appears to be associate with the most damaging general effects of diabetes.[3] You should monitor your peak sugar levels with what must become (as my wife, Tammy, tells our diabetic patients) your new friend, a glucometer. If money is a concern, Walgreen’s TrueTrack glucometer kit is the least expensive on the market; using it and its test strips can save you a great deal of money. You'll also need to systematically monitor to find your effective dosage of Nature-Throid. At minimum, you should aim at four targets: (1) a basal body temperature between 97.8° and 98.2°F (36.56° and 36.78°C); (2) a basal heart rate in the 70s; (3) freedom from your hypothyroid symptoms and signs; and (4) a sense of well being. When I say “systematically monitor” in the above paragraph, I mean posting to line graphs at least two sets of measures: (1) your measurements of temperature and heart rate, and (2) the estimated intensity of your symptoms with “symptoms severity scales” twice each week. You can print free of charge both symptoms severity scales and line graphs from our page of evaluation forms; you should use the forms in set 3. (To learn about how to properly monitor, please read chapters 4.3 and 5.2 in The Metabolic Treatment of Fibromyalgia.[4]) With a high degree of probability, you can control both your hypothyroidism and your diabetes. To maximize your chances, I urge you to maintain an unyielding commitment to optimal health, insist on truly effective clinical care, and tweak your treatment at intervals based on systematic monitoring. I sincerely wish you the best. References
July 19, 2008 Here is what I am wondering. My ability to work is almost non-existent. I am having to put my head down on my desk at least every 20 minutes and am really struggling just to make it through the day. I know I am supposed to do the saliva tests, but I am extremely concerned that I’ll become worse while waiting for this process to take place. I am wondering if you’re willing to recommend that I immediately start the Cortef prescribed last week by the doctor who referred me to you for consulting? I believe doing a trial of Cortef [hydrocortisone] could be diagnostic in its own right, and I will then use saliva testing to regulate my dosing if I show improvement. Dr. Lowe: Regarding your suggestion that you begin to use Cortef based on your symptoms, your prescribing doctor is the clinician who must authorize you to do an empirical trial of the medication. Based on clinical experience, I don’t think you're likely to harm yourself by a short empirical trial of Cortef, even if you actually don’t need more cortisol or if you have an excess. However, in that my relationship with you is educational, I must point out an observation from my clinical practice. I have had several patients, all of whom had classic cortisol deficiency symptoms, who turned out to have high rather than low cortisol levels. We learned this as soon as we received their salivary cortisol test results. These patients immediately ceased taking cortisol, and some had to use cortisol-suppressing agents to produce a normal diurnal cortisol pattern. The brief cortisol trial did these patients no apparent harm. In principle, though, considering the outside likelihood of adverse effects, you may want to err on the side of caution. A patient who decides to try cortisol empirically before we receive her cortisol test results stands some chance, low as it might be, of inducing cushingoid symptoms, such as increased belly fat. Other cushingoid symptoms include mental and emotional lability. I know you’re suffering now, and I wouldn’t want you to worsen how you feel. Waiting for your cortisol test results is tough enough, but a risk in doing an empirical trial of Cortef—if you have high rather than low cortisol—is worsening any unpleasant mental and emotional effects you’re now suffering from. When a patient adds cortisol to an already high cortisol level, she risks inducing damage to hippocampal cells in the brain. This can cause a loss of short term memory. Excess cortisol can also suppress immune function, making the patient more susceptible to infections. And as I explain in The Metabolic Treatment of Fibromyalgia,[1,p.487] long-term excess cortisol levels can cause a loss of bone mineral density. Of course, I understand your sense of urgency. In view of the risks, you may be willing to take the gamble and use Cortef to see if it reduces or eliminates some of your troubling symptoms. If you decide to take the risk, however, you must have your prescribing doctor’s approval, as we must respect his province in this circumstance. If he and you decide to commence with a trial, I’ll be happy to help both of you decide how it affects you. May 6, 2008 Dr. Lowe: Your problem, as you described it, seems simple enough to me. Gynecological problems are legend among undertreated hypothyroid females. Common among the problems, as I described in the largest chapter in The Metabolic Treatment of Fibromyalgia,[1,p.509-571] is the cessation of periods (amenorrhea). Such problems make the sale of pharmaceutical drugs to control the symptoms of thyroid under-treatment highly profitable. It’s unfortunate when women are caught in this drug-marketing system. Too often, I regret to say, reproductive endocrinologists continue or worsen a woman’s problem by continuing her under-treatment with thyroid hormone. Most hypothyroid women with suspended periods—and even more often, those with profuse and prolonged bleeding—don’t need the specialized care of a reproductive endocrinologist; they simply need for their doctors to treat them effectively for their hypothyroidism. You said that you’re now taking 100 mcg of Synthroid. For most patients, that dosage is woefully too low. History shows that for some 95% of patients, safe and effective dosages of any brand of T4, such as Synthroid, range between 200 to 400 mcg.[2][1,p.986 & 859-898] Tragically, few conventional doctors allow their patients to use high-enough dosages of T4 (or any other thyroid hormone preparation) to be effective. And for many patients (up to 50% [3]), T4-replacement therapy is never effective. Research and vast clinical experience show that most of these patients are rescued by T4/T3 products or T3 alone, when their doctors let them use high enough dosages.But you have good reason to be hopeful. No one today has to settle for the incompetent care that conventional medicine offers most hypothyroid patients. You have options and only need to learn about and avail yourself of them. Some conventional doctors will tell you to stay away from the Internet in looking for solutions to your health problems. They have good reason to be defensive; as one Harvard Nobel Prize-winning physician wrote, a paltry 25% of patients are satisfied with the care they offer. [4] The Internet, however, is a treasure trove of effective alternatives to often failed conventional medicine. While filtering through Internet nonsense intelligently, I encourage you to use it lavishly.References 1. Lowe, J.C.; The Metabolic Treatment of Fibromyalgia. Boulder, 2000. 2. Pearce, C.J. and Himsworth, R.L.: Total and free thyroid hormone concentrations in patients receiving maintenance replacement treatment with thyroxine. Br. Med. J., 288: 693, 1984. 3. Saravanan, P., Chau, W.F., Roberts, N., et al.: Psychological well-being in patients on ‘adequate’ doses of L-thyroxine: results of a large, controlled community-based questionnaire study. Clin. Endocrinol. (Oxf.), 57(5):577-585, 2002. 4. Lown, B.: The Lost Art of Healing: Practicing Compassion in Medicine. New York, Ballantine Books, 1999. February
