Thyroid correction: The woeful prevailing standard

27. July 2009 William Davis (16)
Rich has been taking Synthroid or levothyroxine for many years.

When Rich came to my office for continuing management 10 years after his bypass surgery, I checked his thyroid panel:

TSH 7.44 uIU/L

Free T4 1.88 ng/dl (Ref range 0.80-1.90 ng/dl)

Free T3 2.0 pg/ml (Ref range 2.3-4.2 pg/ml)


Rich's thyroid hormone distortions--high TSH, low T3--are sufficient to account for a tripling of heart attack risk long-term.

As Richs' thyroid was being managed by his primary care physician, I notified this doctor of Rich's panel. He therefore increased Rich's levothyroxine from 75 mcg per day to 100 mcg per day. Another thyroid panel several months later showed:

TSH 0.98 uIU/L

Free T4 2.38 ng/dl

Free T3 2.0 pg/ml


As you would expect, increasing the intake of the T4 hormone (levothyroxine) increased free T4 and suppressed TSH.

But what about T3? It's unchanged.

Indeed, Rich says that he feels no better and, in fact, wakes up in the morning foggy and requires a nap in the afternoon.

In my experience, the majority (approximately 70%, but not 100%) experience subjective improvement when T3 is added in some form and the free T3 level is increased. While the data (summarized here) are conflicted on whether there is objective benefit to T3 management and supplementation, there seems to be a poorly-quantified subjective improvement.

Rich's increased levothyroxine dose decreased (calculated) LDL cholesterol by 10 mg/dl. Based on my experience, I'll bet that his lipid panel would likely be further improved with T3 correction.

What I find incredible is the absolutely rabid resistance waged by primary care physicians and endocrinologists against this notion of T3, mostly due to fears of the remote likelihood of inducing atrial fibrillation and osteoporosis, while they are ready to prescribe lifelong statin drugs without a moment's hesitation.
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Comments (16) -

  • William Trumbower

    7/28/2009 9:46:33 PM |

    Dr. Davis    You are so right!  I always check Ft3 as well as thyroid antibodies for Hashimotos.   If the antibodies are elevated, the patient probably has gluten induced autoimmune disease.   I also suggest checking reverse T3 if they have been on L-thyroxine.  If elevated, they are converting their T4 into reverse T3 instead of T3.   Keep up the good work.  Bill Trumbower MD

  • Ross

    7/29/2009 12:50:40 AM |

    Follow the money.  Synthroid (T4 only)is a highly profitable drug being actively pushed by drug reps.  Armour Thyroid (T3 and T4) is cheap and profitless.

    Where was that recent article on how drug companies (and their sales reps) shamelessly said anything needed to get doctors to prescribe their higher-profit lines?

  • Dr. William Davis

    7/29/2009 2:52:49 AM |

    Dr. Trumbower--

    Thanks. I'd like to continue the conversation.

    I can be reached through contact@trackyourplaque.com.

    Plenty to share!

  • Dr. William Davis

    7/29/2009 2:54:24 AM |

    Ross--

    You've hit at the essence of the problem.

    The depth of this rabid adherence to the drug company-induced dogma is incredible. Endocrinologists will turn blood-red arguing that Synthroid is the only means of correcting thyroid and that iodine deficiency no longer exists.

    Believe me--I've seen it happen first hand.

  • Anna

    7/29/2009 4:52:03 AM |

    This is a littke off-topic, but still about thyroid health so I hope it's ok.  

    The word is getting out in some of the online hypothyroid forums (STTM & Mary Shomon's about.com forums) that many hypothyroid patients are not happy with the recent reformulation of Armour desiccated thyroid.  Apparently, the new Armour formula no longer dissolves well for those who prefer to take it sub-lingually.  Additionally, many (who take it sublingually or swallow it) are finding the change in binder formulation (sugar was also reduced) coincides with a return of some symptoms, so perhaps the hormone absorption has changed.

