This publication just out in Thyroid journal discusses using NDT (DTE) and T3 in suitable circumstances. It is I believe the opening of the door that has closed against NDT and T3 use, and in the future should encourage properly designed trials. They acknowledge the existence of a subset of patients who need these. Only have the abstract yet because it's behind a paywall, but am asking for full access which I'll pass on to TUK when I get it:
Thyroid Vol. 30, No. 10 Reviews and Scholarly Dialog
Liothyronine and Desiccated Thyroid Extract in the Treatment of Hypothyroidism
Thaer Idrees, Scott Palmer, Rui M.B. Maciel, and Antonio C. Bianco
Background: The basis for the treatment of hypothyroidism with levothyroxine (LT4) is that humans activate T4 to triiodothyronine (T3). Thus, while normalizing serum thyrotropin (TSH), LT4 doses should also restore the body's reservoir of T3. However, there is evidence that T3 is not fully restored in LT4-treated patients.
Summary: For patients who remain symptomatic on LT4 therapy, clinical guidelines recommend, on a trial basis, therapy with LT4+LT3. Reducing the LT4 dose by 25 mcg/day and adding 2.5–7.5 mcg liothyronine (LT3) once or twice a day is an appropriate starting point. Transient episodes of hypertriiodothyroninemia with these doses of LT4 and LT3 are unlikely to go above the reference range and have not been associated with adverse drug reactions. Trials following almost a 1000 patients for almost 1 year indicate that similar to LT4, therapy with LT4+LT3 can restore euthyroidism while maintaining a normal serum TSH. An observational study of 400 patients with a mean follow-up of ∼9 years did not indicate increased mortality or morbidity risk due to cardiovascular disease, atrial fibrillation, or fractures after adjusting for age when compared with patients taking only LT4. Desiccated thyroid extract (DTE) is a form of combination therapy in which the LT4/LT3 ratio is ∼4:1; the mean daily dose of DTE needed to normalize serum TSH contains ∼11 mcg T3, but some patients may require higher doses. The DTE remains outside formal FDA oversight, and consistency of T4 and T3 contents is monitored by the manufacturers only.
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diogenes
Remembering
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A trial of combination therapy with LT4+LT3 can be considered for those patients who have unambiguously not benefited from LT4.
Concerning that they appear to demand no benefit from LT4. Not what we so often see, which is some, indeed sometimes considerable, benefit from LT4, but still having issues.
Might be that I am taking their words very literally. Probably too literally. But so too will at least some who read the paper and make decisions on treatment.
Afraid I all too often see the bad in bigger letters than the good!
Yes - at heart, it is VERY encouraging.
If only a company would produce a fully licenced desiccated thyroid product. One that is both very good quality and appreciated by those who get to take it. (This applies to all systems/countries - UK, USA, EU and everywhere else.)
They still lean on TSH being in the healthy reference range as a sign of proper therapy whether of T4, T3 or DTE. They cannot get over the different sensitivities of the pituitary and hypothalamus to larger T3 fractions in therapy as opposed to more T4 in health. Also we are honoured by their refusal to quote anything we write - even though it well predates this new awakening. That says it all.
Keep writing is all I can say. It's often the lone voices willing to challenge the status quo that turn out to be right! After all, the NHS kept telling us different makes of levo in the UK were all bioequivalent but it turned out not to be so. There was a lone chemistry student who posted results of a dissolution test on the Internet show g that the tests used at that time were faulty. The student was right as it emerged.
Diogenes you made me so very hopeful. I suffered for many years after my TT with high T4 dosages. I had palpitations since I'm not a good T4 to T3 converter . It literally debilitated me . After much begging and pleading with my then Endo he lowered my T4 and added 5 mcg T3 . It was a start for me . And I'm forever grateful for that.
I'm very excited that thyroid patients will now have new hope that they can be helped and dosed with the very much needed T3 the more active thyroid hormone without having to beg/plead to feel well.
I'm afraid I've become more pessimistic about progress these days. When I still see so much advice on the forum that people who need T3 - especially in T3 monotherapy - must never dose to rise above the serum reference range, regardless of whether peripheral effects are sufficient, then I'm afraid there is still much education to be done among both professionals and patients.
I agree, Hillwoman. It is depressing at times to read the same sad stories repeated over and over again highlighting the ignorance of our medical professions on all things thyroid.
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..... keep rolling the bouncing bombs
