Re: advice from British Thyroid Foundation

[Guest guest]

Hi Fishyfeet (Great name!)

Well....I get so angry everytime I read anything from the disgraceful organisation that is 'The British Thyroid Foundation'.

I am in no doubt whatsoever that this 'organisation' is merely there to generate money between various other medical groups and Endocrine societies. Monetary awards are presented to them annually to carry out another one of their farcical studies...some of which never see the light of day and others which are used as 'concrete' evidence because they funded it and their medical advisors are all experts in the field of course.

They continue to ignore mounting evidence especially in regards to T3 therapy and quote studies from 10 years back and beyond.I don't need any randomised controlled studies to prove anything.I already know that when I am on T4 only I ache in all my muscles and joints (Fibromyalgia my dear old doc calls it.) And when I switch to T3 it goes away.So,my question would be "Why do I have this 'Fibromyalgia' on Thyroxine but NOT on Liothyronine?

Now if it were a BTF 'advisor' responding to that question they would no doubt call it the 'placebo effect'...another of their favourite explanations for everything.

I cannot take them seriously.Their answers are not based on Science but on doctrinal coercion. Afterall their bonuses,perks,promotions,holidays etc depend upon it.Why would they want that to end ? Would you?

Regards Peary In summary there is no clear evidence from clinical literature of a proven link between the conditions or the effectiveness of T3 treatment of fibromyalgia. > > Our medical adviser writes; > > Fibromyalgia is a chronic condition of uncertain cause characterised by widespread pain, muscle tenderness and reduced pain threshold. However, most patients with fibromyalgia also report other symptoms such as tiredness after exercise, low mood, sleep disturbances, etc. Fibromyalgia is present in about 2% of the population and affects women more than men (about 6 times more common) > > There have been no randomised controlled trial – which is the gold standard of finding the cause of a condition or to check the effectiveness of a treatment - of thyroxine or T3 therapy in patients with fibromyalgia. Therefore, it is difficult to be absolutely certain that T3 therapy is effective in this condition. However, there have been a number of such trials in patients with an underactive thyroid (8 to be exact) that have shown no benefit of T3/T4 combination over T4 alone in reducing symptoms.

[Guest guest]

Well my question would be - why when on T3 does my digestive system work perfectly yet when I am on thyroxine alone I get IBS. It cannot be a placebo effect because originally when I had this problem I didn't (nor did the doctor of course) connect it to thyroxine only.

Then one day I started T3 and hey presto I was normal again. I still did not put two and two together until after a few years of being normal the doctor told me to stop taking the T3. I did, got the IBS symptoms but STILL didn't put two and two together.

However with all the other symptoms I was having I started back on the T3. There was no doubt then, I immediately was normal again.

So definitely no placebo effect. They cannot measure pain and therefore they can put it down to the placebo effect when someone says they feel better. But surely they cannot deny something the effects of which can be 'seen' and monitored.

I wonder who these people are who they did the tests on. I suppose to get the outcome they wanted they tested people who were quite OK with thyroxine alone.

Lilian

So,my question would be "Why do I have this 'Fibromyalgia' on Thyroxine but NOT on Liothyronine?

Now if it were a BTF 'advisor' responding to that question they would no doubt call it the 'placebo effect'...

[Guest guest]

> It is possible that the relationship between thyroid disease and fibromyalgia

may be co-incidental since there is more case-finding due to some similarities

in symptoms. For example, a patient presents to their GP with pain and/or

tiredness and the GP performs a number of tests including thyroid function and

it is found that there is a slight abnormality in the thyroid result. >

*Would that be like being a tiny bit pregnant?

> There have been no randomised controlled trial – which is the gold standard of

finding the cause of a condition or to check the effectiveness of a treatment -

of thyroxine or T3 therapy in patients with fibromyalgia. Therefore, it is

difficult to be absolutely certain that T3 therapy is effective in this

condition. However, there have been a number of such trials in patients with an

underactive thyroid (8 to be exact) that have shown no benefit of T3/T4

combination over T4 alone in reducing symptoms.

Furthermore, there has been one trial (Pollock et al, BMJ 2001) that studied 25

individuals with symptoms of an underactive thyroid but with normal thyroid

function tests (in response to the argument that blood tests may not be very

specific for detecting an abnormal thyroid gland or its function). This study

found that thyroxine was no more effective than placebo (dummy tablet) in

improving cognitive function (brain processes) and psychological well-being.

