“Sub-laboratory” Hypothyroidism and the Empirical Use of Armour® Thyroid use

A very useful article by Dr Alan Gaby.

Abstract

Evidence is presented that many people have hypothyroidism undetected by conventional laboratory thyroid-function tests, and cases are reported to support the empirical use of Armour® thyroid. Clinical evaluation can identify individuals with “sub-laboratory” hypothyroidism who are likely to benefit from thyroid-replacement therapy. In a significant proportion of cases, treatment with thyroid hormone has resulted in marked improvement in chronic symptoms that had failed to respond to a wide array of conventional and “alternative” treatments. In some cases, treatment with desiccated thyroid has produced better clinical results than levothyroxine. Research supporting the existence of sub-laboratory hypothyroidism is reviewed, and the author’s clinical approach to the diagnosis and treatment of this condition is described.

Alternative Medicine Review, Volume 9, Number 2, 2004

http://www.altmedrev.com/publications/9/2/157.pdf

Mary Shoman Interviews Dr Kenneth Wolinger – New Hypothyroidism Guidelines Ignore Patient Concerns

Kenneth Woliner, MD is an integrative physician in private practice in Boca Raton, Florida, who uses conventional medicine as well as evidence-based complementary and alternative therapies to treat a variety of conditions, including hypothyroidism. Dr. Woliner has concerns about the American Thyroid Association (ATA) new “Guidelines for the Treatment of Hypothyroidism,” and has shared them in this Q&A interview.

Dr Wollinger: I think they are misnamed. Instead of being called “Guidelines for the Treatment of Hypothyroidism,” this white paper should have been called “Levothyroxine: How to Protect its Market Share.” Simply put, the entire paper, starting with its “Background Statement” is a defense of levothyroxine monotherapy, despite the general dissatisfaction that many patients have when faced with no choices, and told there is only one possible drug to treat their medical conditions.

See the whole interview at:

http://thyroid.about.com/od/Treatments/fl/Dr-Kenneth-Woliner-New-Hypothyroidism-Guidelines-Ignore-Patient-Concerns.htm

Public Support and New Research Promote Changes in Thyroid Treatment Guidelines

Gary Pepper M.D.    Metabolism.com    October 21, 2014

Clearly this is not an endorsement for the use of desiccated thyroid but it does open the door for its use when the clinical situation is appropriate. Until now, a prescriber could face the accusation of recommending toxic treatment, if held to the AACE standard.

In overturning the prior ban on Armour the new AACE recommendations refer to a study done at the NIH by Hoang and colleagues published in May 2013 in  Clinical Endocrinology and Metababolism  which showed that desiccated thyroid could be used safely and effectively in treatment of hypothyroidism.  In this study, about 50% of the individuals treated at different times with levothyroxine and Armour preferred Armour, while 19% preferred levothyroxine. Since the time of publication of the NIH study, Paul Cassanova-Romero  and myself, published our study showing that almost 80% of people who had inadequate relief of hypothyroid symptoms on levothyroxine, preferred Armour Thyroid treatment.

In explaining the new stance of the AACE on use of desiccated thyroid, the committee also referenced a growing understanding of the diverse genetic factors controlling how the body utilizes and responds to thyroid hormone. Due to genetically programmed differences it is plausible that a portion of the hypothyroid population would require treatment with supplemental T3 (as opposed to  Synthroid or levothyroxine made of the hormone T4) supplied by Armour. In addition, desiccated thyroid contains other hormones which could be important to achieving full clinical benefits of thyroid replacement therapy. Genetic testing is not yet at a point where this could be used to determine who needs the addition of T3.

As far as the AACE’s stated concern about safety of Armour Thyroid, it seems strange that desiccated thyroid which has been in use for 100 years is questioned while the synthetic thyroid preparations available for merely half that time, are not being held to the same safety standards.

I have made a request to the organizers of the yearly national meeting of endocrinologist, to allow presentation of our study on patient preference for Armour Thyroid.  Several weeks have gone by without response to our request, however.  A public campaign will help assure the new information reaches the nation’s endocrinologists. For this purpose please email Sheila Spitola, administrator for the national meeting,  (sspatola@aace.com)   , with the statement,   “ I support an open discussion of use of desiccated thyroid in the treatment of hypothyroidism.  The authors of Conversion to Armour Thyroid from Levothyroxine Improved Patient Satisfaction in the Treatment of Hypothyroidism,  should be given the opportunity to present their data at the 2015 national AACE meeting. “

http://www.metabolism.com/2014/10/21/public-support-and-new-research-promote-changes-in-thyroid-treatment-guidelines/#more-21444

 

 

Conversion to Armour Thyroid from Levothyroxine Improved Patient Satisfaction

An interesting article by Gary M. Pepper & Paul Y.  Casanova-Romero in the Journal of Endocrinology, Diabetes & Obesity,  2(3): 1055, (2014), which contains this telling sentence:

. . . treatment of hypothyroidism with levothyroxine (L-T4) monotherapy has been the standard of care in the United States for over 3 decades. This is despite the reported failure of this form of therapy to result in satisfactory resolution of symptoms in a portion of treated individuals.

