I have an online magazine account and been recently reading articles from a magazine called “What Doctors Don’t Tell You” and thought this blurb called “No Better Than A Sugar Pill” was interesting about T4/T3.
Attached is the screenshot of the article blurb …. Don’t ask me for entire article because I unable to share it here wish I could.
It seems to mix fact and fiction.Levothyroxine works for most people with primary hypothyroidism but about 15% have residual cognitive problems.
A study in elderly people with a mildly elevated TSH and normal fT4 found that levothyroxine gave no benefit. This is probably because TSH is usually higher in the elderly and so the trial group would have consisted mostly of people without a thyroid condition. More to the point, TSH is not a good marker unless it is very high, it is patients presenting with hypothyroid signs and symptoms that allows doctors to use an elevated TSH to 'confirm' primary hypothyroidism (and miss the diagnosis in those without an elevated TSH).
I don't like journals like this one, to survive in the market they rely in hyping the facts one way or another. They are neither balanced or informative and make life more confusing.
I agree TSH shouldn’t be used but the reality is that’s what doctors use and we the sufferers have no way around it, unfortunately… anyway the rest of the article had variety.
I agree. It made me smile that they write sub-clinical means no obvious symptoms.... so no surprise then that a tablet makes no difference?
I agree with you totally jimh111 except that T3 in addition so very helpful and important for my palpitations. I was dosed with T4 only after my TT. I experienced terrible palpitations to the point that I was afraid to leave my home. I would never know when it would happen the palpitations. I went to many Dr's and even to a cardiologist and knowingly that I had no thyroids and was on T4 only. It never accord to them that maybe just maybe I was missing and needing some T3. I can't emphasize enough that if anyone is experiencing palpitations especially if they are thyroid patients to please ask for some T3 if T4 alone is not enough and experiencing palpitations. The heart is a muscle and muscles need T3. This is my personal experiences that I wanted to share.
While it's really good that you've taken the time to share this clip with us... and it is absolutely correct that there should be open and rational discussions about topics related to all things thyroid, I'm afraid I'm with jimh111 on this one!
Seems like a very extreme precis that has the potential to miss many key points. In addition, it's ringing alarm bells with me as being a piece of negative marketing "by stealth" by a competitor of Wockhardt - not necessarily by another levothyroxine seller but maybe a competitor who has another drug that Wockhardt also sells. This is due to the fact there's a picture of very obvious branded levothyroxine with a huge red X over the top. This serves to, subconsciously, make negative associations with Wockhardt in the reader - even if they don't need levothyroxine!
I'd be checking out the adjacent adverts, that invariably appear in magazines like this, for an advert from a rival pharma company 😑
I wish I could share the entire article not just this little snippet .
Just out of interest - are there any adverts for other things around or on nearby pages to this article?
I really am interested to try to deduce if there is some element of competitive "sniping". I don't mean the content of the clip as much as the very obvious accompanying image.
A much more limited claim at the end of the discussion than the WDDTY article. I'll note that the brand of levothyroxine used as illustration varies depending on publication.
Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism
List of authors.
David J. Stott, M.B., Ch.B., M.D., Nicolas Rodondi, M.D., Patricia M. Kearney, M.D., Ph.D., Ian Ford, Ph.D., Rudi G.J. Westendorp, M.D., Ph.D., Simon P. Mooijaart, M.D., Ph.D., Naveed Sattar, F.Med.Sci., Carole E. Aubert, M.D., Drahomir Aujesky, M.D., Douglas C. Bauer, M.D., Christine Baumgartner, M.D., Manuel R. Blum, M.D., John P. Browne, Ph.D., Stephen Byrne, Ph.D., Tinh-Hai Collet, M.D., Olaf M. Dekkers, M.D., Ph.D., Wendy P.J. den Elzen, Ph.D., Robert S. Du Puy, M.D., Graham Ellis, M.D., Martin Feller, M.D., Carmen Floriani, M.D., Kirsty Hendry, Ph.D., Caroline Hurley, M.P.H., J. Wouter Jukema, M.D., Ph.D., Sharon Kean, Maria Kelly, M.Pharm., Danielle Krebs, Ph.D., Peter Langhorne, M.D., Ph.D., Gemma McCarthy, M.P.H., Vera McCarthy, Ph.D., Alex McConnachie, Ph.D., Mairi McDade, B.Sc., R.G.N., Martina Messow, Ph.D., Annemarie O’Flynn, Ph.D., David O’Riordan, M.Pharm., Rosalinde K.E. Poortvliet, M.D., Ph.D., Terence J Quinn, M.D., Ph.D., Audrey Russell, M.M.Sc., Carol Sinnott, Ph.D., Jan W.A. Smit, M.D., Ph.D., H. Anette Van Dorland, Ph.D., Kieran A. Walsh, M.Pharm., Elaine K. Walsh, M.B., B.Ch., B.A.O., Torquil Watt, M.D., Robbie Wilson, M.Sc., and Jacobijn Gussekloo, M.D., Ph.D.
for the TRUST Study Group*
June 29, 2017
N Engl J Med 2017; 376:2534-2544
DOI: 10.1056/NEJMoa1603825
In conclusion, this trial indicated that treatment with levothyroxine in older persons with subclinical hypothyroidism provided no symptomatic benefits.
nejm.org/doi/full/10.1056/N...
