Hyper/Hypothyroidism

All t4 is made by the thyroid gland, whereas only 20% of t3 is made by the thyroid gland. The other 80% of t3 is produced from a conversion reaction within the tissues of the body (liver, kidney etc.) via an enzyme called 5’ deiodinase. This enzyme also produces t2 (a weak thyroid hormone) from rt3 (also known as reverse t3), which in itself is produced by an enzyme known as 5 deiodinase from t4. Wow!!! This is a lot to swallow but read on.

T4 is the most abundant of all the thyroid hormones, but it is not the most active. In different terms, t4 is three times less potent (active) but four times more abundant (available) than t3. As mentioned earlier, t2 and rt3 are very weak and essentially inactive thyroid hormones. Now…

Under stressful situations such as pregnancy, (childbirth being the number one event leading to Wilson’s syndrome), acute or chronic illness, steroids and other medications, starvation, emotional stresses, and often times surgery, the body converts t4 less to the active hormone t3 and more towards the inactive hormone rt3 to conserve energy. With less t3 in the cells the body will slow down, and with it a falling of the temperature may be noted. When this happens it affects our metabolism (the way in which we consume energy or calories.) This phenomenon helps explain why people who go on low calorie diets or fasting diets tend not to lose weight. This decreased metabolism often times gets stuck in low gear even after one begins to eat normally again, which is seen as an increase in weight greater after the completion of the diet than one was before it!

In addition to affecting your weight, decreased metabolism affects all cell functions within the body. Enzymes, which are catalysts produced by living cells in our body that regulate cell function, work by accelerating chemical reactions within the body that carry on life-preserving functions. We cannot live without enzymes, and some believe that exogenous enzymes, (those produced and taken from an outside source such as pork insulin), are the answer to many of our most serious and chronic illnesses including coronary artery disease and cancer. All enzymes are dependent on their amino acid sequence as well as their confirmation, or shape, to function. Genetics codes for the amino acid sequence, but this can also be altered by outside sources of internal pollution such as antibiotics and pesticides, to name a few. The shape of an enzyme, however, is a function of the temperature in which it exists. If the temperature is too cold it will cause the enzyme to react slowly. If the temperature is too hot it will cause the enzyme to react too quickly. Both of these extremes are literally life-threatening and a temperature difference of just one to two degrees in either direction can, and in most cases, will cause various symptoms in an individual. This is depicted in the symptoms of lassitude, myalgias, arthralgias, and headache seen when we have the flu or when our temperatures are low.

So now we understand that how well a person feels depends a great deal on enzyme function, which depends on body temperature, which in turn depends primarily on t3 stimulation of the cells. Let’s go on.

Knowing that various physical and mental stressors cause a 50% decrease in t3 and as much as a 50% increase in rt3, the inactive hormone, one can see that the body temperature will be lowered in these situations for the reasons mentioned above. Keeping in mind that it is the lowered temperature that causes the symptoms in Wilson’s syndrome patients, it should then be reasonable to believe that increasing the temperature to normal would rid the body of these symptoms. What’s most fascinating is that this is true! Even more interesting is that after normalizing your temperature and resolving the undesirable symptoms, patients with Wilson’s disease frequently remain healthy and can wean off their medication usually in three to six months!

The explanation that addresses the how and why of treatment is difficult and lengthy so I will try to put it into the easiest terms as possible. For perhaps a better and more thorough explanation of this, one may purchase Dr. Wilson’s book entitled “Wilson’s Syndrome-The Miracle Of Feeling Well” or get online at www.wilsonsthyroidsyndrome.com. Here you may interact with actual cases that Dr. Wilson has treated.

To understand the thyroid system one must first understand the principle of negative feedback. Negative feedback refers to a process whereby an accumulation of a downstream end product will shut down the stimulus that caused the formation of the end product in the first place. Let’s look at it in a different way:

Your boss tells you that you must produce more and more “widgets” – say maybe a certain toy like a cabbage patch doll because the demand is so high for the holidays. The stimulus to produce is the boss and the end product is the doll. But what happens when the holidays are over and the shelves are filled with hundreds to thousands of unsold dolls and no one to purchase them? This keeps the shelves from being occupied by other more popular selling toys, and thus disturbs a normal functioning profitable business. What happens next is that the stimulus for the end product (the boss’ orders) is now halted because of the lack of need for the end product. Also, because of the lack of space on the shelves for any other product to occupy these shelves, business cannot go on as usual until the shelves are cleared of the poorly selling dolls. Well, the need for thyroid stimulation by the cells causes TRH, or thyroid releasing hormone, which is produced in the hypothalamus of the brain, to be released from the hypothalamus. This in return causes a stimulus within the pituitary gland in the brain to release TSH, or thyroid stimulating hormone, (these stimuli are akin to the orders from your boss’ boss to him and your boss’ orders to you). The release of TSH is the stimulus for the production and release of thyroid hormone from the thyroid gland, which of course is analogous to the making of the end product or the doll. Once enough thyroid hormone is available for the body’s needs, the production of TSH ceases, thus stopping further production of thyroid hormone. This is what is meant by a negative feedback mechanism. In the case of the factory, it’s like supply and demand. Once the demand has been met the supply is no longer an immediate necessity.

