NDT for older people

[Chett]

I have been on Armour for about 10 years and NatureThroid before that. I’ve been doing fine. My doctors office called me today and said that NDT is not recommended for people over 65 because of cardiovascular issues. Has anyone heard this?

[Sunflower64]

Did they elaborate on this? NDT tends to suppress the TSH and many doctors think that causes heart disease (as they interpret a low TSH to mean hyperthyroidism).

[Chett in reply to Sunflower64]

Hi there,

She just said that there was a study done that said older people shouldn’t take NDT.

[greygoose in reply to Chett]

Yes, well, 'a study' can show anything you want it to. Doesn't mean it's right. Sounds to me more like they just don't want to keep prescribing and they're using this as an excuse. I was over 60 when my doctor put me on Armour, and he was a hormone specialist, not just a mere GP.

[Chett in reply to greygoose]

You could be right. Last month they only sent in a 30 day supply instead of the normal 90 days. Thank you!

[Margo in reply to greygoose]

Well said.

[greygoose in reply to Margo]

Thank you.

[Jazzw in reply to Chett]

Ask to see a copy of the study.

If they manage to provide one (I smell BS…) share it here and we’ll have a look between us to see if it actually says what they say it does.

[Chett in reply to Jazzw]

Good idea. I will.

[Hidden]

They cannot suddenly withdraw your NDT that would be detrimental to your health

What do they think we took before the artificial Synthroid? Years ago that is what we all took and everyone was well they did not go by TSH or blood tests doctors went by symptoms and how the patient felt

I would be arguing my case with them if I was you and make sure they know how ill this will make you feel if you have to take levothyroxine instead of NDT

[Chett in reply to Hidden]

Believe me, I will.

[Margo]

Usual rubbish from doctors, because they don't want to prescribe it.

[Hidden in reply to Margo]

So true

[Redditch]

It's not true. Lies put out by big pharma.A consistent Free T4 of over 22 is a risk of cardiovascular issues.

There is no evidence at all that a low TSH or a high FT3 or NDT causes cardiac issues

Ask for the empirical evidence.

[Chett in reply to Redditch]

I will.

[Britpol]

Yes, my husband who is almost 90 was told about the risk of atrial fibrillation but he is absolutely fine on Armour Thyroid . He has been taking it for the last 8 years after 12 years of misery on Levothyroxine. Why dont they talk about risks from Levo? With regular testing and monitoring there should be no problem of using Armour. Three members of my family are on Armour (purchased privately) switching from Levothyroxine and all three are doing much better than on Levo. @The decision to discourage the use of Armour must be, to an extent, financially motivated.

[Chett in reply to Britpol]

I’m glad everyone is doing well. If they try to take away my Armour, I will raise a stink.

[helvella Administrator]

I suspect the AGS Beers Criteria are the source - but could well be wrong.

The 2019 version is at the link below but inaccessible to me:

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

agsjournals.onlinelibrary.w...

The 2023 version is at the link below:

American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults

By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel

Journal of the American Geriatrics Society

Entry point to 2019 version - link in right Recommendations bar::

agsjournals.onlinelibrary.w...

Actual 2023 document:

agsjournals.onlinelibrary.w...

However, whilst we can read it online, we cannot print it, nor copy from it and, the final straw, cannot search it.

The evidence seems to be largely documentary.

The quality of evidence can be Low.

The strength of the recommendations can be Weak.

A lot of recommendations are conditional - for example, if Creatinine Clearance is below a certain level. Not absolute. But you can be quite sure that the mere mention of a medicine will be interpreted by some as “DO NOT USE”.

You can calculate your Creatinine Clearance rate using a calculator if you have your blood creatinine level and basic body parameters:

Creatinine Clearance (Cockcroft-Gault Equation)

mdcalc.com/calc/43/creatini...

You might be shocked at the number of medicines which are advised against. Including, for example, almost all antihistamines.

In what I found, relying on visual search or what is accessible, I saw nothing about thyroid. But it is so very easy to miss things - if you find anything, let me know, I'll happily update this reply.

[Chett in reply to helvella]

Wow, thank you. I will read it when I come back from my doctor appointment.

[Chett in reply to helvella]

I did glance at the report before I left, and saw nothing regarding the thyroid.

[helvella Administrator in reply to helvella]

So they have LOW quality evidence but assert a STRONG recommendation.