Interesting observation about the branding - suggests I'm probably wrong (no change there then!) 😊🙄
But you might have been right with respect to WDDTY!
how do you pronounce that? "WT" "DD" "TY"
WHAT DIDHE TIE?
Somehow in this thread an extra T has crept in to the abbreviation which makes it more confusing.
WDDTY
What Doctors Don’t Tell You
If a patient is subclinical, s/he may be at risk heartwise but not have any observable cardiac or other symptoms. Taking T4 will restore TSH within range (preferably about 1 or even lower) without any obvious effect but may prevent (further) cardiac damage. So the T4 may be extremely beneficial even though it may well look like nothing more than a sugar pill to a medic whose knowledge of hypothyroidism is severely lacking.
I wasn't able to reach the website through the link. Could you double-check it? Thanks.
Which link? The ones I've tried work for me.
The one on the New England Journal of Medicine article.
Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism
Not sure why but for some reason, the link has symbols inserted in it. When I pasted the link into notepad, this is what I saw:
"healthunlocked.com/redirect...%3A%2F%2Fnejm.org%2Fdoi%2Ffull%2F10.1056%2FNEJMoa1603825"
I was able to find it
nejm.org/doi/full/10.1056/N...
I just checked and my link has the same symbols. Most likely, the website was "down" at the time I checked. There's nothing wrong with the link you posted. Sorry for the inconvienance
The odd symbols are for characters like hyphens, full stops, commas, quotes, question marks, etc. The HU software takes the full link and changes the characters that cause problems into these codes. But they should work when you use them!
When you pasted the link into your reply, the HU software got hold of it and treated it as a link converting some of it to blue, but some black. easiest way of handling a link you want to post for discussion (rather than using as a link) is to add some spaces to the link - maybe after every "/" and full stop?
Glad it worked in the end. 
if someone is sub clinical and the GP gives only 25mcg or 50mcg levothyroxine …..then patients aren’t going to feel any better…..quite likely worse
We see this all the time…
GP think’s patient is only just/mildly hypo …..prescribe 25mcg or 50mcg and leave them on that dose, often for years/decades
Just because someone is older ….they still need dose increased slowly up to full replacement dose
Plus low vitamin levels, especially low B12 even more likely in anyone over 65 years old
This might not be the study I vaguely remember. TSH dropped from 6.41 to 3.63 which is a very small change when you consider the inverse log relationship to thyroid hormones. They should have brought TSH down to around 1.0 to 2.0. This would have required about twice as much levothyroxine.In any event I doubt a trial in elderly subjects with just mildly elevated TSH and generally asymptomatic would be any use.
An interesting article from the same website with the title :
The thyroid killer lurking in your water
is on the subject of fluoride and chlorine :
wddty.com/features/the-thyr...
I switched to hydroxyapatite toothpaste and cut down on my tea drinking some time ago, also buy bottled water in Ireland if there. I really hope they don’t fluoridate the remaining areas of the UK, but there are still people with outdated info campaigning for it unfortunately.
I really hope they don’t fluoridate the remaining areas of the UK
Too late. The government have already decided they are going to do exactly that :
theguardian.com/society/202...
gov.uk/government/publicati...
The local authorities haven’t all gone ahead yet but yes, I worry it’s a matter of time, unless the idiots read the latest research on how stupid it is. ….
But unfortunately some local councils generally just sit there and vote on what’s presented to them, and are being fed the ’ safe and effective’ line and some decades old study from Birmingham from before they invented the toothbrush, rather than the up to date neurotoxins and IQ reduction research.
newfc.org.uk/50-reasons-to-...
Scroll through to item 26 and 44 if time is scarce - 50 reasons not to fluoridate....
Recent US research has indicated a reduction in childhood IQ... 😔
Is it just me being old cranky and cynical but , governments are supposed to work to benefit the nation and it's health. Whenever I read/hear /see an announcement by the Government about some wonderful new scheme being implemented two things happen. I wonder, so who's mate/sponsor/relative is going to gain financially . I actually visualise that builder technique, as they suck air through their clenched teeth, to impress to the recipient of a quote just how much this is going to cost. They would be better funding NHS dental contracts appropriately, it is lack of affordable or free dental care that causes problems, not the lack of fluoridated water. If you can afford private dental care you have good teeth if you can't well tough luck
I do remember reading a theory about fluoride some years ago, but I have no idea if it is remotely accurate. I suspect it is just a conspiracy theory.
