One day, a patient I was treating handed me a book titled, Hypothyroidism: The Unsuspected Illness, written by a doctor Broda Barnes, MD, copyrighted 1976, published by Harper and Row. She suggested that I read the book saying that it was a very good book on thyroid problems. I thanked her and assured her that I really didn't need to read the book since I already had a good understanding of the thyroid system. Nevertheless, she left the book with me and it sat on my bookshelf for about three weeks when I decided it probably would not hurt to look it over. As it turned out, I found the book extremely interesting. Doctors had noticed that patients' body temperatures would often drop quite low in severe hypothyroidism (myxedema). But to my knowledge, Dr. Barnes was the first doctor to emphasize the correlation between low thyroid function and low body temperature as a guide to therapy. He also pointed out the importance of being mindful of the many and varied manifestations of deficient thyroid function and that it can be important in an unsuspectedly large number of health problems.

Note:
Hypothyroidism is inadequate thyroid gland function. It is considered permanent and requiring life-long supportive treatment with T4-containing medicine.

Euthyroid Sick Syndrome is the term for abnormal thyroid tests during a non-thyroid sickness. The patients don’t have thyroid symptoms (they are euthyroid), and don’t require thyroid treatment.

In Wilson's Temperature Syndrome the thyroid blood tests are usually normal. The patients often suffer from debilitating symptoms of low body temperature (as in hypothyroidism) that can last for decades if left untreated. It can often be reversed with proper T3 therapy and/or natural medicines in a matter of months and does not require life-long treatment.

After reading Dr. Barnes' book, I began asking patients that I was treating more specifically about their symptoms. If a patient would complain of being tired, I would ask him if he also noticed having headaches, depression, dry skin, dry hair, fluid retention, and all the rest of the complaints. When they complained of having headaches, then I would also question them about whether or not they also noticed having trouble sleeping, difficulty swallowing, itchiness, and the like. I was amazed at how frequently the patients' symptom came on together with a large group of other symptoms; and not just random symptoms, but the symptoms of low thyroid system function. When I requested the patients to take their body temperatures, I was also intrigued to discover that many times, if not always, they were low, on average.

Dr. Barnes also had a few pages on the treatment of hypothyroidism (one cause of DTSF) as diagnosed by symptoms and low body temperature patterns. By following his treatment recommendations, I noticed that many of the patients' symptoms improved dramatically as their body temperatures began to normalize. I could see evidence that there was an unequivocal relationship between the symptoms and the body temperature pattern. Unfortunately, the treatment results were not very reproducible and predictable, and when symptoms did improve, they frequently did not improve completely. Such patients could remember how they felt prior to the illness, could tell the symptoms had improved, but could also tell that some symptoms remained.

A few months later I came across another source of information which was a review article from a medical journal: Thyroidal and Peripheral Production of Thyroid Hormones; Schimmel; Utiger; Annals of Internal Medicine, 87: 760-768, (December 1977). The significance of this article has been overlooked for a long time, like the proverbial "needle in a haystack." Its significance lies namely in the pointing out of the importance of the conversion of thyroid hormones that takes place, for the most part, outside the thyroid gland (peripherally) in the tissues of the body. This article makes it clear that the degree to which T4 is converted to T3 or to RT3 could have profound physiological consequences. The article suggests that the function of the system may not depend merely on how much T4 a patient's thyroid gland produces or how much T4 the patient's body is given, but may very much depend on what the patient's body does with the available T4. New data reviewed in the article has forced a reassessment of long-held views on thyroid hormone physiology. There was some speculation in the article that elevated RT3 levels resulting from a transient shunting of T4 towards RT3 and away from T3 could then secondarily inhibit T4 to T3 conversion. Not only can this happen, it does happen. The same article reviewed the well-known facts that T4 to T3 conversion can be impaired or decreased by fasting, illness, glucocorticoid, and in the fetus.

