I'm not surprised you aren't getting good results with replacement thyroid in older adults. The adrenal hormone levels are low as evidenced by increasing incidence if arthritis and allergies. It takes adrenaline to use thyroid effectively. If you don't have enough you can't use the thyroid.
13
Synthroid doesn't work on most people. Don't tell big pharma. They are sure it works. Don't tell your doctor because they are sure it works and will brush you off like lint on a sweater. They'll convince you that it's all in your head. They won't test FT3, FT4, RT3. Nope. They'll just test TSH, ignore your symptoms, and send you on your way. It is time for doctors to get back to actual doctoring. Listen to your patients, test TSH, FT3, FT4, RT3, adrenals. If you as a doctor don't know how, learn. For 30 years I was told I was fine when I wasn't. I was brushed off until I crashed so hard I ended up in bed for 2.5 years. I was told it was all in my head. T4 only meds work said my GP. Here, take this antidepressant. It didn't work. I found a functional MD who now treats my thryoid. I highly recommend everyone do the same. Maybe when GP's and endo's lose patients they'll clue in and learn that synthetic T4 is not the answer. Natural desiccated thyroid medication needs to be brought back to mainstream medicine.
19
My thyroid is effected every time I get a virus not to mention nodes that have come and gone over the years. The post viral impact goes away after a few weeks. Both situations were true of my mother as well. Fluctuations need to be taken into consideration when testing is done. Interestingly the one time I was prescribed meds, they made me fell much, much worse.
4
I would agree with the author, Paula Span's conclusion that levothyroxine (generic Synthroid) doesn't relieve low thyroid symptoms in many patients taking it. I refer to this group of patients as the "Escapees and Refugees from the Endocrinology Office". The lucky ones find a sympathetic physician willing to switch them to NDT (Natural Desiccated Thyroid) which contains both T3 and T4, and prescribes enough dosage to relieve symptoms of fatigue, lethargy, puffy appearance of the face, etc. typical for the low thyroid condition. This brings us to the errors in modern thyroid endocrinology which creates all these escapees from the endocrinology office in the first place. Here they are:
1) Reliance on TSH as the only test to Diagnose and Monitor Treatment.
2) Current Dogma Dictates Avoiding TSH suppression with thyroid medication. However, some patients may actually require TSH suppressive doses of medication for full relief of symptoms.
3) Reliance of T4 Only-Monotherapy (Levothyroxine or Synthoid)
4) Refusal to consider NDT –Natural Desiccated Thyroid which may actually be a better choice for some patients.
for references see:http://jeffreydachmd.com/2016/10/antonio-bianco-tsh-inadequate-for-levot...
jeffrey dach md
1) Reliance on TSH as the only test to Diagnose and Monitor Treatment.
2) Current Dogma Dictates Avoiding TSH suppression with thyroid medication. However, some patients may actually require TSH suppressive doses of medication for full relief of symptoms.
3) Reliance of T4 Only-Monotherapy (Levothyroxine or Synthoid)
4) Refusal to consider NDT –Natural Desiccated Thyroid which may actually be a better choice for some patients.
for references see:http://jeffreydachmd.com/2016/10/antonio-bianco-tsh-inadequate-for-levot...
jeffrey dach md
21
As before, individual is the magic word. Even if the whole is scientifically documented here, ALWAYS the individual case, the condition and the cause of the subfunction should be included. It takes some time until the appropriate dose is found. I am afraid that, on the basis of such general studies, one might think that no longer prescribe hormones to old people at all. In my experience it is more an individual attitude. If L-thyroxine is only prescribed over a TSH above 10, this can also lead to misjudgments. I had a radioiodine therapy in Graves' disease in 2008 and my thyroid gland was very slowly decomposed. Although the TSH has never left the standard areas, there is now only a minimal residual tissue present. I am personally grateful for having prescribed hormones for me. After years "All values in the norm and depression" an endocrinologist has finally looked at the size more closely and initiated a hormone therapy. I've got my old life quality back.
5
I spent 17 years with mis-diagnoses about my debilitating fatigue, and feeling cold all the time. I didn't gain weight but I could barely get out of bed many days and when I started to feel better, after days of rest, if I did anything strenuous or had any emotionally stressful experiences, I was wiped out again for days. Doctors had run a gazillion tests. I saw internists, virologies, liver specialists. Not until I found an endocrinologist who treated me symptomatically did I find the solution. He said the TSH test is worthless. He tested for Free T3 & Free T4 and had me get an ultra-sound on my thyroid. They found nodes, an indicator of hypothryoidism. He treated me with Cytomel (T3). My body wasn't responding to Synthroid (T4). The body is supposed to convert T4 to T3, that's why everyone prescribes Synthroid (T4). But if you don't convert it, it's useless. The direct dose of 25mcg of Cytomel (or the generic) solved all my issues in a week (after 17 years of struggle). I now go to the gym 3 times a week and have plenty of energy and I'm 69 years old.
35
Most of these people are just iodine deficient and their thyroids will work just fine with more iodine.
