Tag Archives: combination therapy

Eric, Metabolism.com member, explains why T4 only doesn’t work


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A long time member of metabolism.com, Eric Pritchard, has been a determined critic of “T4 only” treatment of hypothyroidism.  In his latest comment Eric shows that scientists were aware of the inadequacy of “T4 only” treatment since 1947!  I wanted to give everyone a chance to read his comment so I am posting to the main blog. Thanks again for your insight Eric.

Eric writes:

Endocrinologists have a hard time with the symptoms of hypothyroidism in the same sort of way that New York City folks believing that there is anything worthwhile west of the Hudson River. However, there are very relevant functions to the thyroid hormone effectiveness that exist beyond the boundaries of the classical endocrine system. This potential was given initial credence by Drs. Kirk and Kvroning in 1947 when they published a note saying that not all patients’ symptoms were managed by thyroxine (T4). This was collaborated in 1954 by Dr. Means. Drs. Gross and Pitt-Rivers discovered triiodothyronine (T3) and found it far more active than T4, which is now called a pro-hormone. The concept of euthyroid (your thyroid is OK) hypometabolism (but you are dragging anyway) was demonstrated by Dr. Goldberg in 1960. Drs. Refetoff and Braverman, circa 1970, discovered the connections between the thyroid gland and symptom producing cells, namely the cellular reception of hormones and the conversion of T4 to T3 outside of the endocrine system, which produces 80% of the body’s requirement for the active hormone, T3.

Another issue that is dismissed is the necessity of supporting chemistry to function properly. For example, every thyroid hormone replacement counter-indicates is use if the adrenals are insufficient.

So there is far more going on than endocrinology is willing to promote. That is why there are 1.7 million patients suffering in spite of T4 therapy. That is why there are still more patients suffering from false negative diagnoses for the symptoms of hypothyroidism.

 

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What’s Inside My Ebook, Metabolism.com?


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My ebook Metabolism.com is now available; I think you will find it a great resource for many of the common problems members have asked me about over the past 15 years. Buy it now and use it for years to come. Don’t forget to check out the Weight Loss and Weight Gain Programs included for free!

Chapter 1: What Is Metabolism? 9

Turning Food into Energy 10
The Importance of Hormones 11
Role of Metabolism in Weight Loss or Gain 14
Is My Metabolism Healthy? 16

Chapter 2: What Makes Your Metabolism Fast or Slow? 17

The Role of the Thyroid 22

Chapter 3: How to Increase or Decrease Metabolism 25

Problems with Losing Weight 25
Problems with Gaining Weight 34
A Pleasurable Exercise Routine is a Must 39

Chapter 4: Fact vs. Fiction—Smoking and Weight Loss 41

Chapter 5: Thyroid Treatment 47

How Are T3 and T4 Regulated? 48
Types of Thyroid Diseases 49
Hyper- and Hypothyroidism 49
Thyroid Nodules 51
Is Your Thyroid Nodule Hot? 53
Thyroid Treatments 54
Using Thyroid Function Tests To Diagnose Disease 56
Hyperthyroidism Treatments 57
Hypothyroidism Treatments 58
T3 Plus T4 Combination Therapy 59
How to Talk to Your Endocrinologist 66
The Recent Shortage of Armour Thyroid 67

Chapter 6: Diabetes Treatment 73

The Bad News—Major Stumbles in the Treatment of Diabetes 74
The Call for Tight Glycemic Control 74
2010 Diabetes Treatment Guidelines Lack Credibility 76
Setbacks in Diabetes Drug Development 81
The Failure of Inhaled Insulin 86
Dangerous Commercial Weight Loss Programs 87
Perhaps the Biggest Stumble of Th em All 89
The Good News—What Really Works 90
Diet and Exercise 90
Weight Loss Surgery 94
Incretins 95

Chapter 7: Hormone Treatments 99

Hormone Replacement Therapy—Estrogen 101
Heart Health 101
Breast Cancer 103
Benefits of Estrogen: Brain Function and Blood Pressure 104
Testosterone Replacement for Men 106
Testosterone Replacement Options 107
Benefits of Testosterone Replacement 108
Potential Risks 109
Human Growth Hormone in Adults 111
Diagnosing Growth Hormone Deficiency 113
Benefits of Growth Hormone Supplementation 113
Adrenal Fatigue: Fact or Fiction? 115

Conclusion 117

The Birth Of Metabolism.com 119
My Path Into Endocrinology 121
Recent Contributors On Metabolism.com 125

Appendix 1: Personal Nutrition Profile 127
Appendix 2: Ultimate Weight Gain Program 145
Appendix 3: Food Journal 165

Relevant Studies

Michelle Gets a Boost from T3 (Cytomel)


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Michelle shares her success story with T3. Michelle’s story demonstrates how combination therapy with T4 and T3 can be clinically superior to T4 (Synthroid, Levothyroxine) alone. In her story she mentions Wilson’s syndrome which I personally think is a “made up” diagnosis to help Dr. Wilson’s retirement fund but I do think her experience is fairly typical of a lot of people with hypothyroidism who eventually discover they need T3 added to conventional treatment with T4 to achieve best results.

