July 19, 2008

Question: Thank you for our phone consultation yesterday. I have an additional question for you. From what I am reading about adrenal fatigue, my symptoms seem pretty severe. I have read in several sources that there is no harm in replacing cortisol at a physiologic dose. If the body doesn't need it, it will not cause any harm if the patient weans off it slowly. But if the body does need it, signs of benefit will show fairly rapidly.

When a patient adds cortisol to an already high cortisol level, she risks inducing damage to hippocampal cells in the brain. This can cause a loss of short term memory. Excess cortisol can also suppress immune function, making the patient more susceptible to infections. And as I explain in The Metabolic Treatment of Fibromyalgia,[1,p.487] long-term excess cortisol levels can cause a loss of bone mineral density.

Dr. Lowe: Your problem, as you described it, seems simple enough to me. Gynecological problems are legend among undertreated hypothyroid females. Common among the problems, as I described in the largest chapter in The Metabolic Treatment of Fibromyalgia,[1,p.509-571] is the cessation of periods (amenorrhea).

You said that you’re now taking 100 mcg of Synthroid. For most patients, that dosage is woefully too low. History shows that for some 95% of patients, safe and effective dosages of any brand of T4, such as Synthroid, range between 200 to 400 mcg.[2][1,p.986 & 859-898]

Tragically, few conventional doctors allow their patients to use high-enough dosages of T4 (or any other thyroid hormone preparation) to be effective. And for many patients (up to 50%[3]), T4-replacement therapy is never effective. Research and vast clinical experience show that most of these patients are rescued by T4/T3 products or T3 alone, when their doctors let them use high enough dosages.

But you have good reason to be hopeful. No one today has to settle for the incompetent care that conventional medicine offers most hypothyroid patients. You have options and only need to learn about and avail yourself of them. Some conventional doctors will tell you to stay away from the Internet in looking for solutions to your health problems. They have good reason to be defensive; as one Harvard Nobel Prize-winning physician wrote, a paltry 25% of patients are satisfied with the care they offer.[4] The Internet, however, is a treasure trove of effective alternatives to often failed conventional medicine. While filtering through Internet nonsense intelligently, I encourage you to use it lavishly.

February 4, 2008
Question: In your book The Metabolic Treatment of Fibromyalgia, you seem to demolish Dr. Dennis Wilson’s theories. What you say makes sense to me. But what about the fact that lots of doctors, mine included, say they get patients well by using T3 as Dr. Wilson teaches. How do you reconcile on the one hand him being wrong about so much, and on the other hand patients getting well with his treatment?

Dr. Lowe: It is nothing new for people to succeed at practical matters despite not understanding why. An example from another field is Adolf Hitler’s economic successes before world war II. (I hasten to add that in using this example, I make no association whatever between Dr. Wilson’s beliefs or teachings and Hitler’s hideous crimes against humanity. I use the example because it’s about the issue of some people succeeding at something and maybe not knowing why.)

Historian John Toland (who lost relatives in the holocaust) wrote, “Hitler’s achievements in the first four years [of his regime] had truly been considerable and impressive. Like Roosevelt, he had paved the way to social security and old-age benefits. And, like Roosevelt, he had intuitively divined that the professional economists, whose thinking was hobbled by accepted theory, had little understanding of the depression. Both leaders, consequently, had defied tradition to expand production and curb unemployment.”[1,p.403]

Toland then quotes economist J. Kenneth Gallbraith: “That a nation oppressed by economic fear would respond to Hitler as Americans did to FDR is not surprising.” Toland inserted, “Perhaps [Hitler] understood economics too little to know what he was doing.” Then he quotes Gallbraith again: “But in economics it is a great thing not to understand what causes you to insist on the right course.”

Perhaps that’s true in economics. But I can’t agree that in medicine it’s a great thing not to understand why a clinician does the right thing and helps patients. I believe that Dr. Wilson failing to know why his therapy helps some patients is a not so great a thing. The T3 therapy he recommends does indeed help many patients. Based on his book,[4,p.17] however, he is mistaken about why the therapy helps them.

For example, as I wrote in The Metabolic Treatment of Fibromyalgia,[2,pp.844-6] he claims that T3 increases body temperature, and the increased temperature activates enzymes that enable patients to get well. It’s true that in a research lab, raising the temperature of a petri dish may increase the activity of some enzymes in it. But inside the human body, the range of temperature changes is generally too small to markedly change the activity of enzymes.

Dr. Wilson has it backward: T3 doesn’t Increase enzyme activity by raising the body temperature; instead, it’s the other way around: T3 increases gene transcription for enzymes (such as sodium-potassium-ATPase), and the resulting increased enzyme activity raises the body temperature. The enzymes do this by cleaving phosphates off ATP molecules. The cleaving releases the energy that was maintaining the phosphate bonds. About half the energy is used to fuel chemical reactions. The other half is released as body heat.

This may seem trifling, and indeed, the issue of which comes first, increased temperature or enzyme activity, may only be an academic concern. But other issues I believe Dr. Wilson gets wrong have practical implications. For example, I don’t believe sustained-release T3 is the best use of T3. The reason? The longer T3 stays in the small intestine, the greater the chance that calcium and other agents in food will bind some of the T3. The binding will then carry the T3 out in the patient’s stool, reducing the amount that reaches his blood.

Moreover, Dr. Wilson’s idea that the enzyme that converts T4 to T3 gets “stuck”[3,p.2] is entirely without scientific substantiation.[2,p.280] In fact, the relevant research literature shows this notion to be close to the outer realm of possibilities. Directing treatment at a “stuck” enzyme is to therapeutically shoot way off target. In contrast, treatment intelligently directed at a target that is truly instrumental in causing a patient’s symptoms is far more likely to benefit the patient.

As may be with Hitler’s economic successes, Dr. Wilson’s treatment protocol enables some patients to get well, although I believe he doesn’t know why. Too of many of the mechanisms he proposes are refuted by the research literature. Therefore, I believe that what I wrote of the success of his treatment and the mechanisms by which it does so is consistent. Nonetheless, I appreciate you bringing the seeming inconsistency to my attention.

