Dr. Lowe's E-Chapters...

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Q. Do you have a maximum amount of capsules that I should take of the 300mg?

We don't suggest that anyone take more than 2 capsules of the 300mg without the guidance and care of a qualified clinician. The 300mg is our strongest dosage and it is designed for people who have had their gland removed. If a person still has a functioning gland, then we suggest supportive dosing with the 150mg. 

Q. I've been taking 1 capsule of the 300mg and 1 capsule of the 150mg daily and feel amazing. My doctor says that my labs show that I am taking too much but when I drop the dose, I feel awful. What should I do?

If you and your doctor can make a clear determination of overstimulation at the tissue level, that would be helpful. Testing your basal temperature, your basal pulse level and your basal blood pressure, will provide measurements that you can use to determine if you are taking too much Thyro-Gold. If you are, then dropping the dosage down to 1 capsule of either dosage, would be appropriate.

Q. I’ve started Thyro-Gold and for the past week have felt great. However, today I am feeling hypo again and I know that I have another week to go before I can increase my dosage. Is there any reason why this might be happening to me?  

More than likely your initial response was from the active T3 in the Thyro-gold. The dip that you are experiencing may be an impaired conversion of the T4 to the T3. There may be antibodies on your gland that will impair the conversion process. It is important to wait the two weeks before adjusting the dosage because the conversion can just be delayed but able to complete during the 2nd week.  If you were to increase your dosage during the two-week window, you may get a secondary increase of thyroid hormone from the conversion but also overshoot by adding the 2nd capsule too soon. This could cause overstimulation of the tissues and leave you feeling “hyper” or thyrotoxic. If that happened, you would have to back the dosage down and wait for the tissues to clear out the excess hormone. 

Q: Has Thyro-Gold™ been chemically "stripped" of T4 and T3 in the same manner as other so-called "dietary" thyroid supplements? Or is it pure, unadulterated bovine thyroid that contains naturally occurring T4,T3,T2,T1 hormones?

Dr. Lowe: Thyro-Gold™ contains all the natural contents of the bovine thyroid gland. Many people believe there is such a thing as "thyroxine-free" desiccated thyroid. Presumably, the T4 has been selectively removed from these products, leaving only T3, T2, and T1.

Maybe there are "thyroxine-free" products with the T3, T2, and T1 left in. But if there is a technology for selectively removing T4, it's being cleverly hidden from me and my colleagues, such as the biochemist who researches such issues with me.

As far as I know at this point, the term “thyroxine-free desiccated thyroid” actually refers to desiccated thyroid tissue from which all the iodinated compounds (T4, T3, T2, and T1) have been removed.

I say this based on carefully acquired evidence: we’ve systematically tested “thyroxine-free” thyroid tissue, and we found it to be metabolically inert. If the tissue we’ve tested is typical of all products labeled “thyroxine-free,” this means that people who use them to increase their body’s thyroid hormone regulation are likely to be very disappointed. We’ll notify readers if we find evidence that justifies a change in our current belief. But right now, our belief is this: dietary desiccated thyroid either contains the full array of thyroid hormones, or it contains none at all. Thyro-Gold™ contains them all.

Q: Here in the UK, we can buy a product named "Nutri-Thyroid." I started taking 3 capsules, and 3 days later I felt so tremulous that I stopped it. When I bought it, my understanding was that it has no thyroid hormones in it. Are you familiar with Nutri-Thyroid and have you any notion why it caused me to have tremors? Do you think I would also have tremors if I take Thyro-Gold™?

Dr. Lowe: I only learned about the product Nutri-Thyroid several days ago. I looked the product up on the Internet and found that advertisements describe it as “thyroxine-free.” 

It appears to me that the product is equivalent to Nutri-Meds over-the-counter (dietary desiccated thyroid) sold in the US. Both products are described as “glandulars.” Each capsule of each product contains 130 mg of desiccated thyroid powder from animals in New Zealand. The Nutri-Thyroid ads say that the powder is from cows, but Nutri-Meds sells both cow- and pig-derived desiccated thyroid products.

Judging from Nutri-Thyroid ads stating that the product is “thyroxine-free,” we’re left with the assumption that the product still contains T3, T2, T1, and calcitonin. This is a reasonable assumption in that these hormones are natural to thyroid gland tissue. 

