Author Archives: Gary Pepper M.D.

About Gary Pepper M.D.

Board Certified by the American Boards of Internal Medicine, and Endocrinology and Metabolism Dr. Pepper received his medical degree from the Tufts School of Medicine in Boston. He completed his internship and residency in internal medicine at Montefiore-Einstein Medical Center in New York. In addition, Dr. Pepper completed fellowship training in Endocrinology and Metabolism at Mt. Sinai Medical Center in New York City. More about Gary Pepper M.D.

End the War on Patients by Allergan Pharmaceuticals (or is it Actavis or is it Pfizer)


By Gary Pepper, M.D.

http://www.dreamstime.com/stock-photo-expensive-medicine-image3053770Have you noticed that prices of prescription drugs including generics are skyrocketing? The public is being squeezed by the pharmaceutical industry to pay increasing prices for the same medications while inflation in other areas of the economy is all but absent. Some fairly simple answers exist as to why this is occurring and there is a need to do something to stop it. Continue reading

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Can a Blood Test Identify Those Who Need T3 for Proper Treatment of Hypothyroidism?


Dr. Gary Pepper and Dr. Paul Aoun discuss recent findings about thyroid hormone treatment at the 15th International Thyroid Congress

Dr. Gary Pepper and Dr. Paul Aoun discuss recent findings about thyroid hormone treatment at the 15th International Thyroid Congress

By Gary Pepper, M.D.

According to experts, 10 to 20% of hypothyroid individuals fail to respond completely to T4-only (levothyroxine, Synthroid) treatment. Dr. Anthony Bianco, the president of the American Thyroid Association, and his associates believe this is due to genetic variations in the way thyroid hormone is converted in the body from T4 into T3. T3 is the much more potent form of thyroid hormone and unless the cells of the body receive enough T3, normal function cannot be achieved and symptoms of low thyroid such as fatigue, mental fogginess, constipation, muscle aches etc, persist. Based on the research conducted by Dr. Bianco and colleagues it is thought that in those with the genetic trait making T4 treatment ineffective, blood tests would show low T3 levels. Continue reading

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Which Pesticides Create Precancerous Changes in Thyroid Cells?


pesticidesBy Gary Pepper, M.D.
Last week I posted a few highlights from the just concluded International Thyroid Congress. One of the research papers presented at the meeting generated particular concern. Endocrinologists and scientists at UCLA Medical Center led by Dr. Jerome Hershman investigated the potential for pesticides to damage the DNA of thyroid cells. The group focused on double strand breaks, the type of damage that could eventually lead to cancer. This is a particularly relevant point due to the explosion in newly diagnosed thyroid cancers being reported in many areas of the world. The increase is likely related, at least in part, to improved diagnostic techniques for thyroid cancer but could also represent environmental influences. Continue reading

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Highlights of the 2015 International Thyroid Congress


Update from the 15th International Thyroid Congress, Orlando Florida, October, 2015
By Gary Pepper, M.D.
Welcome     I just returned from Orlando, Florida, where I attended the 15th International Thyroid Congress and want to provide a report of my experience, to readers of metabolism.com. This was truly an international event with an estimated 50% of the attendees from outside the U.S. Organizers of this event describe it as, “Renowned experts in thyroid function and biology, diagnosis and management of thyroid disease, and novel therapies for treating thyroid cancer are gathering at the 15th International Thyroid Congress (ITC) to present, discuss, and debate the latest advances in thyroidology. Held every five years, the ITC is a collaborative meeting of the four world thyroid associations; the ATA (American Thyroid Association), Asia-Oceania Thyroid Association (AOTA), European Thyroid Association (ETA), and Latin American Thyroid Society (LATS).”
I was particularly excited to be attending this conference this year since my colleagues, Drs. Paul Cassanova and Kathryn Reynolds and I were presenting our study on the use of combination T3 plus T4 for the treatment of underactive thyroid (hypothyroidism).
Here are some papers I found to be of particular interest; Continue reading

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Eight Suggestions to Help Get Your Booty Back


jumpinglady

By Gary Pepper, M.D.
The views and opinions expressed here are those of the author and may not reflect the opinions of your health professional. Please consult your own doctor before embarking on any new exercise routine.