    And of course, the continued shortage of Armour in some doses continues with no end in sight.  

    I heard about this reformulation issue just before I planned to change from Levoxyl (T4) & Cytomel (T3) combo therapy to Armour, so I asked my doctor to write the Rx for Naturethroid instead of Armour.  

    It's been a very smooth transition from synthetic T4/T3 once a day to 1/2 grain Naturethroid natural desiccated thyroid hormone twice a day, with a huge improvement in the "afternoon slump" that was still a prominent feature even after several years of tweaking my T4/T3 treatment.  In fact, now I have to set a reminder on my phone to remind me to take the second dose, because I don't often have the afternoon slump "reminder".

  • Tom

    7/29/2009 11:57:20 AM |

    Question please:  does it make sense for those of us without known thyroid issues to take an iodine supplement such as kelp?

    Thank you for any thoughts.

    Sincerely,

    Tom

  • Mar

    7/29/2009 12:36:55 PM |

    Dr. Davis,

    I think that your article is so correct re: the need to have both Free T4 and Free T3 corrected.  I can remember arguing with the endocrinologist that we needed to check a Free T3 level too.  He finally checked it, but only one time.  I continue to have low Free T3.  I pay for my own test since he doesn't do it. I am gluten sensitive and my replacement T4 works better now that I am GF, but my Free T3 is still low.

  • kris

    7/29/2009 8:23:37 PM |

    It is hard to find a doctor who would understand desiccated thyroid medication never mind prescribing it. To add injury to the insult, the medical system in Canada doesn’t cover desiccated medication to begin with. people with affordability problem, continue to stay on synthetic medication and in the long run it cost the medical system lot more in order to correct the spinoff of thyroid issue through other diseases.

  • Anne

    7/30/2009 12:30:54 AM |

    I seemed to be doing fine on Synthroid. My TSH was .8. I then changed to a generic med and I watched my TSH slowly rise to almost 4 and my energy decline. Of course my doctor was unconcerned, but I insisted on getting a free T3 done too - it was low.

    I am now back on Synthroid and will be getting my TSH, free T3 and free T4 retested soon.

    I am gluten free x6yrs and now grain free. I hope it is just the generic that caused the worsening TSH.

  • Anonymous

    7/30/2009 8:53:21 PM |

    In British Columbia, Canada it's almost impossible to get a prescription for desiccated thyroid hormone. Synthroid gives me a backache, T4 compounded alone gives me migraines. Severe incapacitating chills started in 2000; it took several years to get a possible diagnosis and start on desiccated, but that doctor has moved away. The chills are 80% improved but get worse with any stress. Would iodine or kelp or Lugols or Iodoral help? My health fell apart with quitting smoking, systemic Candidiasis, hypoglycemia, diabetes, severe depression, menopause, etc and I can now digest very few foods, supplements, etc. Also most foods and all hormones cause migraines. Any suggestions would be appreciated.

  • William Trumbower

    7/31/2009 11:09:49 AM |

    Dr Davis     I went to the site you mentioned, but I could not find how to reach you.  Sorry I must not be very experienced to figure it out.   Dr. Trumbower

  • Jim

    7/31/2009 12:19:34 PM |

    I stumbled on this article with tons of citations about a possible cause of the apparently huge increase in thyroid problems at http://www.earthclinic.com/fluoride_questions_and_answers.html

    The first quotation from an expert was, "Today, many people living in fluoridated communities are ingesting doses of fluoride (1.6-6.6 mg/day) that fall within the range of doses (2 to 10 mg/day) once used by doctors to reduce thyroid activity in hyperthyroid patients. This is of particular concern considering the widespread problem of hypothyroidism (under-active thyroid) in the United States. Symptoms of hypothyroidism include obesity, lethargy, depression, and heart disease."