Reference
1. Toland, J.: Adolt Hitler. NY, Ballantine Books, 1976.
2. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, McDowell Publishing Co.,
2000.
3. Wilson’s Syndrome Patient Instruction Sheet. Publisher nor date designated.
4. Wilson, E.D.: Wilson’s Syndrome. Orlando, Cornerstone Publishing Co., 1991.

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.

December 10, 2007

Question: My internist is urging me to order your book The Metabolic Treatment of Fibromyalgia. Dr. Jones told me that the book is an encyclopedia of everything I’ll want to know about the thyroid field and that I should have it during my treatment. Your publishing company says that the book is on back-order. My doctor loaned me one of his copies, but he made me vow to bring it back. As I sat in his office and scanned the many informative chapters, I began to understand why he treasures it so much. The information seemed endless and it was as though someone had written a book about my symptoms that made sense. Do you know when the publisher will have new copies to sell? After reviewing my doctors’ copy, I am anxious to have my own.

Dr. Lowe: I talked with the publisher after I read your email yesterday. I was told that they’ve been shipping the newly printed and bound books for the last two weeks. If you’ll contact them, I’m sure they’ll get a copy to you quickly.

I’m sorry the publisher ran out of copies and you couldn’t get one when you first ordered it. The publisher keeps a tight check on the available inventory of the book. They do so to avoid running out of copies before having the book printed and bound again. But I was told that at times, so many copies are ordered at once that it cleans out what seemed like an adequate inventory. Then they have to wait for new copies to be printed, bound, and shipped to the fulfillment center. Sorry you got caught in the middle of one of those episodes.

I want to thank you for your letter; it gave me pause that has improved my state of mind, and I’m grateful. The pause your email gave me was for a specific reason. This past year has been especially difficult for me on a personal level and it has interfered with my ability to help those people who need help the most. As the year nears its end, though, your email reminds me that I have good reason to feel happy and fulfilled, no matter what the horrors of the last year.

The Metabolic Treatment of Fibromyalgia, my magnum opus, has been enormously successful in improving understanding, and through that, enabling doctors to relieve more of their patients’ suffering. I have to say, however, that more patients than doctors have bought the book and helped themselves.

I made the book an encyclopedic coverage of the fields of hypothyroidism and thyroid hormone resistance. In doing this, I used what we’ve called "fibromyalgia" as the main pattern of symptoms to illustrate vitally important points about thyroid-regulation of the body and mind. I pressed on for some ten years, working almost every waking hour, until the encyclopedic job was done. With the support of my editor, Jackie Yellin and her husband, Michael, I was able to complete this enormous task.

Looking back, Jackie, Michael, and I don’t know how we finished the book, and in all honesty, we don’t believe we could do it again. Despite that, The Metabolic Treatment of Fibromyalgia now exists. And although we’ll eventually add addenda in a second volume, every word in the book is as valid as it was when McDowell Publishing Company published it in 2000.

When I think of the good so many people say the book has done for them, the troubles of the last year dwarf into insignificance, and I feel that my goal of relieving as much human suffering as I can during my short time here has not been a frustrated commitment. Thousands of emails and letters of thanks from physicians and patients testify to the help the book has been. Moreover, when I think that Bjørn Johan Øverbye, MD, in Norway, was inspired by the book enough to spend a year doing research that turned out to confirm what he terms "The Lowe Thesis," I feel immense gratitude to him and great satisfaction with the book.

I guess I’ve digressed a bit. To get back to your question, the book is now available for prompt shipping. I sincerely hope that for you, the book justifies your internist’s confidence in it. My sincerest thanks for your email and best wishes for your holidays.

November 1, 2007

Question: Have you worked with any medical doctors in Anchorage Alaska? If so, could you pass on their name? I need a good doctor to work with me. Thank you.

Dr. Lowe: I regret to say that I haven’t worked or communicated with any doctors in your area whom I can refer you to. I trust that there are some quality practitioners there, but I just haven’t yet had the opportunity to communicate with any.

I think your best chances for finding a cooperative, scientifically-minded, up-to-date clinician is to go to the following website of the Functional Medicine Institute:

http://www.functionalmedicine.org/resources/healthpractitioners.asp

If you click on the "Find a FM Practitioner" link, you may locate a quality clinician in your area. Keep in mind that the clinician who’ll serve your needs best may be any one of the different types of physicians, an MD, DO, ND, or DC. Or the clinician may be a nurse practitioner, physician’s assistant, or another type of practitioner. The scope of practice of the different types of clinicians may differ somewhat, but what's most important is the functional medicine orientation.

I spoke at the annual conference of the Functional Medicine Institute this part year. My wife, Tammy, and I had the privilege—and I sincerely consider to have been a privilege—of spending a lot of time talking with clinicians who are members of the Institute.

I must say, I’ve never interacted with another group of clinicians with whom I was more impressed. They were truly inspiring. They were open-minded and eager to learn cutting-edge methods from scientific natural medicine. Of extreme importance to me, they were earnest and passionate about acquiring whatever new information they could use to help their patients get well. And in addition, I’ve never encountered a group of clinicians who, as a whole, had a more accurate understanding of rational clinical methods for treating hypothyroid and thyroid hormone resistance patients.

I wish you the best for finding a functional medicine clinicians in your area.

October 29, 2007

Comment: I admire your courage for speaking against Dr. Honeyman’s statements about metabolic rehabilitation. A similar situation happened to me years ago after I taught a surgical resident a technique I developed. The surgical resident that I mention here returned to his country, changed my technique a little, then lied by saying he created the whole technique himself. He then used the altered technique to build a profitable reputation and career. I was most upset over the change he made to the technique because this made it less effective for the patients I developed it for.

