April 26, 2007
Question: I
just read your latest update about your clinic where you do all the testing
for metabolism. Didn’t Dr. Broda Barnes simply have people take their
temperatures to measure what’s going on in their tissue?
Dr. Lowe: No, he didn't just have them
take their temperatures. I’ve had the privilege of having patients who,
decades ago, had also been patients of Dr. Barnes. They and I talked at
great length about how he assessed and treated them.
Of course, he did use their basal body temperatures. But, according to
these patients, their temperatures weren’t the only measures by which he
decided whether they needed thyroid hormone and how much they needed. He
also physically examined them, tested their Achilles reflexes, and assessed
their symptoms. In addition, he looked for other evidence of low thyroid,
such as high cholesterol. As a diagnostician, then, he seems to have been as
holistic as a doctor could be back then; he appears to have considered all
available indicators of hypothyroidism.
No matter what he did or didn’t do, there is a subset of hypothyroid
patients for whom the basal body temperature is not a useful gauge of how
tissues are responding to thyroid hormone. These people's temperatures don't
increase even when they are overstimulated by thyroid hormone. I’ve seen
these patients become fully free from symptoms and their metabolic rates
become completely normal, yet their temperatures remain abnormally low.
I’ve seen the same with some thyroid hormone resistance patients. I’m one
of them. For many years, I’ve taken my optimal dosage of T3, 150 mcg. On
this dosage, I no longer have symptoms of thyroid hormone resistance. Those
symptoms were mostly mild body aches; treatment-resistant trigger points;
poor memory and concentration; and intermittent, severe depression. My
latest basal metabolic rate (taken when I woke up from a night’s sleep) was
+6%. That means that my metabolic rate was 6% above the calculated normal
for me. This is within the 10% plus and minus range that we consider normal.
Yet, through all these better years for me, my underarm basal body
temperature has remained between 96.7 and 97.2 degrees F. (Dr. Barnes
defined the normal basal temperature as 97.8-to-98.2 degrees F.)
The reason some patients’ temperatures remain low is what I call
"differential tissue sensitivity to thyroid hormone." I came to this
conclusion from many discussions with molecular biologists who do thyroid
hormone research. In patients whose temperatures stay low, the
temperature-raising enzymes whose gene transcription is increased by thyroid
hormone (such as sodium-potassium-ATPase) are apparently partly or wholly
exempt from regulation by thyroid hormone. Because of this, the patients’
body temperatures simply aren’t a useful gauge. They must use other
physiological measures to assess their tissue responses to a particular
dosage of thyroid hormone.
What we do at The Lowe
Clinic and Research Center is basically, although more extensively, what
Dr. Barnes did: use all available relevant indicators of hypothyroidism. Of
course, we also use indicators of thyroid hormone resistance. We have more
technological methods today, and we make full use of these. As a research
center, we’re studying how usefulness these methods are and how they can
help us to help patients recover as fast as possible.
I believe other doctors caring for thyroid patients should also use
multiple assessment methods for three reasons: (1) one or more measures,
such as the basal temperature, may not be useful for an individual patient;
(2) the more measures that point to hypothyroidism or thyroid hormone
resistance, the more confident we can be in the diagnosis; and (3) from
multiple abnormal measures, the doctor may learn the type of thyroid hormone
product the patient needs.
Of course, during our comprehensive metabolic evaluations, we sometimes
identify causes of low metabolism other than too little thyroid hormone
regulation. When we do, I tailor an individualized treatment regimen for the
patient. Our full evaluations are comprehensive; that is, they
include the basal body temperature, but every other relevant measure
available to us today. Because of this, we’re usually able to learn whether
a patient is hypometabolic, how low his or her metabolism is, and the most
likely cause of the low metabolism. During this process, we find which
measures of tissue response to thyroid hormone (and other treatments) will
be most useful for the patient and the treating doctor. By providing this
information to the doctor and patient, we enable them to systematically
judge how the patient’s tissues respond to treatment.
In short, what we’re doing is building on the groundbreaking work of Dr.
Broda Barnes. And we’re using every tool we can to carry that work to the
highest possible level in the serve of our patients.
July 4, 2006
Question: I am a general practitioner in Australia who treats
many hypothyroid patients. My question is, can a hypothyroid patient benefit
from using a MedGem calorimeter at home to assist in adjusting her dosage of
thyroid medication? I have a patient who lives in a desolate region of
Australia. She can travel to my clinic only every three months or so, and it
seems that she could use the MedGem at home and provide me with the results.
Can you advise me on whether it would be of benefit for her to have one?
Dr. Lowe: For a patient to measure his
or her resting metabolic rate at home, the best option was the MedGem.
Unfortunately, the company that marketed it, HealtheTech, has dissolved. The
portability of the MedGem, of course, was an advantage over other
calorimeters. Occasionally, we’ve had a patient in our clinic who couldn’t
relax enough for us to get his or her true resting metabolic rate. We would
teach the patient how to use the MedGem and let him or her take the
instrument to the motel (most of our patients come from out-of-town) and use
it upon awakening. That way, we were able to get a reading that was closer
to a true resting rate.
Now patients who want their metabolic rates measured must find clinicians
who use another indirect calorimeter, Korr’s instrument called "ReeVue."
An advantage of the ReeVue calorimeter is that it is better designed for
clinic use than was the MedGem. The ReeVue is thereby free from some
problems the MedGem imposed, such as the patient having to hold the
calorimeter during the test.
If you are interested in obtaining a ReeVue calorimeter or finding
another clinician who uses one and can measure your patient’s metabolic
rate, you can email our contact person at Korr, Shelley Steward at sstewart@korr.com.
March 27, 2005
Question:
I am a fibromyalgia patient in Tel Aviv, Israel. I
suffered from fibromyalgia for the last eight years. Finally, my family
doctor found that I’m hypothyroid. He prescribed 100 mcg of thyroxine
(T4), but after two months, I hadn’t improved. After I read your website,
I convinced him to add 25 mcg of T3 to the thyroxine. Two weeks later, he
increased the dose of T3 to 50 mcg. Within a week, I finally started feeling
better. Three months have passed and my arm and foot pains have gone away,
my depression has lifted, and my fingers and toes are no longer freezing all
the time. But I’m still tired and have pain off-and-on in my back. Also,
the extra 25 lbs I’d put on has only slightly gone down. Seeing the
results so far, my doctor is open to your suggestions. He feels that I
should also come to Boulder, Colorado to have a metabolic evaluation. I will
be in the US in June and would like to come for the evaluation. My question
is, how many days will I need to be in Boulder?
Dr. Lowe: By taking your basal body
temperature and basal pulse rate for five days before coming to Boulder, you’ll
have completed part of your metabolic evaluation before you get here. We
complete the evaluation in the clinic by measuring your resting metabolic
rate and body composition. Taking those measurements and examining you
physically takes up to three hours. That means that you’ll need to be in
Boulder only one day.
Some patients who travel to Boulder stay longer than one day, but their
extended stay is to experience this beautiful part of the country. You may
want to do as other patients do, however, and fly out the same day as your
evaluation. You should fly into the Denver airport the day before your
evaluation. We'll begin your evaluation at 9 AM and finish about noon. You
can then travel back to the airport and fly out in the mid or late
afternoon.
Fortunately you have a doctor who is cooperating by treating you
properly. If you didn’t, you could see the prescribing doctor on our
treatment team. You would see him in the afternoon following your metabolic
evaluation, and then you could fly out in the early evening.
I hope this answers your question, and I look forward to meeting you in
person at your evaluation.
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