Re: L-Thyroxine or Armour?

[Guest guest]

HI TerryThese are extracts from posts which have appeared in April.

"Don't worry about Dr Skinner starting you on Thyroxine - this is absolutely fine and normal. Let's hope that you are one of the majority who do well on only L-thyroxine."

"You must remember that the NHS treatment protocol is synthetic 'inactive' L-thyroxine. You need T3 in every cell to make your body function. This is why we advocate the use of T4/T3 combination therapy, either synthetic or natural, as in Armour Thyroid. The studies used synthetic L-Thyroxine (T4) only."

The second quote was used to support the contention that the studies which showed thyroid hormone treatment to have no effect on cholesterol were flawed by the fact that L-thyroxine was used.

I was not aware whether the people involved in these studies had been checked to see whether they could, in fact, convert the inactive thyroxinto the active T3 or not. Thyroxine may not have worked for some. Reasons should be found as to why these patients cholesterol didn't drop after starting L-thyroxine therapy. It is the T3 that is needed to help lower cholesterol. Studies should be done on patients who ARE able to convert.

Yes, the way the NHS deals with hypothyroidism is very often extremely poor but at the same time we need to avoid unduly emphasising the inadequacy of L-Thyroxine (T4).

The more I read, the more I am aware that for many sufferers of hypothyroidism, that thyroxine alone simply does not work. The majority of poor patients out there have no access to the Internet and accept what their doctors tell them, and if they still feel unwell on T4 only, they believe it is all part and parcel of the illness. Some doctors, like Dr Lowe who I read a lot, will not treat using L-thyroxine alone ever - and there are many others who do not either. Such doctors use T4/T3 in combination, T3 alone or Armour Thyroid.

It is the first quote that is correct. Estimations from practitioners in the US indicate that at around 75% of people with hypothyroidism are still able to convert T4 to T3 normally.

How do we know this. Where have they collected their evidence that 75% can still convert? Have they evidence as to how well their T4 is converting to t3 and whether this is sufficient for them to function normally? The majority of practitioners are no longer testing their Free T4 or Free T3 - and we know that there are thousands of patients using the Internet to find out why they still remain ill. If L-thyroxine alone was working for them, they wouldn't need to do this. Treatment of hypothyroidism has been a huge controversial matter for years the world over - and we need to find the answers as to why. In some people, conversion of T4 to the active T3 is poor and many, many studies have demonstrated that additional T3 is beneficial for some hypothyroid patients. If 75% of patients are able to 'convert' how is it that in our TPA-UK Hypothyroid Patient Survey - when asked of those patients undergoing L-thyroxine only therapy, "Do you feel that you have fully regained your optimal state of health?", out of a total of 1500 participants, 1176 (78.4%) answered "No". this doesn't make any sense.

Armour which is derived from pig's thyroid has a T3 to T4 ratio far higher than that of humans. Its use, or indeed any T3 medication, isn't indicated where a person doesn't have a T4 to T3 conversion problem.

I disagree with this. Armour has other natural thyroid hormones beside T3, It has t2, T1 and calcitonin and other goodies as yet unspecified. There is accumulating evidence that it is the T2 in Armour that does the job of getting such patients back to normal health, and not T3 as many believe. Armour does have a higher amount of T3 compared to T4 than the relative amounts of T3 to T4 secreted by the human thyroid gland, however it is well documented that Armour is often more effective and is better tolerated than synthetic preparations of T4, T3 and T4/T3 combination.

This is because the T3 in natural thyroid extract is absorbed more slowly than synthetic (purified, unbound) T3. The normal thyroid gland contains approximately 200 mcg of T4 per gram of gland, and 15 mcgs of T3 per gram. The ratio of these two hormones in the circulation does not represent the ratio of the thyroid gland, since about 80% of peripheral T3 comes from monodeiodination of T4. Peripheral monodeiodination of T4 also results in the formation of reverse T3, which is iatrogenically inactive.