9
I am a women in my 60s, diagnosed with hypothyroidism, 10 years ago.Six months ago I developed, on two separate occasions , three months apart.
hyperthyroidism due to the fact that I was overmedicated. It was horrible, since I had no idea why I was so speedy, emotional, sweating and had severe muscle aches. Twice,my medication was reduced. It was hell in the interim.Plus now I am worried that I may have heart damage and have been diagnosed with osteoporosis.It is indeed an imprecise science and we post menopausal women
are the victims.
hyperthyroidism due to the fact that I was overmedicated. It was horrible, since I had no idea why I was so speedy, emotional, sweating and had severe muscle aches. Twice,my medication was reduced. It was hell in the interim.Plus now I am worried that I may have heart damage and have been diagnosed with osteoporosis.It is indeed an imprecise science and we post menopausal women
are the victims.
12
A doctor who specializes in bone health told me informally that this class of drugs harms bones. Alarmed for a loved one, I did some digging and found that there do appear to be some studies that show significant increase in risk of bone fracture in people who take Synthroid and similar. Sounds like a careful balancing of risks may be needed for some. Never anything wrong with a second opinion. It is upsetting when doctors don't fully advise patients as to side effect risks of medications. Here's an overview of the research on bone loss, written by a doctorate in pharmacology. God bless and good luck.
http://www.medscape.com/viewarticle/749533
http://www.medscape.com/viewarticle/749533
11
There are many uncertainties about thyroid disease. The article itself focuses slightly elevated TSH levels in an elderly person. This issue is especially difficult because many non-specific symptoms could potentially be due to thyroid dysfunction or (more commonly) to something else. And, that something else may defy ready explanation, frustrating both the person with symptoms and the physician.
Although we may be dealing with "dis-ease" rather than disease, we are left with a patient who has non-specific symptoms and with imperfect tests to sort things out. TSH levels are often obtained and the question remains what to do when the results are slightly high.
The study cited indicates that there is no benefit to its treatment with the commonly used medication – l-thyroxine. Avoiding an unnecessary medication is a good thing, especially when overtreatment can cause problems. However, although there is no benefit on the average, individual results can vary. Every patient is unique and as physicians, we should treat people and not numbers. Laboratory tests can be enormously helpful, but they are not all there is.
I am reminded of the words of the Hippocratic Oath, specifically a modern version written by Dr. Louis Lasagna: "I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism… I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being…"
Although we may be dealing with "dis-ease" rather than disease, we are left with a patient who has non-specific symptoms and with imperfect tests to sort things out. TSH levels are often obtained and the question remains what to do when the results are slightly high.
The study cited indicates that there is no benefit to its treatment with the commonly used medication – l-thyroxine. Avoiding an unnecessary medication is a good thing, especially when overtreatment can cause problems. However, although there is no benefit on the average, individual results can vary. Every patient is unique and as physicians, we should treat people and not numbers. Laboratory tests can be enormously helpful, but they are not all there is.
I am reminded of the words of the Hippocratic Oath, specifically a modern version written by Dr. Louis Lasagna: "I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism… I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being…"
20
Well said! You are special! Unfortunately, modern doctors are trained to test and prescribe and or recommend surgery. A very mechanical approach. Having experienced this mechanical approach I prefer Chinese medicine with its holistic approach.
For example, a number of years ago I saw a doctor because I had a strange sensation on the left side of my face. He did not listen when I said I rarely if ever get a headache. He did not touch me but immediately ordered an MRI to rule out a brain tumor.
Being a fairly healthy person, I intuitively declined the test and went to see my Chinese doctor. He listened to me. Touched a point on the back of my neck on the left side and asked if it hurt. Yes, it did. He diagnosed an inflammation of my main facial nerve and gave me few acupuncture treatments and even after the first treatment I felt fine. Problem solve.
The point here is the western doctor's approach would have had me do an MRI for nothing all because doctor's, don't really listen, don't touch, just test and prescribe. This is not a one-time anecdote. Have seem it with friends, where they have gone through unnecessary test procedures
For example, a number of years ago I saw a doctor because I had a strange sensation on the left side of my face. He did not listen when I said I rarely if ever get a headache. He did not touch me but immediately ordered an MRI to rule out a brain tumor.
Being a fairly healthy person, I intuitively declined the test and went to see my Chinese doctor. He listened to me. Touched a point on the back of my neck on the left side and asked if it hurt. Yes, it did. He diagnosed an inflammation of my main facial nerve and gave me few acupuncture treatments and even after the first treatment I felt fine. Problem solve.
The point here is the western doctor's approach would have had me do an MRI for nothing all because doctor's, don't really listen, don't touch, just test and prescribe. This is not a one-time anecdote. Have seem it with friends, where they have gone through unnecessary test procedures
7
The article didn't mention a major reason that thyroid medication often fails: feedback control. Your body makes thyroxin, and strives for equilibrium. So if you are suddenly ingesting a significant outside source of it, such as in a pill, your body will simply suppress it's own production to prevent a meaningful increase. I think a better solution is to find ways to up the body's natural thyroid output, such as kelp or other iodine rich sources. There are some yoga positions, such as the shoulder stand, that are said to stimulate the thyroid too.
5
Physician & Big Pharma, heal thyself.
After all the time & money we spend on so-callled health care, we find that the heath outcomes of Americans are worse than many other nations.
Is there a pill for that?
After all the time & money we spend on so-callled health care, we find that the heath outcomes of Americans are worse than many other nations.
Is there a pill for that?
