First of all I have to thank Dr. Starr for his hard work to put this book together. Just for that he deserves a 5. I don't believe we should give stars to anybody who makes an encyclopedia like this from old studies combined but Amazon doesn't let me have a no comment option. There are few things to watch out specially by younger Dr generations.
1-No matter what, even right, if you diagnose any hypothyroidism just based on body skin stiffness , low body temp, low BMR, fatigue..if labs are not included or correspond then you have done malpractice. If anybody gets harmed the next license, when you get out of slammer, would be Taxi license in airport at best if you are lucky. So do no harm.
2-Playing with thyroid hormone is very tricky and potentially dangerous(I had my share of mishaps when I was an intern), specially synthroid. Elderly with coronary artery disease can really get harmed if unnecessarily med is given to them.
3-Dessicated natural hormones have T4:T3 ratio which is excessive. Based on European Thyroid Association (ETA) the ratio should be above 15:1 even 20:1(T4:T3). Also desiccated hormones do get deactivated at times by antibodies to thyroid gland. But not synthetics. Also synthroid synthetics half life is very long and stays longer in body, if Diodinase does its job to convert. Synthroid is much better and consistent than Levothyroxine generic per experience of some of the patients.
4-If patient is a poor converter of T4 to T3 a combination of Synthroid and Liothyronine is at times the best option. or just Liothyronine bid.Please read the ETA review to understand the Ft4/Ft3 ratio for poor converters diagnosis.
Not much recent data was in this book but on few cases of Autism, thyroid hormones were used in recent articles with not much result but side effect of med was noted.
However, personally I have had success story in poor converters, by changing Levothyroxine to Synthroid lower dose, in combination with Liothyronine(T3) to bring the dose equivalent to original dose. For example a 100 mcg Levothyroxine was changed to 75 mcg and then 5 mcg Liothyronine (its dose equivalent to synthroid is 5=25). So patients are very thankful and feel a difference.
Diagnosing poor converters is an Art not just science and you have to document everything and correlate it with labs closely, even if labs are "normal" slight closeness to lower normal of Ft3 or high rT3 will reveal it. Usual a ratio of FT4x10/FT3 must be 3.2 to 4, less or more you have to correlate with clinical picture and interpret. There is higher chance of success by this ratio if learned and interpreted correctly.
Unfortunately none of these were mentioned in this book.Book must show ways of treatment. I am sorry for lay persons starting Blogs and trying to treat themselves , it is all wrong and dangerous, see a Dr with open mind.
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