17, 2008 Dr. Lowe: I began working with patients who were hypothyroid in the late 1980s. To learn about the treatment of hypothyroid patients, I spent a lot of time talking with other doctors about thyroid hormone therapy. I soon learned that most doctors tenaciously held two beliefs that had been shrewdly planted in their minds by the corporation that marketed Synthroid. The beliefs were: (1) the potency of Synthroid tablets was perfectly reliable, and (2) the potency of the tablets or capsules of other products—especially Armour Thyroid—was highly unreliable. Based on these two beliefs, the doctors dogmatically pronounced that all hypothyroid patients should be treated with Synthroid. The doctors’ pronouncement was thoughtless parroting of a sound bite from the corporation’s marketing campaign—a campaign so effective that Synthroid eventually became the third most-prescribed drug in the U.S. In my view, the doctors who parroted the Synthroid marketing hype should feel shame; they allowed themselves to be duped by a sales campaign for a product that was—and still is!—no more reliable than any other thyroid hormone product. In previous publications, I have cited the FDA evidence for Synthroid’s lack of reliability. Of course, Synthroid isn’t the only thyroid hormone product with reliability problems. In my experience, no brand of thyroid hormone is especially reliable. By this, I mean that fairly often, patients find that the potency of the thyroid hormone products they’re taking is lower than the label states. In my experience, the reliability problem has been worse with products from compounding pharmacies, but the problem is also common for the products of large pharmaceutical companies. It appears to me, then, that all thyroid hormone products are highly vulnerable to influences that reduce their potency. Accordingly, no claim that a product has superior reliability is legitimate. If you’re new to the use of thyroid hormone, and you’re up to a dose that should be working for you, but you’re not benefiting from it, be sure to let your doctor and your pharmacist know. The dosage range that’s safe and effective for most patients is between 2-to-4 grains (120-to-240 mg) of desiccated thyroid. The equivalent dosage range for T4 is 200-to-400 mcg (0.2-to-0.4 mg). If you’re not improving within this dosage range, you may have thyroid hormone resistance, or the potency of the tablets or capsules you’re using may be lower than what’s stated on the label. If your thyroid hormone product was prescribed, the bottle containing the pills or capsules will have a batch number. Your pharmacist will probably replace your thyroid hormone tablets or capsules with others from another batch. If you’re using an over-the-counter product such as Nutri-Meds desiccated thyroid, the bottle won’t have a batch number, but you can ask the company to replace the capsules or tablets your currently using. If thyroid hormone has effectively relieved your hypothyroid or thyroid hormone resistance symptoms, but some of your symptoms have reappeared, you should consider whether the capsules or tablets your presently using have a lower-than-stated potency. You should let your doctor and pharmacist know the symptoms that have recurred. It will also help to have objective evidence, such as a decreased basal body temperature. Your doctor may find that your Achilles reflex that had become normal with thyroid hormone therapy has become slow again. And you may find that your basal temperature is decreased. If your TSH level was within the reference range, it may now be much higher now. Also, if your free T3 level was within the reference range, it may be much lower now. (This is a rare time during treatment when thyroid function testing can actually be of help.) Clearly, all thyroid hormone products occasionally have potency problems. Because of this, it’s important for patients to stay vigilant for signs that the potency of the capsules or tablets they’re taking isn’t consistent. February 5, 2008 My reason for this different protocol is simple: the TSH, free T3, and free T4 tell us only how the pituitary and thyroid glands are interacting. Of course, the test levels may also tell us something of the influence of thyroid hormone over the hypothalamus in its secretion of TRH, another hormone that influences the pituitary gland's secretion of TSH. Tissue measures of thyroid hormone tell us what is most important, that is, how the patient's tissues other than the pituitary and hypothalamus are responding to a particular dosage of thyroid hormone. To accomplish this objective, with long distance patients, I mainly use the basal body temperature, basal pulse rate, speed of the Achilles reflex, and the voltage of the electrocardiogram tracing. With patients who come in for comprehensive metabolic evaluations, I use these same physiological measures. But I also use indirect calorimetry to measure the patient's metabolic rate at rest, and I use bioelectrical impedance to learn the fat content, lean mass, and water content of his or her body. I also use a variety of biochemical measures, a history, the patient's current health status, and a physical exam. I use these to differentially diagnosis the most likely cause if the patient’s metabolic rate is abnormally low or high. The physiological measures enable me to determine a patient's metabolic status. If it's low, the measures help me to determine the likely cause, such as too little thyroid hormone regulation. If the patient is using thyroid hormone, the testing also enables me to specify how the dosage is impacting the patient's tissues. Unfortunately, the most widely used tests, the TSH, free T3, and the free T4, simply can't give us any meaningful information about that most important question that Dr. Barnes long ago asked—how is a particular thyroid hormone product and dosage affecting the patient's tissues? I hope this answers your question adequately. All best wishes. February 4, 2008 Toland then quotes economist J. Kenneth Gallbraith: “That a nation oppressed by economic fear would respond to Hitler as Americans did to FDR is not surprising.” Toland inserted, “Perhaps [Hitler] understood economics too little to know what he was doing.” Then he quotes Gallbraith again: “But in economics it is a great thing not to understand what causes you to insist on the right course.” Perhaps that’s true in economics. But I can’t agree that in medicine it’s a great thing not to understand why a clinician does the right thing and helps patients. I believe that Dr. Wilson failing to know why his therapy helps some patients is a not so great a thing. The T3 therapy he recommends does indeed help many patients. Based on his book,[4,p.17] however, he is mistaken about why the therapy helps them. For example, as I wrote in The Metabolic Treatment of Fibromyalgia,[2,pp.844-6] he claims that T3 increases body temperature, and the increased temperature activates enzymes that enable patients to get well. It’s true that in a research lab, raising the temperature of a petri dish may increase the activity of some enzymes in it. But inside the human body, the range of temperature changes is generally too small to markedly change the activity of enzymes. Dr. Wilson has it backward: T3 doesn’t Increase enzyme activity by raising the body temperature; instead, it’s the other way around: T3 increases gene transcription for enzymes (such as sodium-potassium-ATPase), and the resulting increased enzyme activity raises the body temperature. The enzymes do this by cleaving phosphates off ATP molecules. The cleaving releases the energy that was maintaining the phosphate bonds. About half the energy is used to fuel chemical reactions. The other half is released as body heat. This may seem trifling, and indeed, the issue of which comes first, increased temperature or enzyme activity, may only be an academic concern. But other issues I believe Dr. Wilson gets wrong have practical implications. For example, I don’t believe sustained-release T3 is the best use of T3. The reason? The longer T3 stays in the small intestine, the greater the chance that calcium and other agents in food will bind some of the T3. The binding will then carry the T3 out in the patient’s stool, reducing the amount that reaches his blood. Moreover, Dr. Wilson’s idea that the enzyme that converts T4 to T3 gets “stuck”[3,p.2] is entirely without scientific substantiation.