Mainstream endocrinologists seem to be moving grudgingly toward acceptance of combination T4 plus T3 therapy for hypothyroidism. A great example of the mixed feelings harbored by endocrinologists in this regard is the title of a recent editorial, “ Combo (treatment) a Last Resort for Hypothyroidism†. Although the author, Dr. Bruce Jancin of the University of Colorado, recognized the value of combination T4 plus T3 therapy, he did so with the least possible enthusiasm. In his article the doctor acknowledged the weakness of scientific studies showing negative results with combination therapy and pointed out the findings of the Watts Study which provides a genetic rationale for why some people need to have T3 added to T4 to return to proper thyroid hormone balance. (more…)
I thought Richards comments about the battle he faces getting treatment for hypothyroidism after having his thyroid removed for cancer, would be of interest to many readers at metabolism.com.
Richard writes:
I recently ordered Thyroid-S on Amazon.com and after all the research and apparently good results I have found online, I think I made the right choice. I had my thyroid removed because of cancer in 2005, took Cytomel at first, felt great, told to stop cytomel and start Levothyroxine, felt horrible. Two months out(125mcg) TSH was 43.0, increased dose to 137mcg wait another 2 months, TSH was 31.0 Finally told to take 200mcg and TSH started to come down. It took about 6 months to get my TSH where they wanted it and for the side effects I was given all types of medications. (more…)
A long time member of metabolism.com, Eric Pritchard, has been a determined critic of “T4 only” treatment of hypothyroidism. In his latest comment Eric shows that scientists were aware of the inadequacy of “T4 only” treatment since 1947! I wanted to give everyone a chance to read his comment so I am posting to the main blog. Thanks again for your insight Eric.
Endocrinologists have a hard time with the symptoms of hypothyroidism in the same sort of way that New York City folks believing that there is anything worthwhile west of the Hudson River. However, there are very relevant functions to the thyroid hormone effectiveness that exist beyond the boundaries of the classical endocrine system. This potential was given initial credence by Drs. Kirk and Kvroning in 1947 when they published a note saying that not all patients’ symptoms were managed by thyroxine (T4). This was collaborated in 1954 by Dr. Means. Drs. Gross and Pitt-Rivers discovered triiodothyronine (T3) and found it far more active than T4, which is now called a pro-hormone. The concept of euthyroid (your thyroid is OK) hypometabolism (but you are dragging anyway) was demonstrated by Dr. Goldberg in 1960. Drs. Refetoff and Braverman, circa 1970, discovered the connections between the thyroid gland and symptom producing cells, namely the cellular reception of hormones and the conversion of T4 to T3 outside of the endocrine system, which produces 80% of the body’s requirement for the active hormone, T3.
Another issue that is dismissed is the necessity of supporting chemistry to function properly. For example, every thyroid hormone replacement counter-indicates is use if the adrenals are insufficient.
So there is far more going on than endocrinology is willing to promote. That is why there are 1.7 million patients suffering in spite of T4 therapy. That is why there are still more patients suffering from false negative diagnoses for the symptoms of hypothyroidism.
Many members here at metabolism.com have shared their thoughts and experience on ways to stop smoking. There have been many who feel defeated because they can’t beat the weight gain that accompanies their efforts. SweetiePie has a clear message about how not to beat yourself up while achieving the goal of a smoke free (and healthier) life.
Here’s what SweetiePie has to say;
Hello:
55 Year old female here, 200 lbs, hypothyroid smoke free for 6 months. Feeling great about being smoke free and this time its permanent and for real.
I have quit smoking and relapsed so many times in my life. And dieting, on again and off again for 40 years. Pfffft…..This time what prompted me to go to the doctor and quit was that my heart feels heavy and hurts sometimes. Not angina yet, but scary and depressing. I’m fine, it turns out, but I definitely needed to quit smoking and still need to exercise more and lose weight . I am no expert in the weight loss department, having had limited success with that over the years. I can see from this interesting thread that I am not as weight conscious as most of you, but I still thought I’d share what my doctors told me because it may help and inspire you the way it did to me: When I tried to bring up the weight gain and the overweight with doctors heres what they said: CARDIOLOGIST told me I’d have to be about 100 lbs over my ideal weight of 145 for the weight to be as stressful and damaging on my heart and cardiovascular as SMOKING, GP #1 told me the key was, instead of focusing on an ideal weight and size, was to focus on preventing DIABETES through NONSMOKING, AND EXERCISE just as important as wholesome diet, and GP #2 (I moved and needed a new doctor for my thyroid perscription) told me, after my bloodwork tested all ok, “why don’t you just forget about losing weight for a little while and focus on quitting SMOKING? Well, I took all of that advice, and this time, it worked! I’ve really kicked the smoking habit and finally found freedom from that deadly addiction. The “permission†from doctors to stop beating myself up about my weight freed me up mentally to do what I needed to do (giving myself plenty of rewards, including food treats and being lazy treats!) in order to become smoke free and never going back! I am ready now to step up to exercise and weight loss this year with the same strategy: Increased exercise first, food modification instead of deprivation. The reason for my post is to say stick with it but your QUIT is SO IMPORTANT – don’t ever let your desire to be thinner or to get back down to an ideal outweigh your resolve to stay SMOKE FREE. SMOKING is the singlemost damaging behavior -don’t lose sight of that! Never take another puff! Oh, btw I gained about 5% while quitting and my first goal is to go back down 5%.
