T4 - levothyroxine

[shaws]

The following I've probably published before but may be of interest to newer members who are having problems with levothyroxine. I don't have a link so the article is below:-

Increased Incidence of Disease and Medication Use Among Patients on T4-replacement

Researchers recently conducted the first large, community-based study in the UK of the health status of hypothyroid patients using T4-replacement therapy.[37] Compared to matched control patients, hypothyroid patients on "adequate" dosages of T4 had a higher reported incidence of four diseases: depression, hypertension, diabetes, and heart disease. Hypothyroid patients on inadequate T4-replacement (their TSH levels were elevated) also had a higher incidence of strokes. In addition, hypothyroid patients chronically used more prescription drugs, especially for diabetes, cardiovascular disease, and gastrointestinal conditions.

We’ve recently been consulted by many hypothyroid patients whose physicians have reduced their T4 dosages to extremely low amounts, in some cases as low as 25 mcg. The patients report to us that their physicians refer to reports by endocrinologists that TSH suppression increases the risk of atrial fibrillation three-fold. As I explain in Addendum 4, this is an unjustified generalization from a study of elderly (60 years of age and older) sedentary people. This misguided practice by physicians is likely to increase the patients’ incidence of coronary artery disease and cardiac fatalities.

The dosage of T4 that suppresses the TSH level varies considerably, but may be as much as 171 mcg or as little as 50 mcg.[56][57][58][59][60][61][62] Hypothyroid patients should be concerned when their physicians restrict them to lower-end dosages of T4. In one study, researchers used coronary angiography to assess the progression of coronary atherosclerosis in elderly hypothyroid patients. In 5 of 6 patients who kept their T4 dosages at 150 mcg or more, the disease didn’t progress. But in all 6 patients whose dosages were 100 mcg or less, the disease had progressed.[63] This study suggests that elderly patients whose TSH levels are suppressed by fairly low dosages of T4, and whose physicians insist on keeping their TSH levels within the reference range, may, as a result, have increased progression of coronary artery disease, leading to strokes and/or heart attacks. In that the incidence of atherosclerosis is high even among young individuals in modern societies, younger hypothyroid patients should be concerned over the possibility of lower dosages of thyroid hormone inducing or exacerbating atherosclerosis.

Dilemma for the Endocrinology Specialty

The four studies that are the subject of this document clearly show that neither T4- nor T4/T3-replacement is effective for many hypothyroid patients. The ineffectiveness of the two replacement therapies translates into three likely adverse consequences for these patients with inadequate thyroid hormone regulation: continued suffering from symptoms, susceptibility to potentially disabling or lethal diseases, and increased use of drugs to control the symptoms and diseases. The endocrinology specialty sets and maintains practice guidelines for the diagnosis and treatment of hypothyroidism; that it does so imposes upon it an ethical and humanitarian responsibility to expediently act to protect hypothyroid patients from the three adverse consequences. That responsibility is the compelling reason for the endocrinology specialty to promptly reform its incorrect official position that T4-replacement is safe and effective for all hypothyroid patients.

Many researchers, physicians, and patient advocates believe that the endocrinology specialty has been curiously obstinate in its advocacy of T4-replacement. Its obstinacy is evident in its disregard for the protests of thousands of patients and a growing number of doctors that T4-replacement is ineffective and harmful for many patients.

The specialty’s obstinacy may be sustained by financial incentives from corporations that profit from the practice of T4-replacement therapy. This suspicion of financial motivation is reinforced by the specialty’s standard method of enforcing the practice of T4-replacement among doctors: political tyranny rather than scientific argument and debate. The suspicion will only mount if the specialty—despite the recent studies showing replacement therapies to be ineffective[1][2][3][4] and harmful[37][63] for many hypothyroid patients—sidesteps the issue now at hand. How safe and effective is T4-replacement compared to alternate approaches to thyroid hormone therapy now in widespread use? For its own credibility, it is imperative that the specialty immediately address this issue free from prejudicial preconceptions.

[UrsaP]

Tag linda96

[mischa]

Shaws is it possible to have a copy of this article.

Recently my Endo and GP have said they both wanted to reduce my Levo and I have so far argued against it.

Thanks

[shaws Administrator in reply to mischa]

You will have to copy and paste it as I don't have the link.

I wonder if TUK have a copy? If you email Dionne:

[e-mail]

she may be able to tell you.

[shaws Administrator in reply to mischa]

What are your latest results? Put in the ranges after the results.

The worst thing they can do is reduce your dose according to your TSH. They somehow seem to believe we have become hyPERthyroid if our TSH is low but if we took too much thyroid hormones, we'd soon reduce our dose as the effect will be unpleasant. Have they tested your Free T4 and Free T3 before asking you to reduce?

