Point: Hypothyroidism - Mild Hypothyroid Diagnosis - Hypometabolism ad Thyroid Therapy



The advent of "scientific and laboratory medicine" in the latter half of this century has brought many benefits, but in certain instances it has led to dogma and worse care of patients. One such error has been the equation of normal thyroid hormone level in the blood with normal physiologic response (metabolic rate and cell/tissue development). The technical problems of the BMR machine led to abandonment of physiologic measurement, but in the 1940's Dr. Broda Barnes began using basal temperature as a reliable parameter. Those physicians who have read his book and applied his techniques have seen some amazingly good results, but they have also seen many failures to respond. This has in most cases been due simply to fears of titrating dosage of thyroid hormone to higher levels, often based on an incomplete understanding of where the physiologic disturbance lies.

One practitioner did full thyroid lab testing on over 40 patients with clear-cut hypometabolism per Dr. Barnes' criteria. Fewer than 5% had any lab abnormalities, showing that the physiologic problem is not in the thyroid-pituitary axis and feedback system. The problem lies at the cellular level and relates to enzyme dysfunction. This is sometimes due to deficiency of substrate (vitamins, minerals, proteins), especially in younger patients. More often, however, it is due to toxic effects of chemicals, heavy metals, or endogenous toxins. These cause blockage and inefficiency of the enzyme systems needed to utilize thyroid hormones. Therapy, must therefore be aimed at proper nutrition and supplements, and, as often is needed, the exact dose of thyroid hormone sufficient to push the enzymatic reaction through at a normal rate. As we are polluting our internal and external environment increasingly, the titration process is becoming longer and dosages higher. The results in the patient, however, justify stubborn continuation until the endpoint is reached.

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A review of the published literature is presented. 23 cases are cited documenting the breadth of the problem.

Case Anecdotes in Hypometabolism

This review derived from one doctor's practice summarizes basic findings supportive of hypothyroidism.

Nutritional Inadequacy

P.M., 32, female with coldness, fatigue, and weight gain. Cholesterol 272. Even on a 200-500 calorie diet, unable to lose weight, but very junky diet. Eumetabolic on 8 gr. Thyroid, but if eating poorly is hypometabolic on 12 gr. 15-year-old daughter with same condition, but controlled on 2 gr.
M.R., 40, female with craving for sweets. Hypoglycemic, probable Candida overgrowth, allergies, and emotional instability. Self-destructive diet errors; thyroid up to 18 gr/day without normal basal metabolism. Treatment failure due to patient non-compliance.
A.N., 72, male with weakness, Carpal tunnel release, 2 bypass surgeries. Depression, achlorhydria with extreme mineral depletion. Cholesterol 210. Nutritional program restored eumetabolism, cholesterol 160. IV minerals and HCL improved mineral levels. Feeling great.
Bowel Toxicity

4. E.W., 70, male with tic douloureux. Universal reactor. Health food hypoglycemic. Mineral depletion. Negative indican but mild elevation of anti-Candida antibodies. Chronic weight loss on high-calorie diet; much less aches and allergic reactivity, and became eumetabolic. Tic nearly disappeared on hypoglycemic diet, later returned. Efforts continuing to treat with HCL and IV minerals.

Thought/Mood Disorders

5. L.G., 52, male with abdominal pain. Heavy coffee drinker, ex-alcoholic, worn out, frustrated at job. Cholesterol 270. Depressed and compulsive gambler, non-compliant. Unable to get off caffeine until eumetabolic on 0.45 mg T-4 daily. Sudden surge of energy, optimism, and rejection of gambling.
6. S.S., 53, female with fatigue. Solvent intoxication with galactorrhea, endometriosis, weight gain, depression, little improvement, difficulty complying with nutrition program. Argumentative and negligent until eumetabolic suddenly on 5-6 gr. Thyroid. Now happy with life despite lousy job; losing weight. Cholesterol 269>198. Abnormal stress EKG.

7. K.F., 70, male with claudication. Diabetes severely out of control with fasting blood sugar 324, cholesterol 422, triglycerides 2320. Axillary temperature 95.2-96.0. Diabetes uncontrollable until he took 3 gr. Thyroid, then no problem, cholesterol 244 and triglyceride 423.

