Can T3 Play a Therapeutic Role For Patients With Persistent Hypometabolic Symptoms And Normal TSH Levels?

For years, naturopathic medical schools have included the diagnosis and treatment of reversible hypometabolic symptoms in their curricula — and practitioners have accordingly treated their patients for it. Yet, conventional medicine has resisted the concept. This is largely due to the American Thyroid Association’s official position that hypometabolism is induced by hypothyroidism and — while treatable with thyroxine (T4) — is therefore irreversible.

That’s the theory. In practice, of course, naturopaths and mainstream practitioners alike know that many hypothyroid patients continue to exhibit symptoms of metabolic slowdown, including low body temperature, fatigue, depression, anxiety, poor concentration, headaches, low libido and more, even when their thyroid stimulating hormone (TSH) levels have been normalized with T4. Why is this? Some patients are unable to efficiently convert synthetic T4 (synthroid) into active triiodothyronine (T3), a reaction that is required for metabolic regulation. Alternatively, others are resistant to thyroid hormone altogether, which cannot be measured in lab tests, yet exhibit normal TSH levels. And, of course, historical disagreement over what constitutes a “normal” TSH lab value means that still others are under-treated.

Yet another possibility — one examined at length in a published article in the Journal of Restorative Medicine by Denis Wilson, M.D. — suggests that a separate condition, called hypometabolic syndrome, may be to blame. This syndrome can occur independently of, or concurrently with, hypothyroidism, making it easy to miss or dismiss.

Wilson posits that, not unlike chronic fatigue syndrome (CFS) or fibromyalgia syndrome (FMS) —two poorly understood but widely accepted conditions — hypometabolic syndrome may be triggered by systemic stress, either from physical injury, acute illness or emotional trauma. And while the correlation has not been fully explored, Wilson argues the well-documented fact that such periods of stress inhibit the conversion of T4 to T3, which can lead to disrupted homeostasis that may linger long after the initial stress has resolved.

This begs the question: could patients with normal TSH levels, but unresolved hypometabolic symptoms, benefit from a T3 treatment protocol?

Wilson asserts they can. Such a protocol is not without parallel. In patients with dysfunctional uterine bleeding, for example, physicians regularly prescribe a short-term course of oral contraceptives — a treatment that often reverses the condition. “Likewise, with the exclusion of other causes of low body temperature and hypometabolic symptoms, patients can be considered for a therapeutic trial of sustained-release T3,” Dr. Wilson says.

A private-clinic study supports this notion. In the study — conducted in the practice of Michael Friedman, N.D. — 11 euthyroid patients with persistent fatigue and low body temperatures were treated with sustained-release T3 (synthetic liothyronine compounded in hydroxypropyl-methylcellulose) every 12 hours, until a body temperature of 98.6°F was achieved. Exact dosing depended upon patient response — measured by improvement in symptoms and elevation of temperature — and was adjusted as needed.

Although Wilson himself had previously developed this protocol (called Wilson’s T3 Protocol, or WT3) and had successfully treated more than 5,000 patients with it, the protocol had never been tested in a controlled clinical setting. Because he had previously observed a remarkable correlation between a normalized body temperature and improvement in symptoms, one key objective of the study focused on the relationship between T3 dosing according to body temperature, and symptom mitigation.

The results were encouraging. While the length of treatment varied (from three weeks to 12 months) due to individual response, each participant successfully achieved normalization of oral body temperature. Patients reported statistically significant alleviation of five hypometabolic symptoms: fatigue; headaches; anxiety; insomnia; and myalgia. Further, after discontinuation of WT3, the majority of these patients reported continued improvement as many as 30 days later. Three patients reported almost complete reversal of symptoms. And the protocol proved safe: unlike with Cytomel®, which has shown to trigger irregular heartbeat and occasional atrial fibrillation, WT3 appears to offer a predictable, well-tolerated method to normalize body temperature.

The full article is available online. Dr. Wilson will be among the speakers at the 15th Annual International Restorative Medicine Conference, being held Oct. 5-8 in Tucson, AZ. For more information, visit the conference page