People usually go to the doctor when they are being bothered by a medical problem which they cannot easily solve on their own. When addressing such a problem, the doctor may consider the possible causes of the problem and the alternative approaches in addressing it. Pros and cons, risks and benefits of each alternative are weighed in deciding how to proceed. In patients suspected of suffering from Wilson's Temperature Syndrome, because there is no explanation with blood tests or otherwise to account for the patient's classic presentation and complaints, there are several alternative approaches.

1. Non-treatment
2. Alternative treatment including behavioral and dietary changes
3. Definitive treatment, when necessary, with Wilson's T3 Protocol

 

Some people may wonder why Wilson's Temperature Syndrome is so common. They may be surprised that so many people could suffer from such a condition. Yet these same people may not be surprised that people bleed when they are cut with a knife. It is not at all unexpected that if a person is cut with a knife that he might bleed. It's a normal response, but it may not be very desirable. Great measures have been taken to counter this "normal" response such as bandages, sutures, blood banks, surgeries, etc.

In like manner, some may say that it is normal for people to become depressed, tired, irritable, headachy, forgetful, and have trouble sleeping during periods of significant physical, mental, or emotional stress. Yet again, there is a difference between normal and desirable, especially when the response persists inappropriately even after the stress has passed. Even in the midst of the stress, the response is not necessarily favorable or adaptive but may be deleterious. If a person gets cut with a knife, they bleed, and if a person is sufficiently pulverized from stress, they can likewise be "injured," leaving them with a persistently impaired system. If one is bleeding from a knife wound, the wound might stop bleeding on its own, heal up eventually and leave a scar. On the other hand, if the wound is sutured, treated with antibiotics and dressed with bandages, it may be less likely to develop an infection, it may heal more quickly, and it may leave less scarring. If the wound is severe and left untreated, it may not heal by itself, and the patient could bleed to death.

So the choice of treatment approach can certainly affect the outcome. Likewise, with Wilson's Temperature Syndrome, how the problem is addressed can certainly affect the outcome. It can be left untreated, and if it is not too severe, it may resolve spontaneously without treatment returning to normal after the stress is over, leaving very little persistent impairment ("scarring"), if any. If the condition is more severe and is left untreated, more persistent impairment may result and the body's system may not return to normal on its own without definitive intervention. In severe cases, definitive intervention may be disappointing, just as it is sometimes not possible to fully restore the function of a person who has been injured in a severe auto accident. However, the definitive WT3 protocol can sometimes prevent a WTS sufferer from losing decades of productivity and quality of life.

It is "normal" for women to go through menopause later in life and develop hot flashes, vaginal dryness, and increased bone loss, but that doesn't prevent intervention from often being desirable and appropriate. Female hormones are often given routinely to post-menopausal woman because it is felt that intervention frequently favorably affects outcome. Wilson's Temperature Syndrome is not usually life-threatening, just as menopause is usually not life-threatening. However, proper intervention can make all the difference in a person's life; and getting it treated, perhaps more than any other medical problem, may make all the difference in our society as a whole. Getting it treated can have everything to do with eventual outcome.

The symptoms may be seemingly unrelated until they get better simultaneously with the WT3 protocol. Many times patients state that they didn't fully realize how badly they were feeling until their symptoms were alleviated. They frequently state that, "Now I remember what it feels like to be normal again."

Occasionally patients will state that the resolution of a secondary symptom has proven to be more beneficial than the resolution of their primary complaint. For example, a patient with fatigue, migraines, PMS, depression, dry skin, dry hair, constipation, fluid retention, insomnia, inappropriate weight gain, and others might state prior to treatment that the primary complaint is fatigue. But when all of the symptoms resolve, the patient might later report that the resolution of the migraine headaches has actually had a larger impact on his life. This is frequently because the patients themselves can sometimes not fathom that the symptoms could get better together. They may not be able to picture that a particular symptom, such as migraines, might resolve. However, seeing is believing. Many patients state that one really can't appreciate one's good health and normal functioning until its gone, and sometimes they don't realize how bad off they were until their normal health and functioning is restored with the WT3 protocol.

Considering the information presented thus far in this book it is hard to understate the tremendous impact that WTS can have on a person's life. Once developed, Wilson's Temperature Syndrome can, after a period of time, resolve on its own; but in other instances, it can persist for 20,30,40 years or more.
 

Considering the origins of Wilson's Temperature Syndrome, it stands to reason that there may be non-medical alternatives in its management. If emotional, mental, or physical stress can lead to the development of Wilson's Temperature Syndrome or can aggravate it, then the elimination of stress from one's life might be a good place to start. Of course, eliminating destructive stress is one of the great secrets of life. A certain amount of stress is unavoidable, and in some cases it may actually help us grow stronger and more adept at overcoming obstacles. But when the stress is overwhelming, then "injury" can result.

Considering the reduction and/or elimination of stress from one's life as an alternative treatment of Wilson's Temperature Syndrome calls to mind a fascinating case history. It is very interesting because prior to seeing this patient I was in the habit of suggesting to people to eliminate stress when they asked me about what they could do to correct Wilson's Temperature Syndrome without medical treatment. As I would review the alternative measures that one might implement, I would include that one could "completely eliminate stress out of his life." With that they would frequently look at me with a look on their face as if to say, "Yeah, right, who is ever going to be able to completely eliminate stress out of their life?" Sometimes I would jokingly say, "Yes, if you didn't have any job concerns or family concerns, and you lived in the Bahamas and you walked, ran, swam at the beach or exercised all day, and you ate pineapple, fruit and practiced good nutrition all day long and relaxed, then you would probably be much better."

Coincidentally, much later, the patient with the following case history came to my office. She had many complaints including fatigue, depression, fluid retention, PMS, irritability, itchiness, dry skin, dry hair, and inappropriate weight gain. One of the things that troubled her, however, was something that she could never understand. There was a brief period of time in her life that lasted approximately two years in which she did not suffer from these complaints. Prior to these two years, she had developed Wilson's Temperature Syndrome and, among other things, had quite a bit of difficulty with maintaining her weight. But then she went through that two year period of time losing 60 to 80 pounds, no longer having a tendency to gain weight inappropriately. Then after that two year period was over, she suddenly began gaining weight inexplicably (with no increase in dietary intake or decrease in activity) and gained all of her weight back. She couldn't understand how she could possibly feel badly and have a weight problem, then feel well with the weight problem resolving on its own, and then all of a sudden feel poorly again and have a weight problem again out of the blue. After a careful history and questioning, a very interesting pattern became apparent. The patient had undergone a stressful living situation which started her Wilson's Temperature Syndrome. At the beginning of the two year period she also underwent a life-style change. What had happened, believe it or not, was that her husband who was in the military, had been transferred to the Bahamas. He was stationed on a military base, and while they were there, the utilities were paid, their food was paid, their rent was paid, as were all their other necessities of life, including clothing and other needs. She had spent a great deal of time on the beach lying out in the sun. Notably, she did not get an excessive amount of exercise, but she did rest a lot. And she remembers eating more at that time than she had previously or afterwards. When the two years ended, she and her husband moved back to the states and once again needed to concern themselves with living expenses and other problems associated with daily living. Without an increase in her appetite or dietary intake and without a decrease in her physical activity, her symptoms returned as did her weight problem. This patient's case clearly illustrates how Wilson's Temperature Syndrome can sometimes come and go under periods of stress and relaxation respectively.

The body can also be prompted to leave the conservation mode and return to the productivity mode by leading it to think that certain important things need to get done. The conservation mode is not productive and not favorable when it prevents the human body from protecting himself from predators; and when it prevents him from hunting, obtaining food, and building a shelter for his family and for himself. So if a patient can mimic the physical activity that would be required for a human to protect himself from a predator (to flee or to fight), and the level of physical activity that would be required in hunting game and building shelters, it may be possible to coax his body to return back to the productivity mode. The body may pull out of the conservation mode and return to the productivity mode if it is persuaded to realize that it is necessary for survival. In other words, a good moderate exercise program, even 12 to 15 minutes at a time, 2, 3, or 4 times a day, especially after meals, may be enough to encourage the body's metabolism to come up out of, and stay out of the conservation mode. This can be accomplished by walking, swimming, treadmill, exercise bike, or similar activities.

Since Wilson's Temperature Syndrome is, among other things, a coping mechanism for starvation gone amuck, it is easily understandable why patients often do better on hypoglycemic-type diets. Hypoglycemic dieters are characterized by small frequent meals, usually six small meals a day rather than the usual three. These diets are usually higher in protein and lower in carbohydrates than other diets; that is, they are higher in meats such as chicken and turkey as well as others and include eggs, tuna fish, and other sources of protein. They have less carbohydrates such as potatoes, bread, fruits, vegetables, and refined sugars such as cookies, candy, cakes, etc.

I sometimes describe a very simple diet for people to follow that involves eating from these different groups. The protein group includes tuna fish, yogurt, cottage cheese, chicken, turkey, fish, and even beef and pork. The carbohydrate group includes bread, cereal, potatoes, pasta, crackers, rice, and preferably should be of the less refined variety. The fruit and vegetable group includes, of all things, fruits and vegetables. To make it easy, I suggest that the patient trace a silver dollar and two nickels. I recommend that patients eat foods from the three groups in those proportions. A "dollar" size of protein, a "nickel" size of carbohydrates and a nickel size of fruits and vegetables six times a day. Some patients may do better with a little less protein than this, and it can be adjusted. One patient with a classic story for Wilson's Temperature Syndrome was able to correct her symptoms and return back to normal merely by changing her eating habits and using a hypoglycemic type diet. She was able to have her symptoms of Wilson's Temperature Syndrome disappear with her metabolism returning back to the productivity mode.

The benefit of hypoglycemic diets are interesting from several different perspectives. First, it can be pointed out that foods that are higher in protein have higher "biological" value than carbohydrates. To illustrate the principle of biological food value, let us consider a typical food chain. If one considers a field of grain, that grain might be harvested and consumed directly in the form of carbohydrates by people; or the grain may be first be consumed by pigs, cattle, and chickens, and in turn the chickens, cows, and pigs might then be consumed by the humans. Because the cows and pigs feed on the grain, they are higher up in the food chain than grain, with humans being at the very top. Because the pigs and cows are higher in the food chain, they are considered to have a higher biological value than does grain. One reason is that since the cows and pigs feed on the grain and burn up the calories of that grain in their daily activities and in the development of their bodies, quite a bit of grain can be consumed in the raising of those domestic animals.

For argument's sake, let us suppose that a human can survive on the grain harvested from a two-acre field for a period of one year, subsisting only on that grain. Let us suppose that a pig would require 1 1/2 acres and a cow 3 acres. Let us suppose that one cow and two pigs would be necessary to sustain that same person for the period of one year if that person subsisted only on the meat of the 2 pigs, and the cow. Then, if he subsisted on grain alone, he would account for only two acres of grain in a year's time. However, if that same person were to subsist on one cow and two pigs, he would account for six acres of grain. So more acreage of grain would be necessary for the sustenance of one person, the higher up in the food chain he eats.

So it can be said that the cow and two pigs have a greater biological value because as sustenance for a person they represent six acres of grain, as compared to the two acres of grain a person would consume if he ate the grain directly. It is an interesting consideration to me because it seems to me that if conditions became severe (famine), then less grain might be "wasted" on domestic animals and more grain would be consumed directly by people, in order that the available harvest and food would go farther in feeding them and there would be enough food to go around. It would seem that under such conditions the people would live less "high on the hog." They would probably eat more beans and rice and grains rather than the biologically "costly" meats and proteins.

This causes me to wonder if diets high in carbohydrates and low in protein do not send a signal to the body that times might be hard, encouraging the body to enter into the conservation mode. I wonder too if diets higher in protein and lower in carbohydrates signal the body that times are plentiful, and by keeping a little bit of food on the stomach all day (with six meals a day) the body might have less incentive (won't think it's starving) to enter into the conservation mode, and indeed might be more prompted to enter into the productivity mode. This may partly explain why hypoglycemic diets are very helpful for WTS sufferers. Second, some of the symptoms of Wilson's Temperature Syndrome are consistent with symptoms of low blood sugar, for example, night sweats that wake a person in the middle of the night, clamminess, lightheadedness, shakiness, headaches, and even anxiety.

Patients have noted that these symptoms are sometimes improved in the short run by drinking a glass of orange juice or having something to eat. It is interesting that many diabetics have noticed that when their blood sugars are low, their body temperatures are low and when their blood sugars are higher, their body temperatures are higher. Hypoglycemic diets may be helpful in these patients to the extent that they help prevent low blood sugar levels and, therefore, help prevent lower body temperature patterns.