Abstract

The use of Armour Thyroid (natural desiccated thyroid) in the treatment of hypothyroidism has generated debate among endocrinologists although there is evidence that a significant percentage of patients prefer this medication to T4-only replacement strategies. In this retrospective analysis we investigate the preference for replacement therapy of patients with persistent subjective symptoms of  hypothyroidism on T4-only treatment who subsequently switched to Armour Thyroid (AT).

Methods: 450 consecutive patients being treated for hypothyroidism were screened. Of these, 154 had been switched from either generic or brand T4 replacement to AT for treatment of persistent symptoms of hypothyroidism. Patients undergoing treatment for thyroid cancer or on suppression therapy for nodular thyroid disease were excluded. Patients were instructed to have their blood sampled for thyroid function testing in the morning after taking their medication. After a minimum of 4 weeks on medication patients were asked to compare AT treatment versus T4-only treatment using a 5 point satisfaction rating scale. Results are reported as mean ± SD.

Results: On a 5 point Satisfaction Rating Scale with “5” indicative of the highest level of satisfaction, 117 (78.0%) patients gave a score of greater than “3” in preference for AT. Three patients treated with AT and one treated with LT4 reported adverse events, all minor. TSH was 1.30 ± 1.9 mIU/L and T3 1.81 ± 0.78 pmol/L on L-T4 monotherapy while TSH was 1.27 ± 2.2 mIU/L and T3 2.31 ± 1.33 pmol/L on AT (NS for TSH and p<0.003 for T3 ). T4 to T3 ratio on L-T4 monotherapy was 8.45 ± 3.7 while it was 4.70 ± 2.0 (p<0.001) on AT. There was no significant change in weight after switching to AT.

Conclusion: AT treatment produced high satisfaction scores in a group of hypothyroid patients with persistent symptoms on L-T4 therapy. Our findings suggest that AT preference is not due to placebo effect, induction of hyperthyroidism or weight loss. No significant untoward effects of this therapy were noted inclusive of 30 subjects 65 yrs of age and older. As suggested by Hershman [20], AT seems no more dangerous than adding T3 to L-T4 therapy and can be offered to patients who “don’t feel normal” on L-T4 monotherapy. Larger prospective studies would help clarify what role AT plays in replacement therapy of   patients dissatisfied with L-T4 monotherapy for hypothyroidism. Our results are encouraging to clinicians that this drug does provide a viable treatment alternative.

ABBREVIATIONS

TSH: Thyroid Stimulating Hormone; L-T4: Levothyroxine; T4: Thyroxine; T3: Triiodothyronine; AT: Armour Thyroid; L-T4 levothyroxine; NT: No Thyroid Disease; SRS: Satisfaction Rating Scale

See the full article at:

http://www.jscimedcentral.com/Endocrinology/endocrinology-2-1055.pdf

Cold hands? Always tired? It could be the hidden thyroid problem many doctors refuse to treat

From  The Daily Mail – by Jerome Burne, 26 August 2012, Updated 29 August 2014

1 in 20 – The proportion of people in the UK affected by thyroid disorders

A decade ago, Lilian Swallow got very ill, with a long list of complaints. ‘At my worst, I had an irritable bowel, my hair was falling out and I was so tired that just making a cup of tea exhausted me.’

Her GP sent her for various tests but they all came back negative.

‘Eventually, he decided I must be depressed and that it was all in my head,’ says Lilian, now 75. ‘But that didn’t seem right. I was so weak, I couldn’t even pick up my baby granddaughter. Friends never called after 9pm, as they knew I’d be asleep.’

Lilian, a retired legal secretary, sought the advice of another doctor, who checked her thyroid and found one crucial form of thyroid hormone was present in very low levels. She was prescribed a hormone replacement and ‘the effect was astounding. Within a few weeks all my symptoms started to clear up’.

However, the thyroid hormone Lilian was lacking is not normally screened for by the NHS, and the treatment she received is contrary to official guidelines – although a growing number of doctors disagree.