    Paul Connett, PhD
    Co-Founder, Fluoride Action Network"

  • Dr. William Davis

    7/31/2009 2:52:15 PM |

    Dr. Trumbower--

    You could try this: Cut and paste following web address:

    http://www.trackyourplaque.com/fo06-00about.asp

    Hope to see you there.

  • scall0way

    11/10/2009 8:18:11 PM |

    I'm going back and reading all your thyroid related posts after getting diagnosed yesterday with Hashimoto's. It gets depressing reading about the state of thryoid treatment in the US - total tunnel vision. The Dr. I was absolutely and utterly will not prescribe dessicated thyroid, only the synthetic T4s. I'll start out there but if it doesn't seem to help I'll have to look outside my network somewhere I guess.

  • buy jeans

    11/3/2010 12:21:38 PM |

    In my experience, the majority (approximately 70%, but not 100%) experience subjective improvement when T3 is added in some form and the free T3 level is increased. While the data (summarized here) are conflicted on whether there is objective benefit to T3 management and supplementation, there seems to be a poorly-quantified subjective improvement.

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Heart scan curiosities 1

Heart scan curiosities 1

27. November 2006 William Davis (3)
Heart scans often reveal more than coronary plaque. From time to time, I'll show some curious findings that people have displayed during routine heart scans.

This 65-year old man had a relatively low heart scan score of 73, but showed an impressive quantity of calcification of his pericardium, the usually soft-tissue sack that encases the heart. The calcified pericardium is the white arcs that surround the heart in the center of the image.



Thankfully, because he's without any symptoms of breathlessness, excessive fatigue, or leg swelling, he won't need to have it surgically corrected. When the pericardium becomes rigid and encircles the heart, it can literally squeeze the heart, a condition called "constrictive pericarditis". The surgery is pretty awful.

This man's calcified pericardium likely resulted from one or more viral infections over his lifetime.
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Comments (3) -

  • Cindy

    11/29/2006 3:03:00 AM |

    curious....does calcification show up on a lung scan done with and without dye?

  • Dr. Davis

    11/29/2006 11:53:00 AM |

    Yes, it does.

  • Cindy Moore

    11/30/2006 4:35:00 AM |

    yes!!!

    I have had 3 CT scans, lung for questionable areas in the lung found incidentally on a kidney CT scan (hematuria).

    So far all have come back normal, the initial areas are gone, and no new ones are showing up (they were very tiny, but mom had lung CA). I still have 3 or 4 more scans to go in the protocol, and wondered if it that would suffice. I'm an exsmoker and with family history, my doc is recomending continuing yearly after the protocol is done. For peace of mind I figured I'd probably continue.

    There is no family history of heart disease so far, even with rampant diabetes on one side of the family, so I'm not really concerned about heart disease, but this makes me feel better. (I have high cholesterol, but very low triglycerieds and high HDL and fairly good inflammatory markers...wgt is getting better, as is amount of activity/exercise, and I've quit smoking)

    The lung CT report doesn't mention calcifications/artherosclerosis specifically, but does say heart, mediastinum, etc all normal.  

    Thanks!

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Be patient with niacin

Be patient with niacin

19. January 2007 William Davis (0)
Mel's HDL started at 37 mg/dl one year ago. Mel had several other abnormal lipoprotein patterns along with his HDL (inc. small LDL and Lp(a)), but HDL was clearly a crucial factor in his panel.

With a heart scan score of 1166, we needed to raise Mel's HDL to the Track Your Plaque target of 60 mg/dl. So Mel started niacin, our number one method to raise HDL, in addition to reducing his exposure to wheat products and other high glycemic index foods; increasing his physical activity; trying to reduce his excess tummy fat; fish oil; dark chocolate (2 oz per day) and red wine (1-2 glasses per day, preferably dark French reds). The form of niacin we often choose is SloNiacin (Upsher Smith), available over-the-counter for about $12-14 per 100 tablets.

