Re: Reverse T3 (Dr Lowe) Q & A

[Guest guest]

Thanks for that Sheila, here is some more info on thyroiud horkone

resistance of which Dr Lowe speaks.

Mo

http://en.wikipedia.org/wiki/Thyroid_hormone_resistance

>

> March 24, 1999

>

> Question: In reading your Web site and published articles, I see

that you

> have not paid attention to high reverse-T3 as a cause of thyroid

hormone

> resistance in fibromyalgia. Why have you and other fibromyalgia

researchers

> not given attention to high reverse-T3 as a cause of fibromyalgia?

> Dr. Lowe: Some readers will not be familiar with reverse-T3, and I

know from

> experience that many others harbor misconceptions about the

molecule.

> Because of this, I have summarized in the box below what we know

about

> reverse-T3. I've answered your question below the summary.

> Conversion of T4 to T3 and Reverse-T3: A Summary

>

> The thyroid gland secretes mostly T4 and very little T3. Most of

the T3 that

> drives cell metabolism is produced by action of the enzyme named

> 5'-deiodinase, which converts T4 to T3. (We pronounce the " 5'- " as

> " five-prime. " ) Without this conversion of T4 to T3, cells have too

little T3

> to maintain normal metabolism; metabolism then slows down. T3,

therefore, is

> the metabolically active thyroid hormone. For the most part, T4 is

> metabolically inactive. T4 " drives " metabolism only after the

deiodinase

> enzyme converts it to T3.

> Another enzyme called 5-deiodinase continually converts some T4 to

> reverse-T3. Reverse-T3 does not stimulate metabolism. It is

produced as a

> way to help clear some T4 from the body.

> Under normal conditions, cells continually convert about 40% of T4

to T3.

> They convert about 60% of T4 to reverse-T3. Hour-by-hour,

conversion of T4

> continues with slight shifts in the percentage of T4 converted to

T3 and

> reverse-T3. Under normal conditions, the body eliminates reverse-T3

rapidly.

> Other enzymes quickly convert reverse-T3 to T2 and T2 to T1, and

the body

> eliminates these molecules within roughly 24-hours. (The process of

> deiodination in the body is a bit more complicated than I can

explain in

> this short summary.) The point is that the process of deiodination

is

> dynamic and constantly changing, depending on the body's needs.

> Under certain conditions, the conversion of T4 to T3 decreases, and

more

> reverse T3 is produced from T4. Three of these conditions are food

> deprivation (as during fasting or starvation), illness (such as

liver

> disease), and stresses that increase the blood level of the stress

hormone

> called cortisol. We assume that reduced conversion of T4 to T3

under such

> conditions slows metabolism and aids survival.

> Thus, during fasting, disease, or stress, the conversion of T4 to

reverse-T3

> increases. At these times, conversion of T4 to T3 decreases about

50%, and

> conversion of T4 to reverse-T3 increases about 50%. Under normal,

> non-stressful conditions, different enzymes convert some T4 to T3

and some

> to reverse-T3. The same is true during fasting, illness, or stress;

only the

> percentages change--less T4 is converted to T3 and more is

converted to

> reverse-T3.

> The reduced T3 level that occurs during illness, fasting, or stress

slows

> the metabolism of many tissues. Because of the slowed metabolism,

the body

> does not eliminate reverse-T3 as rapidly as usual. The slowed

elimination

> from the body allows the reverse-T3 level in the blood to increase

> considerably.

> In addition, during stressful experiences such as surgery and

combat, the

> amount of the stress hormone cortisol increases. The increase

inhibits

> conversion of T4 to T3; conversion of T4 to reverse-T3 increases.

The same

> inhibition occurs when a patient has Cushing's syndrome, a disease

in which

> the adrenal glands produce too much cortisol. Inhibition also

occurs when a

> patient begins taking cortisol as a medication such as prednisone.

However,

> whether the increased circulating cortisol occurs from stress,

Cushing's

> syndrome, or taking prednisone, the inhibition of T4 to T3

conversion is

> temporary. It seldom lasts for more than one-to-three weeks, even

if the

> circulating cortisol level continues to be high. Studies have

documented

> that the inhibition is temporary.

