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Same Principles Applied Differently
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Same Principles Applied Differently |
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There are certain principles of T3 therapy that I think every doctor
using T3 should understand. These principles are based on the physiology
of the thyroid system and its hormones. They are essential in obtaining
amazing results, for avoiding side effects, and are thoroughly described
in the Chapters of this manual. However, these principals can be
applied with a variety of methods. I've included below some methods other
doctors are using.
For example, the importance of letting the T4/RT3 preponderance dissipate
before increasing T3 to unnecessarily high levels is explained on page
157. On that page, the principle is used to explain why it makes sense
to allow the T4 from T4-containing medicines to dissipate before chasing
patients' temperatures with T3. Dr. Leighton's approach below applies
this same principle in patients who aren't weaning off T4-containing
medicine. When the patients' pulse rates increase but their temps don't
come up he sees that as an indication that there is enough T3 to decrease
the patients' T4/RT3 backlog but perhaps too much of a backlog for it
to be a good time to chase the patients' temps with T3. So he leaves them
on that dose as a plateau for at least 4 weeks. On the other hand, when
patients' temps come up normally without much increase in pulse rate,
apparently there is not too much of a backlog problem. I like Dr. Leighton's
variation because although it is more conservative it may not be giving
up much benefit, and may even gain benefit, depending on how long it takes
for the T4/RT3 preponderance to wash out. My protocol is based on the
idea that it is depleted quickly, his is based more on the idea that it
may take longer to clear. I think you may find the methods of each of
the doctors below useful in the treatment of some of your patients.
In Addition, every method carries with it a different risk versus benefit
consideration. More conservative approaches may be better suited for some
patients but may not provide all the same benefits quite as quickly, if
at all.
You may find other methods on our web site: www.WilsonsTemperatureSyndrome.com
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I think that heart rate is often a more sensitive indicator of thyroid
stimulation than body temperature. If patients' heart rates rise on the
order of 20 points during the taper up phase of the treatment cycle, or
after establishing on a plateau dose (rising, say, from 65 beats/minute
before treatment to around 85 beats/minute while on the T3) it is clearly
a thyroid effect. I cycle patients up on the T3 therapy until one or more
of 5 criteria are met:
1) Their temperature rises into a "normal" range of 97.8 to 98.6
2) Their heart rate rises from 15 - 25 beats per minute (taken at the
same time each day)
3) Their symptoms clearly improve (no sense in going beyond the point
of symptomatic improvement)
4) They reach the maximal level of 90 mcg of T-3 Q12h, or
5) They develop signs or symptoms of excessive thyroid stimulation (tremors,
palpitations, anxiety...similar to drinking too much caffeine).
It has happened, not infrequently, that these signs will not develop until
after the patient has been at the maximal dose of 90 mcg Q12h for 1 to
3 weeks. Then it seems as though a "light switch" has turned on and suddenly
they develop evidence of too much thyroid stimulation. This makes sense
when considering this from the aspect of clearing the RT3 from the receptor
sites [which may sometimes take 3 weeks]. At that point, we taper back
down to a lower level where the signs of excess thyroid effect disappear
again. Then, as in the all of the 5 situations above, I usually put patients
on a plateau dose for at least 4 weeks to give more time for the RT3 to
be cleared out. It appears that patients are more likely to progress on
the subsequent cycle(s) with this approach.
Stephen L. Leighton, MD
Family Care Health & Wellness Center, Inc.
Winston-Salem, NC 27101
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Although the results may take longer, many patients can still benefit
from a conservative low dose T3 therapy approach. Though there are some
patients who feel better fairly soon with such an approach it's normally
a longer haul, which is characteristic of a more naturalistic approach.
In some patients I use a "mini cycling" approach where I give them a 7.5
mcg dose of sustained release T3 once a day. In a sense, they "wean on"
during the day, and "wean off" at night. I have seen several patients
who have seemed to do quite well with that over time.
In addition, I'm often less interested in very fast results and in being
able to reset people's system so that they'll be able to remain off T3
therapy than I am with wanting to help people feel better as safely and
conveniently as possible. Therefore I often start patients on 1/2 grain
of Armour thyroid, which contains T4. But if the 1/2 grain is not enough,
instead of increasing the Armour, I'll add low dose sustained-release
T3. I'm kind of giving them a low dose T3 therapy, with Armour as the
stabilizing influence.
I pay attention to their adrenal systems as well. To me, when patients
don't do well on thyroid treatment that's almost diagnostic of adrenal
fatigue. However, on low dose hydrocortisone such patients almost never
have side effects to the thyroid. They start much more smoothly on the
thyroid when they already have adrenal support going. I often give patients
a cortrosyn challenge test and give them cortisol as described in the
book, Safe Uses of Cortisol by William Jefferies, MD. Conversely, sometimes
low doses of thyroid can improve adrenal function (as reflected in adrenal
saliva testing) as well.
Ron Hunninghake, MD
Wichita, KS
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