Mel started out with niacin 500 mg per day at dinner, increased to 1000 mg at dinner after four weeks. Although this is usually too soon to reassess HDL, Mel insisted. His HDL 41 mg/dl. Mel's disappointment was palpable. He was the usual type A personality: he wanted his HDL higher--now! So Mel insisted that we increase niacin to 1500 mg per day. (We never go higher than this if low HDL or small LDL is the indication for niacin; only when Lp(a) is present do we go higher.)

Six months into this process, HDL: 45 mg/dl. Still a sluggish response.

One year later, HDL: 68 mg/dl. Finally!

That is typical for niacin, as well as combination of lifestyle changes Mel made. None of them result in an immediate rise in HDL; all take months to 1-2 years to exert full HDL-raising effect.

Think of HDL as the 82-year old grandma who takes a long time to cross the street-she does get there!

Note: Doses of niacin >500 mg per day should be taken with medical supervision.
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"Fish oil is stupid"

"Fish oil is stupid"

3. April 2007 William Davis (13)
"Fish oil is a waste of time and money. It's stupid. Just stop it."

So a patient of mine was advised by another physician when he complained that he occasionally experienced a fishy aftertaste.

This attitude perplexes me. After all the confirmatory data that support the enormous health benefits of omega-3 fatty acid supplementation, including the 11,000 participant GISSI-Prevenzione Trial, you'd think this attitude would be history. What's a little fish aftertaste when heart attack risk is slashed 28%?

Perhaps the tendency to pooh-pooh fish oil is because it's available as a nutritional supplement. This shouldn't make fish oil appear inconsequential. Far from it.

If you witness the extraordinary power for fish oil to reduce triglycerides, you will be immediately convinced of its effectiveness. The ability of omega-3 fatty acids from fish to eliminate intermediate-density lipoprotein (IDL), the persistent abnormal lipoprotein which signals an inability to clear dietary fats from the blood, can also convince you. More than 90% of people with excessive IDL have it completely eliminated by 4000-6000 mg of fish oil (providing 1200-1800 mg EPA + DHA) per day.

The fact that fish oil is available as a prescription "medication," as well as an over-the-counter supplement, causes some physicians to dismiss the power of the supplemental form. This is nonsense. The over-the-counter form is every bit as effective as the prescription form.

The makers of prescription Omacor also make the claim that their preparation is safer and purer. That may be true, but I'd like to see independent verification from the FDA, USDA, or an unbiased organization like Consumer Reports before I accept their marketing as fact--particularly at $120 to $240 per month! If Omacor proves to contain substantially less mercury and pesticide residues, then that will need to be factored in. (Please note that both Consumer Reports and Consumer Labs measured no substantial mercury or pesticide residues in their analyses of 16 and 41 brands, respectively.)

I try to persuade my colleagues that the idea of taking supplements is a wonderful trend that allows people to express ownership of their own health. What people need is guidance, not salesmanship for a more expensive version, nor dismissal of nutritional preparations that actually possess considerable benefits.
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Comments (13) -

  • Cindy

    4/3/2007 1:24:00 AM |

    I've heard that fishy burps means the fish oil is rancid and should be thrown out!? I've also been advised to cut open and taste a capsule every once in a while (I do it weekly) and to throw it out if it tastes or smells fishy.

  • Dr. Davis

    4/3/2007 1:49:00 AM |

    Cindy--
    You're brave. My experience is that virtually all fish oil is fishy to one degree or another. The Consumer Lab analysis is probably the most enlightening on this question: they found that only 2 of 41 preparations had any rancidity breakdown products present. That's pretty good. Neither of the two preparations that flunked their analysis were popular brands.

  • JJ

    4/3/2007 7:15:00 PM |

    Can you help interpret EBT scan results.  50 y/o male with 3rd EBT scan now indicates a decrease:  
    '05 152;
    '06 417;
    '07 350.  
    Is this common?  An error? Please advise.  Thanks you.