For years, I protested the reduced effectiveness of the technique. My protests, however, drew accusals that I was only jealous of the successful reputation of the younger surgeon. Few surgeons and other physicians cared about the true basis of my protests. After several years, I stopped protesting and watched him build a name for himself based on his alteration of my technique.

I expect that like I, you have taken barbs for speaking out and protesting. By making the truth known, however, you may avoid some bitterness I have had since my former resident’s degradation of my technique. Knowing this first hand, I sympathize with the protest you wrote, and again, I admire you for speaking out.

Dr. Lowe: Thank you for your sympathy over this issue. In turn, I empathize with your feelings from your experience with your former resident. What’s most unfortunate, of course, is that your surgical technique, revised for your former resident’s personal gain, may help patients less than the technique you originally formulated. To me, that’s not jealousy; it’s a matter of humane concern for the patients for whom you developed the surgical technique.

I suppose the outrage you and I have felt is a price some doctors pay for our pro bono contributions to humanity. Other innovative doctors go about it another way: they patent the procedures they develop and then sell them to other clinicians through binding contracts. One could say that these other doctors are wiser than you and I. Maybe that’s true: the patents they take out and contracts they make may protect the integrity of the procedures they develop and thereby ensure that patients gain from the procedures as they were originally developed.

However, if I had to once again originate and develop metabolic rehab, I would do it the same as before—widely publish how it’s properly done and encourage as many doctors and patients as possible to use it. I created the protocol to help relieve as much human suffering as possible. Because of this, widespread use of the protocol is more important. This is far more important to me than contractually keeping another clinician from misrepresenting it, as contracts might limit the clinicians who’d use the protocol. Instead of contracts, I’ll use my freedom of speech and continue to speak out to protect the protocol’s integrity and to promote its use.

Again, thank you for your sympathetic letter. And please accept my condolences for the misrepresentation of your surgical technique.

October 22, 2007

Question: I asked my family doctor to let me try T3 therapy and she has agreed. She told me, however, that if I take too much and get overstimulated, it may take a few weeks for me to get over it. Is it true that I may be overstimulated that long?

Dr. Lowe: If your doctor is concerned about you taking too much T3 for you and being overstimulated, I suggest that you ask her to prescribe a small quantity of propranolol tablets, as a safety net. Propranolol is a general beta-blocker, and usually, 20-to-30 minutes after swallowing it, overstimulation of tissues stops.[1,p.766] This is true whether T3 or T4 causes the overstimulation. The relief from a single dose of propranolol, in my experience, may last from two-to-eight hour.

Of course, patients who have asthma should not use beta-blockers. For them, it’s usually better just to wait for the overstimulation to subside. Just waiting works fairly quickly if the patient gradually reduces his or her dose of T3,[2,p.394-395] starting with the next dose. After decreasing the dose, abnormally fast metabolism from T3 usually decreases within 1-to-2 days. From taking T4, however, metabolism may slow only after 10-to-14 days.

As I wrote in The Metabolic Treatment of Fibromyalgia,[3,p.1022] excessively rapid metabolism slows down even faster than 1-to-2 days in some patients when they reduce their T3 dosages. I’ve read reports of different times for the offset of symptoms of overstimulation after patients stopped T3 or reduce their dosages. The reports are consistent with my clinical experiences.

Tittle, for example, wrote that when his patients had adverse reactions to T3, the reactions disappeared within several days after the patients lowered their dosages of T3 or stopped it altogether.[4,p.273] In contrast, Wiener and Lindeboom reported that they gave a patient a dose of 300 mcg of T3 each day for two weeks. They wrote, "The patient grew restless and nervous, her eyes gleamed, and she complained of headache, cold perspiration, and palpitation. Her pulse rate was 120." Her symptoms of overdosage disappeared, they wrote, in the course of the same day when they reduced her dosage to 150 mcg (50 mcg three times per day).[5] I, too, have seen this rapid offset of overstimulation, although for most of my patients, relief has taken a day or two.

References

1. Dillmann, W.H.: The cardiovascular system in thyrotoxicosis. In Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text, 6th edition. Edited by L.E. Braverman and R.D. Utiger, New York, J.B. Lippincott Co., 1991, pp.759-770.

2. Sawin, C.T.: The development and use of thyroid preparations. In The Thyroid Gland: A Practical Clinical Treatise. Edited by Van Middlesworth, Chicago, Year Book Medical Publishers, Inc., 1986, pp.389-403.

3. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, McDowell Publishing Co., 2000.

4. Tittle, C.R.: Effects of 3,5,3’ l-triiodothyronine in patients with metabolic insufficiency. J.A.M.A., 162:271-273, 1956.

5. Wiener, J.D. and Lindeboom, G.A.: Observations on an unusual case of myxoedema. Acta Endocrinol., 39:439- 456, 1962.

October 7, 2007

Question: My doctor believes that T4 primarily effects the neuropsych arena, the brain, and that the best symptoms to monitor are cognitive function and mental sharpness. He believes that T3 primarily effects the peripheral parts of the body, with the best symptoms to monitor being coldness, fatigue, heart rate, hair, skin, nails, and constipation. Because of this, he prescribes Synthroid, which is T4 for depression and poor memory, and Armour, which has T3, for the rest of the body. Is there any evidence of this?

August 19, 2007B

Question: During the past 5 weeks I have been attending a weight-loss program and have lost 11 pounds. I need to lose at least another 3 stones [a "stone" is a British weight unit equivalent to 14 pounds]. However, I have not felt well whilst on this diet despite eating "healthily." In fact some of my hypothyroid symptoms have returned, and I’m feeling very tired, breathless, and am losing hair, and so on. I recently had a blood test which showed TSH 0.02 (0.35-4.5), T4 24.4 (11-26), T3 4.6 (3.9-45.8). Apart from the TSH, all levels are within the range given. My questions is, please: Does weight loss unbalance one's thyroxin levels? I would be so grateful for any advice, as I’m at a loss of how to help myself.

