Thyroxine a waste of time apparently

[Blondiejayjay]

Article in the Express on a study by Professor David Stott University of Glasgow

google.co.uk/amp/s/www.expr...

Here’s the link. I thought it was worth posting here for debate

[Hidden]

Interesting, thanks for posting! However, the way I read it is: thyroxine is often prescribed in older people suffering from subclinical hypothyroidism and, in those cases, it's of limited, if any, use. However, the article does not say anything about the importance of adding T3 in many cases, so I'm not sure it's going to help those who are fighting to get their doctors to put them on NDT or a T3 + T4 combo...however, it's good to see the usefulness of thyroxine questioned even in a different context and, hopefully, the word will spread from there...

[Marz]

Could this be part of a new approach to cutting back even more on Thyroid hormones - I smell a rat

[Blondiejayjay in reply to Marz]

Marz I am thinking the same. It is a limited study and openly states that it wasn’t able to look at the other effects such as coronary impact etc. Only whether the subjects ‘felt’ tired of not.

I’m not a medical person but logic tells me that the study is probably flawed, so what was the point of it 🤔

[Fruitandnutcase in reply to Marz]

Great comment after the article by someone called Duggan saying

“What most doctors don't know about thyroid would fill an encyclopaedia”

Sadly I have to say I’m coming round to thinking that too.

[SeasideSusie Remembering]

Article published in May 2017.

As usual, a very misleading headline.

It is about prescribing Levo for pensioners, not any other age group. Maybe they didn't benefit because of nutritional deficiencies, plenty of B12 deficiencies become apparent with that age group and older.

I started on Levo in about 1975 when I was in my 20s and did well enough on it for about 20 years, many patients do well on Levo, so hardly a waste of time and money.

[crimple]

No doubt only TSH was tested and not T4 and T3 to get a full picture. Also anyone with antibodies is likely to be low on vitamins such as iron, ferritin, e, B12 and VitD. But don't suppose they were tested either. Another pathetic piece of research not worth the paper it is written on!

[humanbean]

This man's work has been discussed on the forum before. He was hyping up the results of this dreadful research :

nejm.org/doi/full/10.1056/N...

In the results section you see the following info :

"The mean age of the patients was 74.4 years, and 396 patients (53.7%) were women. The mean (±SD) thyrotropin level was 6.40±2.01 mIU per liter at baseline; at 1 year, this level had decreased to 5.48 mIU per liter in the placebo group, as compared with 3.63 mIU per liter in the levothyroxine group (P<0.001), at a median dose of 50 μg."

And at the end of that section :

"No beneficial effects of levothyroxine were seen on secondary-outcome measures. There was no significant excess of serious adverse events prespecified as being of special interest."

What this means is they started out with a group of people who had subclinical hypothyroidism, and divided them up into a treatment group and a control (placebo) group.

The TSH (thyrotropin is another name for TSH) level at the start was 6.40 +/- 2.01 miu/L.

After 1 year the control group (i.e. no treatment given except placebo) had a TSH of 5.48 miu/L.

After 1 year the treatment group had a TSH of 3.63 miu/L at a median dose of 50 mcg of Levo per day.

So, basically, this man and his cronies treated some people with Levo for a year, treated them just enough to get them into the reference range (which was 0.40 to 4.59 mIU per liter), and found that they didn't feel significantly better, and then declared there was no point in treating them at all.

[Note, the patients started the research with a TSH of 4.60 to 19.99 mIU per liter, and Free T4 in range.]

I know what I think of the research and the people who carried it out. The word sadists comes to mind.

[Rapunzel in reply to humanbean]

Ave hb; so much more useful than a career spent spitting feathers

[SilverAvocado in reply to humanbean]

A median dose of 50mcg sounds pretty rubbish. On the forum we often see people feeling worse on that kind of dose.

A bit strange that the placebo group reduced so much. I guess these patients were selected for having a high TSH, so you get some regression to the mean. This is whenever you select a group for having extreme scores, when you retest them the group as a whole will be less extreme. This is because on the first test you picked everyone up who was having their most extreme day, and other patients who are generally high but were having a low day get excluded.

[SilverAvocado in reply to SilverAvocado]

Oops, just seen this is quite an old thread. No idea how I got here

[humanbean in reply to SilverAvocado]

Still a useful reply though!

[SilverAvocado in reply to humanbean]

Thank you

[humanbean]

Ah, just found a previous post on this paper from helvella :

healthunlocked.com/thyroidu...

[Clutter]

Blondiejayjay,

This isn't the first study to note that mild subclinical hypothyroidism in elderly patients isn't relieved by Levothyroxine. I would like to see what TSH and FT4 were before and after Levothyroxine was prescribed.

[humanbean in reply to Clutter]

The patients started the research with a TSH of 4.60 to 19.99 mIU per liter, and Free T4 in range.

[Clutter in reply to humanbean]

HB,

Funny thing about Levothyroxine, like a lot of medicines, you need sufficient dose before it will work

[humanbean in reply to Clutter]

I agree. The research was just a big and expensive waste of time.

[diogenes Remembering]

The problem with this study is that it has looked at only 2 legs of a three legged stool ie TSH and FT4. And the T4 given only got the patients down to what I would think is still a bit high in range for TSH. What don't we know from this work: first how efficient is T4 in inhibiting the pituitary from making TSH - answer seemingly not as well as in younger people; second we know both T4 and T3 inhibit TSH so what role is T3 playing and how efficient is it at inhibiting TSH; third how good are the elderly at conversion of T4-T3 in the body; fourth is there any shortfall in direct T3 production by the thyroid that could affect the control mechanisms. I don't doubt that perhaps T4 is given a bit too liberally, in the old, if it doesn't apparently have much effect. But the patients still have muscle weakness and tiredness so something is wrong. The problem is that giving T3 is a bit fierce for the elderly and can easily overdose. Paradoxically I think that in this case NDT could be a better exploratory option. This is because it contains both T4 and T3 and low doses might be useful. Furthermore some of the T4 and T3 in NDT is bound on to protein and it takes time to release it in the stomach for use (a partial slow release formula) . So I think the work is indeterminate though it does show T4 alone isn't so useful in many cases.

[Baobabs]

Very interesting piece of research and lots of lively and very relevant comments. Seems not to be much consideration of variables such as the existence of antibodies? Then again how many medics think this is relevant when prescribing treatment. I appreciate that many people do well on Levothyroxine, however if this forum is anything to go by, many do not. Also I understood that Levo is cheap as chips so why all the hullabaloo in this research about cost and waste of money? Lastly, surely there is a need for more basic and relevant research into thyroid disease than sub clinical hypothyroidism in the ‘elderly’? I’d be interested to see who funded this study and why?

[Baobabs]

It is concerning that any piece of research lacks a consideration of so many important variables. When will medics ad researchers realize that this is an extremely complex disease.

[Angel_of_the_North]

Did the poor old people get enough levo for them to convert a reasonable level of T3? We don't know. Were they deficient in iron, D3 folate or B12 - probably. Did they care whether elderly patients had increased risk of dementia or heart disease? Yet another useless study.

[Blondiejayjay in reply to Angel_of_the_North]

Professor Stott’s disclaimer is classic ‘“It would worry me if people started stopping this medicine without proper consultation. There are people that really need it. Some people have very underactive thyroid and for them the medicine is important if not life-saving.

[Kalicocat]

This is a very scary article which is published in The New England Journal of Medicine. It is then read by stupid doctors in the UK and other countries who then stop treating their patients based on complete bulls**t. What the hell is going on?