Patients suffering with Wilson's Temperature Syndrome occasionally suffer from intense and previously unfamiliar cravings for sweets. The low body temperature patterns might affect the function of enzymes involved in glucose metabolism which may result in lower blood sugar levels which might contribute to sweet cravings.

Another observation is that WTS sufferers frequently do most poorly on a diet regimen that might put more of a strain on blood sugar levels namely; not eating anything all day and just eating dinner at night right before going to bed. Interestingly, many patients with WTS , especially those who work have fallen into this very eating pattern - which is not preferable.

As an aside, many times a patient's predisposition towards having these symptoms of hypoglycemia has been resolved with normalization of body temperature patterns with the WT3 protocol. The WT3 protocol may help eliminate hypoglycemic tendencies by limiting blood sugar fluctuations by limiting temperature fluctuations.
 

If T3 therapy is not done properly, patients can waste a lot of time and money (on visits and medicine) without even knowing it. We use the term Wilson's T3 Therapy (the WT3 protocol) to distinguish our protocol from other ways doctors give T3 medicine.

The WT3 protocol for Multiple Enzyme Dysfunction due to low body temperature patterns is directed towards normalization of body temperature patterns in order to relieve the symptoms of MED. In many cases the symptoms of MED have been seen to be almost inseparably related to body temperature patterns. The WT3 protocol can often very effectively, predictably, reproducibly, and comfortably influence body temperature patterns. The symptoms of MED and body temperature patterns have frequently been seen to remain persistently improved even after the WT3 protocol has been discontinued. So the WT3 protocol can be useful as a symptomatic (addressing the symptoms) and/or a therapeutic (correcting the underlying problem) intervention for the symptoms of MED due to low body temperature patterns especially when due to Wilson's Temperature Syndrome. This book contains a good description of the treatment for Wilson's Temperature Syndrome but any doctors, or patients for that matter, that are actually pursuing the treatment of Wilson's Temperature Syndrome are referred to the Doctor's Manual for Wilson's Temperature Syndrome (currently in its 6th Edition). Over a year was spent carefully revising it. It contains the treatment protocol in full detail, including the answers to all the questions that come up with the WT3 protocol. There's an illustration on almost every page, 8 case studies, 12 pages of management flow-charts, and lists of the important points and questions, and their answers (you can read it here for free online). When this book and the first edition of the manual first came out, the response was overwhelming. There are over a thousand doctors treating this now. It became immediately obvious that I would not be able to personally assist every doctor or patient with the protocol. But perhaps only WTS sufferers themselves, felt any more acutely than I, the need for me to make my experience available to other doctors. So I poured it into the Doctor's Manual. The protocol is finite, and it's in there.
 

The proper treatment for decreased thyroid system function in any given patient certainly depends on the underlying cause. As discussed previously, there are several causes of DTSF, low body temperature patterns, and the symptoms of MED, and more than one cause can be present at the same time. DTSF can be caused by a hypothalamic problem, hypopituitarism, hypothyroidism, and Wilson's Temperature Syndrome.

Hypopituitarism and hypothyroidism both result in deficient production of T4, which is the raw material the body uses to produce the active thyroid hormone T3. In such cases the treatment of choice is T4 because of its long half-life (which helps provide steady T3 levels), once-a-day administration, and usefulness in the treatment of such cases. Patients with hypopituitarism and hypothyroidism may, however, suffer with Wilson's Temperature Syndrome at the same time. In such cases, T4 therapy may not be adequate because impaired conversion of the T4 supplementation to the active compound T3 may prevent sufficient normalization of body temperature patterns, and, in some cases, can even feed the vicious cycle of Wilson's Temperature Syndrome.
 

Let us consider the case of a perfectly healthy (no symptoms of any kind), 35-year-old woman who suddenly develops classic signs and symptoms of DTSF due to hypothyroidism (low thyroid gland function), demonstrated with blood tests showing T4 levels below the lower limits of normal and TSH levels being above the upper limits of normal. The patient is started on T4 therapy (the treatment of choice for decreased gland function) with many of her symptoms improving and many of the symptoms resolving completely. The T4 therapy is used to return the blood test levels to their normal ranges in the hopes of eliminating all of her symptoms completely. Unfortunately, even upon normalization of the blood test levels, and even after months and years of T4 therapy, the symptoms of DTSF, which first appeared with the development of her hypothyroidism, are still not resolved completely and the patient's function still remains quite unsatisfactory. The symptoms persist, even after T4 therapy has been used to correct the T4 and TSH blood test levels to within normal limits. So the T4 therapy might replace the T4 that the body is not producing in sufficient levels to bring the T4 level on the blood test back up within the normal range, and satisfy the pituitary gland resulting in normalization of TSH test levels, but the patient may still have symptoms of DTSF. So blood tests aren't always extremely predictive in how well a patient is going to feel with treatment and how well the thyroid system will be returned back to normal. The reason for this is obvious, because, again, where the "rubber meets the road" in the thyroid system, is not in the pituitary gland, nor the thyroid gland, nor the blood stream, but at the level of the thyroid hormone/ thyroid hormone receptor interaction at the level of the nuclear membrane of the body's cells.

Therefore, just because circulating raw material (T4) levels have been changed through the use of T4 supplementation to the satisfying of the pituitary and thyroid hormone blood tests does not necessarily mean that adequate levels of T3 are being provided to the active site of the thyroid system. To think so is a little like thinking that one can tell how fast a car is traveling based on how far down the gas pedal is pressed. The pedal may be pressed down, but whether a car is traveling 55 MPH depends also on how well the engine is combusting the fuel, what gear the car is in, and whether it is going up or down hill. Some cars cannot travel 55 MPH no matter how far down the gas pedal is pushed. So a patient can have normal blood tests all day long and still have classic signs and symptoms of Wilson's Temperature Syndrome or DTSF.

This explains some blood test abnormalities and responses to treatment which many people apparently think are not possible. For example, it is commonly thought that elevated T4 levels and low TSH levels necessarily indicate excessive thyroid system function. Most people think that such blood test findings should correlate well with symptoms of hyperthyroidism (excessive thyroid gland function). However, I have seen patients with elevated T4 levels and low TSH levels who showed the classic signs, symptoms, and presentation of Wilson's Temperature Syndrome, and whose symptoms of WTS or DTSF resolved quickly and easily with the WT3 protocol. This situation can be seen in both patients who are on no thyroid medication and, especially in patients who are being treated with T4 therapy prior to presentation. In fact, many times patients will come to my office being treated with T4 medicine with T4 levels being above normal in the 15 to 18 range, when the normal range is between 4 to 12. They also sometimes have exceptionally low TSH levels (thyroid stimulating hormone) indicating almost complete suppression of their pituitary gland and, therefore, their own thyroid gland function by the T4 medication they are being given by mouth. Such blood test findings would usually lead a doctor to conclude that if the patient is having any complaints that they necessarily would be due to hyperthyroidism. But sometimes these patients have classic signs and symptoms of decreased thyroid system function and respond very well to weaning the patient's excessively high T4 supplementation and to the administration of the WT3 protocol. So even though the patients have more than enough T4 floating around in their blood stream according to their blood test levels, they may still lack sufficient levels of the active thyroid hormone at the level of the nuclear membrane of the cells due to impaired T4 to T3 conversion.

Actually, impaired T4 to T3 conversion can be made worse with T4 therapy. If a patient cannot convert the T4 produced by their own body very well, then it is likely that they will not be able to convert effectively T4 given by mouth. In such cases, T4 can actually feed the vicious cycle which leads to Wilson's Syndrome. That is, if more T4 is given to the body and that T4 cannot be properly converted to T3 either, then more T4 will be shunted towards RT3 which may result in further competitive inhibition of the enzyme 5'-deiodinase, leading to further T4 to T3 conversion impairment. In fact, some of the most severe derangements of the thyroid system that I have seen are in patients who seem to have been pushed too far in the wrong direction with the wrong thyroid hormone medicine, namely T4. The RT3 levels are frequently more elevated in these cases than in other cases of Wilson's Temperature Syndrome. Frequently, these patients will also have the highest RT3/T3 ratio. So non-judicious use of thyroid hormone supplementation may feed the vicious cycle of Wilson's Temperature Syndrome rather than reverse it.

I'm not saying that T4 medication is not sometimes a preferable and excellent method of treatment. I'm just saying that it is not always the treatment of choice. And, in every case the choice of thyroid hormone medication, how it is started, how it is adjusted, how it is monitored, and whether or not it should be changed, depends on the underlying cause of the patient's DTSF.
 

Of course, one approach to alleviating Wilson's Temperature Syndrome is to address and eliminate possible contributing causes or factors. If Wilson's Temperature Syndrome is made worse under conditions of severe stress, one may seek to eliminate such conditions. If periods of starvation, excessive dieting, or certain kinds of diets send signals to the body that times are "tough" and that the body should enter into the conservation mode, then one may also seek to change those conditions when possible. If elevated levels of RT3 serve to perpetuate the vicious cycle of Wilson's Temperature Syndrome, then one may seek to decrease the levels of RT3 in a person's body. RT3 is produced by the body from T4, so one way of reducing the levels of RT3 is by reducing the levels of T4. Of course, lowering T4 levels results in a decreased supply of raw material with which the body may make T3. However, the body's T3 levels can be supplemented with T3 taken by mouth.

One may decrease T4 levels by decreasing the levels of thyroid stimulating hormone which regulates the body's production of T4. The body's thermostat (pituitary gland) decreases TSH production when there is a certain amount of T4 and/or T3 already present in the system. So TSH production can be decreased when the body itself produces a certain level of T4, when it produces a certain level of T3, or when it produces certain levels of T4 and T3.

Likewise, the body's production of thyroid stimulating hormone can be decreased when a certain amount of T4 is added to the system by mouth, when a certain level of T3 is added to the system by mouth, and when certain levels of T4 and T3 are added to the system by mouth. Interestingly, when T4 is added to the system by mouth, decreased TSH levels and increased T4 levels may result. However, when T3 is added to the system by mouth, there may result decreased levels of TSH and decreased levels of T4. In either case, the body still has a source for the critical thyroid hormone T3. How adequately those sources are being utilized, however, depends on how adequately the body is converting the T4 to the critical T3, and how sufficiently and steadily the T3 is being supplied by mouth and absorbed by the system.

The WT3 protocol by mouth can accomplish two things at once. It can provide sufficient levels of T3 at the active site to generate adequate body temperature patterns while reducing TSH production, thereby reducing T4 production, thereby reducing Reverse T3 production, thereby decreasing the impairment of T4 to T3 conversion by decreasing competitive inhibition for the converting enzyme. This is important because it can provide for a "resetting" of the system, thereby improving the body's chances of being able to once again properly convert T4 to T3.

As an analogy, we can consider the function of a seat belt. If a person's seat belt "catches" before it can be fastened when it is only half-way across the person's lap, then, try as he might, he will not be able to pull the seat belt any further in order to fasten it until he first lets it go backwards. The seat belt mechanism is reset by disengaging the component that is preventing further advancement. This is accomplished by letting the seat belt be retracted to its starting position.

Likening the thyroid system to this analogy, one component that can hinder the return of a temporarily impaired conversion of T4 to T3 back to normal is the transient elevation of RT3 levels that can result from the impaired conversion. This may lead to a vicious cycle which causes the system to be "stuck" in a position in which there is insufficient conversion of T4 to T3 (this cannot be easily be detected with blood tests). But in order for this conversion to be increased, it must first be decreased in order to "reset" the system by decreasing T4 levels and thereby, decreasing RT3 levels in order to disengage the component that is preventing further advancement. Then when the treatment is weaned, the T4 to T3 conversion can return to more normal levels. The only difference between the analogy of the seat belt and the thyroid system is that the WT3 protocol is not only useful in "resetting" the system, but also in providing necessary levels of T3 for adequate, if not ideal, functioning in the meantime.

Another example that can be considered in understanding the rationale for the WT3 protocol, is the example of the use of birth control pills in patients with irregular periods. There are times when women begin having irregular periods. Their periods can be out of synchronicity, excessively heavy, too light, or skipped completely. In such cases female hormone blood tests and other tests are often found to be completely normal. The only indication that there is a problem is that the woman notices a change in the pattern of her menstrual cycles which she feels is inappropriate and undesirable. Upon careful history and examination, her physician may agree that the symptoms she describes are inappropriate and undesirable. Without any tests available to determine the underlying problem the doctor often suspects a female hormone imbalance. Based on that suspicion, every day, many such patients across the country are given a therapeutic trail of birth control pills by their doctors in an attempt to "regulate" their menstrual irregularities. These patients can sometimes be "cycled" on birth control pills for several months causing their female hormone system and menstrual cycle to fall into a normal pattern again. After the system has been placed into a normal pattern again, the patient may be weaned off the birth control pills and enjoy a persistent improvement and normalization of her menstrual cycles.