A similar ratio can be obtained by prescribing both Armour and synthetic thyroxine, although clinical response and symptom control should take precedence over a theoretical ideal. Perhaps the ultimate form of thyroxine for difficult patients is whole thyroid extracted from animals, such as Armour thyroid tablets. The long history of successful use thyroid extract in America has seen natural thyroid extract products successfully compete with the heavily promoted synthetic T4 and T3 preparations. Not only are whole glandular extracts often superior to T4 for the treatment of hypothyroidism, but there is evidence to suggest that such products are also superior to combined T4/T3 preparations. Shames and Shames report a patient who was treated unsuccessfully with a combination of T4 and T3 who experienced a dramatic improvement when switched to Armour. When synthetic T4 and T3 first became available, Arem reports the considerable difficulties he experienced when switching patients from thyroid extracts to the new synthetic preparations. According to Arem, "The new treatment was seldom entirely successful....... Once switched from these natural T4/T3 tablets to T4 tablets, patients complained of sluggishness, decreased memory, impaired concentration, and a host of symptoms of ill-being. This was in spite of having reached normal blood levels of thyroid hormone and TSH." - nothing has changed as far as I can see.

Since at least a third of treated hypothyroid patients whose blood tests have been restored to "normal" continue to have symptoms, this shows that T4 only therapy is often unsuccessful, a fact which is hardly surprising given the fact that T3 is the crucially important active thyroid hormone; and the commonly seen failure to convert T4 to T3 (and also, to a lesser extent T2) will result in an unsatisfactory treatment outcome. Clearly, much greater priority must be given to a symptomatic approach and the importance of how the patient feels, given the relative ineffectiveness of T4 and the dubious usefulness of the serum TSH test alone for diagnosis - of which I hope to write a paper about later. There was an article in The Daily Mail last January. This article included information about the success of combination therapy (synthetic and natural) other than L-thyroxine alone. The response from the general public requesting further information was so great that the Mail’s switchboard was inundated with calls and they were unable to cope. TPA was approached to get together a team of helpers to meet the demand. It is sensible that experienced practitioners like Dr S and Dr M in this country start people off on L-Thyroxine and monitor the effect.However, as we know, most GPs are unwilling to offer any kind of treatment if T4 and TSH values are in the usual range and will decline to offer a T3 test on the basis that it is either unreliable or irrelevant.

It is also a fact that both Dr S and Dr M will move away from T4 only therapy if their patients do not respond satisfactorily and use combination therapy or natural thyroid extract. Studies were done using L-thyroxine alone v T4/T3 combination therapy. The results for most showed that T3 made no difference. THESE STUDIES WERE FLAWED. The majority of doctors base their decisions on these studies and what the BritishThyroid Association state. The bTA policy is to use T4 only - and the reason why the vast majority will not stray away from this mainstream protocol is because their fear of being reported tol the GMC and their livelihood taken away from them. What we are campaigning for on this particular forum is to stop doctors using the TSH and T4 blood tests only and to 'treat' the patient. They should be going by their patients symptoms, signs (of which there are many) - the patients family history, checking to see if they have antibodies to their thyroid and generally listening to their patients story, and looking at the results of blood tests alongside these. The fact is - they are not.

Patients might find it helpful to go armed with the little book by Toft, "Thyroid Disorders." This is a book in the BMA Family Doctor series which hopefully will carry some weight!! He argues for treatment to be based on symptoms and not just test results and suggests that when the correct dose of thyroxine is given the values of T4 and TSH are likely to be around 24 and 0.2 respectively (the outer limits of normal) and at the same time does not have the effect of producing excess T3.

I completely agree with this as stated above, but how do we go about ensuring that every NHS doctor does this and that he is being taught the facts about diagnosing hypothyroidism. If L-thyroxine works for a patient, this will be titrated until they reach the dose that makes them well - whatever the blood result at the end of the day, but again, these Internet forums are not for those doing well on L-thyroxine, they are for sufferers who are NOT doing well on the NHS protocol and need combination therapy, either synthetic or natural.

As a matter of interest, I have had 3 general practitioners phone me at home asking me for information about Armour. Each of them was hypothyroid, each of them was on T4 only therapy and each of them remained unwell and was desperate for more information about natural thyroid extract and where they could obtain it. Doesn't that say a lot?

The book is available cheaply from Amazon and can also be read on-line at the address below and is well worth downloading. That said, Toft doesn't discuss the 25% of us who have a T4 to T3 conversion problem.

http://www.familydoctor.co.uk/onlinebooks/thyroid/thyroid.html

Luv - SheilaTerry

[Guest guest]

We need more of those hypo docs trying Armour

Shows you are getting the word out though Shiela, well done

lotsa luv

Dawnx