Thyroid extract - The End

[helvella]

A letter to the British Medical Journal in 1978 said:

Thyroid extract

SIR, -- We write to suggest that thyroid extract (Thyroid, BP) be removed from the British Pharmacopoeia and that its manufacture be abolished.

We continue to see patients who have been diagnosed as having myxoedema and who are being treated with apparently adequate doses of thyroid extract but who are clinically and biochemically hypothyroid. They have subsequently responded to thyroxine.

Although it is never to be certain that drugs prescribed are being taken, there is good evidence the potency of thyroid extract is variable and its shelf-life dated. As both active constituents. thyroxine and triiodothyronine, have been available for many years we see no reason for the retention of thyroid extract, which we consider to be dangerous.

W van't Hoff G M Besser

R Hoffenberg J S Staffurth

D R London David C Anderson

R Hall J Jenkins

G F Joplin R L Himsworth

Peter Sonksen

Br Med J 1978; 2 doi: doi.org/10.1136/bmj.2.6131.... (Published 15 July 1978) Cite this as: Br Med J 1978;2:200

From bmj.com/content/2/6131/200.4

The letter to the BMJ, which appears to have hammered the nail into the coffin of Thyroid BP, puts forward three arguments against the product:

It is variable.

That is fundamentally a manufacturing issue. We have seen remarkable variation across all thyroid hormone products even just in this century. We have also seen remarkable improvements in the ability to assay the products.

It is shelf-life dated.

This somewhat odd statement. In these days of advanced packaging technology, is there any reason to think the shelf-life is any more questionable than that of levothyroxine?

Thyroxine and triiodothyronine, have been available for many years.

Yes, I suppose they had, even then. And now, theoretically, they have been available for even more years! But effectively triiodothyronine (also known as liothyronine) is rapidly becoming unavailable. So, unless something is done to make it available again, this argument disappears.

Arguments not put forward:

Patients don’t need any T3/liothyronine medicines;

Patients prefer levothyroxine;

We tried increasing the dose of Thyroid, BP but that didn’t help;

Cost.

[Note: So far as I can tell, the UK Thyroid, BP product was half the potency of the USA products. Some papers seem not to recognise this important difference.]

[silverfox7]

Well I was prescribed Thyroid Extract In the early 80's. I dosed according to my basal temperature and never had a problem with it! I was forced to stop after a few years as it was imported from Canada and due to some sort of dispute supplements dried up so I was put this medication.

[TSH110]

Yes it does not make sense that patients were found to be hypothyroid if the treatment protocol was to treat until symptoms were alleviated. If TSH was used instead you'd expect their nutty conclusion was the NDT made everyone hyperthyroid. It simply does not add up.

[helvella in reply to TSH110]

They certainly had more faith in their biochemical testing than we have today. Despite the substantial advances in the technologies.

And testing still has major deficits.

[crimple]

My constant refrain is: if a healthy thyroid produces T4 and T3 then why is it accepted that T4 is all that we thyroidies need? the medics and pharmas are in denial about how a healthy thyroid functions and that it cannot be right to prescribe T4 only. Of course the useless TSH testing only serves to perpetrate the abuse we thyroidies suffer.

It isn't just animal thyroid extract that can have variable thyroxine content. I suffered badly with the Teva debacle (100microgram tablets delivering variable doses)

[diogenes Remembering]

That was then. Control of NDT content of T4 and T3 was done by a completely inadequate method for Pharmacopeia definition. Accordingly, since the measurement of the hormones in product production was unsatisfactory, variation in hormone content from batch to batch was inevitable then. Since then in the 80's a much better quality control method came in, and the reliability of the product much improved. Also in those days the assumption was that however an individual expressed health through a combination of thyroid production and body conversion, T4 would always suffice by itself. May I remind you that there was no formal clinical trial done to substantiate what these authors were saying, merely anecdotal experience, which nowadays would not be accepted as definitive. And no such trial has ever been performed, merely that changes occured according to statements like those above, which might have some force at the time but which don't apply today.

[helvella in reply to diogenes]

Much appreciated.

As one of the many who suffered from the Teva levothyroxine being unable to deliver on its claimed potency, despite everything that should be in place to identify and manage quality issues, I suggest that similar variability in desiccated thyroid today would be picked up by aware patients.

In the middle of the twentieth century, the Armour laboratories used to have an animal lab in which they tested their product. Maybe that was why they were frequently regarded as the best product on the market? Along with marketing efforts, of course. (No idea if the animal lab still exists.)

[Glynisrose]

Doctors would LOSE money if levo were taken off the market thats why its there.

[helvella in reply to Glynisrose]

Why would any UK doctor lose money?

(The forum is in the UK, so I am taking it you are referring to UK doctors.)

[Glynisrose in reply to helvella]

Because they are invested in levo.

[helvella in reply to Glynisrose]

So what money does my GP get from prescribing levothyroxine for me, rather than, say, desiccated thyroid?

(Assuming the doctor doesn't personally invest in manufacturers, etc.)

[Glynisrose in reply to helvella]

Lots you are assuming a lot.

[helvella in reply to Glynisrose]

I am only taking that as a start point to understand the financial benefit my GP gets from prescribing a £2.02 pack of levothyroxine for each month.

Please explain more.

[Clutter in reply to Glynisrose]

Glynisrose,

Really? Yet another pronouncement you are unable to substantiate I suppose?

[Hidden in reply to Clutter]

If you have any doubts on this matter I recommend you read the book “Deadly Medicines and Organised Crime, how big pharma has corrupted healthcare” by Peter C Gøtzsche, which should eliminate any doubts you may have.

As this book has received praise from the BMA I am rather inclined to believe it. I imagine it would be heavily criticised by the BMA if they cared to make any comments about the book.

[helvella in reply to Hidden]

As I do not have a copy of that book, are you able to give a specific example where it identifies levothyroxine as providing financial benefit to ordinary GPs within the UK?

[Hidden]

The author mentions many medicines in his book and the facts he provides remain, to my knowledge, as being unchallenged by anybody. Unfortunately levothyroxine is not mentioned. If every existing medicine were mentioned, then the book would be the size of Encyclpædia Britannica. I suggest you write to the author and suggest he does a second volume that does include levothyroxine. I cannot be expected to have access to any of the damning information that he obviously possesses. It would be very rash to suggest that because I, as a mere mortal, cannot produce it, then it is untrue. I could provide you with a pdf of the book that I have produced for my own information, but that would be breaking the copyright.

In order to give TRUE FACTS, that I CAN prove for the information of everybody on this forum, including yourself, about something far more disturbing, I am about to make a new post concerning how STUPID, UNPROFESSIONAL and INCOMPETENT the "professionals" in the "medical industry" actually are. I can think of no other reason for any of them to make publicly available declarations of this nature unless all of them are under the direct financial influence of some form of big pharma, be that of this world or elsewhere, "$$$£££", goods and services or career prospects.

As theses facts ARE TRUE, I can see no reason to disbelieve any allegations made against levothyroxine.

See "Thyroid extract - The End (as still seen by the NHS)"

[BadHare]

UTTER SLOBLOCK!

My last endocrinologist harped on about Thyroid extract being unsuitable. I explained to my GP, following the letter he received, that the standardised product I buy has never been recalled in 75 years of production, unlike the levothyroxine that's widely prescribed.

The signatories of that letter must have been very ignorant, or in receipt of a hefty backhander from the pharmaceutical companies!

[joydot]

Depressing