[2,p.280] In fact, the relevant research literature shows this notion to be close to the outer realm of possibilities. Directing treatment at a “stuck” enzyme is to therapeutically shoot way off target. In contrast, treatment intelligently directed at a target that is truly instrumental in causing a patient’s symptoms is far more likely to benefit the patient. As may be with Hitler’s economic successes, Dr. Wilson’s treatment protocol enables some patients to get well, although I believe he doesn’t know why. Too of many of the mechanisms he proposes are refuted by the research literature. Therefore, I believe that what I wrote of the success of his treatment and the mechanisms by which it does so is consistent. Nonetheless, I appreciate you bringing the seeming inconsistency to my attention. Reference 1. Toland, J.: Adolt Hitler. NY, Ballantine Books, 1976. 2. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, McDowell Publishing Co., 2000. 3. Wilson’s Syndrome Patient Instruction Sheet. Publisher nor date designated. 4. Wilson, E.D.: Wilson’s Syndrome. Orlando, Cornerstone Publishing Co., 1991. January 2, 2008 After a large stress, however, I developed hypothyroid symptoms again. I increased by T3 to 70 mcg, but all that did was keep me awake and not relieve my symptoms. My doctor tested me and said that my TSH levels showed that I was hyperthyroid. Because of this, he lowered my dosage to 30 mcg of T3 and added 25 mcg of T4. I became severely ill on this and my health declined drastically over six months. My doctor refused to change the medication because now my TSH level was back to normal. On my own, I added two grains of Armour per day and improved very quickly. Under the care of another doctor, I’m now on 4 grains of Armour per day and 15 mg of hydrocortisone. I’m fairly stable on this combination, but my weight is a problem, and I’m concerned about it. When I was on 50 mcg of T3, my other symptoms (depression, anxiety, fatigue, muscle pain, hair falling out, poor concentration, insomnia) cleared up. My weight also fell back to normal, and I maintained the lower weight. But this time, after my episode of hypothyroidism, my weight hasn't come back down. This is troubling because I follow an excellent health program. I eat a perfect diet, take nutritional supplements, and I’ve done practically every healing regimen in the natural medicine world. I exercise very hard with weights and cardio—one hour in the morning four-to-five days a week. Then I do a very brisk walk for an hour most evenings. Despite this regimen, I’m in constant pain. And my weight has stayed higher than normal. I have a layer of fluidy, fatty, flabby, cellulite type of fat over my arms, belly, thighs, and butt. It doesn't seem to shift no matter how hard I exercise. Is it possible that I need more T3 to get rid of the pain and flab? I love your work. Thank you in anticipation of your reply. Dr. Lowe: I am sorry you’ve had the health problems you describe. Whenever I hear from a clinician such as you, I regret even more the confusion that reigns in the field of clinical thyroidology. You’re by far not the only clinician perplexed about how to use thyroid hormone effectively to alleviate problems such as your pain and fat. When you went through the severally stressful time you mentioned, you most likely needed to temporarily increase your cortisol dosage rather than your T3 dosage. And by increasing your T3 dosage, you may have worsened the cortisol deficiency induced by the stress. When the adrenal cortices are functioning well, stress causes them to substantially increase their secretion of cortisol. In my opinion, during stress, the person on physiologic cortisol therapy, as you’re on, should mimic what the adrenal cortices do during stress. The person should take more cortisol than during tranquil times. During the stressful time you experienced, it’s highly likely that your need for cortisol markedly increased. By increasing your T3 dosage, you may have sped up the clearance of cortisol through your liver. This would have decreased the cortisol available to your cells at a time when you needed much more than usual. You said that at this time, you again developed symptoms of hypothyroidism. It’s possible that the symptoms were actually those of a cortisol deficiency. That’s likely if the hypothyroid-like symptoms included fatigue, muscle weakness, lower tolerance of stress, and low blood pressure upon standing up. Armour works well when the patient takes a high-enough dosage. It’s possible, however, that you aren’t taking enough. On your dosage of 4 grains, you’re getting 36 mcg of T3. This is only 4 mcg less than when you felt well and stable on 50 mcg. However, the difference may be substantial for you as an individual. The problem I see in cases such as yours is a black hole of sorts: how much of the T4 in the Armour (152 mcg in the 4 grains) do you absorb and convert to T3? We don’t know. Some studies indicate that while we absorb almost 100% of T3, we absorb variable amounts of T4, for example 80% or 85%. But how much of it ends up converted to T3 and bound to T3-receptors is a mystery. Because we never know how much T4 is effectively used by one’s body, I believe that using T3 is preferable. The relationship between symptoms or symptom relief and the T3 dosage is far clearer than with T4. More T3 dosage might also reduce or relieve your pain by inhibiting substance P production, by repressing the preprotachykinin-A gene, which codes for both substance P and its receptor.[1,p.732] I hope, doctor, that you’re soon able to relieve your pain and lose your excess fat. I suspect that you can do so by raising your T3 dosage a small amount. Also, if you experience any prolonged or intense stress, I hope you’ll consider that temporarily increasing your cortisol dosage is the proper course of action. Reference December 10, 2007 Dr. Lowe: I talked with the publisher after I read your email yesterday. I was told that they’ve been shipping the newly printed and bound books for the last two weeks. If you’ll contact them, I’m sure they’ll get a copy to you quickly. I’m sorry the publisher ran out of copies and you couldn’t get one when you first ordered it. The publisher keeps a tight check on the available inventory of the book. They do so to avoid running out of copies before having the book printed and bound again. But I was told that at times, so many copies are ordered at once that it cleans out what seemed like an adequate inventory. Then they have to wait for new copies to be printed, bound, and shipped to the fulfillment center. Sorry you got caught in the middle of one of those episodes. I want to thank you for your letter; it gave me pause that has improved my state of mind, and I’m grateful. The pause your email gave me was for a specific reason. This past year has been especially difficult for me on a personal level and it has interfered with my ability to help those people who need help the most. As the year nears its end, though, your email reminds me that I have good reason to feel happy and fulfilled, no matter what the horrors of the last year. The Metabolic Treatment of Fibromyalgia, my magnum opus, has been enormously successful in improving understanding, and through that, enabling doctors to relieve more of their patients’ suffering. I have to say, however, that more patients than doctors have bought the book and helped themselves. I made the book an encyclopedic coverage of the fields of hypothyroidism and thyroid hormone resistance. In doing this, I used what we’ve called "fibromyalgia" as the main pattern of symptoms to illustrate vitally important points about thyroid-regulation of the body and mind. I pressed on for some ten years, working almost every waking hour, until the encyclopedic job was done. With the support of my editor, Jackie Yellin and her husband, Michael, I was able to complete this enormous task. Looking back, Jackie, Michael, and I don’t know how we finished the book, and in all honesty, we don’t believe we could do it again. Despite that, The Metabolic Treatment of Fibromyalgia now exists. And although we’ll eventually add addenda in a second volume, every word in the book is as valid as it was when McDowell Publishing Company published it in 2000. When I think of the good so many people say the book has done for them, the troubles of the last year dwarf into insignificance, and I feel that my goal of relieving as much human suffering