Monthly Archives: January 2009

Dear Dr. Repas, on Treating Hypothyroidism

Dear Tom

I read your article in magazine from January 10, 2009 and wish to reply. To restate your position, being that most people with hypothyroidism and normal thyroid function tests who continue to report complaints typical of thyroid hormone deficiency, are generally suffering from other conditions such as depression, polycystic ovarian syndrome or non-endocrine conditions.

I have heard similar analyses of resistent hypothyroid symtoms many times at endocrine conferences or hallway “round tables”. The speaker generally rolls their eyes and gives a sly smile to the audience while reporting their conclusion (meant to imply frustation at kooky patients and their persistent complaining).

I do not have the definitive study which confirms or refutes this type of conclusion. I do have a few questions for those who hold beliefs similar to yours, however.

First, why is there such a wide range of normal for thyroid hormones, and TSH? For TSH there is almost a 10 fold difference between high and low normal values. Second, why is there such a wide spectrum in the function and tissue location of 5′ deiodinase (to convert t4 to t3)? Additionally, why are t3 levels so exquisitly sensitive to minor metabolic challenges such as missing a meal or coming down with a virus ? Thirdly, do you think a single does of t4 daily can even remotely reproduce the daily variation and rhythm of thyroid hormone economy produced by a normal thyroid-pituitary axis? Given the extraordinary variability of thyroid hormone levels in the blood, I imagine there are at least a billion different combinations of set points for these levels available for each individual. Finally, in all the years that synthetic thyroid hormone has been available and promoted by pharmaceutical companies, where are the studies that show pure t4 preparations are clinically superior to biologic extracts such as Armour thyroid or careful t4 with t3 combination therapy?

I don’t have the answer to these questions either. What I do have is a healthy respect for persistent complaints by hypothyroid patients. Unlike the results you report with combination treatments my success has been much better. I will be happy to help out my fellow endocrinologist who wishes to dismiss these difficult patients, by accepting them into my practice.


Gary Pepper, M.D.

Thyroid-Mimic Drugs Lower Cholesterol and Weight

A new class of experimental drugs known as oral selective thyroid hormone receptor agonists (also known as STORMS) has shown remarkable ability to lower cholesterol levels as well as cause weight loss. These drugs were originally targeted at improving heart function in heart failure patients but failed to achieve the desired results. During these studies researchers noted that subjects treated with the experimental STORM drug DITPA, lost 15% of body weight and body mass index along with achieving a substantial drop in cholesterol and triglyceride levels.

DITPA is one of the new STORM drugs. These drugs work by mimicking thyroid hormone action on certain tissues in the body such as the liver and blood vessels.Their effect on the liver is thought to be responsible for the beneficial effects on cholesterol and triglycerides.

Another promising STORM drug is eprotirome being studied by the Swedish drug firm Karo Bio. This drug has also shown remarkable ability to lower cholesterol and triglyceride levels in human studies. Subjects with high triglyceride levels saw levels fall by up to 40% when receiving eprotirome.

Weight loss associated with STORM agents is thought to as a result of increase in metabolism as well as possible central nervous system effects to reduce food consumption (appetite suppression).

Researchers are quick to point out that high doses STORM’s cause unpleasant side-effects such as racing heart, tremor, irritability, diarrhea and sweating. These side-effects are similar to symptoms experienced by people with hyperthyroidism (excess levels of thyroid hormone).

Many more studies are in progress to try to find ways to harness the benefits of STORMs while minimizing side-effects. No drugs of this class are presently approved for use in humans.

Only you and your medical professional can decide which treatment is appropriate for you. If you have more questions about these drugs consult your health care professional or post your inquiry at

Gary Pepper, M.D.

Member Blog: How to stop being fat

That’s the thing that is on everyone’s mind.  Our world, our country, ourselves.  How do we really stop being fat?  A great question, but not an easy one to answer.  Ten years ago I made up my mind to stop being fat.  Having grown up with an unhealthy relationship with food, my weight grew to 358 pounds by my junior year of highschool.  By my freshman year of college I had had enough.  I changed my lifestyle, my relationship with food, and incorporated exercise into my life.  Now ten years and 140 pounds healthier, I feel balanced and complete.  This experience has lead me to an unwavering passion of health.  I am a certified nutritional health counselor and life coach, and my profession allows me to help people through my passion and experience.  If you want to know more please voice it as a response to this blog.

Member Blog: Benefits of Fish Oil for Fitness and Health

When the words oils and fats are mentioned, healthconscious individuals tend to run for cover. What they fail to realize is that there are good fats and bad fats. Complete avoidance of intake of oils and fats would actually be detrimental – rather than beneficial – to their health.

The Truth about Fish Oil
Essential fatty acids must always be part of our daily diet – without them, we take one step closer to our deaths. Essential fatty acids are divided into two families: omega-6 EFAs and omega-3 EFAS.

Although there are only very slight differences to distinguish the two groups of essential fatty acids from each other, studies have revealed that too much intake of omega-6 EFAs can lead to inflammation, blood clotting and tumor growth. The good news, however, is that the opposite is true for omega-3 EFAs. Omega-6 EFAs can be found in vegetable oils while omega-3 EFAs can be found in fish oils among other foods.

Omega-6 vs. Omega-3
Physicians and scientists are of the same opinion that the cause behind increasing cases of heart disease, hypertension or high blood pressure, obesity, diabetes, premature aging and certain kinds of cancer is none other than an imbalanced intake of omega-3 and omega-6 EFAs.

New Pill Combo May Speed Weight Loss

By Gary Pepper, M.D. Editor-in-Chief
We recently commented on how combining Symelin and a leptin-like drug caused more weight loss than either drug alone.

There is now evidence that combining two oral medications, bupropion (Wellbutrin) and Zonigran (zonisamide) can cause significant weight loss in healthy obese people. Zonigran is approved to treat certain types of seizures (epilepsy) and Wellbutrin is approved as an anti-depressant. Neither drug is approved by the FDA for use as an aid to weight loss.

In a study reported by Dr. Frank Greenway from the Pennington Biomedical Research Center, 55% of otherwise healthy obese individuals lost over 10% of their body weight over the 48 weeks of treatment with the drug combination. This is significantly more than with either of these drugs used separately.

Wellbutrin itself is known to cause some weight loss in doses used to treat depression, but in combination with Zonigran the effect was more pronounced and reliable. Anti-seizure medications besides Zonigran have also shown ability to promote weight loss. One such drug is Sabil (vigabatrin), which causes weight loss in rodents. A similar medication causing weight loss is Topamax (topiramate) also approved to treat seizure disorders. In fact recently the American Diabetes Association released a position paper reviewing the possible use of Topamax to aid obese diabetics in the treatment of their disease.

None of the drugs discussed in this article have been approved for weight loss by the FDA. Studies are underway in the U.S. and Europe to explore this possibility. Consult your physician before starting any medication or treatment plan.

Gary Pepper, M.D.

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