Prophylactic treatment of Hashimoto's thyroiditis.
Dr. Lupo stated that prophylactic treatment of euthyroid patients with Hashimoto's thyroiditis is not indicated.
I in fact had one endocrinologist tell me that there were no prophylactic treatment available for Hashimoto's thyroiditis.
However, I later found this study, "One-year prophylactic treatment of euthyroid Hashimoto's thyroiditis patients with levothyroxine: is there a benefit?"
which suggests that, "prophylactic LT4 treatment might be useful to stop the progression or even manifestation of the disease."
This makes sense because TPO, which is the "problem/target" antigen in Hashimoto's thyroiditis, is upregulated by TSH. Supressing TSH by LT4 treatment should reduce immune reaction and thus reduce TPO antibodies as the results of this study indicates.
So then what is the reason for stating that prophylaxis is contraindicated?
Considering that one definition of prophylactic treatment is "The institution of measures to protect a person from a disease to which he or she has been, or may be, exposed. Also called preventive treatment", then I can understand why the doctors made that statement. As far as I understand, there is no med/treatment that will protect from or prevent Hashi's,
When a patient has Hashi's, the autoimmune system produces antibodies that attack the thyroid glands continually until the glands are eventually destroyed. As this is proceeding, the patient's thyroid hormone levels are gradually declining and to avoid hypo symptoms, thyroid meds are appropriate. Starting meds early, as outlined in this link, is said to be a preventive of significant hypo symptoms, but not Hashi's itself.
In the study you mentioned, the patients receiving T4 meds did of course see a benefit in their symptoms, and also showed a reduction in TPO antibodies. But as stated in the last part, " Therefore, prophylactic LT4 treatment might be useful to stop the progression or even manifestation of the disease. However, the long-term clinical benefit of prophylactic LT4 therapy in euthyroid patients with HT is yet to be established".
So the bottom line is, I think, that thyroid meds improve symptoms and can also reduce the level of TPO antibodies, but there was nothing proved about curing, or even preventing further deterioration from Hashi's. Since this study was reported in 2001, I would think that if this were this case, followup studies proving it would certainly be widely known by now.
In some Hashimoto's thyroiditis, the culprit is an intolerance to gluten. When gluten is removed from diet, the patient is cured/treated/prevented from thyroiditis. So I'm sorry, but I feel that your answer reflects a lack of some fundamental knowledge and understanding on this subject.
TPO is an enzyme produced by the thyroid which is upregulated by TSH (thyroid stimulating hormone). I believe you also do not understand the concept of negative feedback in this system. In this feedback system, TSH is suppressed in the presence T4 & T3 thyroid hormones (converted from T4 by deiodinase). When there is a lack of thyroid hormones, this causes a feedback to increase TSH in the system, which then increases TPO in order to produce more T4 and T3. The more TPO is upregulated, the more intense the immune reaction and destruction of the thyroid. When enough T4 is given to a patient, TSH will be suppressed and thus TPO decreases significantly and thus immune reaction is decreased significantly. The word "decrease" is used because nothing's ever quite 100% in biology. However as the study indicates, this is quite significant and is prophylactic, compare to non-treatment. Sure more study can be done regarding long-term treatment, but I find your reasoning to just give up and let the thyroid burn (while we wait for the long-term results I suppose?) when there is a way to stop it, sadistic. So in short, I'm not satisfied with your answer. I pray for a more scientific explanation or reasoning.
Sorry to say, but I find your response to be needlessly insulting. To avoid misunderstanding, I started by defining prophylactic. If you have some special knowledge that the medical community is unaware of, you should by all means let them know, but I doubt that you will convince them that there is anything that prevents or cures Hashi's. I recognized that T4 medication improved symptoms, as well as showed a reduction in TPO ab levels. The 2001 study you cited, however. did not even go so far as to say that LT4 treatment stopped the "progression or even manifestation of the disease". So that study certainly did not disprove what I said. So I think that some of our argument is due to semantics.
By the way, I understand fully the concept of negative feedback in the hypothalamus/pituitary/thyroid system. I see nothing in my reply that should prompt such a disparaging remark. Believe it or not, there are other people that understand these concepts.