My ebook Metabolism.com is now available; I think you will find it a great resource for many of the common problems members have asked me about over the past 15 years. Buy it now and use it for years to come. Don’t forget to check out the Weight Loss and Weight Gain Programs included for free!
Chapter 1: What Is Metabolism? 9
Turning Food into Energy 10
The Importance of Hormones 11
Role of Metabolism in Weight Loss or Gain 14
Is My Metabolism Healthy? 16
Chapter 2: What Makes Your Metabolism Fast or Slow? 17
The Role of the Thyroid 22
Chapter 3: How to Increase or Decrease Metabolism 25
Problems with Losing Weight 25
Problems with Gaining Weight 34
A Pleasurable Exercise Routine is a Must 39
Chapter 4: Fact vs. Fiction—Smoking and Weight Loss 41
Chapter 5: Thyroid Treatment 47
How Are T3 and T4 Regulated? 48
Types of Thyroid Diseases 49
Hyper- and Hypothyroidism 49
Thyroid Nodules 51
Is Your Thyroid Nodule Hot? 53
Thyroid Treatments 54
Using Thyroid Function Tests To Diagnose Disease 56
Hyperthyroidism Treatments 57
Hypothyroidism Treatments 58
T3 Plus T4 Combination Therapy 59
How to Talk to Your Endocrinologist 66
The Recent Shortage of Armour Thyroid 67
Chapter 6: Diabetes Treatment 73
The Bad News—Major Stumbles in the Treatment of Diabetes 74
The Call for Tight Glycemic Control 74
2010 Diabetes Treatment Guidelines Lack Credibility 76
Setbacks in Diabetes Drug Development 81
The Failure of Inhaled Insulin 86
Dangerous Commercial Weight Loss Programs 87
Perhaps the Biggest Stumble of Th em All 89
The Good News—What Really Works 90
Diet and Exercise 90
Weight Loss Surgery 94
Incretins 95
Chapter 7: Hormone Treatments 99
Hormone Replacement Therapy—Estrogen 101
Heart Health 101
Breast Cancer 103
Benefits of Estrogen: Brain Function and Blood Pressure 104
Testosterone Replacement for Men 106
Testosterone Replacement Options 107
Benefits of Testosterone Replacement 108
Potential Risks 109
Human Growth Hormone in Adults 111
Diagnosing Growth Hormone Deficiency 113
Benefits of Growth Hormone Supplementation 113
Adrenal Fatigue: Fact or Fiction? 115
Conclusion 117
The Birth Of Metabolism.com 119
My Path Into Endocrinology 121
Recent Contributors On Metabolism.com 125
Appendix 1: Personal Nutrition Profile 127 Appendix 2: Ultimate Weight Gain Program 145 Appendix 3: Food Journal 165
Thyroid cancer is one of the most common cancers of young adults. Many of these cancers have no symptoms until a routine exam reveals a lump in the neck. This was the case with Patti who shares her upbeat experience with us. The good news about this type of cancer is that despite spread to lymph nodes (metastasized) it is still very curable. So, if you notice an unexplained neck lump don’t hesitate to have it evaluated by an endocrinologist or other knowledgeable physician.
Here is what Patti has to say about her thyroid cancer experience;
I found a lump in my throat in August of this year. I am one of the few (about 10%) who tested positive for Thyroid cancer. I also had cancer in 4 of the lymph nodes of my neck. I am a competitive athlete (for fun not for a living) and I worried what would happen. I had surgery in September and although the last 4 months have been very hard on me, I am happy to report I am running, swimming and cycling again. The cancer is completely gone based on my body scan and negative bloodwork.
Most likely you do NOT have cancer. But you can’t roll the dice and not know. And if you do, you can and will get through it and go on to live a wonderful life. It takes work and perseverance to be healthy but it is worth it. 🙂
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 “something missing†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.
Without effective intervention the early stage of type 2 diabetes known as prediabetes carries a high risk of progressing to outright diabetes. Metabolism.com provides an up-to-date summary of recommendations from national authorities, for preventing and possibly reversing this life long affliction
Diabetes can be defined simply as elevated blood sugar levels. What exactly is high blood sugar and when should someone be concerned about their level? Does having prediabetes mean diabetes is around the corner? Metabolism.com tackles this tricky but important topic in this comprehensive review.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
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.
