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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Omega-3 fatty acids likely NOT associated with prostate cancer

Omega-3 fatty acids likely NOT associated with prostate cancer

18. July 2013 William Davis Omega-3 fatty acids (6)
A weakly constructed study was reported recently that purportedly associated higher levels of omega-3 fatty acid blood levels and prostate cancer. See this CBS News report, for instance.

Lipid and omega-3 fat expert, Dr. William Harris, posted this concise critique of the study, exposing some fundamental problems:

First, the reported EPA+DHA level in the plasma phospholipids in this study was 3.62% in the no-cancer control group, 3.66% in the total cancer group, 3.67% in the low grade cancer group, and 3.74% in the high-grade group. These differences between cases and controls are very small and would have no meaning clinically as they are within the normal variation. Based on experiments in our lab, the lowest quartile would correspond to an HS-Omega-3 Index of <3.16% and the highest to an Index of >4.77%). These values are obviously low, and virtually none of the subjects was in “danger” of having an HS-Omega-3 Index of >8%. So to conclude that regular consumption of 2 oily fish meals a week or taking fish oil supplements (both of which would result in an Index above the observed range) would increase risk for prostate cancer is extrapolating beyond the data.

This study did not test the question of whether giving fish oil supplements (or eating more oily fish) increased PC risk; it looked only a blood levels of omega-3 which are determined by intake, other dietary factors, metabolism and genetics.

The authors also failed to present the fuller story taught by the literature. The same team reported in 2010 that the use of fish oil supplements was not associated with any increased risk for prostate cancer. A 2010 meta-analysis of fish consumption and prostate cancer reported a reduction in late stage or fatal cancer among cohort studies, but no overall relationship between prostate cancer and fish intake. Terry et al. in 2001 reported higher fish intake was associated with lower risk for prostate cancer incidence and death, and Leitzmann et al. in 2004 reported similar findings. Higher intakes of canned, preserved fish were reported to be associated with reduced risk for prostate cancer. Epstein et al found that a higher omega-3 fatty acid intake predicted better survival for men who already had prostate cancer, and increased fish intake was associated with a 63% reduction in risk for aggressive prostate cancer in a case-control study by Fradet et al). So there is considerable evidence actually FAVORING an increase in fish intake for prostate cancer risk reduction.

Another piece of the picture is to compare prostate cancer rates in Japan vs the US. Here is a quote from the World Foundation of Urology:

"[Prostate cancer] incidence is really high in North America and Northern Europe (e.g., 63 X 100,000 white men and 102 X 100,000 Afro-Americans in the United States), but very low in Asia (e.g., 10 X 100,000 men in Japan).”

Since the Japanese typically eat about 8x more omega-3 fatty acids than Americans do and their
blood levels are twice as high, you’d think their prostate cancer risk would be much higher...
but the opposite is the case.

Omega-3 fatty acids are physiologically necessary, normalizing multiple metabolic phenomena including augmentation of parasympathetic tone, reductions of postprandial (after-meal) lipoprotein excursions, and endothelial function. It would indeed make no sense that nutrients that are necessary for life and health exert an adverse effect such as prostate cancer at such low blood levels. (Recall that an omega-3 RBC index of 6.0% or greater is associated with reduced potential for sudden cardiac death.)

I personally take 3600 mg per day of EPA + DHA in highly-purified, non-oxidized triglyceride form (Ascenta Nutrasea liquid) that yields an RBC omega-3 index of just over 10%, the level that I believe the overwhelming bulk of data suggest is the ideal level for humans.
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Comments (6) -

  • Jeff

    7/23/2013 10:56:11 PM |

    Can you advise where you get the Nutrasea Liquid that you mention you personally use above?.  I'm not finding any in the 3600mg range.  I couldn't find any where 2 doses equals that amount either.  Looking for high quality Omega 3's that are not sourced from Krill due to shell fish allergy.  Currently taking fish oil gel caplets of dubious quality.  Thanks in advance.

  • pickinthefive

    7/29/2013 5:58:45 PM |

    Hi Dr. Davis,
    A question I would have.  If you are at a known risk for prostate cancer, i.e. father or uncle's already have it, or in my case a reletively high PSA and symptoms of BPH, would it be wise to avoid the Omega 3's ?
    Thank you,
    Monty

  • Edwin

    8/14/2013 9:27:43 AM |

    So my eating a canned salmon sandwich for lunch most days which has about 1g of Omega3 (I take no supplements) should be safe?

  • Stephen in Anaheim

    8/15/2013 5:29:38 AM |

    I have to say that this is a great thing to read! In most dietary articles that I stumble across nowadays, I can find at least a paragraph or more on why people should be adding more Omega-3 fatty acids to your diet. In fact, I have read that Omega-3 can be quite beneficial for a number of medical conditions ranging from childhood asthma to fibromyalgia. It is scary to think that it could associated with a higher risk of prostate cancer, even though the underlying study was not well constructed.

  • Edward

    8/16/2013 3:08:29 AM |

    Dr. Davis,
    I take fish oil from a brand called "Carlson fish oil" it contains omega 3 fish oil 1,600. What would be the highest safest amount a person can take in Omega 3 in your experience from your patients and practice? What are your thoughts on the Linus Pauling Heart therapy which calls for a person taking at least 10 grams of vitamin C and 3-5 grams of Lysine in order to reverse plaque and heart disease? I have read the two time Nobel prize winner's books and his writings on heart disease are compelling. I would love the insight from an actual cardiologist with a practice to confirm what works and doesn't work.

  • Edward

    8/16/2013 1:19:06 PM |

    Dr. Davis,
    How much fish oil would you consider the highest and safest dosage for a person to take for heart disease and would the dosage a person who is healthy or heart problems differ?

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