Dr Lowe Q&A – Immune System
January 6, 2004
Question: I am hypothyroid because of autoimmune thyroiditis. I read an article in a magazine that said patients who have one autoimmune disease may also have others. My question is, should I get evaluated for other autoimmune diseases? The reason I ask is that I still have symptoms (mainly fatigue, cold intolerance, and dry skin) that seem like hypothyroid symptoms. But it doesnt make sense that these are hypothyroid symptoms. I use 50 mcg of Synthroid and my doctor says this is enough, since my thyroid tests are now normal.
Dr. Lowe: With a high degree of probability, the symptoms you describe are due to your hypothyroidism. Its common for patients taking such a small dose of thyroid hormone to continue suffering from hypothyroid symptoms. I have two suggestions: first, that you insist that your doctor prescribe a product containing both T4 and T3; second, that you get your doctor to ignore your TSH level and raise your dose high enough to relieve your symptoms without causing overstimulation.
The article you read is correct: some patients withautoimmune thyroid disease do also have other autoimmune diseases. Moreover, some evidence suggests that the incidence of other autoimmune diseases is higher among patients with autoimmune thyroid disease. Researchers reported this in 1998.
The researchers studied the incidence of other autoimmune diseases in 218 patients with autoimmune thyroid diseases. Among these patients, 30 (13.7%) also had other
autoimmune diseases. The researchers noted that this incidence is higher than in the general population.
The other autoimmune diseases most common among the patients were Lupus and Sjgrens syndrome. Thirteen of the patients developed the other diseases several years before developing autoimmune thyroiditis. The researchers advised doctors to occasionally reevaluate patients who have either autoimmune thyroid diseases or other autoimmune diseases to learn whether theyve developed another autoimmune
As I said, your symptoms are most likely due to under-treatment with thyroid hormone. If you insist on effective thyroid hormone therapy, you wont have hypothyroid symptoms. Then, if you eventually develop symptoms from another autoimmune disease, youre likely to have a clearer perception that youve developed a new disease.
 Gaches, F., Delaire, L., Nadalon, S., Loustaud-Ratti, V., and Vidal, E.: Frequency of autoimmune diseases in 218 patients with autoimmune thyroid pathologies. Rev. Med. Interne., 19(3):173-179, 1998.
February 28, 2003
Question: It seems to me that there are two plausible causes for fibromyalgia. There is your theory of hypo-metabolism, which seams logical as youve described it in your book The Metabolic Treatment of Fibromyalgia.
Then there is the infection theory. This also seems plausible. It does especially since some studies have shown a high rate of mycoplasm or fungal infection (more than 90%, I believe) in chronic pain syndromes including fibromyalgia compared to low rates of infection in the general public. So I began to speculate on a connection between the two. I wondered if maybe slow metabolism worsened the effects of, or increased the prevalence of, low grade infections. I also wondered if possibly there was a more direct link. Maybe cellular resistance could be caused by an infection. So I thought it was very interesting that I stumbled across a physician, Dr. Mike McNett, who believes there is a connection and that cellular resistance to thyroid hormone is that connection! Im interested in whether or not you had already considered this and what you think about this concept.
Dr. Lowe: Thanks for your interesting and important thoughts on the role of infections in fibromyalgia. Ive thought about this issue a great deal. In fact, one of the largest chapters in my book The Metabolic Treatment of Fibromyalgia is on the immune system and infections.
As you know, Dr. Mike McNett proposes that candida releases a chemical that blocks thyroid hormone from binding to thyroid hormone receptors. And he proposes that theblocking causes fibromyalgia patients hypothyroid symptoms. His hypothesis is entirely conjectural at this point. He’s told me he’s planning to test his hypothesis in studies sometime in the near future. I admire the process of his reasoning and the boldness of his hypothesis. Nonetheless, I believe the hypothesis is false. Of course, to know for sure, we’ll have to wait for the outcome of the studies he’s planning.
As you may know, Dr. Garth Nicolson is the molecular biologist who more than any other research has studied mycoplasm infections in fibromyalgia patients. Before The
Metabolic Treatment of Fibromyalgia was published, he was kind enough to give me editorial comments on the section of my immune system chapter in which I reviewed his studies on fibromyalgia and mycoplasm infections.