So then, in addition to just asking patients about their symptoms, I began asking them specifically when their symptoms began, to see if they could identify their onset with any obvious stress, illness, or injury. To my amazement, patients suffering from symptoms of DTSF, while having normal thyroid blood tests, could, in almost every instance (greater than 90%), identify specific stresses which marked the onset and/or worsening of their symptoms.

The scientific information printed in the Annals article (after Dr. Barnes' book was published) made it possible to understand how a person could have symptoms of DTSF even with normal thyroid hormone blood tests. And it led to the finding that symptoms of DTSF can come on after a stress and persist inappropriately even after the stress has passed. It helped also in understanding why patients' symptoms of DTSF don't always resolve completely, as some would expect, with the use of T4 preparations or T4/T3 preparations (medicines). It also helped pave the way for the development of new, better directed, more predictable, more reproducible, and more effective treatment for DTSF symptoms (especially symptoms of DTSF caused by Wilson's Temperature Syndrome).

The clinical information contained in Dr. Barnes' book helped provide the basis for the all important guides (especially symptoms and body temperature patterns) to therapy. Without this information, the scientific data could not effectively be put to use. Without the scientific understanding provided by the review article, the information presented in Dr. Barnes' book alone could not explain why some patients responded satisfactorily to his suggested treatment, while a number of them did not.

Since then, I have performed computer searches of all the available medical literature on the subject. Although I have found many articles supporting the information found in the first two sources, I have found very little that adds to the information, and I haven't found any sources that could substitute for the first two sources. When taken together, they formed the embryo that has been developed into the information contained in this book. I had stumbled on to extremely simple, yet important information. Simple because of the few number of variables involved and important since it involved one of the most fundamental processes of the body, namely body temperature regulation.
 

Since then I have spent my full time working in this area of medicine. Since I have been dealing with patients suffering from symptoms of MED (again, in the thousands), I have seen surprisingly reproducible and predictable patterns. These patterns become quite obvious when one has the two sources of information just referenced above and when one works with the same problem day in and day out, month after month, year after year. Some of these patterns are only easily seen when one deals with a large number of patients, because some of them are subtle. Since most doctors probably think about the thyroid system only three or four times per month while treating patients in their practice, their observations might be so few and far between that the pattern might not be as evident. So, it really is not too difficult to see how Wilson's Temperature Syndrome has been overlooked for so long. The best indicator that patients' symptoms are being caused by Wilson's Temperature Syndrome are when their symptoms resolve together and completely when proper therapy is given. By treating so many patients and carefully analyzing their responses, an extremely effective treatment has been developed. In addition, when a doctor is treating a large number of patients with a treatment that very effectively resolves their symptoms, patients sometimes make comments or observations that the doctor might not have been particularly listening for. But if one hears the same comments often enough, a particular pattern might gain one's attention. By exploring these patterns more fully, it is possible to find that they are quite reproducible and predictable. The patterns may contribute to changes which make the treatment even more predictable, reproducible, and effective.

This process has also made it possible to see the effect of the thyroid system on many symptoms and complaints that previously seemed unrelated. All these relationships can be very useful in recognizing the clinical picture of a patient suffering from Wilson's Temperature Syndrome. In fact, the clinical picture can be so recognizable that it is sometimes obvious just by looking at someone that they are likely to be suffering from Wilson's Temperature Syndrome. With a little experience, one could probably recognize several likely sufferers while walking through the mall. Many of the varied manifestations of Wilson's Temperature Syndrome will be discussed in Chapter 9.

Tools of Problem-Solving
Perhaps the greatest value of medical learning is its usefulness in the treatment of patients' problems. Learning is obtained by reading and studying what is already known or believed to be true. Then it may be applied. By applying medical information one can gain experience. There are some things that aren't written yet, and some of the things that are written are incorrect, and that's what experience is for. As we gain experience, we can employ common sense postulates of problem solving that are used by all doctors in approaching medical ailments. Since there are still far more things in medicine that remain unknown than are known, it is better to use words like could, should, probably, maybe, possibly; and less often words like definitely, always, never, etc.. All we can do is the best that we can with the tools that we have available. The usefulness of tools certainly depends on how well they are used. The following are some common sense postulates:

1. When a cluster, group or multitude of characteristic symptoms appear or worsen at the same time, it is more likely that they are related.