This is the same goal of therapy for DTSF due to Wilson's Temperature Syndrome. If a patient's thyroid system is inappropriately stuck in the conservation mode, then the patient may be cycled on proper thyroid hormone treatment to again establish the proper pattern and balance for a period to time. Then when a patient gradually weans off the medicine, the responsibility of normal thyroid system function is returned to the body gradually, and the patient is frequently able to enjoy persistent improvement and normalization of the system even after thyroid medication is weaned.

When birth control pills are given to women with irregular periods, their own female hormone system function decreases to a great extent, if not completely, while the birth control pills are taking control of the system. Once the proper pattern has been set or the female hormone system has been "regulated", the birth control pills can be weaned in the hopes that the patient's body can maintain the newly reset proper pattern on its own once again. In that same way the WT3 protocol can be used to take control of the thyroid system for a time, and set it into a proper pattern. When the body temperature patterns have been normalized, then the WT3 protocol can be weaned in the hopes that the body can maintain the newly set proper balance once again on its own by gradually returning the responsibility of proper thyroid system balance back to the body.

So no matter where the problem is located in the thyroid hormone system, whether it is in the hypothalamus, pituitary gland, thyroid gland, conversion of T4 to T3, or even in the thyroid hormone receptors, the bottom line of therapy is always to adjust the medication in the thyroid hormone system in such a way as to provide a sufficient and desirable pattern of interaction between the thyroid hormones (primarily T3) and the thyroid hormone receptors at the nuclear membrane of the cells of the body.

If the problem is in the hypothalamus, pituitary gland, or thyroid gland, resulting in insufficient production of T4, then T4 supplementation can be given to provide sufficient raw material for the body to make the active thyroid hormone T3. In this way T4 supplementation can indirectly produce sufficient T3 stimulation of the receptor sites, to generate normal body temperature patterns (providing the body can adequately convert the raw material T4 to the active thyroid hormone T3). But if the problem is in the conversion of T4 to T3 and the body is already having difficulty converting its own T4 to T3, then it often has difficulty converting T4 given by mouth (which again can actually worsen the thyroid hormone imbalance responsible for Wilson's Temperature Syndrome). So, many times T3 supplementation is preferable in treating patients with Wilson's Temperature Syndrome, since not only can it provide the T3 necessary for thyroid hormone receptor interaction, but it can also reverse the imbalance of the thyroid hormone system that may have caused the impairment to begin with.
 

It is really hard for anyone to understand how debilitating Wilson's Temperature Syndrome can be until they have experienced it personally or have been closely associated with someone that has suffered from it. It is so common that there are a whole lot of people who could benefit from the WT3 protocol just as there are a whole lot of people who benefit from taking aspirin, birth control pills, female hormone replacement therapy, blood pressure medicine, and others.

Some wonder, "How could so many people benefit from the same medicine? Shouldn't different people need different medicines?" Giving the WT3 protocol to a Wilson's Temperature Syndrome sufferer can be similar to giving insulin to a diabetic. If one is treating diabetes, then one frequently prescribes insulin; and when one treats Wilson's Temperature Syndrome, one frequently prescribes liothyronine (T3). Diabetics are frequently deficient in insulin and therefore, are supplemented with insulin. Wilson's Temperature Syndrome patients are frequently deficient in T3 and are frequently best supplemented with T3. And, if it is very common, a significant portion of the population may benefit from the WT3 protocol at one time or another in their life. Just as many of us have sustained injuries that "needed stitches" to better treat the wound and promote healing, many of us have and will sustain "injuries" that may "need T3" to reverse the impairment and promote the return of normal functioning.

The WT3 protocol is a tool that can be commonly used to make all the difference in a person's life. It is not candy and should not be taken for the fun of it, nor is it completely without risk. But when used properly, it can produce benefits that many patients have considered to be in the "miracle" category. The treatment is not intended to elevate anyone's level of metabolism or thyroid system function above normal, but to bring it back up to normal. The WT3 protocol is not intended to "burn the candle at both ends" and make someone able to perform at above normal levels. Thyroid hormone medication is not "speed" and excessive levels do not cause a person to feel well, high, or above normal, but actually results in side effects and decreased benefit. Thyroid hormones don't have their action specifically on the nervous system but on the cells of the body, in general.
 

The treatment in this section is not the treatment of choice for all causes of decreased thyroid system function, just Wilson's Temperature Syndrome (due to an impairment in the conversion of T4 to T3). Proper treatment of DTSF depends, in every case, on the underlying cause and this chapter describes only the preferred treatment for Wilson's Temperature Syndrome.

As described more fully in Chapters 4 and 6, the following
1. Past Medical History including previous surgeries, reproductive history, current medical problems, and the like.
2. Family History in terms of thyroid, cardiovascular and other problems is also important.
3. Current Medicines considered in terms of how they may interact with thyroid medicine, and in terms of whether or not they might be contributing to the symptoms, if not the problem.
4. Patient's Complaints, when they started, and under what circumstances they improved or worsened are also important. When the symptoms come on together, it is more likely that they are related.
5. Body Temperature Patterns are extremely useful in helping to predict whether or not a patient's symptoms may respond to the WT3 protocol.
6. Nationality or heritage can be like the icing on the cake.

If no other apparent cause of the symptoms can be found, then one might consider the WT3 protocol. Useful tests for this purpose include multichemistry tests, complete blood count, EKG, and even ANA, SED rates and possibly others when indicated. Thyroid hormone blood tests (including T4, TSH, Total T3 RadioImmuno Assay (RIA), Total RT3 RIA) are recommended to rule out other obvious causes of DTSF, and as a baseline to which later tests can be compared.
 

Because of the daily cycles (and monthly in women) in body temperature, I recommend that it be taken three times a day, three hours apart, beginning three hours after awakening three days in a row, at times other than ovulation or immediately premenstrually. Once treatment has been initiated, however, I recommend that the body temperature patterns should be monitored every day even at ovulation and premenstrually. It should be remembered that although these are typical patterns, there are people whose body temperatures do not follow these patterns. Special attention should be made to the patient's body temperature patterns in relation to the pattern of their presenting complaint. For example, if the patient feels worse in the morning, what happens to their temperature pattern at that time? And if they feel worse at 3 o'clock, what happens to their temperature pattern at that time? And if they feel worse two days before their period what happens to their temperature during those two days?

Dr. Barnes' basal temperature test involves taking the body temperature under the arm prior to getting out of bed each morning. It is often suggested that it be taken especially on the third day of the period when body temperatures are supposed, by some, to be most normal.

Since I am mainly concerned with the symptoms that these patients complain about, I am more concerned about the body temperature patterns at the time their symptoms are most disturbing. If the patient's complaints affect their productivity primarily during the bulk of the day, preventing them from functioning normally at home or at work, then I am more concerned about their body temperature patterns during the bulk of the day. If their complaints are more severe in the morning or evening, then I may be more interested in the body temperature pattern at those times. However, there are two more reasons that I usually recommend that patients take their body temperatures more during the bulk of their day, or what should be their most productive hours. One is that most Wilson's Temperature Syndrome sufferers' symptoms take their toll in terms of productivity, especially during the "productive" hours during the bulk of the day (even though the symptoms may be worse in the morning until the body temperature rises as the patient "warms up"). The second reason is that if the patient's body temperature runs low when measured several times a day, several hours apart, during the bulk of the day when the body temperatures are usually at their highest ( as compared to low body temperature readings taken in the morning when body temperatures are usually lower), then it is even more likely that the patient's body temperature patterns are abnormally low. By taking several temperatures during the bulk of the day when the temperature is usually at its highest, it is felt that the results may be more meaningful, with few false positives.

It should be remembered that one temperature by itself doesn't mean a thing, since body temperatures normally fluctuate at different times under different conditions. However, body temperature patterns can be quite useful. I like to look at body temperature readings the way one looks out over an ocean to determine whether it is choppy or calm or whether it is high tide or low tide. Certainly the level of the body temperature is important with both "low tide" and "high tide" being capable of causing symptoms. When the body temperature patterns are "choppy" or unsteady, symptoms may also result. Preferably, the body temperature pattern should be normal and steady to provide maximal enzyme function and efficiency. One cannot determine by looking at the crest of one wave whether it is high tide, low tide, choppy, or calm. One must look out over the whole ocean to get a feel for the marine conditions. Likewise, one cannot tell by one body temperature reading the nature of a person's body temperature patterns, but one may get a feel for them by looking over all the body temperature readings.

Patients' body temperatures are usually higher in the doctor's office (like pulse and blood pressure readings presumably because of nervousness). Because they are frequently higher, and because one body temperature by itself does not tell very much, body temperature readings taken in the doctor's office are not very useful. Patients are often already aware that their body temperatures run consistently below normal. They have been told by nurses in hospitals or doctor's offices that their temperatures run unusually low, that the "thermometer must be broken", or asked by the nurses, "are you alive?"

Many times WTS sufferers will come down with a cold or flu, feel feverish, and measure their body temperatures expecting high temperatures, only to find that their temperatures are not very high and may actually be below normal. WTS sufferers frequently indicate that temperatures that might not be considered significant in most people indicate severe illness for them. They equate a temperature of 99.4 for them to be like a fever of a 102 or 103 for other people who are just as sick. They often say, "I have to get sick to run a normal temperature," or, "If I run a temperature of 99.6 then I've got to be really sick." Patients are often surprised when they follow their body temperature patterns to see how low, and sometimes how erratic their body temperatures do run. Some patients who feel hot all the time and sweat easily are astounded to find that their body temperatures never get above 97.8 (8/10th's of a degree below normal).

Digital thermometers can be less accurate when their batteries are low or when they've been dropped 5" or more. But due to environmental legislation, glass/mercury thermometers are becoming less available (click here for an alternative). The important thing is to see the change in the patients' temps with treatment. So if using digital, patients should make sure to replace the batteries as needed (changed every two weeks?), and to not drop their thermometers. Temperatures should be taken at least 15 minutes after eating or drinking and should be taken for at least 4 to 5 minutes when using a glass thermometer. Fortunately, body temperature patterns end up being of great predictive value in the monitoring of the WT3 protocol. I consider daily temperature ranges of 2 to 3/10th's of a degree to be consistent with a relatively steady body temperature pattern. Some patients, however, are surprised to find that their body temperature patterns can fluctuate from 1 to 2, or even 3 whole degrees. Most patients that I treat typically present with body temperature patterns averaging about 97.8 degrees, although symptoms can be caused by temperatures closer to 98.6 degrees. Some patients have temperatures between 96 and 97.8 degrees. A few have body temperatures less than 96 degrees, and I have seen some patients with body temperatures that can go as low as 93 degrees at times.

The best indicator that a patient's symptoms are related to their temperature pattern is that when the patient takes the right kind of thyroid medication, in the right way, to get their body temperature pattern up to 98.6 degrees, and if the patient's complaints resolve within two days to two weeks, then that is a pretty good indicator that one is on the right track. If the patient's symptoms remain gone and his body temperature remains in the 98.6 degree range even after the WT3 protocol has been discontinued, then that is a pretty good indicator that some persistent correction has been effected. This is what is known as a therapeutic trial.

In a sense, everything in medicine, as discussed previously, is a therapeutic trial. One never knows how a patient will respond to high blood pressure medicine, asthma medicine, ulcer medicine, or antibiotics until they are administered and the patient's response evaluated. In many ways, medicine is far less of an exact science than some people make it out to be. The patient's response to treatment helps to more firmly establish the diagnosis of the patient's presenting problems and complaints. So, just like everything in life, physicians can only do the best they can with what they have, going about their business with the best tools available, working on correcting problems.

In spite of the fact that there are few medical problems that respond to treatment as predictably as Wilson's Temperature Syndrome, the particulars of the patients' response to treatment vary tremendously. The clinical patterns and presentation of the classic signs and symptoms of Wilson's Temperature Syndrome, and the body temperature pattern, can be extremely predictive and can predict favorable response to therapy in 95% of cases. There are few problems in medicine that can respond as predictably and reproducibly as Wilson's Temperature Syndrome can to the WT3 protocol. In this sense, the clinical pattern of presentation or clinical picture and body temperature patterns are extremely accurate and valuable tests. Nevertheless, as in all medical therapies, the treatment itself may be the test that best helps determine whether the diagnosis was correct. If the patient responds well to a specific therapy directed at the cause, then it is more likely that the suspected cause was indeed the cause of the patient's complaints, and it is more likely that the therapy resolved their complaints by successfully addressing this cause, particularly if the symptoms remain resolved even after the therapy has been discontinued.
 

