Earlier, (http://www.metabolism.com/2009/01/21/dear-dr-repas/) I wrote a letter to Dr. Thomas Repas, explaining why I disagreed with his publication which opposes combination treatment for hypothyroidism (using t3 in addition to the traditional t4 therapy). I never received a reply to my letter. Somehow I wasn’t surprised.
His latest article appearing in the February 10, 2009 edition of endocrinetoday.com, goes even further in attacking the use of combination treatment, specifically as it applies to desiccated thyroid (Armour). He poses the question, “So why do I and most other endocrinologists refuse to use dessicated thyroid?”. He also states, “I believe that desiccated thyroid is antiquated therapy and should no longer be used.” His position then is that using Armour thyroid and similar preparations is an unacceptable medical practice. In fact, the last sentence of his editorial, states that desiccated thyroid preparations are unacceptable for treatment.
Dr. Repas bases his argument on the idea that the amounts of thyroid hormone in desiccated thyroid preparations are more variable than synthetic thyroid preparations. This is true but irrelevant. For the average person, variations in the time medication is taken, the rate the medication is absorbed from the stomach, and the general health of the person taking the medication which alters the metabolism of the thyroid hormone in the tissues, makes the variations in hormone levels in these preparations meaningless for clinical purposes. What Dr. Repas misses is the big picture, which is that for good health the human body requires a more complex form of thyroid hormone replacement then an unchanging daily amount of pure t4. A therapy like Armour which combines t4 with t3 is closer to what a normal thyroid secretes. Not everyone responds but in my experience the vast majority of unsuccessfully treated hypothyroid patients who continue to experience symptoms compatible with thyroid hormone deficiency, these symptoms respond very favorably to Armour thyroid.
In my letter to Dr. Repas from January 2009, I pose various key questions about thyroid hormone metabolism in the body. I challenge any endocrinologist to answer these questions in a meaningful way. Until we have a clear understanding of what comprises the perfect form of thyroid hormone replacement, I find it unacceptable to have physicians with opinions which differ from mine, telling me what is appropriate therapy for my patients.
Thyroid hormone replacement therapy is often complex and takes time and collaboration between physician and patient, to come upon the best treatment solution. Those endocrinologists and other physicians who prefer to over-simplify their approach to treatment with a rigid adherence to a single dose of pure t4, in my opinion, are only fooling themselves.
For recommendations for treatment of medical conditions you should consult your own health professional. My statements are solely for educational purposes, and are not intended to imply treatment advice.
The disclaimer for metabolism.com applies to this publication.
Gary Pepper, M.D., Editor-in-Chief, Metabolism.com