Help Me...I know my thyroid isn't working right! Robert G Carlson, MD, FACS

Most endocrinologists. Internists and Family Practice physicians subscribe to the practice guidelines of the American Association of Clinical Endocrinologists. Guidelines that totally disregard a patient’s symptoms and place more importance on worthless reference range lab values. Why do they totally disregard a patient’s plea of classic symptoms of low thyroid function, with weight gain, exhaustion, hair falling out, dry skin and worsening memory, even depression when confronted with a “normal” TSH level??? I have no idea why. I believe how the patient actually feels is the absolute most important decision making factor in choosing therapy as well as in increasing or decreasing doses. The TSH level is absolutely, unadulteratedly worthless test! Studies have repeatedly shown the ineffectiveness and potential harm of only T4-replacement. The studies show that T4-replacement leaves many patients suffering chronically from hypothyroid symptoms and gaining weight they can't lose through dieting and exercise. I believe Synthroid may be a reasonable medication, but ONLY for someone who has no stress. T4 is inactive, and does not interact well with thyroid receptors. It has to be activated to T3, which is the only form of thyroid hormone that interacts with thyroid receptors. Stress blocks this conversion. Therefore giving a patient synthroid to a patient with any type of physical, emotional or situational stress is a worthless effort. It will not work! Patients have to use the combination of T3, and T4. The T3 will provide immediate energy. I prefer the Armour thyroid from Forrest labs, and avoid the use of generic thyroid supplements.
Now here is one more twist. When a person has Hashimoto’s (Autoimmune Thyroiditis), they have antibodies that have attacked their own thyroid. Because these antibodies “gum” everything up and block any hormone from interacting with thyroid receptors, thyroid levels are absolutely worthless. You can have high “normal “ values and still demonstrate severe low thyroid symptoms. By the way, 30 % of women over the age of 50, will have positive antibodies, and all the lab tests will be worthless. Therefore in these women, women presenting with classic low thyroid symptoms and who are often told their thyroid is “normal”, the ONLY reliable factor for adjusting the thyroid medication dose or the need for treatment is “HOW DO YOU FEEL?” The lab tests are worthless, and the ONLY way to manage Hashimoto’s Thyroiditis is by adjusting the medications to a patient’s signs and symptoms. I repeat …Lab results are worthless, and patient’s symptoms are the most important and only way to adjust medications. The only way! So, spending time speaking with patients, as well as ongoing adjustment of thyroid replacement therapies is critical to achieve optimization of thyroid management.

How Common Is Thyroid Disease? You might be suprised to see how common it is! Robert g Carlson, MD, FACS

Thyroid Disease: The Numbers
How Common Is Thyroid Disease?

When the AACE (American Association of Clinical Endocrinologists) established new TSH Guidelines (0.3 - 3.0 vs. 0.5 - 5.0, and Labcorp and your physician still insist that a level of 4.5 is normal?)) the number of people estimated to be affected by abnormal thyroid function doubled.
According to the AACE, the number of people affected by Thyroid Disease now surpasses the number of people diagnosed with Diabetes or Heart Disease.
• 27 Million: The number of Americans estimated to suffer from Thyroid Disease. (And 75 % of those patients are being treated with the worthless therapy of only T4 or synthroid alone)
• 13 Million: The number of Americans estimated to suffer from Thyroid Disease...but remain undiagnosed.( I think that this number is much higher)
• 14 Million: Estimated number of Americans affected by Hashimoto's Thyroiditis (Autoimmune Thyroiditis / Hypothyroidism). And that means that the TSH lab test , and even all the basic thyroid lab tests are worthless. And by the way, 30% of women over the age of 50 will have these antibodies, will have classic low thyroid symptoms, and will be told their lab values are normal! The lab tests are worthless, and the ONLY way to manage Hashimoto’s Thyroiditis is by adjusting the medications to a patient’s signs and symptoms.
• 8 out of 10: Patients with Thyroid Disease are women.
• 5x - 8x: Women are 5 to 8 times more likely to suffer from Hypothyroidism than men.
• 25%: Approximate number of women that will develop permanent Hypothyroidism.
So stop suffering from low energy levels (especially in the late afternoon), weight gain( despite eating right and exercising), brain fog, muscle aches and pain, poor digestion, hair loss, dry skin and depression. Just say “no” to only being tested with TSH, and demand to get the full panel. If you are NOT getting better on replacement therapy, demand that your doctor checks your thyroid antibodies. And demand that your doctor takes care of you and NOT a worthless unreliable lab test like TSH.

Why T4 is prescribed when T3 is what patients need?