Dr. Lowe: I’m sorry you feel at a loss, but I really don’t think you have reason for concern. I say this because your TSH and thyroid hormone levels are what we expect in most people when they severely restrict their calorie intake. Based on the relevant studies, these altered levels will reverse back to their usual levels, even if you continue to restrict your calorie intake.

You wrote that your TSH was out of range, and your T4 and T3 levels were in range. However, it’s important to note that your T4 was in the upper end of its range, and your T3 was in the lower end of its range. If your levels weren’t the same before your began dieting, then the answer to your question about thyroxine is yes: weight loss through calorie restriction can alter your thyroxine level, but also your TSH and T3 level. If calorie restriction is severe enough, the T4 level usually goes up, often into the upper end of the range, where yours is.

Our understanding of what happens to our hormone levels during calorie restriction comes partly from studies of anorexic patients.[1] When humans, including those with anorexia, lose substantial weight quickly, the person is stressed, and this causes her cortisol level to rise. When the cortisol level rises far enough, the cortisol suppresses the thyroid system. It suppress the system in two ways: First, the cortisol inhibits TSH secretion, lowering the TSH level; second, the cortisol inhibits the enzyme that converts T4 to T3, raising the T4 level and lowing the T3 level. Your TSH and thyroid hormone levels exactly fit this high-cortisol-induced pattern: a lower TSH, a higher T4, and lower T3 level.

Again, I caution you not to fret over this lab pattern. If your cortisol level is high and suppressing your thyroid system, the suppression is transient. When your cortisol level comes down, then your TSH and thyroid hormone levels will return to their usual levels. This usually takes 1-to-3 weeks.[3][4][5] [3][4][5]

Keep in mind, however: if your dieting-raised cortisol level remains high for some reason, your thyroid system will most likely escape from the cortisol suppression. The same is true for the patient who is taking cortisol analog drugs such as prednisone and prednisolone for a prolonged time: her thyroid system is almost certain to escape the suppression within weeks.

This well-documented escape of the thyroid system is something Dr. Dennis Wilson apparently wasn’t aware of when he formulated and disseminated one of his beliefs. That belief is that high cortisol causes the enzyme that converts T4 to T3 to get "stuck" in some people. When it sticks, and the people then generate too little T3 from T4, they develop symptoms of too little thyroid hormone regulation. Wilson crowned these symptoms "Wilson’s syndrome." (I discuss this matter at length in the section titled "Reverse-T3 (rT3)" on pages 806 and 807 of The Metabolic Treatment of Fibromyalgia.[2])

As I said, you don’t have to be concerned about this enzyme becoming stuck in you. My friend and colleague Richard Garrison, MD, and I looked long and hard for lab evidence that Wilson’s theory of a stuck enzyme was right. After a year or so of laboratory testing of patients, we failed to find evidence that Wilson was right.

I know that losing weight is tough for many people, and want you to know that I admire you for going through the process of losing the 11 lbs. I hope that what I’ve written here will give you an understanding why your TSH and thyroid hormone levels are as they are. From that, I hope you’ll continue on with your weight lose program without worry over these temporarily altered levels.

References
1. Natori, Y., Yamaguchi, N., Koike, S., et al.: Thyroid function in patients with anorexia nervosa and depression. Rinsho Byori, 42(12):1268, 1994.

2. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, 2000.

3. Nicoloff, J.T., Fisher, D.A., and Appleman, M.D.: The role of glucocorticoids in the regulation of thyroid function in man. J. Clin. Invest., 49:1922, 1970.

4. Alford, F.P., Baker, H.W.G., Burger, H.G., et al.: Temporal patterns of integrated plasma hormone levels during sleep and wakefulness. I. Thyroid-stimulating hormone, growth hormone and cortisol. J. Clin. Endocrinol. Metab., 37:841, 1973.

5. Brabant, A., Brabant, G., Schuermeyer, T., et al.: The role of glucocorticoids in the regulation of thyrotropin. Acta Endocrinol. (Copenh), 121:95, 1989.

August 19, 2007

Question: I sent you a question by email, and the next day I saw something that horrified me. You posted my question about my personal medical problem to your website at AskDrLowe@drlowe.com. I’m shocked and disappointed that you obviously have no concern that my family and friends might know that I’m the person who wrote to you. Don’t you care about people’s privacy? How can you claim to want to help people but then put them at risk of embarrassment this way?

Dr. Lowe: I care a great deal about other people’s privacy, and I avoid any potentially embarrassing disclosure of information people send to me at AskDrLowe@drlowe.com. For the reason I give below, your upset is not warranted, and I hope you calm down after reading it.

When I wake up from sleep (usually in the early morning hours, and then again after a nap before my clinic duties start), my first action is usually to turn on my computer. Then I go online to read the new emails at AskDrLowe@drlowe.com, where I found yours. Some days I see only a few new emails, and others days I find upwards toward a hundred.

Among the new emails, I first look for ones that suggest the writers may be suicidal. I answer those first. I give their questions top priority because I feel that it’s imperative to quickly give them any hope or practical help I can.

Next, I look for another category of emails: those that contain virtually the same question as several other emails I’ve read that morning—or, sometimes, many other emails I’ve received over the last month or so. Some days, five, ten, or more emails contain practically the same question, often word-for-word. I give the question in these emails second priority. I do this because I assume answering multiple emails containing the same question gives me the chance to do something important: save time writing different versions of the same answer, and, through a single answer, help more than one person at once.

When I answer these multiple emails on AskDrLowe@drlowe.com, I don’t, of course, post all the people’s emails along with my answer. As I said, the authors of the emails ask basically the same question. It would be repetitious to my readers to read all the emails.

To answer the question the writers have asked, I often select one of the emails—the one that most clearly expresses the question all have asked. Sometimes I post the author’s email exactly as he or she wrote it. But most of the time, I edit the question (as little as possible) for two reasons: to make it concise, and to make sure it clearly expresses the specific concern of all the writers.

On the day I opened and read your question, I’d received several others that asked basically the same question. That question in the other emails could have been written by you almost verbatim. As it happened, however, I did not use your email as the one to edit and answer.