as I can during my short time here has not been a frustrated commitment. Thousands of emails and letters of thanks from physicians and patients testify to the help the book has been. Moreover, when I think that Bjørn Johan Øverbye, MD, in Norway, was inspired by the book enough to spend a year doing research that turned out to confirm what he terms "The Lowe Thesis," I feel immense gratitude to him and great satisfaction with the book. I guess I’ve digressed a bit. To get back to your question, the book is now available for prompt shipping. I sincerely hope that for you, the book justifies your internist’s confidence in it. My sincerest thanks for your email and best wishes for your holidays. November 1, 2007 Dr. Lowe: I regret to say that I haven’t worked or communicated with any doctors in your area whom I can refer you to. I trust that there are some quality practitioners there, but I just haven’t yet had the opportunity to communicate with any. I think your best chances for finding a cooperative, scientifically-minded, up-to-date clinician is to go to the following website of the Functional Medicine Institute: http://www.functionalmedicine.org/resources/healthpractitioners.asp If you click on the "Find a FM Practitioner" link, you may locate a quality clinician in your area. Keep in mind that the clinician who’ll serve your needs best may be any one of the different types of physicians, an MD, DO, ND, or DC. Or the clinician may be a nurse practitioner, physician’s assistant, or another type of practitioner. The scope of practice of the different types of clinicians may differ somewhat, but what's most important is the functional medicine orientation. I spoke at the annual conference of the Functional Medicine Institute this part year. My wife, Tammy, and I had the privilege—and I sincerely consider to have been a privilege—of spending a lot of time talking with clinicians who are members of the Institute. I must say, I’ve never interacted with another group of clinicians with whom I was more impressed. They were truly inspiring. They were open-minded and eager to learn cutting-edge methods from scientific natural medicine. Of extreme importance to me, they were earnest and passionate about acquiring whatever new information they could use to help their patients get well. And in addition, I’ve never encountered a group of clinicians who, as a whole, had a more accurate understanding of rational clinical methods for treating hypothyroid and thyroid hormone resistance patients. I wish you the best for finding a functional medicine clinicians in your area. October 29, 2007 For years, I protested the reduced effectiveness of the technique. My protests, however, drew accusals that I was only jealous of the successful reputation of the younger surgeon. Few surgeons and other physicians cared about the true basis of my protests. After several years, I stopped protesting and watched him build a name for himself based on his alteration of my technique. I expect that like I, you have taken barbs for speaking out and protesting. By making the truth known, however, you may avoid some bitterness I have had since my former resident’s degradation of my technique. Knowing this first hand, I sympathize with the protest you wrote, and again, I admire you for speaking out. Dr. Lowe: Thank you for your sympathy over this issue. In turn, I empathize with your feelings from your experience with your former resident. What’s most unfortunate, of course, is that your surgical technique, revised for your former resident’s personal gain, may help patients less than the technique you originally formulated. To me, that’s not jealousy; it’s a matter of humane concern for the patients for whom you developed the surgical technique. I suppose the outrage you and I have felt is a price some doctors pay for our pro bono contributions to humanity. Other innovative doctors go about it another way: they patent the procedures they develop and then sell them to other clinicians through binding contracts. One could say that these other doctors are wiser than you and I. Maybe that’s true: the patents they take out and contracts they make may protect the integrity of the procedures they develop and thereby ensure that patients gain from the procedures as they were originally developed. However, if I had to once again originate and develop metabolic rehab, I would do it the same as before—widely publish how it’s properly done and encourage as many doctors and patients as possible to use it. I created the protocol to help relieve as much human suffering as possible. Because of this, widespread use of the protocol is more important. This is far more important to me than contractually keeping another clinician from misrepresenting it, as contracts might limit the clinicians who’d use the protocol. Instead of contracts, I’ll use my freedom of speech and continue to speak out to protect the protocol’s integrity and to promote its use. Again, thank you for your sympathetic letter. And please accept my condolences for the misrepresentation of your surgical technique. October 22, 2007 Dr. Lowe: If your doctor is concerned about you taking too much T3 for you and being overstimulated, I suggest that you ask her to prescribe a small quantity of propranolol tablets, as a safety net. Propranolol is a general beta-blocker, and usually, 20-to-30 minutes after swallowing it, overstimulation of tissues stops.[1,p.766] This is true whether T3 or T4 causes the overstimulation. The relief from a single dose of propranolol, in my experience, may last from two-to-eight hour. Of course, patients who have asthma should not use beta-blockers. For them, it’s usually better just to wait for the overstimulation to subside. Just waiting works fairly quickly if the patient gradually reduces his or her dose of T3,[2,p.394-395] starting with the next dose. After decreasing the dose, abnormally fast metabolism from T3 usually decreases within 1-to-2 days. From taking T4, however, metabolism may slow only after 10-to-14 days. As I wrote in The Metabolic Treatment of Fibromyalgia,[3,p.1022] excessively rapid metabolism slows down even faster than 1-to-2 days in some patients when they reduce their T3 dosages. I’ve read reports of different times for the offset of symptoms of overstimulation after patients stopped T3 or reduce their dosages. The reports are consistent with my clinical experiences. Tittle, for example, wrote that when his patients had adverse reactions to T3, the reactions disappeared within several days after the patients lowered their dosages of T3 or stopped it altogether.[4,p.273] In contrast, Wiener and Lindeboom reported that they gave a patient a dose of 300 mcg of T3 each day for two weeks. They wrote, "The patient grew restless and nervous, her eyes gleamed, and she complained of headache, cold perspiration, and palpitation. Her pulse rate was 120." Her symptoms of overdosage disappeared, they wrote, in the course of the same day when they reduced her dosage to 150 mcg (50 mcg three times per day).