The Dangers Of Pure T4 (Synthroid) Treatment

haidut

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Ray has written about the benefits of dessicated thyroid and the dangers of pure T4. However, for the last several decades researchers like him have been consistently ignored by mainstream medicine and even the venerable Armour changed their formula to mimic better the effects of pure T4.
However, given the disastrous results of monotherapy over the last decade, mainstream medicine is starting to recognize the dangers of Synthroid (pure T4). According to this study, most patients (65%) not only benefit physiologically from switching to combined T4/T3 regimen but also do NOT want to go back to pure T4 after trying the combined regimen. The study also has some interesting discussion on how pure T4 can have anti-thyroid effects by conversion to rT3 and what is the optimal ratio of T4 to T3.

http://suppversity.blogspot.de/2012/08/ ... d-try.html
 

aguilaroja

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haidut said:
... According to this study, most patients (65%) not only benefit physiologically from switching to combined T4/T3 regimen but also do NOT want to go back to pure T4 after trying the combined regimen. The study also has some interesting discussion on how pure T4 can have anti-thyroid effects by conversion to rT3 and what is the optimal ratio of T4 to T3.

http://suppversity.blogspot.de/2012/08/ ... d-try.html

On glancing at the suppversity post, the main study cited seems to be the 1999 Bunevicius article:

http://www.ncbi.nlm.nih.gov/pubmed/9971866

http://www.nejm.org/doi/pdf/10.1056/NEJM199902113400603

Bunevicius R1, Kazanavicius G, Zalinkevicius R, Prange AJ Jr.
Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.
N Engl J Med. 1999 Feb 11;340(6):424-9.

The study has been discussed by thyroid advocates for a while, such as here:

http://www.thyroid-info.com/articles/t3drugsnejm.htm

Though the Bunevicius study has merits, it did not shift medical practice consensus much over the past fifteen plus years. Numerous published studies since did not show much or any benefit, whatever the failings of study design.

http://www.ncbi.nlm.nih.gov/pubmed/25617173

Escobar-Morreale HF1, Botella-Carretero JI2, Morreale de Escobar G3.
Treatment of hypothyroidism with levothyroxine or a combination of levothyroxine plus L-triiodothyronine.
Best Pract Res Clin Endocrinol Metab. 2015 Jan;29(1):57-75. doi: 10.1016/j.beem.2014.10.004.

"To date, combined levothyroxine plus liothyronine treatment for hypothyroidism has been evaluated in 15 clinical trials in humans. In two studies, combined therapy seemed to have beneficial effects on mood, quality of life, and psychometric performance of patients, compared with levothyroxine alone; in some of these studies, the patients preferred levothyroxine plus liothyronine combinations. This preference should be balanced against the possibility of adverse events resulting from the addition of liothyronine to levothyroxine. Until clear advantages of levothyroxine plus liothyronine are demonstrated, the administration of levothyroxine alone should remain the treatment of choice for replacement therapy of hypothyroidism."

While Dr. Peat's viewpoint seems helpful and I have met hundreds of people for whom added T3 made major improvements, the journal research frequently expresses reservations.

The Bunevicius team is still doing interesting work, for instance:

Bunevicius A1, Iervasi G, Bunevicius R.
Neuroprotective actions of thyroid hormones and low-T3 syndrome as a biomarker in acute cerebrovascular disorders.
Expert Rev Neurother. 2015 Mar;15(3):315-26. doi: 10.1586/14737175.2015.1013465.

"Acute cerebrovascular disorders are common causes of death and disability worldwide. Prognostication of stroke victims rests mainly on admission clinical and radiological indexes of disease severity. Preclinical studies strongly suggest that thyroid hormones have a capacity to exert neuroprotective actions in the central nervous system under ischemic conditions via genomic and nongenomic actions. Low triiodothyronine (T3) syndrome affects 32-62% of patients following acute cerebrovascular events. Lower serum T3 concentrations are associated with greater stroke severity, more complicated clinical course, greater mortality rates and elevated risk for poor functional outcomes at discharge and long term."
 

youngandold

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Too much T3 too son can (and it has) cause strokes. Google thyroid storm.
The body lowers T3 AFTER the stroke to protect itself.

Low T3 isn't proved to cause strokes.
 

Bodhi

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If all hormones are balanced, liver function is ok, no endotoxin, low serotonin etc, i think pure T4 will convert in the right amount of T3 the body is asking for, the reason i think this is that more often woman have problems doing well on pure T4 then men, due to different liver function and hormones.
 

Bodhi

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Haidut, which article Ray talks about the negatives on pure T4? i have not read it anywhere...

There are also many cases of people with high RT3 who only respond on T3 only...
 
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haidut

haidut

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Haidut, which article Ray talks about the negatives on pure T4? i have not read it anywhere...

There are also many cases of people with high RT3 who only respond on T3 only...

