Requesting help with research, please

Discussion in 'Fibromyalgia Main Forum' started by BethM, Apr 22, 2003.

  1. BethM

    BethM New Member

    My NP has prescribed thyrolar (T3/T4 medication), but wants documentation of this 'off label' use of thyroid hormone. I had found several articles which I had printed in anticipation of this request, but in the chaos of house painting (still on-going, the contractor is ill, so we are stalled. gack.) I've lost them. Can't re-find them, either, here or on Dr. Lowe's site. Can anyone here direct me to something I can print and present to her? She is open minded and is willing to work with me, but wants documentation, too. She needs to be able to justify my course of treatment, should it be questioned.

    I've looked, and am now convinced I've lost my mind. I KNOW those articles were here somewhere!

    Thank you kindly,
  2. kgg

    kgg New Member

    Especially Dr. Jacob Teitelbaum. He addresses the thyroid issue. I'm sure others do too, but I haven't read them all. Hope this helps. . .
  3. BethM

    BethM New Member

    I did as you suggested, and was able to find some documentation. I just couldn't remember where I found the information. (Teflon brain strikes again...)

    Also, someone else posted a reply, for which I was notified via email notice, but it never showed up here. Whoever it was, thank you, but I did not receive your message.

  4. layinglow

    layinglow New Member

    by Jacob Teitelbaum, M.D.


    Hormonal Treatments
    Thyroid supplementation -several studies show that thyroid therapies can be very helpful in CFIDS/FMS -even if your blood tests are normal. This treatment is, however, very controversial -even though it's usually very safe. All treatments (even aspirin) can cause problems in some people though.
    The main risks of thyroid treatment are:
    1. Triggering caffeine-Iike anxiety or palpitations. If this happens cut back the dose and increase by ½ to 1 tablet each 6 to 8 weeks (as is comfortable) or slower. Sometimes taking vitamin B1 (thiamine) 100 to 200mg a day will also help. If you have severe, persistent racing heart, call your family doctor and/or go to the emergency room.
    2. Like exercise (i.e., climbing steps), if one is on the edge of having a heart attack, thyroid hormone can trigger it. In the long run though, I suspect thyroid may decrease the risk of heart disease. If you have chest pain, go to the emergency room and/or call your family doctor. It will likely be chest muscle pain (not dangerous) but better safe than sorry. To put it in perspective, I've ~ seen this happen despite treating many hundreds of patients with thyroid. Increasing your thyroid dose to levels ~ the ~ limit of the normal range may accelerate Osteoporosis (which is already common in CFIDS/FMS).
    Because of this, you need to check your thyroid (Total T3 and Free T4 –not TSH) levels after 4 to 8 weeks on your optimum dose of thyroid hormone. All this having been said, we find treatments with thyroid hormone to be ~ than Aspirin and Motrin. If you have risk factors or Angina, do an exercise stress test to make sure your heart is healthy before beginning thyroid treatment. The risk factors include: 1. Diabetes, 2. Elevated cholesterol, 3. Hypertension, 4. Smoking, 5. Personal or family history of Angina, 6. Gout, 7. Age over 50 years old.
    There are several forms of thyroid hormone, and one kind will often work when the other does not. Do not take thyroid within 6 hours of iron supplements or you won't absorb the thyroid (take your multi vitamin with iron at bedtime). It can take 3 to 24 months to see the thyroid's full benefit.
    30. Synthroid -(L- Thyroxine) 50mcg -(1 00mcg=.1 mg)
    31. Armour Thyroid -30mg ( ½ grain = 30mg) (natural thyroid glandular)
    32. Thyrolar- ½ (this equals T4 25mcg plus T3 6.25mcg)
    For each of these 3 forms, take ½ tablet each morning on an empty stomach for 1 week and then 1 tablet each morning. Increase by ½ to 1 tablet each 2 to 6 weeks (till you're on 2 tablets). Check a repeat Total T3 and Free T4 blood level when you're on 2 tablets a day for 4 weeks. If okay, you can continue to raise the dose by ½ to 1 tablet each morning each 6 to 9 weeks to a maximum of 4 a day and then recheck the Total T3 and Free T4 4 weeks later. Adjust it to the dose that feels the best (lower the dose if shaky or if your pulse is regularly over 88/minute). Do not go over 4 tablets a day without discussing it with your doctor. When on your optimum dose, you can often get a single tablet at that strength. 33. Sustained Release T3 -(T3 SR = activated thyroid) -get 7 ½ to 15mcg capsules (when you are up to 60mcg a day -order 60mcg capsules as well. It is much cheaper to get one large dose capsule than many smaller ones). In Fibromyalgia, resistance to normal thyroid doses may occur and patients often need very high levels of activated T3 SR Thyroid to improve. One research group feels that the average dose needed in FMS is 125mcg each morning -!lli!.9.b. higher than your body's normal production. because we are often going above normal levels with T3 SR, the risks/side effects noted above increase. Because of this, if you have risk factors, it is more important to consider an exercise stress test to make sure your heart is healthy (i.e., no underlying Angina) before beginning this protocol. Also, if your Total T3 blood test goes above normal (the Free T4 will normally be low on this treatment), consider a Dexa (Osteoporosis) Scan each 6 to 18 months while on treatment.
    This having been said, in our experience this treatment has been quite safe and, in some FMS patients, dramatically effective. Begin with 7 ½ mcg each morning and continue to increase by 7 ½ mcg each 3 days until you're at 60mcg a day and then increase by 15mcg a day each 4 to 6 weeks until (whichever comes first):
    1. You reach 120mcg each morning (or 60mcg if you're over 50 years old unless approved by your physician).
    2. You feel healthy,
    3. Your oral temperature is routinely at least 98.4° during midday.
    4. You get shakiness, worsening significant palpitations (occasional "flip flops" are common) or other side effects.
    Check a Total T3 level each 2 months and discuss with your doctor if it is above normal (which it may need to be). If you feel no better even on the maximum dose, taper off (decrease by 7 ½ mcg each 3 days until you're at 15mcg a day. Take 15mcg a day for 3 weeks. Then take 7 ½ mcg a day for 3 weeks and then stop).
    After being on treatment for 3 to 4 months, many patients can lower the T3 dose or stop it. Feel free to try dropping the dose. If you feel better initially and then worse (beginning more than 4 weeks after starting a new dose), you probably need to lower the dose .