Vascular Disease

8. A.E., 49, male with angina since age 41. Heart attack and 2 bypass operations. Hypoglycemic, ex-alcoholic. Cholesterol 301. Took 25 mcg. T-3 but angina worsened. Then put on propranolol, and he tolerated 40 mcg. T-3, had axillary temperature 97.5, cholesterol 239.
9. F.L., 69, male with angina for 5 years. 30 years of gassing up race cars; toxiC lead and cadmium in hair. Chronic persistent hepatitis, mild diabetic, achlorhydria with moderate mineral deficits. Ater 50 chelations, only a small reduction in heavy metals, no change in liver function tests or low white blood cell count. Treadmill EKG poor. Untreated hypometabolism noted, and on 1.5 gr. was eumetabolic, but some increased angina, so reduced to 1 gr. Back on chelation, no angina or limits on exertion.
10. W.C., 60, male with three heart attacks in 16 months, 11 angiograms, and 4 angioplasties. Fatigue, poor memory, impotence (vascular), fear of death. Extreme mercury toxicity in hair (printer by trade). On Lovastatin for high cholesterol but discontinued when on good diet and chelation, and eumetabolic on 100 mcg. T-3, cholesterol 191. Feeling very good; return of potency.

11. L.G., 36, female with pre-menstrual depression. Long history of birth control pills, antibiotics; probable Candida overgrowth. 40-day cycle. Responded only to progesterone suppositories, not to nutritional/supplement program. Hypometabolism resolved on 50 mcg. T-3, cycle length normal, PMS cured as long as diet is good.


12. O.G., 80, female with pain in legs diffusely for 15 years. Also pain in rectum, coldness, frequent urinary tract infection, dry skin, constipation, hoarseness. Cholesterol 309, Triglyceride 280, Sedimentation rate 46. Axillary temperature 96.1. X-rays of her hip showed severe degenerative arthritis. Despite conflicting orthopedist opinions, scheduled for hip replacement for pain in legs; T-3 begun, but patient too confused and distraught, no compliance, and despite warning of poor result, had hip surgery. Poor result occurred, and pain continued, but patient still not in for follow-up.

Morbid Obesity

13. J.H., 37, female with fatigue. Weight 328. Minimal diabetes, migraine, depression. Daily caloric intake 2000, but she can't lose weight on over 500 calories/day. T4 test 6.0. Axillary temperature 95.6-96.6 on nutrition program. On 14 gr./day of Thyroid, temperature 97.2-97.6 and T4 only 13.0.27# weight loss with ease in 7 months. Feels energetic, happy.
14. D.P., 35, female with fatigue. Weight 354. Cholesterol 232. History of long-term paranoia, depression, PMS. 2 miscarriages, then 2 children with congenital deformities. Amenorrhea. Diffuse allergies. Massive weight loss and eumetabolism (or nearly so) on 0.9 mg/day of T-4. Mood fair (Ongoing family problems).
15. L.B., 36, female with fatigue. Weight 380+. Cholesterol 251. Irregular menses, infertility, weight climb until 9 years ago, when put on Thyroid and diet pills. Lost 110#; energy and periods normal, got pregnant and obstetrician forced her off Thyroid (nl. T4), then rapid weight gain, fatigue. Now, T4 4.0, axillary temperature 96.9, sedimentation rate 61, anti-thyroglobulin antibody present, indican 3+ with halitosis across room and oral plaque 1/8" thick. On T-4 0.7 mg/d. 57# weight loss in 4 months with better energy, cholesterol 209 and triglyceride 200; axillary temperature 97.4. Lost to follow-up due to odontoiatrophobia, but per phone, weight 295.
Failure of Healing

