Jul 16 2003
Do you have a sense of the level of patients who may need this sort of T3-only therapy, and among those who try it, how many find it effective?
I do frequently make the judgment that people are having problems converting to active T3, although I don't often call this "Wilson's Syndrome." I look for several things: [1] symptoms of low thyroid [2] symptoms of sluggish adrenal / stress function (since this will promote rT3 formation) [3] low basal body temperatures, usually underarm. I also do a metabolic laboratory urine test called an Organic Acid test, it looks at all of the products of metabolism, and you can frequently see the imprint of a sluggish thyroid by finding multiple low metabolic products. When I see this, I give T3 therapy in the following manner: I have a compounding pharmacist make up time-release T3, usually 7.5 mcgm capsules, and I give them twice daily (sometimes three times daily). After three weeks, I gradually increase the dose.
At the same time, I look for other factors compounding metabolism. This Is the idea of the "Metabolic Matrix" that I described in my book, the idea that thyroid and metabolic function can't be separated from looking at the digestion, the detoxification organs, the adrenal / stress system, the neuroregulatory system, the sex hormone system, the immune system and the environment. Thus, I give (where appropriate) digestive support, adrenal support, immune support, detoxification, heavy metal assessment, etc. This gets back to the question of the "find it, fix it" mentality. We cannot significantly improve patient health by changing from T4 to T3 therapy. What we really have to do is to look through a wider lens at the question Of metabolism and thyroid function.
5. How do you suggest patients get beyond their physician's resistance to prescribing natural desiccated thyroid, or T3 supplementation?
A tough question, but one that I believe is becoming a bit easier to Answer as time goes on. Just yesterday, I received an e-mail from a very conventional physician in my community asking what I would advise about natural hormone replacement therapy (HRT) for menopausal women. He had a patient that was having symptoms related to menopause, she did not want to take synthetic hormones due to recently-publicized negative research, and this physician was open-minded enough to consider a natural alternative. A good relationship with an open-minded physician would be my most critical bit of advice.
Beyond that, I suggest that patients become well-informed. Your physician is overwhelmed with the amount of new research, new recommendations and new therapies, and is barely able to keep up with the most important ideas, in the environment of increasing insurance regulations, HIPAA compliance, etc. Many physicians welcome information delivered by patients, such as information from this website, that comes from clinical experience.
In the case of T3, which is produced commercially as Cytomel, I suggest that patient ask their doctors to add a bit of Cytomel to their T4 treatment, then try to taper the T4 and build up the T3. Or, use one of the combination products on the market. In a couple of cases, I had my compound pharmacist prepare some information to send to the physician, and I found that to be helpful. In the case of natural desiccated thyroid, it becomes more difficult since there is a bias against natural medications that is entrenched in physicians' minds. Having the physician prescribe Armour as "no substitution" helps sometimes, asking the physician for a three month trial sometimes is helpful. But there is no substitute for a physician who sees himself or herself as a partner in healing.