13
Paula Spann reports that a great many people are now taking Levothyroxin who perhaps do not need it. Perhaps, but people who really do need it will not benefit from this artificial Thyroid medication because they need the real thing. When I first moved to New England in 1975, after having been on it from a very young age, my new physician was embarrassed that I was taking the old-fashioned Armour Thyroid, the original medication—which according to my later endocrinologist, is, after Aspirin, the oldest medication still in use. So I made the change, and quickly developed all sorts of medical problems, which were only solved when I went back to California for a year, where my previous physician put me back onto Armour Thyroid, and I immediately improved. When I returned to New England a year later, I was referred an endocrinologist, who wisely said, “If it ain’t broke, don’t fix it!” For more than sixty years now I have remained on Armour Thyroid, and have fared well. Big Pharma of course opposes Armour Thyroid, for their own reasons, which never used to be expensive—a $5 deductible easily covered the cost. Now that the big health plans have taken over, however, it is not even covered on most health plans—the only thing they cover is synthetics. So when they tell us to stop taking thyroid medications, they ought to be a little more honest. Yes, the synthetics don’t work. But if you need the real thing, they ought to make it available. Patricia A. Johnston
17
Extremely misleading article
I suffered for 10 years with sub-par primarily care physicians and multiple endocrinologists that wanted to convince me that my thyroid function was normal based solely on a TSH test. Anyone not an "expert" could tell I was hypothyroid just by looking at me. I was a walking textbook case.
Very long story short - I found a local specialist and I'm now on desiccated thyroid meds and at a dose that has improved my quality of life back to what it was before this started.
Many of us with Hashimoto's thyroiditis (which is an auto-immune disorder) can start out with a normal TSH, and we often don't do well on a T4-only synthetic thyroid replacement (which is often the only med mainstream physicians prescribe).
And if I understand the physiology – the TSH is an accurate measure of your pituitary gland function. Not your thyroid gland function. So any physician making recommendations for what you should or should not do based on the TSH test alone - is, at the very least, extremely misguided - and in my opinion, "doing harm" (which, the last time I checked, is against their principles).
So, if you have a lot of the symptoms of an under active thyroid - and your doctor tells you there's nothing wrong – run! do not walk to find another physician who can help you.
Oh, and BTW - disregard this article - because it in no way tells the whole story.
I suffered for 10 years with sub-par primarily care physicians and multiple endocrinologists that wanted to convince me that my thyroid function was normal based solely on a TSH test. Anyone not an "expert" could tell I was hypothyroid just by looking at me. I was a walking textbook case.
Very long story short - I found a local specialist and I'm now on desiccated thyroid meds and at a dose that has improved my quality of life back to what it was before this started.
Many of us with Hashimoto's thyroiditis (which is an auto-immune disorder) can start out with a normal TSH, and we often don't do well on a T4-only synthetic thyroid replacement (which is often the only med mainstream physicians prescribe).
And if I understand the physiology – the TSH is an accurate measure of your pituitary gland function. Not your thyroid gland function. So any physician making recommendations for what you should or should not do based on the TSH test alone - is, at the very least, extremely misguided - and in my opinion, "doing harm" (which, the last time I checked, is against their principles).
So, if you have a lot of the symptoms of an under active thyroid - and your doctor tells you there's nothing wrong – run! do not walk to find another physician who can help you.
Oh, and BTW - disregard this article - because it in no way tells the whole story.
23
Ms. Harris is absolutely correct. I found an endocrinologist who said TSH tests were worthless. He tested Free T3 & Free T4 and also prescribed Cytomel which is a T3 supplement. The reason Synthroid doesn't work for some people who are hypothyroid is their bodies don't convert the T4 (Synthroid) to T3 as the body is supposed to. When I started on Cytomel all my issues cleared up in a week.
16
This article is misleading and irresponsible. Leaving an under-active thyroid untreated can cause people severe problems. There are no easy fixes and no medication fixes everything 100%, but without synthroid/levothyroxine the problems are much greater. Hypothyroidism is also not just a disease for older people either. I was diagnosed when I was 15 years old and for many years I didn't take the medicine regularly or seriously, and my symptoms increased and worsened. Finally, at the age of 21 or so I could hardly get out of bed or function and when my Dr. found out I wasn't taking the medicine regularly, she firmly told me how serious things could get for me. The difference in the way I felt after taking my synthroid consistently for only a week after that was so drastic, I never questioned taking the medicine again. Taking synthroid for under active thyroid is especially important for women who are pregnant or thinking of getting pregnant! It's wild there's no mention in this article of how this medicine is so important to those women. All I know is that I can barely function without my medicine. And, to suggest that diet and exercise can 'cure' hypothyroidism is so wrong.
10
Korie, there is no mention of treatment for women who are pregnant, or considering pregnancy, because the New Old Age column focuses on aging and caregiving. The people it writes about are not teenagers, and they're not pregnant. But I'm very glad to hear that you are feeling better with your medication.
4
I am glad I came across this article. I have been taking an increasing does of levothyroxine over the past seven years and I still feel a bit fatigued (I am over 80 so I am not all that surprised). I cut out the drug this week and not only have I not felt more tired, strange to say I have felt -less- tired.
I am clipping this article and a related article from The Lancet to show my physician.
I think you guys are onto something here.
I am clipping this article and a related article from The Lancet to show my physician.
I think you guys are onto something here.
5
But I think an overlooked problem is how you measure "mild" symptoms. If "subclinical hypothyroidism" has mild symptoms, and those symptoms are variable between individuals and not severe, how do you construct a test that will not be doomed to failure from the beginning. I'm not saying that the drug works for this population. But if you get a room full of overt hypothyroid people (you can pick them out from "binders full of hypothyroid people"), they won't all have the same symptoms. The inter-individual variance is quite high. Why is that? Whatever the reason, it makes these kinds of studies doomed to be replaced by later studies based on better information.
