I was gathering information about T4, T3 and thyroid in general, when I came across a page on the BTF site that says treating hypothyroidism with T3 is NOT recommended and that treating it with T4 alone has better results.
I was a little bit surprised by this statement and wondered what their thinking was behind it? Are they sponsored by big pharma who like to push T4 or is there something else to it?
Generally interested in what people thought of this advice and whether people agreed with it.
The advice is under "Are there alternative treatments to Levo..."
In this case, I don't see "big pharma" as being a direct and manipulative reason.
I see ignorance and closed-mindedness and unwillingness to accept having been wrong for decades. Pretty much from the 1960s onwards. So not just current generation of endocrinologists but previous generations.
However, in 1980, Thyroid BP (desiccated thyroid) disappeared because that generation had lost faith in it. Yet that disappearance was predicated on the availability of BOTH levothyroxine and liothyronine.
It is since then that liothyronine ended up as something to positively avoid. While the massive price increases played a huge role, few endocrinologists were prescribing liothyronine even when it was £12 to £20 a pack. So that is not the sole reason.
I'd add in treating to blood tests, especially TSH as a major factor. Plus lack of experience. Prejudice. And unwillingness to accept anything that had not been formally trialled. (Ignoring that the change to near-universal levothyroxine was completely untrialled.)
helvella - The End of Thyroid BP
A brief note of one public statement about the final withdrawal of the UK product, Thyroid, BP. I suspect it summaries the attitude of the time..
Researchers discovered in 1970 that T4, which is produced by the thyroid, is converted within various tissues within the body to T3, e.g. within the liver and the kidneys. T3 has one less iodine atom than T4, so conversion involves knocking a specific iodine atom off molecules of T4.
The thyroid itself also produces T3 directly - about 20% of the body's total production.
Doctors leapt on this and decided that thyroid treatment was simple. Just give T4 (aka Levo) to thyroid patients and they could create their own T3. All they thought they needed to know was TSH - it does all the controlling of T4 production, and the body created T3. Easy-peasy!
So, we ended up in the situation we're in now. Measure TSH, which stimulates the thyroid to produce T4 and the body automatically produces T3 from the T4.
Current assumptions under which doctors treat hypothyroidism, several of which are wrong (the bits in italics are wrong) :
1) The hypothalamus produces TRH (Thyrotropin Releasing Hormone). Thyrotropin is another name for TSH. The hypothalamus never makes mistakes and always produces sufficient TRH for good health.
2) The pituitary produces TSH (Thyroid Stimulating Hormone). The pituitary never makes mistakes and always produces sufficient TSH for good health.
3) The thyroid produces T4/thyroxine/levo in perfect amounts as long as the TSH is perfect.
4) The body converts T4 to T3 and always produces what the body needs even if the patient doesn't have a thyroid or their thyroid is diseased and the patient takes Levo in a pill.The loss of T3 production from the thyroid is irrelevant - T4 to T3 conversion always makes up for the loss.
5) Problems with the hypothalamus or the pituitary causing TSH to be too low and therefore thyroid hormone production to be too low are very rare so don't need to be considered when testing and treating.
6) Low nutrients are caused by the patient eating a poor diet. People living in the western world are almost never short of vitamins or minerals.
7) Patients who get fat are eating too much and/or are lazy and have only themselves to blame.
British Thyroid Foundation( for patients) is VERY closely associated with the British Thyroid Association, which is basically the professional body for Endo's in the uk.
The previous president of the BTA was professor Simon Pearce (Endocrinologist), who is openly and ardently anti T3 use for hypothyroidism , extremely dismissive of any patients on levo who claim to have remaining symptoms.. to the point of using sarcasm against them on his twitter feed.
and the current president is not much more open minded on the subject of T3 use .
the BTA has huge influence on training / research , and guidelines.. and presumably on the career progression of endocrinologists ..
So basically , if the BTA don't like something , the BTF are not going to promote it... and any endo's who do are putting their head above the parapet , which may well have consequences for them professionally.
The BTF says "...L-T3 (liothyronine), but this is not recommended for routine use in hypothyroidism."
That's correct - national guidance says it's not recommended for routine use (that is first-line treatment) but it can be prescribed as a second-line treatment if levothyroxine doesn't make a patient well etc.
The BTF has chosen to write not in bold, which NHSE does not do. I assume that is on the advice of the BTA as they seem to write much of the info for BTF.
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The British Thyroid Foundation's Response to the Scottish Parliament in November 2013
Does everyone know how/why they have hypothyroid? 
HOW MUCH T3 DOES A HEALTHY THYROID SECRETE?
Are you adding t3 to NDT? Why and does it work for you?
