by Mary J. Shomon
Richard Shames, M.D. graduated Harvard and University of Pennsylvania, did research at the National
Institutes of Health with Nobel Prize winner Marshall Nirenberg, and has been in private practice for
twenty five years. Dr. Shames practices holistic medicine -- with a focus on thyroid and autoimmune
conditions -- and has for twenty years been engaged in the search for answers about thyroid
disease. Karilee Halo Shames R.N., Ph.D. , Dr. Shames' wife, is herself hypothyroid, and is a Clinical
Specialist in Psychiatric Nursing and a Certified Holistic Nurse with a PhD. in Holistic Studies. The
Shames have a new book called Thyroid
Power out in June of 2001, talking about thyroid disease. I had an opportunity to talk to them
about their thoughts about thyroid disease, and am pleased to be able to bring you this interview.
Do you use thyroid blood tests at all to diagnose hypothyroidism, or do you rely
on body temperature and symptoms as your means of diagnosis?
As a broad-based General Practice Doctor, who has been
conventionally-trained but has one foot in holistic medicine, I am interested in whatever will be
use in securing a diagnosis. I typically rely on the combination of
family history, related illnesses, blood tests, and basal temperature
evaluation to arrive at my conclusion. The blood tests are not the final
arbiter, either in making the diagnosis or in telling the person "I don't
think you have a thyroid problem." I have over the years seen many people
have turned out to have definite thyroid difficulties proven by biopsy and
scans whose many blood tests were all totally normal. The blood test I
most revealing is the Total T-3. A close second is a good Thyroid Antibody
Panel. I also employ the other standard tests, and even the special TRH
when necessary for particular patients. Regardless of blood tests, I have
patients do the basal temperature evaluation.
What form of thyroid hormone replacement do
you typically recommend for patients? (
I am a very open-minded, eclectic physician, who blends conventional
with alternative medicine, often with very positive results. I listen very
carefully, then follow my patient's cues, and interests, and aspire to
meet them where they are. In 25 years of practice, I have found that it
doesn't necessarily matter which kind of thyroid hormone you start with so
much, as which kind you end up with after trying several different types
see which one works best for you. Initially, I typically recommend
type they have either heard about, have a "gut-feeling" about, know family
members who have a good response to a particular kind of medicine, or have
philosophical inclination for one kind or another. I prescribe all that
you've mentioned, either singly, or in combination when necessary.
it it the combination of two or three of the above medicines that proves
be the magic solution for a particular person.
For instance, if a person is interested in natural approaches to healing,
they might typically want some form of natural thyroid. This could be the
milder products like homeopathic thyroid drops, trophin products (nucleus
material of thyroid cells), or desiccated thyroid gland. This latter item
comes in two forms, thyroid glandular at the health food store, and
desiccated thyroid at the pharmacy, by prescription. Usually people will
me which of these they are most interested in trying first, after I cover
options with them.
On the other hand, there are plenty of folks who have heard of Synthroid
Levoxyl, or Cytomel, and want to try one or more of those. I start them on
mild dose of what they feel inclined to start with, and if it works well,
once we get to a normal dose they can simply stay on that preparation for
long as they like. If, on the other hand, the initial item tried does not
give 85-95% improvement, I then encourage the person to either add
to their first choice product or discontinue it and start something
As you can see, it is my firm belief that the state of the art in finding
optimal medicine is still trial and error. It is true that a person whose
levels on blood tests are noticeably low might best start with a
strong in T-3, such as Cytomel or Armour, but -- oddly enough -- this is
always what works best in the final analysis. To me, this intricate dance
with each patient is the true art of medicine.
"...the state of the art in finding
the optimal medicine is still trial and error."