@Johnny 4732 wrote:

Trying to learn more about the thyroid, I came across something called Wilson`s Temperature Syndrome. From what I can tell, this theory is not accepted by modern school medicine.

What is your opinion on this theory, Dr Mariano? Weak pseudo-science or is there something to it?

From Wikipedia:

The term “Wilson’s syndrome” was coined in 1990 by E. Denis Wilson, a physician practicing in Longwood, Florida. Wilson said that the syndrome’s manifestations included fatigue, headaches, PMS, hair loss, irritability, fluid retention, depression, decreased memory, low sex drive, unhealthy nails, easy weight gain, and about 60 other symptoms. Wilson wrote that the syndrome can manifest itself as “virtually every symptom known to man.” He also says that it is “the most common of all chronic ailments and probably takes a greater toll on society than any other medical condition.”

Wilson says that low thyroid symptoms and low temperatures in the presence of normal thyroid function tests are not due to hypothyroidism, and might be reversed with a few months of treatment. To distinguish this condition from hypothyroidism, he named it Wilson’s (temperature) syndrome. He states that it is “especially brought on by stress” and can persist after the stress has passed. He says that the main diagnostic sign is a body temperature that averages below 98.6 °F (37.0 °C) (oral), and that the diagnosis is confirmed if the patient responds to treatment with a “special thyroid hormone treatment”. He says that certain herbs can also help support normal body temperatures.

After a patient’s death of an arrhythmia in 1988 while taking a large amount of thyroid hormone:

members of the Florida Board of Medicine stated that there was no evidence [Wilson’s] syndrome existed. They described Wilson’s treatments as dangerous and a scam, stating that Wilson was fleecing insurance companies and patients with treatments for “a phony syndrome”.

From the Mayo Clinic:

No, Wilson’s syndrome, also referred to as Wilson’s temperature syndrome, isn’t an accepted diagnosis. Rather, Wilson’s syndrome is a label applied to a collection of nonspecific symptoms in people whose thyroid hormone levels are normal.

Proponents of Wilson’s syndrome believe it to be a mild form of thyroid hormone deficiency (hypothyroidism) that responds to treatment with a preparation of a thyroid hormone called triiodothyronine (T3). However, the American Thyroid Association has found no scientific evidence supporting the existence of Wilson’s syndrome.

In a public health statement, the American Thyroid Association concluded:

The diagnostic criteria for Wilson’s syndrome — low body temperature and nonspecific signs and symptoms such as fatigue, irritability, hair loss, insomnia, headaches and weight gain — are imprecise.
There’s no scientific evidence that T3 performs better than placebo in people with nonspecific symptoms such as those described in Wilson’s syndrome.

From the Endocrine Society:

Dr. Wilson described Wilson’s temperature syndrome in 1990 as the presence of many different symptoms along with a low body temperature and slowing metabolism. By metabolism, we mean the way our bodies convert the foods we eat into energy. Dr. Wilson believes the syndrome is caused by illness, injury, or stress.

The many possible symptoms of Wilson’s syndrome are common and non-specific, meaning they can occur in many diseases or even be part of a normal, busy life. Supporters of Wilson’s syndrome believe it is a form of thyroid hormone deficiency, even though low hormone levels are not detected in blood tests.

What is Dr. Wilson’s theory?

During periods of stress or illness, more T4 than normal is changed into an inactive form of T3 called reverse T3 or rT3. Dr. Wilson believes that long-term stress leads to too much rT3 in the body, which in turn keeps T4 from being converted into enough active T3 to fuel the body’s energy needs. This supposed thyroid hormone deficiency—undetectable in blood tests—lowers body temperature and triggers many non-specific symptoms.

Supporters of Wilson’s temperature syndrome believe this condition can be reversed by taking Wilson’s T3 (WT3), a special time-released form of T3. Several cycles of WT3 are said to raise body temperature to 98.6 degrees F. After a few months, the person is slowly taken off WT3 and, the theory goes, normal production of T3 starts up again.

The amount of T3 recommended by Dr. Wilson is much higher than the amount of T3 needed for normal body function. Also, Dr. Wilson claims that taking special herbal and nutritional supplements—called WTSmed supplements—along with WT3 can help ease symptoms like rapid heartbeat that can be caused by high doses of T3.

Wilson’s Syndrome is a political term since it goes against large, well-established groups in endocrinology and the medical establishment: The American Thyroid Association, the American Association of Clinical Endocrinologists, and the Endocrine Society. Wilson’s Syndrome – because of its prominent use of thyroid hormone treatment – is an endocrine diagnosis. E. Denis Wilson wen’t completely against their right to create an established diagnosis that is accepted for general use via an ICD designation. There is no ICD designation for Wilson’s Syndrome. Never go against a politically well-supported establishment. In politics, shit always rolls downhill. Always work with it to achieve your goals.

Broda Barnes, an physician described in Wikipedia as having made similar claims to Dr. Wilson, did not make claims that Dr. Wilson did. Rather Broda Barnes called what he saw “hypothyroidism”. He would first establish the diagnosis of hypothyroidism then treat patients with thyroid hormone the old way – until their signs and symptoms (such as low temperature) remitted. Broda Barnes did the research which he published in the Journal of the American Medical Association establishing the basal metabolic temperature – taken in the armpit – as a way to monitor thyroid function. He then used the armpit temperature – not oral – as one sign to establish the diagnosis of hypothyroidism. Unlike Dr. Wilson, Broda Barnes did not lose his medical license nor did he go against the medical establishment.