> A popular belief nowadays (proposed by Dr. Dennis ) has not

been

> proven to be true, and much scientific evidence tips the scales in

the

> " false " direction with regard to this idea. The belief is that the

process

> involving impaired T4 to T3 conversion-with increases in reverse-T3-

becomes

> stuck. The " stuck " conversion is supposed to cause chronic low T3

levels and

> chronically slowed metabolism. Some have speculated that the

elevated

> reverse-T3 is the culprit, continually blocking the conversion of

T4 to T3

> as a competitive substrate for the 5'-deiodinase enzyme. However,

this

> belief is contradicted by studies of the dynamics of T4 to T3

conversion and

> T4 to reverse-T3 conversion. Laboratory studies have shown that

when factors

> such as increased cortisol levels cause a decrease in T4 to T3

conversion

> and an increase in T4 to reverse-T3 conversion, the shift in the

percentages

> of T3 and reverse-T3 produced is only temporary.

> To answer your question: In a 1994 article, I did write of my

testing of

> fibromyalgia patients for laboratory evidence of elevated reverse-

T3. [Lowe,

> J.C., Eichelberger, J., Manso, G., and , K.: Improvement in

> euthyroid fibromyalgia patients treated with T3. J. Myofascial

> Ther.,1(2):16-29, 1994.] During one year, I tested 50 fibromyalgia

patients

> to see if they had laboratory values that would suggest that they

had

> impaired conversion of T4 to T3 with elevated reverse-T3. I've also

tested

> other patients since 1994. However, I have not found laboratory

evidence of

> impaired T4 to T3 conversion in a single patient.

> Also, if impaired conversion was the source of the problem in my

> fibromyalgia patients, they would respond to a normal physiologic

dosage of

> T3. However, most euthyroid fibromyalgia patients require far more

than

> normal physiologic dosages to overcome their thyroid hormone

resistance.

> Finally I decided that if some patients' fibromyalgia symptoms do

indeed

> result from impaired conversion of T4 to T3, it is a rare

phenomenon. I

> could no longer justify charging patients for the laboratory tests

that

> would identify impaired conversion. As a result, I don't even bother

> ordering the tests any longer. This is the reason that you haven't

read

> about impaired conversion of T4 to T3 and elevated reverse-T3 at

this Web

> site or in more of our published articles.

>

[Guest guest]

Thank

you Mo. This is a very interesting subject and I wonder how many sufferers

there are who actually do have thyroid hormone resistance. I picked up this

from your link - but the problem is in finding a doctor that would work with

such patients to find the level of thyroid hormone replacement they need to

overcome this. The BTA et al would not approve of such therapy one bit … http://en.wikipedia.org/wiki/Thyroid_hormone_resistance

"

….Dr. Refetoff has also noted that

there are many cases that present thyroid hormone resistance without the

genetic mutation. Nobody knows what causes thyroid hormone resistance in these

patients but doctors have discussed the possility of environmental toxicities,

stealth viruses, mutated bacteria, systemic fugal infection and others. Dr.

Marshall has invented a protocol for Sarcoidosis and autoimmune disease that is

proving to free many thyroid hormone resistant patients from their symptoms and

their large doses of medication. His research would indicate that there is an

autoimmune manlfunction causing thyroid hormone resistance.

However, thyroid hormone resistance is suspected to

occur in 1%-3% of the entire female population if Dr. Lowe is correct in his belief

that Fibromyalgia is thyroid hormone resistance. Dr. Refetoff believes that

many people with ADD have thyroid hormone resistance which would cover another

large chunck of the population. In fact, it is unknown how many people have it,

but we now know that it is not a rare disorder as once was believed.

The other symtoms that indicate a person may have

thyroid hormone resistance include but are not limited to: low body

temperature, blood pressure problems, chronic fatigue, constipation,

fibromyalgia or widespread pain, weight gain, memory problems, cognitive

dysfunction, asthma or allergies, and all other symptoms commonly associated

with either Hashimoto's thyroiditis and/or regula hypothyroidism, and/or

regular hyperthyroidism. The symptoms of this illness are many but the only way

to really know if you have it, is to work with a doctor on a therapeutic trial

of the thyroid hormone therapy. If a person cannot achieve homoeostasis without

large doses of T3 or T4, then she/he may have thyroid hormone resistance. Dr.

