READ, READ, READ, READ, READ.............

[Guest guest]

(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