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THYROID CHALLENGE TESTING
Click HERE for detailed dosing schedule.
I have often stated that I don't trust ANY laboratory test for thyroid function. Over and over again, people with clear hypothyroid (low thyroid levels) symptoms have test results that suggest that they are in the normal range. Therefore, their doctor is reluctant to prescribe a thyroid supplement. Most often the person is told that either, "they're getting old", "it's in your head", or that they should "learn to live with the symptoms".

At best, those kinds of comments are cold, but when they deny a person treatment that will help them live better, such comments are actually harmful to health. And what doctor would be satisfied with that outcome? None! They want to help, but sometimes find that their hands are tied.

I have concluded that all thyroid tests are basically useless. For one thing, the levels of measurable thyroid hormone change throughout the day. For another, it seems that looking in the water-based serum for a lipid soluble hormone is like looking for penguins in the the Bahamas. They're looking in the wrong place.

Well then, what's a person to do if he or she has a list of symptoms that suggest low thyroid, yet the standard testing says everything is fine? Accept the test results or trust the clinical symptoms? I strongly suggest that doctors would be best fulfilling their obligations to believe their patient over the test results. But, that can pose a dilemma for doctors these days. If the standard of care depends heavily on testing (which it does) then any treatments must follow the test results. Otherwise a doctor could be accused of malpractice - violating the standard of practice in his or her community. I completely understand the doctors' position. Of what good would they be to anyone if they were penalized or put out of business for violating some concept of the practice standards?

What's a person to do when there is clinical evidence of low thyroid but the tests don't support it? I suggest that the person ask the doctor for a mild thyroid "challenge test". Yes, it's another test but it is different in that it uses real thyroid hormones to help detect if there is a deficiency. Simply, if a person with symptoms uses a thyroid supplement AND they have some improvement it would be clear that the improvement happened because the person was finally receiving the thyroid supplement he or she needed. The doctor can then state confidently that the person does indeed have a deficiency that requires treatment with a prescription thyroid supplement.

Compounding pharmacists can help you by assembling such a thyroid challenge test kit. We offer one that provides 5 different strengths of triiodo-l-thyronine (commonly referred to as T3). The kit does require a doctor's prescription so don't just call up and ask your pharmacist for one. Here's what we put in our setup:
  • Ten capsules each of 7.5mcg, 15mcg, 22.5mcg, and 30mcg
  • Four capsules of 37.5mcg
  • Packed into 5 separate bottles

Click HERE for detailed dosing schedule.

The patient takes one capsule every 12 hours, starting with the lowest strength and moving up every two days. After completing the 4 capsules of the 37.5mcg strength the person uses the doses every 12 hours in decreasing amounts every three days until all capsules are taken. This takes 22 days and there should be no skipped days during the challenge. While taking the capsules the patient records his or her basal temperature each time they take a dose (basal thermometers measure in tenths of a degree).

After completing the full 22 days of T3 capsules the patient returns to the doctor and together they decide on a starting supplemental dose of T3. There is a commercial T3 tablet on the market (called Cytomel), but I think there are distinct advantages to using a compounded version that has been made with a slow release filler. The first dose tried usually isn't the one the patient ends up with. This is a process through which the patient, doctor, and compounder work together to find the dose that fits just right.

Many people have had great success with this approach. The idea about using differing doses starts with a thyroid protocol often referred as Wilson's. That protocol is designed with the idea that it may be possible to "kick start" a thyroid that is underperforming. That happens in some cases, but what about those that don't revert to a more normal level after following the Wilson's protocol? Those are the people who need a regular T3 supplement, maybe even for the rest of their lives. Over the years we observed numerous cases where the Wilson's approach worked, for awhile. That happened with a large majority of the orders we filled. It seemed rational, then, to use the varying doses as a sort of T3 challenge. This has been useful.

Simply: 1. Believe the patient who says they have low thyroid. 2. Prescribe a 22-day T3 Challenge 3. Observe levels of improvement. 4. Complete the challenge and begin on a dose that matches the greatest improvement level during the challenge 5. Adjust dosing as needed.

I think this is an excellent approach to thyroid deficiency symptoms. It is simple, safe, and useful as a diagnostic tool. It makes far more sense than a blood test that looks in the wrong place for the thyroid hormones. Doctors who are interested in more details about this challenge can contact me at The Compounder (larry@thecompounder.com). I would be happy to share the prescription specifics and recording log with them.
 

Click HERE for detailed dosing schedule.

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