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.

What is DTE Image with medicine and medical supplies

What is DTE Therapy?


DTE stands for “desiccated thyroid extract” which is made up of thyroid hormones refined from pig thyroid and used to treat people with hypothyroidism (low thyroid hormone). This is possible because human and pig thyroid are very similar in the production of the 4 known thyroid hormones. For over 100 years, DTE had been used successfully to treat hypothyroidism.

T4, also known as levothyroxine, is the most abundant of the 4 thyroid hormones and synthetic levothyroxine has almost completely replaced DTE treatment since the 1980’s. There is no scientific evidence however, that synthetic T4 is better than DTE for treating hypothyroidism. The almost universal switch to levothyroxine and away from DTE appears to be due to a shrewd worldwide marketing campaign by the makers of brand synthetic T4.

Due to this marketing, Synthroid, the major brand of synthetic T4, became the most widely prescribed medication in the U.S. during the 1980’s and 90’s. Only in recent years has the medical community begun to recognize the failure of synthetic T4 to properly treat all people suffering with hypothyroidism, and the role of DTE to improve results.

Thyroid Project doctor

Introducing The Thyroid Project


The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of “something missing” in the way suffers of hypothyroidism are treated for their disease.

Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors. Continue reading

Patient with Endocrinologist

American Thyroid Association clarifies public dissatisfaction with treatment of hypothyroidism


For decades doctors have recognized synthetic thyroid hormone known as levothyroxine or brand name Synthroid, as the undisputed choice for treating hypothyroidism (low thyroid function). By virtue of hypothyroidism being extremely common levothyroxine has been the most prescribed medication in the U.S.

According to key medical organizations in this country, the only acceptable treatment of hypothyroidism is the use of levothyroxine alone. Using any other form of therapy is not recommended. Pointing to a significant number of patients receiving levothyroxine who continue to complain of symptoms of hypothyroidism health advocates have been calling for recognition of alternative treatments. One such alternative with a small but enthusiastic following is extract of pig thyroid (desiccated thyroid extract). All of the major organization of endocrinologists fail to recommend this form of treatment but in particular the American Association of Clinical Endocrinologist or AACE in the US has flatly stated this form of therapy should never be used. Physicians and their patients remain deeply divided on this issue.

In the spring of 2017 the American Thyroid Association (ATA) convened a symposium on treatment of hypothyroidism and determined that “it is important to describe the patient perspective regarding hypothyroidism treatment and to share it” with the medical community. Now, after an enormous expenditure of time and effort, the results of their survey of patients being treated for hypothyroidism were published on-line. The full report in print will become available in the coming months. Here are some to the highlights of the ATA analysis of over 12,000 participant responses.

  1. Overall satisfaction with the present choices of thyroid hormone treatment is 5 out of a possible 10Treatment satisfaction with desiccated thyroid extract (DTE) such as Armour and NP Thyroid was highest at 7 out of 10.

  2. Lowest satisfaction was with levothyroxine or Synthroid alone at 5 of 10

  3. Treatment with levothyroxine plus t3 (Cytomel, tri iodothyronine) was next best at 6 out of 10

  4. Patients taking DTE were less likely to report problems with weight management, fatigue, mood and memory as compared to levothyroxine alone or levothyroxine plus t3

The authors conclude, “a subset of patients with hypothyroidism are not satisfied with their current therapy or their physicians” and “higher satisfaction with both treatment and physicians is reported by those patients on DTE”.

After decades of dispute among physicians themselves about the best ways to treat hypothyroidism, patient are finally having their say. Some readers of this blog may have been among the participants in the survey and deserve great credit for sharing their experience with the medical community. It is hoped that this survey will mark a turning point in the discussion about treatment of hypothyroidism and help to forge a change in the way physicians approach this very common and often disabling condition.

Family Nutrition

Weight Management, Family Style


Weight management is a key component of a healthy lifestyle although keeping one’s weight on track is often a frustrating and perplexing task. To get the whole family involved in the weight management effort may seem almost impossible.
Simply identifying a younger member of the family as overweight can be a challenge.

A 2015 study from the U.K. found that 31% of parents underestimated their child’s weight status. For a child who is “very overweight” per government guidelines there was an 80% chance the parent would classify the child as healthy weight. Teens themselves are not very good at identifying themselves as overweight as 80% of overweight teenaged boys and 71% of overweight teenaged girls perceived themselves as normal weight. Recognizing that a child is overweight is crucial to preventing the progression to adult obesity. 72% of overweight kindergartners were obese by the time they reached 8th grade. Continue reading

Sad Lady

If Hypothyroid and Unhappy, Which Came First?


If Hypothyroid and Unhappy, Which Came First?

By Gary Pepper, M.D.

Medical specialists increasingly accept that some patients being treated for hypothyroidism continue to be symptomatic and “unhappy”. The degree to which patients experience this problem while on conventional treatment for hypothyroidism with levothyroxine (Synthroid, Levoxyl, Unithroid, T4) has motivated many specialists to look for other approaches to treatment such as adding T3 (Cytomel, liothyronine) or switching to desiccated thyroid extract (Armour, WPthyroid, Westhroid

Not all experts are convinced looking for new treatment options for hypothyroidism is the right approach. Continue reading

Children eating more healthy

Share Childhood Food Memories to Help Combat Childhood Obesity


Without question the eating habits we develop as kids helps determine if we are going to be a heavy adult. Almost a third of children and adolescents in the US are classified as either overweight or obese (JAMA 2014; Ogden, CL).

Many of these children become obese adults. If a child’s parents are heavy their risk is doubled for becoming an overweight adult.

Metabolism.com is involved in finding ways to reduce childhood obesity.

The first step is to raise awareness of the dangers of childhood obesity and how crucial it is for young people to learn how to eat properly. For this reason we are kicking off a Facebook and Instagram campaign called “ Food Flashback”.

Food Flashback means sharing memories of how each of us first learned about food and nutrition. Most of us have some vivid recollections of family meals, watching our parents cooking, favorite foods and snacks as a child.