You seem to feel that you and your health problem are widely known by the general public—so much so that describing the problem is, to you, certain to reveal your identity, and, as a result, we’re all sure to see your picture on the front page of the Inquirer as we stand in line at supermarket checkout counters. Of course, you may be Brad Pitt or Bill Clinton. If so, please understand that scores of thousands of others share exactly the health problem you have. That assures your anonymity. This is especially true in that I didn’t publish your name in the Q&A, and the question in the Q&A isn’t in your rather distinct writing style.

I regret your upset, but this matter is really nothing for you to be upset about.

August 18, 2007

Question: My 12-year-old daughter has symptoms that her pediatrician said are fibromyalgia. From reading what you’ve written on drlowe.com, I know that you’ve proven that fibromyalgia is really hypothyroidism. When I told her pediatrician this, he tested her TSH. He said it was normal so she’s not hypothyroid. But I also know from reading drlowe.com and ThyroidUK.org that the TSH is not a good test for hypothyroidism. My husband and I want to bring our daughter to your clinic to see if her metabolic rate is low. My question is, do you only test the metabolic rates of adults, or can you test children, too? Keep in mind that she’s only 12-years-old.

Dr. Lowe: We do measure the resting metabolic rates of children, just as we do adults. However, there is an important difference in calculating the metabolic rates of children and adults.

In calculating a child’s metabolic rate, I use equations that are different from those for adults. Fortunately, through the 20^th century, researchers developed equations that are appropriate to different age groups.

Because of this, when we measure the metabolic rate of a child, I use the equations that are appropriate for the child’s age group. Otherwise, if I used equations appropriate for adults, I would reach a wrong conclusion about the child’s metabolic rate. For quality metabolic testing, then, age-specific equations are essential. It took me several years to accumulate the different equations scattered through many journals, some of them published in languages other than the only one I speak, English. But I do have them to use, depending on the age of a child.

By the way, you wrote, "I know that you’ve proven that fibromyalgia is really hypothyroidism." My specific conclusion is, "too little thyroid hormone regulation is the main underlying mechanism of most patients’ fibromyalgia." I have a special reason for this specific statement. That is, most doctors think of hypothyroidism as a thyroid hormone deficiency; however, the cause of many patients’ fibromyalgia is not a thyroid hormone deficiency, but is instead peripheral resistance to thyroid hormone. So, I usually state that most patients’ fibromyalgia is underlain by either a thyroid hormone deficiency, or thyroid hormone resistance.

However, you can use the terminology of my friend and research colleague Richard Garrison, MD that he used in my book The Metabolic Treatment of Fibromyalgia.[1,pp.322-323] Accordingly, by analogy to diabetes: a thyroid hormone deficiency is "type I hypothyroidism"; and thyroid hormone resistance is "type II hypothyroidism." Using his terminology, your statement is correct: most patients’ fibromyalgia is underlain by hypothyroidism—a disorder for which the TSH is not a valid or reliable test.

Reference

1. Lowe, J.C.: The Metabolic Treatment of Fibromyalgia. Boulder, McDowell Publishing Company, 2000.

August 4, 2007

Question: My medical doctor told me that I have fibromyalgia. But my chiropractic physician says she thinks I have thyroid resistance. When she takes my thyroid blood tests, however, they keep coming up negative, and my medical doctor says that this shows nothing is wrong with my thyroid. I just want to know. Do I have fibromyalgia or is it thyroid resistance? Can you send me something I can give my doctors to explain which of these I have?

Dr. Lowe: With the little information you gave, I can only answer you in general terms about the two disorders you mentioned—fibromyalgia and thyroid hormone resistance. Feel free to give my answer to your question to both your medical and your chiropractic doctors. Hopefully my answer will clarify for them—and you—that what one of them calls "fibromyalgia" can be exactly the same as what the other calls "thyroid hormone resistance."

First, though, let me say that I’m sincerely sorry you’ve been suffering. I’m especially sorry that your suffering is complicated by confusion over what disorder underlies your symptoms, and what to do to alleviate it.

My research shows that what we call "fibromyalgia" is, for the most part, several signs and symptoms caused mainly by too little thyroid hormone regulation. The inadequate thyroid regulation may result from a thyroid gland disorder that causes it to produce too little thyroid hormone. We call this disorder "primary hypothyroidism." On the other hand, your symptoms may result from a failure of your hypothalamus or pituitary gland (two structures in your brain) to properly regulate your thyroid gland. When improperly regulated, the gland can produce less than optimal amounts of thyroid hormone. This disorder is called "central hypothyroidism."

Then again, your fibromyalgia symptoms may result from what we classify as peripheral thyroid hormone resistance. (I’ve championed the diagnosis and treatment of peripheral thyroid hormone resistance for some twenty years. Because of this, I possibly have more experience treating this particular disorder than anyone else.) TSH, free T4, and free T3 levels are "normal" when a patient has this particular form (the peripheral form) of thyroid hormone resistance. As a result, the TSH, free T4, and free T3 levels are completely useless for distinguishing which patients have or don’t have peripheral thyroid hormone resistance.

Many doctor and patients are confused about why the TSH, free T4, and free T3 levels are normal in peripheral resistance patients. However, we understand clearly why these blood hormone levels are useless when it come to diagnosing or treating peripheral thyroid hormone resistance. The reason is that in this disorder, the pituitary gland responds normally to thyroid hormone. When the thyroid hormone level rises, the TSH goes down, and when the thyroid hormone level goes down, up goes the TSH. This relationship, of course, is the normal interaction of the pituitary and thyroid glands.

But in patients with peripheral resistance, tissues other than the pituitary gland respond sluggishly to the normal levels of free T4, and free T3. Because of these peripheral tissues’ sluggish response, "normal" amounts of free T4 and free T3 are too little properly regulate the metabolism of the tissues; patients must have larger amounts of T4 and T3 to keep the metabolism of most peripheral tissues normal and the afflicted patients free from symptoms. Without larger amounts of the hormones, patients suffer symptoms associated with deficient regulation of the tissues by thyroid hormone—just as if they had a thyroid hormone deficiency.

