Hypothyroidism and T3: Articles by Doctors
Purpose of this compilation
To show that treating hypothyroidism with T3 (triiodothyronine) in addition to T4 (thyroxine) has a scientific as well as a clinical basis, and that for many hypothyroid patients, supplementing with T4 alone does not constitute adequate treatment.
See the other compilations of articles by doctors:
A. Scientific basis for T3 treatment
B. Clinical basis for T3 treatment
A. Scientific basis for T3 treatment
1. Richard I. Gracer, MD: "Hypothyroidism (low thyroid)"
T4 is converted to T3 at cellular level by a specific enzyme. T4 is not actually used by the cells. T3 is the active hormone. It seems clear that the enzyme that changes T4 to T3 may be deficient, causing symptoms of hypothyroidism even in people who have normal T4 levels. These patients need to take T3.
2. John C. Lowe, MA, DC: "drlowe.com Most Recent Q&As"
[March 12, 2003] Doctors commonly prescribe a variety of drugs to control hypothyroid symptoms that continue despite patients' use of T4. In stark contrast to T3, most of these drugs have long lists of potentially harmful effects. The safety of T3 use starkly contrasts with the risks of using the other drugs.
[November 19, 2000]...this [T4 only] mandate is not scientifically based. Instead, it's based on a powerful marketing campaign of a major pharmaceutical company....As a result, they [conventional endocrinologists and other doctors] 've deprived themselves of clinical experience with any thyroid preparation other than T4.
3. John C. Lowe, MA, DC: "What Your Hypothyroid Patients Should Know about Synthroid"
...T4 does not increase the metabolism of many patients' tissues, no matter how high the dosage. Only a thyroid hormone preparation that contains T3 will accelerate these patients' metabolism. Hence, when T4 therapy normalizes TSH blood levels of many patients, it leaves their metabolism subnormal.
4. Ralph J. Luciani, DO, MS, PhD, MD: "Hypothyroidism: An Undertreated Illness"
Synthetic T4 (Synthroid) will not work if the enzyme required to convert T4 to T3 is not normal. Often patients are placed on Synthroid or a similar drug for low thyroid and feel no different even though the TSH levels become normal. The reason is obvious. Their T4 is not converting adequately to the active T3 hormone or not enough T3 is getting into cells for whatever reason. The blood test looks great — the patient feels lousy.
5. Kenneth N. Woliner, MD, ABP: "Combined T4/T3 Therapy: Placebo or Tomato?"
...there are some patients who have difficulty converting T4 to the active T3 hormone because of selenium deficiency or other conditions that interfere with human iodothyronine selenodeiodinases.
B. Clinical basis for T3 treatment
1. Kenneth Blanchard, MD, PhD: "Hypothyroidism at Midlife"
The standard medical view is that T3 is unnecessary because T4 is converted to T3 in the body. But many patients taking the standard 100% T4 hormone report chronic fatigue, depression, menstrual abnormalities, fibromyalgia, irritable bowel syndrome, restless legs and other complaints, and these complaints are almost always better when some T3 is added....The use of T3 has been standard in my practice since 1990....
(The above article was online at www.menopause-consultant.com/MDs/kennethblanchard.html as of September 10, 2003, but is no longer at that URL as of October 12, 2003.)
2. Barry J. Durrant-Peatfield, MB, BS, LRCP, MRCS: "Suggestions for an Approach to the Management of Thyroid Deficiency"
Thyroxine has a half-life of 8 days and works fairly well for the more simple, uncomplicated, early, not too severe, hypothyroid patient. But note should be made that this is not how thyroid hormone is naturally produced. There is a body of opinion, sympathetically supported by the writer, that if natural thyroid is not to be used, then at least T4 should be combined with T3 for a more satisfactory and more logical replacement.
3 Joseph Mercola, DO: "Optimum Diagnosis and Treatment of Hypothyroidism With Free T3 and Free T4 Levels"
If the Free T3 level is significantly lower than the Free T4 level, it is next to useless to treat with Synthroid/ Levoxyl/Levothroid (T4) only replacements. If the patient could not muster sufficient T3 from their gland (which produces some T3 directly), then they are certainly not going to convert enough T3 from T4 only. Traditional medicine assumes that preparations like Synthroid which are T4 only converts peripherally in the body to T3 in fairly standard amounts and at fairly standard rates. Unfortunately, clinical experience shows this is not true for the majority of patients.
4. Gabe Mirkin, MD: "Use of T3 Thyroid Hormone to Treat Depression"
...some people become depressed when they take just T4 and their depression can be cured when they take both thyroid hormones, T3 and T4.
5. Richard Shames, MD, and Karilee Halo Shames, RN, PhD: "Preliminary Response1 from Drs. Richard & Karilee Shames, Authors of Thyroid Power"
It doesn't matter if 100, or 1000, studies show that most people do better with thyroxine alone. There are always some people in any of those studies that did better on thyroxine with T3 added. There are some people who do better on T3 alone. There are some who do better on Armour thyroid alone. There are some who do better with a mix of Armour and thyroxine.
None of the studies of these questions will ever be 100% in any one direction. People are just too different. Nothing is black and white.
1 To the October 2003 press release "Combination Hormone Therapy Does Not Benefit Hypothyroid Patients, Says New Study"
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