Re: T3/T4 studies. Doesn't patient preference count as evidence?

[Guest guest]

Hi Jon

Thanks for this info. This is the sort of information and references I need for our comments to the BTA statement - the BTA need to give us some answers. From what they state, it seems that patients preference does not count, and what is worse, they have left these studies and not followed them up with a BIG study. I cannot understand why so FEW patients were used in the studies mentioned.

Up until this week, I had thought no studies into Armour v T4 or T4/T3 combination had never been done, but I may have some news for you, I am waiting for the researcher to get back to me with some details. Many thanks for your contribution. Escobar et all had done two previous studies, which showed entirely different results to the one you mentioned.

Escobar-Morreale HF, del Rey FE, Obregon MJ, de Escobar GM. Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroidectomized rat. Endocrinology. 1996 Jun;137(6):2490-502

Escobar-Morreale HF, Obregon MJ, Escobar del Rey F, Morreale de Escobar G. Replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. J Clin Invest. 1995 Dec;96(6):2828-38

I've said it before, and I'll say it again, 2008 IS GOING TO BE THE YEAR WHEN THINGS WILL CHANGE IN OUR FAVOUR.

Luv - Sheila

..The Escobar-Morreale et al study (Here)shows that there were (seemingly) no advantages to T3 + T4 therapy, and that there was a disadvantage (increased urinary concentrations of bone remodelling markers)Despite this 12/26 patients preferred T3+T4 therapy in the proportion 15:1, 6 preffered T3 + T4 in the proportion 11.7:1, 2 preferred the T4 only and 6 had no preference.About ¾ of patients preferred the T3 + T4 therapy. Doesn't this show that the tests used to monitor the performance of either medication (ie. Quality of life, mood etc.) do not tell the whole story? There was seemingly no benefit using these tests, so why did ¾ of patients prefer the combined treatment?I don't think it is coincidence either as "This preference for the combined therapy might have resulted from chance. But patients in the Bunevicius et al. (30) study also preferred levothyroxine plus liothyronine combinations, and a similar result has been recently confirmed in a large study conducted in The Netherlands by Appelhof et al. (45)." (from Escobar-Morreale et al)In the Bunevicius et al. Study 20 patients preferred thyroxine plus triiodothyronine, 11 had no preference, and 2 preferred thyroxine alone. This is almost a 2/3 preference to T3+T4. I couldnt find the Appelhof et al. study.Out of the 9 studies showed in the summary, 4 did not look for patient preference. Of the 5 that did, 3 shows a preference to T3 + T4, one found the preference to be equal for both treatments, and one found preference to be for the T4 only. The latter thought is now known to have use a proportion of T3 that is far too high. – "We know nowadays that all their patients were overtreated, with the adverse effects using the combinations being easily explained by the addition of 40–60 µg liothyronine to an already excessive levothyroxine dose" (from Escobar-Morreale et al). So it is no wonder most preferred T4 only.Overall, even though there is not hard proof of the benefit of T3 + T4 therapy, dowsn't the patients preference count for anything? In my mind it makes me think that the combined treatment is having an effect that is not, or cannot be, measured in any way.Also: these studies use T3 and T4, but not Armour, so patients are still not getting all the hormones (T1, T2 ..) that they naturally would. Dos anyone know if there are any studies that have used Armour? If not, would one that did be interesting?Jonny

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[Guest guest]

H Jonny, you seem to have a good understanding of research - are you a medic or a student or similar?

Gill

Subject: T3/T4 studies. Doesn't patient preference count as evidence? __,__

[Guest guest]

>

> H Jonny, you seem to have a good understanding of research - are you

a medic or a student or similar?

>

> Gill

> Subject: T3/T4 studies. Doesn't patient

preference count as evidence?

>

> __,__

>

No, Im doing maths at uni at the moment but have not done anything

medical. I just was looking into it and came across that summary of

those studies and thought 'why did the patients prefer the combined

therapy when the were no benefits to it (according to the study)?'. My

common sense tells me that patients wouldn't just prefer something for

no reason.

