Lazarus article in GP Pulse

[Guest guest]

Hi SheilaJust saw this new article in GP pulse magazine with Lazarus trying to diss patient groups who ask for T3 and dessicated thyroid. Thought you might be interested.http://www.pulsetoday.co.uk/story.asp?sectioncode=50 & storycode=4129600 & c=1Case oneA 43-year-old lady was diagnosed with hypothyroidism six months ago. She attends for review and you note her biochemical thyroid parameters are satisfactory. ‘But I feel no better, doctor,’ she says. She goes on to say that she has joined a thyroid sufferers’ forum via the internet and wonders if you could give her T3 hormone or animal thyroid extract.1. Are most hypothyroid patients likely to notice an improvement in wellbeing when they start thyroid treatment? How should this be broached prior to starting levothyroxine?The majority of patients with hypothyroidism start to feel back to normal on levothyroxine therapy.1

But this may take some time and it is likely that blood tests would normalise before the symptoms do. On the other hand, hypothyroid symptoms – such as weight gain and fatigue – are quite non-specific, and

some of these may not be related to hypothyroidism in the first place. So patients being started on levothyroxine replacement therapy should be

advised that improvement in symptoms may take a few months and that some symptoms may not improve. 2. What range of thyroxine (T4) and thyroid-stimulating hormone (TSH) reflects satisfactory thyroid replacement?In

people with normal pituitary function and primary hypothyroidism, the best marker of adequate levothyroxine replacement is a serum TSH within the normal reference range. In some patients, it may be necessary to aim

for a serum TSH towards the lower limit of the reference range for optimal feeling of well-being. This does not apply to people with secondary hypothyroidism (pituitary disease), who should usually be managed by a specialist.3. What is the rationale behind some thyroid patient groups’ requests for treatment with T3 or animal thyroid extract? Is there any evidence to support this?T4

is a pro-hormone which is deiodinated – an iodine atom is removed from the molecule – in the periphery to produce the active hormone T3. In humans, the normal thyroid gland produces all of the body’s T4 and some T3. A few patient groups feel that levothyroxine replacement is not able

to mimic normal physiology since a diseased thyroid gland may not produce adequate T3. In addition, it is speculated that some patients may not be able to convert levothyroxine to T3 in the tissues.There

was one study that compared levothyroxine therapy alone with levothyroxine/T3 combined therapy in 33 hypothyroid patients, and concluded that the combined therapy led to an improvement in mood and neuropsychological function. But this study was not representative of general hypothyroid patients, as more than half of the

recruited participants had been on replacement for treated thyroid cancer. Subsequently, nine randomised controlled trials have failed to validate these results in patients with primary hypothyroidism.2