2. If such a group of symptoms begin and end together at identifiable times, it is more likely that they are related.

3. If the onset of a group of symptoms was closely related in time to a particular event and the resolution of that cluster of symptoms was closely related in time to a particular treatment, it is more likely (although not definite) that the event was the cause and that the treatment was correct.

4. If the symptoms appear after a particular event, resolve after a particular treatment, remain resolved after that treatment has been discontinued for a time (for example 10 months), return after a particular event extremely similar to the first, and resolve again after the same treatment and remain resolved after the treatment has been discontinued again, it is even more likely that the events were causes and that the treatment was correct.

5. If the symptoms appear after a particular event, then resolve after a particular treatment and remain resolved after that treatment has been discontinued, then it is more likely that a persistent correction has been effected.

6. The fewer the variables involved in a particular problem, the easier the solution.

7. The more predictable a patient's response to a particular treatment, the fewer unaddressed or unanticipated variables present.

8. The fewer the treatments the better, so there is less chance of drug interaction and also better chances of good compliance (patients following instructions as prescribed).

9. The more instances in which certain clinical observations are found, the more reliable are those observations.

These common-sense postulates have been useful in helping to uncover Wilson's Temperature Syndrome and to provide the information contained in this book. They have helped in generating certain criteria useful in the recognition and treatment of Wilson's Temperature Syndrome. It is easy to predict whether a person will or will not respond to proper T3 treatment. Many times patients will receive treatment and they will have their symptoms corrected and they will stay corrected for long periods of time, even years after the treatment has been discontinued. In such cases, the same symptoms may return again after another physical, mental, or emotional stress.

Wilson's Temperature Syndrome follows very predictable and recurrent patterns, and is based on a particular model, or theory. Considering how predictable and reproducible patients' responses are to treatment, monitoring, diagnosis, etc., it stands to reason that the model, or theory, upon which the treatment is predicated is very close to being correct, with there being few unaddressed variables. For example, when something happens 95 times out of a 100 just the way one would expect it to happen; the principles, ideas, or premises which caused one's expectations are likely to be very close to correct.

Adages from Medical School
There were some additional principles of common sense that we were taught in medical school to help us reason through medical problems and the various alternatives that can be used in addressing those problems. Some of these adages follow:

"It is better to treat the problem, not the symptoms." Patients with Wilson's Temperature Syndrome, suffering from a multitude of complaints, frequently find themselves being treated for their symptoms to varying degrees in varying ways. It stands to reason that it is always best to treat the underlying problem rather than treating the symptoms. However, with no obvious cause in sight, sometimes we are left to handle the symptoms as well as we can until a cause can be uncovered. For this reason, patients who present to doctors with symptoms consistent with Wilson's Temperature Syndrome will frequently be treated with a number of symptomatic treatments pointed toward handling the symptoms. The characteristic thing about symptomatic therapy is that when the treatment is discontinued, the symptoms return or persist.

I compare this to the problem of a ship that is taking on water. One can turn on a pump to get water out of the ship, or one can plug the hole through which the water is entering. If the pump is effective enough, it may be able to remove the water. However, if the pump is turned off and the ship continues to take on water, it is unlikely that the hole has been plugged.

One saying that I really like, was told to me by an old professor. "If you listen to your patients long enough, they'll tell you what's wrong with them, and if you listen longer still, they'll tell you how to fix It." This saying underscores the point that the patients are the ones that live in their bodies 24 hours a day, 7 days a week, 365 days a year. After spending so much time with their own bodies, they frequently become quite well acquainted with their own bodily functions. In many ways, they know their own bodies better than anyone else does. When patients' symptoms of Wilson's Temperature Syndrome have resolved after the WT3 protocol they sometimes remark, "It's great to have all these symptoms gone, it's great to feel normal again, I knew I wasn't crazy. I had been told so many times that there wasn't anything wrong with me and I was even told that it was all in my head. But I knew my own body well enough to know that there was definitely something wrong. I knew that something, somewhere was not quite right. I could tell that something was out of balance."

