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
In a blog at metabolism.com several months ago, website visitors were asked to join an email campaign addressed to Dr. Mack Harrell, President of the American Association of Clinical Endocrinologists (AACE). The purpose was to ask help reversing the existing practice recommendation # 22.4 published by the AACE in 2012, calling for a ban on the use of Armour Thyroid in the treatment of hypothyroidism. With over 800 individuals participating, the campaign appears to have achieved some success as the latest AACE treatment guidelines released last month no longer stipulate that desiccated thyroid is unfit for treatment of hypothyroidism. Instead the statement is issued, “ We recommend that levothyroxine be considered as routine care for patients with primary hypothyroidism, in preference to use of thyroid extracts. “, and…. “ Furthermore, there are potential safety concerns related to the use of thyroid extracts, such as the presence of supraphysiologic (unnaturally elevated, ed.) serum T3 levels and paucity of long-term safety outcome data.” Continue reading
by Gary Pepper, M.D.
Early in May 2014 a patient being treated with Armour Thyroid (desiccated thyroid) for hypothyroidism reported that her pharmacy service would not refill her prescription for Armour Thyroid because it was an “illegal” drug. We were both very distressed to learn of this, but for different reasons. My patient was rightfully concerned that she might be receiving a wildly inappropriate medication, while I was concerned that I might not be able to prescribe a medication I knew to be extremely helpful and safe. Continue reading
Here is a clear example of how the new Diabetes Treatment Guidelines and big Pharma have failed to protect the needs of diabetics who are disadvantaged by economic circumstances and disease. This is the story of one of my patients, an elderly, blind and impoverished woman with blindness due to diabetes. She managed to maintain some degree of independence and did not complain about what a lousy hand life had dealt her. One of the ways she remained independent was by using a device known as an insulin pen. The pen is an all-in-one device equipped with a needle , contains an insulin reservoir and is adjusted to a specific insulin dose by a twist of its dial. With this device she was able to inject her insulin dose daily by herself with sufficient accuracy to control her diabetes. The older method of using a separate syringe and insulin vial required too much dexterity and vision for her to use safely and would have require someone to help her on a regular basis. The type of insulin she uses, NPH, dissolves slowly so her risk of low blood sugar (hypoglycemia) was less than if she used the newer insulins which contain rapid acting insulin. What’s more, NPH insulin is still relatively inexpensive, costing about one half the price of the newer insulins.
I became aware of her problem at her visit with me last week. I learned the NPH insulin pen was being discontinued and there is nothing on the market to replace it. The only insulin pens now available contain insulin with rapid action or are at least twice as expensive as her present pen. What could have caused this sudden shift in the medical supply chain? I recently reviewed the American Association of Clinical Endocrinologists (AACE) new Diabetic Treatment Guidelines (see http://www.metabolism.com/2010/01/18/diabetes-treatment-guidelines-flawed/ ) which dismisses NPH insulin as out moded and recommends the newer (more expensive) insulins be used in its place. The company’s decision to stop making NPH insulin pens coincides almost simultaneously with this new AACE policy statement. In my mind the close timing of the corporate and the professional actions implies cross communications between them. Could the AACE decision to downgrade the use of NPH in some way support corporate economics? I wouldn’t be suprised at all.
Diabetes is the most common cause of blindness in the U.S. . My guess is that there are more blind, and poor diabetics who could make good use of the inexpensive NPH insulin pen. In the case of my patient, we are scrambling to put together a support plan for her so she can maintain her independence, her pocket book and still control her diabetes to a reasonable degree. I hope others in her position can find a similar support network.
Gary Pepper, M.D. Editor-in-Chief, Metabolism.com