16. J.K., 65, male with cold, tingly hands and burning pain in abdominal wall. Nearly died of leaky abdominal aneurysm. Congestive heart failure with atrial fibrillation, chronic obstructive pulmonary disease, vitiligo, rheumatoid arthritis. Reconstructed abdominal scar very painful; can hardly wear clothes. Cholesterol 222. Addicted to Halcion. Indican test turned red, and porphobilogen mildly elevated. Later diagnosis abdominal causalgia, then reflex dystrophy (no significant peripheral vascular disease on Doppler). Improved on T-3 and acupuncture, switch to flurazepam; relapsed badly off all these; better again on them. Depressed, so continuing compliance problem. Nearly eumetabolic on 75 mcg. T-3, no cardiac problem.
17. L.C., 54, female with persistent ankle pain for 8 years after plantaris longus rupture. Ankle stabilization 1985 with pain for unknown reason. Depressed, gaining weight. No better with good nutrition. On 65 mcg. T-3 and acupuncture pain disappeared, mood normal. Cholesterol 268>166,15# weight loss, axillary temperature 97.4.
Chemical Toxicity

18. S.B., 40, male with poor stamina. Recent carpal tunnel surgery with persisting soreness, and inability to sustain triathalon training due to hip soreness. Lots of healthful sweets. History of many childhood allergies and infections. Caloric intake 700/day less than predicted. Axillary temperature 96.0-97.2, with little help from idealized diet. Eumetabolic on 0.3 mg. T-4 with excellent stamina.
19. M.M., 57, female with abdominal pain. Many GI complaints, sciatica. Cholesterol 308, T-4 7.3. Axillary temperature 95.8-96.3, with weight gain on low calorie diet. On 6 gr. Thyroid temperature in low 96's; on 0.6 mg T-4 temperature 97.4 with fine weight loss. No GI symptoms on Pancreatin/Bile. Cholesterol 200. After 9 months more, T4>20 and cholesterol 150 with alkaline phosphatase 167. Thyroid dosage reduced to 4 gr., but temperature back to 95-96, same alkaline phosphatase. Then on trip got hysterectomy and oophorectomy for ovarian cyst. Thyroid was cut to 0.3 mg. T-4, and now still gaining weight. Dosage titrated up, and even on 1.0 mg/day temperature only 97.2. Feeling better, but not seen for 7 months.
20. N.Z., 41, male with recurrent Candida intertrigo. History of infantile milk allergy, otitis, frequent antibiotics, radiation of adenoids. Boils, seborrhea, several surgeries. Toxic and allergic from organic chemical exposures, especially formaldehyde. Weak liver, hypoglycemia. Reformed diet in 1980. On juice fast developed extreme hypometabolism. Did detoxification program and went on Thyroid; eumetabolic on 3 gr. Intoxication with pentachlorophenol in rug glue 1985 led to white spots on fingernails (despite normal zinc and calcium levels), recurrent groin Candida infection on excellent diet, and increase in Thyroid requirement to 4 gr. Upcoming repeat sauna detoxification and chelation for mild mercury intoxication.

21. B.A., 61, female with tic douloureux. Mild hypertension, TMJ dysfunction, urticaria. Mineral depletion of earlier hair analysis not seen at time of 1st visit. Axillary temperature 95.4-96.2. On 3 gr. Thyroid had tachycardia spells, 150/min. On 6 gr. thyroid axillary temperature 96.9-97.3 with office thermometer, T4 test 15.5, but atrial fibrillation. Thyroid reduced to 3 gr., but rapid atrial fibrillation and dyspnea persisted despite propranolol. Axillary temperature dropped back to 95.8-97.2, then rose to 97.0-97.8 with new thermometer; T4 test 12.6. Tic relieved by cranial manipulation and TMJ splint. With 15% reduction in Thyroid dosage, T4 was same as on no Thyroid, but axillary temperature 97.4-97.8. Atrial fibrillation persisted when off Thyroid with temperature 97.0. Put on 3 gr. again. Then tic resumed, dyspnea, weakness. Update on hair showed mineral depletion, but Heidelberg test for HCL normal. Minerals switched to capsules; IV minerals given. Switched to T-4 up to 0.4 mg/day, and became eumetabolic and free of tic. Dyspnea and weakness also gone, but atrial fibrillation persists.
22. R.P., 37, male with weakness and lightheadedness. Much family stress, hypoglycemia, food allergies. Axillary temperature 95.8-96.6. Cholesterol 228. On 0.4 mg. T-4 temperature 96.5-97.2; on 0.5 mg. temperature 97.0, but got toxic. Felt good on 0.3 mg, but a few months later got toxic. On 0.2 mg temperature low, so used 0.25 mg with temperature in low 97's, finally 0.2 mg 6x/wk with temperature 97.3. Feels good, home life stable, preparing to do sauna detoxication soon.
23. R.W., 49, female and spouse L.W., 58, male; she was fatigued on 2.5 gr. Thyroid, he had a toe abscess. These 2 peas in a pod required over 14 gr. and 10 gr. daily, respectively, of Thyroid, but they soon got toxic, she developed tachycardia, sweats, and increased alkaline phosphatase (bone), he developed chronic cough and mild increases SGOT/PT. She had a T4 of only 12.3 (vs. 7.1 originally) on 14 gr./day. Her cholesterol went from 286 to 179 (slightly toxic), and his from 247 to 168 (slightly toxic). He is on HCL for mineral depletion, but energy has improved. She is now on 12 gr./day and he is now on 7 gr./day.
Hypometabolism and Thyroid Therapy Bibliography, Chronological

