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 “unhappyâ€. 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. (more…)
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. (more…)
Why Patients Aren’t Receiving the Most Effective Treatment for Hypothyroidism By Gary Pepper, M.D.
For the past 3 to 4 decades endocrinologists worldwide have adhered to the belief that only synthetic T4 (the most abundant of 4 thyroid hormones produced by the thyroid) is appropriate therapy for a sluggish thyroid even though it is known that a substantial number of those treated with T4 only continue to suffer from persistent symptoms of the disease. This may be because under normal conditions the thyroid produces two principle hormones T4 and T3. In 2013 an NIH study showed that 50% of those with hypothyroidism preferred treatment which includes T3 and our group reported that 78% of a subgroup of patients preferred T3 containing medication to treat hypothyroidism . (more…)
In a blog at metabolism.com several months ago, website visitors were asked to join an email campaign addressed to Dr. Mack Harrell, President of the American Association of Clinical Endocrinologists (AACE). The purpose was to ask help reversing the existing practice recommendation # 22.4 published by the AACE in 2012, calling for a ban on the use of Armour Thyroid in the treatment of hypothyroidism. With over 800 individuals participating, the campaign appears to have achieved some success as the latest AACE treatment guidelines released last month no longer stipulate that desiccated thyroid is unfit for treatment of hypothyroidism. Instead the statement is issued, “ We recommend that levothyroxine be considered as routine care for patients with primary hypothyroidism, in preference to use of thyroid extracts. “, and…. “ Furthermore, there are potential safety concerns related to the use of thyroid extracts, such as the presence of supraphysiologic (unnaturally elevated, ed.) serum T3 levels and paucity of long-term safety outcome data.†(more…)
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.
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.
by Gary M. Pepper, M.D. and Sam Jeans, MSc The global anti-obesity drug market, in 2021was valued at over $2 billion. Within one year this figure had skyrocketed to $8 billion and is expected to climb to nearly $ 20 billion by 2027. This astounding growth is a reflection of soaring obesity rates, and the arrival of a new class of weight loss medication fueling a craze both in the USA and across the world.
The FDA and global health regulators, until very recently, had maintained a very tight ship when it comes to treating obesity with medication, placing the emphasis on diet and exercise rather than weight loss drugs. Since the 80s, anti-obesity drugs continued to be controversial, and a more stringent FDA implemented ongoing safety trials along with other precautions. There is some speculation that a shift in attitude toward approval of weight loss medication by the FDA , is underway
Weight loss drug controversies are far from over and, in fact, may soon rival the amphetamine crisis of the 70’s. For that reason, metabolism.com has felt it important to provide our guide to weight loss drug issues, past and present.
Anti-Obesity Drugs Timeline
Prescription drugs for lifestyle diseases such as obesity were marketed heavily throughout the 1950s to the 1970s. Amphetamines entered the public domain after the Second World War where they were used extensively in the military.
In the 50s, walk-in clinics prescribed diet pills with other medications almost at random, with or without genuine concern for one’s weight. These brightly colored pills became known as “rainbow pills”.
In the 1960s and 1970s, the so-called “rainbow pill diet” of pills was finally coming to an end as the FDA began to systematically ban many of the drugs involved. A high-profile expose by investigative journalist Susanna Mcbee, published in Life magazine, brought attention to this new modern public health crisis.
The rainbow pill diet combined amphetamines, laxatives, thyroid hormones, and even diuretics to produce extreme weight loss, combined with benzodiazepines, barbiturates, and steroids to reduce side effects, and antidepressants to suppress medication-induced insomnia and anxiety.
In 1968, rainbow pills were linked to over 60 deaths, with numerous accounts of their devastating impact surfacing in the news and media. Within just two months, 48 million pills were seized and destroyed. Nevertheless, amphetamine-based diet pills remained extremely popular throughout the 1970s. In 1978, some 3.3 million prescriptions for amphetamines were written each year, with some 50 million pills a year ending up in the black market.
In 1979, the FDA banned amphetamines as a weight loss aid, but that is hardly the end of the USA’s love affair with obesity medication.
Here’s a brief timeline of recent anti-obesity drugs:
Lack of energy and inability to lose weight are constant challenges for many people and are every day complaints encountered in the doctor’s office. Almost anyone can find some relief from these problems by accessing the healing properties of physical activity. Mentioning to a patient the need for ‘more exercise’ often causes rolling of the eyes, sighing, shrugging, snorting or worse yet, the hundred-yard stare. We all know exercise is important but who has the energy for that? It seems like a vicious cycle. Surprisingly, when done correctly, exercise can improve energy with the additional advantage of promoting weight loss and restoring tone and stamina. It is helpful to remember that the human body was designed for a lot more physical activity and a lot less food than we are privileged to experience in present day life. It therefore takes will power and knowledge to maintain the environment required for optimal health. Here are eight steps to get in the swing of regular exercise. Some suggestions may surprise you.
