Dr. Kunz’s Thyroid/BHRT Protocol

by | Feb 28, 2013 | Thyroid and Hormone Balance

The Thyroid and Bio-Identical Hormone Balance Protocol

For patients interested in Dr Kunz’s approach to this much-misunderstood medical problem, the sections that follow could be helpful.


Let me say a few words about expertise and qualifications. In this world of conflicting opinions and information overload, we all tend to rely upon the “expert.” Academic institutions bestow degrees and credentials so that a careful and responsible user, buyer, customer, consumer, or patient may know whom to trust for sound, tested, scientifically reviewed opinions and advice.

The medical world has many levels of such credentialing, beyond a basic medical degree. Among them is the Board Certified Medical Specialty of Endocrinology, the diagnosis and treatment of disorders of the glands and hormones of the body.

Although I am a Medical Doctor, Board Certified in Family Medicine, I am not an endocrinologist. My credentials in this area consist not in certification by a recognized medical specialty group, but only in my thirty years of medical practice, listening intently to the issues of my patients, and having an intense curiosity that has forced me to learn every day newer and better ways to help those who enter my door.

Perhaps not being an endocrinologist has been an advantage. Not being constrained by the standards and restrictions of a particular specialty, I have been able to think and work “outside the box” and to see things that others do not. At least I hope so.

The Ignored Patient

“I’m sick and tired of being sick and tired…” This is the worn out refrain of miserable patients that every primary care doctor dreads to hear. This complaint is frequently accompanied by a long litany of other mental and physical symptoms. The doctor looks for a place to hide.

“I’ve been to several doctors over the years,” these patients say to me. “ I have told them my story. They have all checked my thyroid with a “TSH test” and said I absolutely did not suffer from low thyroid. They gave me Prozac.”

I have to confess I was one of those doctors for nearly fifteen years. And it wasn’t that I wasn’t paying attention. It wasn’t that I was not trying to help. I most certainly was trying. But according to my training, and from the point of view of the overwhelming majority of doctors who have learned thyroid diagnosis and treatment the traditional way, I was doing the right thing. After all, what would you do for a patient (usually, but not always, a woman) with a laundry list of symptoms concerning nearly every system of the body? Take them by the hand and say, in the most consoling manner, “There, there?”

Believe me, I have spent over thirty years listening to the tearful frustration of hundreds of patients who were subjected to condescending platitudes, upward rolling of the doctor’s eyes accompanied by deep sighs and fidgeting, followed by hasty diagnoses, futile treatments, or extensive, expensive, even invasive and risky diagnostic ordeals. Until the last seventeen years, I, too, may have been guilty of the futile- treatment-or-unnecessary diagnostics part.

It is a daunting list of symptoms, after all. A doctor only has three choices: 1) embark on an endless wild goose chase of various diagnostic tests to track down those symptoms that seem most important or, 2) chalk all those varied symptoms up to stress and prescribe – you guessed it – Prozac (or some related drug) or, 3) punt – tell the patient you can’t help and send her away.

What are those symptoms that drive patients (and doctors) to distraction? Here is a rather comprehensive list, organized by system. The most common or important ones are italicized. In The Thyroid Protocol, anyone scoring fifteen or more (each symptom counting “one point”), regardless of other known causes of specific individual symptoms, is more than likely in need of more thyroid hormone. (I’ll explain my logic behind this at the end of this section).

CONSTITUTIONAL — fatigue (especially excessive drowsiness and extreme need for afternoon or evening nap), weight gain or inability to lose weight, or, conversely, inability to gain weight, inability to increase strength or muscle mass with exercise, or excessively slow recovery from exercise or stress, “tired and wired” syndrome (especially in the afternoons and leading to the evenings – i.e., too tired to function, too wired to rest), awakening in the morning without feeling rested or recovered, temperature intolerance (especially to cold, but sometimes to heat or changes in temperature), fluid retention (especially puffiness in face and under eyes, swelling of feet and lower legs)

MENTAL/EMOTIONAL — “brain fog” (such as, the inability to hold a phone number in your head, or do simple math comparing prices in the grocery store isle), depression, anxiety, inability to focus/poor concentration (a lot like Attention Deficit Disorder), mood swings

NEUROLOGICAL — headaches (tension or migraine), carpal tunnel syndrome

GASTROINTESTINAL — constipation, bloating, gas, indigestion, heartburn, sluggish bowels, food cravings (especially carbs/sweets/starches)

CARDIOVASCULAR — high blood pressure, high cholesterol, palpitations (sudden surges in heart rate or irregularities of rhythm)

SKIN/HAIR — excessively dry skin (especially shins, forearms, knees, elbows), hair loss or thinning, dry brittle hair, inability to perspire, thin, bendable, or splitting fingernails that do not grow well (in fact, if nails improve on thyroid therapy this is nearly diagnostic of the body’s need for thyroid), thinning of outer half of eyebrows, premature graying of hair

ENDOCRINE/REPRODUCTIVE — irregular or heavy menstrual cycles, shortened cycles with increased flow, infertility, loss of libido, increased incidence or severity of endometriosis, PMS, galactorrhea (inappropriate discharge of milk from the breasts), symptoms of early menopause, fibrocystic breasts

ALLERGY/IMMUNITY — increased frequency of colds, chronic nasal congestion, sinus infections, hay fever symptoms, increased frequency of bladder infections, interstitial cystitis

MUSCULO-SKELETAL — joint stiffness and pain, muscle soreness or stiffness.

Special mention must be made of family history. In adding up the “symptom score”, if a parent or sibling has been diagnosed with a low thyroid condition, this counts as two points! Low thyroid is strongly hereditary.

Why do these symptoms add up to a high probability of low thyroid, when there are dozens of other medical problems that can contribute to this list? The logic is simply this: while there are, indeed, many causes of each or several of the symptoms listed above, to my knowledge – and I have asked this question almost daily for the last decade and a half – there is one and only one diagnosis that can contribute to every item on this list. That diagnosis is HYPOTHYROIDISM.

Therefore, would it not be logical at least to try to treat the one disease that can negatively impact everything on the above list? It’s simple logic that is not routinely followed by medical doctors. The pressure to ignore the obvious is great.

So why has this problem and those who suffer from it been ignored? The answer lies in the history of medical education and the development of knowledge regarding diagnosis and treatment of thyroid disorders (more on this later). But the cynical answer is money. Hypothyroidism is not a “big money” disease. Unlike heart disease, diabetes, COPD and lung disorders, breast cancer, etc., hypothyroidism is not filling up Emergency Departments and ICU’s with sick and dying people. It’s not stoking research budgets of Universities and Medical centers with government, charity, and pharmaceutical dollars. It’s not the topic of funding drives, public awareness campaigns, or media events. It’s not generating an impetus for the development of new and more sophisticated technologies or drugs.

No, hypothyroidism is just a disease that annoys internists, gyns, and family doctors with the endless and unsolvable problems and symptoms of a bunch of complaining women – okay, and a few men. Furthermore, the diagnosis and treatment of hypothyroidism has long been settled in the minds of Western traditional doctors. And the solution cheap and generic, not likely to generate big profits for anyone: thyroid hormone therapy in the form of levothyroxine (T4), triiodothyronine (T3), natural dessicated thyroid, or compounded thyroid preparations.

In defense of my colleagues, the cardinal rule of medical care is: “First, do no harm.” The fear of “overtreating” hypothyroidism is instilled in every medical student from the time of his first introduction to endocrinology to his every clinical rotation in medicine. We will cover this next.