* Well, it would if thats what they were looking for and such a small control

group!! How can they prove anything with less than a 100 patients in the group

study?

>

>

[Guest guest]

Hi All, I'm relatively new to all but wondered if the following paper, dated 1995, would help with T3 treatment?

! T3-induced recovery from fibromyalgia by a hypothyroid patient resistant to T4 and desiccated thyroid . C. Lowe, MA, DC: . Journal Myofascial Therapy, 1(4):26-31, 1995.Abstract. The main purpose of this case report is to illustrate a clinical observation common to me: that fibromyalgia syndrome (FMS) patients with central hypothyroidism who fail to benefit from T4 or desiccated thyroid completely recover when they switch to T3. A similar observation was reported by numerous researchers in the 1950s, after the discovery and synthesis of T3. Changing status in the patient was evaluated in three ways: a psychiatrist used a depression inventory, a physical therapist performed functional musculoskeletal assessments, and I performed algometer tender point exams and monitored symptoms. I hope the description of the management of this case, in which the patient fully recovered from FMS symptoms, provides a protocol that other clinicians will use with FMS patients similar to the one who is the subject of this report.

Bill

'The British Thyroid Foundation' continue to ignore mounting evidence especially in regards to T3> therapy and quote studies from 10 years back and beyond.

[Guest guest]

Hello Fishyfeet - don't let the BTF and the 'nameless' BTA medical adviser get away with this. This is utter rubbish being published by an organisation that should know better, and such publication of this rubbish is causing real harm to those suffering the symptoms of hypothyroidism - fibromyalgia being just one of these.

"Thank you for your enquiry about the connection between hypothyroidism andfibromyalgia, and whether T3 would be beneficial to someone suffering bothconditions.

Our medical adviser has reviewed your enquiry and their guidance is given below."

Ask why they do not disclose the `medical adviser's' name. This is essential as we have no guarantee that such `guidance' has come from anybody with the necessary qualifications – it could have been written by anybody. This is NOT good enough and is totally unprofessional.

"In summary there is no clear evidence from clinical literature of a proven linkbetween the conditions or the effectiveness of T3 treatment of fibromyalgia."

OK….so let's take this further.

We might as well say that there is also no clear evidence from clinical literature of a proven link between the conditions of the effectiveness of T3 treatment of all the other symptoms of hypothyroidism –e.g. Extreme Tiredness, Fatigue, Weight Gain, Lethargic, Sluggish, Joint & Muscle Pain (Fibromyalgia), Sleep Problems, No Motivation, Depressed, Cold Intolerance, Mood Swings, Lack of Stamina, Weak, Brittle, Ridged Nails, Memory, Loss, Foggy Mind, Impaired Concentration, Dry Skin, Sore Skin, Scaly Skin, Body Hair Loss, Outer Eyebrow Loss, Lifeless Hair, Poor Appetite, Constipation, Hoarse Voice, Tingling of the Hands (Carpal Tunnel Syndrome), Abnormal Periods, Deafness, Slow Reflexes, Slow Movements, Puffy Face, Slow Pulse Rate, and Enlarged Thyroid Gland.

BTA/RCP insist that all such symptoms are `non-specific', as is fibromyalgia. However, if the `Medical Adviser' for BTF had done a little homework,s/he would have found that Drs. Baisier, Hertoghe, and Eeckhaut (Thyroid Insufficiency? Is Thyroxine the Only Valuable Drug?) studied the failures of the customary practice of endocrinology and found an evaluation of eight nonspecific symptoms is a good clinical diagnostic. [baiser, W V, Herto ghe, J., Bee khaut, W .Thyroid Insufficiency? Is Thyroxine the Only Valuable Drug? , J Nutr and Environ Med, September 2001, 11(3):159-166,]- but, TPA keeps passing on such information to the BTA Executive Committee, who refuse to take any of the scientific evidence we send into consideration!!

