T3

for

Clinical Hypothyroidism

I read your editorial on hypothyroidism with dismay. In California we have a law that limits the medical board’s jurisdiction to instances when there is harm to the patient or inadequate informed consent. I thought that Oregon was more relaxed about this type of thing. A couple of clinical thoughts. First there is a wonderful book written by a Baylor College of Medicine endocrinology professor, Ridayh Arem, called The Thyroid Solution, which advocates using T3 and which states that TSH of 2.0 or over may be seen with hypothyroidism. He does not like Armour Thyroid, but does advocate Cytomel. 

Another thought is the treatment of refractory depression with high doses of T3 in patients with normal TSH. Thyroxine does not work for this situation. This is a well-known and widely accepted augmentation method. I believe the reason that it works is due, at least in part, to occult T3 hypothyroidism. If a practitioner has a patient with resistant depression, they can use T3 for that indication regardless of the TSH. If that is a problem, then many psychiatrists should be investigated for improper prescribing. Look it up in the PDR or on Epocrates.

There are other issues that are important when using this type of therapy. One is to let the patient know that it is “unconventional” and also that a low TSH may be a risk factor for osteoporosis, although I am not sure this has really been decided with good data. I have doubt that when a patient has a normal pulse, fells well, and has no symptoms of hyperthyroidism, that their bones are turning over quicker than normal. In any case, I get a bone density exam and make sure that they talk adequate vitamin D, calcium, magnesium, and other important supplements for bone health.

Using T3 for clinical hypothyroidism is one of the most powerful treatments that I have learned and used since I became interested in nutritional/preventative medicine 20 years or more ago.

Richard I. Gracer, MD