Wilson’s temperature syndrome

Wilson’s temperature syndrome also called Wilson’s thyroid syndrome or Wilson’s syndrome, refers to the presence of common and nonspecific symptoms, relatively low body temperature, and normal levels of thyroid hormones in blood ¹. Dr. E. Denis Wilson, who named the syndrome after himself, contends that it represents a form of thyroid hormone deficiency responsive to treatment with a special preparation of triiodothyronine (T3). The American Thyroid Association’s thorough review of the biomedical literature has found no scientific evidence supporting the existence of “Wilson’s temperature syndrome.”

The American Thyroid Association also has specific concerns about the following issues ¹:

• First, the proposed basis for Wilson’s thyroid syndrome is inconsistent with well-known and widely-accepted facts about thyroid hormone production, metabolism, and action. Triiodothyronine (T3) is one of the two natural thyroid hormones. Normally, it is mainly produced in target tissues outside of the thyroid gland from metabolism of thyroxine (T4). This production of T3 from T4 (thyroxine) occurs in a highly regulated manner. This is one reason that T3 is not currently recommended for thyroid hormone treatment in most patients with thyroid hormone deficiency. T4 therapy allows T3 to be produced, as it is naturally, by the regulated metabolism of the administered T4 medication to T3.
• Second, the diagnostic criteria for Wilson’s temperature syndrome–nonspecific symptoms and body temperature measurement–are imprecise.
• Third, there is no scientific evidence that T3 therapy is better than a placebo would be for management of nonspecific symptoms, such as those that have been described as part of Wilson’s temperature syndrome in individuals with and normal thyroid hormone concentrations.
• Fourth, T3 therapy results in wide fluctuations in T3 concentrations in blood and body tissues. This produces symptoms and cardiovascular complications in some patients, and is potentially dangerous.

American Thyroid Association’s Review

The “Wilson’s syndrome” website ² lists 37 symptoms as well as “others” that can occur as part of the condition. All of these symptoms do cause suffering, distress, and functional disability in millions of people. Some of these symptoms can, in fact, be due to true hypothyroidism. In hypothyroid patients, they are typically responsive to thyroid hormone therapy. Other problems, such as asthma, are not associated with thyroid hormone deficiency. Many of these symptoms are present from time to time in virtually everyone. In addition to hypothyroidism, they may be due to a variety of illnesses or life circumstances. In other words, they are nonspecific.

The “Wilson’s syndrome” website states that Dr. Wilson named this concept after himself “because it had not been previously described.” In fact, for more than a century, the same set of symptoms has been given different names and attributed to a variety of causes by others, including the syndromes of neurasthenia, chronic fatigue, fibromyalgia, multiple chemical sensitivity, chronic Ebstein Barr disease, and chronic candidiasis.

The frequency of complaints attributed to Wilson’s temperature syndrome has been recently reviewed ³. At any time, more than 20% of adults report significant fatigue and 30% have current musculoskeletal symptoms. Furthermore, the typical adult has one of the symptoms every 4 to 6 days, and more than 80% of the general population has one of these symptoms during any 2 to 4 week period.

The advocates of Wilson’s temperature syndrome view the cause, diagnostic evaluation, and treatment of these symptoms very narrowly. Their viewpoint does not acknowledge that when these symptoms are persistent, they may be due to a number of different subacute and chronic medical conditions, psychological or social stress, or mood disorders, including depression and anxiety. Some of these symptoms may also simply be a part of life. Wilson’s temperature syndrome attributes them all to a biochemical theory, which is unsupported by laboratory or clinical research. It does not consider the impact of other potential illnesses and psychosocial factors on how we feel. In doing so, attributing one or more of these symptoms to Wilson’s temperature syndrome may delay recognition of treatable medical illnesses and potentially addressable life stresses.

The American Thyroid Association has the following specific concerns about Wilson’s temperature syndrome and its recommended treatment.