Refetoff has studied people who needed 1000mcg of T4 and 500mcg of T3 before

feeling well. These are doses that would kill a normal person and yet for those

with thyroid hormone resistance, living without these supraphysiologic doses

feels like death.

_,_._,___

[Guest guest]

I have a question about THR. Can someone with THR still show TSh, FT4

and FT3 in normal ranges?

Venizia

>

> Thank you Mo. This is a very interesting subject and I wonder how many

> sufferers there are who actually do have thyroid hormone resistance. I

> picked up this from your link - but the problem is in finding a

> doctor that would work with such patients to find the level of

> thyroid hormone replacement they need to overcome this.

[Edit Abbrev Mod]

[Guest guest]

Sheila,

Again, this paper is mostly quite accurate and easy to follow, except

for the crucial part:

> ... if impaired conversion was the source of the problem in my

> fibromyalgia patients, they would respond to a normal physiologic dosage

> of T3....

This is just not correct. If there is RT3 in the system, it will block

T3 receptors, effectively _creating_ the apparent resistance that Dr.

Lowe blames for the fibro.

> ....However, most euthyroid fibromyalgia patients require far more

> than normal physiologic dosages to overcome their thyroid hormone

> resistance....

Exactly as expected, just the wrong explanation. The recommended

treatment, give more T3 meds, is the same for either explanation. He

says the T3 is overcoming a lack of active receptors, the RT3 model says

those receptors are blocked by RT3, so avoid T4 meds. I think the latter

makes more sense. His paper did not follow a protocol that could tell

the difference.

Chuck

[Guest guest]

Hi Chuck

Very interesting to learn that it is RT3 that causes resistance to

cellular uptake of T3. Elsewhere Dr L speaks of the need to flood the

receptors with T3 in high doses. If RT3 is so to speak hogging the

cells, it seems it is not prepared to budge under a moderate

onslaught of administered T3.

However, I'm trying to see where exactly you & Dr L differ. You say

that he " says the T3 is overcoming a lack of active receptors " . But I

see no reference by Dr L, at least in the text posted by Sheila (nor

do I recall seeing such in any of his material that I've read), to

the nature of resistance. Dr L confines himself to conversion. He

points to his findings which he says indicate that there is normally

no chronic imbalance in conversion from T4 to T3 and RT3 (from the

norm, which he gives as 40:60 [T4 to T3]:[T4 to RT3]). And he argues

against the thinking of some ( " Some have speculated that the elevated

reverse-T3 is the culprit, continually blocking the conversion of T4

to T3... " ) that the conversion process is impeded by elevated RT3.

Rgds

Hans

Sheila,

Again, this paper is mostly quite accurate and easy to follow, except

for the crucial part:

... if impaired conversion was the source of the problem in my

fibromyalgia patients, they would respond to a normal physiologic

dosage of T3....

This is just not correct. If there is RT3 in the system, it will

block T3 receptors, effectively creating the apparent resistance that

Dr. Lowe blames for the fibro.

.....However, most euthyroid fibromyalgia patients require far more

than normal physiologic dosages to overcome their thyroid hormone

resistance....

Exactly as expected, just the wrong explanation. The recommended

treatment, give more T3 meds, is the same for either explanation. He

says the T3 is overcoming a lack of active receptors, the RT3 model

says those receptors are blocked by RT3, so avoid T4 meds. I think

the latter makes more sense. His paper did not follow a protocol that

could tell the difference...

> Chuck

[Guest guest]

Hans,

You wrote:

>

> Very interesting to learn that it is RT3 that causes resistance to

> cellular uptake of T3.

That isn't exactly what I said. " Resistance " is technically reserved for

something like a shortage of receptors, typically a genetic condition.

RT3 blocks those receptors, which prevents T3 from having the usual

effect, but this is not properly called resistance.

>...If RT3 is so to speak hogging the

> cells, it seems it is not prepared to budge under a moderate

> onslaught of administered T3.

Receptors do not stay blocked very long. This is a rather dynamic

process, and the RT3 gets released and broken down into T2, just like

the T3 does.

>

> However, I'm trying to see where exactly you & Dr L differ....

Mainly in interpretation. I don't think he was the source of the notion

of " resistance, " and he dismissed the idea that RT3 blocked receptors or

had any activity at all. He sees RT3 as simply representing T4 that did

not get converted properly, when its effect is really significantly

larger than that, so much so that a small change in the RT3 ratio could

have a large effect on thyroid status. Plus, even a small T4 source

could maintain the RT3 interference.