From my point of view, “Wilson’s Syndrome” or “Wilson’s Temperature Syndrome” is a very poor and nonspecific term – just like the term “Adrenal Fatigue”. I recommend never using it.

The problem of the term Wilson’s Syndrome is that Dr. Wilson did not go far enough to determine the underlying cause of the low oral temperature and other symptoms he found in his patients. If Dr. Wilson did, he would have realized that many of the symptoms he describes as being part of Wilson’s Syndrome are actually more correctly ascribed to one or more other illnesses – such as depression, anorexia nervosa premenstrual dysphoric disorder, and other mental illnesses, fasting, starvation, infection, stress, trauma, surgery, heart disease, renal disease, hepatic disease, adverse effects of certain medications, autoimmune illnesses, nutritional deficiencies and many other illnesses. These other conditions would be the correct diagnosis.

The term “syndrome” does not give you a treatment. You have to go farther to determine the actual pathophysiology of the illness to help determine treatment. “AIDS” was a syndrome and had no treatment until the cause – infection from Human Immunodeficienchy Virus – was found.

If a more accurate diagnosis along with a differential diagnosis was established, then Dr. Wilson would have been able to consider alternative treatments in addition to his one hammer of thyroid hormone. He would have been better able to assess the risks versus benefits of treatment to help maintain patient safety. He may have found alternative treatments as better first line treatments from some conditions. If the illness was depression, for example, then he could have considered psychotherapy or antidepressant treatment for the patient rather than jump right to T3 treatment. Since he said many of the symptoms of Wilson’s Syndrome is due to stress, then perhaps he should have treated them with a psychiatric medication first which can reduce stress or prescribed them a therapy that could reduce stress such as yoga or meditation. If he found nutritional deficits, then perhaps he could have treated them with nutrients first – certainly this would make thyroid hormone treatment safer as well – running out of B-vitamins for example when metabolism is increased by thyroid hormone may lead to the arrhythmias and congestive heart failure.

Better Terms to use instead of Wilson’s Temperature Syndroms when TSH and thyroid hormone levels are normal are Nonthyroidal Illness Syndrome (NTIS) or Euthyroid Sick Syndrome or simply call it Non-Thyroidal Illness.These are well established terms to describe exactly what Dr. Wilson saw. These are also accepted by the medical establishment, the Endocrine Society, etc. It even has a ICD-9-CM Code: 790.94 Euthyroid Sick Syndrome.

If Dr. Wilson had use these terms, then he would have not gotten into so much trouble in giving a patient a non-accepted diagnosis – particularly if he did the further investigation needed to establish the pathophysiology of the illness. If he had given his patients the diagnosis of Euthyroid Sick Syndrome, then at least he would be speaking the same language as endocrinologists and other physicians and perhaps what he was seeing could be more understandable. The only problem then remaining in his treatment is his use of high dose T3 without taking into account the risks, particularly since his diagnosis or established pathophysiology was too nonspecific and consideration of alternative treatment wasn’t done as a result.

The use of T3 treatment is supported in the treatment of various conditions with Nonthyroidal Illness Syndrome as described in this article:

De Groot LJ. Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab. 1999 Jan;84(1):151-64. PMID: 9920076

Here are some review articles:

Warner MH, Beckett GJ. Mechanisms behind the non-thyroidal illness syndrome: an update. J Endocrinol. 2010 Apr;205(1):1-13. Epub 2009 Dec 16. PMID: 20016054

Adler SM, Wartofsky L. The nonthyroidal illness syndrome. Endocrinol Metab Clin North Am. 2007 Sep;36(3):657-72, vi. PMID: 17673123

McIver B. Nonthyroid Influences on Thyroid Function. Hospital Physician Endocrinology Board Review Manua. Turner-White Communications 2001.

Langton JE, Brent GA. Nonthyroidal illness syndrome: evaluation of thyroid function in sick patients. Endocrinol Metab Clin North Am. 2002 Mar;31(1):159-72. PMID: 17673123

Major depressive disorder and other mood disorders are often Non-Thyroidal illnesses – i.e. there is nothing wrong with the thyroid gland. But thyroid function may be affected in the illness. A commonly used treatment in psychiatry for depression is to add T3 to treatment even if the patient is euthyroid.

In Bipolar disorder, treatment with levothyroxine (T4) to a “hyperthyroid state” to stabilize mood is well supported in research studies at UCLA. From my point of view, they did not actually achieve a hyperthyroid state so much as a euthyroid state for that person. Since they did not address the other components of the illness (e.g. pro-inflammatory signaling, nutritional, other neurotransmitter, etc problems), as the patient improved, I find that the thyroid doses generally have to be reduced otherwise the patient may end up actually being hyperthyroid.

As a postscript, I appreciate the research and thoughts of Broda Barnes. However, when treating a person with thyroid hormone, multiple other considerations also come into play, limiting the dose of treatment. These can’t be ignored when going to high dose treatment. This includes nutritional status, immune system status, nervous system status, other hormones, other health problems, etc. For example, nutrition needs to be optimized to avoid adverse effects from thyroid hormone including arrhythmias, etc.