It is interesting to watch, however, peoples' attitudes towards their symptoms and the resolution of those symptoms. I have a distinct vantage point because I see patients who are complaining with a large number of generalized complaints, and I have the opportunity to watch many of those complaints resolve quickly and completely, with the patients often experiencing a dramatic difference from before to after. Some people will say, "I was beginning to wonder if I was a hypochondriac." Others will say, "I knew I wasn't a hypochondriac." And most interestingly, some will say, "I'm sure you see a lot of hypochondriacs, but I knew I wasn't one of them."

Before treatment, certain patients sometimes seem to think that only they, of all the patients that I see, are not hypochondriacs. It seems strange, because of all people, it would seem that those who have been through it would be less likely to be prejudiced against others who may be unfortunate enough to be suffering from medical science has not yet been able to easily recognize or correct. Especially, when they have gone through the frustration and know what it is like to have their friends, neighbors, and doctors look at them as if they are complaining because they enjoy feeling bad; as if they are looking for sympathy or excuses; and as if they have ulterior motives. But sometimes even they seem to imply that they feel hypochondria is a prevalent condition.

Another adage states, "When you hear hoof beats, think of horses, not zebras." This saying emphasizes that it is best to think of common things first, because common things are more likely to happen than rare things. By far, is abnormal body temperature is the most common cause of the symptoms of MED. We have already discussed that abnormal body temperature patterns could, theoretically, be caused by adrenal hormones, female hormones, and thyroid hormones as well as by other factors. I feel that DTSF is by far the most common explanation or cause of abnormally low body temperature. Since the thyroid system normally adjusts up and down in response to stress and other conditions, it seems reasonable that the thyroid system is the most likely to get stuck in a position that causes inappropriate body temperature patterns. This is a little like a man who often travels back and forth between two cities that are separated by a certain forest of trees. Suppose that through the middle of the forest runs a paved highway. Through other sections of the forest can be found two narrow and unpaved paths that wind through the forest from one city to the next. If the man called me asking me to bring him a can of gas because he had run out of gas halfway between the two cities, and hung up before he told me exactly where he was, the first place that I would look is on the paved highway. I would check the highway first because I know that even though the two paths also connect the two cities, they are both barely manageable with ordinary vehicles and they are used mainly for recreational purposes. I would reason that it would be much more likely that the man would run out of gas on the highway because he more commonly uses the highway for traveling.

"Treat the patient, not the tests." This adage underscores the important of remembering the shortcomings of our medical technology. The physical and emotional manifestations of patients suffering from DTSF resolve far more quickly, predictably, reproducibly, and completely with normalization of body temperature patterns than with normalization of thyroid hormone blood tests

Another saying that I remember hearing in medical school that I find quite useful is, "Everything in medicine is a therapeutic trial." This saying underscores the importance that we constantly reevaluate the clinical course of a patient. Because nothing in medicine is absolute, one can never be absolutely 100% sure of the diagnosis or 100% sure about how a patient is going to respond to a certain therapy. Subsequent therapy should always be based a patient's response to initial therapy. In other words, the plan of management should be continually reevaluated based on a patient's response. This decreases the chance of overlooking any important developments because of tunnel vision. This is another way of saying that there is always a small chance that the initial diagnosis and plan of management might not necessarily be optimal. In medicine, how patients respond to therapy is always the bottom line. In some medical problems, especially in those that affect lower levels of organization of the body, how a patient's symptoms respond to treatment may be one of the only indicators available.

For example, it is practically impossible to measure the chemical imbalances in a person's brain that are causing him to be depressed. Yet, with careful questioning and with careful observations, doctors frequently diagnose patients as having clinical depression and will often prescribe antidepressant medication in an effort to alleviate the condition. If the patient responds, this positive response to treatment provides more reassurance that the patient was suffering from depression and that the treatment prescribed was effective.

