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 →
Do you wonder if you need t3 (Cytomel, triiodothyronine, liothyronine) added to your thyroid hormone treatment to feel normal again? The answer could be in your genes.
Recent discoveries reviewed by Antonio C. Bianco, M.D., Ph.D. at the recent American Thyroid Association meeting, reveal how genetic differences influence the effectiveness of thyroid hormone replacement. Dr. Bianco’s lecture focused on studies pinpointing inborn differences in the way people metabolism thyroid hormone to explain why t3 treatment of hypothyroidism is probably required by some to restore normal functioning of their brain, muscle and heart.
The most frustrating problem for people with hypothyroidism is being unable to convince their doctor that treatment with Synthroid, Levoxyl or similar pure t4 product, isn’t working. Continued symptoms of fatigue, weakness, inability to concentrate or think clearly, and inability to lose weight despite really trying, result in tension between the doctor and the “complainer”. When assessing the adequacy of thyroid hormone replacement therapy most doctors rely on the blood tests known as the Thyroid Function Panel. Typically this includes a measurement of t4, t3, t3RU, and TSH. Some panels may also include free t4 or free t3 measurements. If the hormone levels on these tests are “within normal limits” the doctor will often insist that the treatment is a success but it is the patient who fails to recognize this. A minority of endocrinologists know many of these “failures” can be turned into success by the addition of t3, the less utilized but much more powerful form of thyroid hormone.
Most of the biological effects of thyroid hormone in the body are due to the action of t3. The most common forms of thyroid hormone replacement however, involve giving t4 in the form of Synthroid, Levoxyl, levothyroxine etc. The t3 required by our tissues is produced by specific enzymes which convert t4 to t3 in the cells of the liver, kidney, brain, muscle, heart etc. These converting enzymes are known as deiodinases and under normal conditions they are responsible for about 80% of the body’s t3. The process
by which t3 is produced from t4 is known as peripheral conversion.
It has long been the contention of the leaders in thyroid disorders that based on their arithmetic, t4 replacement is sufficient to provide all the t3 the body needs via peripheral conversion and giving t3 supplementation doesn’t make good medical sense. Now, based on the new information provided by researchers like Dr. Bianco, the “arithmetic guys” will, in my opinion, need to revise their thinking finally allowing the way for acceptance of t3 replacement approaches.
I will continue the explanation of the new breakthrough in genetic control of thyroid hormone replacement treatment in Part 2 of this post.
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 →
Dr. Gary Pepper and Dr. Paul Aoun discuss recent findings about thyroid hormone treatment at the 15th International Thyroid Congress
According to experts, 10 to 20% of hypothyroid individuals fail to respond completely to T4-only (levothyroxine, Synthroid) treatment. Dr. Anthony Bianco, the president of the American Thyroid Association, and his associates believe this is due to genetic variations in the way thyroid hormone is converted in the body from T4 into T3. T3 is the much more potent form of thyroid hormone and unless the cells of the body receive enough T3, normal function cannot be achieved and symptoms of low thyroid such as fatigue, mental fogginess, constipation, muscle aches etc, persist. Based on the research conducted by Dr. Bianco and colleagues it is thought that in those with the genetic trait making T4 treatment ineffective, blood tests would show low T3 levels. Continue reading →
By Gary Pepper, M.D.
Last week I posted a few highlights from the just concluded International Thyroid Congress. One of the research papers presented at the meeting generated particular concern. Endocrinologists and scientists at UCLA Medical Center led by Dr. Jerome Hershman investigated the potential for pesticides to damage the DNA of thyroid cells. The group focused on double strand breaks, the type of damage that could eventually lead to cancer. This is a particularly relevant point due to the explosion in newly diagnosed thyroid cancers being reported in many areas of the world. The increase is likely related, at least in part, to improved diagnostic techniques for thyroid cancer but could also represent environmental influences. Continue reading →