OTOH, his approach is very similar to what I would expect for excess

RT3: increase the T3 medication until symptoms go away.

Chuck

[Guest guest]

Yes I questioned the logic of this too Chuck.

Looks like whatever the obstacle is, in terms of me getting enough T3

into my cells, that I need MORE T3.

Which is proving problematic because my adrenals will not tolerate an

increase.

I just tried a small increase and have crashed badly.

Mo

>

> Again, this paper is mostly quite accurate and easy to follow,

except

> for the crucial part:

>

>

> > ... if impaired conversion was the source of the problem in my

> > fibromyalgia patients, they would respond to a normal physiologic

dosage

> > of T3....

>

> This is just not correct. If there is RT3 in the system, it will

block

> T3 receptors, effectively _creating_ the apparent resistance that

Dr.

> Lowe blames for the fibro.

>

> > ....However, most euthyroid fibromyalgia patients require far

more

> > than normal physiologic dosages to overcome their thyroid hormone

> > resistance....

>

> Exactly as expected, just the wrong explanation. The recommended

> treatment, give more T3 meds, is the same for either explanation.

He

> says the T3 is overcoming a lack of active receptors, the RT3 model

says

> those receptors are blocked by RT3, so avoid T4 meds. I think the

latter

> makes more sense. His paper did not follow a protocol that could

tell

> the difference.

>

> Chuck

>

[Guest guest]

Dr P will work with it of course but yes, I agree, not many others

but no surprises there at all as most of them cannot work with just

the straightforward stuff

My problem now is finding a way to strengthen the adrenals

sufficiently to make the necessary raises to get enough T3 into my

cells.

I am on top dose h.c at 40 mg and NAE and still not strong enough.

Bev are you there???? You said something about taking an ever higher

dose of h.c because of your size? Would you mind telling us more abut

this?

Ta.

Mo

p.s. Dr Lowe also said in that piece you posted Sheila, that the

extra T3 gets into the cells of the heart before it gets into the

muscles generally and that his often causes palps. And betablocker is

needed to get through this stage.

WEll, I wonder if this is why I started to need a betablocker some

time ago? The assumption was that I was hyper but I was not.......

>

> Thank you Mo. This is a very interesting subject and I wonder how

many

> sufferers there are who actually do have thyroid hormone

resistance. I

> picked up this from your link - but the problem is in finding a

doctor that

> would work with such patients to find the level of thyroid hormone

> replacement they need to overcome this. The BTA et al would not

approve of

> such therapy one bit .

> http://en.wikipedia.org/wiki/Thyroid_hormone_resistance

>

> " ..Dr. Refetoff has also noted that there are many cases that

present

> thyroid hormone resistance without the genetic mutation. Nobody

knows what

> causes thyroid hormone resistance in these patients but doctors have

> discussed the possility of environmental toxicities, stealth

viruses,

> mutated bacteria, systemic fugal infection and others. Dr. Marshall

has

> invented a protocol for Sarcoidosis and autoimmune disease that is

proving

> to free many thyroid hormone resistant patients from their symptoms

and

> their large doses of medication. His research would indicate that

there is

> an autoimmune manlfunction causing thyroid hormone resistance.

>

> However, thyroid hormone resistance is suspected to occur in 1%-3%

of the

> entire female population if Dr. Lowe is correct in his belief that

> Fibromyalgia is thyroid hormone resistance. Dr. Refetoff believes

that many

> people with ADD have thyroid hormone resistance which would cover

another

> large chunck of the population. In fact, it is unknown how many

people have

> it, but we now know that it is not a rare disorder as once was

believed.

>

> The other symtoms that indicate a person may have thyroid hormone

resistance

> include but are not limited to: low body temperature, blood pressure

> problems, chronic fatigue, constipation, fibromyalgia or widespread

pain,

> weight gain, memory problems, cognitive dysfunction, asthma or

allergies,

> and all other symptoms commonly associated with either Hashimoto's

> thyroiditis and/or regula hypothyroidism, and/or regular

hyperthyroidism.