Lack of energy and inability to lose weight are constant challenges for many people and are every day complaints encountered in the doctor’s office. Studies show that almost everyone can find some relief from these problems by accessing the healing properties of physical activity. In my experience, mentioning the need for “more exercise” often results in rolling of the eyes, sighing, shrugging, snorting or worse yet, the hundred yard stare. Yes, we all know exercise is important but who has the energy for that? It seems like a vicious cycle. What is surprising is that when done correctly, exercise can actually improve energy with the additional advantage of promoting weight loss, and restoring tone and stamina. It is helpful to remember that the human body was designed for a lot more physical activity and a lot less food than we are privileged to experience in present day life. It therefore takes will power and knowledge to maintain the environment required for optimal health. Here are eight steps to get in the swing of regular exercise. Some suggestions may surprise you. Continue reading

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New Diabetes Medications Give Early Indication of Danger


warning signby Gary Pepper, M.D.
Chances are, if you have diabetes you have heard about a new class of drugs to treat high blood sugar (glucose). The first of these new medications to gain FDA approval in the U.S., in 2013, is Invokana manufactured and promoted by Janssen Pharmaceuticals and Johnson & Johnson. In the last year and a half the number of these drugs known as SGLT2 inhibitors, has multiplied faster than tribbles to include Farxiga, Xigduo, Jardiance and Invokamet. Prescriptions for these medications are also showing explosive growth, increasing 300% since January 2014. A recent forecast by Express Scripts calls for this one class of drugs to be responsible for about a 20% increase in the yearly cost of prescriptions per all members per year for the next 3 years . The explanation behind the eager adoption and dissemination of this brand new class of medications may eventually serve as a tragic lesson for diabetic patients and for the medical community in general.
Continue reading

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Tara Struggles with Persistent Symptoms of Hypothyroidism and Her Medical Care


Sad LadyMetabolism.com received this message from one of our readers. Her story seems typical of the sort of dilemma so many people face today. The best advice usually comes from others who face the same problem. It would be helpful to hear what others would do in her situation.

Tara’s message;

I was diagnosed with Grave’s Disease in 2009, I had RAI in 2011, after my daughter turned 3 months. Being pregnant with Severe Grave’s was the scariest thing in my life at the time. I gained weight prior to my pregnancy, during, and after RAI. My family doctor told me no matter how much you ate while severe Hyperthyroid you should have been anorexic, so something else is wrong. Continue reading

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Medical Specialists Fail to Sanction Treatment for Hypothyroidism Preferred by Patients


Why Patients Aren’t Receiving the Most Effective Treatment for Hypothyroidism
By Gary Pepper, M.D.

http://www.dreamstime.com/stock-photo-sad-brunette-woman-image22633210

For the past 3 to 4 decades endocrinologists worldwide have adhered to the belief that only synthetic T4 (the most abundant of 4 thyroid hormones produced by the thyroid) is appropriate therapy for a sluggish thyroid even though it is known that a substantial number of those treated with T4 only continue to suffer from persistent symptoms of the disease. This may be because under normal conditions the thyroid produces two principle hormones T4 and T3. In 2013 an NIH study showed that 50% of those with hypothyroidism preferred treatment which includes T3 and our group reported that 78% of a subgroup of patients preferred T3 containing medication to treat hypothyroidism . Continue reading

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How the Sunshine Act Will Save You Money


By Gary Pepper, M.D.

Offering Promotional Money

Have you noticed that medication costs are skyrocketing? Even if you don’t take medication these higher costs are passed along to you in your health insurance premiums. The recently enacted Sunshine Act will combat these economic forces but in ways you may not realize. The legislation requires pharmaceutical companies to report all payments made to doctors. Physicians receiving substantial amounts of money from these companies include “thought leaders” who are sponsored by the drug companies to lecture the nation’s doctors on newly approved medications. Continue reading

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Public Support and New Research Promote Changes in Thyroid Treatment Guidelines


http://www.dreamstime.com/royalty-free-stock-photo-thumbs-up-down-image17557325In a blog at metabolism.com several months ago, website visitors were asked to join an email campaign addressed to Dr. Mack Harrell, President of the American Association of Clinical Endocrinologists (AACE). The purpose was to ask help reversing the existing practice recommendation # 22.4 published by the AACE in 2012, calling for a ban on the use of Armour Thyroid in the treatment of hypothyroidism.  With over 800 individuals participating, the campaign appears to have achieved some success as the latest AACE treatment guidelines  released last month no longer stipulate that desiccated thyroid is unfit for treatment of hypothyroidism. Instead the statement is issued, “ We recommend that levothyroxine be considered as routine care for patients with primary hypothyroidism, in preference to use of thyroid extracts. “,   and…. “ Furthermore, there are potential safety concerns related to the use of thyroid extracts, such as the presence of supraphysiologic (unnaturally elevated, ed.) serum T3 levels and paucity of long-term safety outcome data.” Continue reading

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