6
To the readers who are upset with the seeming dismissal of using a medication to help alleviate symptoms: This article focuses on the "sub-clinical" condition. Some of us with that condition do not need treatment, if we have no symptoms. I agree that if a round of medication helps a patient, that's all for the good, and they should continue. I find that my doctors tended to see any number beyond the 4.5 as troublesome and immediately wanted to place me on medication. I had a terrible reaction to it. I did not know that I was "sub-clinical" until I did some research and underwent more testing on my own. In no written diagnosis that I received was the term "sub-clinical" to be found.
4
A TSH level above 10 is considered the point where thyroid replacement is needed. My level was 98. I could barely complete a sentence. The doctor said she was surprised I was up and walking. It was the highest level she'd ever seen.
People should certainly be tested if they have symptoms of thyroid insufficiency. My life is so much better with treatment.
People should certainly be tested if they have symptoms of thyroid insufficiency. My life is so much better with treatment.
11
I was shocked to read this rather inflammatory article based on a single study, which made all sorts of claims contrary to my own experience but also is based on questionable science. It also distresses me that the senior author claimed that a rather arbitrary single-significant-figure TSH cut-off (10 mIU) was the last word in diagnosing hypothyroidism. The use of this number arose decades ago before the error level in the TSH assay (5-10 mIU in 1965) was reduced enough to make a workable reference range possible. But it was never the result of precise measurement.
I have had "subclinical" hypothyroidism for many years, treated off and on by doctors with different philosophies. Now that I am off Synthroid, my TSH is constant over 3 years at just above the top of a long-used normal range (4.5 mIU), according to measurements by LabCorp. However, my TSH as measured at one local medical center was lower and extremely variable, although at another it was similar and varied only with continuing treatment and improving health; this suggested assay quality issues. Of course, there is no way of checking on the quality of the assays done for this study. At any rate, I feel ill at this level, much more so than when I was taking Synthroid and my TSH was kept at 1.0-1.5 mIU.
Yes, I'm one of those old people, and I'm shocked to read all of this.
I have had "subclinical" hypothyroidism for many years, treated off and on by doctors with different philosophies. Now that I am off Synthroid, my TSH is constant over 3 years at just above the top of a long-used normal range (4.5 mIU), according to measurements by LabCorp. However, my TSH as measured at one local medical center was lower and extremely variable, although at another it was similar and varied only with continuing treatment and improving health; this suggested assay quality issues. Of course, there is no way of checking on the quality of the assays done for this study. At any rate, I feel ill at this level, much more so than when I was taking Synthroid and my TSH was kept at 1.0-1.5 mIU.
Yes, I'm one of those old people, and I'm shocked to read all of this.
10
This article misses the point entirely. Focusing on TSH tests is the mistake that GPs make all the time. As other comments have already stated, FreeT3 & T4 tests are also needed to see the whole picture. The reason synthroid doesn't work is because 1. it's synthetic and 2. it's only addressing part of the problem. Is it over-prescribed - probably. Because doctors don't want to look deeper and listen to educated patients or help educate. That takes time. Natural thyroid meds that contain both T3 and T4 are the only way to address under-active thyroid as thousands of thyroid patients will tell you. The NYT should not be proud of this article.
14
The byline - Doctors often prescribe levothyroxine to treat an underactive thyroid, AND FOR MOST IT HAS NO EFFECT" - is flagrantly misleading. "for most elderly with subclinical hypothyroidism...." would be the accurate statement. For people with overt hypothyroidism, the medication is needed. So thanks.
6
As others have mentioned. Measure fT3, bring it up to the top 25th percentile of a labs reference range and see how your patients feel. TSH and levothyroxine is stone age thinking.
11
The title of this article is deceiving and borderline sensationalist. And the article itself does serious disservice in its level of superficial discussion of diagnosis and treatment for hypothyroidism. There can be many reasons why levothyroxine may not be working, not just that the person actually doesn't have thyroid disease and doesn't need treatment . Read up on functional medicine in the treatment of thyroid disease, on the full range of thyroid tests needed to diagnose and appropriately treat thyroid disease(not just TSH; not just levothyroxine by itself ; the need for T3 as well as T4 for many ; alternatives to levothyroxine...) , on the reference range for treatment (not treating unless TSH is 10 or above?!) , on Hashimotos versus thryroiditis....
6
This article doesn't even begin to cover the complexities of dealing with a Thyroid condition. Were the people tested for thyroid antibodies? if not, and they had Hashimoto's, a small dose would of course have had no effect. The TSH requirements for people with an autoimmune disease are different than the general population. I know, my TSH is currently 0, and that's great for me. I have no adverse symptoms or reactions, just the ability to maintain my weight, and a lack of depression.
The problem with TSH in the US right now is far more often an unwillingness to prescribe correct doses, maybe from a fear stemming from the 70's, when people tried to abuse levothyroxine as a weight loss drug.
The problem with TSH in the US right now is far more often an unwillingness to prescribe correct doses, maybe from a fear stemming from the 70's, when people tried to abuse levothyroxine as a weight loss drug.
