Yet another T3...

[LindaC]

Just stumbled across this - American Thyroid Association - any value in it? Or scaremongering?

WHAT ARE THE IMPLICATIONS OF THIS STUDY?

This study found that the use of L-T3 (alone or in combination with L-T4), compared to L-T4 alone, was associated with increased risk of heart failure and stroke, but not osteoporosis, cancer or atrial fibrillation.

Additional studies focusing on only the L-T4 and L-T3 combination group are needed, as the dose to L-T3 is much lower than with L-T3 alone. However, until those studies are done, it is important to take into consideration the risk of heart failure and stroke when considering adding L-T3 for the treatment of hypothyroidism.

thyroid.org/patient-thyroid....

[jimh111]

They like to quote this study. There are problems with it. It doesn't correct for dose or atempt to select patients with similar degrees of hypothyroidism. In general patients on combination therapy have more severe symptoms and are on higher overall doses.

If we assume that those on combination therapy were on higher overall doses with lower TSH it shows the risks associated with higher than average hormone levels. This is a risk of high dose not of liothyronine.

One of my previous posts healthunlocked.com/thyroidu... suggests that levothyroxine carrries additional cardiac risks compared to equivalent doses of liothyronine.

[LindaC in reply to jimh111]

Yes Jim, I recall that post. Most interesting - thank you. Some of us need a high dose of T3, since ranges seem to have little to do with us!

[jimh111 in reply to LindaC]

Yes, I need around 45 mcg and it does carry risks. The problem is I can’t function with less and being clinically hypothyroid also carries risks that are likely to be higher. This is why I always encourage people to try and get by with lower doses if they can but to take more if they absolutely have to. Levothyroxine monotherapy carries very high risks but it is difficult to persuade the medics.

[LindaC in reply to jimh111]

Thank you jimh - I now take 87.5 mcg of T3 to feel well - gradually added to over many years and only added to when essential. Yes, indeed - there is a need to get by with lower doses - but the choice of well or not well has to be individual... something medics simply don't grasp. My heart seems to have improved over these years and I feel pretty well, compared to those very dark times. Levo never worked for me, it made me hyper!

[jimh111 in reply to LindaC]

I was severely hypothyroid and needed higher doses than you. After many years I discovered it was due to endocrine disrupting chemicals. I treat it with either Enterosgel one teaspoon daily or WindEze three capsules daily. I was able to drastically reduce my T3 dose. If you haven't tried it give it a try but keep a close eye on your pulse and if it increases drop your T3 dose quickly.

[LindaC in reply to jimh111]

Oh, thank you jim!! I've taken WindEze in the past - have diverticular disease - and currently use Fybogel. My pulse can go as low as 33 and as high as 170...!? Generally it's fine, 60s - 80s.

How did you discover that your severe hypothyroidism was due to endocrine disrupting chemicals? There certainly is so much to this condition.

[jimh111 in reply to LindaC]

Incredibly long story, some of hit described here ibshypo.com/index.php/acqui... .

[LindaC in reply to jimh111]

Thank you! Much appreciated.

[tattybogle]

not enough detail to show anything much re. cause/ effect.

no idea of the kind of dosages taken , no idea of TSH / fT4 / fT3 levels , just they had taken 'some T3 for at least 3months' .......so no idea if these were taking T3 in a way that we would regard as sensible , or not .

also , no idea of the history of why they were taking T3 , and not just levo ...... no way to know what impact that has had..... eg presumably includes people who only ended up taking T3 after decades of suboptimal T3 levels on levo....

lots of things they found no increased risk for , so if we do choose to believe it ,, it;s not all bad news.

so you pays your money and takes your choice..... it would not surprise me at all if T3 use increases some risks ....... but it is usually taken in an attempt to improve quality of life , not length of life.

'death and taxes' ......if taking it improves someone's life enough , then they will probably continue to take it even if it does mean they are more likely to die of 'something heart related'... rather than stop taking it and die from 'giving up on life' .

[LindaC in reply to tattybogle]

Couldn't agree more - I've had a hugely improved quality of life, since first using T3 [2010/11] and never looked back. Indeed, quality attempts not necessarily quantity of years. Yes, many of us have been in 'sorry states' prior to using liothyronine. Few hiccoughs, sometimes locating it, that's all. My heart has certainly improved since using T3, as has much else. xox

[humanbean]

I'm not convinced about the paper. It's behind a paywall so we can't see it, which I always think is dodgy in any subject where there is ... disagreement.

There are alternative links on T3 and the heart which show different conclusions :

thyroidpatients.ca/2018/07/...

ahajournals.org/doi/10.1161...

ahajournals.org/doi/10.1161...

ahajournals.org/doi/full/10...

bmccardiovascdisord.biomedc...

frontiersin.org/journals/ph...

ahajournals.org/doi/full/10...

[LindaC in reply to humanbean]

No, I'm not convinced either - thank you for your view - and anyone else cautious of this - a lot of papers do have to be carefully considered. Thank you for these - so much appreciated.

[Tina_Maria]

I cannot see the whole paper but it does seem to have some flaws.

First of all, 90 days of follow up is not a lot of time, considering that patients taking liothyronine are most likely to be on it for years. So the follow up would need to be a lot longer to be meaningful.

In addition, have those patients been analysed for heart failure or stroke before they have started T3 therapy? Many patients who go onto having T3 therapy, have had low levels of circulating T3 for a considerable amount of time - hence their need for combination therapy. T3 plays a major role in regulating heart rate, cardiac contractility, and arterial peripheral resistance, all which are implicated in heart failure or stroke. Low levels of T3 can cause cardiac problems or can make existing heart disease worse. Is it not more likely that these patients have been at risk for heart disease BEFORE they have started their T3 therapy and that the low T3 they had over a long period of time is more likely to be the culprit, rather than the T3 therapy itself?

And an association or correlation is not always causation. Simple example: there is a strong correlation between eating ice cream and sunburn. But does eating ice cream cause sunburn? No, as both are caused by sunny weather. So even if there is a strong correlation between T3 combination therapy and incidences of heart failure and stroke, it might not be the entire story.

[LindaC in reply to Tina_Maria]

Yes, agree. This paper does not provide much in the way of reliability or validity re the background experiences of many hypothyroid - T3 taking - patients. My heart was certainly beginning to play up from 2003/07, with a list of hypothyroid signs/symptoms (recorded by x2 GPs as 0.0?, so 'just within range', yet this was ignored out of hand.

After a few more years of quite awful difficulties, I recalled that in 2007 a [private] cardiologist questioned my thyroid status, which sent me on the bizarre track of discovering the hypothyroid world. On seeing what was going on, I was stunned at/by the flippant and sneering attitudes of hapless endos. I found two great guys - from HU comments - and found out about Gordon Skinner and Barry Peatfield - doctors who understood hypothyroidism. Yes, diagnoses + Armour Thyroid, then 2010 to used Liothyronine for LIFE. Aside from the odd blip, life returned and remains as such.

My background included conducting virtually every statistical test in existence and boy did I used to rub this in the faces of the 'maze dull rats', spouting their little ranges. Causation is incredibly difficult to show, often impossible.