Before starting the WT3 protocol as with any other medical therapy, one must first consider the potential risks and benefits. One can increase the chance of benefit and decrease the risk by ruling out other obvious causes of the patient's presenting complaints. Some of the more important things to rule out are Addison's Disease (adrenal insufficiency), Cushing's Disease (excessive glucocorticoid), congestive heart failure, anemia, leukemia, atrial fibrillation, irregular heart rhythms, lupus, Sjogren's Syndrome, and others. It is important to rule these conditions out as well as possible and to think of these things when considering treatment for Wilson's Temperature Syndrome because some of these conditions can get worse with thyroid hormone treatment. This is especially true of Addison's Disease, for example, which is sometimes characterized by severe abdominal pain. These conditions are really quite rare, but are, nevertheless, important to consider.

Let us now consider more specifically the risks of the WT3 protocol. Thyroid hormones have been continually present in every person's body since birth. Adequate thyroid hormone levels are necessary for survival. If someone is living, they necessarily have T3 in their blood stream and if they are not on any medication, then they have T4 in their blood stream as well. Unlike most other medications, thyroid hormones are found in nature and in every person's body. This helps explain why there has not been a reported incident of anyone having an allergic reaction to thyroid hormone medication. Most other medicines, however, are designed by men in laboratories, are foreign, and are different from the molecules that are produced by the body naturally. For this reason, it is unlikely that thyroid hormones have many long term side effects. It is unlikely that thyroid hormones can directly damage tissues such as the brain, lungs, heart, or other tissues, since these tissues have been exposed to the very same hormone since birth. Thyroid hormones have been on the market for over 40 years and have not been shown to increase the chance of a person developing cancers or other unusual reactions in patients who have been treated with thyroid hormones for several decades. In fact, patients are frequently told, once they have been diagnosed as having DTSF, that they will need to take thyroid hormone medication "for the rest of their lives." Thyroid hormone medication has been seen to be tolerated well enough and to be sometimes necessary to take daily for the rest of one's life.

There have been some studies recently to show that patients in their later years who are being replaced with T4 supplementation levels that are so high that the TSH level is below the lower limits of normal over a period of years (even ten years), may have a higher degree of bone loss or osteoporosis as compared to patients who are not on thyroid hormone medication. However, that these patients TSH levels were suppressed significantly, indicates that they might have been taking excessive levels of T4 supplementation. We have already discussed how some patients' thyroid systems can be pushed too far in the wrong direction with too much T4 supplementation. The cause of bone loss in these patients has not yet been determined and body temperature patterns have not been taken into account, and it may be that these patient's thyroid systems were not being properly monitored and regulated.

Thyroid hormone supplementation cannot be properly monitored if body temperature patterns are not taken into consideration. Just because the patients' T4 levels were excessive does not necessarily mean that they were getting sufficient levels of the active hormone T3. T4 is the thyroid hormone preparation most often prescribed for long-term maintenance therapy and is generally considered to be quite benign (not harmful). Of course, T4 is not the physiologically active thyroid hormone, T3 is. T4 has to be converted to T3 before it has its action. So essentially, T4 is "T3 waiting to happen." Therefore, in a sense, when one takes T4, one is taking T3, thus the WT3 protocol does not expose the body to any substances that T4 therapy doesn't. The effects of T4 and the WT3 protocol on the body differ mainly in the extent to and the steadiness with which they provide the body with the physiologically active thyroid hormone T3. These effects can be maximized through the use of correct pharmacological principles. Also T3 and T4 therapy can be judiciously combined in certain cases to take advantage of the effects of each.

One interesting study showed that when some people are born with out thyroid function, they can sometimes be supplemented with T3 instead of T4. One such person was raised entirely on T3 medication and never had any T4 in his body during his entire life. By the age of 26, he had grown and developed normally.

The more substantive risks of thyroid hormone therapy are more short term rather than long term. They are more due to the indirect effects of the medicine (on blood pressure and pulse), than they are due to direct tissue damage. If every medicine has a risk and I were to assign one for the WT3 protocol, then I would say that if a person was on the verge of having a heart attack or stroke anyway, changes in his or her blood pressure or pulse could aggravate the situation like the straw that broke the camel's back. Other factors that fall into the same category include: getting into arguments, driving in heavy traffic on the interstate, and many other types of medicine (such as caffeine, alcohol, decongestants, blood pressure medications, and others). If a person already has a tendency towards having an irregular heart rhythm (of which he or she is already aware, or that can be seen on an EKG), then the WT3 protocol might increase that patient's chances of having irregular heart rhythms. If a patient is not on the verge of a heart attack or stroke, then it would be hard to see how the WT3 protocol can bring them there, since it is a hormone that has been well tolerated in his/her body since birth.

The WT3 protocol is generally extremely well tolerated, and when used with proper care and consideration, it is usually quite easily managed. When properly managed, one does not expect any drastic problems because one makes no drastic changes. The medication is started at extremely low levels and increased in very small increments, so that if the patient does develop any complaints, they usually come on gradually, not all at once. It is important to take the medication on time and as directed.

Another important thing to remember is that not every doctor currently understands the WT3 protocol or Wilson's Temperature Syndrome. It is important not to stop thyroid hormone medicines (especially T3) abruptly.

There is quite a bit of mythology about the thyroid system and thyroid hormone supplementation. This is easy to understand considering the difficulty available tests have had in predictably and reproducibly measuring the function of the thyroid system ( in relation to signs and symptoms of DTSF). Some say that once on thyroid therapy, always on thyroid therapy, but this is not necessarily true. Some say that taking thyroid hormone medication will cause a person's gland to atrophy and that the gland will be ruined so that he will always need thyroid therapy. That some patients will need to take thyroid hormone medication for life is true, especially those patients who no longer have a thyroid gland. However, not all patients on thyroid medication will have to take it forever. And temporarily suppressing the gland does not mean that the gland will be ruined. I have seen many patients who have been treated with T4 therapy for years (even 20 and 30 years), with their TSH levels all the while being at or below the lower limits of normal (which indicates that their pituitary gland's secretion of TSH had been suppressed by the T4 medication resulting in almost complete suppression of the patient's thyroid gland). These patients sometimes present, nevertheless, with classic signs and symptoms of DTSF in spite of being on years of T4 therapy. With careful weaning of T4 therapy and administration of the WT3 protocol, the patients' cause of DTSF (concurrent Wilson's Temperature Syndrome) can often be reversed with resolution of their symptoms of MED with normalization of body temperature patterns. Upon gradually weaning the WT3 protocol, these patient's thyroid gland production of T4 can often resume again on its own for the first time in 20 to 30 years (especially in cases in which the patients' original diagnosis was based on less than solid evidence - which is often the case). These patients are sometimes able to wean off the WT3 protocol and maintain normal body temperature patterns and resolution of the symptoms of MED on their own. If a thyroid gland can function normally after being suppressed for 20 or 30 years, it is hard to imagine a normal thyroid gland's function not resuming after being suppressed for two weeks, two months, or even two years. There is no medical literature that demonstrates that suppression of the thyroid gland with thyroid hormone supplementation can result in permanent damage to the thyroid gland. In the approximately 5, 000 cases that I have treated, I have never seen it happen. Of course, I suppose in medicine anything that can happen does happen, and therefore, thyroid hormone supplementation should not be taken casually and should only be taken if it is decided by the patient and the doctor that the potential benefits outweigh the potential risks. Then one might consider a therapeutic trial of the WT3 protocol.

It is understandable how the body and thyroid gland tolerate thyroid hormone supplementation so well when one considers that the thyroid system is not a static system but a dynamic one. The thyroid hormone levels are constantly being adjusted by the body to accommodate different circumstances. So if the thyroid system can adjust to drastically different physical and environmental changes, and then can adjust back to normal once those changes have passed, it is easy to see how the thyroid system can adjust back to normal after "artificial" adjustments have been exerted on the thyroid system for a time with thyroid hormone supplementation.

The potential side effects of thyroid hormone treatment are very similar to the symptoms of DTSF. This is because the symptoms are "thyroid" symptoms. If the symptoms are treated properly, then they will improve. If they are improving with treatment for a time and for some reason the treatment is not done properly or other problems occur, then the symptoms that have improved might begin to get worse again. So in that sense, they might be considered side effects from the treatment. In other words, if the system is affected properly, the symptoms get better and if the system is being affected improperly, the symptoms can get worse again and in that sense be considered "side effects." That is why many patients can have many of the "side effects" prior to treatment that are correlated with treatment such as shakiness, lightheadedness, hot flashes, fever blisters, weakness of the legs, panicky feelings, fatigue especially after a meal, jitteriness, diarrhea, constipation, sweating, dizziness, leg cramps, etc. If a patient should develop any symptoms or side effects from the treatment, it is an indication that the thyroid hormones are not adjusted properly and that the medication needs to be adjusted.

Thyroid hormone therapy should not be considered a "no pain, no gain" treatment. There is no point in "toughing out" any sensations that might remotely be considered side effects of therapy, because ideally, the symptoms are supposed to only improve with absolutely no complaints. Again, any complaint that is in any way suspected to be related to the medicine should be considered an indicator that the thyroid hormone treatment might be less than ideally adjusted. The side effects, like the symptoms, can be caused by body temperature patterns that are too low, too high, or unsteady.

The medication should not be stopped abruptly. One might wonder what effects such an action would have. If patients stop their the WT3 protocol abruptly, nine times out of ten, they will not be able to tell the difference. Five times out of one hundred, the patient may notice being more tired and achy; about one time out of a hundred, the patient may become significantly more tired, lightheaded upon standing, clammy, aware of low blood pressure, and have other such symptoms for several days and even a few weeks. So it is not advisable to stop the medicine abruptly.

Most of the patients that I treat have normal thyroid hormone blood tests (which is typical of Wilson's Temperature Syndrome), and, by far, the majority of them get better with treatment. In previous chapters the limitations of the thyroid hormone blood tests have been thoroughly discussed. Suffice it to say that thyroid hormone blood tests can be misleading, having a large number of false negatives in the evaluation of DTSF and the symptoms of MED. Most of the patients that I treat have normal blood tests much the way patients with migraines, premenstrual syndrome, depression, irregular periods, and infertility frequently have normal blood tests. Of course, patients are treated for migraines, depression, and PMS every day because many doctors understand that our medical technology is not exhaustive. They understand that there are still more things that are unknown than are known.

How does the doctor know when a patient is suffering from the symptoms they are describing, which happen to be consistent, for example, with the clinical picture of migraine headaches? The only way he has of knowing that a patient is suffering from such complaints is because the patient says so and because the doctor believes the patient. Since there is no "migraine-o-meter," the doctor is left to make a provisional diagnosis and begin therapeutic trials in an effort to alleviate the patient's condition. The same situation holds true for depression and the administration of antidepressants which are among the most widely prescribed medicines in the world. Doctors are doing the best they can with what they have, and by approaching the problems of migraines, depression, and PMS analytically, doctors have been able to relieve untold anguish and misery. It seems very strange then, that the limitations of blood tests and medical technology are so well recognized in certain areas of medicine, while the results of tests seem to be unduly considered cut-and-dry, conclusive, exhaustive, and infallible in others. Perhaps it is because thyroid hormone blood tests can be useful in identifying some of the causes of DTSF. But we must not jump to the conclusion that necessarily means that they can identify all causes of DTSF.

With all of our knowledge, advancements, technology, and sophisticated tests, we sometimes lose sight of the fact that tests are only as valuable as they are useful in predicting the outcome of therapy and directing treatment to make patients' problems better (which is the real goal of medicine). The value of a test isn't always best measured by how difficult the test is to perform, how much it costs to make or develop the machine used, or how expensive the test is to obtain. Just because a test is extremely complicated, sophisticated, and expensive, doesn't necessarily mean that it is extremely useful, predictive, or valuable in addressing certain problems. Wilson's Temperature Syndrome signs and symptoms, their clinical presentation, and body temperature patterns aren't expensive, complicated, or technologically highly sophisticated, nevertheless, they are extremely valuable in helping to predict who will and who will not respond to the WT3 protocol, and in helping to direct that therapy. Often objective (from tests) information has more predictive value than subjective (from the patient) information in the diagnosis and treatment of medical problems. However, in the diagnosis and treatment of Wilson's Temperature Syndrome, information obtained from the patient ends up being extremely predictive.