12
Well, maybe if they went back to using natural desiccated thyroid medication that was used for well over 100 years and WORKED they'd see HUGE improvements, but no stick with a synthetic that does nothing but lower TSH and then tell older people they don't need thyroid meds. What a ridiculous article.
19
My doctor prescribed nothing without testing my free T3 and T4 levels. They were low - both of them. Now they have gone back to normal levels with treatment. So, who prescribes levothyroxin based on TSH alone? TSH should only be a signal to do the other testing, unless I'm missing something. This whole article was weird and not at all what I thought it was going to be. I'm thanking God at this point that I have really great doctors who actually took the next steps of testing my free T3 and T4.
16
An astounding OMISSION by every doctor in this article:the potential diagnosis of Resistance toT4.
(Synthroid) is synthetic T4. The thyroid gland produces T4. That does NOT mean every person's body recognizes T4. Failure to CONVERT T4 to the hormone T3, which is the only form of thyroid hormone used for energy and metabolism results in Hypothyroidism. MORE of the hormoneT4 that possible does not convert forced the patient to remain Hypothyroid.
No Conversion = No T3 = no energy = NO metabolism!
And yet, not a SINGLE WORD of that process in this article. It is, therefore, a misleading article on a VERY serious medical condition. Cytomel (T3) saved my life. I take it three times per day. It was not until I did my own medical research that I learned about T4 resistance, and the conversion of T4 to T3. Poor conversion? T4 resistance? Then, you are unwittingly sentenced to years of Synthroid, and the never ending symptoms of Hypothyroidism.
This article is a half truth, and as one can read . . . the evidence will not back it up. T4 CONVERTS to T3, which the body utilizes for energy and proper metabolism. No conversion, no energy and no metabolism. Resistance to T4 is NOT corrected by Synthroid, which is T4. Synthroid will fail, or make the patient more ill.
It is a puzzle as to why these facts are totally ignored in your article. your readers deserve better.
(Synthroid) is synthetic T4. The thyroid gland produces T4. That does NOT mean every person's body recognizes T4. Failure to CONVERT T4 to the hormone T3, which is the only form of thyroid hormone used for energy and metabolism results in Hypothyroidism. MORE of the hormoneT4 that possible does not convert forced the patient to remain Hypothyroid.
No Conversion = No T3 = no energy = NO metabolism!
And yet, not a SINGLE WORD of that process in this article. It is, therefore, a misleading article on a VERY serious medical condition. Cytomel (T3) saved my life. I take it three times per day. It was not until I did my own medical research that I learned about T4 resistance, and the conversion of T4 to T3. Poor conversion? T4 resistance? Then, you are unwittingly sentenced to years of Synthroid, and the never ending symptoms of Hypothyroidism.
This article is a half truth, and as one can read . . . the evidence will not back it up. T4 CONVERTS to T3, which the body utilizes for energy and proper metabolism. No conversion, no energy and no metabolism. Resistance to T4 is NOT corrected by Synthroid, which is T4. Synthroid will fail, or make the patient more ill.
It is a puzzle as to why these facts are totally ignored in your article. your readers deserve better.
24
to sell more synthroid. Plain and simple. Its a useless drug that does nothing except lower TSH. Does nothing for symptoms and is EXPECTED that the person will convert to useable T3. People need to switch to NDT. Find a doctor who knows what he/she is doing.
6
Are you kidding me?
The TSH is the most ridiculous way to diagnose hypothyroidism in the first place. It can sit smugly in the so-called normal range for years while the patient has growing hypothyroid symptoms...as a huge body of thyroid patients have reported firsthand.
Second, levothyroxine or Synthroid can have numerous side effects, as millions of patients have reported over the years and shown on the Stop the Thyroid Madness website in the "long and pathetic" symptoms list. The side effects range from depression, easy fatigue, aching joints, the need to nap, hair loss, rising blood pressure, high cholesterol, dry skin, anxiety and so many more.
i.e. though some report doing better on Synthroid or levo than others, the large percentage who don't is a travesty.
And guess what turns these people around? Having direct T3 in their treatment.....but of course, they have to correct the damage done by being held hostage to the crap TSH lab test as well as T4-only: inadequate iron levels and/or cortisol issues.
This is a lousy article which perpetuates the scandal of diagnosis and treatment of hypothyroidism, all the more so for our older population.
The TSH is the most ridiculous way to diagnose hypothyroidism in the first place. It can sit smugly in the so-called normal range for years while the patient has growing hypothyroid symptoms...as a huge body of thyroid patients have reported firsthand.
Second, levothyroxine or Synthroid can have numerous side effects, as millions of patients have reported over the years and shown on the Stop the Thyroid Madness website in the "long and pathetic" symptoms list. The side effects range from depression, easy fatigue, aching joints, the need to nap, hair loss, rising blood pressure, high cholesterol, dry skin, anxiety and so many more.
i.e. though some report doing better on Synthroid or levo than others, the large percentage who don't is a travesty.
And guess what turns these people around? Having direct T3 in their treatment.....but of course, they have to correct the damage done by being held hostage to the crap TSH lab test as well as T4-only: inadequate iron levels and/or cortisol issues.
This is a lousy article which perpetuates the scandal of diagnosis and treatment of hypothyroidism, all the more so for our older population.
22
Thank you Janie Bowethorpe!!! Because I found your website in 2008 at a time I had already been on T4 only since 1993 and I was a hurting unit in 2008. No enegry, chronic fatgue, ongoing depression etc. Thanks to you and your website and books I now have an NP and an Osteopath and now am enjoying the good health and energy I was meant to have at age 53. Thank you agin!
