Update from the 15th International Thyroid Congress, Orlando Florida, October, 2015
By Gary Pepper, M.D.
    I just returned from Orlando, Florida, where I attended the 15th International Thyroid Congress and want to provide a report of my experience, to readers of metabolism.com. This was truly an international event with an estimated 50% of the attendees from outside the U.S. Organizers of this event describe it as, “Renowned experts in thyroid function and biology, diagnosis and management of thyroid disease, and novel therapies for treating thyroid cancer are gathering at the 15th International Thyroid Congress (ITC) to present, discuss, and debate the latest advances in thyroidology. Held every five years, the ITC is a collaborative meeting of the four world thyroid associations; the ATA (American Thyroid Association), Asia-Oceania Thyroid Association (AOTA), European Thyroid Association (ETA), and Latin American Thyroid Society (LATS).â€
I was particularly excited to be attending this conference this year since my colleagues, Drs. Paul Cassanova and Kathryn Reynolds and I were presenting our study on the use of combination T3 plus T4 for the treatment of underactive thyroid (hypothyroidism).
Here are some papers I found to be of particular interest;
1. The detection of thyroid cancer is increasing rapidly worldwide aided by the use of sensitive ultrasound guided biopsy techniques. The use of gene testing on the biopsy sample is helping doctors to distinguish between benign and malignant thyroid nodules. The bad news is that because of the rising incidence of ultrasounds and biopsies more people are being subject to procedures than ever before. This is leading to many more invasive tests being performed and the detection of tumors which would very likely never been of any harm if left alone. Some experts are referring to this as an “epidemic of over diagnosisâ€. This is very similar to what is now occurring in the fields of breast and prostate cancer treatment. (multiple papers were presented on this topic)
2. One third of over the counter diet supplements tested contain enough biologically active thyroid compounds to lead to serious medical problems. (Dr.C. Seger and colleagues, UCLA)
3. Some pesticides can damage the DNA of thyroid tissue in ways which could lead to cancer. ( Dr. Jerome Hershman and colleagues, UCLA)
4. Preliminary animal based research suggests that changes in the enzymes in the brain that process thyroid hormone can lead to anxiety and depression. Exercise seems to reverse this problem. (Dr. B. Bocco, A. Bianco and colleagues, Rush University)
5. Thyroid hormone levels in the low normal range can raise blood pressure. (Dr. F. Jiang, and colleagues, China Medical University)
6. Treating pregnant women in the first trimester with thyroid hormone to lower TSH levels below 2.5 uIU/ml can reduce miscarriage rates. (S. Kobayashi and colleagues, Keio University, Japan)
7. Nutritional iodine excess can lead to increased formation of enlarged thyroid (goiter) in children and increased incidence of Hashimoto’s Thyroiditis and hypothyroidism in adults. (A. Kiyaev and colleagues, Ural Medical University, Russia)
8. A newly described congenital syndrome known as Allan-Herndon-Dudley Syndrome or AHDS, caused by failure of the cells to respond normally to T3 is explained by researchers in the Netherlands. A related disorder known as TH receptor alpha mutation can lead to retardation and immune defects is also described. ( E. Lima de Souza, and colleagues, Erasmus University Rotterdam and A. van der Spek, and colleagues, Academic Medical Center, Amsterdam)
9. Hypothyroid patients who continue to be symptomatic on levothyroxine or Synthroid and who have a much better response to Armour Thyroid treatment show a tendency to have higher T3 levels in their blood than normal before switching over to Armour. (Dr. Pepper, Cassanova, Reynolds, Palm Beach Diabetes and Endocrine Specialists and University of Miami)
I will be providing more in depth information on these topics in the very near future. Please check back at metabolism.com soon or sign up for our newsletter.
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Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
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Off- Label Use
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GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.
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Here’s a brief timeline of recent anti-obesity drugs:
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