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    Not so out of step with mainstream medicine..
    nonpareil posted:
    I thank Dr. Goldberg for this fascinating discussion. My psychiatrist told me that I would just have to suffer because he had done everything that mainstream medicine recommended. I went home and tried to kill myself. Came close too. Later when I asked my psychiatrist to try high does thyroid he went so far as to say high dose thyroid was malpractice. When I brought up the following information he fired me. He said that thyroid used this way would cause osteoporosis. I am confused. You say that Dr. Kelly's ideas do not reflect the current standard of care for treating bipolar disorder. In Dr. Kelly's article he used high dose T3 only after patients failed 14 other medications. I applaud Dr. Kelly for not giving up like my psychiatrist did. On the other hand recommendations for high dose thyroid are found in three treatment guidelines. "The Texas Medication Algorithm Project for bipolar disorder" recommends high dose thyroid hormone treatment with T3 up to dose of 160 mcg per day. T4 is recommended up to a dose of 500 mcg. I found this in "The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000". There seemed to be no shortages of experts recommending high dose thyroid. Both of these were cited in Drs. Kelly and Leiberman's paper. I also found a new recommendation for the use of high dose thyroid in the "Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013". I'm not so sure that it is Dr. Kelly who is out of step with the current standards of treatment. As to reverse T3, after looking at the medical literature it looks like all sorts of illnesses can cause elevations in reverse T3. I think that that the high levels of reverse T3 in bipolar disorder just reflects that the body is majorly stressed. The use of high dose T3 blocks the production of T4 by the thyroid gland and therefore the T4 can't be converted into reverse T3.
    Joseph F Goldberg, MD responded:
    Dear Nonpareil, The Expert Consensus Guidelines are now 10 years old and in the last decade a number of more compelling options have come along since the Cytomel rage of the 90s and early 00's. While adding T3, T4, or both for treatment resistant depression if any pole is certainly still an option -- and hardly malpractice if done with proper monitoring -- I can think of many more compelling alternative treatment strategies. Dr G

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