"There have been no randomised controlled trial – which is the gold standard offinding the cause of a condition or to check the effectiveness of a treatment - of thyroxine or T3 therapy in patients with fibromyalgia. Therefore, it isdifficult to be absolutely certain that T3 therapy is effective in thiscondition. However, there have been a number of such trials in patients with anunderactive thyroid (8 to be exact) that have shown no benefit of T3/T4combination over T4 alone in reducing symptoms. "

This is a cheat, hoping we are the idiots they actually believe us to be. First they say there have been no randomised controlled trials to check the effectiveness of T4 or T3 therapy in patients with fibromyalgia – and then they go on to quote the 8 trials in patients with an underactive thyroid that have shown no benefit of T3/T4 combination over T4 alone in reducing symptoms. I thought we were supposed to be talking about fibromyalgia SPECIFICALLY. What a cop out!

Dr E Chester Ridgeway states :

􀂃 "T4 … is not the active ingredient. T3 is the active ingredient and it's the thing that accounts for the thyroid hormone action. As I've been reminded many times, there are no intracellular events that we know that can be described by T4 at the level of the nucleus. Only T3. T4 is not the active compound. Likewise, the site of action is in the nucleus. The site of action is not T4 in the plasma." [Ridgway, E.C.: Equivalence of levothyroxine sodium products. Joint Public Meeting (Cosponsored with the American Thyroid Association, The Endocrine Society, and the American Association of Clinical Endocrinologists). Monday, May 23, 2005.]

The metabolism of T4 to T3 is necessary for the thyroid to have an effect. Peripheral metabolism was discovered by Braverman, et al., in 1970. [braverman LE, Ingbar SH, Keinwern S, Conversion of Thyroxine (T4) to triiodothyronine (T3) in Athyreotic Human Subjects, The J clin Invest, 107-,49]

"Furthermore, there has been one trial (Pollock et al, BMJ 2001) that studied 25 individuals with symptoms of an underactive thyroid but with normal thyroid function tests (in response to the argument that blood tests may not be very specific for detecting an abnormal thyroid gland or its function). This study found that thyroxine was no more effective than placebo (dummy tablet) in improving cognitive function (brain processes) and psychological well-being."

Ask them to read the critique written by Dr Lowe who sent this to the BTA without them giving him the courtesy of a receipt - http://www.thyroidscience.com/Criticism/lowe.3.16.09/bta.rebuttal.htm

I would suggest that you also update the BTF and ask them to pass on the following references to other studies they obviously have failed to take into account, even though TPA has sent these to them on numerous occasions, to each individual member of the Executive Committee of the BTA.. Ask them WHY they refuse to take these into account and let's see what they have to say – though don't be surprised if they fail to even acknowledge receipt

Arguments pro treatment with T4 and T3 combinations

T3-T4 (and T3) treatments work better than T4

1. Saravanan P, DJ, Greenwood R, s TJ, Dayan CM. Partial substitution of thyroxine (T4) with tri-iodothyronine in patients on T4 replacement therapy: results of a large community-based randomized controlled trial. Clin Endocrinol Metab. 2005 Feb;90(2):805-12 1032.

2. Kloppenburg M, Dijkmans BA, Rasker JJ. Effect of therapy for thyroid dysfunction on musculoskeletal symptoms. Clin Rheumatol. 1993 Sep;12(3):341-5

3. Hertoghe T, Lo Cascio A., Hertoghe J. Considerable improvement of hypothyroid symptoms with two combined T3-T4 medication in patients still symptomatic with thyroxine treatment alone. Anti-Aging Medicine, Ed. German Society of Anti-Aging Medicine-Verlag 2003- 2004; 32-43

4. Pareira VG, Haron ES, Lima-Neto N, Medeiros-Neto GA. Management of myxedema coma: report on three successfully treated cases with nasogastric or intravenous administration of triiodothyronine. J Endocrinol Invest. 1982;5:331-4

5. Chernow B, Burman KD, DL, McGuire RA, O' JT, Wartofsky L, s LP. T3 may be a better agent than T4 in the critically ill hypothyroid patient: evaluation of transport across the blood-brain barrier in a primate model. Crit Care Med. 1983 Feb;11(2):99-104

6. Arlot S, Debussche X, Lalau JD, Mesmacque A, Tolani M, Quichaud J, Fournier A. Myxoedema coma: response of thyroid hormones with oral and intravenous high-dose L-thyroxine treatment. Intensive Care Med. 1991;17(1):16-8

T3-T4 treatment: adding T3 to T4 results in greater improvement of clinical symptoms and signs in hypothyroid patients

7. Benevicius R, Kazanavicius G, Zalinkovicius R, Prange AJ. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med.1999; 340: 424-9.

