Is Thyroid Overprescribed?

[3ball]

This article suggests that thyroid is overprescribed. Obviously, this is 180 degrees from what Peat says. Can anyone help me understand? Is it just that it is Synthroid?

Could be the thyroid; could be ennui. Either way, the drug isn't helping

 

[Peatit]

Is it just that it is Synthroid?

Yes, T4 only is very often ineffective...

 

[tankasnowgod]

This article suggests that thyroid is overprescribed. Obviously, this is 180 degrees from what Peat says. Can anyone help me understand? Is it just that it is Synthroid?

Could be the thyroid; could be ennui. Either way, the drug isn't helping

I would say this is another example of how any sort of health and nutrition articles reported in the mainstream media are complete and utter garbage.

First of all, here is the study mentioned in the article- Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

The way it's reported in the article, you'd think there was no difference between the two groups. But that's not true. There where twice as many deaths in the T4 treated group (10 vs. 5), however, fewer T4 patients overall had what was deemed "Serious Adverse Events" (78 in T4 vs. 103 Placebo) and fewer total number of said events (142 T4 vs. 201 Placebo). Each group contained 368 people aged 65 or older, so feel free to draw your own conclusions about what those numbers mean (if anything).

The article doesn't even mention T3 as a form of treatment (either alone or in combination with T4), or Natural Desiccated Thyroid.

Beyond that, Peat's ideas regarding thyroid are more in line with Broda Barnes's work, which suggested that the thyroid blood tests (even the modern ones) are no substitute for either the Basal Metabolism test, or Temperature and Pulse. (Blood tests can be useful in addition to those tests, however). Dr. Barnes suggested that thyroid was drastically UNDER prescribed, estimating that about 40% of the population is hypothyroid. That was basing it on the way thyroid had been prescribed for the early part of the 20th century, before blood tests became popular, and the synthetics were even invented.

Bottom line, the author of the article ignores two medications used in hypothyroidism, misrepresents the results of the T4 only study, and doesn't seem to have a grasp of issue she is writing about, and simply relies on testimony of doctors and "experts" rather than digging into the data herself.

 

[3ball]

Thanks, this is very helpful.

 

[encerent]

No it's under prescribed

 

[aguilaroja]

Below are links to the New England Journal of Medicine article referenced, and the original NY Times article republished in the Star-Tribune.

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. - PubMed - NCBI

https://www.nytimes.com/2017/04/21/...ui-either-way-the-drug-isnt-helping.html?_r=0

Sadly, a lot of effort was expended by perhaps well-meaning researchers, and has found its way into prominent professional and popular press. An anti-informative conclusion will be made.

The consistent experience among my acquaintances matches @Peatit and @tankasnowgod that, long term added T3 helps even the clearest responders to T4-only thyroid supplementing.

There’s a lot to comment on. The results basically continue the circular argument that T4-only is used to bring TSH down to under 4.5, and that is all professionals can do. For many decades now, the hypothesis of using combination T4/T3 support, adjusted intelligently and bringing TSH down much more (as only one factor in dose adjustment) has not been thoroughly tested, despite “expert” hand-waving.

Practitioners have habits of using medications literally hundreds of times more dangerous than supplementary thyroid, for milder complaints.

TSH in the treated group (levothyroxine/T4) only went down on average to 3.47. The vast majority of treated subjects (76% at 1 yr & 67% extended) received 50 micrograms or less (less than one grain equivalent) of T4 as their highest dose. [Geriatricians will protest that older people metabolize drugs more slowly.]

There’s a lot more to scrutinize here, including the issue of whether considerably vetted scales like the ThyPro [thyroid-specific QoL questionnaire] inventory really tell the story.

The concept of “sub-clinical” hypothyroidism is inaccurate, since careful questioning or examination reveals pronounced low thyroid function. It is interesting that both the T4 and placebo groups were pretty fatigued to begin with, and BOTH were MORE tired at one year follow-up. A lot of people need help.

 

[sladerunner69]

Thyroid Hormone is definitely over-prescribed-except that it isn't.

 

[Waynish]

I'd like to add the question: how do we know TSH over 2 is always bad? Why cant @ TSH of 3 be part of the biodiversity of a healthy individual?

 

[aguilaroja]

...how do we know TSH over 2 is always bad? Why cant...TSH of 3 be part of the biodiversity of a healthy individual?

It’s a long account even in the orthodox literature about the uncertainties in thyroid lab values. But some references can be found even in official psoturing, like the Clinical Endocrinologist group position paper:
https://www.aace.com/files/hypothyroidism_guidelines.pdf

I know people with TSH values in the 5 to 7 range who by every measure (no symptoms, no signs, a fulfilled life) seem fine.

