1. Copyright, Dr. Tedde Rinker 2/23/2010 Wilson’s Temperature Syndrome and Lyme disease Dr. Tedde Rinker Stress Medicine Consulting www.stress-medicine.cwww.stress-medicine.com www.stress-medicine.c

2. Copyright, Dr. Tedde Rinker 2/23/2010 Wilson Temperature Syndrome  Denis Wilson, MD, a GP in rural Florida  Developed protocol over several years  Of clinical observations and treatment  Found lab tests often didn’t match patient’s symptoms.  Discovered a method to restore “normal” temperatures, eliminate low thyroid symptoms, and eventually stop taking thyroid hormones.

3. Copyright, Dr. Tedde Rinker 2/23/2010 Symptoms of low thyroid  Low body temperature  Dry brittle hair, nails  Feels cold, cold hands and feet  Dry, itchy skin  Fatigue  Poor sleep quality  Hair loss  Puffy eyes, eyebrow hair loss lateral 1/3  Aching muscles and joints, weakness  Depressed, low motivation  Concentration and memory problems  Weight gain, constipation

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5. Copyright, Dr. Tedde Rinker 2/23/2010 Most Important Tools for WTS  Scored symptom list  Temperature Chart  Lab Testing

6. Copyright, Dr. Tedde Rinker 2/23/2010 Scored Symptom List  60 symptoms listed, score 1-10  Score of 600= perfect health  Score <350 = likely thyroid problem  Score >350 but 350 but <500 =likely hormonal  Score 10 for “not a symptom”  Score 1 for serious, worst symptom

7. Copyright, Dr. Tedde Rinker 2/23/2010 Temperature Chart  Prior to treatment take temperature 3 times a day for 5-10 days  Use reliable, accurate thermometer  Start 2 or more hours after waking  Last temp of day should be more than 3 hours before bed

8. Copyright, Dr. Tedde Rinker 2/23/2010 Laboratory Testing  Should test both Adrenal and Thyroid function  Thyroid Labs: Free T3, Free T4, Reverse T3, TSH, TPO antibodies, and Thyroglobulin antibodies (For hyperthyroid, should also get TSH receptor antibodies)  Adrenal Testing: 4-point saliva cortisol testing in am, noon, mid afternoon and bedtime.

9. Copyright, Dr. Tedde Rinker 2/23/2010 Why do we want optimal daytime temperatures?  Enzyme activity throughout the body is temperature sensitive.  Metabolic rate of all organ systems are enzyme and temperature dependent.  Detoxification pathways slow down with low body temperature.

10. Copyright, Dr. Tedde Rinker 2/23/2010 Optimal Daytime Temperatures  98.2-98.6 (F) 90- 100% metabolic activity  97.5-98.1 (F) 55-75% metabolic activity, expect these temps at night.  < 95.6- 97.4 (F) 50% or lower metabolic activity.

11. Copyright, Dr. Tedde Rinker 2/23/2010 TSH T4 Conventional Medical View is that you only need this limited amount of information to diagnose and treat.

12. Copyright, Dr. Tedde Rinker 2/23/2010 F F F F F F R R R R F R F F R R F F F FT3 T4 RT3 (not active) STRESS TRAUMA TOXICITY INFECTION INLAMMATION STARVATION SUDDEN HORMONE CHANGE EVENTS TG-T4 T3 T4-TG REVERSE T3 5’ DEIODINASE SELENIUM 5 DEIODINASE TPO Ab TG Ab

13. Copyright, Dr. Tedde Rinker 2/23/2010 Stress Hypothalamus Pituitary Adrenal Medulla Thyroid Adrenal Cortex Cell TRH TSH CRH Cortisol Adrenaline T4 T3 ACTH Stress-induced Thyroid Dysfunction inhibit

14. Copyright, Dr. Tedde Rinker 2/23/2010 Pregnenolone Progesterone DHEA-S Testosterone Androstenedione Increased levels followed by depletion as stress or low thyroid continues to lead to Adrenal Fatigue. Adrenal Fatigue Due to Low Thyroid Function

