Friday, September 17, 2010
Transdermal Thyroid Treatment? Huh?
I love to write about the Wiley Protocol because it is so wildly controversial. Perhaps best known for mimicking the estrogen and progesterone levels of a 20-something, with peak estradiol on day 12, and peak progesterone on day 21 given in a rhythmic fashion, did you know that you can get the Wiley Protocol for your thyroid?
T. S. or Susie Wiley is the creatrix of the Wiley Protocol. She is a medical theorist with a background in molecular biology. That'll become more relevant in a moment. But know that she is not a medical doctor.
Susie has been an avant garde thought leader in the realm of hormones for years. Her main contribution? That of RHYTHM – meaning that specific patterns of hormone levels are needed for harmony between sex hormones (estrogen, progesterone, testosterone), thyroid and adrenal hormones. There is a rhythm to our light/dark cycle, our food supply, families, plants, hypothalamus, pituitary, ovaries, thyroid and adrenals -- why not, as Wiley fan and oncologist Julie Taguchi, MD suggests -- mimic the buzzing and humming of our glands which send signals to grow, bloom, seed, hibernate or die? She has applied the concept of rhythm to the dose and timing of externally-applied transdermal hormones.
Susie believes that we have to really understand each hormone in a woman’s body and how it acts both alone and as part of the symphony, rather than simply whether you are getting too much or too little Synthroid.
It makes sense theoretically: we know that there’s a see-saw relationship between thyroid hormone and estrogen levels, so when estrogen is up, thyroid is down. So in the Wiley Protocol, the idea is that you adjust your thyroid dosage with where you are in your menstrual cycle (in Wiley Land, that concept applies equally to pre- and post-menopausal women, with and without a uterus). In other words, static dosing of thyroid medication (same dose daily) deranges both estrogen and progesterone receptors.
Let me describe it another way: when you are cycle day 1-5, your estrogen is really low. On the standard Wiley Protocol Thyroid, that means you take 6 lines (0.6mL as measured on their handy syringes) of T4 (21.8 mcg/line) + T3 (7.4mcg/line). The reason? T3 provokes an estrogen receptor, so you will improve estrogen turnover and make more estrogen receptors on target tissues. You then adjust down to a nadir of 1 line on peak estradiol day 12, and spike back up to 6 lines day s 14-16. And so on.
What positive things can I say about the Wiley Protocol Thryoid? I like the transdermal approach. As you know, absorption of your thyroid pills through your gut… well, it sucks. That’s why you are told to wait 20-60 minutes to eat or drink anything after you take your morning pills. So it makes sense that a transdermal approach is more convenient, and perhaps absorbed better.
I also like the adjustment with the menstrual cycle, especially for my patients who are exquisitely sensitive to the steady up/down of their estrogen (estradiol). Many of my patients find that they bloat like crazy at ovulation and just before/during their menses. Sometimes more thyroid hormone is the fix (but you must see your doc on this one – I do not recommend reckless experimentation in the service of bloat prevention).
Final positive are these: apoptosis and receptor turnover.
What the heck is apoptosis, you might ask.
Apoptosis is “Programmed Cell Death.” Now, before your eyes glaze over, let me point out why this is cool, important and relevant. Apoptosis is good – it’s designed to keep you young and vibrant. It’s a way of getting rid of the debris in your body without damaging you – it gets rid of receptors you no longer need, for instance. It confers advantages and is completely different from necrosis, which is cell death as a result of traumatic injury or cancer. In your body today, 50-70 billions will die as a result of apoptosis.
Receptor turnover is another important aspect of your glandular goodness. As an example, when women are given PremPro (estrogen from PREgnant MARe urINe and synthetic progesterone, proven to cause heart disease and breast cancer in women aged 50-79), the same dose every day makes your progesterone receptors stagnate. According to Susie and the data she cites, this results in inadequate cell apoptosis and a higher chance of disease such as breast cancer. In other words, chronic, same-dose-daily leads to down-regulation of progesterone receptors, and tissue badness downstream.
If you take the WP Thyroid Transdermal Restoration for Women, you check your thyroid function tests on day 13 or 14 because that is when your endogenous thyroid levels are at their maximum.
Negative feedback? There’s the absolute lack of randomized clinical trials, the gold standard for deciding if something is safe or even just a good idea. Recall all the trouble we got into with prescribing estrogen (1950-1999: take it! 1999-2002: never take it! Dangerous & risky! 2002-now: take it if you really need it, however you best define that! Confusing)? That was because we based our recommendations for estrogen on biased data (observational studies or worse quality), and randomized, controlled trials have the least bias.
Truth be told, I tried WPT for a few months. Actually, I try almost everything before considering it for my patients. I didn’t notice much difference in my bloating or hypothyroid symptoms (the usual: fatigue, easy weight gain – such as looking at a muffin, constipation).
Problem is this: we’ve got limited options as we augment or completely replace the function of our thyroid. I welcome new kids on the block. I find that selecting the right thyroid treatment is a lot like shoe shopping – it can often take nearly forever to find the right fit. So keep the faith and know there’s choices available. Check it out if you must, but buyer beware: no (unbiased) data, no data, no data.
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- Dr. Sara Gottfried, MD
- I'm an organic gynecologist, yoga teacher + writer. I earn a living partnering with women to get them vital and self-realized again. We're born that way, but often fall off the path. Let's take your lousy mood and fatigue, and transform it into something sacred and useful.