1. Fishberg A. Arteriosclerosis in thryoid deficiency. JAMA 1924; 82:463.

Discussion of autopsy findings in a very young man with thyroid failure. The first good presentation of the causative role of hypothyroidism ("without myxedema") in diffuse atheromatous disease and diastolic hypertension.

2. Bruger M. Arteriosclerosis and hypothyroidism: observations on their possible interrelationship. J Clin Endocrinol 1942; 2:176.

In patients over 55 a very strong correlation between BMR and arteriosclerosis was shown. Non-glandular causes of hypometabolism are discussed.

3. Barnes B. Basal temperature versus basal metabolism. JAMA 1942; 119:1072.

Clinical research establishing oral basal temperature validity and ranges. Documents unreliability of BMR machine. Dosage up to 3 gr. desiccated thyroid daily normalized temperature in the majority of 1000 cases; higher dosage not disparaged. Pioneering article.

4. Barnes B. Furunculosis - etiology and treatment. J Clin Endocr 1943; 3:243.

Discussion of thyroid hormone effect on tissue resistance and the use of oral basal temperatures.

5. Lerman J. Metabolic changes in young people with coronary heart disease. J Clin Invest 1946; 25:914.

In angina patients 40 years old or less, all but 2 on small doses of thyroid became free of angina, and elevated cholesterol levels dropped. This report is flawed by the paucity of specific data.

6. Israel M. A new approach to the control of atherosclerosis. Medical Record 1949 (Dec.):14.
4 cases described of arteriosclerosis reversed with "oxytropic" factors (B/C vitamins), lipotropic factors (choline, inositol, B-6), thyroid, and a low-fat, high-protein diet. It is impossible to tell which of these factors worked, or even others. Still, the therapy's key points are still in use today amongst disciples of Dr. Barnes, who claim similar excellent results.
7. Menof P. The thyroid treatment of essential hypertension. S Afr Med J 1952; 26:967.
Case studies of severe hypertension showing good results on thyroid hormone in non-renovascular cases on toxicity.

8. Watson B. The hypometabolic state: a clinical entity. NY J Med 1954; 54:2045.

The first full description of non-myxedematous hypothyroidism, with low basal temperatures and excellent response to thyroid, 2 - 8 gr./day. PBI and 1-131 uptake were not yet generally available. It is likely that some of these patients had mild thyroid glandular failure. The greatest significance is the dosage used without creating hypermetabolism, since titration was according to symptoms.

9. Buxton CL. Effect of thyroid therapy on menstrual disorders and sterility. JAMA 1954; 155:1035.

A single-blind study of symptomatic women, showing no overall statistically significant results on thyroid therapy, but a cure rate in hormonal sterility of 24% vs. 11% for placebo. It points out the poor correlation between PBI, I-131, and BMR.