Now the problem arises, just like in the scenario above, of what happens when you have too much of the end product and become stuck with an essentially inactive and undesired end product. We must utilize the end product (rt3) before we can put new toys, or in the case of the thyroid system, active t3 hormone on the shelves (in the case of thyroid system the receptors of the cells.) New and more popular toys (or active hormone) can be sold (or utilized in the case above), the inactive hormone which is analogous to the overproduced toy, rt3.

Just like the unsold toy is essentially inactive, so is rt3, thus causing a loss of profitability or a decreased function to the body as a whole. The temperature drop that occurs with this bogging down of the system from the occupation of receptor sites by inactive hormone is akin to the drop in profits, which is a consequence of the occupation of the shelves with slow selling toys. But, once the dolls are slowly sold and more popular toys fill the shelves, the factory runs smoothly and profitably.

The body too is a factory that will also run more profitably and smoother with the return to normal temperature, resultant return to normal function, and resolution of unwanted symptoms mentioned at the beginning of this article.

You are now probably asking how is it that the rt3 gets off the receptor sites on the various tissues and cells of the body. (Receptor sites are areas on the cells that hormones will attach to so that they can perform their activities within the body.)

Well, just like the idle toys will eventually sell out in time, so will the rt3 “wear out” in time. By this I mean that the amount of time any of the hormones- be it t4, t3 rt3, or t2- is not indefinite and as time goes on, the energy from the available hormone(s) will be expended.

In the case where one is ill and more rt3 than t3 is being formed from t4, there is a competition for the receptor sites between t3 and rt3 and until rt3 predominance drops and more t3 becomes available, the system is malfunctioning.

Sometimes chronically or acutely ill persons with the symptoms mentioned at the start of this article may be treated by a knowledgeable physician in the diagnosis of hypothyroidism, even though the blood tests are normal. This is what is known as euthyroid clinical hypothyroidism. When it is combined with a low temperature and it responds to treatment with t3 (not t4), and after treatment the symptoms remain abated of medication, the condition is known as Wilson’s syndrome.

A problem that arises with many physicians who are willing to treat these patients is that they utilize t4 or a combination of t3/t4 and actually compounds the picture. This is because t4 will preferentially convert to rt3, not t3, making even more inactive hormone available to the cells and causing even further lowering of the temperature and increased associated symptoms.

The most important aspect in treating Wilson’s syndrome is keeping a steady balance of t3 and t4 as well as rt3. Getting too much t3 too quickly with the resultant unsteady levels throughout the day can cause symptoms that are the same, but perhaps worse than those caused by the initial rt3 dominant state. It is therefore extremely important that a patient follow instructions closely when taking your medications as well as in taking your temperatures.

In order to properly treat and follow up someone on t3 therapy, a daily log of heart rate as well as temperature must be taken. This is to ensure that you are not taking too much or too little medication. Remembering that the goal of therapy is to normalize temperature so that we normalize enzyme function and ultimately attain the best physiologic state for our body. As a result, it is imperative that obtaining your temperature readings becomes part of your daily life.

The exact way in which the t3 is to be taken is individualized in every patient. For a detailed description on this procedure, refer to the patient instruction sheet at the end of this article.

In summary, the diagnosis of euthyroid clinical hypothyroidism is made on clinical grounds utilizing information regarding patient symptoms and noting a decrease in normal temperature of 98.6 degrees. The diagnosis is further established by the clinical improvement and the maintenance of improvement after treatment with t3 even after hormone therapy has been discontinued. By cycling t3 over a course of time, one can “reset” the body’s thermostat that regulates all enzymatic activity, and thus all activities within the body. Just as the respiratory system will immediately correct for a change in its oxygen or CO2 content by altering depth or rate of breathing, so too is the thyroid system so finely tuned as to require a precise constant temperature for normal homeostasis.

Just like any medical treatment there can be side effects with the use of t3, and not everyone should take t3 for a variety of medical reasons. But with proper treatment and follow up, literally thousands of people worldwide can regain their lives, which have been severely altered by symptomatology that was passed off as an untreatable illness.

Addendum 6-18-12:

Although this is good information, I no longer routinely treat my patients with subclinical hypothyroidism with T3 alone. It is very difficult to do so on the part of both the practitioner as well as the patient. In addition, with the newer therapies I now offer, a synergistic effect is seen to boost the entire endocrine system, making the use (need) of T3 as a stand-alone therapy a rare occurrence….Mark Bartiss, MD.