Every year, one in four people in Britain has a standard blood test to see if their thyroid hormone levels are normal. Three million are told they are thyroid deficient (or hypothyroid), and the majority are successfully treated with a synthetic version of the thyroid hormone, known as T4.

But patient groups and some experts claim the test is unreliable because it measures only one thyroid hormone. In fact there are two. The thyroid gland produces T4, which is checked in the blood test. This is then converted into T3 – the active hormone that can be used by the body’s tissues and cells.

People such as Lilian can be fine for T4 but low in T3. However, the T3 tests are complex and rarely offered by the NHS.

So, if your blood test doesn’t show you to be low in T4, you won’t be prescribed thyroid hormones that could alleviate your symptoms, including fatigue, weight gain, cold extremities, muscle aches and weakness. Instead, these symptoms are often dismissed as being ‘all in the mind’.

It is estimated that 300,000 people, mostly women, are in this position.

Official policy advises they shouldn’t get thyroid hormone replacement because they aren’t deficient – despite not knowing what their T3 levels are – and that giving them the drug could cause an overdose or damaging side-effects such as raised blood pressure.

If your blood test doesn’t show you to be low in T4, you won’t be prescribed thyroid hormones that could alleviate your symptoms, including fatigue, weight gain, cold extremities and muscle aches

This leaves doctors in a difficult position. Only around 100 are prepared to treat these people. One is Professor Stafford Lightman, a senior endocrinologist at Bristol University, who believes that there is a case for giving these patients either form of thyroid hormone.

‘Many of my patients are angry,’ he says. ‘They’re convinced doctors aren’t going to take them seriously.

‘But we don’t have a reliable blood test to tell us if enough T3 is getting into tissues. If it is, then an excess can cause harm, but if it isn’t, that’s when patients should be treated.’

T3 is given as a treatment to some patients, but mainly those who have had thyroid cancer.

Sheila Turner, chairwoman of the charity Thyroid Patient Advocacy, is fundraising for a legal challenge to the guidelines. ‘My blood tests show my thyroid levels are normal, but I can only campaign as hard as I do because I get a hormone supplement from a supportive doctor. Without it I’d be on the floor, almost paralysed with fatigue,’ she says.

She wants endocrinologists to accept there are two sorts of hypo-thyroidism – the ‘official’ sort that affects 85 per cent of patients, and those with ‘Low T3 Syndrome’. She explains: ‘We produce enough T4 but don’t turn it into T3 at all well.’

However, she and other patients may have their supply of T3 withdrawn because of the pressure put on doctors not to prescribe it. In a letter recently sent to the charity, an endocrinologist admitted to feeling ‘vulnerable and fearful’ over reports of medics being struck off or suspended for prescribing an unofficial thyroid remedy.

‘I am withdrawing my name from your list until I have been able to clarify the situation,’ she wrote.

Sheila and her supporters are taking on the Royal College of Physicians and five other bodies, including the Society for Endocrinology and British Thyroid Association. Their combined policy statement says that if a blood test shows you are not deficient in T4, you don’t need a replacement. But Sheila says: ‘It assumes that the only reason people have low thyroid hormones is that their thyroid gland isn’t making enough. It doesn’t allow for the fact that even though you’ve got enough in your blood, not enough is getting into your cells.’

Some experts agree. One is American endocrinologist Dr Kent Holtorf, medical director of the Holtorf Medical Group and the National Academy of Hypothyroidism. He says that as well as people who can’t convert T4 into T3 effectively, other patients don’t benefit from standard thyroid tests either.

‘If you’ve got a chronic disease, you’re going to have less energy for getting thyroid hormone into the cells where it is needed,’ he explains. ‘This could mean you show up as having a normal level in your blood when you actually have a damagingly low level in your cells.’ Depression, obesity, diabetes and auto-immune disease are examples.

The Royal College of Physicians is opposed to treating patients with normal blood levels of T4 because symptoms such as fatigue and weight gain are common in people in their 50s and 60s due to other factors. ‘That’s why the blood test is so useful,’ says a spokesman. ‘If patients get treated for an illness they don’t have, genuine and more serious illnesses such as cancer or liver disease could be missed.’

But one result of withdrawing treatment is that patients are driven to get supplies elsewhere, such as unregulated online pharmacies.

Lilian resorted to buying supplies from the internet when, two years after her health improved, her doctor said her blood levels of thyroid hormones were too high and she was in danger of overdosing. Her dose was cut, and within a few weeks her symptoms returned.