10. Kurland G. Studies in non-myxedematous hypometabolism. J Clin Endocrin 1955; 15:1354.

Anecdotal series of 4 patients selected due to "poor clinical response to desiccated thyroid up to 5 gr./day." BMR and PBI were used, suggesting inconsistent responses after therapy. This included very high doses of medication: desiccated thyroid, T4, T3, or combinations thereof. The most serious study flaw limiting the correctness of their conclusions was the ignoring of differing kinetics and half-lives of T4 and T3: all responses are consistent when this and malabsorption are considered. Interestingly, correct theoretical ideas on non-responsiveness to thyroid hormone are listed.

11. Israel M. An effective therapeutic approach to the control of atherosclerosis illustrating harmlessness of prolonged use of thyroid hormone in coronary disease. Am J Dig Dis 1955; 22:161.

An extension of author's 1949 article in Medical Record, Using a more standardized protocol of intravenous thyroxine. Cholesterol levels monitored rather than BMR.

12. Jones AC. Hypothyroidism as a cause of headache. Arch Otolaryngol 1955; 62:583.
118 patients (doubtlessly including some with mild thyroid gland failure) were titrated on desiccated thyroid until headaches disappeared. Dosage ranged from .5 gr. to 8 gr. daily with no serious toxicity. Obviously headache can have many other causes, but why overlook one so easily treated? The author introduces basal pulse testing as an alternative to averaged BMR testings.
13. Hollender AR. Hypometabolism in relation to ear, nose, and throat disorders. Arch Otolaryngol 1956; 63:135.
Nice summary of the differing views of that era on hypometabolism and thyroid therapy. Discussion of very good clinical results from thyroid therapy (including the new Synthroid) for vasomotor rhinitis, postnasal discharge, and deafness and/or tinnitus.

14. Wallach E. Cardiac disease and hypothyroidism-complications induced by initial thyroid therapy. JAMA 1958; 167:1921.
4 cases of cardiac decompensation from overly aggressive thyroid therapy (desiccated thyroid or liothyronine) in myxedema of varying degree. Benefits of gradual titration on heart physiology using desiccated thyroid discussed.
15. Barnes B. Prophylaxis of ischemic heart disease by thyroid therapy. Lancet 1959; 2:149. Prospective study of patients with cholesterol levels over 200 with or without angina or myocardial infarction, treated with 1-4 gr. desiccated thyroid daily. Excellent reductions in cholesterol levels and symptoms were achieved using titration per basal body temperatures. No untoward outcomes from thyrotoxicity. A good discussion of the early 20th century reports of dangers of thyroid therapy based on excessive dosages without proper physiologic monitoring.
16. Levin ME. Metabolic insufficiency; a double-blind study using triiodothyronine, thyroxine, and a placebo: psychometric evaluation of the hypometabolic patient. J Clin Endocr 1960; 20:106.
A poorly designed study using BMR machine for patient selection. The overwhelming error is the failure to titrate thyroid medications past 75 mcg. T-3, based on the concept that hypometabolism is a thyroid gland disease. Apparently no one showed toxicity at this "high" dose. The very low prevalence of low BMR scores is demonstrative of how unreliable the technique is.

17. Sikkema S. Triiodothyronine in the diagnosis and treatment of hypothyroidism: failure to demonstrate the metabolic insufficiency syndrome (controlled study). J Clin Endocr 1960; 20:546.

The second half of the 1-2 knockout punch to hypometabolism in the same journal issue. Fortunately, a highly flawed double-blind study; unfortunately still relied on by endocrinologists as the last word. A 3-part study, only Part A double-blind, in which only 20 patients were selected, using BMR and fatigue among young professionals (skewing sample toward neurotics and non-metabolic causes, as hypometabolism worsens with age and poor nutrition - their placebo effect was - 50%, the same rate as "good response"). Responders to T-3 (given up to 150 mcg./d, with frequent toxicity) needed 62 - 150 mcg., much above average thyroid gland output. No cross-over done to see if responders would also respond to placebo, and insufficient follow-up to see if placebo effect would wear off. "It would seem that either these patients did not have metabolic insufficiency, or that a beneficial effect of triiodothyronine on metabolic insufficiency cannot be shown by a double-blind study." (The first is true, but the second is not, one suspects, if better patient selection were done using Barnes' axillary basal temperature test.) In Part B, without controls, T-3 therapy caused good response in 50% (dose mode 100 mcg.); when patients were abruptly switched to desiccated thyroid, a prompt return of fatigue ensued. In Part C, without controls, 12 good responders to T-3 were taken off it, relapsed (with beautiful BMR changes), then were given desiccated thyroid, with good response again, suggesting that these patients should have the double-blind study done on them. "It seems best to regard these cases as representing mild to moderate hypothyroidism, and to consider the BMR superior to the PBI determination as a screening test in such instances." The authors are evenhanded, but Barnes took the next logical step, only to be ignored (perhaps because of the specialty journal his paper appeared in).