For millions of patients, thyroid hormone under-regulation of tissues other than the pituitary gland causes classic (and historically-documented) symptoms of characteristic of hypothyroidism. The symptoms, for the most part, are the same as those of fibromyalgia: chronic pain and abnormal tenderness, stiffness, fatigue, cold intolerance, dry skin, hair loss, depression, poor memory and concentration, and exercise intolerance. Doctors, such as your medical doctor, typically diagnose patients with these symptoms as having "fibromyalgia." The doctors simply fail to understand that for these patients, so-called "normal" amounts of T4 and T3 are woefully inadequate to maintain normal metabolism and health.

So, if you and your medical and chiropractic physicians differ on what to call your condition, both may be right: by current convention among doctors, the term "fibromyalgia" is appropriate. But the underlying mechanism, and the real disorder from which you suffer may be "thyroid hormone resistance." Where both your doctors may be wrong is in believing that the two labels refer to two different disorders. For many patients, the two labels are simply different names for exactly them same condition.

If you do have peripheral thyroid hormone resistance, the treatment for it is pretty straightforward. For almost all patients, effective thyroid hormone treatment involves the use of the thyroid hormone T3 (the plain, non-sustained-release form). Your medical doctor can prescribe this. However, to function normally, resistant peripheral tissues must be exposed to higher than so-called "normal" amounts of thyroid hormone. Although these "supraphysiologic" doses of thyroid hormone usually free patients from their symptoms, they also suppress patients’ TSH levels. This bothers most doctors because the endocrinology specialty has misled them into thinking that TSH suppression is harmful. Nonetheless, for these patients, no TSH suppression means no improvement or recovery.

However, I strongly recommend that you stay under the care of your chiropractic physician. As epidemiological studies have shown, her care (along with massage therapy) is likely to give you palliative improvement of your symptoms until you undergo appropriate metabolic treatment.

If you do have thyroid hormone resistance but can’t get a decisive diagnosis and proper treatment in your home town, we’ll be happy to evaluate you at our clinic and research center. Or, if your local doctors will be cooperative, we may be able to guide you long distance to improvement or recovery. Either way, give Tammy at 603-391-6061.

I hope this answer at least mitigates your confusion to some degree, and that of your doctors as well. Best of luck for a quick recovery from your symptoms, no matter what you choose to call the underlying cause.

July 26, 2007

Question: I recently read a book posted on a website about undiagnosed viruses preventing women from getting pregnant. My husband and I have been trying to get pregnant for three years with no success. I suspect that the book may be right, and I may have a viral infection that is preventing me from getting pregnant. I was on T4-replacement for several years, but I never felt well on it. Because of this, my family doctor switched me to Armour Thyroid. I am now on 2 grains. My TSH level is now suppressed, and this concerns me. But what am I to do? If I have to suppress my TSH level to strengthen my immune system, am I in danger of causing more problems?

Dr. Lowe: It may be true that your inability to become pregnant over the last three years is due to some microbial infection, such as a low-grade, chronic viral infection. Even so, microbial disruption of body functions (maybe fertility included) often results from too little thyroid hormone regulation of the immune system. (I extensively cover the research evidence for this in Chapter 3.13 of The Metabolic Treatment of Fibromyalgia).

Many patients free themselves from chronic or recurrent infections by switching from T4-replacement (usually with Synthroid in the US and Canada) and using more effective products such Armour. I’ve been involved with thyroid hormone therapy for the last twenty years. During those years, many times, women patients of mine have became pregnant after switching from T4-replacement to Armour or similar products. Of course, they had to use doses high enough to be effective, not the namby-pamby doses that doctors typically allow their patients to use. Perhaps for some of these women, fertility came about from enhanced immune function from the more effective thyroid hormone therapy.

The 2 grains of Armour you’re taking may seem high to some doctors. However, this wasn’t the case going back some forty years or so ago. Before then, doctors allowed patients to use higher dosages. The dosage range that was safe and effective was generally 2 to 4 grains.

As you can see from this, you’re at the lower end of the historic safe and effective dosage range. In view of this, you may recover strong immune function and fertility simply by gradually and cautiously increasing your dosage of Armour. This may work for you by enhancing your immune system and relieving and infection. On the other hand, it may work simply by better regulating your sex hormone system. For your purposes, it probably doesn’t matter.

Whether your TSH is suppressed or not is, in my opinion, irrelevant; I know of no scientific evidence that a suppressed TSH level will adversely affect you in any way.

July 1, 2007

Question: I am a 41-year-old woman. Five years ago, part of my thyroid gland was surgically removed because of a tumor that turned out to be benign. My TSH level was normal, so my doctor didn’t prescribe thyroid hormone. In the last year, however, some symptoms have come up that seem like hypothyroid symptoms to me, and I’m concerned about them. I’ve gained 50 lbs, my hair is falling out, and white patches have come up on my hands and nose. They bother me because I have a dark complexion. My doctor says the patches are vitiligo. I searched the Internet and found some sites that say vitiligo may be caused by hypothyroidism. Do you think all this means that I have another tumor in my thyroid gland?

Dr. Lowe: I’m sorry about your weight gain and hair loss, and that you’ve developed vitiligo. (For readers who aren’t familiar with vitiligo, it’s a skin condition. It's pronounced vit" l i’ go, with the last i pronounced as in ice. The patient has smooth, white skin patches on various parts of his or her body. The skin turns white because it loses its natural coloring pigment.) I get inquiries about vitiligo and thyroid disease fairly often, so your concern is shared by some other readers of drlowe.com.