I wonder what these patients would say if they were asked why they

prefered the combined treatment?

Jonny

[Guest guest]

re: No, Im doing maths at uni at the moment

Hi Jonny - well this probably accounts for your understanding of the research! I think you are spot on re the Escobar review - but what I find so frustrating is that this is taken as evidence that there is no benefit to combination therapy when there is obviously something they havent asked patients about or considered in their findings. Wouldnt you think that this would flag up that there is more research to be done to find out why patients preferred the combination therapy? Unfortunately not to the medics!

Gill

[Guest guest]

>

> re: No, Im doing maths at uni at the moment

>

> Hi Jonny - well this probably accounts for your understanding of the

research! I think you are spot on re the Escobar review - but what I

find so frustrating is that this is taken as evidence that there is no

benefit to combination therapy when there is obviously something they

havent asked patients about or considered in their findings. Wouldnt

you think that this would flag up that there is more research to be

done to find out why patients preferred the combination therapy?

Unfortunately not to the medics!

> Gill

>

I would love to know what the patients said as to why they preferred

the combination therapy. Do you think there is any chance that

contacting any of the authors of these studies with that question

would result in a reply? I guess it is worth a go.

[Guest guest]

That's a great idea (now why didnt i think of that!) I'll see if I can find an email address for Escobar-Moreales.

Gill I would love to know what the patients said as to why they preferredthe combination therapy. Do you think there is any chance thatcontacting any of the authors of these studies with that questionwould result in a reply? I guess it is worth a go.

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[Guest guest]

I have emailed Escobar-Moreales. I need to study this paper more but although they are saying that so far T4 therapy should remain as treatment of choice, they do make a number of points in the paper for why some of the studies dont show a benefit from combination T3/T4 therapy - such as patients are over medicated, and in some, patients were undermedicated. Surely these factors undermine the results of the studies and the review?

Gill

[Guest guest]

they do make a number of points in the paper for why some of the studies dont show a benefit from combination T3/T4 therapy - such as patients are over medicated, and in some, patients were undermedicated. Surely these factors undermine the results of the studies and the review?

Gill

I know my gp says he has some patients whp take T3 as well as T4 and that they do say they feel much better on the combined therapy

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[Guest guest]

Yes I think they do. I think the results of these studies cannot

really be used. But the Escobar-Morreale study used proportion that

are in the correct proportion, eliminating this. I think the patient

preference in this study should be much more accurate than the other

studies.

[Guest guest]

You know, if these researchers wanted to find out whether combination therapy (synthetic or natural) actrually did make sufferers feel better and that it actually did work, all they need do is to join any of the hundreds of Internet hypothyroid forums throughout the world and read the messages. Save an awful lot of money.

Luv - Sheila

they do make a number of points in the paper for why some of the studies dont show a benefit from combination T3/T4 therapy - such as patients are over medicated, and in some, patients were undermedicated. Surely these factors undermine the results of the studies and the review?

GillI know my gp says he has some patients whp take T3 as well as T4 and that they do say they feel much better on the combined therapy

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[Guest guest]

What puzzles me is the previous two studies done by Escobar, et al., suggesting that replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroidism in all tissues, as studied in thyroidectomized rats. and another study showing only the combined treatment with thyroxine AND triiodothyronine ensures euthyroidism in all tissues of the thyroidectomized rat. I have included these previous 2 studies in my paper to back up my evidence, and BTA have used the other study to back up their statement. All quite confusing.

Luv - Sheila

I have emailed Escobar-Moreales. I need to study this paper more but although they are saying that so far T4 therapy should remain as treatment of choice, they do make a number of points in the paper for why some of the studies dont show a benefit from combination T3/T4 therapy - such as patients are over medicated, and in some, patients were undermedicated. Surely these factors undermine the results of the studies and the review?

Gill

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