‘Every part of my body had a pain. I was in bed for 20 hours a day. I felt suicidal,’ she recalls. A local hospital was eventually persuaded to do tests for T3, which found her levels to be low again. Lilian was then prescribed a dose she describes as ‘inadequate’, so she tops it up with a hormone bought from a website. ‘I’ve now got more energy than I had at 60,’ she says.

But such reports don’t convince endocrinologists who support the current policy. ‘There’s a strong placebo effect with these patients,’ says Professor Colin Dayan, director of the Institute of Molecular and Experimental Medicine at Cardiff University.

‘I’ve done double-blind studies that have found patients can respond much more strongly to getting thyroid hormone in a trial, even when they have been getting it as a regular treatment. ‘They assume it’s a new and different treatment.’

But Dr Holtorf claims that official bodies haven’t been keeping up with the latest research.

‘I’ve just done a review in The Journal of Restorative Medicine showing why it is not scientific just to rely on the blood test to rule out hypothyroidism in patients who have chronic conditions,’ he says. Now researchers are looking at the possibility that certain patients do better on T3.

Dr Birte Nygaard, of Denmark’s Herlev Hospital, recently produced proposals for treating patients who have symptoms of low thyroid but normal blood levels of T4. She suggests an ‘experimental approach’, giving them added T3 at specialist centres.

Professor Lightman would like to see a similar approach in the UK.

The Royal College of Physicians has always claimed that not being able to convert one hormone into the other isn’t a serious problem – trials showed that when T3 was given to patients already getting T4, it didn’t make any difference.

But Sheila Turner has compiled a register of nearly 3,000 patients who say they remained ill when they got only the T4 hormone, but their symptoms went away when they got T3.

Meanwhile, Lilian is thankful that she got the help she needed.

‘When I was being treated according to the official guidelines I was taking 17 drugs a day and still felt dreadful,’ she says. ‘Now I’m taking one and I feel great.

‘If a doctor hadn’t gone against the guidelines I’d be dead by now. That can’t be right.’

http://www.dailymail.co.uk/health/article-2734215/Cold-hands-Always-tired-It-hidden-thyroid-problem-doctors-refuse-treat.html#ixzz3CcIyIUGD

Sick to Death – Trailer

This short – very moving –  video tells the story of film maker Maggie Hadleigh-West’s struggle with thyroid issues, misdiagnosis and unsuccessful treatment with thyroxine. The doctor she finally found after a struggle of 30 years explained the importance of treating the patient, not the test results, and with the use of natural desiccated thyroid gave Maggie a new life.

(Warning:The movie contains some strong language.)

http://sick2death.com/about-the-filmmaker-project/trailer/

The following comes from the Sick to Death website.

About Sick to Death!

Please Note: This project is a work in progress, and we are currently shooting footage and gathering information for the website and films. Sick to Death! is funded by the Guggenheim Foundation. In Sick to Death!, a multi-platform project incorporating video, animation, medical research and an interactive website, artist Maggie Hadleigh-West exposes her own disturbing, yet determined thirty-year struggle to regain her spiraling health. After seeing hundreds of doctors who either disregarded her symptoms, misdiagnosed or undertreated her, Maggie discovers that her thyroid problem used to be a fully understood medical issue that has become all but erased, and which today leaves more than 59 million people sick and suffering. Follow Maggie into her colorful, unconventional, creative life where she tackles existential milestones, and through the assistance of her team of advisers, including a charismatic doctor, takes on the medical establishment. Participate in the unveiling of a huge body of medical information, which became obscured through the lobbying and business practices of a pharmaceutical giant. At once a deeply intimate portrait and a rousing invitation to seize life and health to the fullest, Sick to Death! invites audiences to turn our diagnoses into a call to arms. The final films will take several forms, including several short films to be distributed online to fans, a 60 minute television film also entitled Sick to Death!, and an interactive website which includes a platform for audiences to connect with one another and to build intentional communities. The project is intended to serve as both a work of art and a resource for millions of individuals around the world suffering from thyroid disease.

http://sick2death.com/about-the-filmmaker-project/about-the-project/

What do these people have in common: Adams, Bouc, Dach, Edwards, Heyman, Heiser, Luber, Lynch, Phan, Roberts, Saleeby, Stone, Trumbower and Yang?

August 13, 2014

Answer:  Brilliance in thought, courage in action, intelligent reasoning, and a willingness to learn from their patients as medical practitioners.

And that is all exactly why each of them was chosen to contribute as an author to a new Stop the Thyroid Madness book, titled

Stop the Thyroid Madness II: How thyroid experts are challenging ineffective treatments and improving the lives of patients

Janie Bowthorpe, who has offered to support Hormone Choice Singapore on her Stop the Thyroid Madness website, introduces her new book.