For example, if a patient has a classic presentation of Wilson's Temperature Syndrome, it is easy to predict that a patient has a low body temperature pattern and is likely to respond to the WT3 protocol. In fact, if I see 200 patients with a classic presentation of Wilson's Temperature Syndrome, less than one would have a normal body temperature pattern (running 98.6 degrees on average). In fact when a patient relates to me a classic presentation of Wilson's Temperature Syndrome, I will often tell them, "I know your body temperature runs low, have you ever noticed that?" In many cases the patients are already aware that they have consistently low body temperature patterns, but in some they are not. A few patients having classic presentations for Wilson's Temperature Syndrome have gone home and measured their body temperatures and found that their body temperatures were averaging normal or above. To such patients, after making sure that they were not taking their temperatures at the time of ovulation or just prior to their menstrual cycles, I have made the comment: "That means your thermometer is broken and you should check your temperature with another thermometer." These patients are often astounded when they go home and find that sure enough, their body temperature patterns do run consistently below normal when measured with another thermometer. I have been so bold as to make such statements because in a patient with a classic presentation of Wilson's Temperature Syndrome, there is more chance that the patient's thermometer is broken than there is that the patient has a body temperature pattern that runs consistently normal or above. Patients with classic signs, symptoms, and presentations of Wilson's Temperature Syndrome will notice an unequivocal improvement in their symptoms with the WT3 protocol in 95% of cases. There are very few medical problems that respond as reproducibly and predictably to treatment (with or without technologically sophisticated testing) as does Wilson's Temperature Syndrome respond to the WT3 protocol. DTSF symptoms that come on after a major stress associated with low body temperature patterns and normal thyroid blood tests are almost pathognomonic for Wilson's Temperature Syndrome. Pathognomonic is a medical term that means that it is specifically distinctive or characteristic of a disease or pathologic condition; denoting a sign or symptom on which a diagnosis can be made.
 

If blood tests and physical examination reveal no other good explanation for the patient's classic signs and symptoms of DTSF, then one may suspect an impairment in the conversion of T4 to T3 thyroid hormones and one may consider a therapeutic trial with the WT3 protocol. The goal of the WT3 protocol is really made up of two subgoals.

1. Feel well while on the WT3 protocol.
2. Remain well after the WT3 protocol has been discontinued.

These subgoals can be achieved separately or concurrently. During the course of treatment, the symptoms may resolve, but that doesn't necessarily mean that they will stay resolved after therapy is weaned. Sometimes several cycles of treatment are necessary in order to have the symptoms resolve and remain resolved even after the WT3 protocol has been discontinued. Sometimes the symptoms resolve only after the WT3 protocol is discontinued. This is because the accomplishing of each subgoal is predicated upon a different factor. The first subgoal is predicated upon providing sufficiently normal and steady T3 levels to provide sufficiently normal and steady body temperature patterns to maintain normal enzyme activity, to eliminate and prevent the symptoms of MED characteristic of DTSF due to Wilson's Temperature Syndrome. The second subgoal is predicated upon reversing the imbalance leading to impaired T4 to T3 conversion well enough that the body can maintain, on its own, proper thyroid system function once the WT3 protocol has been discontinued. The WT3 protocol accomplishes this goal by reducing competitive inhibition at the level of 5'-deiodinase by systematically reducing RT3 levels, and possibly by establishing a new pattern or new balance in the body's overall system by indirectly effecting changes in other systems such as the female hormone system, adrenal hormone system, glucose metabolism system, and others (rope and ring analogy, see chapter 2).

Sometimes RT3 levels can be lowered to reduce their inhibition of T4 to T3 conversion, even though the artificial levels of T3 have not been stabilized sufficiently to completely eliminate the symptoms of MED. Yet, in such cases, with the underlying impairment corrected and the body's own thyroid system function being restored as the WT3 protocol is gradually discontinued, the symptoms of MED may resolve more going off the WT3 protocol than they ever did while on the WT3 protocol. This demonstrates that the body's own system can be "reset" to function properly on its own, even if the artificial T3 therapy could not be stabilized well enough (during a treatment cycle) to eliminate or prevent the symptoms of MED in the meantime. Usually both subgoals can be accomplished concurrently, but it should be remembered that they are not inseparable. It is fortunate that, in almost all cases, the two subgoals can be accomplished at the same time.
 

Let us take a moment to discuss different types of thyroid medications available. Some medicines contain only levothyroxine (T4), while others contain only liothyronine (T3), while still others contain a combination of T4 and T3. A distinction can also be made between thyroid medicines that originate from animal sources, and those that are made synthetically. In thyroid hormone supplementation, it is important that each dose of the same strength of medication given contain extremely similar amounts of the medication to help provide normal and steady levels. Medications prepared from animal sources are not considered to have as much consistency as compared to synthetic preparations. Consistency is particularly important in the WT3 protocol. T3 medication is prepared synthetically. With the WT3 protocol, steadiness and consistency are everything and I recommend the use of a special T3 preparation that incorporates a sustained-release agent or vehicle used in many sustained-release medicines on the market. It is to be taken every 12 hours.

To review, T3, T4, and RT3 look exactly the same, the way 3 keys look exactly the same except having one notch that's different (see diagram 2-3). The interesting thing is that RT3 has no activity at all, T4 has a little activity, and T3 has four times more activity than T4 at the active site. Interestingly, T4 is converted to T3.

It takes 7 1/2 days for 50% of a certain amount of T4 to be degraded by the body, giving it a "half-life" of 7 1/2 days. The half-life of T3 is shorter than that of T4 being only 2 1/2 days. Since T3 is four times more active and is a third as long acting, and since the whole goal of the WT3 protocol is to provide normal and steady T3 levels to the active site in order to provide normal and steady body temperature patterns, it becomes apparent that the WT3 protocol is most effective when done in a precise manner. T4 medication having such a long half-life needs to be taken only once a day and can provide steady levels of T4 and T3. Unfortunately, as pointed out previously, Wilson's Temperature Syndrome sufferers who have a hard time converting their own T4 to T3 often cannot convert T4 medication sufficiently to provide sufficient levels of T3 at the active site in a sustained manner, nor in a manner that could help reverse the vicious cycle that contributes to persistent T4 to T3 conversion impairment. T4 is usually not helpful in the treatment of Wilson's Temperature Syndrome because it is not useful in systematically reducing RT3 levels, and because improvement of WTS symptoms with T4 medication is usually short-lived (usually about 3 months, if achieved at all). Increases in T4 therapy are then required to maintain the improvements, thereby, often feeding the vicious cycle rather than helping to reverse it. In fact, further increases in the T4 therapy can then even begin to make the WTS symptoms worse.

T4 medicine is a very good medicine, and is the treatment of choice for the other causes of DTSF. But since it is not generally useful in accomplishing the two subgoals of treatment for Wilson's Temperature Syndrome, the WT3 protocol is the treatment of choice. The whole trick to the WT3 protocol is to keep the levels of T3 steady. This requires some care, consideration, and effort considering the short half-life of T3. Most doctors seem to think of thyroid hormone medication in terms of weeks and months, possibly because it takes weeks for T4 medication to provide a "steady state" or prescribed level of T3. However, T3 can be thought of in terms of minutes, days, and weeks since it can start being absorbed into the body within 35 to 45 minutes after the dose and can begin having an effect at the nuclear membrane receptors soon thereafter. This is especially true with the WT3 protocol since it is already "active" and does not need to wait around to be activated by the body.

Available medical resources suggest that T3 levels are more steady when patients are given T4 than when T3 is given directly, and that side effects are more likely when T3 levels are unsteady; yet they also suggest that T4 medication and T3 medication both be given once a day. This does not even make pharmacological sense. Normally, T4 is converted to T3 a little at a time, thousands of times around the clock 24 hours a day. Is it any wonder that this steady supply of T3 can't be closely approximated with T3 given only once a day, or even several times a day? Is it any surprise that T3 levels may be more unsteady when T3 is supplied only once a day as compared to thousand of times around the clock? Perhaps this is one reason why the usefulness of T3 has been overlooked for so long and it may be why the WT3 protocol is sometimes considered to be somewhat prone to causing side effects. Of course, all medicines are prone to being less useful and more likely to cause side effects when taken in ways that do not make pharmacological sense.

There is nothing inadequate about T3 as a medicine or as a molecule, apparently only our understanding and application of it has been inadequate. In fact, it is one of the most important and useful of all medicines, and is a molecule the body can't live without. There are some studies and people that have "concluded" this and "determined" that about T3, the way one can look through the wrong end of a pair of binoculars and "conclude" that they are not useful for seeing long distances. It is amazing how using something correctly can make all the difference in the world.

Some patients can tolerate the WT3 protocol given in single daily doses, some tolerate doses taken twice a day, some three time a day. However, in my experience, taking all patients as a whole, I feel that instant-release T3 medicine should be taken at least every three hours, six times a day, consistently by the clock in order to decrease the chances of side effects, and to increase the chances of benefits. A new approach, however, involves incorporating T3 into a sustained-release vehicle used in many sustained-release medicines on the market. It is intended to be taken every twelve hours and to deliver a little T3 thousands of times over a 12-hour period to provide a more steady supply of T3. When taken twice a day, such a preparation is designed to provide a more steady supply of T3 24 hours a day. So it is easy to understand why such a preparation is far more effective in the treatment of Wilson's Temperature Syndrome than instant-release T3. Since the possible side effects of T3 are most often related to unsteady T3 levels, it is easy to understand also, why there are far less side effects with the WT3 protocol incorporating a sustained-release vehicle as compared to instant-release T3, and why it is much better tolerated. The T3 incorporating a sustained-release vehicle needs to be taken only twice a day as compared to six times a day, which makes it far easier for the patients to take the medicine properly, and on time. Such a preparation incorporating a sustained-release vehicle is not being mass-produced on the market, but is being custom made or "compounded" by some pharmacists with a special interest in compounding (for example, Medaus).

There are a few (approximately five percent of patients) who do respond better to instant-release T3 than the T3 in sustained-release vehicle. However, by far most patients respond far more quickly, far more completely, and with far less side effects to a T3 preparation incorporating a sustained release vehicle. In fact, the incidence and severity of side effects of the WT3 protocol can be reduced approximately 20-fold through the use of such a T3 preparation, as compared to instant release T3.

Many medications such as antihistamines, asthma medicines, blood pressure medicines, and many others have proven to be much more efficacious and better tolerated when administered in slow-release or time-release preparations that maintain more constant delivery and blood levels. Considering the importance of steady T3 levels, it is understandable why T3 in a sustained-release vehicle would prove to be much more efficacious and better tolerated than instant release T3. For this reason, I use, almost exclusively, such a preparation taken by mouth every 12 hours in the patients that I treat for Wilson's Temperature Syndrome. It is important that the such a preparation be taken by mouth every 12 hours, 30 days a month, at the same time every day. If a patient misses a dose by an hour, he or she will probably notice no side effects and might conclude, therefore, that the timing of the dose doesn't really matter. However, I always recommend to my patients that if they want the medicine to work exceptionally well, then they should take the doses right to the minute, not even three minutes late. It is also best that the preparation be compounded with great care and precision. I even recommend using a timer that automatically goes off every 12 hours. Because being off 20 minutes here, and 30 minutes there can add up over a period of a couple of weeks decreasing the potential benefits. Restoring the potential once decreased can take two weeks or more and may require cycling.
 

The purpose of the WT3 protocol is to raise the body temperature patterns to average closer to normal (98.6 degrees). As soon as the starting dose of T3 is administered to the patient, the body begins to be relieved of the responsibility (for a time) of producing so much T4 and T3 on its own. Like a thermostat, the body detects the T3 medication being given by mouth, and a signal is sent to the thyroid gland to let it know that it does not need to produce as much T4, and consequently, T3. As discussed previously, the two subgoals of treatment are to reset the system and to administer the WT3 protocol in the meantime in such a way as to bring the body temperature patterns closer to normal. Bringing the body temperature patterns closer to normal involves supplying enough T3 to stimulate the cells to generate normal body temperature patterns. So initial doses of T3 are administered to begin the effort to restore the body temperature levels to normal.
 