> The symptoms of this illness are many but the only way to really

know if you

> have it, is to work with a doctor on a therapeutic trial of the

thyroid

> hormone therapy. If a person cannot achieve homoeostasis without

large doses

> of T3 or T4, then she/he may have thyroid hormone resistance. Dr.

Refetoff

> has studied people who needed 1000mcg of T4 and 500mcg of T3 before

feeling

> well. These are doses that would kill a normal person and yet for

those with

> thyroid hormone resistance, living without these supraphysiologic

doses

> feels like death.

>

>

>

>

>

>

>

> _,_._,___

>

[Guest guest]

> Looks like whatever the obstacle is, in terms of me getting enough

>T3 into my cells, that I need MORE T3. Which is proving problematic

>because my adrenals will not tolerate an increase. I just tried a

>small increase and have crashed badly.

Mo

I've been following all this and just when it seems you might have hit

upon an answer it seems impossible to implement. Just wanted to say I

hope you can find a way to overcome this latest hurdle. How very

frustrating all this must be for you.

Thinking of you

x

[Guest guest]

Hi Mo

In a paper, Selenium and Iodine Interactions, dated 27 April 1999,

the author noted:

" One study ...indicated that in experimental animals, selenium

deficiency will increase T3 in the heart. This may be the reason that

selenium deficiency causes heart palpitations and rapid heart beat " .

This suggests that one of the many benefits of selenium may be to

make the distribution of T3 in all muscles more uniform.

Rgds

Hans

....

Mo

p.s. Dr Lowe also said in that piece you posted Sheila, that the

extra T3 gets into the cells of the heart before it gets into the

muscles generally ...

[Guest guest]

Thanks for that , I feel like I am teethering on the edge of a

major transformation.

Mo

>

>

>

>

> > Looks like whatever the obstacle is, in terms of me getting

enough

> >T3 into my cells, that I need MORE T3. Which is proving

problematic

> >because my adrenals will not tolerate an increase. I just tried a

> >small increase and have crashed badly.

>

> Mo

>

> I've been following all this and just when it seems you might have

hit

> upon an answer it seems impossible to implement. Just wanted to say

I

> hope you can find a way to overcome this latest hurdle. How very

> frustrating all this must be for you.

>

> Thinking of you

>

> x

>

[Guest guest]

Thanks for that Hans, I have recently run out of selenium and will

get some more as soon as my little legs start to work again.

Mo

>

> Hi Mo

>

> In a paper, Selenium and Iodine Interactions, dated 27 April 1999,

> the author noted:

>

> " One study ...indicated that in experimental animals, selenium

> deficiency will increase T3 in the heart. This may be the reason

that

> selenium deficiency causes heart palpitations and rapid heart

beat " .

>

> This suggests that one of the many benefits of selenium may be to

> make the distribution of T3 in all muscles more uniform.

>

> Rgds

>

> Hans

>

>

> ...

>

> Mo

>

> p.s. Dr Lowe also said in that piece you posted Sheila, that the

> extra T3 gets into the cells of the heart before it gets into the

> muscles generally ...

>

[Guest guest]

I just tried a small increase and have crashed badly.

Hi Mo

Sorry to hear that hon, me too, I increased armour tho, are you on T3

only at the moment?

I cannot afford to buy T3 only really even if I have high rt3.

I am awaiting your major transformation hon, I fully understand your

adrenal problem BELIEVE ME.

I went a bit mad with 1/2 a grain increase, I am assuming you are

taking baby steps yes?/

lotsa luv and keep going hon

Dawnx

[Guest guest]

Yes but my baby step landed me flat on my ****

Maybe half a grain was a bit much at this point Dawn, quarter might be

better for you I am sure you agree after the horrible experience you

have had.

My GP would not test for RT3 and so I simply did not get it done.

BUT in order to see if we do have RT3 and to try and clear it by higher

dose T3, then we MUST have adrenals in good enough nick to enable this

to happen.

I am at the end of my piece of string in this respect, nowhere to go

with it anymore....... On top dose h.c plus NAE and still cannot cope

with a very small T3 increase without crashing like I have.

Well neither of us need this coming up to Crimbo, so much to do and I

cannot get off the sofa, back to being prone and viewing the ceiling

for cracks and cobwebs more like.

So I decided to go for a bigger stress dose today and dropped a dose of

the T3 so I can try and get this show on the road again.

Isn't horrible this place of intense suffering?

