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.
Eric Pritchard brings great insight showing how, for years, the field of endocrinology failed to acknowledge growing evidence of the inadequacy of “t4 only” therapy for hypothyroidism. Eric puts together the historical clues that should have paved the way for acceptance of t4 plus t3 therapy . We are now seeing almost irrefutable evidence ** (https://www.metabolism.com/2009/10/03/breakthrough-discover-t3-genetic/) ** that t4 by itself cannot in all cases provide enough active thyroid hormone to treat hypothyroidism. This is occurring at precisely the same time the practical solution to t4 plus t3 replacement therapy (dessicated thyroid hormone) is being chased from the shelves of pharmacies around the world.
Thanks Eric, for bringing your knowledge and insight to this crucial debate.
Eric writes to metabolism.com :
It is quite amazing that after 50 years of abusing some patients with the T4-only therapy, that medical is beginning to recognized that some patients do, in fact, require T3. It is about time for the practice of medicine to catch up with medical science. In 1960 Dr. Marshall Goldberg published a paper entitled â€œThe Case for Euthyroid Hypometabolism,â€ which recommends a T3 therapy. About that same time researchers like Refetoff were noticing a resistance to T4. Refetoff, et al., discovered the cause, peripheral cellular hormone resistance in 1967. Subsequently, Braverman, et al., discovered peripheral conversion in 1970 and determined that 80% of all T3 comes from peripheral conversion. However, not to be swayed from the old thyroid-gland-is-directly-connected-to-symptoms paradigm, endocrinology has declared peripheral conversion to be fault free (really amazing) and simply ignores the potential for increased hormone reception. To support this wacky notion, they produced questionable studies that proved their old paradigm. These studies showed that the active hormone, T3, was ineffective and the inactive hormone, T4, was effective in spite of knowledge of the relative activity discovered by Gross and Pitt-Rivers in 1952.
All of this reminds us of medicineâ€™s rejection of the empirical antispetic discoveries by Drs. Semmelweis and Lister. Why it was not minute particles of the cadavers that were being disected prior to surgery and child birth, it was the bad humors in the air. The post surgical infections and deaths could not upset the bad humors paradigm. Only after concerned heads of surgury demanded washing up before operating, the invention of the microscope, and Pastuerâ€™s discovery of bacteria, did the merchants of death and illness realize reality.
Endocrinology laughed and dismissed Dr. Goldberg a half century ago, just as medicine drove Semmelweis to his death.
There are physicians who believe that medicine is an art. I have come to that conclusion as well, but not for the same reasons. I believe that medicine is an art because medicine does not have the discipline to be a real science. Real sciences react to counterexamples. We have seen counterexamples to the thyroid gland only diagnostics and T4-only therapy prescriptions. However, endocrinology and thyroidology have dismissed these suffering souls with diagnostic excuses such as â€œnonspecific symptomsâ€ and â€œfunctional somatoform disorderâ€ to blame medicine or blame the patient for the patients continuing suffering. Both of these diagnoses could be avoided if the differential diagnostic procedures had been followed â€” including all possible causes for the patientâ€™s symptoms, euthyroid hypometabolism, deficient peripheral conversion, deficient peripheral cellular hormone reception. But in a perversion of the logic underlying differential diagnostics, medicine claims that the thyroid gland is first the only possible cause of the symptoms and second, when it fails, the symptoms have many causes â€” which were not tested.
Medicine is an art because it does not have the discipline to use clear language. In spite of demands for clarity of definition dating back to the 18th Century and undoubtedly earlier, and demands for clarity in medical guideline authorship protocols, â€œhypothyroidismâ€ may be restricted to only the thyroid gland or may embrace the entire greater thyroid system. In either case, the diagnostics and the therapy recommendations are only applicable to the thyroid gland. Those who suffer from extra thyroid deficiencies in the greater thyroid system are simply allowed to suffer in spite of the existence of proven therapies.
Medicine is an art and not a science because it ignores counterexamples. There are patients who require T3 without any T4 as they will become thyrotoxic on the T4, but require the T3 to overcome hormone reception resistance.
There are patients who have had unsuccessful therapies with all synthetics but live well on desiccated thyroid. The laughter at the use of desiccated thyroid is a reminder that medicine does not have courage to recognize counterexamples and does not have the will to deal with them. Thus, endocrinology is really an art pretending to be a science as ignores suffering patients â€” perhaps a million in the UK and another 5 million in the US.
One could only wish that those laughing fools develop a thyroid related malady that endocrinology chooses not to recognize and then suffer the slings and arrows of mass medical malpractice that has been in vogue for the last half century.