The journal Thyroid has recently wrote an article on Guidelines for treatment of Hypothyroidism. It seems to begin to have some useful movement towards regarding T3 (FT3) measurement as a factor in determining health but still the same insistence on TSH in the normal range. Some way to go still.
Volume 24, no 12 December.
Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement
Jacqueline Jonklaas, Antonio C. Bianco, Andrew J. Bauer, Kenneth D. Burman, Anne R. Cappola, Francesco S. Celi, David S. Cooper, Brian W. Kim, Robin P. Peeters, M. Sara Rosenthal, and Anna M. Sawka
Written by
diogenes
Remembering
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One small step for mankind, I think the saying goes. It will be good if they do take notice of the New Guidelines re T3. Next step, definitely, that they take less notice of the TSH and much more notice of the T3 level in relation to patients symptoms and not keep them underdosed/undiagnosed.
Background: A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy. The purpose of this task force 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. We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care. This document is intended to inform clinical decision-making on thyroid hormone replacement therapy; it is not a replacement for individualized clinical judgment.
Methods: Task force members identified 24 questions relevant to the treatment of hypothyroidism. The clinical literature relating to each question was then reviewed. Clinical reviews were supplemented, when relevant, with related mechanistic and bench research literature reviews, performed by our team of translational scientists. Ethics reviews were provided, when relevant, by a bioethicist. The responses to questions were formatted, when possible, in the form of a formal clinical recommendation statement. When responses were not suitable for a formal clinical recommendation, a summary response statement without a formal clinical recommendation was developed. For clinical recommendations, the supporting evidence was appraised, and the strength of each clinical recommendation was assessed, using the American College of Physicians system. The final document was organized so that each topic is introduced with a question, followed by a formal clinical recommendation. Stakeholder input was received at a national meeting, with some subsequent refinement of the clinical questions addressed in the document. Consensus was achieved for all recommendations by the task force.
Results: We reviewed the following therapeutic categories: (i) levothyroxine therapy, (ii) non–levothyroxine-based thyroid hormone therapies, and (iii) use of thyroid hormone analogs. The second category included thyroid extracts, synthetic combination therapy, triiodothyronine therapy, and compounded thyroid hormones.
Conclusions: We concluded that levothyroxine should remain the standard of care for treating hypothyroidism. We found no consistently strong evidence for the superiority of alternative preparations (e.g., levothyroxine–liothyronine combination therapy, or thyroid extract therapy, or others) over monotherapy with levothyroxine, in improving health outcomes. Some examples of future research needs include the development of superior biomarkers of euthyroidism to supplement thyrotropin measurements, mechanistic research on serum triiodothyronine levels (including effects of age and disease status, relationship with tissue concentrations, as well as potential therapeutic targeting), and long-term outcome clinical trials testing combination therapy or thyroid extracts (including subgroup effects). Additional research is also needed to develop thyroid hormone analogs with a favorable benefit to risk profile.
Maybe levothyroxine works for the majority of thyroid patients and unfortunately the docs then assume it must work for ALL thyroid patients. Easy to look at a model instead of a PERSON! Forgive us for being different!
Does it, though? Does levothyroxine work for the majority of hypothyroid patients? Does anyone ever get back to feeling like they used to before their thyroids started to conk out taking levothyroxine alone?
I'm not convinced. So many people allow themselves to believe that they don't feel as good because they're getting older, or, if female, that they're menopausal. Or that it's because they're overweight (ha, because of their dodgy thyroids :-s ) and unfit. Or - and increasingly, I think this might apply to me - their thyroids have never been brilliant and so they've grown up having less energy than their peers, so their "normal" isn't really normal at all.
Yes my wife of 50 years has for 45 of them had T4 only, suppressed TSH throughout and no problems and good health e.g. fell walking etc up until a few years ago.. The majority with some working thyroid left can use T4 successfully - these are probably the majority.
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NICE and NHS Guidelines - Links to useful bits!
New BTA Guidelines May Actually Help
Petion for review of UK thyroid guidelines.