When T3 and T4 are both supplemented to the food simultaneously with goitrogens, a much better prevention of goiter is obtained than when solely T4 is added, even if T4 is given at doses 7 times higher those of T3-T4 treatments

8. Devlin WF, Watanabe H. Thyroxin-triiodothyronine concentrations in thryoid powders. J Pharm Sci. 1966 Apr;55(4):390-3

In humans, T4-T3 treatments reduce serum cholesterol and increase the speed of the Achilles tendon reflexes better than T4 treatments alone

9. Alley RA, Danowski TS, Robbins T JL, Weir TF, Sabeh G, and Moses CL. Indices during administration of T4 and T3 to euthyroid adults. Metabolism. 1968;17(2):97-104

A study in rats rendered hypothyroid shows that cellular euthyroidism is only obtained in the target organs of hypothyroid rats if T3 is added to the classic T4 medication

10. 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

11. 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

Medications with T4 alone do not succeed in achieving complete cellular euthyroidism in the target organs, probably because T3 is really the active hormone

12. Asper SP Jr, Selenkow HA, and Plamondon CA. A comparaison of the metabolic activities of 3,5,3'-triiodothyronine and l-thyroxine in myxedema. Bull Hopkins Hosp. 1953; 93: 164

13. Blackburn CM, McConahey WM, Keating FR Jr, Albert A. Calorigenic effects of single intravenous doses of l-triiodothyronine and l-thyroxine in myxedematous persons. J Clin Invest. 1954 Jun;33(6):819-24

T3 is much more potent than T4

14. Gross J, Pitt-Rivers R. Physiological activity of 3:5:3'-L-triiodothyronine. Lancet. 1952 Mar 22;1(12):593-4

15. Gross J, Pitt-Rivers R. 3:5:3'-triiodothyronine. 2. Physiological activity. Biochem J. 1953 Mar;53(4):652-7

Conditions that reduce the conversion of T4 to T3 such as aging, obesity, disease, stress, exercise, malnutrition, etc., may reduce the efficacy of a T4 alone treatment. In these conditions addition of T3 to T4 in the treatment may increase the efficacy of thyroid treatment.

16. Burroughs V, Shenkman L. Thyroid function in the elderly. Am J Med Sci. 1982, 283 (1): 8-17

17. JN, Eastman CJ, Corcoran JM, and Lazarus L. Inhibition of conversion of thyroxine to triiodothyronine in patients with severe chronic illness. Clin Endocrinol. 1976; 5: 587-94

18. Tulp OL and McKee TD Sr. Triiodothyronine neogenesis in lean and obese LA/N-cp rats. Biochem Biophys Res Communications. 1986; 140 (1): 134-42

19. Katzeff HI, Selgrad C. Impaired peripheral thyroid hormone metabolism in genetic obesity. Endocrinology. 1993; 132 (3): 989-95

20. Croxson MS and Ibbertson HK. Low serum triiodothyronine (T3) and hypothyroidism in anorexia nervosa. J Clin Endocrinol Metab. 1977; 44: 167-73

21. Harns ARC, Fang SH, Vagenakis AG, and Braverman LE. Effect of starvation, nutriment replacement, and hypothyroidism on in vitro hepatic T4 to T3 conversion in the rat. Metabolism. 1978;27(11):1680-90

22. Opstad PK, Falch D, Öktedalen O, Fonnum F, and Wergeland R. The thyroid function in young men during prolonged physical exercise and the effect of energy and sleep deprivation. Clin Endocrinol. 1984; 20: 657-69

23. Walfish PG. Triiodothyronine and thyroxine interrelationships in health and disease. Can Med Ass. J 1976, 115: 338-42

Toxic substances such as phenols, cadmium, mercury, etc, and medications such as propranolol, amiodarone and several others may interfere by stimulating or inhibiting the T4 to T3 conversion

24. Feyes D, Hennemann G and Visser TJ. Inhibition of iodothyronine deiodinase by phenolphtalein dyes. Fed Eur Biomed Sci. 1982; 137(1):40-4

25. Bahn AK, Mills JL, Snyder PJ, Gann PH, Houten L, Bialik O, Hollmann L, and Utiger RD. Hypothyroidism in workers exposed to polybrominated biphenyls. N Engl J Med. 1980; 302: 31-3

