The Shames' Holistic Approach to Thyroid Disease

An Interview With Thyroid Doctors


Richard Shames, M.D. graduated Harvard and University of Pennsylvania, did research at the National Institutes of Health with Nobel Prize winner Marshall Nirenberg, and has been in private practice for 25 years. Dr. Shames practices holistic medicine—with a focus on thyroid and autoimmune conditions—and has for 20 years been engaged in the search for answers about thyroid disease. Karilee Halo Shames R.N., Ph.D.

, Dr. Shames' wife, is herself hypothyroid, and is a clinical specialist in psychiatric nursing and a certified holistic nurse with a PhD. in Holistic Studies. In this Q & A, I had an opportunity to talk to them about their thoughts about thyroid disease, and am pleased to be able to bring you this interview. 

Q: Do you use thyroid blood tests to diagnose hypothyroidism?

As a broad-based general practice doctor, who has been conventionally-trained but has one foot in holistic medicine, I am interested in whatever will be of use in securing a diagnosis. I typically rely on combining symptoms, family history, related illnesses, and blood tests to arrive at my conclusion. The blood tests are not the final arbiter, either in making the diagnosis or in telling the person, "I don't think you have a thyroid problem." I have over the years seen many people who have turned out to have definite thyroid difficulties proven by biopsy and scans whose many blood tests were all totally normal.

The blood test I find most revealing is the T-3. A close second is a good thyroid antibody panel. I also employ the other standard tests. 

Q: What form of thyroid hormone replacement do you typically recommend for patients?

I am a very open-minded, eclectic physician, who blends conventional medicine with alternative medicine, often with very positive results.

I listen very carefully, then follow my patient's cues, and interests, and aspire to always meet them where they are. In 25 years of practice, I have found that it doesn't necessarily matter which kind of thyroid hormone you start with so much, as which kind you end up with after trying several different types to see which one works best for you.

Initially, I typically recommend whatever type they have either heard about, have a "gut-feeling" about, know family members who have a good response to a particular kind of medicine, or have a philosophical inclination for one kind or another. I prescribe all the medications, either singly, or in combination when necessary. Sometimes combining medicines prove to be the magic solution for a particular person.

For instance, if a person is interested in natural approaches to healing, they might typically want natural desiccated thyroid. On the other hand, there are plenty of folks who have heard of Synthroid or Levoxyl, or Cytomel, and want to try one or more of those. I start them on a mild dose of what they feel inclined to start with, and if it works well, once we get to a normal dose they can simply stay on that preparation for as long as they like.

If on the other hand, the initial item tried does not give 85 to 95 percent improvement, I then encourage the person to either add something to their first choice product or discontinue it and start something totally new.

As you can see, it is my firm belief that the state of the art in finding the optimal medicine is still trial and error. It is true that a person whose T-3 levels on blood tests are noticeably low might best start with a preparation strong in T-3, such as Cytomel or natural desiccated thyroid, but—oddly enough—this is not always what works best in the final analysis. To me, this intricate dance with each patient is the true art of medicine.

Q: What do you feel are the main causes of Hashimoto's/autoimmune hypothyroidism, and why do you feel that it is becoming more common?

We both have researched this question thoroughly because of Karilee's Hashimoto's and that of our three children. Our findings suggest to us that the main culprit is runaway industrial pollution of the air, food, and water, with endocrine disruptor chemicals. Obviously, there are other triggers, such as puberty, childbirth, menopause, stress, viral illness, and neck trauma, to name a few - the endocrine disruptor theory, we believe, helps to account for the tremendous mushrooming incidence of this condition.

It is well known in scientific circles that dioxins and PCB's, some of the most ubiquitous of pollutants, both cause autoimmunity and are directly thyrotoxic. Many thousands of other chemicals are liable to be exerting their own deleterious effects, but have not been as well-studied. The scope of this problem is enormous and utterly daunting to government officials and research scientists alike.

Q: What do you feel the role is of the adrenal system in dealing with hypothyroidism?

Adrenal function is absolutely and directly related to optimal thyroid function. Our various hormone messengers all work in concert, usually to good advantage. When adrenal levels are out of balance, however, thyroid hormone has a harder time getting from the bloodstream into the cells, and in addition has a harder time attaching to the proper binding site inside the cytoplasm before moving to the cell nucleus. Moreover, the conversion of T-4 (storage transport thyroid hormone) into T-3 (active thyroid hormone) is likewise dependent on the proper amount of adrenal support.

