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| Table of Contents |
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| Index (Click on Numbers) |
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Risks, Benefits, and Myths
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Chapter 11 |
RISKS, BENEFITS, AND MYTHS |
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| The pages and page numbers below correspond to the pages in the paper version of the Doctor's Manual. |
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Possible aggravation of cardiovascular predispositions
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The major risk is cardiovascular. I don't advise using T3
therapy in patients with low cardiovascular reserve. The risks are more short-term
than long-term.
As with all medical treatments it is important to carefully
weigh the risks and potential benefits of the T3 therapy before proceeding.
The major consideration in terms of risk of T3 therapy is cardiovascular.
Cardiovascular disease is a major problem in our country. Every day many people
who are not on thyroid medicine have heart attacks, strokes, and develop arrhythmias.
Unsteady T3 levels can increase a patient's
chances of increased heart rate, and palpitations. And if a patient is already
on the verge of having a heart attack or a stroke, these cardiovascular side
effects could aggravate the situation. The whole trick to T3 therapy
is keeping the T3 levels steady.
Thus, the risks of T3 therapy are more short-term (during
treatment) than they are long-term (see myths below, as well as a discussion
of osteoporosis in question 17 ( Q17).
It is sometimes difficult to avoid unsteady T3 levels, and so
it might not be advisable to implement T3 therapy in those patients who
may not have the cardiovascular reserve to tolerate very well much of an increase
in T3-level-unsteadiness (for example, certain elderly patients).
If T3 therapy is administered properly, one does not expect
any drastic problems, because one does not make any drastic changes; the medicine
is taken very much on time, and adjustments or actions are taken at the first
sign of any developing problems.
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Not every doctor understands the management of T3 therapy.
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The above risk is probably most significant in the emergency
medical setting.
It should be counted as a risk that not every doctor
understands T3 therapy. Some practitioners or medical personnel may not
understand the importance of taking the T3 therapy on time, and not stopping
it abruptly. They may not understand the significance, clinical presentation,
or management of unsteady T3 levels. They may also attribute the symptoms of
unsteady T3 levels, to excess T3 levels in terms of quantity (as opposed to
quality of steadiness), or to some other cause. All of these things may make
management of the patient more difficult for them.
This issue would probably be most significant in the emergency
medical setting, for example if the patient was in some kind of serious accident
and was teetering on the edge of life and death, when every variable mattered.
It would be even harder for emergency medical personnel if little or no information
could be obtained about the patient or the patient's current medical treatments
(but of course there are many medical treatments that share this risk, and patients
could diminish this relatively small risk by carrying with them in their wallets,
a written note of information).
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T3 therapy is a therapeutic trial. (like everything in medicine)
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T3 therapy is not a cure-all. One doesn't know before treatment
how well it will help. It is a therapeutic trial. When it works it often works
dramatically well and patients often remain improved after the treatment is
discontinued.
T3 therapy is not a cure-all panacea. It's a temperature
tool (but it is often amazing to see what a difference normalizing a low temperature
can make).
The symptoms of low thyroid function are so
much like the symptoms of so many other different things, and so many people
have such symptoms, how does one know for sure a given patient's symptoms are
thyroid-responsive before treatment? One doesn't.
T3 therapy is a therapeutic trial.
T3 therapy won't work for everyone, but it can do a lot of good
for a lot of people. And it's very instructive when all, or the majority of
a patient's symptoms resolve with normalization of body temperature patterns.
And it's even more compelling when those symptoms remain resolved even
after the treatment has been discontinued.
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T3 therapy gives predictable and reproducible results with many patients
remaining improved even after the treatment is dicontinued.
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T3 therapy often works when all manner of symptomatic therapies
have failed. Most patients who try T3 therapy are very delighted they
did. Among the best responders are those patients who have been caught in the
earlier stages.
If patients symptoms resolve with T3 therapy,
does that mean they had a thyroid system disorder? Not necessarily.
Like so many other treatments in medicine, it's aspects cannot
be easily proven. But it is clear that proper T3 therapy (the design of which
has been based on the Wilson's Temperature Syndrome pathophysiologic paradigm) does
provide reproducible and predictable results.