It has been suggested that fluoride is a waste product of some manufacturing processes and it is cheaper and easier to dump it in water for people to drink than to dispose of it any other way.
Ah see, don't let the environment minister hear about it, they will say dumping raw sewage into the rivers is to increase our potential for free faecal transplantation en masse, we should be grateful it costs £1300 apparently for a treatment
May I ask which brand of hydroxyapatite do you use? I find them all so expensive but I’m looking for one affordable if you know of one 🙏
I think I remember trying Biomed, Biorepair and Dr Wolff Bioniq and they ranged from £3- £8 on Amazon Sub& save deals. I used to use the sensodyne rapid repair which was £3.5-5.
Some of them are very expensive and I meant to compare all the ingredients to see if there was any pros, but that’s something else that fell by the wayside. The Biomed ones (same as Splat?) were the cheapest and first one I tried, someone found them on a thread on here I think, but a review then said it was linked to Russia, so I moved on to try a few others. (It now states made in Bulgaria on the picture .) There’s a Singapore one I think looked interesting was going to check the ingredients.
I keep reading we’re a bit lavish with the toothpaste, I notice I use less with the electric toothbrush heads than in the days of the traditional toothbrush, which used to hold way too much much to the joy of the manufacturers ….
Great thank you I’ll look into those x
I love this bit:-"“Nobody ever taught us in school that as doctors we can’t accept things on blind faith, that we have to challenge and test everything that we’re told, to have an open mind and make sure that what we’re doing is correct and make sure that the science behind what we’re doing hasn’t moved on. We need to be humble about what we do, because a lot of what we do is just plain wrong.”
Alleluya!!! If only they applied this thinking to treating hypothyroidism which has gone backwards in recent decades....
As it has with regard to many other conditions, syndromes and diseases.
Sorry to hear that. I know B12d is another unrealistic night mare regime of treatment!!
I read it more as anti ageism!! But not seen the whole article. Personally I think it's seems to be so flawed on many fronts...... It's a grand statement that doesn't seem to be backed up well. A further consequence when you just rely on one blood test of TSH. And then the assumption that if you are in your 70s then for some unknown reason levothyroxine doesn't work even if the blood test of TSH shows it does!! Magical thinking!!I do wonder if the illusion that been created of the wondrous TSH will ever be dropped. Sloppy doctoring with poor evidence but a grand statement.... Posturing???
The lead-Prof Stott says levo complete waste of time.No better than a sugar pill.
Now similar statements about statins get you struck off.Surprised he's stuck his neck out against the orthodoxy like that.Ditto the man who said don't immunise babies.
He's wrong of course.I'm subclinical but i would say my face is more defined now that i take levo- so it does something.
In the statin debate at least the flat earther's can point to severe side effects and onset of diabetes , but with levo not only does it help but there are no side effects (consistent across a cohort).
From what i read on here we'd like blood tests to look at t3 and some people are exceptions to rules, but i don't think anyone has ever put it forward that levo should not be taken on the basis that it doesn't work.
Levothyroxine doesn't work very well for me.
If I remember correctly, this study was carried out on about 12 people in an old peoples home. They were only given 25 mcg per day and I would imagine, in their circumstance that the Levothyroxine was administered with every other medication they were on, at whatever time of day the care home staff gave them their meds. I think this was the “research “ Boelart and Pearce cited in their recommendations” for NOT prescribing Levothyroxine to the elderly. I’m sure someone will correct me if I’m wrong.
Good point about timing of medication! When I was in hospital, there was no chance of choosing the time I was given my levo… despite my frequent requests. Requests flatly refused.
Could you say which research you refer to Boelaert and Pierce conducting?
I think this was a “talk” given by Boelaert some time ago (I dont know whether this is available on YouTube) when she cited this research as “evidence “ that the elderly found no significant improvement whilst taking Levothyroxine. I believe she was challenged and had to admit that this outcome was based on 12 elderly people living in a care home. Not hardly a scientific research. They must think we’re all stupid and this woman is now the President of the British Thyroid Association 🤬
Thanks!
Words fail me...... No wonder treatment in the UK is in tatters!! 😤😤😢
I heard that talk, very cold attitude and I still can’t get over these so called endocrinologists lack of scientific understanding. It’s almost like you’ve hired the dodgy plumber who’s managed to watch the wrong utube video on mending a leak before arriving.
Dear god - how did she manage that?
I'll just note that if levothyroxine truly is nothing but a placebo in the older population, then a potential and apparently logical inference is that NONE of the older people need it. Not even those who have needed it for their entire life.
Look out for thyroid-less older people having their levothyroxine de-prescribed.
