By Gary M. Pepper, M.D.
(This article is for educational purposes only and is not intended as medical advice or treatment)
During the Covid-19 pandemic my medical practice has been operating as normally as possible. The other day a young woman arrived wearing a surgical mask with a stack of medical records in hand, for a new patient appointment. Her difficulties began 6 weeks prior with intense tenderness in the right side of her neck just above the clavicle (collarbone) which varied in intensity over the course of about 10 days. Evaluation by her primary care physician uncovered newly elevated thyroid hormone levels. During our discussion she recalled a respiratory tract infection starting a week before the neck pain developed.Â Still complaining of lung congestion she denied fever or shortness of breath.Â Sitting comfortably, the thyroid was no longer tender but was slightly enlarged and unusually firm.Â Reading on it will become clear why my preliminary diagnosis is sub-acute thyroiditis, an inflammation of the thyroid following a viral respiratory tract infection, possibly Covid-19.Continue reading →
DTE stands for â€œdesiccated thyroid extractâ€ which is made up of thyroid hormones refined from pig thyroid and used to treat people with hypothyroidism (low thyroid hormone). This is possible because human and pig thyroid are very similar in the production of the 4 known thyroid hormones. For over 100 years, DTE had been used successfully to treat hypothyroidism.
T4, also known as levothyroxine, is the most abundant of the 4 thyroid hormones and synthetic levothyroxine has almost completely replaced DTE treatment since the 1980â€™s. There is no scientific evidence however, that synthetic T4 is better than DTE for treating hypothyroidism. The almost universal switch to levothyroxine and away from DTE appears to be due to a shrewd worldwide marketing campaign by the makers of brand synthetic T4.
Due to this marketing, Synthroid, the major brand of synthetic T4, became the most widely prescribed medication in the U.S. during the 1980â€™s and 90â€™s. Only in recent years has the medical community begun to recognize the failure of synthetic T4 to properly treat all people suffering with hypothyroidism, and the role of DTE to improve results.
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of â€œsomething missingâ€ in the way suffers of hypothyroidism are treated for their disease.
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. Continue reading →
For decades doctors have recognized synthetic thyroid hormone known as levothyroxine or brand name Synthroid, as the undisputed choice for treating hypothyroidism (low thyroid function). By virtue of hypothyroidism being extremely common levothyroxine has been the most prescribed medication in the U.S.
According to key medical organizations in this country, the only acceptable treatment of hypothyroidism is the use of levothyroxine alone. Using any other form of therapy is not recommended. Pointing to a significant number of patients receiving levothyroxine who continue to complain of symptoms of hypothyroidism health advocates have been calling for recognition of alternative treatments. One such alternative with a small but enthusiastic following is extract of pig thyroid (desiccated thyroid extract). All of the major organization of endocrinologists fail to recommend this form of treatment but in particular the American Association of Clinical Endocrinologist or AACE in the US has flatly stated this form of therapy should never be used. Physicians and their patients remain deeply divided on this issue.
In the spring of 2017 the American Thyroid Association (ATA) convened a symposium on treatment of hypothyroidism and determined that “it is important to describe the patient perspective regarding hypothyroidism treatment and to share it” with the medical community. Now, after an enormous expenditure of time and effort, the results of their survey of patients being treated for hypothyroidism were published on-line. The full report in print will become available in the coming months. Here are some to the highlights of the ATA analysis of over 12,000 participant responses.
Overall satisfaction with the present choices of thyroid hormone treatment is 5 out of a possible 10Treatment satisfaction with desiccated thyroid extract (DTE) such as Armour and NP Thyroid was highest at 7 out of 10.
Lowest satisfaction was with levothyroxine or Synthroid alone at 5 of 10
Treatment with levothyroxine plus t3 (Cytomel, tri iodothyronine) was next best at 6 out of 10
Patients taking DTE were less likely to report problems with weight management, fatigue, mood and memory as compared to levothyroxine alone or levothyroxine plus t3
The authors conclude, “a subset of patients with hypothyroidism are not satisfied with their current therapy or their physicians” and “higher satisfaction with both treatment and physicians is reported by those patients on DTE”.
After decades of dispute among physicians themselves about the best ways to treat hypothyroidism, patient are finally having their say. Some readers of this blog may have been among the participants in the survey and deserve great credit for sharing their experience with the medical community. It is hoped that this survey will mark a turning point in the discussion about treatment of hypothyroidism and help to forge a change in the way physicians approach this very common and often disabling condition.
Medical specialists increasingly accept that some patients being treated for hypothyroidism continue to be symptomatic and â€œunhappyâ€. The degree to which patients experience this problem while on conventional treatment for hypothyroidism with levothyroxine (Synthroid, Levoxyl, Unithroid, T4) has motivated many specialists to look for other approaches to treatment such as adding T3 (Cytomel, liothyronine) or switching to desiccated thyroid extract (Armour, WPthyroid, Westhroid
Not all experts are convinced looking for new treatment options for hypothyroidism is the right approach. Continue reading →
On April 11, 2016 an article, Doctors Hear Patients’ Calls for New Approaches to Hypothyroidism, appeared in the Wall Street Journal regarding the growing influence of patient preference on treatment selection for hypothyroidism (sluggish thyroid). The article was written by the WSJ health columnist Melinda Beck. I might have missed it but thanks to a motivated patient I received a copy within a week after its publication. With a glance I knew this report could be a highly significant addition in the on-going debate between specialists treating hypothyroidism (endocrinologists) and advocates of alternative approaches. Continue reading →