Physician Interview: Richard Shames, M.D., on Treating Thyroid Dysfunction, Chronic Fatigue Syndrome & Fibromyalgia
October 31, 2003
Richard Shames, M.D., graduated Harvard University and the University of Pennsylvania, did research at the National Institutes of Health with Nobel Prize winner Marshall Nirenberg, and has been in private practice for twenty-five years. Dr. Shames has published a number of health-related books and is well-known for his prominence and pioneering work in the holistic field. In his medical practice, he treats patients with CFS and FM. His newest book is "Thyroid Power."
ImmuneSupport: Dr. Shames, please provide a little background on how you came to specialize in the treatment of thyroid problems.
Dr. Shames: I first was amazed at how important thyroid was during undergraduate training at Harvard. I was in a biochemistry class when the professor told us that all the energy reactions in the body depend on the presence of thyroid hormone. This surprised me, but was later confirmed in medical school when the professors in anatomy class called the thyroid "The True Master Gland", not the pituitary.
The professor explained that the pituitary is simply a relay station for brain signals. The thyroid however, secretes the hormone that allows DNA to be read, AND releases the mitochondria for the lion's share of every cell's energy.
This information was tucked away until well after medical school, when my wife Karilee had a recurrence of her Hashimoto's problem at the birth of our second child. I was amazed to see how many symptoms - and how much mischief - could be caused by a malfunctioning thyroid gland. Karilee was so exhausted she couldn't get out of bed! We have been doing the "thyroid dance" ever since. In fact, all 3 of our children tested positive for thyroid at puberty!
ImmuneSupport: What are some of the primary symptoms of thyroid dysfunction?
Dr. Shames: There is a huge list of possible thyroid symptoms. Some people have one or more, some have many. They can be anything from fatigue, depression, overweight, dry hair, skin and eyes; low blood pressure, high cholesterol, aches and pains for no reason, and a whole host of female problems, including bad periods or PMS, infertility, difficult menopause, low libido (in men also) as well as constipation... and the list goes on.
ImmuneSupport: Do you treat any Chronic Fatigue Syndrome and/or fibromyalgia patients? With both types of patient, whose symptoms frequently overlap, thyroid and adrenal problems are common and cause very low energy as well as adrenal burnout in some cases. Please describe how you go about diagnosing thyroid problems in CFS and FM patients and how you treat them.
Dr. Shames: I see both kinds of situations regularly in my San Rafael, CA office. There appears to be a wide overlap; one thing is quite common between them. Both of these medical conditions are intimately involved with thyroid and adrenal dysfunction.
I treat them by first isolating for a thyroid problem, and treating that first. Then, once thyroid is as stable as we can get it, I check for and treat adrenal imbalance.
Many people are frustrated in dealing with the hormonal balance difficulty because they don't isolate and treat the thyroid issue first. Thyroid is somewhat prominent and preemptory, it is primary among the endocrine glands, since it is the gas pedal for everything else.
If you try to treat the adrenal imbalance first, in my experience, you can make the system further imbalanced, more difficult to diagnose properly, and success becomes more elusive.
There is one situation, however, where thyroid and adrenal rebalancing need to take place concurrently. This occurs when the adrenal balance is severe and co-exists in tandem with a thyroid imbalance. In these situations, the procedure is to correct the thyroid a little, then correct for adrenal a little, then go back and correct a bit more for thyroid, then a bit more with adrenal corrections. The reason for this dual upward titration is that treating either one of these insufficiencies can "unmask" and exacerbate the insufficiency symptom of the other.
Most of the time, however, this is not the case. Even if low thyroid and low adrenal coexist, frequently correction of the thyroid alone will then throttle the rest of the body, including the adrenal gland, back into some semblance of normal function. Thus, many CFIDS and FM sufferers get a jump-start on their recovery process via careful and rigorous thyroid treatment first.
To accurately diagnose a thyroid problem is crucial. We cannot simply rely on TSH and or Free T4 blood tests, even though this is the industry standard. Instead, we need to do a more complete panel of blood tests, which would include Total T3, Free T3, and thyroid antibodies. In addition to blood tests, we must also include the equally important basal body temperature evaluation, and family history. For more details, I recommend that anyone with CFS or FM look at this issue very carefully. The details of diagnosis and treatment are clearly defined in our book THYROID POWER: 10 STEPS TO TOTAL HEALTH (HarperCollins, 2001).
What is often missed, especially in CFS or FM patients, is the critical four columns of a "temple of diagnosis" (see visual of this on our website www.ThyroidPower.com in cartoons for step 3) that includes using signs and symptoms, family history, associated conditions AS WELL AS blood testing.
ImmuneSupport: Do you use any alternative therapy methods for improving thyroid function in patients?
