18 February 2011 ~ 14 Comments

Dr Jacob Teitelbaum and his Multi-Pronged Treatment Strategy for CFS, Fibromyalgia and Thyroid Disease (Part 2 – Interview)

For Part 1 of this article, please click here

Sarah: Let’s talk about antibodies, an important but vastly misunderstood topic. For instance, my Hashimoto’s antibodies were positive upon diagnosis, but soon afterwards (once I began treatment with thyroid hormone) they turned negative and have been that way ever since. Could it be because my thyroid is working better? One article I read suggests that Hashi’s antibodies can be negative if your immune system is unable to defend itself, but I don’t think this is the case with me because I have in the recent past produced Epstein-Barr antibodies when my Epstein-Barr virus was still active. Also, what’s your experience with iodine and antibodies? Some say it can make your Hashi’s antibodies flare up, but that seems to be another controversial topic.

Dr T: It’s the exception rather than the rule that negative antibodies symbolise a poor immune system. The inability of the immune system to produce antibodies tends to apply more to patients with CFS and severe infections. When the thyroid becomes underactive, it starts to work harder trying to keep up. It may be putting out more of an immune challenge to the body and may undergo more attack. However, when you give a patient thyroid hormone, this can help reset the thyroid, so that the thyroid is not as active and you don’t get as much reaction. Imagine a sick thyroid as a sprained ankle – if you keep trying to run on the ankle, this will cause more and more inflammation. However, if you give the ankle (sick thyroid) a crutch in the form of thyroid hormone, you take the weight off the ankle (sick thyroid), give it chance to rest and heal and as a result it becomes less inflamed.

You can support your thyroid and immune system by taking thyroid hormone and ensuring that you are getting enough iodine through your diet or a supplement. Some patients who take iodine for the first time will stimulate the thyroid gland (resting ankle) and sometimes that can stimulate the reaction to the gland, but that will pass. As you wake up the gland, you stimulate the inflammation of the thyroid and may notice a flare in symptoms. You can take a low dose and slowly work up, but it might be even better if you start on a high dose of iodine because you either won’t get this problem or it will pass very quickly.

Sarah: I have repeatedly read that selenium is supposed to be good for lowering thyroid antibodies. Would you recommend this and what role do antibodies play in your diagnosis of patients?

Dr T: Selenium is good for aiding the conversion of T4 to T3. I’d recommend taking 200 mcg a day, as contained in my multivitamin supplement. However, be careful not to take too much as more than 400 mcg a day can be toxic. Positive TPO antibodies are indicative of Hashimoto’s thyroiditis. I check that antibody once to confirm diagnosis and then never check it again. There is no need to lower the Hashimoto’s antibodies as they help balance the immune system.

Sarah: Tell me more about your diagnosis process and what steps you take to get a person well.

Dr T: As far as I’m concerned, it’s better to spend less money on blood tests and more time on asking the patient how they actually feel. How is your temperature? Do you feel less achy? How about your intolerance to cold? Are you able to lose weight? What about your skin texture?

It’s common sense to customise the treatment to how the person feels because everyone is an individual and I’d rather treat the person than the blood test. In the old days, doctors didn’t have tests, but had to listen to the person and perform a physical examination. Doctors these days are trained not to trust their own art of medicine, which is wrong because blood tests are not all that reliable. It’s interesting to note that the normal range for blood tests is based on two standard deviations. Take 100 people and the 95 in the middle are defined as the normal range. This is akin to saying that the normal range for shoe sizes is four to thirteen. Of course, in reality, this isn’t the case.

When it comes to hypothyroidism, I like patients’ blood tests to be in the middle to the top of the range. I need to find the person’s optimum level. Once their TSH is under 2.5, I check their free T4 level to make sure it’s in the normal range and the patient isn’t hyperthyroid. I then adjust the thyroid to the dose that feels best based on their symptoms. I find the free T3 to be a meaningless test because a blood test won’t tell you how much free T3 is being made in the cells. I may check free T3 once and if it’s low I’ll push more to give T3. Reverse T3 to T3 ratios also give more information, but are usually more complicated than most people need. For most people, if their TSH is high, you know they need hormone. It’s also important to make sure the patient is getting sufficient iodine, selenium and tyrosine.

Sarah: What is the relationship between CFS, fibromyalgia and thyroid disease?

Dr T: Hypothyroidism is one of many triggers for CFS and fibromyalgia. If someone has CFS or fibromyalgia, unless their free T4 is elevated and they are hyperthyroid, I give them a trial of thyroid hormone. I presume that 100 percent of people with fibromyalgia and CFS also need treatment for hypothyroidism. But if people have hypothyroidism, it doesn’t mean they also have CFS or fibromyalgia. You deserve a trial if you have symptoms and you should try different types and adjust to the dose that feels best. Some people may need a high dose of T3.

Sarah: If hypothyroidism is not found to be a cause of fibromyalgia, what are the other causes and treatments for it? Is there a way to prevent fibromyalgia?

Dr T: Fibromyalgia can be caused by an energy crisis triggered by malfunctioning of the hypothalamus [Sarah: this is a portion of the brain that links the nervous system to the endocrine system via the pituitary gland], which controls the thyroid and the adrenals. Think of the hypothalamus as a fuse – once the fuse is blown, the thyroid and adrenals no longer function properly. Fibromyalgia can also be caused by other triggers that disrupt sleep, toxic chemicals, hormone imbalances, infections and nutritional deficiencies.

Sarah: What is the relationship between thyroid disease and adrenal fatigue? How do you treat too much versus too little cortisol and what are the possible causes of these?