1. The diagnosis of Wilson’s temperature syndrome is based on an incorrect definition of normal body temperature: that it is 98.6ºF (37 °C). Mackowiak, et al ⁴ measured oral temperature in 148 healthy persons. Average temperature varied throughout the day. At 8 AM, the average temperature was 97.6ºF (36.4 °C) with more than 50% of all the measurements less than 98.6ºF (37 °C) and many less than 98.0ºF (36.7 °C). This study concluded that “thirty-seven degrees centigrade (98.6ºF) should be abandoned as a concept relevant to clinical thermometry; 37.2°C (98.9°F) in the early morning and 37.7°C (99.9°F) overall should be regarded as the upper limit of the normal oral temperature range in healthy adults aged 40 years or younger” ⁴.
2. The prescription of T3 for Wilson’s temperature syndrome is inconsistent with normal physiology and represents a potential hazard. There is no question that T3 is an active, effective thyroid hormone. However, in most vital organs, much of the T3 is produced by removal of an iodine atom from T4 delivered by the blood to sites of thyroid hormone action. The extent of T4-to-T3 conversion varies from one organ to the other, but in some organs, like the brain and pituitary, this process provides most of the T3. Treatment with T3 produces an unnaturally large amount of T3 in some organs. This may be inappropriate, especially in times of illness or nutritional deficiency. Long-term T3 treatment may cause harm. Excessive T3 treatment can affect the heart and skeleton. These effects can be serious and even life-threatening.
3. The sole clinical evidence supporting T3 therapy offered by the Wilson’s syndrome website is in the form of testimonials from people who feel better after taking T3. Evidence of this kind, based on anecdotal reports of an unblinded intervention is potentially erroneous. Such reports fail to take into account two well established facts. First, many people who suffer these symptoms, even for months, get better without any treatment. Second, as many as one-third of people with nonspecific symptoms have a so-called placebo response, i.e., they get better when they are given any treatment, even an inactive capsule or sugar pill. The appropriate way to assess a new treatment is to perform a clinical trial in which patients are randomly assigned to receive either the test drug or placebo. Furthermore, the response to treatment should be assessed in a double blind manner, keeping track of what gets better, what does not change, and what gets worse, with neither the patient nor the doctor knowing which treatment the patient is taking. The American Thyroid Association has been unable to find any such studies of any treatment, including T3, for Wilson’s temperature syndrome. The Wilson syndrome website reports only success stories. Responsible medical research into a new treatment keeps track of, and reports, not only successes, but also success rates, and how often there are inconclusive responses, failures, and side effects.
4. The term Wilson’s syndrome should not be confused with Wilson’s Disease. Wilson’s Disease is a well established and carefully studied rare metabolic disorder caused by excess accumulation of copper in the body.

American Thyroid Association conclusion

The American Thyroid Association has found no scientific evidence supporting the existence of Wilson’s temperature syndrome. The theory proposed to explain this condition is at odds with established facts about thyroid hormone. Diagnostic criteria for Wilson’s temperature syndrome are imprecise and could lead to misdiagnosis of many other conditions. The T3 therapy advocated for Wilson’s temperature syndrome has never been evaluated objectively in a properly designed scientific study. Furthermore, administration of T3 can produce abnormally high concentrations of T3 in the blood, subjecting patients to new symptoms and potentially harmful effects on the heart and bones.

The American Thyroid Association supports efforts to learn more about the causes of somatic symptoms that affect many individuals, to test rigorously the idea that some as yet unidentified abnormality in thyroid hormone action might account for even a small subset of these symptoms, and to pursue properly designed clinical trials to assess the effectiveness of lifestyle, dietary, and pharmacological treatments for these common ailments. However, unsupported claims, such as those made for Wilson’s temperature syndrome, do nothing to further these aims.

Is Wilson’s thyroid syndrome a legitimate ailment?

No, Wilson’s syndrome, also referred to as Wilson’s temperature syndrome, isn’t an accepted diagnosis ⁵. Rather, Wilson’s thyroid syndrome is a label applied to a collection of nonspecific symptoms in people whose thyroid hormone levels are normal.

Proponents of Wilson’s temperature syndrome believe it to be a mild form of thyroid hormone deficiency (hypothyroidism) that responds to treatment with a preparation of a thyroid hormone called triiodothyronine (T3). However, the American Thyroid Association has found no scientific evidence supporting the existence of Wilson’s syndrome.