  • Dr. Davis

    4/3/2007 7:35:00 PM |

    JJ--
    I'd advise you to see the website, www.trackyourplaque.com. We discuss these issues extensively here. Or go to my book, Track Your Plaque, available on Amazon. From what little you've told me, it could be true or it could be an error, i.e., scanner inaccuracy, depending on the type of scanner used. However, the entire Track Your Plaque concept is built on the idea of trying to gain control over your heart scan score.

  • Anonymous

    5/22/2007 5:03:00 PM |

    Your last paragraph makes perfect sense and is logical. I think that this is exactly what the pharma companies dont want is for the patient to express ownership of their health or realize that otc supplements have any merit. I applaud you for sticking to the facts that you find not just the data and marketing that the pharma companies and reps feed the doctors.

  • Fr. Gregory

    8/17/2007 1:28:00 PM |

    Fish oil is immensely beneficial for many reasons.  The challenge is that most manufacturers of fish oil are not held to any standards, so as Cindy says above, if you are having problems with "fishy heartburn" or the like, chances are it is rancid.  Norway is one country that has strict standards for the production of fish oil.  Hence, Nordic Naturals is a good brand, because it is produced there.  My two cents worth: use Norwegian Fish oil products.  Be wary of product in America.  The "taste test" is a good way to note if the fish oil is of quality.  Rancid fish oil, I've been told, can be worse for you than no fish oil at all.

  • mill

    9/23/2007 6:53:00 PM |

    I know of so many people who have lowered their cholestral but after 6 months of taking 6 caps of 1250 mg daily mine actually went up a few points. I called the company (Res-Q) and they said that happens to some people. What is your opinion?

  • Dr. Davis

    9/23/2007 11:39:00 PM |

    I have never seen anyone reduce LDL cholesterol with fish oil, but that is not its purpose.

    Fish oil 1) reduced triglycerides, 2) reduces lipoprotein patterns like VLDL and IDL, and 3) reduces heart attack and other heart events.

    The only way fish oil can reduce LDL cholesterol is by reducing triglycerides and thereby providing the appearance of a drop in LDL, since LDL is calculated with values that include triglycerides.

  • Mark

    3/18/2008 11:44:00 PM |

    I think it is quite ignorant of you to claim that a dietary supplement is the same as a prescription medication.

    There is a reason that manufacturers need to place a disclaimer on their products "These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."  Simply put, manufacturers can put whatever they like in a supplement, as long as they put their precious disclaimer on the bottle.

    By the way, there is no such thing as an "over the counter" fish oil.  OTC implies that a product, at one time, was available with a prescription (i.e. Claritin), and is now available without a prescription.

    Lastly, your idea about Consumer Reports doing a comparison of dietary supplements versus Lovaza/Omacor is a valid one.  However, it seems to me it would be easier to simply compare the EPA and DHA contents of the product to get an idea of their efficacy.  In my experience, there are no products in the market that can match the potency of the prescription product.

  • mill

    6/27/2008 12:36:00 PM |

    Dr Davis
    I've been on 2 naicin tabs daily and my cholestral is done from 240 to 164!!!!it's amazing. Can i go back to taking just one daily  now?
    Thanks so much!

  • mill

    7/9/2008 9:39:00 PM |

    How much naicin is bad for the liver?

  • lizzi

    8/25/2008 3:05:00 PM |

    I worry about omnacor (Lovaza) because they chemically altered fish oil, (made it an ester, I think) in order to increase stability.  I just hope this doesn't ruin its good effects.  The process reminds me of the creation of transfat to enhance the stability of margarine in the 1950's.  It took us 40 plus years to figure out that was a big mistake.  Anyone else worried about this?

  • Mary P

    4/27/2009 2:03:00 PM |

    I have concerns about the amount of fish that it takes to produce supplements.

    If you don't want to take a fish oil supplement and are not in one of the demographics that should limit the consumption of oily fish - is there a daily consumption of dietary fish that would meet nutritional needs? E.g., 80g of sardines or mackerel?

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