A 'Natural' thyroid storm! & Thyroxine and Triiodothyronine Content in Commercially Available Thyroid Health Supplements

[helvella]

Well, looks like at least one desiccated thyroid "supplement" does contain some thyroid hormone. But I am not entirely happy with this paper.

The second paper is an analysis of several over-the-counter supplements.

The image at the top of this post is taken from that paper.

J Clin Pharm Ther. 2019 Jun 18. doi: 10.1111/jcpt.12996. [Epub ahead of print]

A 'Natural' thyroid storm!

Mohebbi MR1, Chen AT2.

Author information

1 Department of Emergency Medicine, St Joseph's Medical Center, Stockton, California.

2 Department of Physiology and Pharmacology, University of the Pacific, Stockton, California.

Abstract

WHAT IS KNOWN AND OBJECTIVE:

Over the counter supplements are often taken for granted during medication reconciliation in the emergency department. Supplements are not regulated by FDA, and some can be potentially dangerous.

CASE SUMMARY:

We report a case of thyrotoxicosis secondary to over the counter bovine thyroid supplements. Our patient presented with atrial fibrillation with rapid ventricular response refractory to calcium channel blockers. Had we not known about the supplement, the course of treatment would have been different with potential adverse outcome.

WHAT IS NEW AND CONCLUSION:

Natural thyroid supplements are marketed as over the counter products and are largely unregulated. Thyroid extracts have been found to have disparaging inconsistencies in composition, delivering anywhere from non-existent to supratherapeutic doses. Thyroid supplements should be regulated considering the potential side effects.

© 2019 John Wiley & Sons Ltd.

KEYWORDS:

OTC; cardiovascular disease; clinical pharmacokinetics; clinicians; over-the-counter medications; supplement; thyroid

PMID: 31211437

DOI: 10.1111/jcpt.12996

ncbi.nlm.nih.gov/pubmed/312...

Thyroid Dysfunction: Hypothyroidism, Thyrotoxicosis, and Thyroid Function Tests normal

Thyroxine and Triiodothyronine Content in Commercially Available Thyroid Health Supplements

Grace Y. Kang, Jonathan R. Parks, Bader Fileta, Audrey Chang, Maged M. Abdel-Rahim, Henry B. Burch, and Victor J. Bernet

Published Online: 25 Sep 2013 doi.org/10.1089/thy.2013.0101

Abstract

Background: As defined by the Dietary Supplement Health and Education Act 1997, such substances as herbs and dietary supplements fall under general Food and Drug Administration supervision but have not been closely regulated to date. We examined the thyroid hormone content in readily available dietary health supplements marketed for “thyroid support.”

Methods: Ten commercially available thyroid dietary supplements were purchased. Thyroid supplements were dissolved in 10 mL of acetonitrile and water with 0.1% trifloroacetic acid and analyzed using high-performance liquid chromatography for the presence of both thyroxine (T4) and triiodothyronine (T3) using levothyroxine and liothyronine as a positive controls and standards.

Results: The amount of T4 and T3 was measured separately for each supplement sample. Nine out of 10 supplements revealed a detectable amount of T3 (1.3–25.4 μg/tablet) and 5 of 10 contained T4 (5.77–22.9 μg/tablet). Taken at the recommended dose, 5 supplements delivered T3 quantities of greater than 10 μg/day, and 4 delivered T4 quantities ranging from 8.57 to 91.6 μg/day.

Conclusions: The majority of dietary thyroid supplements studied contained clinically relevant amounts of T4 and T3, some of which exceeded common treatment doses for hypothyroidism. These amounts of thyroid hormone, found in easily accessible dietary supplements, potentially expose patients to the risk of alterations in thyroid levels even to the point of developing iatrogenic thyrotoxicosis. The current study results emphasize the importance of patient and provider education regarding the use of dietary supplements and highlight the need for greater regulation of these products, which hold potential danger to public health.

liebertpub.com/doi/full/10....

[Hidden]

Hmm. It would be good to know how much of each hormone is in a particular given brand, and if the amount is consistent.

"...highlight the need for greater regulation of these products, which hold potential danger to public health."

Regulation. Protecting us from"Potential" danger. Ah yes. Control the masses of thyroid patients by making sure they take no risks except from what is officially allowed.

[Nico101 in reply to Hidden]

Seems BP has turned its greedy eyes on the supplement business - and not for the first time. Still, it's for our own good, right?

[Greekchick]

Hi helvella,

What makes you unhappy about these papers? I’m curious what you think is missing - would like to hear your thoughts. Thanks.

[helvella Administrator in reply to Greekchick]

First Paper

First, the very title. Excess thyroid hormone is definitely not something to play about with and this person would appear to have been well and truly over-dosed. But the term Thyroid Storm (apart from being now generally deprecated in some quarters) applies to a very specific state. The big problem being the continuing increase of thyroid hormone.

They say the course of treatment would have been very different had they not known. Maybe, but wouldn't thyroid hormone testing be one of the things to do in the differential diagnosis? Yes, could have taken longer. But if the patient were suffering from a "real" thyroid storm, would they have missed it?

They appear not to have assayed the thyroid hormone content of the product being taken. Thus they do not nail down the proof.

Finally, in some ways the reason for the products not emblazoning their thyroid hormone content is very largely the way medicines are regulated.

Second Paper

Much more balanced. Much I agree with but I'd argue that inter-tablet and inter-batch variability is a very important issue. And much of the fault, again, is the existing regime which forces companies to hide information.

[jgelliss in reply to helvella]

helvella Great Points . Thank You for Sharing .

[Greekchick in reply to helvella]

You may find this recent article on thyroid storm of interest - it’s in the latest issue of Thyroid

liebertpub.com/doi/full/10....

All the best.

[Greekchick in reply to helvella]

Sorry not latest issue! Read too fast.

[Greekchick]

Thanks, helvella. When I read the first paper, I thought the title was not literal - but sort of a play on words. Poor choice by the authors as thyroid storm is a very specific phenomenon as you say. But I agree with you - the docs didn’t manage situation well at all. Scary.

The second paper - good points in the work, but I can’t fault the authors for inadequate regulations with r respect to disclosure of contents in the supplements. This is the sort of work that should be brought to the attention of the FDA or other regulatory bodies in other countries.

[penny]

These ‘supplements’ might be cheaper than buying T3 online. (Tongue in cheek.)

[jacrjacr]

I would say any thing csn be misused.aspirin,tylenol, ibuprofen, iron, d3,anything.....I am more concerned w over regulation....

[helvella Administrator in reply to jacrjacr]

One of the things missing from the paper is why that person switched from levothyroxine to bovine desiccated thyroid.

If they were doing very poorly on levothyroxine, we perhaps should apportion considerably more blame on those who failed to improve her treatment.

(In the paper, though possibly not in reality, there was no consideration of whether the patient also took things like selenium, iron, zinc, and so on. When someone sees things that might make a difference, who would blame them for trying all of them?)

The single biggest change in thyroid over the past twenty years is almost certainly the internet. We see so many people who have gone from never questioning their doctors, their treatment (or lack of), assuming their issues are nothing to do with thyroid, to at least moderate enlightenment. They will ask for their results. They will ask for a test or a change in dose. (Even if they keep pretty strictly to the guidelines and don't expect T3, suppressed TSH, etc..)

That is, at the most basic level, patient education. Which might have helped the poor person to avoid what happened.