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

1. You reach 125mcg each morning (or 60mcg if you're over 50 years old unless approved by your physician).

2. You feel healthy.

3. You get shakiness, worsening significant palpitations (occasional "flip flops" are common), anxiety, racing heart, sweating or other uncomfortable side effects. If this happens, lower the dose a bit for 2-4 weeks and then try raising the dose again till you note significant improvement without uncomfortable side effects or you tried to raise it 3 times and still became shaky/hyper.

Blood tests for thyroid hormone or TSH are not reliable or useful on this regimen. If you feel no better even on the maximum dose, taper off (decrease by 5mcg each 3 days until you're at 15mcg a day. Take 15mcg a day for 3 weeks and then drop to 5mcg a day for 3 weeks--then stop).

After being on treatment for 3 to 6 months, some patients can

lower the T3 dose or stop it. Feel free to try dropping the dose. If you feel better initially and then worse (beginning more than 4 weeks after starting a new dose), you probably need to lower the dose. If you lose too much weight, try to eat more (and discuss this with your physician).

I think you will find that treating subclinical hypothyroidism (i.e.--low thyroid with normal labs) can have a dramatically beneficial effect in your patients' lives. If they are tired, achy, cold intolerant, and/or have weight gain--think low thyroid! I feel that, in the absence of cardiac risk factors, a therapeutic trial is the best way to tell. Dr. Richard Shames is an excellent thyroid expert (author of Thyroid Power) who can consult with your patient by phone (707-823-2077) and help you optimize your patient's thyroid treatment. In addition, Mary Shomon has a superb on-line support group, books, and newsletter for you and your patients as well (see www.thyroid-info.com/ contact.htm). Have fun watching your "untreatable" patients get well!

Jacob Teitelbaum MD is director of the Annapolis Research Center for Effective CFS/ Fibromyalgia Therapies, which sees patients with CFS/FMS from all over the world (410-573-5389; www.EndFatigue.com) and author of the best selling book From Fatigued to Fantastic! His newest book Three Steps To Happiness/Healing Through Joy has just been released. He gives 2-day workshops on effective CFS/Fibromyalgia therapies for both prescribing and non-prescribing practitioners. He accepts no money from any company whose products he recommends and 100% of his royalty for products he makes is donated to charity.