Wilson’s Temperature Syndrome
Wilson’s Temperature Syndrome. (WTS)
Wilson’s Temperature Syndrome (WTS) is a syndrome when you have symptoms of low thyroid, yet your blood tests indicate your thyroid is normal. How could this be? The most common lab done to indicate a thyroid issue is the thyroid stimulating hormone (TSH). The TSH is not really a thyroid hormone, but a hormone secreted by the pituitary to stimulate the thyroid. The TSH is to help regulate how much thyroid hormone is made. The TSH does not really indicate what the thyroid is doing with the thyroid hormone. Dr Denis Wilson, an endocrinologist, has studied the syndrome for over 20 years, hence this is the term given to this syndrome.
The physiology of the thyroid is described under the thyroid section. Stress is one of the most common contributing factors related to WTS. Stress is not just an emotional state but can be a physiological state, such as pregnancy, infection, or surgery. Women are more susceptible due the many episodes of hormonal disruptions such as pregnancy, menses, or menopause. During times of stress, the body may try to conserve energy by slowing down the conversion of inactive to active thyroid hormone. The thyroid regulates body temperature (metabolism) so if the conversion of thyroid hormone is slowed, then the body temperature will drop.
In the diagram, the blue line goes up (temperature) and then the pink line follows (metabolism). This is like turning on the stove (temperature) and then the water boils (energy).
The purpose of T3 (active thyroid hormone) is to go into the cells and create energy and stimulate DNA. The amount of T3 hormone and its ability to get into the cells determines your metabolic rate and body temperature.
What is the Difference in Hypothyroidism and WTS?
Remember, the body is interdependent systems and there are many mechanisms in place to prevent destruction (like a dam that would hold the water back during a flood). Hypothyroidism is when not enough T4 is being supplied by the thyroid gland. There is not enough thyroid hormone in the bucket to even be turned into the active T3. This low T4 would cause the thyroid stimulating hormone (TSH) to be high as it would be “screaming” at the thyroid to make more thyroid hormone. There would not be adequate T3 since there is not adequate T4.
In WTS, there is adequate thyroid hormone from the thyroid gland, or if taking oral thyroid hormone, (TSH) is normal, but there is a problem with the conversion of inactive to the active thyroid hormone. The T4, inactive hormone, could be converting to the RT3 as a means of conserving energy, as the RT3 is not available for use. The body has initiated a mechanism to conserve energy (put up the dam) due to some stressor. The stressor may be an accumulation of events causing exhaustion or an acute event. The symptoms of WTS and hypothyroidism may be the same yet have a different cause. Symptoms of hypothyroidism/WTS could include fatigue, intolerance to cold or heat, fluid retention, dry skin or hair, constipation, headaches, depression, anxiety, memory changes, weight gain, abnormal cholesterol, menstrual irregularities.
This diagram is illustrating the T4 converting to T3 under good control and then to RT3 under stressful conditions.
(Used with permission of Dr Denis Wilson, 2021)
WTS is much more common than hypothyroidism. Investigating all the thyroid labs and body temperature with the symptoms, helps to determine WTS or hypothyroidism. Hypothyroidism is a lifelong condition, yet WTS can be reversed.
It is important to determine and address the stressor but even then, the temperature may not come back up to normal. The body is supposed to speed back up after stress has passed, but in some circumstances, the prolonged stress caused some body dysfunction that needs attention before the temperature will come back up and the thyroid resumes normal functioning. A body temperature that is off by 1.5 degrees can cause some low thyroid symptoms.
Many times, the thyroid will recover on its own with nutritional changes, exercise, sleep, and stress reduction. It is important to rule out gut imbalance, adrenal dysfunction, and genetic variants that can all be contributing factors. Once any imbalances are ruled out or addressed, and you still have characteristics of WTS, then you might be a candidate for T3 (active thyroid) hormone therapy.
The most common symptoms are low body temperature (less than 98.6), fatigue, weight changes, anxiety, cold, insomnia, and constipation. WTS is reversible using T3 therapy. Successful treatment does involve determining what caused the body to try and conserve energy. The T3 therapy is a sustained release T3, and this is a compounded medication.
In the diagram, it shows the variance in temperature during the day with obesity (dark circles) with daytime stress, compared to the lean controls. There is a 1-degree difference during the day.
Used with permission of Dr Denis Wilson. Daniela, Grimaldi, Federica Provini; Evidence of a diurnal thermogenic handicap in obesity: Chronobiology International, (2014) DOI: 10.3109/07420528
Although both T4 (thyroxine, an inactive form that is converted to T3 in other areas of the body) and T3 (triiodothyronine, the active form) are secreted by the normal thyroid gland, many hypothyroid patients are treated only with levothyroxine (synthetic T4). For example, T4 preparations are often ineffective for some patients with chronic conditions causing chronic stress on the thyroid, such as chronic fatigue syndrome, or Rheumatoid Arthritis.
A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable to T4 alone. However, the only commercially available form of T3 is synthetic liothyronine sodium (Cytomel®) in an immediate release formulation which is rapidly absorbed and may result in higher-than-normal T3 concentrations throughout the body causing serious side effects. Research indicates there is a need for sustained release T3 preparations to avoid adverse effects. Ultimately, it is the expertise of the prescriber, use and interpretation of appropriate tests, dosing of the T3 or T4/T3 combinations, and the formulation of the medications that determines the success of treatment.