However, as soon as the initial doses are given, the body begins to make less T3. So more T3 can be given by mouth to continue the effect to bring the body temperature up to normal, and again the body may make less. And again, then more can be given, and the body may make less. Interestingly, this process also serves the purpose of resetting the system by diminishing T4 levels and, therefore, RT3 levels. When the body temperature is brought up to a normal level, the T3 dose does not need to be increased any further. In most cases, the patient's body temperature can be brought up to average close to normal on less than 150 micrograms per day (dosing discussed later this chapter). With the initial dose of T3 adding additional T3 to the body, the body temperature may be raised closer to normal. But when the body compensates by making less T3, the body temperature may drop back down somewhat and the next incremental increase of T3 can be given.

Different people compensate at different rates. The recommended starting dose is 15 micrograms per day and the incremental increases are also recommended to be 15 micrograms per day. On average, most people will compensate to a 15 microgram incremental increase of T3 in the system within three or four days. However, some may take up to three weeks to compensate in a reproducible way to such an incremental increase. Some may compensate to a 15 microgram increment in one day, and some may even compensate within hours. The more quickly a person compensates to incremental increases of the WT3 protocol, the more difficult it is to maintain very steady levels of T3 and, therefore, very steady body temperature patterns. Three-week compensators, on the other hand, are usually very easy to manage.

Sometimes, the body can compensate to supplemental the WT3 protocol in such a way that the body temperature can actually drop instead of going up, because of over-compensation. This presents a situation that is similar to wanting to cross a street that has quite a bit of water in the gutters. If you do not want to get wet, then you should run fast enough and jump high enough to clear the water, or not jump at all. Because if you are too tentative, go too slowly, and don't jump high enough, then you run the risk of getting wet. So it is best to either take control of the system and to get the job accomplished or to not affect the system in the first place. The WT3 protocol should not be undertaken for the fun of it, but only when it is determined that the person's function and quality of life is so impaired and unsatisfactory that the potential risks are outweighed by the potential benefits. The WT3 protocol should only be undertaken in a deliberate way to accomplish a specific objective. the WT3 protocol should be administered in a very precise manner and never in a casual manner.
 

It might be remembered that "the deeper the water, the deeper the waves," and the higher the dose of T3 taken, then greater the tendency for T3 levels to be unsteady. But since steadiness is everything, then it is easy to understand why the people that always do the best are the ones that are lucky enough to get their body temperature patterns up to normal on the smallest amount of medicine. People who have been "out of bounds" further and longer may require larger doses to reset their systems. If a person has only had Wilson's Temperature Syndrome for six months, it is generally easier to restore them back to a normal pattern more quickly with less medicine than those who have suffered for twenty years. Interestingly, age, sex, and weight do not seem to be very predictive in determining who will and will not require larger doses. The dose required does vary tremendously, but is usually large in patients whose condition is more severe and more long standing. Lower doses are easier to keep steady which increases the chances of benefit, and decreases the chances of side effects. If a person does happen to need more T3 than is contained in the lower doses to reset the system, then one may always be gradually weaned off the medicine and restarted on the T3 therapy again. This process is known as "cycling" and is extremely helpful. Usually with each cycle, smaller T3 doses are needed in order to maintain normal body temperature patterns, and to further reset the system; so that the patient can get closer and closer to normal on less and less T3 medicine until, ideally, the patient is weaned off the WT3 protocol completely.

With each cycle requiring less medicine, T3 levels and body temperature patterns become progressively more steady and the patient's symptoms are frequently more improved and the treatment is better tolerated with each cycle until eventually, hopefully, the patient is able to stay normal even after the WT3 protocol has been discontinued. This cycling process can be repeated, as necessary, from time to time during a patient's life if the conversion impairment returns after a major stress. However, once it has been reset, the sooner the Wilson's Temperature Syndrome relapse is treated, the easier it is to correct. If caught early, it can be more easily "nipped in the bud" such that if an initial treatment lasted six months, a subsequent treatment after another significant stress, say two years later, may only take a week if the syndrome is recognized quickly and addressed early enough in the proper manner. We have talked already about how much more beneficial it is that the medicine be taken precisely on time. This is to keep the T3 levels as steady as possible. There is a principle known as steady state. When one begins to take a certain dosage of medicine, there is a period of time over which the level continues to build until it steadies out at a certain level. When the medicine reaches this certain level it is said that steady state has been reached. In most cases, it takes 5 1/2 half-lives for a medicine to reach steady state. For liothyronine, which has a half-life of 2 1/2 days, steady state is reached in approximately 14 days. So when the dosage is changed or interrupted in some manner, it may take two weeks in order for the medicine level to "steady down" again (a significant consideration primarily in this and other medicines that work best when levels are very steady). In practice, I have seen evidence that the level sometimes continues to become more and more steady on the same dose when taken consistently with greater and greater benefit derived not over just two weeks, but sometimes even up to six weeks. It seems to settle into a groove, so to speak, when taken precisely on time, consistently, day after day. It may be that associated changes in systems other than thyroid contribute to the settling effect. Any aberration in the dosage is usually tolerated without complaints, however, it may send "ripples" through the body's T3 levels the way ripples are sent through a water bed when one taps the edge. Considering these things, and considering the fact that steadiness is so important in the WT3 protocol, it cannot be over-emphasized how much more effective the WT3 protocol is when administered and taken precisely. The more carefully it is done the better it works. Preciseness is important because the loss of potential will come on without warning since one can lose a whole lot of potential before one's T3 levels are unsteady enough to cause any side effects.
 

1. Since the less T3 one takes, the easier it is to keep T3 levels steady and the less chance there is of side effects, it is best to begin with a small dose in the neighborhood of 15 micrograms per day (7.5 mcg by mouth ever 12 hours).

2. Since the half-life of T3 is short (2 1/2 days), and since side effects may result from T3 levels that are too low, too high, or unsteady, it is critically important that the medication be administered in the right dose and in a steady fashion.

3. Since the goal of the WT3 protocol is to normalize body temperature patterns and to resolve the symptoms, if the goal is reached by using the starting does of 15 micrograms per day, then the starting dose can be continued as maintenance, or may be discontinued in the hope that a persistent correction has been effected. These two alternatives can be considered at any time during treatment once the goals of treatment seem to have been reached. This is true even if the average body temperature is less than 98.6 degrees, but persistent resolution is more likely with body temperature patterns averaging closer to 98.6 degrees.

One may wonder how soon the WT3 protocol can begin to be weaned once the goals seem to have been reached. If a person's body is going to compensate to a certain dose it will probably compensate within one day to three weeks. So there is probably no benefit in waiting longer than three weeks, and, the WT3 protocol may sometimes be weaned successfully much earlier than three weeks. In fact, the shortest period of time that I have seen it take to pull a patient with a classic presentation of Wilson's Temperature Syndrome from the conservation mode back into the productivity mode is ten days start to finish. The patient was able to raise her body temperature patterns up to normal within days of initiating the WT3 protocol, was able to quickly resolve her symptoms of Wilson's Temperature Syndrome, and was able to wean off the medication by the tenth day, enjoying a persistent correction in her symptoms and body temperature patterns. She has been fine ever since (approximately two years).

Sometimes the smallest starting dose is not enough to accomplish the goals of treatment, namely to normalize body temperature patterns and to bring the patient out of the conservation mode and return the patient to the productivity mode. So progressively larger doses can be given to accomplish the resetting of the thyroid system. However, the only reason to use higher doses is so that one can be cycled onto lower doses. By gradually weaning off the WT3 protocol, the responsibility for supplying the body with T3 is gradually given back to the body. With the levels of RT3 having been decreased, as well as other possible changes in the body having taken place, it is hoped that with decreased inhibition at the site of 5'-deiodinase, that the body will be able to better convert the T4 produced in its thyroid gland to the active thyroid hormone T3. Fortunately, this is often the case and when the body can produce sufficient levels of T3 through conversion of its own T4, it can generally do it quite steadily (often more steadily than can be accomplished with medication taken by mouth). If and when the body "tries its wings" again at T4 to T3 conversion and enjoys a persistent benefit, but not a complete resolution of its Wilson's Temperature Syndrome symptoms, then subsequent cycles can be implemented in an attempt to systematically, step by step, return the body fully to the productivity mode. The first cycle I often refer to as the "reset cycle" since it is usually there that the bulk of the work can be accomplished. Subsequent cycles remind me of "fine tuning".

4. 98.6 degrees Fahrenheit measured orally is considered to be normal body temperature under normal circumstances. Since the resolution of the symptoms correlates with normalization of body temperature patterns, and since the effects of a dosage level of the WT3 protocol can be evident within hours and can be maximal within days, then if the symptoms have not satisfactorily resolved with the starting dose and the body temperature is averaging below 98.6 and the patient is not having any side effects, then the daily dose may be increased by an increment of approximately 15 micrograms per day up to the next level of 30 micrograms per day. Since the risk of treatment increases with increased side effects, the dosage should not be increased if the patient is suffering from side effects (which is an indication that the medication may not be adjusted properly).

5. If at any time the patient does have any side effects, the patient may be weaned gradually off the WT3 protocol. If the temperature rises significantly above 98.6 degrees, for example to 99 degrees, the patient may be reduced gradually on the WT3 protocol.

6. If the symptoms are not significantly improved, the temperature is averaging normal at 98.6 and there are no side effects, the patient may be weaned off the T3 medicine. In a case like this, the T3 levels often steady down as the patient weans off the WT3 protocol with the symptoms resolving only after the patient's therapy has been weaned. If the patient's symptoms are not sufficiently improved with the body temperature averaging around normal and the patient is without side effects, it is probably because of unsteady T3 levels.

7. If the symptoms are not sufficiently improved, if the body temperature average remains below 98.6 degrees, and if there are no significant side effects, the daily dosage may be increased every one to three days in small increments (15 micrograms per day) until: (a) the symptoms are gone; (b) the body temperature averages normal; (c) there are side effects; or (d) levels of 150 to 200 micrograms per day are reached. The higher the dose, the higher the chances of side effects and there is usually little benefit in increasing the dose higher than 150 to 200 micrograms per day. It is usually better to wean off the medicine and then start it again (after at least a couple of days of rest), since sometimes the body temperature cannot be brought up to normal in one step no matter how much T3 is used, much the same way a car cannot be jacked up with one push on the tire iron no matter how hard that push is.

8. At this stage, the WT3 protocol may be weaned and restarted or cycled. By cycling, the patient usually is able to achieve more normal temperatures on lower T3 doses. The closer the body temperature pattern gets up to normal with previous cycles the more likely it is that less medicine will be needed to reach the same temperatures with subsequent cycles. This can be thought of as being like a car jack: if the weight of the car is pushed up high enough, it can catch on the next step up. However, if it is not lifted high enough, then it may slide back down to the level it is currently occupying. The less the T3 dose, the more steady the T3 levels, the more effective the treatment, and the less the side effects. The more normal the temperature, the more effective the treatment and the less the side effects.

To wean, the daily dosage may be decreased in small increments, for example, 15 micrograms per day at a time, at intervals necessary to prevent a drop in temperature (generally in intervals of about two to ten days). As it turns out, patients are able to increase their body temperature with the WT3 protocol, often enjoy their body temperatures remaining close to the new increased level even while weaning off the WT3 protocol. The trick to weaning off the therapy in a way that permits correction to remain effective, is to wean slowly enough that the temperature does not drop again. For obvious reasons, this is not best attempted or easily accomplished under periods of extreme physical, emotional, or mental stress (since stress often started the problem to begin with). Patients are frequently able to wean off T3 by 15 micrograms per day, every two days on average. Some have to wean off by 15 micrograms-per-day-increments every four days and some have to go off every seven to ten days because if they go faster than that their temperatures will drop. If the patient's symptoms resolve or remain resolved completely after T3 is weaned, then the WT3 protocol need not be restarted. Usually the less a patient's body temperature drops, the less medication will be needed in the next cycle to bring the body temperature up closer to normal. Sometimes with each cycle, the patient may enjoy a decrease in the necessary dosage. It is common for patients to need only a 7th, a 10th, a 20th, or a 25th of the amount of medicine in the second cycle to accomplish the same as, or more than, in the first.

9. In cases where complete resolution of symptoms have not been effected by way of the first cycle of the WT3 protocol, a second cycle may be implemented. This is especially called for if the symptoms are positively effected, if there was a net improvement in the symptoms from the first cycle, and if there was a net change in the body temperature pattern. Almost always the patient is able to achieve more normal body temperature patterns on less medicine than the first cycle. This represents progress and this progress can be continued until the patient is able to come closer and closer to normal (with symptoms and temperature) on less and less T3 until the symptoms resolve and remain resolved off the WT3 protocol.

