Re: READ, READ, READ, READ, READ.............

[Guest guest]

Wow, Dr. V Dommisse MD is a TOP doc for sure!!!

Margreet.

>

> (The following " Letter to the Editor " was submitted by Dr.

Dommisse

> to the JOURNAL OF CLININCAL ENDOCRINOLOGY a year ago...and

rejected.

> It was in response to another ridiculous article stating that

adding

> T3 to treatment was a failure. Is ANYONE here SURPRISED? HUH?? Do

> Endocrinologists WANT to hear the TRUTH??? Not. Janie)

>

> November 16, 2003

>

> AIRBORNE EXPRESS

> P. Bilezikian, Editor-in-Chief

> The Journal of Clinical Endocrinology & Metabolism

> College of Physicians & Surgeons of Columbia University

> 630 West 168 Street

> Mail Box 42

> New York, NY 10032, USA

> Phone:

>

> Re: The " failure " of the substitution of T3 to improve mental

> or physical functioning in hypothyroid patients (Oct. 3, 2003).

>

> Dear Dr Bilezikian,

>

> Having treated about 3,500 people with hypothyroidism extremely

> successfully over the past 14-year period, I am again shocked by

the

> degree to which researchers (1,2) and opinion-makers (3) are still

> inhibited in their approaches to hypothyroidism treatment by the

> fear of causing or aggravating osteoporosis or cardiac

arrhythmias.

> Optimizing the serum dialysis free-T4 and -T3 levels in all my

> patients has not contributed to osteoporosis at all (on the

> contrary, serial DEXA scans have usually shown dramatic increases

in

> bone density despite my never prescribing any drugs for

osteoporosis

> but using nutritional and metabolic corrective approaches

instead);

> and cardiac arrhythmias are taken care of by making sure there is

no

> functional deficiency of any of the pertinent minerals in the

> appropriate fluid spaces (RBC/packed cell levels in the case of

> magnesium and potassium). Not doing these things, and assuming

that

> a " normal " TSH always means normal—even optimal—thyroid hormone

> function, is causing vast under-diagnosis and under-treatment in

> millions of patients in the US and around the world. Surveys of

> patient satisfaction with treatment, and websites devoted to this

> topic, invariably show deep distrust of the adequacy of their

> treatment.

>

> The " fatal flaw " in both articles? In adding T3 (in the case of

the

> Western Australia school, in a single daily dose, which is

extremely

> incorrect, and in insufficient amount to even compensate for the

> loss of T4), both teams still insisted on keeping the TSH within

> its " normal range, " which is not the best approach, in my opinion

> and that of many others. It is recognized by some that many

patients

> do much better clinically—and don't become osteoporotic or cardiac-

> arrhythmic, as long as FT4 and FT3 are not above their normal

ranges—

> on thyroid treatment that lowers their TSH level well below

> its " normal " range. Even the NEJM article in Feb 1999 (4) made the

> same error but somehow managed to come up with improvement on the

> substitution of T3 for some of the T4.

>

> So all these researchers are still so hooked into the TSH-only-in-

> diagnosis/T4-only-in-treatment approach that they can't even

> envisage adding T3 2-3x/day without subtracting a supposedly-equal

> amount of T4 in the daily intake. I say " supposedly-equal "

because,

> after the substitution, if the TSH dropped below its " normal

range, "

> one or both doses of T4/T3 were then lowered in order to bring the

> TSH level into its " normal range. " So even these published dosages

> became less when the TSH fell below its " normal " range.

>

> If, as I believe they should, they would go by the accurate

> (Dialysis) free-T3 and -T4 levels instead, they would find that

most

> people on T4-treatment-only are WAY below optimal in their FT3

level

> and some would be suboptimal even in their T4 level—in which case

T4

> needs to be added, as well as T3 being added, to optimize both

> levels!

>

> One of the biggest losses of function in T3 deficit is life

itself,

> as well as cardiovascular function, due to hyperlipidemia (5,6,7).

> By optimizing all my patients' T3 (and T4) levels, I have never

had

> to use any statin drug to normalize anyone's lipid levels. And the

> only death in my practice in the past nine years was that of a 79-

> year-old, very obese woman who often could not afford her

treatments.

>

> The editorial by Kaplan et al admits that these authors believe

that

> correcting ALL symptoms of ALL hypothyroid patients is an

impossible

> dream. Since they are approaching the subject under the same

> assumptions as the researchers in the same issue, we can see why!

>

> Yours faithfully,

> V Dommisse MD, FRCP©

> Member, American Association of Clinical Endocrinologists