Interesting read that a lot of us could relate to

[Guest guest]

When I read this, my first thought was instead of adding T4 the patient

should have upped the HC. Dr. Lowe agrees:

January 2, 2008

Question: I am a naturopathic doctor and have hypothyroidism and adrenal

insufficiency. I’ve been taking medication for these conditions over the

past several years. Despite experimenting with different dosages and

combinations, I am yet to find the correct doses. I did feel well and stable

for 18 months while on a combination of 50 mcg T3 and 15 mg of

hydrocortisone.

After a large stress, however, I developed hypothyroid symptoms again. I

increased by T3 to 70 mcg, but all that did was keep me awake and not

relieve my symptoms. My doctor tested me and said that my TSH levels showed

that I was hyperthyroid. Because of this, he lowered my dosage to 30 mcg of

T3 and added 25 mcg of T4. I became severely ill on this and my health

declined drastically over six months. My doctor refused to change the

medication because now my TSH level was back to normal.

On my own, I added two grains of Armour per day and improved very quickly.

Under the care of another doctor, I’m now on 4 grains of Armour per day and

15 mg of hydrocortisone. I’m fairly stable on this combination, but my

weight is a problem, and I’m concerned about it. When I was on 50 mcg of T3,

my other symptoms (depression, anxiety, fatigue, muscle pain, hair falling

out, poor concentration, insomnia) cleared up. My weight also fell back to

normal, and I maintained the lower weight. But this time, after my episode

of hypothyroidism, my weight hasn't come back down. This is troubling

because I follow an excellent health program. I eat a perfect diet, take

nutritional supplements, and I’ve done practically every healing regimen in

the natural medicine world. I exercise very hard with weights and cardio—one

hour in the morning four-to-five days a week. Then I do a very brisk walk

for an hour most evenings. Despite this regimen, I’m in constant pain. And

my weight has stayed higher than normal. I have a layer of fluidy, fatty,

flabby, cellulite type of fat over my arms, belly, thighs, and butt. It

doesn't seem to shift no matter how hard I exercise. Is it possible that I

need more T3 to get rid of the pain and flab? I love your work. Thank you in

anticipation of your reply.

Dr. Lowe: I am sorry you’ve had the health problems you describe. Whenever I

hear from a clinician such as you, I regret even more the confusion that

reigns in the field of clinical thyroidology. You’re by far not the only

clinician perplexed about how to use thyroid hormone effectively to

alleviate problems such as your pain and fat.

When you went through the severally stressful time you mentioned, you most

likely needed to temporarily increase your cortisol dosage rather than your

T3 dosage. And by increasing your T3 dosage, you may have worsened the

cortisol deficiency induced by the stress.

When the adrenal cortices are functioning well, stress causes them to

substantially increase their secretion of cortisol. In my opinion, during

stress, the person on physiologic cortisol therapy, as you’re on, should

mimic what the adrenal cortices do during stress. The person should take

more cortisol than during tranquil times.

During the stressful time you experienced, it’s highly likely that your need

for cortisol markedly increased. By increasing your T3 dosage, you may have

sped up the clearance of cortisol through your liver. This would have

decreased the cortisol available to your cells at a time when you needed

much more than usual. You said that at this time, you again developed

symptoms of hypothyroidism. It’s possible that the symptoms were actually

those of a cortisol deficiency. That’s likely if the hypothyroid-like

symptoms included fatigue, muscle weakness, lower tolerance of stress, and

low blood pressure upon standing up.

Armour works well when the patient takes a high-enough dosage. It’s

possible, however, that you aren’t taking enough. On your dosage of 4

grains, you’re getting 36 mcg of T3. This is only 4 mcg less than when you

felt well and stable on 50 mcg. However, the difference may be substantial

for you as an individual.

The problem I see in cases such as yours is a black hole of sorts: how much

of the T4 in the Armour (152 mcg in the 4 grains) do you absorb and convert

to T3? We don’t know. Some studies indicate that while we absorb almost 100%

of T3, we absorb variable amounts of T4, for example 80% or 85%. But how

much of it ends up converted to T3 and bound to T3-receptors is a mystery.

Because we never know how much T4 is effectively used by one’s body, I

believe that using T3 is preferable. The relationship between symptoms or

symptom relief and the T3 dosage is far clearer than with T4. More T3 dosage

might also reduce or relieve your pain by inhibiting substance P production,

by repressing the preprotachykinin-A gene, which codes for both substance P

and its receptor.[1,p.732]

I hope, doctor, that you’re soon able to relieve your pain and lose your

excess fat. I suspect that you can do so by raising your T3 dosage a small

amount. Also, if you experience any prolonged or intense stress, I hope you’

ll consider that temporarily increasing your cortisol dosage is the proper

course of action.

Reference

1. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, McDowell

Publishing Co., 2000.

http://www.drlowe.com/QandA/askdrlowe/mostrecent.htm