Some might ask "How can one tell if a patient might benefit from antidepressants when the situation can't be measured?" Or, others might ask "You mean, it can't be known how one will respond to treatment until it is given?" Yes, one knows best how a particular therapy will go, and how correct the diagnosis is only after one sees a patient's response. This is true for every medical problem and every medical treatment (easily measured or not).

History, physical examination, laboratory tests, and other observations may provide important clues to a patient's diagnosis and likelihood of responding to a particular therapy; but one can never know for sure how a patient will respond to a particular treatment until that treatment is given and the response evaluated. So, even though there are no good tests to pinpoint exactly the chemical imbalance in any given person's brain that is causing them to be depressed, this does not prevent antidepressant medications from being used in therapeutic trials to bring about a great benefit in many lives.

I like to use, from time to time, an analogy of a circuit breaker to illustrate another principle. "If your lights go off in your house all at once, you don't check the light bulbs, you check the circuit breaker," not because it is the only explanation, but because it is the most likely explanation and also the easiest to address first. If you're fortunate enough to find that the circuit breaker has been thrown, you can simply restore your lighting with the flip of a switch. This saves you from having to check all the light bulbs, or calling the power company, an electrician, or a service man. This analogy points out the importance of trying "simple things first."
 

If it cannot be determined precisely which possible solution is correct, then the determination might only be made by a series of therapeutic trials. One can consider the risks and benefits of each alternative, and try one alternative after another until the best solution is found. It makes sense that one should first try, alternatives that have the greatest amount of pros as opposed to cons (greatest benefit as compared to costs/risks). If one treatment had a much greater potential for resolving the symptoms than another, or if one was much more simple to render than another, then the simpler treatment with the greater potential for benefit would seem to be the alternative that should be considered first.

The following are points that make Wilson's Temperature Syndrome and low body temperature patterns one of the first of all medical ailments to be considered rather than the last.

1. It is extremely common and is becoming more prevalent every day because of changes in our society and because of changes in our population brought on, in part, by advancements in medical technology that have helped more people live long enough to develop this problem. Again, "When you hear hoof beats, think of horses not zebras."

2. It is extremely important. The symptoms can be severely debilitating and getting it treated can make all the difference in someone's life. It is hard to imagine any other malady (which is not immediately life-threatening) that takes a greater toll on individuals and our society. It meets, in spades, what is sometimes called the "so-what" criterion.

3. It is an easy solution to a lot of problems. So, if Wilson's Temperature Syndrome is the underlying problem, there is a chance of killing many birds with one stone. It is always better to treat the underlying problem rather than just the symptoms. The potential for benefit is so great because the problem affects such a fundamental level of organization of the body and therefore can have profound physiological consequences.

4. There is a good chance that the problem can be remedied, staying corrected even after the medicine has been discontinued. Women with irregular periods are often helped by being "cycled" on birth control pills for a couple of months to regulate their periods. Once the menstrual cycle has been restored to a regular pattern, they frequently stay regular even after the birth control pills have been discontinued. In much the same way, one may "take control" of the thyroid system and restore it to an appropriate pattern with the symptoms resolving and often staying resolved even after the "cycling" has been discontinued. It's always preferable when someone does not have to take a medicine for life.

5. It doesn't take long for one to see if one is on the right track. Since the problem is so simple, if one responds, the response is usually dramatic, with improvement being seen many times within two days to two weeks. If a symptom responds, it is expected that many, if not all, of the symptoms would also respond at the same time.

6. It's not foreign. Unlike most other medicines, thyroid hormones were not designed by a man in a laboratory. They are substances that have been present in each person's body since birth. This fact decreases the potential of any unforeseen long term side effects to the body, and it decreases the potential for unforeseen drug interactions (but, of course, thyroid medicines are not candy and no medicine is completely without risk).