Ray Peat, PhD on Thyroid, Temperature, Pulse, and TSH – Functional Performance Systems (FPS)
"...The serum’s high ratio of T4 to T3 is a pitifully poor argument to justify the use of thyroxine instead of a product that resembles the proportion of these substances secreted by a healthy thyroid gland, or maintained inside cells. About 30 years ago, when many people still thought of thyroxine as “the thryoid hormone,” someone was making the argument that “the thyroid hormone” must work exclusively as an activator of genes, since most of the organ slices he tested didn’t increase their oxygen consumption when it was added. In fact, the addition of thyroxine to brain slices suppressed their respiration by 6% during the experiment. Since most T3 is produced from T4 in the liver, not in the brain, I think that experiment had great significance, despite the ignorant interpretation of the author. An excess of thyroxine, in a tissue that doesn’t convert it rapidly to T3, has an antithyroid action. (See Goumaz, et al, 1987.) This happens in many women who are given thyroxine; as their dose is increased, their symptoms get worse."
 

Ella

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Bummer, I started Pure T4 and the colour in my hair returned. I think that's pretty impressive. I have all this new growth and it is not grey!! It's my natural colour. My hair turned white overnight from experiencing a huge trauma. My T3/rT3 was below the reference range, so I figure I have a long way to go before before T4 coverts to rT3. I should have started T4 when I started losing all that weight. My TSH shot up as the weight came off. I hated colouring my hair and I was not ready to let it go grey. I am starting to love my hair again instead of fearing mirrors.
 

LeeLemonoil

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It’s not impossible that t4 supplement would have a lot of benefits to the organism .... but it seems it has benefits to the organism of bacteria and other microbes too.
 

Collden

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Bumping an old thread here, but is the harmfulness of pure T4 maybe overstated? Just cursory browsing through reddit/Hypothyroidism/ you can find hundreds of accounts of people who have been on pure T4 for years and decades and have no issues with it, saying it changed their life, etc. The overall attitude there seems to be that T4 works great for the vast majority of hypothyroids, while a minority may need both T4/T3 for good results.
 

thomas00

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I don't think so. And I wonder how many of those happy testimonials aren't just drug company plants.

It doesn't make any sense to give people pure t4. Ray has talked about instances where it can put people in comas when it's administered on its own.

T3 can't do that in a physiological dose, nor can it turn into rT3.

Some studies point to a lot of dissatisfaction with t4 only treatment
Psychological well-being in patients on 'adequate' doses of l-thyroxine: results of a large, controlled community-based questionnaire study. - PubMed - NCBI
 
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Collden

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T4 is a cheap generic at this point, I'm sure drug companies profit more from marketing various innovative mixtures of different thyroid hormones.

And T4 constitutes more than 90% of the thyroid hormone produced by the human thyroid gland so it would seem that most T3 in humans is produced by peripheral T4->T3 conversion, in this sense supplementing pure T4 would be more way more physiological than the 1:5 or even 1:2 T3/T4 ratios some people advocate to supplement.

I recognize that there are potential issues with T4 converting into rT3, and that it may not give good results in people who for whatever reason cannot efficiently make the T4->T3 conversion, but this is supposedly a minority of cases, and there are also issues with taking high quantities of T3 since it completely bypasses your bodys natural regulation mechanisms.

Regarding the study, it seems it was not comparing T4 with T4/T3 treatment, but just stating that people who take T4 feel worse than people who don't feel the need for hormone replacement at all, which is a no brainer. It just means T4 does not work 100% for everyone.
 
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thomas00

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The drug companies also have face to save, as do doctors. Neither want to admit their practices for the last four decades have been incorrect, regardless of how much money t4 makes them. Maintaining an image of trustworthiness and competence is crucial to their business.

T4 alone isn't in any way physiological. I guess you can argue that neither is t3 by itself but it's less risky because there is no risk of failed conversion. I don't know how prevalent conversion issues are. Endocrinologists think they are rare so I'm inclined to think it's safer to assume the opposite is true. STTM has 22,000 members.

Big amounts of t3 are certainly risky and unnecessary. Thyroxine will suppress endogenous thyroid production just as large amounts of t3 would.

It seems the only basis the medical establishment have for arguing that t4 only treatment is fine for most is an argument that relies on reporting of symptoms and TSH. People on SSRIs say they feel OK too but I wouldn't find that a convincing argument for their safety.

What that study shows is that on the basis of a feeling of wellbeing it's clearly an inadequate treatment for some . On the basis of biochemistry it's inadequate for everyone. The study doesn't tell us how the rest fared as time went on.

As long as t4-only approaches can be argued to benefit a majority, patients who complain can be ignored and will have their hypothyroidism neglected and their symptoms incorrectly attributed to some other illness. That's a travesty.

T3 is faster, too.
 

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