Michelle writes:

OMG! Maybe I’m not crazy after all!
I’m 47 in December and can’t remember the last time I felt good or even okay. Same thing – doctors repeating same tests, thinking I’m exaggerating, sent to Psychiatrist…Over the past 6 years or so, major stress, low immune (sick all the time), worsening depression, borderline diabetes, high blood pressure, peri-menopause. Got to the point that I’m sooo exhausted. Don’t want to do anything. Lab diagnosis finally showed up hypothyroidism so doctor put me on Synthroid – I was so happy that I cried. Devastation set in after 6 months as this was not the miracle I thought it would be.

Started taking my temperature 3 to 4 x a day as suggested to me by a naturopath I had seen but couldn’t afford to keep going to. Again, measurements taken 3 x daily for a week averaged to 97.0. Talked to doctor about Wilson’s Temperature Syndrome; she did not believe in it and sent me for more blood tests which came back normal.

FINALLY (after 20 years at same doctor’s office) was lucky enough to be accepted under the care of a physician who hadn’t heard of WTS but had heard about the T4 not converting into the T3 (you all know the fault in the system)… so right then and there wrote me a prescription for Cytomel and told me to stop the synthroid. As the WTS website recommends sustained T3, I’m taking half the dose every 12 hours.

I started today and feel like a kid on Christmas Eve a million times over! I am so hopeful that this can get to the root of so many ailments. So many that I feel that I’m not even living my life, that I’m just here putting in everything I have just to get through the day.

With the lack of memory and concentration I have right now, I hope I remember to come back to this site and update you all!

Breakthrough Discovery: Need For t3 Could Be Genetic


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Do you wonder if you need t3 (Cytomel, triiodothyronine, liothyronine) added to your thyroid hormone treatment to feel normal again? The answer could be in your genes.

Recent discoveries reviewed by Antonio C. Bianco, M.D., Ph.D. at the recent American Thyroid Association meeting, reveal how genetic differences influence the effectiveness of thyroid hormone replacement. Dr. Bianco’s lecture focused on studies pinpointing inborn differences in the way people metabolism thyroid hormone to explain why t3 treatment of hypothyroidism is probably required by some to restore normal functioning of their brain, muscle and heart.

The most frustrating problem for people with hypothyroidism is being unable to convince their doctor that treatment with Synthroid, Levoxyl or similar pure t4 product, isn’t working. Continued symptoms of fatigue, weakness, inability to concentrate or think clearly, and inability to lose weight despite really trying, result in tension between the doctor and the “complainer”. When assessing the adequacy of thyroid hormone replacement therapy most doctors rely on the blood tests known as the Thyroid Function Panel. Typically this includes a measurement of t4, t3, t3RU, and TSH. Some panels may also include free t4 or free t3 measurements. If the hormone levels on these tests are “within normal limits” the doctor will often insist that the treatment is a success but it is the patient who fails to recognize this. A minority of endocrinologists know many of these “failures” can be turned into success by the addition of t3, the less utilized but much more powerful form of thyroid hormone.

Most of the biological effects of thyroid hormone in the body are due to the action of t3. The most common forms of thyroid hormone replacement however, involve giving t4 in the form of Synthroid, Levoxyl, levothyroxine etc. The t3 required by our tissues is produced by specific enzymes which convert t4 to t3 in the cells of the liver, kidney, brain, muscle, heart etc. These converting enzymes are known as deiodinases and under normal conditions they are responsible for about 80% of the body’s t3. The process
by which t3 is produced from t4 is known as peripheral conversion.

It has long been the contention of the leaders in thyroid disorders that based on their arithmetic, t4 replacement is sufficient to provide all the t3 the body needs via peripheral conversion and giving t3 supplementation doesn’t make good medical sense. Now, based on the new information provided by researchers like Dr. Bianco, the “arithmetic guys” will, in my opinion, need to revise their thinking finally allowing the way for acceptance of t3 replacement approaches.

I will continue the explanation of the new breakthrough in genetic control of thyroid hormone replacement treatment in Part 2 of this post.