Vitiligo is not associated with a thyroid hormone deficiency per se; instead, it’s associated with autoimmune disease of the thyroid gland. Researchers think vitiligo is itself an autoimmune disease—one that in many people is associated with autoimmune thyroid disease.[1][2]

Your history of thyroid gland disease, weight gain, hair loss, and vitiligo raises the possibility that you now have anti-thyroid antibodies. I think this is more likely than another thyroid gland tumor having formed. Your doctor, of course, should rule out that possibility. But I think autoimmune thyroid disease is far more likely, and I strongly recommend that your doctor measure your thyroid antibody levels.

If you have high antibody levels, you may have become hypothyroid. If so, you may have gained weight and lost hair from your thyroid hormone deficiency. And, your vitiligo may have developed as an autoimmune skin process associated with your autoimmune thyroid disease. Please let me know when you learn whether your thyroid antibodies are high. Best of luck.

References

1. Trbojeviæ, B. and Djurica, S.: Diagnosis of autoimmune thyroid disease. Srp. Arh. Celok. Lek., 133 Suppl 1:25-33, 2005.

2. Niepomniszcze, H. and Amad, R.H.: Skin disorders and thyroid diseases. J. Endocrinol. Invest., 24(8):628-638, 2001.

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?

April 22, 2007

Question: My doctor recently diagnosed me as having hypothyroidism. She prescribed Synthroid. She started me on 50 mcg and then increased it to 75 mcg. Before starting the drug, I’d become a little foggy headed and was tired, which was unusual for me. But after starting it, I became outright miserable. I was depressed for the first time in my life, and I was so tired that I could hardly get out bed. I became constipated, and I could hardly think at all. My thinking was so bad that I was afraid I was going to lose my job. Because the drug made me so miserable and dysfunctional, I stopped it. That was three weeks ago, and I’m starting to feel better now. My doctor is convinced that I had some coincidental illness, and she wants me to start taking Synthroid again. I disagree with her. The relation is just too clear cut. I felt like crap after starting the drug, and after stopping it, I’m feeling better. Do you have any idea why I would react to the drug this way?

The second possible reason for your bad reaction to Synthroid is that T4-replacement simply won’t work for you. It doesn’t work for many hypothyroid patients. In a recent study in the United Kingdom, for example, T4-replacement left 50% of patient suffering from hypothyroid symptoms (Saravanan, P., Chau, W.F., Roberts, N., et al.: Psychological well-being in patients on ‘adequate doses of L-thyroxine: results of a large, controlled community-based questionnaire study. Clin. Endocrinol. (Oxf.), 57(5):577-585, 2002.) Unfortunately, through faulty reasoning, these researchers concluded that a much smaller percentage of patients suffered from symptoms despite being on T4-replacement. They are mistaken about the percentage. The evidence is overwhelming that T4-replacement is the lousiest approach to thyroid hormone therapy. I’ve documented the widespread failures of the approach in two critiques:

April 21, 2007

Question: I was taking vitamins, but I didn’t see that they were helping me, so I stopped. I just don’t see why you push nutritional supplements so much on your website and in your books. Do you make money off them?

Dr. Lowe: First let me say that unlike many doctors, I have no vested financial interest whatever in any nutritional product. Nor do I resort to the ploy that I donate royalties from supplements to charity. I don’t sell them or profit from them financially in any way.

That issue aside, I’d like to address an issue that could make all the difference in you being relatively healthy and youthful throughout your life. Many patients have told me they felt much better after they started taking nutritional supplements. I even know of a few people whose fibromyalgia and other hypothyroid-like symptoms ceased after they started taking supplements.

Conversely, many people who begin taking supplement for the first time see no dramatic benefits over night. That seems true for you. That being the case, rather than you abandoning supplements, I encourage you to consider the subtle benefits of taking them.

Take, for example, the reduction of free radicals in your body. These are atoms or molecules that have unpaired electrons in their outer shells. These unpaired electrons make the atoms or molecules extremely reactive. They are so reactive that they set off rapid chain reactions. These destabilize other molecules and produce many more free radicals. Antioxidants available in supplements deactivate free radicals.

Anti-aging experts have long argued that free radicals are the main agents of aging. Reduce your body’s free radical content, they argue, and you’ll age more slowly and maintain a more youthful appearance, even into old age.

I had the opportunity to witness a case in point when I was in chiropractic college. Once a month, I attended a meeting of a health organization in Los Angeles. Another often attendee was the beautiful silent-movie actress Gloria Swanson. She was an avid health enthusiast. So was her last husband, William Duffy. He wrote the famous book Sugar Blues, a vade mecum of John Lennon and other anti-sugar advocates. One author wrote, "Gloria was insane about the use of sugar. I mean she would go ballistic if someone used it around her. She claimed that America lost the Vietnam War because of sugar."

Gloria was seventy-five-years-old then, but she was youthful and beautiful enough to hold the attention of most of the men at the meetings—despite the presence of much younger attractive women. Had any of us guys had the chance to leave the meeting with one of the women, it would’ve been Gloria.

Nutrients such as vitamin C reduce free radicals in our bodies. But while they are doing this, no flashing neon gauge pops into the forefront of our minds with a needle telling us how low our free radicals have dropped. We have no immediately perceptual gauge that lets us how much we’ve benefited. But despite that, benefited we indeed have.

What I recommend is that you study credible nutritional literature and come to understand the subtle ways that various supplements can help you over the long haul. You can get high-quality supplements for a modest price, and ingest them quickly each day. The price and time are well worth many the subtle benefits you’re likely to get from them over the years. For example, you may avoid dying of heart disease, and you may stave off cancer. And, at seventy or eighty years old, you may well turn young men’s heads the way Gloria Swanson did mine.

March 9, 2007

Question: My doctor said he wouldn’t mind treating my fibromyalgia with thyroid hormone, but first he has to have proof that your approach is scientific. I loaned him my copy of Your Guide to Metabolic Health, but he said that what he wants is  more "academic proof." I asked what he meant by that and he said "studies and journal articles." If you have that kind of proof, can you send it to me so I can let him see that you are scientific?