26. Ikeda T, Ito Y, Murakami I, Mokuda O, Tominaga M and Mashiba H. Conversion of T4 to T3 in perfused liver of rats with carbontetrachloride-induced liver injury. Acta Endocrinol. 1986;112: 89-92

27. Paier B, Hagmüller K, Nolli Mi, Pondal M, Stiegler C and Zaninovich AA. Changes induced by cadmium administration on thyroxine deiodination and sulfhydryl groups in rat liver. J Endocrinol. 1993; 138: 219-24

28. Barregärd L, Lindstedt G, Schütz A, Sällsten G. Endocrine function in mercury exposed chloralkali workers. Occup Envir Med. 1994; 51: 536-40

Deficiencies in hormones (T3 itself, TSH, growth hormone, insulin, melatonin, etc) and trace elements (selenium, iron, zinc, cupper, etc) partially block this essential step for thyroid function

29. Burger AG, Lambert M, Cullen M. Interférence de substances médicamenteuses dans la conversion de T4 en T3 et rT3 chez l'homme. Ann Endocrinol (Paris). 1981,42:461-9

30. Grussendorf M, Hüfner M. Induction of the thyroxine to triiodothyronine converting enzyme in rat liver by thyroid hormones and analogs. Clin Chim Acta. 1977;80:61-6

31. kson VJ, Cavalieri RR, Rosenberg LL. Thyroxine-5'-diodinase of rat thyroid, but not that of liver, is dependent on thyrotropin. Endocrinology. 1982;111:434-40

32. Rezvani I, Di AM, Dowshen SA, Bourdony CJ. Action of human growth hormone on extrathyroidal conversion of thyroxine to triiodothyronine in children with hypopituitarism. Pediatr Res. 1981;15:6-9

33. Schröder-Van der elst JP, Van der heide D. Effects of streptozocin-induced diabetes and food restriction on quantities and source of T4 and T3 in rat tissues. Diabetes. 1992;41:147-52

34. Gavin LA, Mahon FA, Moeller M. The mechanism of impaired T3 production from T4 in diabetes. Diabetes. 1981;30:694-9

35. Hoover PA, Vaughan MK, Little JC, Reiter RJ. N-methyl-D-aspartate does not prevent effects of melatonin on the reproductive and thyroid axes of male Syrian hamsters. J Endocrinology. 1992;133:51-8

36. Chanoine J-P, Safran M, Farwell AP, Tranter P, Ekenbarger DM, Dubord S, s, Arthur JR, Beckett GJ, Braverman LE, Leonard JL. Selenium deficiency and type II 5'-deiodinase regulation in the euthyroid and hypothyroid rat: evidence of a direct effect of thyroxine. Endocrinology. 1992;130:479-84

37. Arthur JR, Nicol F, Beckett GJ. Selenium deficiency, thyroid hormone metabolism, and thyroid hormone deiodinases. Am J Clin Nutr Suppl. 1993; 57:236S-9S

38. Beard J, Tobin B, and Green W. Evidence for thyroid hormone deficiency in iron-deficient anemic rats. J Nutr. 1989;772-8

39. Fujimoto S, Indo Y, Higashi A, Matsuda I, Kashiwabara N, and Nakashima I. Conversion of thyroxine into triiodothyronine in zinc deficient rat liver. J Pediatr Gastroenterol Nutr. 1986;5:799-805

40. Olin KI, Walter RM, and Keen CL. Copper deficiency affects selenoglutathione peroxidase and selenodeiodinase activities and antioxidant defense in weanling rats. Am J Clin Nutr 1994;59:654-8

On the other hand, excesses in hormones (glucocorticoids, ACTH, estrogens,…) and trace elements (iodine, lithium, …) may slow down this conversion.

41. Westgren U, Ahren B, Burger A, Ingemansson S, Melander A. Effects of dexamethasone, desoxycorticosterone, and ACTH on serum concentrations ot thyroxine, 3,5,3'-triiodothyronine and 3,3',5'-triiodothyronine. Acta Med Scand. 1977;202 (1-2): 89-92

42. Heyma P, Larkins RG. Glucocorticoids decrease the conversion of thyroxine into 3,5,3'-triiodothyronine by isolated rat renal tubules. Clin Science. 1982; 62: 215-20

