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Immune System
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January 6, 2004
 Question:
I am hypothyroid because of autoimmune thyroiditis. I read an article in a
magazine that said patients who have one autoimmune disease may also have
other ones. My question is, should I get evaluated for other autoimmune
diseases? The reason I ask is that I still have symptoms (mainly fatigue,
cold intolerance, and dry skin) that seem like hypothyroid symptoms. But it
doesn’t make sense that these are hypothyroid symptoms. I use 50 mcg of
Synthroid and my doctor says this is enough, since my thyroid tests are now
normal.
Dr. Lowe: With a high degree of
probability, the symptoms you describe are due to your hypothyroidism. It’s
common for patients taking such a small dose of thyroid hormone to continue
suffering from hypothyroid symptoms. I have two suggestions: first, that you
insist that your doctor prescribe a product containing both T4 and T3;
second, that you get your doctor to ignore your TSH level and raise your
dose high enough to relieve your symptoms without causing overstimulation.
The article you read is correct: some patients with autoimmune thyroid
disease do also have other autoimmune diseases. Moreover, some evidence
suggests that the incidence of other autoimmune diseases is higher among
patients with autoimmune thyroid disease. Researchers reported this in 1998.[1]
The researchers studied the incidence of other autoimmune diseases in 218
patients with autoimmune thyroid diseases. Among these patients, 30 (13.7%)
also had other autoimmune diseases. The researchers noted that this
incidence is higher than in the general population.
The other autoimmune diseases most common among the patients were Lupus
and Sjögren’s syndrome. Thirteen of the patients developed the other
diseases several years before developing autoimmune thyroiditis. The
researchers advised doctors to occasionally reevaluate patients who have
either autoimmune thyroid diseases or other autoimmune diseases to learn
whether they’ve developed another autoimmune disease.
As I said, your symptoms are most likely due to under-treatment with
thyroid hormone. If you insist on effective thyroid hormone therapy, you won’t
have hypothyroid symptoms. Then, if you eventually develop symptoms from
another autoimmune disease, you’re likely to have a clearer perception
that you’ve developed a new disease.
[1] Gaches, F., Delaire, L., Nadalon, S.,
Loustaud-Ratti, V., and Vidal, E.: Frequency of autoimmune diseases in 218
patients with autoimmune thyroid pathologies. Rev. Med. Interne.,
19(3):173-179, 1998.
February
28, 2003
Question:
It seems to me that there
are two plausible causes for fibromyalgia. There is your theory of
hypo-metabolism, which seams logical as you’ve described it in your book
The Metabolic Treatment of
Fibromyalgia. Then there is the infection theory. This also seems
plausible. It does especially since some studies have shown a high rate of
mycoplasm or fungal infection (more than 90%, I believe) in chronic pain
syndromes including fibromyalgia compared to low rates of infection in the
general public. So I began to speculate on a connection between the two. I
wondered if maybe slow metabolism worsened the effects of, or increased the
prevalence of, low grade infections. I also wondered if possibly there was a
more direct link. Maybe cellular resistance could be caused by an infection.
So I thought it was very interesting that I stumbled across a physician, Dr.
Mike McNett, who believes there is a connection and that cellular resistance
to thyroid hormone is that connection! I’m interested in whether or not
you had already considered this and what you think about this concept.
Dr. Lowe:
Thanks for your interesting and important thoughts on the role of infections
in fibromyalgia. I’ve thought about this issue a great deal. In fact, one
of the largest chapters in my book The
Metabolic Treatment of Fibromyalgia is on the immune system and
infections.
As you know, Dr. Mike McNett proposes that candida releases a chemical
that blocks thyroid hormone from binding to thyroid hormone receptors. And
he proposes that the blocking causes fibromyalgia patients’ hypothyroid
symptoms. His hypothesis is entirely conjectural at this point. He's told me
he's planning to test his hypothesis in studies sometime in the near future.
I admire the process of his reasoning and the boldness of his hypothesis.
Nonetheless, I believe the hypothesis is false. Of course, to know for sure,
we'll have to wait for the outcome of the studies he's planning.
As you may know, Dr. Garth Nicolson is the molecular biologist who more
than any other research has studied mycoplasm infections in fibromyalgia
patients. Before The
Metabolic Treatment of Fibromyalgia was published, he was kind
enough to give me editorial comments on the section of my immune system
chapter in which I reviewed his studies on fibromyalgia and mycoplasm
infections.
