Part 2—protocols for treating an under active thyroid—despite normal blood tests - Highly Effective Treatments for Pain and Fatigue

Townsend Letter for Doctors and Patients, August-Sept, 2003 by Jacob Teitelbaum

To put the risk in perspective, in the many hundreds (and perhaps thousands) of patients that I have put on thyroid, I don't remember any having a heart attack or dangerous problems from taking it. In the long run, I suspect thyroid treatment is more likely to decrease one's risk of heart disease by lowering cholesterol.

The other main concern is that excess thyroid hormone can cause osteoporosis (bone thinning). In my research, I have seen no studies showing any increase in osteoporosis in pre-menopausal women if one keeps the Free T4 thyroid blood levels in the normal range. I do not consider TSH to be a reliable monitor of thyroid levels in CFIDS/ FMS because of hypothalamic dysfunction. We don't know for sure if keeping the T3 level above normal in FMS patients with thyroid resistance worsens the osteoporosis already commonly seen in CFIDS/ FMS, but this has not been a problem. If you need to keep T3 or T4 above the upper limit of normal, you should consider a DEXA (osteoporosis) scan each six to twelve months. If this is showing osteoporosis, lower the thyroid dose. If this is not possible, consider other osteoporosis prevention measures.

Below is the section from the preprinted treatment protocol we use with our patients. The full treatment protocol with over 150 treatments listed by category can be seen at www.endfatigue.com. Click on the "treatment protocol" link (on the far left, bottom button). If you would like a free copy of the file with the complete treatment protocol and the patient questionnaire, which you are welcome to use in your practice (both of which will save you an incredible amount of time), feel free to e-mail me at: endfatigue@aol.com

Hormonal Treatments--Patient info sheet

Thyroid supplementation--several studies show that thyroid therapies can be very helpful in CFIDS/FMS--even if your blood tests are normal. This treatment is, however, very controversial--even though it's usually very safe. Ail treatments (even aspirin) can cause problems in some people though. The main risks of thyroid treatment are:

1. Triggering caffeine-like anxiety or palpitations. If this happens cut back the dose and increase by 1/2 to 1 tablet each 6 to 8 weeks (as is comfortable) or slower. Sometimes taking vitamin B1 (thiamine) 100 to 200mg a day will also help.

2. Exercise (i.e., climbing steps), if one is on the edge of having a heart attack or severe 'racing heart' (atrial fibrillation), thyroid hormone can trigger it. In the long run though, I suspect thyroid may decrease the risk of heart disease. If you have chest pain, go to the emergency room and/or call your family doctor. It will likely be chest muscle pain (not dangerous) but better safe than sorry. To put it in perspective, I've never seen this happen despite treating many hundreds of patients with thyroid. Increasing your thyroid dose to levels above the upper limit of the normal range may accelerate Osteoporosis (which is already common in CFIDS/FMS). Because of this, you need to check your thyroid (Free T4--not TSH) levels after 4 to 8 weeks on your optimum dose of thyroid hormone. All this having been said, we find treatments with thyroid hormone to be safer than Aspirin and Motrin. If you have risk factors or Angina, do an exercise stress test to make sure your heart is healthy before beginning thyroid treatment. These risk factors include: 1. Diabetes, 2. Elevated cholesterol, 3. Hypertension, 4. Smoking, 5. Personal or family history of Angina, 6. Gout, 7. Age over 50 years old.