43. Scammell JG, Shiverick KT, Fregly MJ. Effect of chronic treatment with estrogen and thyroxine, alone and combined, on the rate of deiodination of l-thyroxine to 3,5,3'-triiodothyronine in vitro. Pharmacology. 1986;33: 52-7

44. Aizawa T, Yamada T. Effects of thyroid hormones, antithyroid drugs and iodide on in vitro conversion of thyroxine to triiodothyronine. Clin Exp Pharmacol Physiol. 1981; 8: 215-25

45. Voss C, Schrober HC, Hartmann N. Einfluss von Lithium auf die in vitro-Deioderung von l-Thyroxin in der Ratten leber. Acta Biol Med Germ. 1977; 36:1061-5

The absorption of oral T4 can be variable (50 to 73%40,41), contrasting with that of T3 that is more constant and efficient (95%)

46. Hays MT. Absorption of oral thyroxine in man. J Clin Endocrinol Metab. 1968; 28 (6):749-56

47. Surks MI, Schodlow AR, Stock Jm, Oppenheimer JH. Determination of iodothyronine absorption and conversion of L-thyroxine using turnover rate techniques. J Clin Invest. 1973; 52:809-11

48. Hays MT. Absorption of triidothyronine in man. J Clin Endocrinol Metab. 1970; 30(5):675-6

Defects in the commercial T4 preparation43,44

49. Hubbard WK. FDA notice regarding levothyroxine sodium. Federal register. 1997; 62(157): 1-10

50. Peran S, Garriga MJ, Morreale de Escobar G, Asuncion M, Peran M. Increase in plasma thyrotropin levels in hypothyroid patients during treatment due to a defect in the commercial preparation . J Clin Endocrinol Metab. 1997;82(10):3192-5

Corrective Thyroid Therapy

Thyroid medications

Alley RA, Danowski TS, Robbins TJ, Weir TF, Sabeh G, Moses CL Indices during administration of T4 and T3 to euthyroid adults. Metabolism. 1968 Feb;17(2):97-104 (equivalencies between T4, T3, T3 + T4, desiccated thyroid preparations)

Thyroxine

51. Oppenheimer JH, Braverman LE, Toft A, , IM, Ladenson, PW. Thyroid hormone treatment when and what? J Clin Endocrinol Metab. 1995;80:2873-83

52. Dong BJ, Brown CH. Hypothyroidism resulting from generic levothyroxine failure. J Am Board Fam. Pract. l991;4:167-70

53. Roti E, Minelli R, Gardini E, Braverman LE. The use of misuse of thyroid hormone. Endocrine Rev. 1993;14:401-23

54. Toft AD. Thyroxine therapy. N Engl J Med. 1994 Jul 21;331(3):174-80

55. USP Dispensing Information: Volume 1- Drug Information for Health Care Professionals. The United States Pharmacopeial Convention, Rockville, MD, 1997

56. Ridgway EC, McCammon JA, Benotti J, Maloof F. Acute metabolic responses in myxedema to large doses of intravenous L-thyroxine. Ann Intern Med. 1972;77:549-55

Thyroxine-triiodothyronine associations

57. Rees- RW, Larsen PR. Triiodothyronine and thyroxine content of desiccated thyroid tablets. Metabolism. 1977 Nov;26(11):1213-8

58. Mangieri CN, Lund MH. Potency of United States Pharmacopeia desiccated thyroid tablets as determined by the antigoitrogenic assay in rats. J Clin Endocrinol Metab. 1970 Jan;30(1):102-4

59. Gaby AR. Sub-laboratory hypothyroidism and the empirical use of Armour thyroid. Altern Med Rev. 2004 Jun;9(2):157-79

60. Hertoghe T, Lo Cascio A., Hertoghe J. Considerable improvement of hypothyroid symptoms with two combined T3-T4 medication in patients still symptomatic with thyroxine treatment alone. Anti-Aging Medicine (Ed. German Society of Anti-Aging Medicine-Verlag 2003) 2004; 32-43

61. Hertoghe T. Many conditions related to age reduce the conversion of thyroxine to triiodothyronine - a rationale for prescribing preferentially a combined T3 + T4 preparation in hypothyroid adults. Anti-Aging Medical Therapeutics 2000; IV: 138-53

Some patients with low or borderline low cortisol levels may poorly tolerate any type of thyroid medication, and in particular thyroxin-triiodothyronine combinations

