Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline (It says not everyone needs medication for it)

[Sandy287]

Hi Everyone,

I thought I should share with you this interesting link. I read one article in German magazine and there I found this link on Thyroid medicine. It says that thyroid medication is not beneficial for many patients especially when they do not have big complications, are not planning to have a kid, or not age below 30 years.

This medical report is in English but the YouTube video of one medical doctor is unfortunately in German. Link of the Medical report. bmj.com/content/365/bmj.l2006#

And the video is in German that how one can quit Thyroid medication youtu.be/3siF3PjykgQ(Not working as expected?)

Let me know your opinion on it. Thanks

[msmono]

Hi, Interesting, thanks for posting it. I've read papers stating similar dating as far back as 2012 so not a new ideas as such. I've only had a quick look and I'm not medically trained but these areas stick out (as potentially problematic)

"When to treat SCH

Guidelines generally recommend thyroid hormones for adults with TSH levels above 10 mIU/L. For those with lower TSH levels, most guidelines recommend treatment only when people are younger, symptomatic, or have other indications for prescribing (such as cardiovascular disease or antibodies to thyroid peroxidase). Table 1 summarises current guidance from various organisations. 582122"

"Most guidelines recommend treatment only when people are...... "

Exactly. I think that's many of us on here. I.e. symptomatic or have anti-bodies.

"What are the symptoms?

Around 1 in 3 patients with SCH have no symptoms at all. 7 The type of symptoms people link to SCH include those of overt hypothyroidism: fatigue, muscle cramps, cold sensitivity, dry skin, voice changes, and constipation. 8 Other symptoms include poor memory, slowed thinking, weak muscles, puffy eyes, anxiety, and depression. 7910 Many of these symptoms are not specific to hypothyroidism. Around 20-25% of people with normal TSH levels report one or two of these symptoms.7 The relation between symptoms and biochemical TSH levels remains unclear."

"Around 20-25% of people with normal TSH levels report one or two of these symptoms".

Well yes but many of us on here have *all* the symptoms. I don't think anyone wants to take pills if they've just got a couple of manageable symptoms.

And finally re the chart "Practical Issues".I think that should be for the patient to decide. For myself I'm willing to put up with the practical issues of treatment in order to feel a bit better" Perhaps they should've included under practical issues 'dealing with closed-minded, G.P.'s'

I really like the idea of non-treatment and I do toy with it especially as my G.P. belittles my level of illness but when I've tried to cut down/do without it, I feel like I've been flattened by a steam roller (and that's just one of about 10 symptoms)

[diogenes Remembering]

This paper simply perpetuates the mistaken "shoehorn" belief that you can safely categorise patients by whether they are within or outside certain arbitrary limits. Take TSH >10 for example. as a guideline for action. Some people including more elderly ones will be hypothyroid at TSH =5 or less and other may not show symptoms until TSH is much greater than 10. The definition of SCH is also wrongly devised. It is said to mean TSH above the reference range with FT4 (note FT3 not measured) in its range. It is incorrect to just measure the two separately and put into a graph (univariate comparison). Because the FT4 and TSH are closely linked in an individual the correct comparison should be done with both together (bivariate comparison). If you do that then quite a lot of symptomless patients with SCH judged by univariate statistics appear normal by bivariate statistics. To treat TSH and FT4 as separate unlinked entities is a fundamental error that the medical world has adopted. The lesson here is to use the art of medicine (ie conversing with and examining the patient), before looking at numbers. Numbers have become dominant over presentation and patients are accordingly often misdiagnosed. Numbers that are healthy for one person can be unhealthy for another. We all have our unique signature of thyroid hormones and are not robots to be range-dominated diagnosis.

[msmono in reply to diogenes]

And this is exactly what I’m going to say to my GP when he rings me later Great post. Thanks

[DippyDame in reply to diogenes]

The voice of reason!

[Sandy287 in reply to diogenes]

Thanks a lot. It makes sense. In my case I’m taking a risk to quit my thyroid medication after new Euthyrox formula which has made me totally sick. I lowered the dose from 50 mcg to 25 mcg and my thyroid result came normal. I’m now trying to quit it completely in hope that it will work for me. I’m doing this for a reason that switching to another thyroid medication with cellulose is not a healthy choice either. First time in my 7 years I quit my first dose and I slept so well after ages. Also my body pain joint and muscles are reduced as well. I am sure it was due to Mannitol added to new Euthyrox. I’m not sure what my Endocrinologist will say as I have appointment with him on coming Monday.

[Marz in reply to Sandy287]

Am sure you will have checked the Bio of diogenes - who responded above. He is an Independant Research Analyst involved in Thyroid Research. The papers he has been involved with are all detailed on his page ..

[helvella Administrator Thyroid UK in reply to Sandy287]

One thing we have seen time and again here is: someone stops levothyroxine and, for a day or a few days, feels better. Then they start to go downhill.

There are reasons for this happening and it potentially can be explained.

Afraid I don't know the ongredients of other levothyroxine products in Germany, except L-Thyroxin Henning. That does contain cellulose. I got on well with it! (Which doesn't mean you would, of course.)

[Sandy287 in reply to helvella]

Thanks for the reply, Henning also adds Manitol as an ingredient which has given me loads of trouble with new Euthyrox. I actually stopped taking Euthyrox by lowering dose from 50 mcg to 25 mcg and then no more. I’m feeling much better now. After 7 years I can finally sleep at night so well (touch the wood). Also my endocrinologist in University clinic Eppendorf Hamburg told me to not take it anymore as my body is doing great. I’m going for another blood test and in 6 months one more. It is to play safe but he is sure that I will be ok. He said I’m not the first with lower dose quit and done better. Of course those with higher dosage and having complications should not do that and also not without surveillance. I quit once the doctor told me to do while I was asking him if he can recommend me alternative of Euthyrox.

[helvella Administrator Thyroid UK in reply to Sandy287]

L-Thyroxin Henning doesn't contain mannitol according to this document, dated December 2019, from Sanofi Deutschland:

Die sonstigen Bestandteilesind:Maisstärke, vorverkleisterte Stärke (Mais), mikrokristallineCellulose, Natriumcarbonat, Natriumthiosulfat (Ph.Eur.), hochdisperses Siliciumdioxid, hydriertes Rizinusöl.

(Google translation: The other ingredients are: corn starch, pre-gelatinized starch (corn), microcrystalline cellulose, sodium carbonate, sodium thiosulfate (Ph.Eur.), Highly disperse silicon dioxide, hydrogenated castor oil.)

mein.sanofi.de/produkte/L-T...

Wish you well.

[Sandy287 in reply to helvella]

Oh yes you are right, I mixed it with another brand. And yes It has cellulose that is why I was afraid to take. I develop multiple polyps in my colon and different types of them. It is due to MHTFR mutation and I try to go safe as I have enough on my plate and cellulose does effect colon though after very slow process.

[helvella Administrator Thyroid UK in reply to Sandy287]

You have to do what you have to do.

Again, wish you well.

[Sandy287 in reply to helvella]

Thank you but I will certainly update you guys about my next blood test. I myself is curious actually 😄