Dr. Nicolson is correct about the high incidence of mycoplasm infections among fibromyalgia patients. But the broad spectrum antibiotics he uses don’t usually permanently relieve patients of the infections; the infections tend to recur. I believe
that when his fibromyalgia patients do get long-term improvement, the improvement results largely from metabolism-regulating therapies the patients use along with
antibiotics. For example, the patients give up high-sugar, high-fat foods; adopt a wholesome, health-inducing diet; use a wide array of nutritional supplements; restore their gut flora to normal; and exercise to tolerance. Dr. Nicolson has noted that patients must continue various nutritional supplements to maintain immune system efficiency and keep mycoplasm infections down.
The high rate of mycoplasm and candida infections among fibromyalgia patients are predicable from the adverse immune system effects of hypothyroidism and thyroid hormone resistance. That the infections are not the primary problem is obvious from a well-documented fact: Metabolic rehab involving the use of thyroid hormone enables 85% of fibromyalgia patients to fully and lastingly recover without the use of antibiotics or anti-candida therapies.
If candida or mycoplasm infections were the primary cause of fibromyalgia, we wouldn’t have our high success rate without using anti-candida therapies or antibiotics. But we’ve rarely had to treat patients for systemic candida overgrowth.
And weve never directly treated any of our patients for mycoplasm infections. Of course, we may have indirectly treated them for the infections by boosting their immune systems through the use of thyroid hormone.
January 21, 2003
Question: I have a question about my thyroid test results and a path of treatment. I had very high thyroid test results and am concerned that they are so abnormal. My free T4 level was 4, TSH was 27, thyroglobulin was 117, and thyroid peroxidase antibodies was 493. Im seeing my gynecologist for the treatment of what she thinks is hypothyroidism. She thinks my pregnancy and childbirth four months ago caused the hypothyroidism. She put me on of 0.05 mg of T4 for three weeks, and then 0.1 mg for one week. My concern is that these very high levels might indicate something more serious than my hormones being out of whack from child birth. Are numbers this high consistent with hypothyroidism resulting from pregnancy? What tests could determine whether pregnancy is responsible and not something more serious. Or should I just wait to see whether the T4 helps? Thanks for your help.
Dr. Lowe: Yes, your abnormal thyroid test results are probably related to your pregnancy. More specifically, the test results are probably related to changes in your immune system related to your pregnancy.
Changes in immune system function during and after pregnancy are well known. Considering these changes helps us to understand the onset or worsening of autoimmune thyroid disease after pregnancy, which youre obviously experiencing.
I’ll briefly explain the dynamics of immune function and autoimmune thyroid disease during and after pregnancy.
Early in pregnancy, the womans immune system typically becomes more active, and in late pregnancy, it becomes less active. When it becomes less active, if the woman has autoimmune thyroid disease, it becomes less active, and her anti-thyroid antibody levels decline. The reduced activity of the womans immune system may serve to lessen the change that her body will reject her foetus.
Just before or after delivery, the woman’s immune system is likely to become more active again. The increased activity will worsen any autoimmune disease she has, or if she didnt have autoimmune disease before, it may now appear. If she already had autoimmune thyroiditis, it will worsen at this time. If so, her levels of thyroid antibodies, TSH, and thyroid hormones will be out of their reference ranges – meaning that according to lab standards, her results will be abnormal. The severity of a woman’s thyroid gland dysfunction usually parallels the severity of her thyroiditis; the higher her antibody levels, the lower her thyroid hormone levels, and the higher her TSH level.
Her antibody levels are likely to peak three-to-seven months after she delivers her baby. Then theyll probably start declining. But even a year after she delivers, her antibody levels are likely to still be higher than at or shortly after delivery. If shes like most women with this problem, her antibody levels will eventually decrease to lower levels. They may even disappear. But if shes like some other women, her antibody levels will remain high. If she has more pregnancies, her severe thyroiditis may recur, and finally, she may develop chronic autoimmune thyroiditis and permanent hypothyroidism.