4
Fifteen years ago I was diagnosed with hypothyroidism, with an impossible, but verified TSH of 87. I was, of course, offered the daily pill for life that eventually destroys the thyroid. Luckily for me, I had a wonderful family doctor who supported my choice to use Chinese herbs prescribed by my Chinese doctor.
My Chinese doctor is not only a Chinese doctor trained in China but he also has an MA and PH.D from McGill University in cellular nutrition, and worked in cellular research, focussing on cancer, for 20 years. So he is both a scientist ad Chinese doctor.
The Chinese herbs brought my TSH levels to normal over a period of months drinking the herbal formula. Recently, after 15 years my TSH, which I always regularly check, rose to 13. I immediately went on the Chinese Herbs and it reduced the TSH to normal.
My Chinese doctor has told me that the pharmaceutical companies can produce a drug that acts like the Chinese medicine. However, in his view, the companies would rather put people on a pill for life. They make more money that way. Sad.
My Chinese doctor is not only a Chinese doctor trained in China but he also has an MA and PH.D from McGill University in cellular nutrition, and worked in cellular research, focussing on cancer, for 20 years. So he is both a scientist ad Chinese doctor.
The Chinese herbs brought my TSH levels to normal over a period of months drinking the herbal formula. Recently, after 15 years my TSH, which I always regularly check, rose to 13. I immediately went on the Chinese Herbs and it reduced the TSH to normal.
My Chinese doctor has told me that the pharmaceutical companies can produce a drug that acts like the Chinese medicine. However, in his view, the companies would rather put people on a pill for life. They make more money that way. Sad.
7
Just wondering which herbs these are. I have been taking Armour thyroid for five years with limited success. Synthroid caused me elevated heart rate when resting and I thought I would have a heart attack, although it did increase energy levels. I made my doctor switch me to the dessicated pig thyroid because I didn't think my heart could take the Synthroid.
1
Do you know what the herbs were he put you on? I know dulse helps b/c of the iodine. Thanks!
1
It's a formula that is a combination of 10 herbs that I cook. Also when I cannot cook the herbs he has prescribed 9 Chinese herbs in the concentrated form, i.e. add hot water to the granule concentrate. That is the easiest way of taking it.The key is to find a good Chinese doctor - trained in China would be best who will prescribe a formula that suits you.
I did not mind the cooking as I was strongly motivated not to go on the Synthroid as it eventually destroys the thyroid. Aside from the side effects, the dose must be constantly monitored.
I did not mind the cooking as I was strongly motivated not to go on the Synthroid as it eventually destroys the thyroid. Aside from the side effects, the dose must be constantly monitored.
I've read that thyroid issues later in life may exacerbate memory loss and dementia. Has anyone studied the long term affects of taking thyroid hormones/keeping TSH levels lower and memory/dementia?
9
This article and the research is wrong on so many levels. Take it from someone who has spent ten years working on balancing their thyroid level. If you or someone you know is struggling with an underactive thyroid please see a practitioner who specializes in thyroid/adrenal matters and who also prescribes natural dessicated thyroid - NOT the chemical levothyroxine. The body does not know how to process that chemical pill. TSH is also NOT the test used by specialists in this field - they test for Free T3, T4 and Reverse T3 - plus a host of other items (iron, B12, D3, etc.) that could be problematic for the thyroid. There are many many endocrinologists who do NOT understand, or care to understand the advancements in this area and keep their patients very very ill. It's almost criminal. Articles like this do a disservice to those truly suffering from hypo or hyper thyroidism.
15
It took doctors awhile to diagnose me with hypothyroidism many years ago. On top of that there was a nodule in my thyroid as well, which was fortunately benign.
I was treated with Iodine 131 and am now taking Synthroid daily. Yes, I do have blood tests to see whether my blood levels are fine - not too much and not too little. It's a very fine line.
Genetics, as I have found out plays a role in this too. My grandmother, mother and now I have some form of Thyroid disease. My daughter will have a strong genetic disposition being 4th generation. I hope when the time comes for her, she listens to what her body is saying as well as a good PCP/Endocrinologist team should she need to consult with them.
I was treated with Iodine 131 and am now taking Synthroid daily. Yes, I do have blood tests to see whether my blood levels are fine - not too much and not too little. It's a very fine line.
Genetics, as I have found out plays a role in this too. My grandmother, mother and now I have some form of Thyroid disease. My daughter will have a strong genetic disposition being 4th generation. I hope when the time comes for her, she listens to what her body is saying as well as a good PCP/Endocrinologist team should she need to consult with them.
2
I thought that my weight gain, apathy, failing memory and failing vocabulary were all part of being over 60 but I also suspect it might be thyroid. For two years I asked my doctor to be tested and she just smiled at me sympathetically and said that I had to get used to growing old. When she finally relented I was too tired to take the test for almost 3 months but I did it over to the lab. Within a day there was a phone call. My prescription for thyroid was waiting for me at the pharmacy. Within a week I felt it been reborn. The fog cleared. My memory returned. My energy came back. My vocabulary became complicated once again. My social life resumed but the 20 pounds I'd gained in two years never came off. However I have not put anymore on. I am fit from my frequent visits to the gym and my active daily life. I am feeling great. Let's not discourage thyroid.