And what results they are: patients often enjoy complete resolution
of very debilitating complaints, with that resolution persisting even after
treatment has been discontinued. This is a much better result than is delivered
(with little if any more uncertainty) by virtually all the symptomatic
therapies to which these patients are routinely subjected.
What percentage of reasonable candidates (based on descriptions
of typical patients in the book: Wilson's Temperature Syndrome-The Miracle of Feeling
Well, and this manual) will respond well to the T3 therapy described in this
manual? It is difficult to quantify precisely because of semantics of terms,
and because it depends on the condition of the patients in a given cohort. I
have been willing to treat relatively mild cases, as well as more severe ones.
Many of the patients that respond most easily to the treatment are the ones
who have been caught in the earlier stages of the condition.
But to give one an idea, in my experience, at least 65% of patients
could be characterized as being very delighted that they ever heard of,
and implemented this approach.
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How T3 therapy is administered affects how often it is successful.
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Although 10 percent of cases could be described as discouraging,
proper T3 therapy for Wilson's Temperature Syndrome works so well that many patients
find it hard to believe that something so simple could have been overlooked
for so long.
If the treatment is not administered very carefully,
about 75% - 80% of patients will notice some unequivocal improvement. If the
treatment is administered very well, the yield can be increased to at least
90% of patients noticing some unequivocal improvement in their symptoms (which
is not to say all of their symptoms necessarily improved, or that any
symptom improved completely, but that there was at least some improvement in
at least one symptom).
The results of about 10% of cases could be described
as discouraging.
What is not conveyed in these numbers, however, is what a profound
difference is made in the lives of those people who do respond well to the treatment.
Imagine a patient who has suffered with debilitating symptoms of fatigue, migraines,
PMS, depression, and anxiety, lumbering along for years with little relief,
thereby living a veritable nightmare. And then with this treatment, all the
symptoms completely resolve (the salient word here being completely)
almost as if they were never really there, when other treatments have helped
very little if at all. When such patients see how simple it was to resolve their
symptoms, they often are upset that those symptoms were ever allowed to be such
a hideous problem, even though the treatment was only developed recently. They're
often incredulous that something so simple has been overlooked for so
long.
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It would be exciting if only a small percentage of patients who respond well
to the treatment remain improved after the treatment is discontinued.
But the percentage appears large (especially if the patients are not under
conditions of severe stress).
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If patients do relapse later after some major stress they
often respond quickly to repeat treatment.
How many patients remain improved even after the
treatment has been discontinued? It's not clear whether patients who have finished
treatment don't return because they stay normal, or for some other reason. Real
follow up studies have not been done, but would be very interesting.
What I have observed is that many of the patients that do experience
a relapse of symptoms similar to those that resolved with T3 therapy, have come
back for repeat treatment. These relapses very typically occur after a major
stress (usually emotional or mental pressure), many months after the
treatment has been discontinued. Such patients are often quite anxious to be
treated again.
I have enjoyed a very good rapport with my patients, and I can
see little difference in the type of patients that return (after relapse), and
the ones that don't. This leads me to believe that the large majority of patients
do not readily relapse, since if they did, I would expect many of them to return
for repeat treatment. And only a relatively small percentage of patients return
for repeat treatment.
In fact, some patients have come back after more than one relapse
on the order of a year apart. For example, one patient did well with treatment
and stayed well for about a year off treatment. She experienced a relapse when
her son totaled her car. She was more easily corrected after this relapse than
originally, and she stayed well for another year. She relapsed again
when someone was trying to persuade this same son to go to the Bahamas to traffic
in drugs. She again responded well to treatment, and is doing well off treatment
so far as I know.
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It is clear that the patients who are under the same kind of
stress when they wean off, that precipitated their Wilson's Temperature Syndrome
in the first place, are less likely to stay well and are more likely
to relapse than those who aren't.
The more corrected a patient's Wilson's Temperature Syndrome is
when the T3 therapy is weaned, the less likely he/she is to relapse.
Also, the earlier a relapse is caught once it occurs (e.g.,
2 weeks vs. one year), the easier it is to correct it. The T3 therapy
can be repeated as needed throughout a person's life.