Doctors should warn women who have thyroid disease that it may worsen after pregnancy. In fact, they should caution all women that thyroid disease may appear for the first time after they deliver. If after delivery, a woman experiences symptoms such as depression, nervousness, sluggishness, fatigue, and mood swings, she should undergo an evaluation for thyroid and metabolic status.
I want to state emphatically that the woman should not settle merely for having thyroid function tests and antibody levels checked. If her doctor doesn’t also know how to perform a clinical evaluation – assessment of her history, symptoms, and physical exam findings – the doctor should refer the woman to another doctor who does not how.
Usually, an endocrinologist is the wrong choice. In general, these specialists have virtually no training in or knowledge of clinical medicine or experience in doing clinical evaluations. The best choice is an alternative doctor knowledgeable about hypothyroidism and experienced in treating patients with products that contain both T4 and T3 as part of a holistic metabolic regimen. If the woman does consult an endocrinologist, she should make sure the specialist isnt a dogmatic advocate of T4-replacement therapy; instead, she should see to it that the endocrinologist is enlightened enough to treat hypothyroid patients as alternative thyroid doctors do.
If the woman is hypothyroid, she may choose to abstain from taking thyroid hormone to see if her thyroid function returns to normal. This makes sense, of course, only if she isnt troubled with symptoms of hypothyroidism. If she does have symptoms, its usually best that she begins thyroid hormone therapy. If she does, she should choose a thyroid hormone product that’s likely to be effective. That means it should be a product that contains both T4 and T3. Using a preparation that contains only T4 is
likely to leave her suffering from hypothyroid symptoms. And chances are, a doctor will diagnose her continuing symptoms as fibromyalgia, chronic fatigue syndrome, or some other so-called “new disease.” Based on the diagnoses, the doctor will prescribe
a variety of drugs to try to control her symptomssymptoms he fails to recognize as those of hypothyroidism.
Whether the woman takes thyroid hormone or not, she should insist that her doctor reevaluate her condition at close intervals. This is important because the woman’s thyroid, metabolic, and symptom status may waver with changes in the severity of her thyroiditis. If she’s taking thyroid hormone, changes in her thyroiditis may require that she alter her dose to maintain optimal metabolism and remain symptom free.
From this summary, I hope it’s clear that, indeed, your clinical picture is consistent with thyroid disease following pregnancy. My concern isn’t that you have some other dread disease that may be producing your extreme lab results; rather, its that you won’t get effective treatment. Your lab test results suggest youre hypothyroid, and you may need thyroid hormone therapy. But I cant calculate symptoms into my opinion since you didnt mention whether you have any.
For many women with postpartum thyroid disease, however, incompetent treatment of their hypothyroidism is where they begin having horrific experiences with conventional medicine. Hopefully you’ll be treated competently. I wish you the very best for good health so that you can enjoy your new child’s early years.
January 12, 2002
Question: Do you believe hypothyroid patients should have flu shots because their immune systems are weakened? Do you take flu shots?
Dr. Lowe: Public health officials, with good intentions, argue that people in poor health (such as older, frail individuals) especially need flu shots (viral inoculations) to avoid the flu. Hypothyroidism does impair some patients immune systems. If public health officials were aware this, I suppose theyd classify these patients as having poor health; then the officials would argue that the patients are among those in special need of flu shots.
It seems to me, though, that impairment of some hypothyroid patients immune systems makes it more likely that theyll have the flu in response to the shots. Most people Ive known who had the flu did so after being vaccinated for the flu. Some patients with a diagnosis of fibromyalgia or chronic fatigue syndrome say they first developed symptoms characteristic of these disorders after being vaccinated. Each patient must make her own decision about flu shots, but considering the risks involved is prudent.
I havent had a flu vaccination, or any other kind, since I was inducted into Army basic training in my early twenties and was forced to submit to them. I seriously doubt that Ill ever have one again. In my opinion, what mainly lies behind mass vaccinations is financial greed and scientific incompetence and fraud. Because of this, I prefer to avoid the flu by using health-protecting methods such as daily mega-doses of vitamin C, a powerful antiviral agent. This approach has protected me from the flu
for more than thirty years. The worst viral diseases Ive had during that time were several colds. I initiated these by wearing down my resistance through overwork. In view of this record, Ill pass on flu shots and take my chances with naturally-induced disease.