15. Copyright, Dr. Tedde Rinker 2/23/2010 Helpful Nutrients for Thyroid Function  Improve T4 production:  Tyrosine, Iodine, Zinc, Vitamin E, Vit A, B-2,B- 3, B-6 and Vitamin C  Improve conversion of T4- T3:  Zinc and Selenium  Adequate Progesterone  Adequate Melatonin  Improves T3 receptor site binding:  Vitamin A

16. Copyright, Dr. Tedde Rinker 2/23/2010 Conventional Medical Interventions  Thyroid: Synthriod™, Levoxyl™,  Thyroxine (T4)  Cytomel™ (short acting T3)  Armour thyroid (both T4 and T3)  Adrenals: Predisone, Cortef™ (hydrocortisone)

17. Copyright, Dr. Tedde Rinker 2/23/2010 Integrative Approach  Get a complete history  Take Temperatures (temp chart)  A complete thryoid/adrenal panel  Examine causative factors  Take steps to restore balance in the system.

18. Copyright, Dr. Tedde Rinker 2/23/2010 What should we do first?  Give Levoxyl, Synthroid (T4)?  Radiate the thyroid gland?  Give Armour thyroid?  Give T3 ?  Give Cortisol/cortisone?  Suppress cortisol production?  Send the patient to a psychiatrist?  Tell patient “There’s nothing wrong with you!”

19. Copyright, Dr. Tedde Rinker 2/23/2010 WTS Protocol  Uses 12-hour Sustained -release T3  Graduated dosing, increasing dose daily by 7.5 mcg every 12 hours (0.625 mcg/hr )  Until average temperature is at 98.6 or patient reaches 75 mcg every 12 hours (6.25 mcg/hr ), or patient has negative symptoms  Hold at max. tolerable dose for 3 weeks, then cycle down (more slowly) to no SRT3 for two days. If temperature drops, begin cycling up again, daily increasing dose.

20. Copyright, Dr. Tedde Rinker 2/23/2010 In the best circumstance  With each successive cycle:  It should take a lower dose to “capture” temperature at 98.6  Temperature should stay close to 98.6 as dosage is cycled down  Until, at zero medication, temperature maintains daytime average around 98.6 and symptoms have resolved.

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23. Copyright, Dr. Tedde Rinker 2/23/2010 When Cycling up is “bad”  If patient starts to cycle up, and within days or the first week feels even worse than before she started, suspect:  Adrenal Fatigue (over stimulated or worse fatigue)  Metal Toxicity (overt symptoms of metal toxicity)  Chronic Infection (infectious symptoms become acute, or obvious for the first time)

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25. Copyright, Dr. Tedde Rinker 2/23/2010 When WTS protocol makes patient feel worse:  If the problem that precipitated the WTS is not resolved :  The body is not yet ready for a ramped up metabolism  The down-regulation was done for a reason. It’s important to remember that  This is also the time that the patient will need extra support, so they won’t give up. It doesn’t mean they can’t benefit from SRT3 treatment.

26. Copyright, Dr. Tedde Rinker 2/23/2010 When Lyme and WTS Present  Cautious ramping of thyroid (SRT3)  Adaptogens to support adrenals  Remove toxins carefully (slowly)  Support low stress lifestyle  Eliminate factors that increase RT3  Treat the infections

27. Copyright, Dr. Tedde Rinker 2/23/2010 F F F F F F R R R R F R F F R R F F F FT3 T4 RT3 (not active) STRESS (overtaxed, untreated) TRAUMA (chronic illness, surgery, loss) TOXICITY (mercury, Lyme toxins) INFECTION (Lyme & co-infections) INFLAMMATION (Herx, immune resp.) STARVATION SUDDEN HORMONE CHANGE child birth, menopause EVENTS TG-T4 FREE T3 T4-TG REVERSE T3 5’ DEIODINASE SELENIUM 5 DEIODINASE TPO Ab TG Ab

28. Copyright, Dr. Tedde Rinker 2/23/2010 Thank You! Questions? Dr. Tedde Rinker 650-964-6700www.stress-medicine.com