Experts in France Suggest Reconsiderting Hypo Treatment

[Rella48]

This article addresses reconsidering treatment of hypothyroidism:

http://www.fsaam.com/article.php3?id_article=22

EXCERPT FROM ARTICLE

The International Hormone Society’s Consensus Group of Experts on Hormone Therapies Consensus (in France) on 9-29-2005.

After having reviewed the scientific literature and exchanged experiences between physicians from all over the world and who are competent in hormone therapies, we, members of the Consensus Group, think the time is ripe to reconsider current concepts on thyroid treatment of hypothyroidism...

...a few studies have shown significantly greater efficacy of combined thyroxine-triiodothyronine medications compared to the use of thyroxine alone in humans on such divergent parameters as serum cholesterol, mental and physical symptoms, and in animals on goitre formation and intracellular triiodothyronine(T3)-euthyroidism, just to name some of the greater benefits.

Concerning the debate about which association treatment works best : synthetic T3-T4 or dessicated thyroid...Reports of patients feeling better on dessicated thyroid may have scientific evidence as these preparations contain next to T3 and T4 also a number of other substances that may have some thyroid activity as diiodo-and monoiodo-thyronines...Thus, dessicated thyroid may work better.

In patients with cortisol deficiency, we recommend the physician to treat the low cortisol state prior or concomitantly to the thyroid treatment. If not, thyroxin alone may be the better treatment of hypothyroidism in the presence of an untreated cortisol deficiency.

[Mark Lupo, M.D.]

I'm sorry, I don't see a question here.

This is a debated topic that remains unanswered - there are data to support both sides of the argument and as previously mentioned several times the treatment of the hypothyroid patient must be individualized and once again, no general statements should be put forth except that we need to consider all the available options (t3, t4, armour and perhaps more to come in the future) as the clinician treating the individual patient.

[ancientmariner]

Yes! I read that article, too. That's why the Armour users here are so generously tryin gto share their experiences. We want everyone to know that Armour works!

Thanks for posting that link!

[Chocobabe]

I've read that too. Glad to see it posted. I have experienced the difference! You would enjoy the natural thyroid hormones group on Yahoo, Rella!

[tamu33]

I am going to my third endo this month and have actually called and talked to them about treatment before I drive 3 hours to see them.  I have been battling with the past two docs about starting treatment for Hashimoto's and they refuse until my labs are over 5 (which is the old standard) even though I feel awful all the time and have gained 20 pounds in the last two years with diet and exercise (did a sprint triathlon this past May!)  The new doc says they go by labs but also how a patient feels and they perscribe 4 different types of meds to include Armour.  From what I have read, I am going to insist on the Armour and didn't want to have to fight to get it.  Thanks for all the info!

[nelsonchatham]

I find this strange that you say "the treatment of the hypothyroid patient must be individualized and once again, no general statements should be put forth except that we need to consider all the available options"...when the truth is - the vast majority of doctors always give a T4 med and dose by the TSH.  So where is the "individualized" in that?  

What is appears to me...is that your statement just resists what the original poster was trying to point out...which is...it is true that desiccated thyroid extract is preferred by patients...and that has a scientific basis.  but still the endos resist that information.  it's really bizarre to so many patients that this attitude is so prevalent among endos.

[Mark Lupo, M.D.]

I am not speaking for most docs, only for what I do and what I recommend for my patients.  I have no control over what docs do and it does seem that many (NOT ALL) patients initially feel better with t4/t3 therapy.

[nelsonchatham]

the only time i've seen a person not do well with Armour is when they have adrenal issues or low ferritin.  i believe the article above mentions that T4 might work better if a cortisol deficiency is present and not being treated.  seems to me that more docs should check adrenal function with hypo folks...although i understand many don't use the 4x a day saliva testing.

[Mark Lupo, M.D.]

The "experts in france" appear to be an anti-aging group -- not a thyroid expert panel -- we need to be careful in reading these opinions and applying them to the general population.  Typing this is beginning to feel like banging my head against the wall in terms of saying that Armour works for many but not all -- no matter what the cortisol and ferritin are.

The only salivary cortisol level that has been proven to be useful is the midnight level in screening for over-production (cushings).

[nelsonchatham]

I would probably trust anti-aging hormone experts over many so-called thyroid experts these days...although I'm like Hotze quite a bit even though your organizations don't.