18. Israle M. Longterm thyroid-vitamin treatment of atherosclerosis in chronic diseases. Southwest Med 1963; 44:14.

Extends the use of vitamins and thyroid to many chronic diseases over 3-20 years of continuous therapy. 80% started with normal PBI. Morbidity and mortality were amazingly low. Suggests the term "euthyroid" needs reevaluation. It is unfortunate he doesn't use basal temperatures to select patients, and so he pushes for everyone to be on prophylactic therapy, which detracts from the scientific aspects of his arguments.

19. Fowler PBS. Premyxedema and coronary-artery disease. Lancet 1967; 1:1077.

This article mixes auto-immune thyroiditis cases with apparent hypometabolism cases, but is interesting for its showing links between increased cholesterol, vascular degeneration, and hypometabolism. One case listed was on up to 3.0 mg/day of thyroxine without harm. Early mention of GLA use in improving body function.

20. Barnes B. Eighteen-year follow-up on thyroid therapy in prophylaxis and treatment of coronary disease. Fed Proc 1969; 28:516.
1569 patients were followed up to 18 years on therapy with desiccated thyroid. Extraordinary reduction in new coronary artery disease and increase in survival rate after myocardial infarction were realized.
21. Golding DN. Hypothyroidism presenting with musculoskeletal symptoms. Ann Rhem Dis 1970; 29:10.
9 cases cured with thyroid therapy, some of which had normal PBI. Good discussion of etiology of the myopathy and neuropathy, especially in carpal tunnel syndrome. Worth remembering.
22. Wren JC. Symptomatic atherosclerosis: prevention or modification by treatment with desiccated thyroid. J Am Geriatr Soc 1971; 19:7.
Excellent 5-year study of 347 patients, although the diagnosis of the group of "asymptomatic atherosclerosis" was questionable. Still, all groups showed statistically very significant decreases in morbidity, mortality, and cholesterol level. 2-4 gr. desiccated thyroid daily was given without toxicity "since thyroid dosage was adjusted carefully to individual tolerance." Lack of aggravation of angina suggests that eumetabolism was not achieved in a certain number of the symptomatic group. Even so...References very useful!

23. Barnes B. Thyroid therapy in dermatology. Cutis 1971; 8:581. Extremely gratifying clinical success in various chronic conditions. Description of use of axillary basal temperatures and technique of thyroid medication titration. Mention of the panoply of presentations of hypothyroidism, including altered growth/healing and immune dysfunction. Forerunner of his book Hypothyroidism: The Unsuspected Illness (1976) for the lay public
24. Jackson IMD. Why does anyone still use desiccated thyroid USP? Am J Med 1978; 64:284.
A poor article due to ignorance of hypometabolism in many of the patients studied. The authors therefore were alarmed by high T3RIA levels (as could be expected in eumetabolic patients on desiccated thyroid), so put them on subtherapeutic dosages of thyroxine. Reductions in thyroxine' dosages for those already on it were based on assumption that low metabolic rate must be a glandular disease needing only replacement therapy. The good part of the article is the discussion of the makeup of desiccated thyroid and its kinetics; understanding this can render its use safe and serum hormone level assessment intelligent.

25. Pelkowitz D. A new treatment for psoriasis. S Afr Med J 1982 (March 13): 381.

Surprisingly bold use of 0.4-0.5 mg/day of thyroxine along with propanolol and "essential phospholipids." Excellent results including in psoriatic arthritis. No report of toxicity, including purely metabolic (e.g., weight loss). A refreshing return to clinical research in an age of dogma and insistence on double blind studies.

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