Dr. Lowe: I understand your doctor’s concern for what he calls "academic proof." He seems to be oriented toward what we call "evidence-based medicine." I, too, am oriented that way, so I appreciate what he’s asking for.

What I first recommend is that you download and print (doing so is free) the two studies I completed and published late last year. These studies provided the final pieces of the puzzle we call "fibromyalgia." The two studies alone should convince your doctor of the scientific credibility of my main argument about fibromyalgia: that too little thyroid hormone regulation causes most patients’ symptoms. Below are the links to the two published studies. You can download them as pdf files and give them to your doctor:

Report at Medical Science Monitor:

 http://www.medscimonit.com/medscimonit/modules.php?name=Current_Issue&d_op=summary&id=8851

Report at Thyroid Science: http://www.thyroidscience.com/experiments.htm

Of course, we have summaries of our previous studies online at drlowe.com. I included the full text of these other studies in an appendix of my book The Metabolic Treatment of Fibromyalgia. I recommend that you get a copy of this book and share it with your doctor. In the book, I cover every aspect of fibromyalgia—massively documenting from the scientific literature the relationship  of each aspect of fibromyalgia to hypothyroidism and peripheral thyroid hormone resistance. By looking at the reference sections of the chapters, your doctor will see that I backed up my arguments with more than 6,000 references to scientific publications.

Oddly, many patients have told me that merely the impressive appearance of this hardback book, The Metabolic Treatment of Fibromyalgia, has melted their doctors’ resistance to treating them with thyroid hormone. I would prefer, of course, that the book’s contents rather than its appearance convince doctors that my approach is scientific. But then, many doctors have told me that they first tested my treatment approach in their practices. When they got positive results with their patients, only then did they go back to the book. They read it in earnest and discovered that the treatment that works for their patients is, indeed, scientifically based.

I can’t really argue that a doctor should come to the truth about fibromyalgia through reading rather than by clinical experience. What’s most important is that they arrive at the truth—not how they happen to get there.

February 22, 2007

Question: My doctor diagnosed low cortisol and has me taking 20 mg of cortisol each day. I am concerned about taking too much, but she told me that 20 mg is a safe dose. What are the symptoms of too much cortisol so that I can watch for them? How much cortisol is too much?

Dr. Lowe: I have included below a list of the symptoms, signs, and test results when patients have severe excess cortisol. Keep in mind that factors other than excess cortisol can cause most of these symptoms, signs, and test results. Because of this, just because you have one or more of these features  doesn’t necessarily mean you’re taking too much cortisol.

Also bear in mind that what is too much cortisol for a patient is an individual matter: What is too much for one patient may be too little for another, and vice versa. Moreover, some patients’ tissues are partially resistant to cortisol, and they have to maintain a higher body level of cortisol than others to be free from cortisol deficiency symptoms and signs. Cortisol resistance is now a scientifically established disorder, but I don’t believe researchers have established the incidence in the population. If a patient suspects he has cortisol resistance, it is crucial that he work with a doctor who is knowledgeable about the disorder and experienced in working with cortisol resistance patients.

My treatment team has worked with some patients who over medicated themselves with cortisol. The patients developed the symptoms and signs of cortisol excess only after several months of taking very large daily doses—several times the 20 mg you’re taking.

As I said, though, how patients respond to different doses of cortisol is an individual matter. Because of this, it’s hard to say what will be excessive for any particular patient. However, it is important for patients to stay within the range considered “physiologic” rather than “pharmacologic.”

“Pharmacologic” refers to the large doses of cortisol analogues (such as prednisone) that doctors use—hopefully briefly—to suppress inflammation. Pharmacologic doses are often used to treat conditions such as severe acute asthma.

“Physiologic” refers to maintaining a body level of cortisol that the adrenal cortices would maintain, were they capable of doing so. One aim, then, of physiologic cortisol therapy is to give the patient just enough cortisol to make up for what his adrenal cortices should be but aren’t providing.

Because of individual variability, it’s best for each patient to work with a knowledgeable doctor to decide what is for that patient a physiologic dose. But I agree with your doctor: your dosage of 20 mg is mostly likely well within the harmless physiologic range.

Symptoms, Signs, and Test Results in Cortisol Excess
O Weakness	O Reduced resistance to infection
O Muscle wasting	O Edema
O Poor wound healing	O Easy bruising
O Obesity of the trunk of the body	O Purple striae (stripes) on the abdomen
O Fat pads above the collar bones	O Fat collection at the junction of the back of neck and upper back ("buffalo hump")
O Skin that is thin and atropic	O Plethoric (overfull, turgid, inflated) appearance
O Rounded "moon" face	O High sodium & low potassium levels
O Psychological disturbance such as mood swings	O Slender arms and fingers and legs and toes
O Glucose intolerance	O Excessive hair growth (hirshutism)
O Kidney stones	O Menstrual irregularities such as amenorrhoea (absence of periods)
O Osteoporosis	O High blood pressure

January 4, 2007

Question: My daughter is now 12 and was born without a thyroid—at least that's what everyone thinks. Her TSH was over 730 at birth and again two weeks later, so she has been on Synthroid since. She has grown in height very well but has always been overweight. She was also diagnosed with celiac disease a year ago. We have switched endocrinologists several times because they just don't seem to hear what we are saying. In addition, she had hallucinations and depression a few years ago and is now on Zoloft. I am convinced that most of this has to do with the thyroid. The reason is that both times her levels of TSH were checked, they were high. But her doctors assured me the high TSH levels didn't have anything to do with her symptoms, although what I read contradicts this. My daughter also sees a pediatric GI specialist and must take Miralax, a drug for constipation, every day to keep her regular. Before that, she would go a very long times between going to the bathroom. I am now taking her to another doctor that is not an endocrinologist but will hopefully look a her T3, too. My daughter is an intelligent 12-year-old girl. She is overweight. She does exercise a little and watches her diet. Currently she is on 0.175 mg Synthroid, and her TSH is 0.14. She clearly still exhibits some hypothyroid symptoms. What do you think?