I am reporting to you from this year’s meeting of the American Thyroid Association now taking place at the opulent Breaker’s Hotel in balmy Palm Beach, Florida. Cushy job if you can get it, I’d say.
Not a lot of laughs during the typical lecture at this three day meeting of the world’s experts on thyroid diseases and treatment but I did hear a few guffaws, giggles and snorts today during the single lecture devoted to using combination t4 and t3 therapy for treating hypothyroidism. The speaker on this topic, Dr. Michael McDermott a Professor of Medicine and Pharmacy at the University of Colorado, was actually significantly more open minded about using combination t4/t3 therapy then speakers from previous meetings on the same topic. He prefaced his comments by acknowledging that about half of patients treated with synthetic t4 continue to experience symptoms typical of thyroid hormone deficiency. What, if anything, doctors are to do to help their patients in this situation appears to still mystify the experts.
The laughs came when Dr. McDermott polled the audience of professionals about their opinions regarding treatment of a hypothetical hypothyroid patient with normal thyroid function blood tests continuing to complain of symptoms suggestive of thyroid hormone deficiency. The speaker put up a slide with 5 or 6 treatment options which the audience then voted on. Although a good portion of experts here gave a philosophical shrug of the shoulders by not choosing any of the options, it was reassuring to see a significant portion of the audience agreed with the statement that some hypothyroid patients appear to improve when t3 is added to traditional t4 treatment. This is far short of a strong endorsement of combination therapy but I would say it is a least a nod to those of us who routinely make use of this treatment option. The laughs and giggles came when the next to last option was read to the audience, proposing that Armour Thyroid was the best choice of treatment in this case. The last choice, that this type of patient should see a psychiatrist also got a few chuckles.
Not much more about dessicated thyroid treatment was mentioned after this curt dismissal but Dr. McDermott expressed his opinion that Armour Thyroid was a poor choice for treating hypothyroidism because it contains too much t3 and that synthetic t3 should be used exclusively if combination therapy was attempted. No one seemed aware that as of this month Armour Thyroid and similar dessicated thyroid medications were no longer available in the United States.
Despite the disturbing aspects of the first part of Dr. McDermott’s lecture he did end with some exciting ideas that I will soon be reporting on. The main idea he reviewed is that a genetic defect may cause resistance to t4 treatment in hypothyroidism. Those with the genetic defect would require the addition of t3 to achieve a healthy thyroid balance and elimination of the symptoms of hypothyroidism. I am sensing that this may be a breakthrough in thinking about why some people require combination therapy with t4 and t3. If so, endocrinologists will be forced to reconsider their reluctance/refusal to provide combination therapy for treatment of their symptomatic and dissatisfied hypothyroid patients. More to come on this breakthrough in my next installment.
Gary Pepper, M.D.