Armour Draws Laughs During Year’s Biggest Meeting of Thyroid Doctors


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I am reporting to you from this year’s meeting of the American Thyroid Association now taking place at the opulent Breaker’s Hotel in balmy Palm Beach, Florida. Cushy job if you can get it, I’d say.

Not a lot of laughs during the typical lecture at this three day meeting of the world’s experts on thyroid diseases and treatment but I did hear a few guffaws, giggles and snorts today during the single lecture devoted to using combination t4 and t3 therapy for treating hypothyroidism. The speaker on this topic, Dr. Michael McDermott a Professor of Medicine and Pharmacy at the University of Colorado, was actually significantly more open minded about using combination t4/t3 therapy then speakers from previous meetings on the same topic. He prefaced his comments by acknowledging that about half of patients treated with synthetic t4 continue to experience symptoms typical of thyroid hormone deficiency. What, if anything, doctors are to do to help their patients in this situation appears to still mystify the experts.

The laughs came when Dr. McDermott polled the audience of professionals about their opinions regarding treatment of a hypothetical hypothyroid patient with normal thyroid function blood tests continuing to complain of symptoms suggestive of thyroid hormone deficiency. The speaker put up a slide with 5 or 6 treatment options which the audience then voted on. Although a good portion of experts here gave a philosophical shrug of the shoulders by not choosing any of the options, it was reassuring to see a significant portion of the audience agreed with the statement that some hypothyroid patients appear to improve when t3 is added to traditional t4 treatment. This is far short of a strong endorsement of combination therapy but I would say it is a least a nod to those of us who routinely make use of this treatment option. The laughs and giggles came when the next to last option was read to the audience, proposing that Armour Thyroid was the best choice of treatment in this case. The last choice, that this type of patient should see a psychiatrist also got a few chuckles.

Not much more about dessicated thyroid treatment was mentioned after this curt dismissal but Dr. McDermott expressed his opinion that Armour Thyroid was a poor choice for treating hypothyroidism because it contains too much t3 and that synthetic t3 should be used exclusively if combination therapy was attempted. No one seemed aware that as of this month Armour Thyroid and similar dessicated thyroid medications were no longer available in the United States.

Despite the disturbing aspects of the first part of Dr. McDermott’s lecture he did end with some exciting ideas that I will soon be reporting on. The main idea he reviewed is that a genetic defect may cause resistance to t4 treatment in hypothyroidism. Those with the genetic defect would require the addition of t3 to achieve a healthy thyroid balance and elimination of the symptoms of hypothyroidism. I am sensing that this may be a breakthrough in thinking about why some people require combination therapy with t4 and t3. If so, endocrinologists will be forced to reconsider their reluctance/refusal to provide combination therapy for treatment of their symptomatic and dissatisfied hypothyroid patients. More to come on this breakthrough in my next installment.

Gary Pepper, M.D.

Dr. Ron Cobbs, Noted Endocrinologist, Speaks Out


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We welcome a contribution from Dr. Ron Cobbs.

Dr. Ron Cobbs and I go way back. We knew eachother when he was finishing his endocrinology fellowship at LIJ Medical Center on Long Island in the 80’s. Later he worked as an attending Endocrinologist at a New York City Hospital when I was the Director of an endocrine training program in another part of the city.

Ron leaves his opinion (below) for us to ponder on the subject of thyroid hormone replacement therapy. I guess Ron and I will just have to disagree about the use of Armour thyroid but we both recognize the value of adding t3 (Cytomel) to traditional pure t4 (Synthroid) therapy in selected individuals who need more complex replacement therapy to achieve a good clinical response.

Thanks Ron for your comments!

gp

Dr. Cobbs writes:

Several points should be noted. The American Assciation of Clinical Endocrinologists (AACE) recommends against the use of dessicated thyroid preparations. They specifically recommend levothyroxine and preferably branded versions as small changes in concentration have marked differences in clinical effects and blood test results such as TSH and free T4. Further, the endocrine literature reports that although most patients are successfully treated with branded levothyroxine alone, there is a small minority who never feel back to normal. However the literature supports the addition of T3 in the form of Cytomel rather than to retreat to the non-precise dessicated thyroid preparations of the past.

An experienced endocrinologist familiar with the literature can by precribing branded levothyroxine be able to treat most of their hypothyroid patients to the satisfaction of both phyician and patient. However the endocrinologist must listen to their patients and follow thyroid function blood tests. Even when the blood tests are normal, if the patient still does not feel normal again, the careful addition of amounts of T3 (cytomel) to the thyroxine will usually help the rest to feel better again.

Also remember to avoid taking iron replacement and medications such as cholestyramine or colesevelam too close to the levothyroxine as they prevent the adequate absortion of levothyroxine in the body.