For decades doctors have recognized synthetic thyroid hormone known as levothyroxine or brand name Synthroid, as the undisputed choice for treating hypothyroidism (low thyroid function). By virtue of hypothyroidism being extremely common levothyroxine has been the most prescribed medication in the U.S.. According to key medical organizations in this country, the only acceptable treatment of hypothyroidism is the use of levothyroxine alone. Using any other form of therapy is not recommended. Pointing to a significant number of patients receiving levothyroxine who continue to complain of symptoms of hypothyroidism health advocates have been calling for recognition of alternative treatments. One such alternative with a small but enthusiastic following is extract of pig thyroid (desiccated thyroid extract). All of the major organization of endocrinologists fail to recommend this form of treatment but in particular the American Association of Clinical Endocrinologist or AACE in the US has flatly stated this form of therapy should never be used. Physicians and their patients remain deeply divided on this issue. Continue reading
If Hypothyroid and Unhappy, Which Came First?
By Gary Pepper, M.D.
Medical specialists increasingly accept that some patients being treated for hypothyroidism continue to be symptomatic and “unhappy”. The degree to which patients experience this problem while on conventional treatment for hypothyroidism with levothyroxine (Synthroid, Levoxyl, Unithroid, T4) has motivated many specialists to look for other approaches to treatment such as adding T3 (Cytomel, liothyronine) or switching to desiccated thyroid extract (Armour, WPthyroid, Westhroid
Not all experts are convinced looking for new treatment options for hypothyroidism is the right approach. Continue reading
Here is a rare opportunity to let the leadership in endocrinology know how you feel about treatment options for hypothyroidism. The American Thyroid Association is asking all those being treated for hypothyroidism to complete a simple questionnaire which will provide feedback regarding your level of satisfaction with present options for treatment of hypothyroidism. If you want to have your opinion counted log on to the following site and complete the survey!
If the link above doesn’t work copy and paste the following URL into your browser https://www.surveymonkey.com/r/hypothyroidpatientsurvey
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
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
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
I am often asked by patients with hypothyroidism (low thyroid hormone levels), “What is the right thyroid hormone dose for me”. Of course, a physician wants to find the appropriate dose of medication to treat each condition a patient has. When it comes to thyroid disease however, this can be a complex question. Not only is there an issue of whether T4 alone or combination T3 and T4 will be required to treat a particular individual but the therapeutic window of these hormones must also be considered. Continue reading
Our member, Ella, has analyzed her own T4 plus T3 thyroid replacement needs and offers a terrific explanation of how she arrived at her conclusions. Follow her thinking in her message to metabolism.com