An Interview with Drs. Richard and Karilee Shames, Authors of Thyroid Power

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.

Mary Shomon: 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?

Drs. Shames: 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 of use in securing a diagnosis. I typically rely on the combination of symptoms, 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 who 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 find 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 test when necessary for particular patients. Regardless of blood tests, I have all patients do the basal temperature evaluation.

Mary Shomon: What form of thyroid hormone replacement do you typically recommend for patients? ([link url=http://thyroid.about.com/library/drugs/bl-levothyroxine.htm]Levothyroxine[/link], [link url=http://thyroid.about.com/library/drugs/bl-cytomel.htm]Cytomel[/link], Armour Thyroid, etc.?)

Drs. Shames: I am a very open-minded, eclectic physician, who blends conventional medicine with alternative medicine, often with very positive results. I listen very carefully, then follow my patient's cues, and interests, and aspire to always 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 to see which one works best for you. Initially, I typically recommend whatever 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 a philosophical inclination for one kind or another. I prescribe all that you've mentioned, either singly, or in combination when necessary. Sometimes it it the combination of two or three of the above medicines that proves to 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 tell me which of these they are most interested in trying first, after I cover the options with them.

On the other hand, there are plenty of folks who have heard of Synthroid or Levoxyl, or Cytomel, and want to try one or more of those. I start them on a 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 as 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 something to their first choice product or discontinue it and start something totally new.

As you can see, it is my firm belief that the state of the art in finding the optimal medicine is still trial and error. It is true that a person whose T-3 levels on blood tests are noticeably low might best start with a preparation strong in T-3, such as Cytomel or Armour, but -- oddly enough -- this is not 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."