23
So glad you feel better, but it's criminal that your doctor kept you sick and suffering for two years because of a refusal to run the correct tests to find the ROOT CAUSE of your suffering. Articles like this perpetuate the myth of everyone should feel like crap because everyone is aging. Not true.
11
The dangers of having a young doctor who is clueless to the fact that one day she too will grow old, unless she dies young. Getting old does not mean getting infirm.
Once doctors understand that they will take their patient's complaints more seriously.
The thyroid is a key land to our health and should not be ignored. Happy to hear that your problem got resolve.
Once doctors understand that they will take their patient's complaints more seriously.
The thyroid is a key land to our health and should not be ignored. Happy to hear that your problem got resolve.
8
My mother has been taken levothyroxine for years, she has had as side effect tachycardia, now she takes propranolol for life , is there any danger ?
1
what an extremely bizarre editorial. most US physicians, including endocrinologists and internists , would not prescribe thyroid replacement hormone for subclinical derangements. also, since thyroid screening is not reimbursable under current guidelines, it's not routinely done.
it is true that US endocrinology guidelines lag behind the science, and there are issues with treatment of this condition (which, if left untreated, eventually would lead to death). however, that would be exceedingly rare in the United States. While overt thyroid disorders generally take a long time to be diagnosed, they eventually are diagnosed and treated.
to think of prescribing Synthroid or a generic equivalent for subclinical forward disease is just strange.
it is true that US endocrinology guidelines lag behind the science, and there are issues with treatment of this condition (which, if left untreated, eventually would lead to death). however, that would be exceedingly rare in the United States. While overt thyroid disorders generally take a long time to be diagnosed, they eventually are diagnosed and treated.
to think of prescribing Synthroid or a generic equivalent for subclinical forward disease is just strange.
3
Synthroid is routinely prescribed in Canada as described in the article. Have been on synthroid for 1.5 years based on TSH levels with no effect on symptoms or health.
2
Thyroid screening is covered under most of the insurance plans here in the US. However, it is not common to test anything more than TSH. You need to test free T3, free T4 and reverse T3 on a regular basis to ensure that your body is property utilizing the medication. If it is not, then you need to begin looking for the reasons why. For many people, it can be struggling adrenals, low iron, inflammation, low vitamin levels, or heavy metals.
For more information, please have a look at Stop the Thyroid Madness' website. It saved my life.
For more information, please have a look at Stop the Thyroid Madness' website. It saved my life.
4
TSH isn't always right. I was on generic levo with "in range" TSH and incredibly symptomatic. Testing my Free T3 and Free T4 have a much more accurate picture. Once I switched to Synthroid and two months later increased my dose again based on my Free T3 and Free T4 I improved significantly. I do not have Hashis like many who take levo, I just don't produce enough T3 on my own. It is possible the reason these patients are not benefiting is because they're still using TSH tests to determine whether the dose is correct when that test isn't very accurate. TSH tests only tells how much "make some chemicals" TSH is in the blood not how much active and ready to use Free T3 and Free T4 is in the blood. They're basically testing for the wrong thing...it's no wonder it's not helping.
9
It took me many years to find a doctor who finally tested me for Hashimoto's in response to the borderline findings re my thyroid function and a myriad of symptoms. After starting a course of Synthroid I felt as though a fog lifted. I wonder, had I been treated earlier, would I have had the multiple miscarriages that I experienced. I can usually tell if my levels need adjustment as my symptoms start to reoccur. It should be noted that the generic form of this medication has been reported to be less effective. The cost of the prescription reflects the failure of our government to protect us from the greed of the pharmaceutical companies.
10
Another alternative diagnosis can feasibly be adrenal fatigue which causes secondary hypo/clinical hypo. I have been been treated for hypo and prescribed 25mcg Levo which made me feel awful (elevated resting pulse, severe insomnia, weight loss, hair loss). My doctor ignored how I was feeling, and only treated my TSH level. I'm no longer taking the Levo and instead working with a homeopathic doctor to treat my adrenal fatigue. No longer hypo and feeling substantially better.
Doctors need to think of the body as a whole unit rather than one malfunctioning organ at a time.
Doctors need to think of the body as a whole unit rather than one malfunctioning organ at a time.
8
Adrenal fatigue is a made up diagnosis not accepted as real by any true medical society or peer reviewed entity. It's a sham diagnosis used by quacks to group common non diagnostic symptoms into a "diagnosis"
1
Some of us have no choice but to take Synthroid. Seven years ago, at age 58, I received extensive radiation treatments for stage 3 tongue cancer (caused by the HPV virus; I don't drink or smoke). The tumour was located at the base of my tongue. The treatment was brutal, but it cured my cancer. However, as a result I was left with a shrivelled and essentially non-functional thyroid. I take a 112-mcg tablet an hour before breakfast and will have to do so for the rest of my life. I get a TSH test prior to each renewal of the prescription and my dosage level has been consistent for several years. Can't say I've noticed any physical benefits. I would love to not have to take the drug anymore but, as I say, I have no choice.
I think articles like this are semi-irresponsible. Lord knows how many Times readers-- and their friends and colleagues who have the article forwarded to them-- will see this piece and begin badgering their doctors to be taken off what a NYT article says is a potentially unnecessary medication. Blanket claims like this are not helpful. As with any medical condition, there are infinite variations among individual cases and each case has to be appraised individually. I feel sorry for all those medical practitioners who will now be required to respond to questions from disgruntled patients and clients armed with inadequate information. This may come as a surprise to some, but quite often your doctor, if competent, really does know what's best for you.