Studies that show that the conversion of T4 into T3 and serum T3 is increased in cortisol deficiency, reducing the serum level of T4 while increasing that of T3

62. Comtois R, Hebert J, Soucy JP. Increased in Ts levels during hypocorticism in patients with chronic secondary adrenocorticaal deficiency Insufficiency. Acta Endocrinol. (Copenh). 1992; 126(4):319-24

Studies that show that glucocorticoids reduce the conversion of T4 to T3

63. Westgren U, Ahren B, Burger A, Ingemansson S, Melander A. Effects of dexamethasone, desoxycorticosterone, and ACTH on serum concentrations ot thyroxine, 3,5,3'-triiodothyronine and 3,3',5'-triiodothyronine. Acta Med Scand. 1977;202 (1-2): 89-92

64. Heyma P, Larkins RG. Glucocorticoids decrease the conversion of thyroxine into 3,5,3'-triiodothyronine by isolated rat renal tubules. Clin Science. 1982; 62: 215-20

Studies that show reduced T3 nuclear receptors in adrenal deficiency

65. De Nayer P et al. Altered interaction between triiodothyroinine and its nuclear receptors in absence of cortisol: a proposed mechanism for increased TSH secretion in corticossteroid deficiency states. J Clin Invest 1987; 17(2): 106-10

[Guest guest]

Would it also pay for Diane to reply to her latest correpondence with something similar;

Dear BTF, You appear to be relying upon the words of a "medical adviser" failing to disclose any of his/her qualifications. I assume that s/he must still be at medical school? Or may even be a DoH bean counter in Whitehall.

But, as there appears to be a huge disparity between your's and our medical advisers information would you be kind enough to enlighten his studies by forwarding the work of Dr Lowe MA. BA. B.S. human biology, doctorate in chiropractic Los Angeles College of Chiropractic, now the Southern California University of Health Sciences and(Director of Research, Fibromyalgia Research Foundation)

T3-Induced Recovery from Fibromyalgia by a Hypothyroid Patient Resistant to T4 and Desiccated Thyroid*

A number of researchers in the 1950s and 1960s reported that hypothyroid patients responded to T3, the metabolically active thyroid hormone, after failing to benefit from T4, desiccated thyroid, or thyroglobulin.[ 8][9,p.13][10,p.274][11][12][13][14]

Many of the symptoms the patients in these reports recovered from are remarkably similar to those characteristic of fibromyalgia. The symptoms are listed in Table 1.

Table 1.

Six sets of symptoms reportedly relieved by T3 after T4, desiccated thyroid, or thyroglobulin failed to relieve them.

1. Aching in both knees, skin pallor, facial puffiness,

a dull feeling, and tiredness.[8]

2 Lethargy, easy fatigue, nervousness, irritability, sensitivity

to cold, headache, musculoskeletal pain, diminished

sexual potency, and menstrual irregularities.[

9]

3. Chronic fatigue, muscle and joint aches, excess

weight, bowel dysfunction, cold intolerance.[10]

4. Muscle aches, stiffness, chronic fatigue, excess

weight, menstrual disturbances, dry hair and skin,

brittle fingernails, nervousness, irritability, depression,

mental apathy, puffiness of the face.[11]

5. In school children, poor school records, short attention

span, lack of ability to concentrate, "don't

care attitude," anxiety, restlessness, poor appetite,

constipation.[12]

6. Muscle and joint pains, fatigue, irritability and mood

swings, lethargy, decreased libido, premenstrual

tension, GI disturbances, scalp seborrhea or hair

loss, palpitations, and shortness of breath.[13]

>> Thank you for your enquiry about the connection between hypothyroidism and fibromyalgia, and whether T3 would be beneficial to someone suffering both conditions.> > > Our medical adviser has reviewed your enquiry and their guidance is given below. In summary there is no clear evidence from clinical literature of a proven link between the conditions or the effectiveness of T3 treatment of fibromyalgia.> > > Our medical adviser writes:> > > Fibromyalgia is a chronic condition of uncertain cause characterised by widespread

[Guest guest]

You may have a problem with conversion of T4 to T3 and this would present with hypothyroid symptoms whereas taking T3 the conversion is unnecessary.

sally xx

So,my question would be "Why do I have this 'Fibromyalgia' on Thyroxine but NOT on Liothyronine?

Now if it were a BTF 'advisor' responding to that question they would no doubt call it the 'placebo effect'...