If you feel well on your dose, refuse and say you feel fine (If you do) on your present dose.

thyroiduk.org.uk/tuk/thyroi...

Why do we have to educate the 'professionals' (small P)?

If we can ask questions and search the internet for the truth, why cannot they do so also??????

Excerpt from following:-

"Dear Thyroid Patients: If you have thyroid gland failure--primary hypothyroidism--your doctor is giving you a dose of levothyroxine that normalizes your thyroid stimulating hormone (TSH) level. Abundant research shows that this practice usually does not restore euthyroidism--sufficient T3 effect in all tissues of the body. It fails particularly badly in persons who have had their thyroid gland removed. TSH is not a thyroid hormone and is not an appropriate guide to thyroid replacement therapy.

The hypothalamic-pituitary secretion of TSH did not evolve to tell physicians what dose of inactive levothyroxine a person should swallow every day. A low or suppressed TSH on replacement therapy is not the same thing as a low TSH in primary hyperthyroidism. IF you continue to suffer from the symptoms of hypothyroidism, you have the right to demand that your physician give you more effective T4/T3 (inactive/active) thyroid replacement therapy. Your physician can either add sufficient T3 (10 to 20mcgs) to your T4 dose, or lower your T4 dose while adding the T3. The most convenient form of T4/T3 therapy, with a 4:1 ratio, is natural desiccated thyroid (NDT-- Armour, NP Thyroid, Nature-Throid). If you have persistent symptoms, ask your physician change you to NDT and adjust the dose to keep the TSH at the bottom of its range-- when you have the blood drawn in the morning prior to your daily dose. This may be sufficient treatment, but IF you continue to have persisting hypothyroid symptoms, and no hyperthyroid symptoms, ask your physician to increase the dose to see if your symptoms willimprove, even if the TSH becomes low or suppressed. You can prove to your physician that you're not hyperthyroid by the facts that you have no symptoms of hyperthyroidism and your free T4 and free T3 levels are normal in the morning, prior to your daily dose. They may even be below the middle of their ranges. Your free T3 will be high for several hours after your morning T4/T3 dose, but this is normal with this therapy and produces no problems. You should insist that testing be done,prior to your daily dose, as recommended by professional guidelines. If you have central hypothyroidism, the TSH will necessarily be low or completely suppressed on T4/T3 therapy. In all cases, your physician must treat you according to your signs and symptoms first, and the free T4 and free T3 levels second.

hormonerestoration.com/

Is it any wonder that the above doctor cannot take on any more patients!

[mischa in reply to shaws]

Thanks Shaws

I've just cut and paste the article You have such interesting articles and are a mine of information. Don't you just love those Drs who stick their necks out but they are so few and far between. Such a pity.

My bloods are: TSH 0.01 (0.27 - 4.20)

FT4 18.7 (12.00 - 22.00)

FT3 5.5 (4.00 - 6.80)

Currently on 75mcg T4 and 20mcg T3

I am quite happy on my current dose and there is no way I am going to reduce - absolutely no way.

Once again thanks Shaws.

[HashiFedUp]

Worryingly NICE recently specified in their guidelines for NHS management of underactive thyroid patients, that T4 be the only drug prescribed. And that there is no evidence that T3 helps or Natural hormone alternatives. Perhaps that’s just because they haven’t bothered to research it!

My Endo kept my T4 to 75mcg and I felt ill with underactive thyroid symptoms for nine months. Went to a private Endo and switched to Natural Dessicated hormone (from pigs!) and am feeling soooo much better. A few bad days but feeling so much better.

[shaws Administrator in reply to HashiFedUp]

The original thyroid hormone replacement was automatically prescribed on a trial basis, when people's symptoms warranted it. No blood tests back then, only the doctors' knowledge.

Patients were not held to ransom due to their TSH not reaching 10 before being diagnosed and it seems that worldwide the professionals have fallen into the trap of T4 alone whilst ignoring clinical symptoms. Also ignoring how disabling most of the symptoms are. Not testing Free T4 and Free T3 either.

[Hidden in reply to HashiFedUp]

Pigs have very similar physiology to humans. I wonder why nobody has suggested we descended from pigs rather than apes!

[Citrine77]

I find this really scary reading, I would like to send a copy of the report to my doctors and also my MP and probably the Health Secretary and the MHRA. Could you tell e where to get the original paper. Thanks

[shaws Administrator in reply to Citrine77]

See my response above to mischa.

Minimouse1

[Minimouse1]

I would also like the link to this article please.