As far as gluten intolerance, I am well aware of the theory that gluten intolerance, along with a "leaky gut" is currently being blamed for many things. I know that there are studies showing Celiac and Hashi's occur together frequently. The reason given for this being that the gluten intolerance causes an immune response creating gluten antibodies. I have seen no explanation for why or how this then supposedly causes the autoimmune system to also produce TPO antibodies. To my knowledge there are no studies that have shown that going gluten free cures or stops Hashi's. If that were really the case, wouldn't it be very easy to collect test data and report that TPO antibodies disappeared? Anecdotal evidence from patients is that they felt better and did not need as much thyroid medication. It was further reported that TPO antibodies did go down (don't know how much), but did not go away. So how does this info fit with your statement that "When gluten is removed from diet, the patient is cured/treated/prevented from thyroiditis"?
You also misunderstood my position about long term treatment. If you read any of the many posts I have made, you will see that I always advocate early medication for patients with Hashi's. Nor in my above reply did I suggest otherwise.
Huh? Why are you upset? I'm very sorry, so you knew about the feedback, wow, but my God, r u spamming me or something? Wow. Okay, back to the subject...
"In conclusion, prophylactic thyroid hormone therapy can be used in patients with Hashimoto's thyroiditis even if they are euthyroid." 2005, vol. 52, no3, pp. 337-343 Endocrine Journal.
Okay, actually I was saving that one for a real doctor, but there it is now. And yes there are more studies, but I don't feel the need to quote any more studies.
Gimel, I really don't understand why you remain adamant, but you were wrong. I don't want you to be upset, but that's what it is. It's okay to be wrong or not know, and that's why I ask questions, but why so adamant about wrong information?
In individuals with Hashimoto's thyroiditis with gluten sensitivity can be cured, and it sounds like it's not just a theory as you suggest it is: " organ-specific autoantibodies (i.e., thyroid antibodies) -- will disappear after 3 to 6 months of a gluten-free diet." (Digestive Diseases and Sciences, February 2000;45:403-406.)
Look, I have posted a question only a doctor or a researcher can answer with any authority. Are you a doctor? Your opinions are not good enough. At least post some peer-reviewed references to back up your claims. Otherwise, dear Lord, why are you spamming me?
You will not find a doctor on this forum; we are simply patients trying to help other patients with issues similar to our own. You might try asking your question on the expert forum.
gimel is one of our most respected members and has done tons of research on thyroid issues; I think you were amazingly insulting and rude.
Even those who write books about gluten sensitivity/leaky gut, in relation to Hashimoto's and hypothyroidism, state point blank that Hashimoto's can not be cured. Yes, there have been reports that TPOab decreased with a g/f diet, but as gimel said, no one reported by how much. Then consider that I'm not g/f by any means, but my TPOab is decreasing steadily as well.
In addition, you said: "This makes sense because TPO, which is the "problem/target" antigen in Hashimoto's thyroiditis, is upregulated by TSH.". What about thyroglobulin? Do you not consider that a problem/target? A patient with Hashimoto's can have either or both TPOab and TGab. Decreasing the TPOab is not going to "cure" Hashimoto's in anyone, but, particularly in one who has both antibodies or only TGab.
Very interesting. You come on to a thyroid patient forum and ask a question that you later say that only a doctor or a researcher can answer with any authority. You seem to know all the answers you want to hear, before you even asked the question. I try to accommodate by providing a definition of prophylactic treatment and then theorizing why I thought the doctors could have made those statements. You respond and attack me in a very personal manner and then move on to what appears to be your real agenda. That agenda appears to involve gluten free diet as a cure for Hashi's. So when are we going to hear what you are really promoting here? Is it a book that you want to sell us? Or what?
Look gimel, congrats for totally spamming my post. Perhaps in real person, you might be a nice person and that your original intentions were to actually help people. I have no book to promote. I simply have a question that you weren't trained to answer. You gave bunch of wrong information, but you wont admit it; instead you are the one personally attacking me. Why would I be asking this question if I knew all the answers? Remember, I'm asking a question, and you are answering it with wrong information. You said there's no cure; yet there is one according to literature. You said there is no prophylaxis; yet there is one according to literature. I wanted to know what scientific reason is there to prove these literature wrong, not your ranting. Are you really trained to answer a question like this? And this isn't some question asking for advice on what to wear where wrong information is not going to kill or hurt you.
I'm not saying at all that you are an impostor, or someone that sadly likes to feel important by pretending to be a doctor. However, if you keep answering questions regarding medical treatment with wrong information, and if you go further, you could really end up hurting someone, or end up in court for attempting to practice medicine without a license. You are the reason why doctors are complaining that there are too much bad medical advice floating around these forums.