Dr. Nicolson is correct about the high incidence of mycoplasm infections
among fibromyalgia patients. But the broad-spectrum antibiotics he uses
don't usually permanently relieve patients of the infections; the infections
tend to recur. I believe that when his fibromyalgia patients do get
long-term improvement, the improvement results largely from
metabolism-regulating therapies the patients use along with antibiotics. For
example, the patients give up high-sugar, high-fat foods; adopt a wholesome,
health-inducing diet; use a wide array of nutritional supplements; restore
their gut flora to normal; and exercise to tolerance. Dr. Nicolson has noted
that patients must continue various nutritional supplements to maintain
immune system efficiency and keep mycoplasm infections down.
The high rate of mycoplasm and candida infections among fibromyalgia
patients are predicable from the adverse immune system effects of
hypothyroidism and thyroid hormone resistance. That the infections are not
the primary problem is obvious from a well-documented fact: Metabolic rehab
involving the use of thyroid hormone enables 85% of fibromyalgia patients to
fully and lastingly recover without the use of antibiotics or
anti-candida therapies.
If candida or mycoplasm infections were the primary cause of
fibromyalgia, we wouldn't have our high success rate without using
anti-candida therapies or antibiotics. But we've rarely had to treat
patients for systemic candida overgrowth. And we’ve never directly treated
any of our patients for mycoplasm infections. Of course, we may have
indirectly treated them for the infections by boosting their immune systems
through the use of thyroid hormone.
Continued
at top of right column . . .
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Q&As
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bottom of left
column . . .
January
21, 2003
Question:
I have a question about my
thyroid test results and a path of treatment. I had very high thyroid test
results and am concerned that they are so abnormal. My free T4 level was 4,
TSH was 27, thyroglobulin was 117, and thyroid peroxidase antibodies was
493. I’m seeing my gynecologist for the treatment of what she thinks is
hypothyroidism. She thinks my pregnancy and childbirth four months ago
caused the hypothyroidism. She put me on of 0.05 mg of T4 for three
weeks, and then 0.1 mg for one week. My concern is that these very high
levels might indicate something more serious than my hormones being out of
whack from child birth. Are numbers this high consistent with hypothyroidism
resulting from pregnancy? What tests could determine whether pregnancy is
responsible and not something more serious. Or should I just wait to see
whether the T4 helps? Thanks for your help.
Dr. Lowe:
Yes, your abnormal thyroid test results are probably related to your
pregnancy. More specifically, the test results are probably related to changes in your immune system related
to your pregnancy.
Changes in immune system function during and
after pregnancy are well known. Considering these changes helps us to
understand the onset or worsening of autoimmune thyroid disease after
pregnancy, which you’re obviously experiencing. I'll briefly explain the
dynamics of immune function and autoimmune thyroid disease during and after
pregnancy.
Early in pregnancy, the woman’s immune
system typically becomes more active, and in late pregnancy, it becomes less
active. When it becomes less active, if the woman has autoimmune thyroid
disease, it becomes less active, and her anti-thyroid antibody levels decline. The reduced activity of the woman’s immune system may serve to
lessen the change that her body will reject her fetus.
Just before or after delivery, the woman's
immune system is likely to become more active again. The increased activity
will worsen any autoimmune disease she has, or if she didn’t have
autoimmune disease before, it may now appear. If she already had autoimmune
thyroiditis, it will worsen at this time. If so, her levels of thyroid
antibodies, TSH, and thyroid hormones will be out of their reference ranges—meaning
that according to lab standards, her results will be abnormal. The severity
of a woman's thyroid gland dysfunction usually parallels the severity of her
thyroiditis; the higher her antibody levels, the lower her thyroid hormone
levels, and the higher her TSH level.
Her antibody levels are likely to peak
three-to-seven months after she delivers her baby. Then they’ll probably
start declining. But even a year after she delivers, her antibody levels are
likely to still be higher than at or shortly after delivery. If she’s like
most women with this problem, her antibody levels will eventually decrease
to lower levels. They may even disappear. But if she’s like some other
women, her antibody levels will remain high. If she has more pregnancies,
her severe thyroiditis may recur, and finally, she may develop chronic
autoimmune thyroiditis and permanent hypothyroidism.
Doctors should warn women who have thyroid
disease that it may worsen after pregnancy. In fact, they should caution all
women that thyroid disease may appear for the first time after they deliver.