Note: If
the purpose of T3 therapy is to leave a person more endogenously T3 rich after
therapy than before, then the question arises: Is it possible that a person
can be left with an endogenous thyroid milieu that is too T3 rich? Of the many
thousands of patients I have treated I have wondered if this were not the case
in about 3 of the patients (some symptoms of T3 level unsteadiness, with temperatures
a few tenths above 98.6 after treatment had been discontinued). These patients
weren't very uncomfortable but did not seem as well adjusted as they could have
been. There are some natural circumstances that tend to slow a person's T4 to
T3 conversion down below normal (stress, fasting), while I cannot think of any
that would tend to increase it above normal. So at least the circumstances in
the world would tend to correct a slightly rich milieu rather than promulgate
it. And one can always recommend fasting for a few days, as I did in those 3
cases, to increase the shunting of T4 toward RT3. The patients did not have
persistent complaints, and the fasting seemed to help although the patients
were lost to long term follow-up.
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Myth #1
T4 is good but T3 is a bad molecule. It damages the body and just causes side effects.
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There are fair number of myths that have been generated about
the thyroid system in general, and the T3 molecule in specific. These myths
seem a lot like those stories that change a little each time they're passed
from one person to another. Even though they are no longer accurate and are
without basis they are still enthusiastically and authoritatively presented
as fact.
Note: T3
is a molecule that is present from birth in every human's body, and is absolutely
necessary for good health. The difference between exogenous T3 and endogenous
T3 is not a chemical one, but how they are delivered to the body. It is important
for exogenous T3 to be delivered as well as possible to limit adverse side effects,
but it can't and hasn't directly damaged heart, brain, or other tissues. Also,
T3 does not expose the body chemically to anything more than exogenous T4 does,
since T4 is T3 waiting to happen. In fact, T4 has to be converted into T3 in
order to have its proper effect. Before the principles of management of Wilson's
Temperature Syndrome were developed, T3 was being used in ways that did not make
pharmacologic or physiologic sense, and so, far more side effects were experienced.
But that's not T3's fault, that's to be expected from any medicine that is being
administered improperly. With proper T3 therapy, it is not intended that there
should be any side effects, patients should only feel better. But as
with any treatment, there is a chance side effects can develop. Any side effects
are an indication that the T3 therapy is not ideally adjusted, and that adjustments
need to be made to make those side effects go away.
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Myth #4
T3 is like cocaine or amphetamines ("speed") and is addictive.
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Note: Perhaps
the biggest thing that amphetamines and T3 have in common is that they were
both abused decades ago in weight-loss treatments. Perhaps this is why some
doctors remember them in their minds as being similar, and maybe the doctors
who subscribe to this myth have simply confused what the similarity was (weight
loss also comes to mind for some with cocaine). It's a little like saying that
water and arsenic are just alike because they both have been used to commit
murder. The difference though is that you can live without arsenic, but you
can't live without water. Likewise, you can live without cocaine and amphetamines,
but T3 is physiologically necessary. Of course T3 therapy is not candy, and
it's not for everyone. Like any medical treatment T3 therapy does have its risks
but addiction is not one of them.
T3 is naturally found in the body, while amphetamines and cocaine
are not. T3, cocaine and amphetamines are totally different pharmacologically,
and in their mechanisms and sites of action. Cocaine is an alkaloid, while amphetamines
are sympathomimetic amines, and both have their actions on the central nervous
system. T3, on the other hand, is an amino acid derivative that has its action
only on thyroid hormone receptors, which are found in all the tissues of the
body.
Cocaine and amphetamines might give a normal person a "high"
of some sort, but excess T3 makes normal people feel worse, if anything, not
better. If a person is very thirsty, then there's nothing quite like a long
drink of water. But if a person's not thirsty, a long drink of water isn't that
enjoyable. Likewise, the purpose of proper T3 therapy is to eliminate classic
symptoms of low body temperature and low thyroid function to bring a person's
clinical status up to normal, not above normal.
When people are weaned off cocaine and amphetamines, they often
have withdrawal symptoms (a characteristic of addiction). But when people are
weaned off proper T3 therapy they don't, and they usually retain a net improvement.
Now, it's not wise to stop T3 abruptly, because it does not give the patient's
own thyroid system enough time to come back up-but that's not addiction, that's
glandular function. And even so, the weaning process is comfortably accomplished
in days without withdrawal, rather than with great discomfort over months.
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