We will definitely go to heaven if amount of suffering is the

criteria

Mo

>

> I just tried a small increase and have crashed badly.

>

> Hi Mo

>

> Sorry to hear that hon, me too, I increased armour tho, are you on T3

> only at the moment?

> I cannot afford to buy T3 only really even if I have high rt3.

>

> I am awaiting your major transformation hon, I fully understand your

> adrenal problem BELIEVE ME.

> I went a bit mad with 1/2 a grain increase, I am assuming you are

> taking baby steps yes?/

> lotsa luv and keep going hon

> Dawnx

>

[Guest guest]

Hi folks,

I feel that this is my problem as I need 3 grains Armour and 80mcg (

keeps rising)T3 to feel well- and I do. But ‘normal ‘ doses just

don’t do anything for my symptoms and I just have every symptoms on the

list if I reduce dose to ‘normal’ levels. My Blood tests are within

range on these doses so where it all goes beats me! I can understand the T4 in

the Armour going to useless RT3, but what happens to all that T3? Hmmm!

-----

Subject: RE:

Re: Reverse T3 (Dr Lowe) Q & A

Thank you Mo. This is a very interesting subject and I wonder

how many sufferers there are who actually do have thyroid hormone resistance. I

picked up this from your link - but the problem is in finding a doctor that

would work with such patients to find the level of thyroid hormone replacement

they need to overcome this. The BTA et al would not approve of such therapy one

bit … http://en.wikipedia.org/wiki/Thyroid_hormone_resistance

"

….Dr. Refetoff has also noted

that there are many cases that present thyroid hormone resistance without the

genetic mutation. Nobody knows what causes thyroid hormone resistance in these

patients but doctors have discussed the possility of environmental toxicities,

stealth viruses, mutated bacteria, systemic fugal infection and others. Dr.

Marshall has invented a protocol for Sarcoidosis and autoimmune disease that is

proving to free many thyroid hormone resistant patients from their symptoms and

their large doses of medication. His research would indicate that there is an

autoimmune manlfunction causing thyroid hormone resistance.

However, thyroid hormone

resistance is suspected to occur in 1%-3% of the entire female population if

Dr. Lowe is correct in his belief that Fibromyalgia is thyroid hormone

resistance.

_,_._,___

[Guest guest]

Ahh that heaven thought Mo new bodies for all, wonderful thought,

no hypo and new adrenals

''back to being prone and viewing the ceiling

for cracks and cobwebs more like'' Yes, it is strange how you realise

the ceiling needs doing when you are like this isn't it? Also how

futile it is to think about the need for decorating lol, how important

is it really to people, only to people who are very very healthy I

think, and obsessives like me hehe.

well I am to go on T3 with my Armour dose dropped. That should be

interesting, never done cytomel before.

Will adopting the same doses of everything you were on before you

crashed help hon? I am still very nervous and not well but my adrenals

seem to be bouncing back after dosing higher for 2 or 3 days and I am

going back on the doses that I was ok on for a few days till the

cytomel comes. Any good in that idea for you?

Its horrible just when you think you were well on your way isn't it?

God be with you, and keep the faith.

lotsa luv

Dawnx

[Guest guest]

Two minds think alike Dawn........ back on earlier T3 dose and stress-

dosed for last few days, tapering now and I am coming back up for

more - glutton for punishment me! LOL

Mo

>

> Ahh that heaven thought Mo new bodies for all, wonderful thought,

> no hypo and new adrenals

> ''back to being prone and viewing the ceiling

> for cracks and cobwebs more like'' Yes, it is strange how you

realise

> the ceiling needs doing when you are like this isn't it? Also how

> futile it is to think about the need for decorating lol, how

important

> is it really to people, only to people who are very very healthy I

> think, and obsessives like me hehe.

>

> well I am to go on T3 with my Armour dose dropped. That should be

> interesting, never done cytomel before.

> Will adopting the same doses of everything you were on before you

> crashed help hon? I am still very nervous and not well but my

adrenals

> seem to be bouncing back after dosing higher for 2 or 3 days and I

am

> going back on the doses that I was ok on for a few days till the

> cytomel comes. Any good in that idea for you?

> Its horrible just when you think you were well on your way isn't it?

> God be with you, and keep the faith.

>

> lotsa luv

> Dawnx

>