In a public health statement, the American Thyroid Association concluded ¹:

• The diagnostic criteria for Wilson’s temperature syndrome — low body temperature and nonspecific signs and symptoms, such as fatigue, irritability, hair loss, insomnia, headaches and weight gain — are imprecise.
• There’s no scientific evidence that triiodothyronine (T3) performs better than placebo in people with nonspecific symptoms, such as those described in Wilson’s temperature syndrome.

Hypothyroidism can be diagnosed by blood tests that detect insufficient levels of thyroid hormone. Wilson’s temperature syndrome shouldn’t be confused with Wilson’s disease — a rare, inherited disorder that causes too much copper to accumulate in certain organs.

Although it’s frustrating to have persistent symptoms your doctor can’t readily explain, it could be worse to accept an unrecognized diagnosis from an unqualified practitioner. Unproven therapies for so-called Wilson’s temperature syndrome may leave you feeling sicker, while a treatable condition — such as fibromyalgia or depression — goes undiagnosed ⁵.

Wilson’s temperature syndrome causes

Dr. Wilson’s Theory

During periods of stress or illness, more T4 thyroxine (a thyroid hormone), than normal is converted into the inactive rT3 (reverse T3). According to Dr. Wilson, prolonged stress leads to excess rT3 in the body, which in turn interferes with the normal conversion of T4 thyroxine to biologically active T3 triiodothyronine. As a result, the active form of T3 cannot be made in quantities needed to adequately fuel the cells’ energy needs. This thyroid hormone deficiency—one that is not apparent in blood tests—lowers body temperature, triggering many non-specific symptoms.

Advocates of Wilson’s temperature syndrome suggest this condition can be reversed by taking special time-released preparations of T3 triiodothyronine, called Wilson’s T3 (WT3). Most pharmacies do not sell WT3; it must be obtained from a specialty compounding pharmacy. Several cycles of WT3 treatment reportedly can elevate body temperature to 98.6 degrees F. A modified protocol adjusts the WT3 dose if the pulse is greater than 100, or if patients experiences other adverse symptoms. After several months, the patient is weaned off this therapy and normal production of T3 triiodothyronine resumes. The total amount of T3 recommended by Dr. Wilson is much higher than the amount of T3 needed for normal thyroid function.

Additionally, physicians certified in Dr. Wilson’s WT3 protocols often utilize organic herbs and vitamins marketed as “Restorative Formulations”, which are only available through trained healthcare professionals.

A Critical Assessment of Wilson’s Temperature Syndrome

It’s true that rT3 (reverse T3) accumulates in the body when people are ill ⁶. However, rT3 levels return to normal after people recover from their illness.

Even during illness, there is 40 times more T4 circulating in the body than rT3—more than enough to produce adequate amounts of active T3.

Advocates of Wilson’s temperature syndrome suggest that a body temperature below 98.6 degrees F., along with various common symptoms, may indicate Wilson’s temperature syndrome. Research has shown, however, that 98.6 °F reflects only an average body temperature ⁴. Normal body temperature varies among individuals, and fluctuates throughout the day in any given individual, so a temperature below 98.6 °F is not necessarily abnormal ⁴.

No randomized trials or scientific research exist comparing WT3 treatment regimen to placebo, (something that seems to be a “real” medical treatment but is not). The Wilson’s temperature syndrome website cites a publication written by Dr. Wilson (J Restorative Medicine, 2012) with warning indicating that it is only an opinion article.A similar study was published by Michael Friedman, president of Restorative Formulations (Puerto Rico Health Science Journal, 2006). This Both papers describe improvement in 11 patients with chronic fatigue who were given higher than normal doses of sustained-release T3. The investigation did not compare these patients to untreated or placebo-treated patients.. Research has shown that 40 percent of individuals with symptoms of hypothyroidism (low thyroid hormone levels) report symptom relief even when given a placebo. This is significant because the absence of a placebo-treated group in these studies the 2006 study do not allow a comparison of which effects might be due to WT3 and which might simply be the “placebo effect.”