And I do wonder how any doc could know that Armour "works for many but not all" when they usually start patients out on T4 and often never even tell the patient of other alternatives.  Many thyroid patients have been stunned - and then quite grateful - to know there is something else out there that can resolve their mood/cognition issues.  i hope you let your patients know the alternatives.  And of course, if dosing by TSH when giving Armour...the person probably would not not do well.  It appears to be so effective at healing the body that underdosing really causes hypo symptoms to return/appear with a vengence. The best results I've seen are those who follow Dommisse's advice and get those Frees in the upper 1/3 of the range.

Yes, I suppose they need more "studies" on the cortisol, huh...but I've seen that the 4x a day saliva testing seems to be quite effective in letting folks know of low adrenal functioning.  

[Rella48]

Dr. Mark, I must clear up your confusion about the article I posted here. It was NOT written by an anti-aging group! It was written by Thierry Hertoghe, MD, a member of the International Hormone Society’s Consensus Group of Experts on Hormone Therapies. The article was recently PUBLISHED in an "anti-aging" magazine or newsletter in France. Dr. Hertoghe is also a world-renowned author and one of the most respected physicians specializing in hormones-endocrinology in the world.

Thanks, everyone, for your replies. I'm hoping Dr. Hertoghe and his associates' guidelines for treating hypO will get some attention from the AACE and ATA here in the USA, as well. But I'm not going to hold my breath because I think the pharmaceutical companies that make synthetics will keep their stranglehold on all the studies that will be done in the future just as they have on past ones. They'll continue to control what students in medical colleges are taught about thyroid disease and treatment. The same-o "TSH and treat with T4 synthetic" standard of care is over 32+ years old, so the only way change can be made is with each of us hypos sharing experiences while we teach one doctor at a time. That's why forums like this are so very important!  

And thank you, Dr. Mark, for your time, and your acknowledgement that Armour may work better...I'm very familiar with "banging my head against the wall". That's exactly the way I felt the whole time I was trying to get well and have any quality of life while the doctors kept me on synthetic T4/T3. Except I had real pain all over - not just in my head. But I don't agree with this part of your statement: "no matter what the cortisol and ferritin levels are". Sufficient cortisol is vital for thyroid hormone to promote metabolism.

Pharmaceutical companies warn patients about adrenal insufficiency (on their patient-info inserts) being a cause for a patient's intolerance of thyroid hormone. Dr. Mark, do you test for adrenal fatigue in patients who can't tolerate thyroid hormone and/or dose adjustments?

Is Addison's disease a sudden-onset type of disease?  If it doesn't develop suddenly, how long can one expect to suffer before a diagnosis of Addison's is made? A lifetime? Is there really that much difference in how a person feels if they have very low cortisol  or  Addison's?

[Chocobabe]

Dr. Mark, I, too, have banged my head against the wall for YEARS going from one doctor to another with chronic debilitating symptoms, and had EACH AND EVERY doctor state that my problems were NOT due to my thyroid as I was "adequately" treated on T4 meds and my TSH was great. But my thyroid WAS the problem. When I was switched to Armour, EVERYTHING cleared up. There was a PROFOUND difference, Dr. Mark. And for you to state here that Armour doesn't work for everyone really concerns me! It gives us exactly what our own thyroid gives us! And from what I am seeing, patients who have problems with Armour are usually finding three reasons--low cortisol, and/or low Ferritin, and/or a doctor who doesn't allow them to take enough to RID themselves of symptoms!

Rella, neither will I hold my breath that AACE or the ATA will take notice. Money and power is the bottom line, and so is the FALSE belief that a pharmaceutical or a medical school has all the answers,when they obviously do NOT and HAVE NOT when it comes to thyroid treatment. WE have suffered.

And Rella is right, Dr. Mark, that the only way knowledge and change is being had is because PATIENTS are sharing, NOT because we are finding out from doctors. And I am also getting the impression that patients are being kicked off here simply because they dared to state something different than what doctors are saying, because I am seeing from past posts here that certain folks are disappearing. That is sad.

Like Rella, I am glad to see you occassionally state that Armour is an alternative, because from my experience and apparently LOTS of us out here, it IS better and it DOES work if a doctor figures out HOW to do it....and figures out that T4 meds are NOT doing the job, period.

And when Rella asks if you test for adrenal fatigue, I hope you know that doing a one-time blood test is NOT necessarily going to find it, nor is the STIM test. Patients are using the 24 hour saliva test and finding out WHEN they are having low cortisol. And when they add cortisol to their treatment, they are suddenly able to tolerate the T3 in Armour and succeed! I personally never needed cortisol, but I see that MANY hypo patients ARE needing it.

Dr. Mark, you seem like a very nice man and a very conscientious doctor, and I SO hope you will be in the forefront of considering that maybe patients here and elsewhere MAY be growing in their information about thyroid treatment that doctors are NOT...and that maybe Armour REALLY IS working and that maybe T4 only meds and dosing solely by the TSH is NOT working.

