The American Thyroid Association's New Guidelines

Do you remember the American Thyroid Association's Conference in 2013 re TSH as the absolute in treating patients. If patients still had clinical symptoms they have to be diagnosed with a Somatization Disorder (statement by one of UK's eminent endocrinologists). They have now produced new Guidelines for the treatment. A few gems:-

1. While the conventional endocrinology community appears to be satisfied with these Guidelines, they are controversial for patients and other practitioners. I have discussed some of the many controversial aspects later in this article.

2.According to the task force, the purpose was "to review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps."

3.The key conclusion of the task force: "levothyroxine should remain the standard of care for treating hypothyroidism."

4. The implications for patients are clear. Endocrinologists, as well as HMOs and insurers, will continue to view levothyroxine as the preferred treatment for hypothyroidism. The task force did not find what they consider to be sufficient evidence of patient need for T3 or natural desiccated thyroid as treatments for an underactive thyroid.

5.One of the key areas of controversy is whether the guidelines are in fact unfairly biased toward levothyroxine, and not in patients' best interests.

In the guidelines, the ATA attempts to address issues regarding conflict of interest, stating that: "Our task force was commissioned and approved by officers of the American Thyroid Association(ATA)...

As is the case with many guidelines, physicians will feel legally bound to follow them -- or potentially face sanction by fellow physicians or professional societies.

6.Interestingly, they fail to mention that the American Thyroid Association itself -- which convened the task force - receives substantial general funding and meeting sponsorship funding from three different levothyroxine manufacturers -- AbbVie (Synthroid), Pfizer (Levoxyl) and Akrimax (Tirosint). (ATA Sponsors)

It's likely that all of the task force members have attended at least one, or many, ATA events that have been sponsored by these same levothyroxine manufacturers.

7 .Are the ATA task force members, who individually or as a group have benefited from the drug company sponsorship of their group, in a position to make truly unbiased decisions?

The research suggests they are not.

A study published in the June 2013 issue of the prestigious British Medical Journal titled "Evidence Based Medicine: Why we can't trust clinical guidelines" described how drug companies negatively influence members of committees that create clinical guidelines, to the detriment of patient care.

A reply from a physican who has treated thyroid patients for over 35 years.

10 Replies

Shaws, I hope the International Thyroid Association guidelines are published soon. They will be worth reading.

If the AFA get funding from three levothyroxine manufacturers, is that not a conflict of interests!

If not it should be!

Definitely it is, but also many doctors get payments for using particular products.

I also think that there is now an investigation in the USA. For instance if you visit a doctor you will get a prescription for the product from whomsoever he gets a 'payment' which may well be detrimental to the patient or more expensive, etc. etc.

As long as there is a profit in the sales of levo the 'guidelines' will always support its use.

Interesting article. however on my last trip to the usa i noticed that the drug companies were s pending a vast amount of money marketing to individuals. "Ask your doctor to prescribe *** drug" was common on TV ads...over and over again. If they can't get to the doctors then they will target patients. Sad state of affairs.

It appears to be 'profits, profits, profits' at whatever cost to patients.

Ain't that the truth. That's capitalism for you.

Yes I keep telling folks that doctors get perks from medical reps/big pharma to push certain drugs for certain companies - anti d, antibiotics and statins to name it a few! Sx

I don't know if it's in the UK so much as the USA but I read the USA government wants them records if they got payments and how much. They want transparency from now on. I think Florida is top of the list at present.

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