And there won't be a single word about the issues of implementing de-prescribing of desiccated thyroid.

Chett

[Chett in reply to helvella]

They didn’t even mention it at my appointment.

[helvella Administrator in reply to Chett]

Not unusual for people to get wound up by anticipation of issues - and then they get missed, forgotten, ignored, or were never going to be discussed.

As if we are all looking for a bit of stress and worry.

[Chett in reply to helvella]

So right.

[BB001 in reply to helvella]

Thanks helvella. I've just put two sets of figures into this creatine clearance calculator. The only difference between them is the creatinine result. I keto sex, age, height, and weight the same. Firstly, I used creatine = 49. [49-90] umol/L

Answer 92 mL/min

Secondly I used creatine = 103

Answer = 44 mL/min [49-90] umol/L

This makes sense to me for the following reasons. When my creatine level is high it corollates with fT3 level being too low, so it makes sense that my kidneys are not working so well in clearing creatine. Vice versa.

I use my creatine level as an additional input into my deciding on whether my current T3 dose is correct.

What would be interesting, would be knowing the T3 lost through urine with a high and low creatine level and the corresponding creatinine clearance rate.

[Lilian15]

I have been on either NDT or a combination of T4/T3 for 25 years (high dose) and I am 85, no bone problems. I did have a touch of osteopenia last year, in one wrist, but taking a calcium/D3 supplement, I think it must have healed because I do not get any pain in my wrist or any problems. They have been warning me of sudden heart attacks and osteoporosis for the past 25 years. The latest that has recently come out that it is levothyroxine that can cause bone problems. If one thinks logically old age brings on a lot of problems including heart attacks - in people who have never had NDT. When I first started onT3 from a private doctor, my GP would blame everything I had on T3. If I had a cold or a broken toe he would blame T3. This is my own personal view (I am not medical), but I think the T3 is what is keeping me well and my heart quite strong. I recently had an echocardiogram and doctor said my heart is strong for quite a few years yet, I have had diabetes for 40 odd years, and I am very overweight, things that are known to contribute to heart attacks. I know everybody is different, but this is my experience.

[arTistapple in reply to Lilian15]

Lilian. I love your post. Thank you for posting.

[TSH110]

it’s rubbish

[Chett in reply to TSH110]

After reading all the responses, I’m inclined to believe you.

[dottyb09]

I have been on NDT (3 grains)for 20 years and I am 81. I did a private test last week and my T4 was 19 and my T3 was 6. I feel good on these results. This week I had an ECG and it was perfect so I would ignore his study.

[Chett in reply to dottyb09]

Thank you, Dotty, I will.

[Helbo123 in reply to dottyb09]

out of interest what is your TSH? I am going to make my own post when I’ve got all my results together but my last test my TSH was really low but my T4 and T3 were on the low side in the range. My doctor seems to be TSH focused and said I should lower my NDT

[dottyb09 in reply to Helbo123]

It's always .01, undetectable and has been for years.

[serenfach]

They said the same for HRT without evidence. I will take my NDT and HRT clutched in my cold dead hands to the next life!

[Chett in reply to serenfach]

Haha, me too!

[Gillybean1]

Please dont fall for this Chett.

Ask for written evidence and the equivalent on Levothyroxine studies.

Every best wish , G.

[Chett in reply to Gillybean1]

Thank you, Gillybean1!

[Analeese]

Perhaps someone ought to contact the Armor company and ask them what is going on. They definitely would be very interested in the information that doctors are telling patients their product is causing heart disease.

[Chett in reply to Analeese]

I think Armour (correct me if I’m wrong), is owned by the same company that makes Synthroid. So, either way, they are making millions.

[helvella Administrator in reply to Chett]

True now - but wasn't the case until about five or so years ago.

AbbVie took over Allergan in about 2019. Allergan (under its previous incarnation as Actavis) had previous acquired Forest, who owned Armour, in 2014.

[Chett in reply to helvella]

I hope they don’t decide to eliminate Armour.

[helvella Administrator in reply to Chett]

They haven't in five years. And they appear to be going through the processes that the FDA are imposing to licence it.

[Chett in reply to helvella]

Oh, ok.

[Dgoebel]

Hi, I have been on NP thyroid for a long time, and it's the first time I've heard about it. Heart problems result if you overdose on the meds.

[Chett in reply to Dgoebel]

Yes, it was the first time I’ve heard of it too.