As I said, Nutri-Thyroid and Nutri-Meds products contain 130 mg of thyroid powder per capsule. By contrast, Thyro-Gold™ contains 150mg and 300 mg of desiccated thyroid powder in available options.

In your two-part question, you asked: (1) Why did you feel tremulous on 3 capsules of Nutri-Thyroid, and (2) would you do better taking Thyro-Gold™?

First, let me say that your tremors are consistent with thyroid hormone overstimulation. I don’t think, however, that thyroid hormone overstimulation was the sole cause of your tremors. I say this because 3 capsules that contain 130 mg of thyroid powder each are not likely to cause most people to have thyroid hormone overstimulation. I’ve talked with many people who've gotten well on products that contain 130 mg of thyroid powder.

Most people who experience symptoms of overstimulation from only 3 of the capsules (390 mg of powder) have one or more underlying conditions that interact with small doses of thyroid hormone to produce adverse effects. Tremors are one such effect. In my experience, the most common of these underlying conditions are: (1) a cortisol deficiency; (2) nutritional deficiencies, most often involving B complex vitamins; (3) abnormal blood sugar regulation; and (4) the intake of xanthine [pronounced zan’ thēn] chemicals, such as caffeine, theobromine, theophyllin, and pseudoephedrine. (Examples of consumables that contain xanthines are coffee, tea, chocolate, cough medicines, and decongestants.)

The interaction of one of these underlying conditions with your low dose of Nutri-Thyroid most likely produced your tremors. And you could, of course, easily mistake the cause of your tremors as being the 3 caps of Nutri-Thyroid you were taking.

 How to know when you're overstimulated by thyroid hormone. 

Q: My family doctor is wonderful. She agreed to take me off Synthroid and help me in using Thyro-Gold™. I'm doing so much better on Thyro-Gold that she and I are excited. She's on board with my Thyro-Gold™ treatment, but has a question. She asked if we're not to use my TSH and thyroid hormone blood levels, how can we tell if I take too much thyroid hormone and get hyperthyroid?

Dr. Lowe: Please give your family doctor my best regards and my thanks for her cooperating with you. I hope more clinicians will emulate her and help their hypothyroid patients by taking them off T4 products and having them use Thyro-Gold or prescription desiccated thyroid products, such as Armour Thyroid. You mention possibly becoming "hyperthyroid" from taking too much Thyro-Gold™. Some people occasionally do take too much of their thyroid hormone product. The product might be Thyro-Gold™ or any other one on the market. When someone takes too much, the excessive exposure of his or her tissues to thyroid hormone overstimulates some of them. However, the proper term to describe the tissue overstimulation is not "hyperthyroidism."

Hyperthyroidism is the production of excessive amounts of thyroid hormone by the thyroid gland. That's all the term denotes. The term does not mean that the person's tissues are Overstimulated. When someone's tissues are overstimulated by thyroid hormone, we call the syndrome "thyrotoxicosis." This term literally means tissue overstimulation by thyroid hormone.

The reason it's important to know the difference is that not understanding it can lead to false beliefs. The person who has an overly active thyroid gland and is in fact overstimulated by too much thyroid hormone typically has a low TSH and high thyroid hormone levels. The low TSH and high thyroid hormone levels in his or her case, are truly due to hyperthyroidism. From this fact, a false belief can arise: that is, anybody who has low TSH and high thyroid hormone levels must be hyperthyroid.

Another false belief also arises: that "hyperthyroid" blood levels of TSH and thyroid hormone and tissue overstimulation are one-and-the-same. But this is not the case. Many people who have low TSHand high thyroid hormone levels are actually underregulated by thyroid hormone. I know this from performing comprehensive metabolic evaluations for hundreds of patients and documenting this pattern of lab values in many of the patients. Unfortunately, though, most conventional clinicians today falsely believe that anyone who has the lab test pattern characteristic of hyperthyroidism is unequivocally overstimulated by thyroid hormone.

The endocrinology specialty has a conspicuous discrepancy none of its members have stepped before microphones to explain: according to the specialty, low TSH and higher-end thyroid hormone levels are harmless to scores of thousands of thyroid cancer patients; for everyone else, however, these blood hormone levels portend devastating adverse effects. If high-enough thyroid hormone dosages to produce these blood levels are safe for thyroid cancer patients, why aren't they safe for other hypothyroid patients?