Now, if one could choose the characteristics of medical problems that should be among the first possibilities considered in addressing any ailment, one would choose:

1. Common or likely
2. Significant and having an impact (so-what criterion)
3. Easy to address
4. Having a potential for correction or "cure"
5. Rapidly responsive
6. Least invasive, being less likely to cause any tissue damage or long-term harm

Because Wilson's Temperature Syndrome affects such a fundamental level of organization, or "cornerstone" of the human body, there is something unbelievably strange about it. Of all chronic medical problems, I believe that Wilson's Temperature Syndrome is the most common, has the greatest impact, is the easiest to address, is the most likely to be remedied, is the most rapidly responding and has the most inherent or non-foreign of treatments. For these reasons, Wilson's Temperature Syndrome should be the first of impairments to be considered in the treatment of patients rather than the last.

If WTS is so common, then how could it be overlooked for so long? Well, what if it was so common and so similar to a body's natural response to living conditions that it was overlooked as being "pretty normal," in spite of the symptoms being recognized, even individually, as inappropriate enough to warrant all manner of symptomatic treatments.

I know as well as anyone that this scenario sounds a little far-fetched. But nevertheless, strange things do happen. Lets talk about strange: A 45-year-old patient has been suffering from severe depression, dry skin, dry hair, memory problems, fatigue, fluid retention, constipation, and panic attacks and has been to numerous doctors who have treated her symptoms with antidepressants, antianxiety medicines, and headache medicines continuously for the past 20 years. She remembers her symptoms beginning 20 years previously when she lost her job and had to move to another state. Since then, her symptoms have not relinquished or subsided. She subsequently divorced and has not been in contact with her children for the past 12 years because of the severe depression. Her symptoms are not mild. In fact, they are quite severe, so severe that she has been continually under doctors' care since the symptoms began. All of her tests are normal, yet her body temperature patterns are low. It seems almost inconceivable, yet the patient's symptoms begin resolving immediately once her body temperature begins to become more normal when she is started on proper thyroid hormone treatment. Within a month and a half, her symptoms are completely resolved, and she has been weaned off the antianxiety and antidepressant medications without difficulty. She feels, for the first time in 20 years, the way she used to feel. If one sees enough of such cases it can begin to affect one's point of view.

In Summary
Wilson's Temperature Syndrome is probably the most common of all chronic ailments and may take a greater toll on society than any other medical condition. Since it is easily recognized and treated, it should be one of the first medical ailments considered in the treatment of patients, rather than the last.

It is paradoxical to be discussing such a simple problem that has such profound implications and yet has been overlooked for so long when it is so easy to recognize and treat. It is also paradoxical because, how could the uncovering of such a significant problem have been so simple or easy? One would expect that something with such great ramifications should have come about only after millions and millions of dollars have been spent by teams of scientists, governments, labs, research hospitals, or pharmaceutical companies; and by having computers read, assimilate, and analyze 54 centuries worth of medical information.

However, as it turns out, developments in science and medicine frequently don't happen in that way. I have always been intrigued by stories about how significant scientific and medical discoveries have been made, and they almost always have one thing in common. That is, someone noticed something a little bit unusual or unexpected and out of the ordinary as compared to what one might have expected. Then, by looking more carefully into the unusual event, and by analyzing it, and by trying to figure out what factors or forces played a part in causing the unexpected event to come to pass; the scientists were able to identify previously unidentified factors of great significance.

For example, in 1928, British scientist Alexander Flemming was working with cultures of bacteria that he was trying to grow in petri dishes. One day he pulled his bacterial culture off the shelf and noticed that it was contaminated with a mold. He could have just discarded the bacterial culture as being ruined, but just before he did, he noticed that the bacteria was not growing within a certain distance of the contaminating mold. He wondered to himself, what was preventing the bacteria from growing near the mold? By analyzing the mold and by looking more closely, he was able to isolate penicillin. That discovery, needless to say, has had an immeasurable impact on the practice of medicine and the lives of millions of people.

Another example is when Madame Curie noticed that when she developed radiographic plates of the image of her hand, she was able to see the outline of her flesh, and she could also see the skeleton of her hand. She realized that the energy that had exposed the plate had passed more easily through the soft tissues of her hand and less easily through the bone, which provided the interesting image on the photographic plate. Such was the humble beginning of the entire field of radiology. This discovery also changed the world forever, and thus, strange things do happen.