Dr. Shames: Absolutely - this is a critical part of how I work. I have been involved in holistic medical care for almost 30 years (and I'm not that old!). I often use relaxation therapies and hypnotic techniques, and teach them to my patients. I also send them to receive a great variety of therapies, depending largely upon a number of factors, such as what they believe has been helpful, their ability to pay, etc. I recommend massage, energy healing or touch therapies, nutritional therapies, biofeedback, visualization and imagery, yoga, chi gung, and lots of fun and healthy exercise when they feel better! These are selected individually depending on who practices in the various areas.
In fact, I provide thyroid coaching for people over the phone, and have the opportunity to "meet" people from all over the US and beyond. I help them to gather the proper materials and family history, seek the best possible testing (some is home-based, such as saliva testing), then learn to advocate better for better health care from their providers. I also do my best to help people from various locations to connect with practitioners in their area who are more open and "thyroid-friendly".
Karilee, who is a holistic nurse, and I have been teaching seminars to health practitioners on Thyroid Power, so we are continuing to develop our practitioner database for various alternative and complementary therapies, as well as for physicians.
We have also been moving more in the direction of home-based testing, so those whose pocketbooks or physical situation (or beliefs) allow them to work with these less medical, less standard, and less approved methods. Some people are having tremendous success using saliva and urine testing for thyroid and other concerns.
ImmuneSupport: How do you believe Omega-3 fatty acids and multivitamin supplements support and promote optimal thyroid function?
Dr. Shames: The thyroid is the gas pedal for your body's energy flow, but you need fuel and spark for the gas pedal to accomplish anything. Fuel would be optimal nutrients, and supplements add the spark.
There are certain steps in the production and utilization of thyroid hormone that require specific nutrients in quantities that many people do not have.
For instance, let’s consider the conversion of inactive T4 in the body. T4 is made by thyroid gland and transported in bloodstream or taken by synthetic pills, but is inactive in the body. It has to be converted to T3 . This conversion of T4 to T3 is dependent on a 5' (prime) deiodinase enzyme. It turns out this enzyme is selenium dependent, so without selenium, it is hard to get active thyroid hormone.
Omega 3 fatty acids are helpful for inflammation (and thyroiditis has
inflammation in the production phase). The omegas help to reduce this inflammation. Also the receptor site on the lipid protein layer of the cell surface seems to be enhanced with the addition of omega fatty acids to the diet.
A good multivitamin provides a variety of the other nutrients known to be just as crucial as selenium, in other pathway bottlenecks. Thyroid status is controlled at seven different hierarchical levels in the body; this is more control than any other process, and taking key vitamins and co-factors will help to ensure proper function at each level.
ImmuneSupport: What traditional medicine approaches do you use to treat patients with thyroid problems?
Dr. Shames: When practicing only using traditional medicine, I use thyroid hormone pills, and I monitor the results with blood tests and basal temperatures. This standard approach, when combined with the alternatives mentioned above, is your best shot at full thyroid recovery.
ImmuneSupport: Do you think there is frequent misdiagnosis in the CFS patient population that could prevent thyroid problems among these patients from being properly treated?
Dr. Shames: Absolutely!! Many of the thyroid symptoms are wrongly considered to be part of the CFS problem. Also many of the symptoms are similar. In fact, some people don't have a thyroid problem until they have the immune system compromised from CFS, then the thyroid can go downhill. The thyroid is easy to treat compared to many aspects of CFS and FM, so it should be handled first.
ImmuneSupport: What issues are you addressing in your new book?
Dr. Shames: In our upcoming project, we are moving beyond strict thyroid care into a more holistic approach to thyroid, adrenal, and reproductive hormone balance.
After 30 years of practice, we have come up with a step by step process to work with these issues, and to help people uncover the roots of their health issues, one step at a time. We believe in slow, careful, methodical care that allows us to unpeel the layers of your condition, addressing them carefully and moving slowly enough that we don't unmask other related conditions, thereby further muddying the waters.
While we know that most people in our society are accustomed to fast food and fast medicine, we believe these underlying difficult to diagnose energy problems must be addressed carefully for optimal results.
ImmuneSupport: What is your advice to patients struggling with debilitating fatigue?
Dr. Shames: My heartfelt advice to people struggling with CFS or fibromyalgia conditions is to do everything possible for diagnosis and treatment of a possible co-existent thyroid insufficiency. This will make the remedies and procedures for CFS and FM more effective, and more long-lasting.
We're not saying that CFS or FM are really being misdiagnosed; there are indeed some people who are truly thyro-compromised and diagnosed with CFS; when they are treated for the underlying thyroid problem, many of their symptoms, sometimes all of them, are better. For most others, however, the thyroid problem co-exists with the CFS/FM syndromes, and can help people to begin to feel better, so they then are more able to address the other more complex concerns.
Our Bottom Line: Remember - YOU CAN STILL BE LOW THYROID, EVEN WITH NORMAL TESTS. Treat the thyroid first!
Wishing every person greater health and peace,
Rich Shames, M.D., and Karilee Shames, Ph.D., R.N., are the authors of THYROID POWER: 10 STEPS TO TOTAL HEALTH (HarperCollins 2001) now available in paperback.
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