One may wonder how much time there should be between cycles. One purpose of weaning off a cycle is to let the body's own T3 production build back up and steady down. This usually takes place within two weeks after a cycle has been discontinued and there would be little added benefit in waiting longer than two weeks. As it turns out, patients can generally tell when T3 levels are steady and when they are unsteady, a patient may have a nondescript feeling of being a little "off the mark" and the patient is often able to tell when that feeling is gone once T3 levels become steady again. So a patient does not necessarily need to stay off the T3 for two weeks between each cycle. If the patient never noticed any sensation of unsteadiness while on the WT3 protocol, then the next cycle can be initiated after two or three days of the previous cycle (and after any sensations of unsteadiness have passed if they were noticed). The more time between cycles, the more time the foundation has to steady down, but one does not want the treatment to last unnecessarily long.

10. The treatment can be employed in the fashion described above anywhere along the path from the beginning of the first cycle to the ending of the last cycle. For example, if the patient is happy to feel normal again for the first time in years, is not having any complaints, and is not anxious to rock the boat, then the patient need not wean the WT3 protocol. If body temperature patterns are normal and steady, and the patient is not having any complaints, they may be maintained on the WT3 protocol for a time. Patients have been known to take thyroid medication for decades (even T3). If the patient feels satisfactorily improved and the body temperature patterns have been normalized, the WT3 protocol can be gradually weaned if the patient would like to see if a persistent correction has been effective. Or, if the patient's symptoms are quite a bit improved but not completely resolved, the patient may:

(a) continue the process of increasing and decreasing the therapy in an attempt to improve the level of correction;

(b) stay on the same dosage level in an effort to maintain the same degree of correction to not "rock to boat" by taking the chance of possibly having side effects on higher doses or by possibly losing ground by weaning off the medication (this alternative is frequently useful during periods of time when the patient is faced with severe stress such as family or business problems), or;

(c) weaning off the medicine in the hopes of being able to maintain the achieved level of correction until the treatment can be pursued again at a later time (useful, for example, when a patient needs to go out of town for many months). The problem usually gets worse in stages over time and can frequently get better in stages over time as well.

11. Not only have the WT3 protocol cycles been used to coax the body temperature to more normal levels, but they have also been used in cases where the average body temperatures were at a normal level but were too unsteady, for the purpose of attempting to make them more steady. Thus, the WT3 protocol can also be implemented as a stabilizing influence on unsteady body temperature patterns, and can thereby, sometimes resolve symptoms of DTSF. This situation, however, is extremely rare. If the two subgoals of the WT3 protocol for Wilson's Temperature Syndrome include going gradually up and down on the WT3 protocol to: 1. Feel well while on the WT3 protocol, and 2. Remain well after the WT3 protocol has been discontinued; then one might wonder when one goes up and when one goes down on the WT3 protocol. Again, the only thing better than feeling well on medicine is feeling well off medicine. A rationale follows:
 

One can think of the WT3 protocol as the road that leads to a distant city. Along that road might be two or three beautiful cities. While passing through these cities on the way to one's final destination, one might appreciate them to the extent that one might prefer to stay a few days in each town, rather than driving straight through to the final city. Such decisions can be made based on available time, condition or quality of the intermediate cities, road conditions, resources (e.g., money), and priorities. Some people may prefer to drive straight through to the final destination while others may prefer to make the trip in several stages. So too are there many options in the progress of the WT3 protocol.

The ultimate goal or destination for most Wilson's Temperature Syndrome sufferers is normalization of body temperature patterns which are then maintained by their own body even after the WT3 protocol has been discontinued. Some patients might have their reason to "drive straight through" to obtain that destination (for example, they might not like taking medicine and may prefer to stop taking the medicine as soon as is humanly possible, or they may be planning to move away in the near future and may want to try to achieve their goal if possible within the time period available). Others might have greater short term needs like the tired and hungry traveler who stops for a time in a closer city to eat, recuperate, and sleep on his way to his more distant, more desirable, final destination. Some Wilson's Temperature Syndrome sufferers, having obtained a certain level of improvement in their symptoms, may prefer not to change therapy for a time, even though their improvement is less than complete. They may have felt so badly for so long and may be so glad to feel halfway normal for the first time in years, that they may not want to "rock the boat" for a time. Usually, however, after they have "rested and recuperated" for a time, they gain the confidence and desire to proceed from "city to city" a step at a time, getting closer and closer to normal on less and less medicine, enjoying more and more improvement in the symptoms with less and less chance of side effects until ideally, the process is complete with the patient being normalized and remaining so even after therapy has been discontinued.

"Road conditions" are also an important consideration. A patient may be in the midst of starting a new business, selling his house, moving, and taking care of his hospitalized mother's affairs, all at the same time. Under such conditions, it may be preferable not to add to the patient's challenges by making a lot of adjustments in his the WT3 protocol, especially if the preoccupying conditions are not expected to last very long. It is sometimes better to weather out the storm in one city before proceeding to the next one. The goal of T3 therapy is to use the treatment to artificially reset the system while providing sufficiently normal and steady levels of the WT3 protocol. The body is given the opportunity to maintain naturally what has been accomplished artificially. This cannot always be accomplished in one step or "cycle."

There can be setbacks in progress. Since stress and starvation are some of the things that can precipitate Wilson's Temperature Syndrome in the first place, they can also impair the body's ability to maintain naturally what has been established artificially. So again, if the patient is satisfactorily improved, then it might be preferable for him to weather out the conditions of stress and/or starvation (or perhaps significant dieting or exercise) before proceeding to his final destination.

Let's suppose a patient who has been staying in a "city" wherein her symptoms are improved, but her temperature is around 98.0, chooses to move on the next "city". Since the patient is more likely to need less medicine with the next cycle the closer her body temperature approaches 98.6, if the patient is not having any complaints, it may be preferable to increase the WT3 protocol in an attempt to "punctuate" the cycle by attempting to bring her body temperature pattern up closer to 98.6 prior to weaning. Of course, the WT3 protocol may be weaned if the patient develops any side effects, if the temperature goes above 98.6, or if the symptoms are not satisfactorily improved even if the temperature is averaging 98.6. Cycling and getting on less T3, is generally the "road" that leads to the final destination.
 

Patients can usually manage ordinary fevers due to colds or flu's in the usual way (without changing the T3 dosage) if being maintained well on a certain level of the WT3 protocol. Remember that each change in the dose of T3 causes ripples the way a tap on the edge sends a ripple through an entire water bed, and these ripples can last for up to two weeks or more before settling down. These ripples may not be noticed in any side effects, and maybe not even in the body temperature patterns, but may be detected in terms of lost potential benefit.
 

These principles may make it easier to understand typical patterns of response to the WT3 protocol:

1. When patients begin the first cycle of the WT3 protocol, they sometimes feel better in the first week of treatment than they do as the cycle proceeds. This is understandable since in the beginning, the WT3 protocol is building upon the steady foundation of the body's T3 with temperatures closer to normal being achieved with relatively small doses which are easier to keep steady. But as one increases the dosage in working towards the subgoals of therapy, the more one takes, the harder it is to keep it steady, and so understandably the improvement in the symptoms may not remain as great.

2. Some patients notice more improvement in their symptoms of MED as they wean off a cycle of the WT3 protocol than they ever did going on. This is understandable since the body sometimes maintains naturally the level of body temperature achieved artificially more steadily than was accomplished artificially.

3. Different levels of improvement can be achieved with subsequent cycles. For example, a patient may achieve 60% resolution of his or her symptoms with the first cycle with the symptoms remaining persistently improved to a 60% degree even after the therapy has been discontinued. Then sometime later with a second cycle, the level of improvement may be brought up to 75%, which may persist even after the cycle has been discontinued. And still another cycle may bring the results up to 90% resolution of the symptoms. However, at any time, if the patient is faced with significant stress or starvation conditions, then the level of improvement may relapse back down to, say, 40% resolution.

4. The symptoms of MED are improved by the body temperature being more normal and steady. The balance of these two factors determines the level of correction of the symptoms. Patterns that are less normal but more steady may result in increased benefit as compared to patterns that are more normal and less steady. But patterns that are both normal and steady are most preferable and most likely to result in a correction of the symptoms of MED.

5. It is difficult to compare the body temperature patterns of one person to another to predict the degree of improvement of MED symptoms. The body temperature of one person compared to himself, however, can be quite useful in predicting improvement in the symptoms of MED. For example, if a patient's body temperature patterns become more normal and more steady with the WT3 protocol, one can expect an improvement in the symptoms of MED even if the patient's body temperature patterns are not as normal and not as steady as the body temperature patterns that were necessary to alleviate the symptoms of some other patient.
 

We have described the inertia of the body's systems by using the example of a ring with ropes tied to it, with each rope pulling with a different tension such that all the tensions in the ropes balance out in such a way that the ring maintains a certain position. In those simple analogies, we have imagined the balancing of only a few forces. However, we can see that there are many systems in the body and many forces at work that influence the overall balance or position of the body. So rather than just a few ropes or forces at work, there are actually many more, a few of which we have mentioned (female hormone, adrenal hormone, thyroid hormone, glucose metabolism, stress, body shape, diet, exercise, medications, etc.).

Frequently, the overall balance can be favorably normalized with the WT3 protocol. The WT3 protocol can seemingly "pull" the thyroid system and consequently even other body systems and forces into a new balance or position. This "settling" may explain why symptoms sometimes continue to improve even after steady state has been reached (in about two weeks) or even up to six weeks or more.

Theoretically, the overall balance could possibly be manipulated through the manipulation of other systems other than the thyroid system. the WT3 protocol may be so much more useful, effective, reproducible, and predictable because of the fewer number of variables involved. Just as it is easier to turn on a light switch with one end of a ruler while holding the other end, than it is to turn on that switch using a segmented bamboo toy snake that flops or "writhes" when one holds it out by the tail against gravity. The greater the number of variables or "segments" the more difficult it is to control a tool in the accomplishing of a specific purpose. The female hormone system, for example, involves progesterones and estrogens that go up and down independently, at different times of the month. There are many different forms of estrogens and progesterones on the market, both separately, and in different combinations. Such a complicated set of variables would be, to say the least, extremely difficult to manage effectively, even if the female hormone system could be manipulated to change the overall balance of the body.

Since the overall balance of the body's system can usually be restored to a desirable position with the WT3 protocol, when progress seems to get "stuck" in terms of a lack of continued improvement in the symptoms of MED during the process of cycling, one might look for "opposing" forces that may be resisting further progress. Referring to the diagram below, one may see in the first situation that if the forces are arranged in this first way then changing the tension in one rope might more easily change the position of the ring than if the ropes or forces are arranged in the second way. Since in the second situation there may be more direct opposition to progress.

Thus, if progress in the resolution of the symptoms of MED is progressing predictably and then all of a sudden seems to get "stuck", then one might look for systems in which tensions can be changed to decrease resistance to improvement. For example, one might consider decreasing a woman's female hormone dosage when she is being treated with female hormones. The patient might be able to make dietary changes that can better maintain favorable blood sugar levels such as with a hypoglycemic diet. Life style changes may be effected to alter the stress levels. Likewise, exercise activity, body shape (through weight changes), and the doses of other medications can sometimes be manipulated in such a way as to permit further progress and normalization of body temperature patterns and functions. Of course, some of these measures can, and many times should be, implemented from the start of the WT3 protocol as part of the overall plan of action.
 

Who are most likely to be able to remain normal after the WT3 protocol has been discontinued? Those who have more sturdy metabolisms, and who enter the conservation mode less easily. Those who enter into the conservation mode more easily, earlier in life, and with less provocation (especially common in certain nationalities) generally have a more difficult time maintaining more normal body temperature patterns after therapy has been discontinued. And they may relapse more easily when they are able to maintain normal temperature patterns for a time. The closer a person is able to return to a normal or ideal level of functioning and physical condition, the more likely they are to be able to maintain naturally body temperature patterns. "The further in bed you are the harder it is to fall out." And, of course, those who are under conditions of stress and/or starvation might more easily relapse and have more difficulty maintaining body temperature patterns naturally.
 

The information outlined in this treatment section of the book is intended as a general overview. The specifics of treatment cannot be reviewed in complete detail because they are outside the scope of this single book. The information here is not intended to be considered exhaustive but is intended to show the reader that there are definitely approaches that can be taken to alleviate and often correct Wilson's Temperature Syndrome. Of course, the WT3 protocol outline in this book cannot and should not be attempted without the supervision of a physician. Despite the space limitation of this book it would probably be helpful to include a few more details:

1. T3 is a temperature tool. Taking the WT3 protocol does not alleviate the symptoms of MED. Achieving more normal and steady body temperature patterns with the WT3 protocol frequently alleviates the symptoms of MED. T3 is not the answer, it is a tool one may use in order to accomplish a certain purpose. T3 is not a "cure-all" but it can be very useful in correcting an imbalance in a vitally important system that can affect virtually every function of the body. One cannot begin to hope for ideal functioning of one's health unless he has adequate thyroid hormone system function.