It looks like there's been some confusion. When someone posts to a thread in an Expert forum, and that thread is closed, it will toss the thread to the corresponding member forum. The statement "This discussion is related to..." indicates that this is what happened. New members may not realize that the question they posed to a doctor is instead being answered by members.
That said, let's all calm down. There is no reason for anyone to be insulting, and it is entirely possible to disagree with someone without making it at all personal.
As I explained, I have no problem with LT4 treatment for Hashi's. I often suggest it and give a link that recommends it. I recognized the benefits for symptoms and also in lowering the levels of TPO antibodies. If that is what you mean by prophylaxis treatment of Hashi's, then I have no problem with it. What I disagreed with was basically semantics, regarding the meaning of prophylaxis. I also disagreed with the inference that going gluten free was a general cure for Hashi's.
You gave a reference from the Digestive Diseases and Sciences Journal as background for saying that people with Hashimoto's and gluten sensitivity can be cured. As I recall that conclusion related only to the 3 % with Celiac Disease, from the total study group of 172 people with autoimmune thyroid disease. I realize that where there is smoke there may be fire, but after ten years since the study, is there nothing more current that would support extending that conclusion to gluten sensivity in general? If there is support for that general conclusion, why wouldn't the medical community have embraced and adopted this treatment protocol? Oh wait, that is the same community that has yet to adopt the changed TSH range, recommended over 8 years ago by the AACE.
Would those complaining doctors include the two you mentioned in your first post that did not believe in prophylactic treatment of Euthyroid patients with Hashi's? I guess they would not like Forum members telling fellow Hashi's members to push for thyroid medication.
I don't see wrong information on Gimel's part nor do I feel he was trying to offend you based of the original answer he gave.
Simply a defination of prophylactic was being discussed and we all know this is a medical term used widely for numerous "medical" issues.
This is how I read the defination of prophylactic.
1.guarding from or preventing the spread or occurrence of disease or infection
2: tending to prevent or ward off : preventive
In the senerio of Hashimoto treating the disease with T4 medication is not a cure. There is no "cure" for antibodies in medical treatment but the discussions are wide spread on this being a reality or true fact depending on what side of the fence a doctor may practice on.
In true Hashimoto antibodies the TSH actually becomes very irregular - including the other T hormones which are very hard to regulate when the attack of the antibodies is going on.
and one feedback link is missing from the equasion listed above and that would have to include the liver processing the conversion hormone. There is nothing in that feedback senerio including the liver which is not recorded here.
Could supplementing the thyroid to healthy levels with T4 meds make things better for some? Sure why not? - Logically if the thyroid is now getting enough and the liver is able to produce the right conversion to get the direct T3 working as it should then the body should respond and decrease TPOabs. Will it work for everyone or even a few I don't think it happens often from what we see here due to mulitple other issues.
eik - I like this quote you have and was wondering if you could provide the medical links that made you say this/ "When gluten is removed from diet, the patient is cured/treated/prevented from thyroiditis." -
Picking apart this whole sentence brings up numerous debates with words like - gluten = ( liver and intestinal/immune issues bringing on sickness) and then the word cured always is a sensitive word when discussions happen with disease involving autoimmune antibodies. I think that word - cure - is thrown out in to too many articles when everyone should agree that the human components in DNA all involve a ratio of antibodies somewhere in the body from birth and when they rear up creating issues - usually something is a root and Hashimoto thyroiditis is not rooted directly off a sick thyroid in that feedback either.
This should lead the thought more on both treatments could be involved making autoimmune Hashi's a 2 stage level of treatment to see if the patient responds well addressing these together. As for treatment with just T4 - that is only one stage helping hypoT levels and there is constant debate on if treatment of T4 soley with regular hypothyroidism is adequent too - setting aside now having autoimmune hypothyroidism.
Gimel has alot of time as it sounds you do to on uncovering many thyroid related material. Please refrain from any insult and I don't view anything here as spam material but only healthy discussion.
eik - if you don't mind me asking please as the CoLeader here that sees this post quite hard core. I would like to understand why you posted this on a community forum instead of addressing it with a doctor like you seem to want to have done? I am not asking this as a defensive quest just trying to understand why it does appear here when you are looking for an expert opinion?
Thanks Emily for stepping in and clarifying some sensitive issues. I hope this post can remain proactive in discussion and does not become too personal.
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