[5] I, too, have seen this rapid offset of overstimulation, although for most of my patients, relief has taken a day or two. Finding each patient’s safe and effective dosage of thyroid hormone is an individual matter. The same is true for the offset of overstimulation when a patient takes too much thyroid hormone. This means, of course, that clinicians must consider each patient as an individual who may not respond as most other patients do. Statistical measures for such matters should serve only as rough guides that may not apply to many patients. I hope this is helpful to you and your doctor. References October 7, 2007 Dr. Lowe: With due respects to your doctor, the evidence is conclusively against what he believes about T4 and T3. His belief is a version of the false belief that T4 but not T3 crosses the blood-brain barrier into the brain. I rank this belief as one the most common false beliefs in modern medicine about thyroid hormone. As best I can determine, the belief derives from researchers who conducted two relatively crude rat studies in the 1950s. From those studies, the researchers reached the unfortunate false conclusion. And, like circulating gossip in some small towns, the falsehood penetrates and lodges in the belief systems of doctors, and it stays there with the resistance to destruction of prions. I’ve explained this matter in detail on drlowe.com where I wrote: "This false belief is virtually an indelible stain in the memory of patients and physicians, and to clear it away, I think we’ll have to scrub long and loud with the solvent of truth." I encourage you to read the short piece and share it with your doctor. To sum up, T3 does cross the blood-brain barrier and enters the brain. It does this by binding to the same transport protein (transthyretin) that carries T4 across the barrier. T4 binds more readily to the thyroid hormone receptors within that protein, but T3 nonetheless grabs hold of the protein and, along with T4, rides it into the brain. August 19, 2007B Dr. Lowe: I’m sorry you feel at a loss, but I really don’t think you have reason for concern. I say this because your TSH and thyroid hormone levels are what we expect in most people when they severely restrict their calorie intake. Based on the relevant studies, these altered levels will reverse back to their usual levels, even if you continue to restrict your calorie intake. You wrote that your TSH was out of range, and your T4 and T3 levels were in range. However, it’s important to note that your T4 was in the upper end of its range, and your T3 was in the lower end of its range. If your levels weren’t the same before your began dieting, then the answer to your question about thyroxine is yes: weight loss through calorie restriction can alter your thyroxine level, but also your TSH and T3 level. If calorie restriction is severe enough, the T4 level usually goes up, often into the upper end of the range, where yours is. Our understanding of what happens to our hormone levels during calorie restriction comes partly from studies of anorexic patients.[1] When humans, including those with anorexia, lose substantial weight quickly, the person is stressed, and this causes her cortisol level to rise. When the cortisol level rises far enough, the cortisol suppresses the thyroid system. It suppress the system in two ways: First, the cortisol inhibits TSH secretion, lowering the TSH level; second, the cortisol inhibits the enzyme that converts T4 to T3, raising the T4 level and lowing the T3 level. Your TSH and thyroid hormone levels exactly fit this high-cortisol-induced pattern: a lower TSH, a higher T4, and lower T3 level. Again, I caution you not to fret over this lab pattern. If your cortisol level is high and suppressing your thyroid system, the suppression is transient. When your cortisol level comes down, then your TSH and thyroid hormone levels will return to their usual levels. This usually takes 1-to-3 weeks.[3][4][5] [3][4][5] Keep in mind, however: if your dieting-raised cortisol level remains high for some reason, your thyroid system will most likely escape from the cortisol suppression. The same is true for the patient who is taking cortisol analog drugs such as prednisone and prednisolone for a prolonged time: her thyroid system is almost certain to escape the suppression within weeks. This well-documented escape of the thyroid system is something Dr. Dennis Wilson apparently wasn’t aware of when he formulated and disseminated one of his beliefs. That belief is that high cortisol causes the enzyme that converts T4 to T3 to get "stuck" in some people. When it sticks, and the people then generate too little T3 from T4, they develop symptoms of too little thyroid hormone regulation. Wilson crowned these symptoms "Wilson’s syndrome." (I discuss this matter at length in the section titled "Reverse-T3 (rT3)" on pages 806 and 807 of The Metabolic Treatment of Fibromyalgia. [2])As I said, you don’t have to be concerned about this enzyme becoming stuck in you. My friend and colleague Richard Garrison, MD, and I looked long and hard for lab evidence that Wilson’s theory of a stuck enzyme was right. After a year or so of laboratory testing of patients, we failed to find evidence that Wilson was right. I know that losing weight is tough for many people, and want you to know that I admire you for going through the process of losing the 11 lbs. I hope that what I’ve written here will give you an understanding why your TSH and thyroid hormone levels are as they are. From that, I hope you’ll continue on with your weight lose program without worry over these temporarily altered levels. References 2. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, 2000. 3. Nicoloff, J.T., Fisher, D.A., and Appleman, M.D.: The role of glucocorticoids in the regulation of thyroid function in man. J. Clin. Invest., 49:1922, 1970. 4. Alford, F.P., Baker, H.W.G., Burger, H.G., et al.: Temporal patterns of integrated plasma hormone levels during sleep and wakefulness. I. Thyroid-stimulating hormone, growth hormone and cortisol. J. Clin. Endocrinol. Metab., 37:841, 1973. 5. Brabant, A., Brabant, G., Schuermeyer, T., et al.: The role of glucocorticoids in the regulation of thyrotropin. Acta Endocrinol. (Copenh), 121:95, 1989. August 19, 2007 Dr. Lowe: I care a great deal about other people’s privacy, and I avoid any potentially embarrassing disclosure of information people send to me at AskDrLowe@drlowe.com. For the reason I give below, your upset is not warranted, and I hope you calm down after reading it. When I wake up from sleep (usually in the early morning hours, and then again after a nap before my clinic duties start), my first action is usually to turn on my computer. Then I go online to read the new emails at AskDrLowe@drlowe.com, where I found yours. Some days I see only a few new emails, and others days I find upwards toward a hundred. Among the new emails, I first look for ones that suggest the writers may be suicidal. I answer those first. I give their questions top priority because I feel that it’s imperative to quickly give them any hope or practical help I can. Next, I look for another category of emails: those that contain virtually the same question as several other emails I’ve read that morning—or, sometimes, many other emails I’ve received over the last month or so. Some days, five, ten, or more emails contain practically the same question, often word-for-word. I give the question in these emails second priority. I do this because I assume answering multiple emails containing the same question gives me the chance to do something important: save time writing different versions of the same answer, and, through a single answer, help more than one person at once. When I answer these multiple emails on AskDrLowe@drlowe.com, I don’t, of course, post all the people’s emails along with my answer. As I said, the authors of the emails ask basically the same question. It would be repetitious to my readers to read all the emails. To answer the question the writers have asked, I often select one of the emails—the one that most clearly expresses the question all have asked. Sometimes I post the author’s email exactly as he or she wrote it. But most of the time, I edit the question (as little as possible) for two reasons: to make it concise, and to make sure it clearly expresses the specific concern of all the writers. On the day I opened and read your question, I’d received several others that asked basically the same question. That question in the other emails could have been written by you almost verbatim. As it happened, however, I did not use your email as the one to edit and answer. You seem to feel that you and your health problem are widely known by the general public—so much so that describing the problem is, to you, certain to reveal your identity, and, as a result, we’re all sure to see your picture on the front page of the Inquirer as we stand in line at supermarket checkout counters. Of course, you may be Brad Pitt or Bill Clinton. If so, please understand that scores of thousands of others share exactly the health problem you have. That assures your anonymity. This is especially true in that I didn’t publish your name in the Q&A, and the question in the Q&A isn’t in your rather distinct writing style. I regret