[tabtools]

Can't help but butt in to back up the doc here.

Many, many patients feel well on T-4 meds alone. (And, I take some T-3 with my meds.)

Hey, Carl Lewis won his 9th gold medal while being treated with a T-4 med.

Many of my friends take T-4 meds and feel well.

My doc basically treats with T-4 meds and I've met some of her patients on that T-4 alone who have energy, interests, and look well too.

The question just nags -- could one feel BETTER with a T-3 med added in.

On another forum, there's been a LOT of discussion on whether or not the percent of T-3 makes a difference.

Armour, for some, does have too high a porportion of T-3.  The Armour site notes there is some risk with diabetes.  Indeed, many forum thyroid patients have reported having their blood sugar levels go up when they begin T-3 meds.  Yet, there are people who MUST have a higher % of T-3 in their meds.  Could it be that they don't convert T-4 to T-3 well?

Well, I'm trying Armour -- but with a T-4 med, because I know  I don't need high levels of T-3 meds -- I seem to convert well. Dr. Blanchard's book is interesting where he prescribes just 2% of someone's med as T-3.

There's LOTS of ideas around -- and each one seems to work well for SOMEONE. It's great to hear a doc recognize the individual differences.

There must

[mepiggy]

The people who appear to do well on Thyroxine alone have no problems, so we don't really need to bring them into this discussion. There are millions of hypothyroids throughout the world who DO do well on T4 only and, unfortunately,also millions who are suffering because they are physically unable to convert T4 to the active T3 and their doctors don't appear to recognise this problem - and these are the people do 'dramatically' well on Armour because it contains all the 'known'hormones that a normal thyroid needs plus other, as yet, unspecified enzymes, and calcitonin.

Desiccated porcine thyroid extract was the ONLY treatment for hypothyroids since 1894 until about 30 years ago when everything started to go downhill for this large minority when they manufacturered synthetic T4 and desiccated thyroid extract fell out of favour as reps. from the pharmaceutical companies  spread bad rumours about its safety and efficacy.

Dr. Mark - you say that Armour doesn't work for everybody. Would you give us examples of cases that you have come across where Armour isn't working. May I suggest that if Armour isn't working, that the patient's adrenals could be fatigued (especially if they have been ill for some time) and, in such cases, it is fact that no amount of T4 or Armour will work until this problem has been addressed. Thyroid medication should be stopped for a couple of weeks when adrenal support is first given.   Another reason why Armour may not be working is that many doctors are unfamiliar with how they should be dosing their patients, and many believe that if their patients are not becoming well, then the dose needs to be increased - where, in fact, in many cases, the dose needs to be decreased.  In other cases, some patients do better with the addition of a little extra T4 (I take 25 mcgs with my 2 1/2 grains of Armour as I still had a little pain in my back and shoulders, and feel brilliant. If I stop the extra T4, then the pain returns. In other patients, they may need to add a little extra T3. Each one of us is different and require different amounts of hormone replacement.

Please don't keep banging your head on the wall Dr. Mark - why cause yourself such unnecessary pain. There is SO much anecdotal evidence from many thousands of patients who write on Internet Support Groups showing that Armour really works for them, but there is also ignorance amongst doctors who tell us that T4 is THE 'medicine of choice' and that Armour can be 'dangerous'. I cannot understand why they do not do a little research themselves to find FACTS, rather than listen to the body of endocrinologists who are looking after their own 'interests' in trying to keep T4 as the ONLY medicine.

As Dr. Hotze stated in a letter to CBS in November 2005 "Surely you are well aware of the incestuous relationship that exists between the pharmaceutical companies and the AACE. If not, then visit their website corporate sponsor page, found at www.aace/com/CAP.php. That pretty much tells the whole story. The AACE, like most medical speciality societies, has sold out to the pharmaceutical companies who pour billions of dollars, every year into marketing their latest drugs to physicians by supporting medical societies, their publications and their conferences. The old adage remains true, if something, which seems reasonable and makes common sense, is not endorsed by the powers that be, then just follow the money trail". Such a 'mafia' will NEVER endorse Armour, as there is no money to be made prescribing 'natural' drugs). Need we say more?

I would say to all doctors, please stop worrying, give your patients a trial with Armour if they are not doing well on T4 and watch them blossom. Desiccated thyroid extract has been prescribed for over 100 years very successfully, and no patient has ever died taking it. Enjoy all the extra time you will create for yourselves as your hypothyroid patients will no longer be cluttering up your waiting room.