Even if that is a gross mis-reading, we know only too well that this line:
In conclusion, this trial indicated that treatment with levothyroxine in older persons with subclinical hypothyroidism provided no symptomatic benefits.
.. will actually be interpreted as
In conclusion, this trial indicated that treatment with levothyroxine in older persons with hypothyroidism provided no symptomatic benefits.
I mean, it is so easy for that to enter our minds. Somehow much easier than remembering to include "subclinical".
Even a modest rearrangement helps with emphasis:
In conclusion, this trial indicated that, in older persons with subclinical hypothyroidism, treatment with levothyroxine provided no symptomatic benefits.
It's also a tautology.Subclinical- no symptoms, so you wouldn't expect the relief of symptoms.I take it and get no tangible benefit, I also take statins and aspirin, ditto.We trust the body of mainstream evidence.
Seems to me if it didn’t work I wouldn’t be here because I don’t have a thyroid at all 👍😀
Ahhh but by default of having no thyroid you are not subclinical...
Referring to the research by Stott et al...
Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism
nejm.org/doi/full/10.1056/N...
They did supply some Supplementary Data at the time of publication which I thought was worth reading at the time, although I don't remember why I thought that :
nejm.org/doi/suppl/10.1056/...
The trial protocol is also available :
nejm.org/doi/suppl/10.1056/...
...
One thing I have a vague memory of reading when this paper first came out (but I don't have a source for this info) was a comment by one of the researchers that confirmed they gave only the smallest dose possible to get people's TSH into the range and no further. And they admitted that allowing people more Levo to reduce their TSH to lower in the range may have been a worthwhile experiment to have done.
...
I also remember reading once that if someone with overt hypothyroidism forgot to take their thyroid hormones repeatedly then after two weeks they would have forgotten they were ever hypothyroid and had ever taken thyroid hormones.
Since overt hypothyroidism requires a TSH above 10 for diagnosis and TSH varies according to time of day, then unless that was taken account of by the researchers those subjects declared to have subclinical hypothyroidism could well have had overt hypothyroidism at another time of day.
Thank you for posting this extract.
It seems to me to be a reminder that not everything we read is true. I can only say that up until 2 years ago I felt myself to be a young 69 year old but the onset of symptoms of what was diagnosed as sub clinical hypothyroidism made me feel an old, failing 70 year old. Thank goodness for the past 18 months of treatment with Levothyroxine which has rescued me and made me feel a reasonably active 71 year old. Ever the sceptic, I would never have believed the recovery or the second chance one tiny tablet has afforded me.
It does actually specifically say it’s related to sub-clininical hypothyroidism where the Patient is not actually showing any overtly obvious symptoms so should be read with caution. If you have symptoms s don’t stop taking your meds
I can tell you a TSH of just under 10 for me felt absolutely dire - the label subclinical is completely arbitrary and utter nonsense. Either you have thyroid disease or you don’t. If you have it you should be treated asap. I spent decades with ill health because of untreated thyroid disorder it was completely unnecessary to suffer like that and did me no favours at all.
I agree with you about "subclinical" hypothyroidism. It is completely arbitrary and was probably invented just to save money. Women are under-served by medicine in all sorts of ways, and it is sadistic as a result.
One of the ways in which medicine saves money is in switching cause and effect.
So, if someone has a TSH over range but under 10 and has symptoms then doctors can tell the patient that a TSH under 10 does not cause symptoms - it is "subclinical" not "overt" - so any problems they have must be caused by "something else" which the doctor will never look for. They will instead label the patient with a dustbin diagnosis, i.e. one of the usual things such as depression, anxiety, patient needs to eat less and move more, fibromyalgia, chronic fatigue syndrome, hypochondriac, health anxiety, ...
The reason this has become so much more common in the last 20 - 30 years (in my opinion) is so that when the NHS collapses and insurance companies take over they can deny health cover (or reduce the length of time the patient is covered for) to all those patients with dustbin diagnoses on their health records. It's all about saving money, cutting costs and increasing profits.
Menopause was a popular one thrown at me…how odd that the symptoms persisted AFTER the menopause 🙄…..it was tommyrot. I’m afraid I can’t help but agree with your observations as to why it’s happening. Keeping people ill is a false economy unless your a money grabbing insurance company with zero moral scruples
I recently read about a case of an elderly woman in a care home, and like many others, she contracted Covid. She was sent to hospital and the doctors took her off all her drugs as she was not expected to survive, but she did and was sent back to the nursing home. For some reason her levothyroxine was not reintroduced and she died some weeks later. The coroner found the direct cause of death was directly attributed to this.
As an elderly female, I feel disposable.
How incredibly sad & maddening. It is crazy the power some have with these issues.
Times Article about Extortionate Prices of Drugs
updated michael crawford article
Another unhelpful article!
Interesting article about Ferritin