I also know people who had TSH around 0.1 with low thyroid symptoms that completely resolved by T3/T4 supplementing. When they stopped their thyroid support on “expert” advice, symptoms rapidly returned. When they re-started support, their symptoms again vanished. This in my view makes the diagnosis of hypothyroidism, no matter what the tests say.

Labs never tell the whole story. Lab values can be off due to lab error, individual variation, skewing influences like time of day, season, and conditions, etc. Even for consistent lab values, treatment response differs.

I emphatically disagree with those who use labs as the primary determinant, especially for thyroid function. For a century doctors have been trained that lab values are supposed to be used to confirm a diagnosis, not to make it. But that is dogma almost no one follows.

 

[Waynish]

It’s a long account even in the orthodox literature about the uncertainties in thyroid lab values. But some references can be found even in official psoturing, like the Clinical Endocrinologist group position paper:
https://www.aace.com/files/hypothyroidism_guidelines.pdf

I know people with TSH values in the 5 to 7 range who by every measure (no symptoms, no signs, a fulfilled life) seem fine.

I also know people who had TSH around 0.1 with low thyroid symptoms that completely resolved by T3/T4 supplementing. When they stopped their thyroid support on “expert” advice, symptoms rapidly returned. When they re-started support, their symptoms again vanished. This in my view makes the diagnosis of hypothyroidism, no matter what the tests say.

Labs never tell the whole story. Lab values can be off due to lab error, individual variation, skewing influences like time of day, season, and conditions, etc. Even for consistent lab values, treatment response differs.

I emphatically disagree with those who use labs as the primary determinant, especially for thyroid function. For a century doctors have been trained that lab values are supposed to be used to confirm a diagnosis, not to make it. But that is dogma almost no one follows.

This sounds reasonable, but then how does someone know they should take thyroid when every source of thyroid makes them feel worse? I've tried basically every kind many times, and after about 3 days in a row I decide "I'd rather feel normal." And I feel fine normally... My TSH is 2, and I seem completely healthy except for Celiac's and certain other (besides gluten) foods in excess cause digestive issues.

 

[aguilaroja]

... how does someone know they should take thyroid when every source of thyroid makes them feel worse? I've tried basically every kind many times, and after about 3 days in a row I decide "I'd rather feel normal." And I feel fine normally... My TSH is 2, and I seem completely healthy except for Celiac's and certain other (besides gluten) foods in excess cause digestive issues.

There seem two topics here.

(1) What is re-assuring that thyroid/general metabolic function is good?

For signs, a resting temperature near 37C/98.6 F throughout the year and brisk return of reflexes during tendon-tap testing.

For symptoms, no or very few symptoms on a thorough hypothyroid symptom checklist.
Good heat & cold tolerance;
good mood, sleep, endurance, recall, digestion & elimination;
clear thinking;
absence of frequent infection/muscle cramps/skin issues/bruising/cold hands-feet-nose
are some of the big ones.

It does not seem indicated to urge thyroid supplementing for someone who is really well. If other things are well, gluten sensitivity seems best accomodated by restricting gluten.

see, for instance
Comprehensive List of Thyroid Symptoms - Printable Checklist
and google for other long lists

Also google for lists of estrogen excess symptoms, which should also be absent.

 

[JohnA]

This 2015 post from @haidut seems relevant:

If you are producing enough T4 then I don't think it is justified to take thyroid supplement since the issue seems to be conversion into T3, which is almost entirely dependent on liver health and somewhat on muscle mass. So, if T3 makes you feel fine and your T4 is low then it's probably OK. But if your thyroid is making enough T4 I see no reason why you should inhibit it by taking T3. A thyroid that has been inhibited by taking T3 sometimes can take months to recover into producing normal amounts of T4 and while it is recovering TSH will likely become very high. On the other hand, I would not take pure T4 either since if liver is not converting it into T3 you are making the situation worse. I guess what I am saying is that there is a valid reason for supplementing with thyroid but if the issue lies somewhere else down the pathways like conversion of T4 into T3 then a person should focus on fixing that issue rather than loading up on T4/T3 combo just to make themselves feel better.

Surrogates For Thyroid Hormone

 

[DaveFoster]

It wouldn't matter if levothyroxine (T4) was over-prescribed; most need T3 as well, as mentioned. Also consider they occasionally adjust the guidelines for clinically "acceptable" TSH. They recently moved the top-end of the range from 4 to 3.

This means that a large number of people with TSH's of 3.1-3.9 were suffering a great deal. Fortunately, we now have permission from our medical overlords to be diagnosed differently; if only thyroid could be patented to the extent of Prozac.