The fact is that low TSH levels and higher-end thyroid hormone levels are no more harmful to the vast majority of hypothyroid patients than they are to thyroid cancer patients. This lab test pattern clearly is not one-and-the-same as tissue overstimulation.

How Best to Test for Overstimulation: If your family doctor and you suspect that you're overstimulated by Thyro-Gold—that is, that you're thyrotoxic—she and you can verify or refute the suspicion easily enough. You can test at home to see whether your basal temperature is too high and your basal pulse rate too fast. And you can lightly touch the palmar parts of your finger tips to your chin to see whether they tremor. (Many of my consulting patients and I called this latter procedure the "Tammy fingertip test" for overstimulation. Tammy discovered and introduced me to the test, and I've never found where anyone else described the test before.)

Your doctor can do an ECG (EKG) to see whether the voltage of the QRS complex is high compared to the voltage on your previous EKGs. She can also test your Achilles reflex to see if it's too fast.

The tests you can do at home and those your doctor can do are far more meaningful tests than your TSH and thyroid hormone levels. If your TSH level is suppressed, or if your thyroid hormone levels are high, you might be over-stimulated, but then you might not be. I have no confidence in these lab tests as indicators of tissue over-stimulation by thyroid hormone.

The reason I don't trust the lab tests is that I've done hundreds of comprehensive metabolic evaluations for patients. I've run statistics many times to see whether the patients' TSH and thyroid hormone levels correlate with their measures of metabolism. What I've consistently found is that the lab levels don't accurately predict which patients have low, normal, or high metabolism. The lab tests therefore don't tell us which patients are understimulated by thyroid hormone, properly stimulated by it, or overstimulated by it.

The TSH and thyroid hormone levels are virtually useless for learning whether a patient is on his or her optimal dose of thyroid hormone. It's far better to use the types of tests I suggested above for your doctor and you to perform.

Q.  I know from what you’ve written in your books and on you website that I should not let my family doctor use my TSH level to find my best dose. If I don’t use my TSH level, how do I decide how much Thyro-Gold to take?

Dr. Lowe: The best way for you to find your safe and effective dosage of Thyro-Gold (or any other thyroid hormone product) is to systematically monitor how you respond to different daily doses. I recommend that you use both physiological measurements and estimates of the severity of your symptoms. You should use these at least 2 or 3 times on each dose. By doing so, and comparing the measurements and estimates on different doses, it will be obvious to you which dose is right for you.

Many alternative clinicians ask their hypothyroid patients to use their basal armpit temperature and their sense of well-being to determine if they are on their optimum dosage. For the typical patient, these are indeed useful gauges of how his or her tissues are responding to a particular dose of thyroid hormone. By comparison, the TSH tells the patient how his or her pituitary gland is responding. But it tells him or her nothing whatever about how the rest of his or her body is responding.

I prefer that my patients use at least four physiological measures, not just the temperature. The other three measures are the patient’s basal pulse rate, basal blood pressure, and fasting body weight.

Using these additional measurements is crucial if some patients are going to find their right daily dose. For example, some patients’ low basal temperatures increase very little; other patients' temperatures don't increase at all. These patients' temperatures stay low even after they’ve fully recovered with thyroid hormone therapy. For them, seeing the basal heart rate rise with higher doses denotes improved thyroid hormone regulation. And some patients’ sense of well-being remains low because of one or more persisting and troublesome symptoms; only after the patients reach a high-enough dose of Thyro-Gold to eliminate their symptoms does their sense of well-being improve.

For an occasional patient, then, the temperature and sense of well-being may not be good barometers of thyroid hormone-induced change. Because of this, if you were a patient of mine, I'd prefer that you watch two types of gauges as you move up toward your optimal dose of Thyro-Gold.

First, I'd ask you to use your basal armpit temperature, but I'd also ask you to use three other physiological measurements: your basal heart rate, basal blood pressure, and your fasting weight. Second, I'd ask that you record estimates of your sense of well-being, but I'd also ask you to estimate how severe your predominant hypothyroid symptoms are.