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
When I became an endocrinologist in 1981 I was truly excited about the field. At that time it seemed that the science of endocrinology was expanding rapidly and new discoveries were on the horizon particularly in regards to the way hormones effect the brain, mood and the immune system. Was I ever wrong! It’s thirty years later and none of those expectations were realized. In fact, I find that the field of endocrinology has barely budged since then and in some areas has actually lost ground.
Bringing on this round of pessimism on my part, is a recent “development” in the area of treatment for hyperthyroidism (over active thyroid). Ever since I was in training there have been two medicines, propylthiouracil (PTU) and methimazole (Tapazole), which are the mainstays of medical treatment for hyperthyroidism. Both medicines have been available since the 1940’s and show excellent efficacy and tolerability (and they are cheap!). Almost all endocrinologists I have met use these two drugs interchangeably although in pregnancy propylthyiouracil is favored due to rare birth defects in fetuses exposed to methimazole.
The “development” which I find so discouraging is the recent action by the FDA to place a very strict (black box) warning on the use of PTU due to the possible occurrence of a rare form of liver injury attributed to the drug. After almost 70 years of exemplary use, this has given rise to extensive debate in the endocrinology literature about how to restrict PTU use.
While it is true that methimazole is equally as effective as PTU to treat hyperthyroidism, I have personally seen numerous cases of fairly severe allergic reactions to methimazole. Fortunately it has been easy to continue medical treatment by simply switching to PTU. If we can’t use PTU freely then the only other options are surgical removal of the thyroid or eradication of the thyroid using radioactive iodine, neither of which is free of potentially adverse outcomes.
I have never encountered severe liver injury with PTU nor has any of the colleagues I have polled. It has to be very, very rare. This is obvious because it has taken 70 years to get around to recognizing it formally. Can we really call it progress that we now have one less simple option for treating hyperthyroidism, a common and relatively benign disease? Let me take my cynicism to the next level. I won’t be surprised if a major pharmaceutical company soon announces the development of a new drug for treating hyperthyroidism. If I’m right the new drug will add nothing of real value that wasn’t previously available but is many times more expensive then the drug it replaces.
So goes endocrinology into the new century, the stogy old lady of medicine.
Suzi has hypothyroidism and high blood pressure. She sends the following story describing how t3 treatment appeared to help normalize her blood pressure. This is the first time I have come across this effect and thought it would be helpful to share her story on the main blog. Does anyone else have a similar (or contradictory) experience?
Hi Dr. Pepper,
I was diagnosed hypothyroid 2 years ago and given levothyroxine. On diagnosis I had lots of symptoms and my BP was 175/115 despite my whole family having low BP. After some months on T4 I did feel an improvement in a lot of ways and my BP got better. Then after a year, things started going wrong, as if my body didn’t like T4.
I tried reducing my dose of T4 back down to 75µg but went hypo. But each time I increased above 75µg my BP increased again, then on 112µg it became a serious problem, especially the diastolic. I still had fatigue, constipation, red eyes, swollen legs and so on.
About 3 weeks ago I started on 10µg T3 and reduced my T4 from 112 to 75µg and pretty much immediately felt clearer headed and more energy, the constipation went etc….. My BP has gone down by an average of 20, which I know because I check it regularly myself. I’m doing a 24-hour BP monitor this week too, because my doctor put me on Amlopidine 6 weeks ago after being shocked by the monitor results from then while on 112µg T4 (only took Amlopidine for 2 weeks after terrible side-effects incl. overwhelming fatigue and massively swollen legs).
So, it looks as though my body goes weird on T4 tablets when the dose is above 75µg, but if I stuck to that dose I’d be really hypothyroid. The T3 has changed my life completely!!
Now I’m wondering what the ideal balance T4 / T3 tablets would be? Is that possible to say or does it depend on each individual body and genetics? My typical BP now is around 120/ 95; it goes down after eating, and gets worse when I’m hungry or tired. The T3 reduced my BP so much more than the Amlopidine did, and on T3 I feel great whereas on Amlopidine I felt half dead. I’d like to get my BP back to before I got hypo, so that’d be 110/70.
All I need to do now is find my ideal dose of T4 and T3, could you possibly advise me on that? If I started 20µg T3 instead of 10µg, would you advise a reduction in T4 from 75µg? ( I’ll be doing a TSH, fT3 and fT4 test in about 5 weeks’ time, maybe I should wait till then?).
Thank you so much!
Every so often I like to bring attention to someone who has struggled to get properly treated for hypothyroidism. Not everyone shares the same dilemma regarding treatment of hypothyroidism because T4 by itself may be sufficient in many instances. But for those who continue to experience symptoms of hypothyroidism despite T4 treatment, adding T3 can be a life changing experience.
Here is Sarah’s story:
I was diagnosed with hypothyroidism in my early twenties and Synthroid did not help. I did not know at the time that many of my symptoms were due to hypothyroidism. After changing to my long time physician, I told her of my original diagnosis some years back. She did only the TSH and told me I was no longer hypothyroid! So for some 15 years after being in her care and continuing to feel crummy, then for the last 8 steadily gaining weight and feeling worse, I was not on any medication. I begged her for Cytomel several years back and was denied…she said she didn’t treat with that. When I finally was deemed hypo by her, she put me on the smallest dose of levothyroxine. It did not help. I finally went to see a shrink and he put me on 25 mcg of Cytomel. For the first time in my post pubescent life, I feel like living. My dose was upped to 50, and I felt even better but my thyroid levels were off, so we are now working on that and I am back to 25 mcg per day. If you can’t get Cytomel from your regular physician, you might get a psychiatrist to prescribe it. It changed my life and I finally feel alive. I’ve since switched primary physician because she wouldn’t listen to me, and she didn’t like that I was on Cytomel. I don’t know what it is about this medication that regular physicians don’t like and make them refuse to treat with it, especially when so many can benefit from it. I’ve lost only 12 lbs since being on it, but I gained nearly 35 unnecessarily while not being properly treated and was told to eat less and exercise more…I only ate about 1500 calories a day and walked my dog 2 miles each day, so I don’t feel it had anything to do with my diet!
The HCG diet has created a great deal of controversy among experts and the people who have tried it. Cami posts these words of warning about the HCG diet based on her own and her husband’s experience.
What Dr. Simeons book does not tell you is that there is a good chance your hair will fall out aproximately three months after completing the 500 calorie phase of the diet. He also doesn’t mention that the shock to your system can cause adrenal fatigue, and hypothyroidism if you were already prone to these conditions.
My husband and I both went on the hCG diet and both lost the weight we had been hanging onto for years. I followed the diet perfectly, but as soon as the hCG stopped, the weight began coming back on, FAST! I had to do a steak day every other day, my blood sugar plummeted and I began to feel awful! I suffered fatigue, dry skin, dry mouth, no energy, no libido, and my muscles and joints began to hurt. The carb and sugar cravings were so intense I felt like a drug addict. I gained all the weight back plus 13 lbs. in three months, then the hair began to fall. My doctor was shocked and completely surprised. His only theory is that the usual dose wasn’t enough for me and I triggered a starvation response which affected my thyroid and adrenals. Together we are going to support adrenal health, then begin t3 therapy in an effort to repair my thyroid. My husband on the other hand, feel great! He has been able to keep off the weight, add some muscle and is happy and energetic every day. hCG does work, but if you have any health problems related in any way to the hypothalmus, I would consider taking the weight off very slowly to avoid starvation response.