Another important connection to keep in mind is the common coexistence of mild adrenal insufficiency along with low thyroid. When these two conditions are found together, but only the thyroid component is treated, the person generally feels worse. The doctor then concludes that thyroid treatment is somehow a mistake, and erroneously discontinues the medicine. This is a tremendous loss. The person needs treatment for the low adrenal condition along with treatment for the low thyroid.

Q: Are there any particular supplements you think most people with hypothyroidism should probably be taking.

I try not to generalize, as each patient is unique. That being said, it is a good bet that low thyroid people have a tendency for low red blood cells. This can be helped with B-12, and folic acid, along with an easily digested iron source if they test low for iron as well. I attempt to steer all my patients toward healthier whole foods and a good multiple vitamin with minerals. This usually covers the bases listed above, as well as the important minerals of zinc, magnesium, copper, and selenium. The essential fatty acids are just that - they are absolutely essential. I recommend supplementing with EPA, Omega-3, and GLA, Omega-6. Finally, a gram or two of free-form amino acids each day helps tremendously. Moreover, the "itis" (inflammation) of thyroiditis benefits greatly from abundant antioxidants. A supplemental item in addition to the multi, therefore, should include liberal amounts of A, C, E, lipoic acid, pycnogenol, and milk thistle, among others.

Q: Many holistic practitioners feel that supplemental iodine (whether it be Lugol's drops, or iodine supplements, or high-iodine herbs like kelp or bladderwrack) should be taken by patients with autoimmune hypothyroidism. What are your thoughts about this?

Karilee especially has researched this, as well as experiencing adverse effects firsthand. It is our contention that iodine is very much a double-edged sword for thyroid suffers. Whereas many practitioners do support supplementing iodine, we have actually gone out on a limb in our book, Thyroid Power,  to suggest that any extra iodine for thyroid sufferers is a big mistake. The whole issue is complex, but suffice it to say that with the tremendous amount of iodine in salt, bread dough, and multiple vitamins, as well as seafood, most Americans are getting, if anything, too much iodine. In fact, this relates to a prior question: "why is there so much more autoimmune thyroiditis these days?". We think another part of the answer could be because the American public has overdosed on iodine in the laudable but misguided global overreaction to the iodine deficiency goiter problem. (Worldwide, of course, low iodine is still the major reason for thyroid problems).

Q: A major complaint many people with hypothyroidism have is difficulty losing weight, even after they've been diagnosed, and are in optimum amounts of thyroid hormone replacement. Do you have any suggestions for those people who are finding it particularly difficult?

Our view is best summarized in our book Thyroid Power, which defines ten steps that are generally needed in the search for recovery. The right dose of the right kind(s) of thyroid medication is Step 5. A number of additional steps are generally necessary before the relief of the overweight issue can occur. These include: balancing adrenal hormone, balancing reproductive hormones, optimizing diet and supplements, specific exercise programs, attention to the underlying autoimmune issue, emotional release work when needed, and rebalancing the brain centers involved in appetite metabolism. Frequently when the stage is set with some or all of these interventions, then a person is in a normal metabolic state, and now needs an effective and user-friendly weight-loss program to now begin shedding the pounds.

Q: Do you ever deal with Graves' disease or hyperthyroidism? Do you have any ways you've found successful in dealing with overactive thyroid problems?

Yes, I frequently assist people with the difficult decisions they face when they have a diagnosis of Graves'. However, keep in mind that this diagnosis is being made these days much more often than is proper. Frequently what is called Graves' disease is the just the initial and temporary hyperthyroid phase of thyroiditis. With managed care, the tendency is to omit the special antibody testing that would determine whether the hyperthyroidism is Graves' disease, thyroiditis, or a combination of the two, called Hashitoxicosis. These three conditions have three different best treatments.

When the diagnosis is definitely Graves' disease, I have found it very useful to advise patients to hold off on surgery or RAI while we try out the Japanese approach of mixing Tapazole with thyroxine.

Q: Is there anything else you'd like to share your thoughts on hypothyroidism?

The most important thing to remember is the multilayered complexity of this autoimmune illness. There are many ways to diagnose the condition than is currently the medical standard. There are different treatments available than is currently the medical standard. There are many ways of interacting with a great variety of practitioners than is currently the medical standard. We urge readers to consider this a grand voyage of exploration, and be the captain of your own ship.