your upset, but this matter is really nothing for you to be upset about. August 18, 2007 Dr. Lowe: We do measure the resting metabolic rates of children, just as we do adults. However, there is an important difference in calculating the metabolic rates of children and adults. In calculating a child’s metabolic rate, I use equations that are different from those for adults. Fortunately, through the 20th century, researchers developed equations that are appropriate to different age groups. Because of this, when we measure the metabolic rate of a child, I use the equations that are appropriate for the child’s age group. Otherwise, if I used equations appropriate for adults, I would reach a wrong conclusion about the child’s metabolic rate. For quality metabolic testing, then, age-specific equations are essential. It took me several years to accumulate the different equations scattered through many journals, some of them published in languages other than the only one I speak, English. But I do have them to use, depending on the age of a child. By the way, you wrote, "I know that you’ve proven that fibromyalgia is really hypothyroidism." My specific conclusion is, "too little thyroid hormone regulation is the main underlying mechanism of most patients’ fibromyalgia." I have a special reason for this specific statement. That is, most doctors think of hypothyroidism as a thyroid hormone deficiency; however, the cause of many patients’ fibromyalgia is not a thyroid hormone deficiency, but is instead peripheral resistance to thyroid hormone. So, I usually state that most patients’ fibromyalgia is underlain by either a thyroid hormone deficiency, or thyroid hormone resistance. However, you can use the terminology of my friend and research colleague Richard Garrison, MD that he used in my book The Metabolic Treatment of Fibromyalgia. [1,pp.322-323] Accordingly, by analogy to diabetes: a thyroid hormone deficiency is "type I hypothyroidism"; and thyroid hormone resistance is "type II hypothyroidism." Using his terminology, your statement is correct: most patients’ fibromyalgia is underlain by hypothyroidism—a disorder for which the TSH is not a valid or reliable test.Reference August 4, 2007 Dr. Lowe: With the little information you gave, I can only answer you in general terms about the two disorders you mentioned—fibromyalgia and thyroid hormone resistance. Feel free to give my answer to your question to both your medical and your chiropractic doctors. Hopefully my answer will clarify for them—and you—that what one of them calls "fibromyalgia" can be exactly the same as what the other calls "thyroid hormone resistance." First, though, let me say that I’m sincerely sorry you’ve been suffering. I’m especially sorry that your suffering is complicated by confusion over what disorder underlies your symptoms, and what to do to alleviate it. My research shows that what we call "fibromyalgia" is, for the most part, several signs and symptoms caused mainly by too little thyroid hormone regulation. The inadequate thyroid regulation may result from a thyroid gland disorder that causes it to produce too little thyroid hormone. We call this disorder "primary hypothyroidism." On the other hand, your symptoms may result from a failure of your hypothalamus or pituitary gland (two structures in your brain) to properly regulate your thyroid gland. When improperly regulated, the gland can produce less than optimal amounts of thyroid hormone. This disorder is called "central hypothyroidism." Then again, your fibromyalgia symptoms may result from what we classify as peripheral thyroid hormone resistance. (I’ve championed the diagnosis and treatment of peripheral thyroid hormone resistance for some twenty years. Because of this, I possibly have more experience treating this particular disorder than anyone else.) TSH, free T4, and free T3 levels are "normal" when a patient has this particular form (the peripheral form) of thyroid hormone resistance. As a result, the TSH, free T4, and free T3 levels are completely useless for distinguishing which patients have or don’t have peripheral thyroid hormone resistance. Many doctor and patients are confused about why the TSH, free T4, and free T3 levels are normal in peripheral resistance patients. However, we understand clearly why these blood hormone levels are useless when it come to diagnosing or treating peripheral thyroid hormone resistance. The reason is that in this disorder, the pituitary gland responds normally to thyroid hormone. When the thyroid hormone level rises, the TSH goes down, and when the thyroid hormone level goes down, up goes the TSH. This relationship, of course, is the normal interaction of the pituitary and thyroid glands. But in patients with peripheral resistance, tissues other than the pituitary gland respond sluggishly to the normal levels of free T4, and free T3. Because of these peripheral tissues’ sluggish response, "normal" amounts of free T4 and free T3 are too little properly regulate the metabolism of the tissues; patients must have larger amounts of T4 and T3 to keep the metabolism of most peripheral tissues normal and the afflicted patients free from symptoms. Without larger amounts of the hormones, patients suffer symptoms associated with deficient regulation of the tissues by thyroid hormone—just as if they had a thyroid hormone deficiency. For millions of patients, thyroid hormone under-regulation of tissues other than the pituitary gland causes classic (and historically-documented) symptoms of characteristic of hypothyroidism. The symptoms, for the most part, are the same as those of fibromyalgia: chronic pain and abnormal tenderness, stiffness, fatigue, cold intolerance, dry skin, hair loss, depression, poor memory and concentration, and exercise intolerance. Doctors, such as your medical doctor, typically diagnose patients with these symptoms as having "fibromyalgia." The doctors simply fail to understand that for these patients, so-called "normal" amounts of T4 and T3 are woefully inadequate to maintain normal metabolism and health. So, if you and your medical and chiropractic physicians differ on what to call your condition, both may be right: by current convention among doctors, the term "fibromyalgia" is appropriate. But the underlying mechanism, and the real disorder from which you suffer may be "thyroid hormone resistance." Where both your doctors may be wrong is in believing that the two labels refer to two different disorders. For many patients, the two labels are simply different names for exactly them same condition. If you do have peripheral thyroid hormone resistance, the treatment for it is pretty straightforward. For almost all patients, effective thyroid hormone treatment involves the use of the thyroid hormone T3 (the plain, non-sustained-release form). Your medical doctor can prescribe this. However, to function normally, resistant peripheral tissues must be exposed to higher than so-called "normal" amounts of thyroid hormone. Although these "supraphysiologic" doses of thyroid hormone usually free patients from their symptoms, they also suppress patients’ TSH levels. This bothers most doctors because the endocrinology specialty has misled them into thinking that TSH suppression is harmful. Nonetheless, for these patients, no TSH suppression means no improvement or recovery. However, I strongly recommend that you stay under the care of your chiropractic physician. As epidemiological studies have shown, her care (along with massage therapy) is likely to give you palliative improvement of your symptoms until you undergo appropriate metabolic treatment. If you do have thyroid hormone resistance but can’t get a decisive diagnosis and proper treatment in your home town, we’ll be happy to evaluate you at our clinic and research center. Or, if your local doctors will be cooperative, we may be able to guide you long distance to improvement or recovery. Either way, give Tammy at 603-391-6061. I hope this answer at least mitigates your confusion to some degree, and that of your doctors as well. Best of luck for a quick recovery from your symptoms, no matter what you choose to call the underlying cause.