2. Wilson' Syndrome sufferers who are being treated for hypothyroidism deserve special consideration. Hypothyroidism can cause DTSF through inadequate production of T4 from the thyroid gland, while Wilson's Temperature Syndrome can result in DTSF because of impaired conversion of the T4 to the active thyroid hormone T3. Some patients presenting to a physician with hypothyroidism may have their hypothyroidism or low T4 production detected with thyroid hormone blood tests which are usually very useful for this purpose. Normally, hypothyroidism is corrected with T4 supplementation to the satisfying of these thyroid hormone blood tests, causing them to return to the "normal range." In many cases, this may also resolve the patient's DTSF since the patient may be able to adequately convert the T4 supplementation given by mouth into T3.

As mentioned previously, the patients who do the best are the ones who are able to get their temperatures closer to normal on lesser amounts of T3 because, the lower the amount of T3, the easier it is to keep it steady. However, the more T4 and RT3 that may be competing with T3 at the active site, the more T3 that may be necessary in order to overcome that competition to provide more normal body temperature patterns. If less T4 and RT3 were present, then less T3 would be needed, since less competition would be present.

One can reduce RT3 levels by reducing the levels of T4, its source. To decrease T4 levels, one may decrease T4 supplementation. T4 supplementation may be weaned from .05 - .10 milligrams per day, per week, until the T4 supplementation has been discontinued for a time. Of course, as the T4 supplementation is discontinued, levels of T3 drop as well which can result in increased symptoms of DTSF. Generally, it is preferable to withhold T3 supplementation for approximately seven to ten days after T4 supplementation has been discontinued, especially if there is not a worsening of the symptoms of DTSF. This is to allow levels of T4 and RT3 to decrease. If while the T4 therapy is being weaned, the symptoms of DTSF do worsen, then low levels of T3 supplementation may be initiated to sustain T3 levels while T4 therapy is being weaned.

It is usually best not to increase the WT3 protocol in an attempt to normalize body temperature patterns and to diminish the symptoms of DTSF until approximately the tenth day after T4 therapy has been discontinued, but only to prevent a worsening of the symptoms of DTSF in the meantime. In this way, one may be able to avoid inadvertently increasing the WT3 protocol to higher levels than would otherwise be necessary (lower T4 and RT3 levels resulting from the weaning of T4 therapy lower the competition against T3 for the active site so that less T3 is required to overcome it and provide more normal body temperatures). By staying on lower levels of the WT3 protocol in the first place, one may avoid having to go through as many cycles of the WT3 protocol.

Cycles of the WT3 protocol can sometimes take from two weeks to two months each. Thus, by only increasing T3 dosage levels to prevent increased levels of DTSF symptoms while T4 therapy is being weaned, one can often be as far along in a few weeks as he otherwise would be in six months. Of course, in Wilson's Temperature Syndrome sufferers who also happen to be hypothyroid one must restore T4 therapy as each cycle of T3 is weaned and after the patient's Wilson's Temperature Syndrome has been corrected (since they don't produce T4 sufficiently on their own). At the beginning of each cycle of the WT3 protocol in such patients, T4 therapy should again be weaned before the WT3 protocol is used to pursue normalization of body temperature patterns. So hypothyroid patients who still suffer from the symptoms of DTSF, in spite of adequate T4 therapy because they are also suffering from Wilson's Temperature Syndrome, can often be helped. Ideally, such patients can be cycled on and off T4 and the WT3 protocol until eventually their Wilson's Temperature Syndrome can be corrected and they may be placed back on T4 therapy and retain resolution of their symptoms of DTSF. In fact, many times they can often feel better on less T4, after T3 therapy, than they ever did on more.

3. T4 Test Dose. The competition between T4 and T3 for the thyroid hormone receptor can be used handily in the management of side effects of the WT3 protocol. Side effects from 12 hour sustained-release the WT3 protocol (most commonly mild achiness, fluid retention, mild headaches, fatigue, and occasionally edginess) usually are related to unsteady levels of T3 resulting in unsteady body temperature patterns, leading to unsteady multiple enzyme function. Let us remember that T4 is about three times longer acting and is four times less active than T3. A small dose of the longer-acting, and, in a sense, more stable T4, can be used to dilute the influence of the more powerful T3 at the level of the active site, thereby, making the thyroid hormone influence at the thyroid hormone receptor more steady. A T4 test dose can decrease the side effects that a patient may be having from unsteady levels of the WT3 protocol. Interestingly, it can do it in about 45 minutes. This is possibly because it does not take long for a dose of T4 to be absorbed from the stomach into the blood stream and to be distributed to the cells of the body, thereby, having its stabilizing effect. In this respect, T4 can almost be thought of as a wet blanket, compared to T3. Many times patients are quite astonished by how quickly and completely their side effects can resolve after a small dose of T4. This may be on the order of approximately 15% to 20% of the number of micrograms of T3 the patient is currently taking each day. For example, 12.5 micrograms (.0125 milligrams) of T4 (e.g. 1/2 of the smallest strength of Synthroid...a new pair of toenail clippers are handy for cutting them in half) may be given to a patient who is currently having some side effects on 30 to 37.5 micrograms of the WT3 protocol incorporating a sustained-release vehicle being taken twice a day.

Although T4 is much more stable, it should be remembered that it can sometimes feed rather than reverse the vicious cycle that leads to Wilson's Temperature Syndrome. It should also be noted that it is often not favorable to take the T4 therapy if it is not necessary for side effects, because it can sometimes block what one is trying to accomplish with the WT3 protocol. The T4 dose is best taken only as needed for side effects. If the side effects resolve quickly within one or two hours of the dose, it is more likely that the patient did need the dose of T4. So the dose of T4 might only need to be taken once, possibly every three days, or only every week or so, but preferably not more often than once a day.

If the thyroid hormone influence cannot be easily and sufficiently steadied with doses of T4, then the patient should be gradually weaned off the the WT3 protocol and perhaps started on another cycle. Incidentally, some patients do quite well with a combination of both continuous T4 and the WT3 protocol, and a few respond better to instant release the WT3 protocol than to sustained released the WT3 protocol. So in every case, the choice of therapy and dosing considerations must be made based on individual patient response and laboratory findings.

4. In light of the information contained in this book, thyroid hormone therapy that does not take into consideration body temperature patterns is not being done correctly.

5. Likewise, considering that Wilson's Temperature Syndrome can be precipitated or made worse by starvation conditions, the use of dietary approaches such as crash diets, low calorie diets, very low calorie diets, and protein sparing modified fasting liquid diets, without regard to body temperature patterns, in patients already suffering from symptoms of MED, can not be considered prudent. As many people are becoming increasingly aware, these measures can cause or worsen a patient's symptoms of MED, leaving the patient to gain all of their weight back and then some. One such measure of dieting or "starvation" may precipitate persistent DTSF due to the patient developing Wilson's Temperature Syndrome, then the patient can be left with debilitating physical and functional problems that can have a profoundly adverse impact on the person's life. Proper diet and exercise certainly are very important. And dietary systems or tools (such as certain liquid diets) do have their favorable uses. It is only inappropriate to use such tools without taking into consideration, on an ongoing basis, a patient's body temperature patterns and symptoms that may be related to MED, DTSF, and Wilson's Temperature Syndrome. These symptoms can be revealed through careful questioning of the patient as part of the monitoring of his dieting process.

6. Symptoms of low blood pressure such as lightheadedness, clamminess, increased heart rate, and shakiness may often actually be due to low blood sugar levels. Such symptoms can frequently be alleviated by eating a little something to bring up blood sugar levels, such as a piece of chicken, cheese and crackers, or orange juice. Refined sugars, such as candy, are usually not preferable since they may result in a rebound drop in blood sugar levels due to the body's reaction to the sugar in the candy. Patients with Wilson's Temperature Syndrome seem to have unstable blood sugar levels which can go too high when they are high and too low when they are low. This can be alleviated through a hypoglycemic diet and also through normalization of body temperature patterns.

7. Since mental and physical stress can lead to precipitation of the symptoms of MED and Wilson's Temperature Syndrome, it is recommended that one should approach diseases associated with mental stress, such as anxiety and depression, while bearing in mind the patient's body temperature patterns. Likewise, when addressing patients who are undergoing severe physical stress such as recovering from car accidents, major surgery, severe infections, or the like, one should always bear in mind the patient's body temperature patterns, since it can have a profound influence on how he will recover. This may be especially important in cases where a patient's recovery could go either way, being balanced on the verge of life and death, such as in intensive care units and in critically ill patients. In such circumstances, consideration of body temperature patterns can literally mean the difference between life and death.

8. If a patient taking the WT3 protocol is scheduled to undergo surgery, then considering the short half-life of T3 and the potential for unsteady blood levels, it is usually advisable for the patient to gradually wean off the WT3 protocol before the surgery. the WT3 protocol may be resumed once the surgery has been completed. It is important, however, to give adequate time for the weaning process so that the T3, body temperature, blood pressure, etc. are not dropped abruptly just prior to surgery.

9. Drug interactions - Since T3 is a substance that is normally found in every person's body, if a particular medicine does not have an adverse chemical reaction with the T3 already inside a person's body, then it will not have a direct chemical reaction with the T3 medication taken by mouth. So, any drug interactions are usually not due to direct chemical reaction between T3 and other medicines but because of indirect effects. T3 can affect a person's temperature, blood pressure, and pulse. In some instances, these effects can be additive, such as with antihistamines, decongestants, antidepressants, asthma medicines, etc. The body normally becomes accustomed to the WT3 protocol by making certain compensatory changes. Some medicines (such as beta blockers) may affect the body's ability to compensate or "get used to" the WT3 protocol. Other medication such as cortisone, progesterone, estrogens, certain anti-inflammatory medicines, and the like, can oppose the purpose of the WT3 protocol, thereby, making it less effective.

10. Thyroid medicine is pregnancy category A, which is the safest category for medicines that can be taken during pregnancy. As a matter of fact, it is usually recommended that thyroid hormone medication not be stopped during pregnancy. In some cases, the thyroid hormone supplementation is important in helping the woman to conceive the pregnancy and to maintain it to full term. However, due to the short half-life of T3, I recommend that patients who become pregnant on the WT3 protocol should gradually wean off the WT3 protocol, mainly because if for some reason they were denied access to their medicine abruptly, they might have problems with their pregnancy. Fortunately, many women with Wilson's Temperature Syndrome do their best when they are pregnant.

11. The WT3 protocol can be symptomatic (used to treat the symptoms), therapeutic (used for a time to correct the underlying problem), used as a maintenance therapy (to maintain an effective correction through the use of continued administration of the medicine), and used as prophylaxis (used intermittently to prevent relapse of Wilson' Syndrome, especially during short periods of extreme stress typical of conditions that have precipitated relapses previously).

As mentioned previously, the considerations discussed in this chapter about the treatment of Wilson's Temperature Syndrome are relatively thorough, but are not nearly exhaustive. Greater details on treatment considerations in various other illnesses and situations is outside the scope of this book. The treatment protocol is explained in full detail in the Doctor's Manual for Wilson's Temperature Syndrome. the WT3 protocol should usually be monitored every two to six weeks by a physician in person, and more frequently, if necessary, by phone (and in person, if necessary). Monitoring should be more frequent initially until one can more fully predict a patient's response, and may be less frequent later in therapy. Although the information presented here is not exhaustive, an effort was made to give enough information to demonstrate that the thyroid system is far more dynamic than it is generally considered to be, and that thyroid medication can be thought of in terms of minutes and days, rather than weeks and months. Thyroid hormone therapy can be adjusted to accomplish much good, and can even make all the difference in a person's life. It should not be considered in terms of merely putting a patient on a certain dosage to see how they do, and leaving the patient on that particular regimen indefinitely regardless of whether or not their symptoms are greatly benefited. To adapt a phrase from The Annals of Internal Medicine article of December, 1977, entitled Thyroidal and Peripheral Production of Thyroid Hormones, that applies both to the information presented in the article and the information presented in this book: This new information has forced a reassessment of long held views of the thyroid system and has profound clinical implications as well (To say the least!).