If after delivery, a woman experiences symptoms such as depression,
nervousness, sluggishness, fatigue, and mood swings, she should undergo an
evaluation for thyroid and metabolic status.
I want to state
emphatically that the
woman should not settle merely for having thyroid function tests and
antibody levels checked. If her doctor doesn't also know how to perform a
clinical evaluation—assessment of her history, symptoms, and physical exam
findings—the doctor should refer the woman to another doctor who does not
how. Usually, an endocrinologist is the wrong choice. In general, these
specialists have virtually no training in or knowledge of clinical medicine
or experience in doing clinical evaluations. The best choice is an
alternative doctor knowledgeable about hypothyroidism and experienced in
treating patients with products that contain both T4 and T3 as part of a
holistic metabolic regimen. If the woman does consult an
endocrinologist, she should make sure the specialist isn’t a dogmatic
advocate of T4-replacement therapy; instead, she should see to it that the
endocrinologist is enlightened enough to treat hypothyroid patients as
alternative thyroid doctors do.
If the woman is hypothyroid, she may choose
to abstain from taking thyroid hormone to see if her thyroid function
returns to normal. This makes sense, of course, only if she isn’t troubled
with symptoms of hypothyroidism. If she does have symptoms, it’s usually
best that she begins thyroid hormone therapy. If she does, she should choose
a thyroid hormone product that's likely to be effective. That means it
should be a product that contains both T4 and T3. Using a preparation that
contains only T4 is likely to leave her suffering from hypothyroid symptoms.
And chances are, a doctor will diagnose her continuing symptoms as
fibromyalgia, chronic fatigue syndrome, or some other so-called "new
disease." Based on the diagnoses, the doctor will prescribe a variety
of drugs to try to control her symptoms—symptoms he fails to recognize as
those of hypothyroidism.
Whether the woman takes thyroid hormone or
not, she should insist that her doctor reevaluate her condition at close
intervals. This is important because the woman's thyroid, metabolic, and
symptom status may waver with changes in the severity of her thyroiditis. If
she's taking thyroid hormone, changes in her thyroiditis may require that
she alter her dose to maintain optimal metabolism and remain symptom free.
From this summary, I hope it's clear that,
indeed, your clinical picture is consistent with thyroid disease following
pregnancy. My concern isn't that you have some other dread disease that may
be producing your extreme lab results; rather, it’s that you won't get
effective treatment. Your lab test results suggest you’re hypothyroid, and
you may need thyroid hormone therapy. But I can’t calculate symptoms into my
opinion since you didn’t mention whether you have any. For many women with
postpartum thyroid disease, however, incompetent treatment of their
hypothyroidism is where they begin having horrific experiences with
conventional medicine. Hopefully you'll be treated competently.
I wish you the very best for good health so
that you can enjoy your new child's early years.
January 12, 2002
Question:
Do you believe hypothyroid patients should have flu shots because their
immune systems are weakened? Do you take flu shots?
Dr. Lowe:
Public health officials, with good intentions, argue that people in poor
health (such as older, frail individuals) especially need flu shots (viral
inoculations) to avoid the flu. Hypothyroidism does impair some patients’
immune systems. If public health officials were aware this, I suppose they’d
classify these patients as having poor health; then the officials would
argue that the patients are among those in special need of flu shots.
It seems to me, though, that impairment of some hypothyroid patients’
immune systems makes it more likely that they’ll have the flu in response
to the shots. Most people I’ve known who had the flu did so after being
vaccinated for the flu. Some patients with a diagnosis of fibromyalgia or
chronic fatigue syndrome say they first developed symptoms characteristic of
these disorders after being vaccinated. Each patient must make her own
decision about flu shots, but considering the risks involved is prudent.
I haven’t had a flu vaccination, or any other kind, since I was
inducted into Army basic training in my early twenties and was forced to
submit to them. I seriously doubt that I’ll ever have one again. In my
opinion, what mainly lies behind mass vaccinations is financial greed and
scientific incompetence and fraud. Because of this, I prefer to avoid the
flu by using health-protecting methods such as daily
mega-doses of vitamin
C, a powerful antiviral agent. This approach has protected me from the flu
for more than thirty years. The worst viral diseases I’ve had during that
time were several colds. I initiated these by wearing down my resistance
through overwork. In view of this record, I’ll pass on flu shots and take
my chances with naturally-induced disease.
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Potential
Adverse Effects from Flu Shots for Patients
with Fibromyalgia/Chronic Fatigue Syndrome
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