July 26, 2007 Dr. Lowe: It may be true that your inability to become pregnant over the last three years is due to some microbial infection, such as a low-grade, chronic viral infection. Even so, microbial disruption of body functions (maybe fertility included) often results from too little thyroid hormone regulation of the immune system. (I extensively cover the research evidence for this in Chapter 3.13 of The Metabolic Treatment of Fibromyalgia). Many patients free themselves from chronic or recurrent infections by switching from T4-replacement (usually with Synthroid in the US and Canada) and using more effective products such Armour. I’ve been involved with thyroid hormone therapy for the last twenty years. During those years, many times, women patients of mine have became pregnant after switching from T4-replacement to Armour or similar products. Of course, they had to use doses high enough to be effective, not the namby-pamby doses that doctors typically allow their patients to use. Perhaps for some of these women, fertility came about from enhanced immune function from the more effective thyroid hormone therapy. The 2 grains of Armour you’re taking may seem high to some doctors. However, this wasn’t the case going back some forty years or so ago. Before then, doctors allowed patients to use higher dosages. The dosage range that was safe and effective was generally 2 to 4 grains. As you can see from this, you’re at the lower end of the historic safe and effective dosage range. In view of this, you may recover strong immune function and fertility simply by gradually and cautiously increasing your dosage of Armour. This may work for you by enhancing your immune system and relieving and infection. On the other hand, it may work simply by better regulating your sex hormone system. For your purposes, it probably doesn’t matter. Whether your TSH is suppressed or not is, in my opinion, irrelevant; I know of no scientific evidence that a suppressed TSH level will adversely affect you in any way.
July 1, 2007 Dr. Lowe: I’m sorry about your weight gain and hair loss, and that you’ve developed vitiligo. (For readers who aren’t familiar with vitiligo, it’s a skin condition. It's pronounced vit" l i’ go, with the last i pronounced as in ice. The patient has smooth, white skin patches on various parts of his or her body. The skin turns white because it loses its natural coloring pigment.) I get inquiries about vitiligo and thyroid disease fairly often, so your concern is shared by some other readers of drlowe.com. Vitiligo is not associated with a thyroid hormone deficiency per se; instead, it’s associated with autoimmune disease of the thyroid gland. Researchers think vitiligo is itself an autoimmune disease—one that in many people is associated with autoimmune thyroid disease. [1][2]Your history of thyroid gland disease, weight gain, hair loss, and vitiligo raises the possibility that you now have anti-thyroid antibodies. I think this is more likely than another thyroid gland tumor having formed. Your doctor, of course, should rule out that possibility. But I think autoimmune thyroid disease is far more likely, and I strongly recommend that your doctor measure your thyroid antibody levels. If you have high antibody levels, you may have become hypothyroid. If so, you may have gained weight and lost hair from your thyroid hormone deficiency. And, your vitiligo may have developed as an autoimmune skin process associated with your autoimmune thyroid disease. Please let me know when you learn whether your thyroid antibodies are high. Best of luck. References 2. Niepomniszcze, H. and Amad, R.H.: Skin disorders and thyroid diseases. J. Endocrinol. Invest., 24(8):628-638, 2001.
June 11, 2007 My question is this: Is it possible that my labs indicate high levels of thyroid hormone but I’m really not getting enough? Dr. Lowe: The answer is a resounding yes! I’ll soon publish a formal study I conducted that bears directly on your question. The study indicates something tragic: Most often, when doctors decide to increase or decrease patients’ dosages of thyroid hormone on the basis of their TSH levels, the doctors make the wrong decisions. Those wrong decisions may well make patients’ symptoms worse. In some cases such as yours, the wrong decisions will disable people from being able to work. Those doctors, then, not only harm their own patients; they also impose unnecessary, burdensome costs on industry and society at large. Because of this problem, the TSH, in my opinion, is a scourge of modern society. In it’s time, the black plague ruined, disabled, and shortened the lives of millions of people in Europe. Now, studies are showing how doctors are harming patients by relying on their TSH levels. (See my Guttler critique and my critique of T4 vs T4/T3 studies.) When the story fully unfolds, the evidence will show something horrific: that doctors’ reliance on TSH levels has been as devastating to humanity as the black plague was. What you need, as do all hypothyroid patients, is accurate gauges of whether or not you’re taking enough thyroid hormone. It’s extremely important to your health that you learn that in general, the TSH is not an accurate gauge. You need to assess as accurately as possible how your tissues are responding to a particular dosage of thyroid hormone. You must do this through systematic monitoring. You should regularly monitor and record the intensities of your symptoms. And you should do the same with physiological measures, such as your basal body temperature and the voltage of your EKG. These types of meaningful measures will most likely help you find your optimal (safe and effective) dosage of thyroid hormone within a fairly short time. Unfortunately, your TSH levels are unlikely to ever enable you to do this.
April 26, 2007 Dr. Lowe: No, he didn't just have them take their temperatures. I’ve had the privilege of having patients who, decades ago, had also been patients of Dr. Barnes. They and I talked at great length about how he assessed and treated them. Of course, he did use their basal body temperatures. But, according to these patients, their temperatures weren’t the only measures by which he decided whether they needed thyroid hormone and how much they needed. He also physically examined them, tested their Achilles reflexes, and assessed their symptoms. In addition, he looked for other evidence of low thyroid, such as high cholesterol. As a diagnostician, then, he seems to have been as holistic as a doctor could be back then; he appears to have considered all available indicators of hypothyroidism. No matter what he did or didn’t do, there is a subset of hypothyroid patients for whom the basal body temperature is not a useful gauge of how tissues are responding to thyroid hormone. These people's temperatures don't increase even when they are overstimulated by thyroid hormone. I’ve seen these patients become fully free from symptoms and their metabolic rates become completely normal, yet their temperatures remain abnormally low. I’ve seen the same with some thyroid hormone resistance patients. I’m one of them. For many years, I’ve taken my optimal dosage of T3, 150 mcg. On this dosage, I no longer have symptoms of thyroid hormone resistance. Those symptoms were mostly mild body aches; treatment-resistant trigger points; poor memory and concentration; and intermittent, severe depression. My latest basal metabolic rate (taken when I woke up from a night’s sleep) was +6%. That means that my metabolic rate was 6% above the calculated normal for me. This is within the 10% plus and minus range that we consider normal. Yet, through all these better years for me, my underarm basal body temperature has remained between 96.7 and 97.2 degrees F. (Dr. Barnes defined the normal basal temperature as 97.8-to-98.2 degrees F.) The reason some patients’ temperatures remain low is what I call "differential tissue sensitivity to thyroid hormone." I came to this conclusion from many discussions with molecular biologists who do thyroid hormone research. In patients whose temperatures stay low, the temperature-raising enzymes whose gene transcription is increased by thyroid hormone (such as sodium-potassium-ATPase) are apparently partly or wholly exempt from regulation by thyroid hormone. Because of this, the patients’ body temperatures simply aren’t a useful gauge. They must use other physiological measures to assess their tissue responses to a particular dosage of thyroid hormone. What we do at The Lowe Clinic and Research Center is basically, although more extensively, what Dr. Barnes did: use all available relevant indicators of hypothyroidism. Of course, we also use indicators of thyroid hormone resistance. We have more technological methods today, and we make full use of these. As a research center, we’re studying how useful these methods are and how they can help us to help patients recover as fast as possible. I believe other doctors caring for thyroid patients should also use multiple assessment methods for three reasons: (1) one or more measures, such as the basal temperature, may not be useful for an individual patient; (2) the more measures that point to hypothyroidism or thyroid hormone resistance, the more confident we can be in the diagnosis; and (3) from multiple abnormal measures, the doctor may learn the type of thyroid hormone product the patient needs. Of course, during our comprehensive metabolic evaluations, we sometimes identify causes of low metabolism other than too little thyroid hormone regulation. When we do, I tailor an individualized treatment regimen for the patient. Our full evaluations are comprehensive; they include not only the basal body temperature but every other relevant measure available to us today. Because of this, we’re usually able to learn whether a patient is hypometabolic, how low his or her metabolism is, and the most likely cause of the low metabolism. During this process, we find which measures of tissue response to thyroid hormone (and other treatments) will be most useful for the patient and the treating doctor. By providing this information to the doctor and patient, we enable them to systematically judge how the patient’s tissues respond to treatment. In short, what we’re doing is building on the groundbreaking work of Dr. Broda Barnes. And we’re using every tool we can to carry that work to the highest possible level in the service of our patients.
