Metabolism

The 2013 guidelines issued by the American Association of Clinical Endocrinologists and the American Thyroid Association reiterated their long standing opinion that only a single hormone, T4 (Synthroid, levothyroxine) is advised for treatment of  hypothyroidism. These key organizations representing the nation’s endocrinologists state there is no evidence supporting use of treatments of hypothyroidism incorporating T3 (liothyronine, Cytomel). This recommendation persists despite recent studies showing a genetic alteration present in about 16% of the population that could make it necessary to add T3 to treatment of hypothyroidism for best results (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515080)

Due to persistent opposition by these national organizations to using combination hormone (T4 plus T3) treatment for hypothyroidism, Medicare has withdrawn coverage for Armour thyroid (desiccated thyroid hormone). Armour thyroid contains both T4 and T3 in a single, inexpensive tablet used for decades in the treatment of hypothyroidism. In the past 20 or more years however, this medication has fallen almost exclusively to use by alternative medicine practitioners and is referred to only jokingly among mainstream endocrinologists (http://www.metabolism.com/2009/09/26/armour-draws-laughs-biggest-meeting-thyroid-doctors)

This leaves seniors without this option for treatment even if “T4 only” fails to provide relief of their symptoms. To justify their decision, policy makers imply that T3 is too strong a hormone for use in the older population, although this is merely conjecture.

Ironically, the American Association of Endocrinologists has just launched a campaign for thyroid disease awareness, called “Same, Same, Same”.  Although the idea is to remind people with hypothyroidism to take the same dose of medication, of the same brand at the same time of day, it symbolizes to me that organizations of this type continue to insist on  “the same old” approach to treating hypothyroidism which may not be the best.

I have used Armour thyroid in my endocrinology practice for years with great success for treatment of persistent symptoms of hypothyroidism despite maximum T4 replacement. At this time I am compiling my experience with Armour thyroid for publication in hopes this will encourage my colleagues to consider incorporating this “new” treatment option into their medical practices. I will make periodic posts to this blog on my progress.