Dr T: Symptoms of thyroid disease include tiredness, achiness, weight gain and cold intolerance. When you’re suffering from adrenal fatigue (low cortisol), you may get irritable when hungry (“feed me now or I will kill you!”) This means that your cortisol levels are not high enough to maintain your blood sugar. We treat adrenal fatigue with Vitamin B5, liquorice, adrenal glandulars or a very low dose of bioidentical cortisol (hydrocortisol is very toxic, but a very low dose is very safe). If a person feels better when you give them adrenal support, this means that they need it.

People with adrenal fatigue should increase their salt and water intake, although if you have high blood pressure or heart failure you should restrict your salt intake. Low cortisol is often indicated by low blood pressure and salt is needed to avoid crashing. Sugar, on the other hand, should be avoided as this exhausts the adrenal glands. My book Beat Sugar Addiction Now talks about the role of sugar and how people need to approach sugar. Sugar is not as big an issue for thyroid disease, but a major issue for adrenal exhaustion because excess sugar is a loan shark for energy.

High cortisol levels are caused by chronic stress, e.g. due to illness – people who are ill may need a high cortisol level to keep them going. When your cortisol levels are chronically high, this exhausts the adrenals and the hypothalamus, which ultimately causes low cortisol (adrenal fatigue) and malfunctioning of the hypothalamus. As mentioned above, the hypothalamus controls the adrenals and the thyroid, so adrenal fatigue and its resulting malfunctioning of the hypothalamus may put you at higher risk of both thyroid disease and autoimmune disease in general.

Sarah: To what extent does our genetics put us at increased risk of thyroid disease and fibromyalgia?

Dr T: You have a 50 percent increased risk of developing Hashimoto’s if someone in your family has it. Sometimes even half-brothers and sisters share the disease. When it comes to fibromyalgia, the genetic connection is very weak and there is only a 2 – 4 percent increased risk of developing it if someone in your family has it.

Sarah: A patient with Graves’ disease who has had radioactive iodine treatment would like to know if you have any tips for exophthalmos (bulging eyes). Sometimes her eyes get worse and sometimes they get better. She takes flaxseed oil for the dryness, but would like something to calm her eye antibodies down. Do you have any recommendations?

Dr T: In Graves’ disease, antibodies affect the swelling. Smoking doubles the risk of bulging eyes. For those with exophthalmos who are now hypothyroid as a result of treatment for hyperthyroidism, I speculate that they may do better on pure synthetic T4 or T3 and might be best avoiding Natural Desiccated Thyroid (NDT) such as Armour Thyroid as this can stimulate antibody production. When it comes to Hashimoto’s, however, more people do better on NDT.

Sarah: What do you think of the TSH test, a test which is often dubbed the “gold standard” for measuring thyroid function?

Dr T: Many tests are very unreliable for diagnosing fibromyalgia, in particular the TSH, as it misses the majority of people who need thyroid hormone. When we look back at the new range introduced by the American Association of Clinical Endocrinologists in 2002 where a TSH of over 3 was considered hypothyroid, we see a big increase in the number of hypothyroid patients from 13 to 26 million. [Sarah: and still there are countries like the UK where people might not get a diagnosis from some doctors until their TSH is much higher – I know I may never have been diagnosed had I stayed there because my TSH on diagnosis was 4.78, which is usually considered pretty normal there – I certainly wasn’t feeling normal].

The TSH is useless for diagnosising chronic fatigue syndrome and fibromyalgia. The hypothalamus regulates the TSH [Sarah: it produces Thyrotropin Releasing Hormone or TRH, which tells the pituitary gland to produce Thyroid Stimulating Hormone or TSH, which tells the thyroid to produce either more or less thyroid hormone], but in diseases such as chronic fatigue syndrome and fibromyalgia there is a malfunctioning of the hypothalamus and it blows a fuse in the brain. This is caused by a depletion in energy and during this energy crisis the hypothalamus acts like a circuit breaker.

Sarah: What are the consequences of this hypothalamic dysfunction?

Dr T: This may result in hormone imbalances such as thyroid, adrenals and sex hormones. It can also result in antidiuretic deficiency [Sarah: the antidiuretic hormone regulates the body’s water retention]. In such cases, the patient drinks like a fish and pees like a racehorse! A malfunctioning hypothalamus can also cause sleep problems. One hallmark of chronic fatigue and fibromyalgia is being exhausted but unable to sleep. The sad part is that although many doctors claim there is no treatment for this, if you follow the SHINE protocol [Sarah: see Part 1 of this article], you should find that it is very treatable indeed.

Sarah: Do you have any other tips for strengthening the immune system?

Dr T: Sometimes people with weakened immune systems fall victim to opportunistic infections that would not survive in a healthy person, e.g. HHV6, Epstein-Barr virus, cytomegalovirus. I sometimes use chronic antivirals, but usually instead of chasing the infections I go after candida (which is the main cause of sinusitis, which I also treat), balance the hormones (by treatment with bioidentical hormones), ensure good nutrition and try to make sure the patient is getting enough sleep because lack of sleep can suppress the immune system. For patients who suffer from dry mouth and eyes, I recommend two to four portions of salmon or tuna or taking a fish oil supplement [Sarah: for more information on Dr T’s treatment protocol, please check out Part 1 of this article].

Sarah: Is there anything else you would like me to tell our readers?

Dr T: It’s important to be aware of the fact that women with TPO thyroid antibodies are about four times as likely to have a miscarriage, but when you give them thyroid hormone this increased risk goes down to zero. Even if their T4 and other thyroid tests are normal, it’s vital to give them thyroid hormone before they get pregnant. In the US alone, there are 50 percent unnecessary foetal deaths a year because doctors aren’t checking the TPO antibody and treating it in pregnant women.

Sarah: Thank you very much for your time, Dr Teitelbaum, and for providing us all with this wealth of information. It was very interesting talking to you.

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