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Dr. John Dommisse's Publication Addresses Optimal Treatment For Hypothyroidism |
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Part 1: Free T3 and Free T4 Are More Effective Than TSH
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Join the Discussion
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"Has anyone tried, either as a patient of Dr. Dommisse, or by following his
recommended protocol, the Free T4/Free T3 management he recommends at his
site and in his paper?"
Mary
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An interview by Mary Shomon
I've had the opportunity to talk to Dr. John Dommisse here at the website about his unique ways of diagnosing and managing hypothyroidism in
a fascinating interview last year. Dr. Dommisse has a report published in the fall of 2000 that may be of interest to people with hypothyroidism. I felt it important for Dr. Dommisse to have an opportunity to share more information about this paper with readers.
Mary Shomon: You have written a self-published paper, titled "Hypothyroidism: Sensitive diagnosis and optimal treatment (of all types and grades) ~ A review and comprehensive hypothesis." What prompted you to write and publish this paper?
Dr. Dommisse: Well, I had been taking a new approach in the diagnosis and treatment of hypothyroidism for 10 years, with over 1,200 patients at that point, so, when a physician on Physicians' Online suggested that I waste no more time in doing so, I went ahead and wrote it and started trying to submit it for publication. You would be amazed at the resistance to this radically different new approach, not only from the 'mainstream' medical journals but also from so-called alternative and complementary journals. However, in fairness, I must say that leaks of the paper by another physician were additional complicating issues in the publication of the paper. So I decided to copyright it first, and then to e-publish it on my own website.
Mary Shomon: The basic idea behind your paper is that hypothyroidism is often undiagnosed, or undertreated. You also believe that diagnosis and management of thyroid conditions should focus on the free thyroid levels Free T4 (FT4) and
Free T3 (FT3), and a lower normal range for the thyroid stimulating hormone level. These theories go against the conventional approaches currently in favor for thyroid treatment. What is your response to the conventional endocrinology community that typically disagrees with your position?
Dr. Dommisse: First of all, I point out to them the fact that they don't appear to have noticed that, in contrast to previous tests for the serum levels of these 2 thyroid hormones, which were NOT accurate, the free levels actually are extremely accurate. I also had to overcome the resistance to reliance on any T3 level due to its much-shorter duration of action (compared to T4) and, therefore, the presumed severe fluctuations in its serum levels at various times throughout the 24 hours of each day, no matter how accurately its level would be measured. I do so by pointing out that, in the normal state, the levels are tightly controlled by feedback mechanisms, both between the serum level and the pituitary gland
(through the Thyroid Stimulating Hormone - TSH) AND between the serum
level and peripheral conversion of T4 to T3. A further mechanism may be
the release of Free T3 from the proteinbound, inactive Total T3 presence
of this hormone. The result is a fairly even serum FT3 level throughout
the 24 hrs, with slightly higher levels by day, when more energy and
alertness are needed, than by night.
The endocrinology establishment has also argued against treatment with any T3, even in combination preparations, for the same reason, namely
that each morning/ daily treatment dose would cause peaks in the
afternoon that are too high, and valleys at night and in the morning that are too
low. It never seems to occur to them that this objection is very easily
overcome by prescribing all T3-containing preparations either after
breakfast and supper daily OR on an empty stomach every 8 hours, e.g., roughly
7am, 3pm and 11pm daily. The reason that after-meal doses allow twice-daily,
vs thrice-daily, administration is that, when T3 is 'cushioned' in food,
its absorption is slowed down, compared to ingestion on an empty stomach.
The result of either of these dosage regimens is that the FT3 level remains
remarkably consistent throughout each day, and that, no matter what time
of day the serum FT3 level is measured, it will give a fair reflection of
its level at any other time of the day.
Mary Shomon: Your paper is basically dedicated to the theory that FT4 and FT3 should always be measured, and should be used as a means of gauging
proper dosage levels of thyroid hormone replacement. Can you briefly explain, in layman's terms for thyroid patients, why you feel this is so important?
Dr. Dommisse: Not only for treatment monitoring but also for diagnosis; this is very important: Only doing the TSH level will miss all types of hypothyroidism other than primary grades 1 and 2 hypothyroidism. Let me back up just a little here, first, and explain that the only reason why an indirect test of thyroid function, the TSH, has been settled on as the main - often the only - test of thyroid function is because of the inaccuracy of previous T4 and T3 serum gauges, and because of the so-called wild fluctuation of the FT3 level. After all, usually, the best way to measure a hormone level is by measuring the level of the actual hormone - and preferably the Free/ Active level of it. But their objections continued, mostly by sheer habit, not for any logical reason, even after the Free levels became available in the past couple of decades, and apparently also even in the face of my suggestion of multiple daily dosing of T3. So, as the TSH has become increasingly sensitive, it has been latched onto as the arbiter of thyroid function, despite the knowledge that there are many factors that influence the height of the TSH, not only the height of the FT4 and FT3 serum levels. But, when one doesn't routinely measure the FT4 and FT3 serum levels, one has to
initially assume that a very low TSH can be due to the treatment being excessive. However, that should not be the end of the decision process; Free T4 and Free T3 levels Must then be run, in order to ascertain whether the initial assumption is correct or whether one or more of the many other factors lowering the TSH must be operating (if the Free T4 and FT3 level are NOT too high).
[Since I always run the FT4 and FT3 levels, I have the answer to this question immediately, and don't need to run a second set of tests for this question to be answered. Although they, especially. the FT3 level, are more expensive than the older standard T4 and T3 tests, the price comes down significantly when one orders them routinely and in many patients every day. I have now, for many years, been getting all 3 tests done for under $80 by all the national reference and specialty laboratories that I have utilized.]
So, in summary, the main reason why the FT4 and FT3 serum levels must be obtained is because they are the only consistently accurate gauges of thyroid function, regardless of the type or grade of hypothyroidism, and regardless of any other intervening illness, medication or other influences that the patient is under!
Simultaneously, these two levels also provide one with the answer to the question: Which thyroid preparation is indicated for this patient's treatment at this time? Or, which thyroid hormone level needs to be increased and which needs to be decreased at this time, in order to produce optimal levels of both hormones? This is another crucial part of my approach: Since the major portion of thyroid function is ultimately carried out by the Free T3 and not by the Free T4 hormone, it seems to me to be somewhat important to ensure that not only the FT4 but also the FT3 level is not only 'in the normal range' but is at the optimal level for that particular patient.
Next page > Synthroid, Armour or Another Drug: What's Best? > Page 1, 2, 3
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