Most endocrinologists doggedly follow practice guidelines from the American Association of Clinical Endocrinologists. As many patients have told us, their endocrinologist switched them to T4 only replacement and they became ill and dysfunctional again. These reports are consistent with studies that show the ineffectiveness and potential harm of T4 alone replacement. The studies show that T4 only replacement leaves many patients suffering chronically from hypothyroid symptoms [1][2][3][4][5][6][7] and gaining weight they can't lose through dieting and exercise.[8] The patients are also likely to be prescribed additional medications to take care of side-effects and mistreated symptoms, which can lead to the development of one or more potentially-fatal diseases.[9]

Potential harm from T4 only replacement has been documented in studies and reports to some of the most reputable scientific and medical journals. In view of the risks, you must consider for yourself whether to allow your therapy to be changed from a T3+T4 combination treatment to a T4 alone treatment. If you decide not to permit it, there are doctors who know the risks and will not let you continue to suffer this mistreatment. A doctor who understands how ineffective and harmful T4 alone replacement is for patients. Some doctors provide individualized care, and are willing to listen to their patients and take the time to find how to treat them, rather than blindly treat them as if a medical guideline is some kind of perfect law written by an all knowing entity.

One needs only look at the history of the practice guidelines to find they are refined when there is an overwhelming amount of evidence that there is a better solution. Bleeding people, lobotomies, electroshock therapy were all widely prescribed practice guidelines at one point. More recently, we have an ever expanding list of medications withdrawn from the market each year, a trend that increased dramatically in the last two decades. Brand names like Fen-Phen, Propagest, Vioxx, Levaquin, Chantix, Prempro, and many others have made the news after overwhelming evidence finally caused them to fall from widely prescribed guideline standards to the focus of public outcry and lawsuits. From this standpoint, it is hard to understand how doctors not prescribing medications with mounting evidence against them are dismissed as “alternative”. Many of these “alternative” medications have long-term evidence of their efficacy and low risk of side effects. In fact, they all have the stamp of approval from the FDA to treat what they are symptoms/disease/disorder for which they have been prescribed. Armour Thyroid, for instance, was the first thyroid medication. The original patent predates the FDA. Until recently, the FDA listed it as GRAS (Generally Recognized As Safe), a designation with more stringent requirements than a new medication goes through. It was only when it was discovered that taking an extremely high dose could worsen heart problems that it was downgraded to a medication like everything else on the market.

What “alternative” medications have one in common is they are available in generic brands. What is revolutionary about them is not that they are some brand new medication. Rather, they is a well refined, heavily researched, better understanding of how best to treat the disorders/diseases/symptoms. The medical community simply knows more about medicine than we did even a year ago. There are many instances when something as simple as knowing when to or how to take a medication is more revolutionary than a new medication to treat the same problem.

Armed with not only the research available, but the knowledge of the issue at hand, you should be able to determine who will help you ferret out and correct the cause of your symptoms.

References

1. Walsh, J.P., Shiels, L., Mun Lim, E.E., et al.: Combined thyroxine/liothyronine treatment does not improve well-being, quality of life, or cognitive function compared to thyroxine alone: a randomized controlled trial in patients with primary hypothyroidism. J. Clin. Endocrinol. Metab., 88(10):4543-4550, 2003.

2. Sawka, A.M., Gerstein, H.C., Marriott, M.J., et al.: Does a combination regimen of thyroxine (T4) and 3,5,3'-triiodothyronine improve depressive symptoms better than T4 alone in patients with hypothyroidism? Results of a double-blind, randomized, controlled trial. J. Clin. Endocrinol. Metab., 88(10):4551-4555, 2003.

3. Clyde, P.W., Harari, A.E., Getka, E.J., and Shakir, K.M.M.: Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial. J.A.M.A., 290:2952-2958, 2003.

4. Cassio, A., Cacciari, E., Cicgnani, A., et al.: Treatment of congenital hypothyroidism: thyroxine alone or thyroxine plus triiodothyronine? Pediatrics, 111(5):1055-1060, 2003.

5. Bunevicius, R., Kazanavicius, G., Zalinkevicius, R., and Prange, A.J. Jr.: Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N. Engl. J. Med., 11:340(6):424-429, 1999.

6. Bunevicius, R. and Prange, A.J.: Mental improvement after replacement therapy with thyroxine plus triiodothyronine: relationship to cause of hypothyroidism. Int. J. Neuropsychopharmacol., 3(2):167-174, 2000 (June).

7. Bunevicius, R., Jakubonien, N., Jurkevicius, R., Cernicat, J., Lasas, L., and Prange, A.J. Jr.: Thyroxine vs thyroxine plus triiodothyronine in treatment of hypothyroidism after thyroidectomy for Graves' disease. Endocrine, 18(2):129-133, 2002.

8. Tigas, S., Idiculla, J., Beckett, G., and Toft, A.: Is excessive weight gain after ablative treatment of hyperthyroidism due to inadequate thyroid hormone therapy? Thyroid, 10(12):1107-1111, 2000.

9. Saravanan, P., Chau, W.F., Roberts, N., et al.: Psychological well-being in patients on ‘adequate' doses of L-thyroxine: results of a large, controlled community-based questionnaire study. Clin. Endocrinol. (Oxf.), 57(5):577-585, 2002.