April 22, 2007 Dr. Lowe: First let me say that what you experienced is fairly common. Many patients react to low-dose T4-replacement as you did—badly—regardless of the brand of T4. There are two potential sources I know of for people feeling awful when they are on T4-replacement. One source is the extremely low dosage that doctors typically prescribe nowadays. A low dose of T4 can effectively reduce TSH secretion. The lower TSH can in turn lower the thyroid gland’s output of thyroid hormone. At the same time, low-dose T4 may not compensate for the thyroid gland’s reduced output of thyroid hormone. The patient then has too little thyroid hormone to properly regulate the metabolism of most of her body’s tissues. She then ends up with abnormally low metabolism and troubling hypothyroid symptoms. I’ve written about this before on drlowe.com. The second possible reason for your bad reaction to Synthroid is that T4-replacement simply won’t work for you. It doesn’t work for many hypothyroid patients. In a recent study in the United Kingdom, for example, T4-replacement left 50% of patient suffering from hypothyroid symptoms ( Saravanan, P., Chau, W.F., Roberts, N., et al.: Psychological well-being in patients on ‘adequate doses of L-thyroxine: results of a large, controlled community-based questionnaire study. Clin. Endocrinol. (Oxf.), 57(5):577-585, 2002.) Unfortunately, through faulty reasoning, these researchers concluded that a much smaller percentage of patients suffered from symptoms despite being on T4-replacement. They are mistaken about the percentage. The evidence is overwhelming that T4-replacement is the lousiest approach to thyroid hormone therapy. I’ve documented the widespread failures of the approach in two critiques:
http://www.drlowe.com/frf/guttler/intro.htm Odds are, if you cooperate with your doctor and try T4-replacement again, you’ll waste time trying to get well. Moreover, you’ll most likely react badly again. T4-Replacement forsakes many patients. But most patients recover quickly with T4/T3 products such as Armour Thyroid, Westhroid, and Naturthroid, and with T3 alone—as long as the patients use high enough doses of the products. If your doctor will cooperate and treat you with one of these products and ignore your TSH level, you’re not likely to have another bad reaction to thyroid hormone therapy. Instead, other factors held constant, you can, I believe, expect a highly positive treatment outcome.
April 21, 2007 Dr. Lowe: First let me say that unlike many doctors, I have no vested financial interest whatever in any nutritional product. Nor do I resort to the ploy that I donate royalties from supplements to charity. I don’t sell them or profit from them financially in any way. That issue aside, I’d like to address an issue that could make all the difference in you being relatively healthy and youthful throughout your life. Many patients have told me they felt much better after they started taking nutritional supplements. I even know of a few people whose fibromyalgia and other hypothyroid-like symptoms ceased after they started taking supplements. Conversely, many people who begin taking supplement for the first time see no dramatic benefits over night. That seems true for you. That being the case, rather than you abandoning supplements, I encourage you to consider the subtle benefits of taking them. Take, for example, the reduction of free radicals in your body. These are atoms or molecules that have unpaired electrons in their outer shells. These unpaired electrons make the atoms or molecules extremely reactive. They are so reactive that they set off rapid chain reactions. These destabilize other molecules and produce many more free radicals. Antioxidants available in supplements deactivate free radicals. Anti-aging experts have long argued that free radicals are the main agents of aging. Reduce your body’s free radical content, they argue, and you’ll age more slowly and maintain a more youthful appearance, even into old age. I had the opportunity to witness a case in point when I was in chiropractic college. Once a month, I attended a meeting of a health organization in Los Angeles. Another often attendee was the beautiful silent-movie actress Gloria Swanson. She was an avid health enthusiast. So was her last husband, William Duffy. He wrote the famous book Sugar Blues, a vade mecum of John Lennon and other anti-sugar advocates. One author wrote, "Gloria was insane about the use of sugar. I mean she would go ballistic if someone used it around her. She claimed that America lost the Vietnam War because of sugar." Gloria was seventy-five-years-old then, but she was youthful and beautiful enough to hold the attention of most of the men at the meetings—despite the presence of much younger attractive women. Had any of us guys had the chance to leave the meeting with one of the women, it would’ve been Gloria. Nutrients such as vitamin C reduce free radicals in our bodies. But while they are doing this, no flashing neon gauge pops into the forefront of our minds with a needle telling us how low our free radicals have dropped. We have no immediately perceptual gauge that lets us how much we’ve benefited. But despite that, benefited we indeed have. What I recommend is that you study credible nutritional literature and come to understand the subtle ways that various supplements can help you over the long haul. You can get high-quality supplements for a modest price, and ingest them quickly each day. The price and time are well worth many the subtle benefits you’re likely to get from them over the years. For example, you may avoid dying of heart disease, and you may stave off cancer. And, at seventy or eighty years old, you may well turn young men’s heads the way Gloria Swanson did mine.
March 9, 2007 Dr. Lowe: I understand your doctor’s concern for what he calls "academic proof." He seems to be oriented toward what we call "evidence-based medicine." I, too, am oriented that way, so I appreciate what he’s asking for. What I first recommend is that you download and print (doing so is free) the two studies I completed and published late last year. These studies provided the final pieces of the puzzle we call "fibromyalgia." The two studies alone should convince your doctor of the scientific credibility of my main argument about fibromyalgia: that too little thyroid hormone regulation causes most patients’ symptoms. Below are the links to the two published studies. You can download them as pdf files and give them to your doctor: Report at Medical Science Monitor: Report at Thyroid Science: | ||||||||
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