Hypothyroidism and T3: Interviews with 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. Unless otherwise indicated, the doctors were interviewed by Mary Shomon.

1. David Brownstein, MD: "Overcoming Thyroid Disorders" (July 2002)

...T4 is a relatively inactive form of thyroid hormone. It has to be converted into the more active T3 for the body to utilize it. If the body is lacking the ability to convert T4 into T3, the response to the T4 preparation will be suboptimal. This is the problem with using T4 preparations....

...my experience has been that many individuals do not adequately convert T4 into T3. That leaves these individuals suffering many of the signs of hypothyroidism, such as fatigue, poor immune system functioning, headaches, coldness, weight gain, etc.

Online at <www.thyroid-info.com/articles/brownstein-thyroid.htm> (accessed 2003/09/02).

2. Alan Cohen, MD: "The Depression/Thyroid Disease Connection Explored" (May 2002)

T3 definitely helps. No question about it! T3 has been used by psychiatrists for decades to augment antidepressant treatments that weren't completely effective (without known hypothyroidism being present).

Online at <www.thyroid-info.com/articles/cohendepression.htm> (accessed 2003/09/02).

3. John Dommisse, MD: "Unique Theories About Hypothyroidism Treatment" (May 2002)

There is not much danger of over-treatment if all you are trying to do is 'put the TSH and, perhaps the T4 level, in its normal range' because you are sailing 'far from the edge' in that case. But your patient is going to suffer the overall disadvantages of continuing to run a low-normal, sub-optimal level of both hormones. In my view, these disadvantages...are far, far greater than the potential dangers of over-treatment, if one knows how to prescribe T3 and monitors the FT4 and FT3 levels regularly.

Online at <www.thyroid-info.com/articles/dommisse.htm> (accessed 2003/09/02).

4. John Dommisse, MD: "Dr. John Dommisse's Publication Addresses Optimal Treatment For Hypothyroidism" (November 2000)

The endocrinology establishment has also argued against treatment with any T3, even in combination preparations...namely that each morning/ daily treatment dose would cause peaks in the afternoon that are too high, and valleys at night and in the morning that are too low. It never seems to occur to them that this objection is very easily overcome by prescribing all T3-containing preparations either after breakfast and supper daily OR on an empty stomach every 8 hours....

Online at <www.thyroid.about.com/library/weekly/aa110300a.htm> (accessed 2003/09/02).

...the standard approach [T4 only] to [patients'] hypothyroidism leaves them still with numerous classic symptoms and signs of hypothyroidism. This is not merely an academic matter; this means that all these people are still at much greater risk of developing coronary heart and other vascular diseases, strokes, high blood pressure; obesity; constipation and impaction; severe dry skin; memory and concentration problems ending in dementia; infertility and miscarriages; etc.; etc.; etc.

Online at <www.thyroid.about.com/library/weekly/aa110300b.htm> (accessed 2003/09/02).

5. John Lowe, DC: "Fibromyalgia Aches and Pains as a 'Symptom' of Hypothyroidism: A Look at the Theories of Dr. John Lowe" (April 1999)

I have found that many hypothyroid patients also have cellular resistance to thyroid hormone. Most of these patients don't benefit much from T4 alone, but some of them do from desiccated thyroid, presumably because of the relatively high T3 content. Some we have to switch to synthetic T3 because they don't benefit from desiccated thyroid. We've stopped altogether giving patients T4 alone.

Online at <www.thyroid.about.com/library/weekly/bldrlowe.htm> (accessed 2003/09/02).

6. Glenn Rothfeld, MD: "...author of Thyroid Balance" (July 2003)

In the case of T3, which is produced commercially as Cytomel, I suggest that patient[s] ask their doctors to add a bit of Cytomel to their T4 treatment, then try to taper the T4 and build up the T3. Or, use one of the combination products on the market. In a couple of cases, I had my compound pharmacist prepare some information to send to the physician, and I found that to be helpful.

Online at <www.thyroid.about.com/cs/alternativehelp/a/thyroidbalance_3.htm> (accessed 2003/09/02).