On April 11, 2016 an article, Doctors Hear Patients’ Calls for New Approaches to Hypothyroidism, appeared in the Wall Street Journal regarding the growing influence of patient preference on treatment selection for hypothyroidism (sluggish thyroid). The article was written by the WSJ health columnist Melinda Beck. I might have missed it but thanks to a motivated patient I received a copy within a week after its publication. With a glance I knew this report could be a highly significant addition in the on-going debate between specialists treating hypothyroidism (endocrinologists) and advocates of alternative approaches. Continue reading
By Gary Pepper, M.D.
According to experts, 10 to 20% of hypothyroid individuals fail to respond completely to T4-only (levothyroxine, Synthroid) treatment. Dr. Anthony Bianco, the president of the American Thyroid Association, and his associates believe this is due to genetic variations in the way thyroid hormone is converted in the body from T4 into T3. T3 is the much more potent form of thyroid hormone and unless the cells of the body receive enough T3, normal function cannot be achieved and symptoms of low thyroid such as fatigue, mental fogginess, constipation, muscle aches etc, persist. Based on the research conducted by Dr. Bianco and colleagues it is thought that in those with the genetic trait making T4 treatment ineffective, blood tests would show low T3 levels. Continue reading
Update from the 15th International Thyroid Congress, Orlando Florida, October, 2015
By Gary Pepper, M.D.
I just returned from Orlando, Florida, where I attended the 15th International Thyroid Congress and want to provide a report of my experience, to readers of metabolism.com. This was truly an international event with an estimated 50% of the attendees from outside the U.S. Organizers of this event describe it as, “Renowned experts in thyroid function and biology, diagnosis and management of thyroid disease, and novel therapies for treating thyroid cancer are gathering at the 15th International Thyroid Congress (ITC) to present, discuss, and debate the latest advances in thyroidology. Held every five years, the ITC is a collaborative meeting of the four world thyroid associations; the ATA (American Thyroid Association), Asia-Oceania Thyroid Association (AOTA), European Thyroid Association (ETA), and Latin American Thyroid Society (LATS).”
I was particularly excited to be attending this conference this year since my colleagues, Drs. Paul Cassanova and Kathryn Reynolds and I were presenting our study on the use of combination T3 plus T4 for the treatment of underactive thyroid (hypothyroidism).
Here are some papers I found to be of particular interest; Continue reading
Metabolism.com received this message from one of our readers. Her story seems typical of the sort of dilemma so many people face today. The best advice usually comes from others who face the same problem. It would be helpful to hear what others would do in her situation.
I was diagnosed with Grave’s Disease in 2009, I had RAI in 2011, after my daughter turned 3 months. Being pregnant with Severe Grave’s was the scariest thing in my life at the time. I gained weight prior to my pregnancy, during, and after RAI. My family doctor told me no matter how much you ate while severe Hyperthyroid you should have been anorexic, so something else is wrong. Continue reading
Why Patients Aren’t Receiving the Most Effective Treatment for Hypothyroidism
By Gary Pepper, M.D.
For the past 3 to 4 decades endocrinologists worldwide have adhered to the belief that only synthetic T4 (the most abundant of 4 thyroid hormones produced by the thyroid) is appropriate therapy for a sluggish thyroid even though it is known that a substantial number of those treated with T4 only continue to suffer from persistent symptoms of the disease. This may be because under normal conditions the thyroid produces two principle hormones T4 and T3. In 2013 an NIH study showed that 50% of those with hypothyroidism preferred treatment which includes T3 and our group reported that 78% of a subgroup of patients preferred T3 containing medication to treat hypothyroidism . Continue reading
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
Mainstream endocrinologists seem to be moving grudgingly toward acceptance of combination T4 plus T3 therapy for hypothyroidism. A great example of the mixed feelings harbored by endocrinologists in this regard is the title of a recent editorial, “ Combo (treatment) a Last Resort for Hypothyroidism” . Although the author, Dr. Bruce Jancin of the University of Colorado, recognized the value of combination T4 plus T3 therapy, he did so with the least possible enthusiasm. In his article the doctor acknowledged the weakness of scientific studies showing negative results with combination therapy and pointed out the findings of the Watts Study which provides a genetic rationale for why some people need to have T3 added to T4 to return to proper thyroid hormone balance. Continue reading
I thought Richards comments about the battle he faces getting treatment for hypothyroidism after having his thyroid removed for cancer, would be of interest to many readers at metabolism.com.
I recently ordered Thyroid-S on Amazon.com and after all the research and apparently good results I have found online, I think I made the right choice. I had my thyroid removed because of cancer in 2005, took Cytomel at first, felt great, told to stop cytomel and start Levothyroxine, felt horrible. Two months out(125mcg) TSH was 43.0, increased dose to 137mcg wait another 2 months, TSH was 31.0 Finally told to take 200mcg and TSH started to come down. It took about 6 months to get my TSH where they wanted it and for the side effects I was given all types of medications. Continue reading
A long time member of metabolism.com, Eric Pritchard, has been a determined critic of “T4 only” treatment of hypothyroidism. In his latest comment Eric shows that scientists were aware of the inadequacy of “T4 only” treatment since 1947! I wanted to give everyone a chance to read his comment so I am posting to the main blog. Thanks again for your insight Eric.
Submitted on 2012/03/25 at 6:11 pm
Endocrinologists have a hard time with the symptoms of hypothyroidism in the same sort of way that New York City folks believing that there is anything worthwhile west of the Hudson River. However, there are very relevant functions to the thyroid hormone effectiveness that exist beyond the boundaries of the classical endocrine system. This potential was given initial credence by Drs. Kirk and Kvroning in 1947 when they published a note saying that not all patients’ symptoms were managed by thyroxine (T4). This was collaborated in 1954 by Dr. Means. Drs. Gross and Pitt-Rivers discovered triiodothyronine (T3) and found it far more active than T4, which is now called a pro-hormone. The concept of euthyroid (your thyroid is OK) hypometabolism (but you are dragging anyway) was demonstrated by Dr. Goldberg in 1960. Drs. Refetoff and Braverman, circa 1970, discovered the connections between the thyroid gland and symptom producing cells, namely the cellular reception of hormones and the conversion of T4 to T3 outside of the endocrine system, which produces 80% of the body’s requirement for the active hormone, T3.
Another issue that is dismissed is the necessity of supporting chemistry to function properly. For example, every thyroid hormone replacement counter-indicates is use if the adrenals are insufficient.
So there is far more going on than endocrinology is willing to promote. That is why there are 1.7 million patients suffering in spite of T4 therapy. That is why there are still more patients suffering from false negative diagnoses for the symptoms of hypothyroidism.