Wilson’s temperature syndrome symptoms

One umbrella diagnosis suggested for literally dozens of common ailments from fatigue, to depression, to headaches, is Wilson’s temperature syndrome or Wilson’s thyroid syndrome. Wilson’s temperature syndrome is not an acceptable medical diagnosis and should not be confused with Wilson’s disease—a medically recognized genetic condition caused by a defect of having too much copper in your body specifically in the major organs ⁶.

E. Denis Wilson, M.D., described Wilson’s temperature syndrome in 1990 as the presence of multiple symptoms along with a low body temperature and slowing metabolism, caused by illness, injury, or stress. Metabolism is defined as the process of converting calories and other nutrients from the foods we eat into the energy needed for all life processes. The many possible symptoms attributed to Wilson’s syndrome are common and non-specific, meaning they can occur in many diseases or even be part of a normal, busy life. Dr. Wilson argues that the syndrome represents a form of thyroid hormone deficiency, even though low hormone levels are not reflected in blood tests. Wilson’s temperature syndrome or Wilson’s thyroid syndrome is not an accepted medical diagnosis based on scientific evidence and the symptoms are unsupported by research.

Wilson’s temperature syndrome treatment

Higher than normal doses of T3 can be harmful for a variety of reasons ⁶:

• High doses can trigger abnormal heart rhythms and other heart complications that may be harmful and, in certain persons, life threatening.
• Long-term treatment can cause loss of calcium from the bone, increasing the risk for fractures.
• Fetal brain development has specific hormone requirements. Very high doses of thyroid hormones given to expectant mothers may harm the baby.

Liothyronine (T3) a manufactured form of the thyroid hormone triiodothyronine is approved by the U.S. Food and Drug Administration (FDA), however these preparations have a short duration of action and, drug companies have been unable to formulate an FDA-approved sustained-release T3 product ⁶. Nonetheless, some endocrinologists combine levothyroxine (T4) and T3 when treating hypothyroid patients who have potential hypothyroid symptoms on T4 alone. Whether this is effective is controversial, but the European Thyroid Association has published a statement supporting individual trials of combined T4/T3 therapy in selected symptomatic hypothyroid patients. Unlike patients treated by Dr. Wilson who may have normal thyroid blood tests, candidates for combined T4/T3 all have a diagnosis of hypothyroidism, and T3 is given in doses that attempt to mimic normal physiology, and therefore avoid the serious side effects that can occur with excess T3 administration ⁶.

In summary, Wilson’s temperature syndrome a supposed thyroid hormone deficiency that is not supported by science, it describes common symptoms that many people experience ⁶. Doctors worry that some of these symptoms may be due to serious medical problems that can be treated successfully but require prompt medical attention. Pursuing hormone therapy for Wilson’s Syndrome might distract patients from seeking a proper diagnosis of a treatable medical condition. Inappropriate therapies, unfortunately, may cause serious health consequences.

References

1. American Thyroid Association Statement on “Wilson’s Syndrome” https://www.thyroid.org/american-thyroid-association-statement-on-wilsons-syndrome
2. WTS Overview. https://www.wilsonssyndrome.com/identify/wts-overview/
3. Barsky AJ, Borus JF. Functional Somatic Syndromes. Ann Intern Med. 1999;130:910–921. doi: https://doi.org/10.7326/0003-4819-130-11-199906010-00016
4. Mackowiak PA, Wasserman SS, Levine MM. A Critical Appraisal of 98.6°F, the Upper Limit of the Normal Body Temperature, and Other Legacies of Carl Reinhold August Wunderlich. JAMA. 1992;268(12):1578–1580. doi:10.1001/jama.1992.03490120092034
5. Wilson’s syndrome: An accepted medical diagnosis? https://www.mayoclinic.org/diseases-conditions/hypothyroidism/expert-answers/wilsons-syndrome/faq-20058414
6. Hormone Health Network.”Wilsons Temperature Syndrome | Endocrine Society.” Hormone.org, Endocrine Society, 24 February 2020, https://www.hormone.org/diseases-and-conditions/wilsons-temperature-syndrome