I think articles like this are semi-irresponsible. Lord knows how many Times readers-- and their friends and colleagues who have the article forwarded to them-- will see this piece and begin badgering their doctors to be taken off what a NYT article says is a potentially unnecessary medication. Blanket claims like this are not helpful. As with any medical condition, there are infinite variations among individual cases and each case has to be appraised individually. I feel sorry for all those medical practitioners who will now be required to respond to questions from disgruntled patients and clients armed with inadequate information. This may come as a surprise to some, but quite often your doctor, if competent, really does know what's best for you.
9
Well, another possible result of this article is that patients may ask their primary care physicians more about what tests were run. They may ask for fuller information about risks of side effects of medication. And they may ask for a referral to an endocrinologist who specializes in thyroid / adrenal. And all of that may add up to some people getting better care, while others may find their care was perfectly appropriate already.
2
By the way, a three month prescription of levothyroxine costs $30 co-pay in the States and $5.50 without insurance in Europe.
7
There is a difference between making a number better ( such as TSH) and making a patient better. But in the old days ( before reliable numbers) a patient would be seriously ill prior to the diagnosis being reliably made. Myxedema anyone? That rarely happens. As the article implies modern medicine unavoidably involves some over treatment--a reasonable price to pay for the minimization of under-treatment, which can be catastrophic.
4
Let's hear it for Synthroid.
When I started taking it about 12 years ago, it changed my life, and I only wish some doctor had thought to test my TSH years earlier.
Before: I was always tired; I gained weight eating almost nothing; I was always slightly unhappy about something; my concentration was terrible.
After: I have much more energy; when I eat very little, I actually lose a little weight; I am much happier much of the time; my concentration is much better.
There are many people for whom Synthroid makes life much pleasanter, and those of you knocking it should not forget the truly hypothyroid, such as myself. I only take 75 mg a day, but even that dosage makes a huge difference.
When I started taking it about 12 years ago, it changed my life, and I only wish some doctor had thought to test my TSH years earlier.
Before: I was always tired; I gained weight eating almost nothing; I was always slightly unhappy about something; my concentration was terrible.
After: I have much more energy; when I eat very little, I actually lose a little weight; I am much happier much of the time; my concentration is much better.
There are many people for whom Synthroid makes life much pleasanter, and those of you knocking it should not forget the truly hypothyroid, such as myself. I only take 75 mg a day, but even that dosage makes a huge difference.
16
It seems that we need a better system for "un-prescribing" medications. Are physicians ever taught that part of the equation?
12
News flash. There are dozens of other hormone deficiencies that could cause the same symptoms, as well as boredom and lack of exercise.
However, thyroid meds are what most docs know anything about. Also the news media has not done a number on estrogen, progesterone, testosterone (for women) etc., and your insurance company will pay for thyroid meds. In may experience, testosterone deficiency also causes similar symptoms. However, because I am a woman my insurance company does not believe I should have that drug and I have to pay for it myself. So maybe I should just use thyroid meds? NOT.
However, thyroid meds are what most docs know anything about. Also the news media has not done a number on estrogen, progesterone, testosterone (for women) etc., and your insurance company will pay for thyroid meds. In may experience, testosterone deficiency also causes similar symptoms. However, because I am a woman my insurance company does not believe I should have that drug and I have to pay for it myself. So maybe I should just use thyroid meds? NOT.
7
My doctor has prescribed low-thyroid medication, high blood sugar medication, high blood pressure medication.
I refused all three, monitor myself (glucose and BP), and adjust with diet and exercise. I take no medications. All tests are now normal.
Doctors like to prescribe meds - its what they do.
I refused all three, monitor myself (glucose and BP), and adjust with diet and exercise. I take no medications. All tests are now normal.
Doctors like to prescribe meds - its what they do.
12
Enjoy that myocardial infraction caused by elevated blood sugar and pressure that you don't care for.
1
In my opinion, development of Synthroid was a cynical money grab by the pharmaceutical industry. It was sold to doctors and insurance companies as superior to an effective natural product. For many patients who are truly hypothyroid, this synthetic product does little to provide a healthy solution. In my case, I was "cold sensitive," with a clinically read body temperature of 92.0. Synthroid raised my body temperature to 94.2. Not until I was put on Armour Thyroid, the natural product, did my temperature approach normal body temperature. For some of us, Synthroid was used as too simple a solution for a miserable situation.
20
The problem is that Armour Thyroid was removed from the market because the manufacturer couldn't adjust the dosage. If it's off the market, what are you taking?
1
Armour is still very much on the market--though I don't take it, my insurance will pay for it. Btw, there are other natural brands besides Armour.
odd. I take Armour Thyroid daily. Just refilled my prescription. It does not appear to be off the market.
Maybe they are using the wrong thyroid medication. Perhaps t3 or desiccated thyroid would work better. Most doctors have been brainwashed into thinking that t4 is the only way to treat thyroid insufficiency but many patients find that desiccated thyroid is a better treatment for them.
22
Oh, great! I have been taking Levothyroxine for over 30 years. It is also known as Synthroid or Levoxyl and maybe other names. I will be sure to provide this article to my GP.
I especially appreciate the Tuesday edition of the NYTimes with its special section on Health and Science. With atrial filibrstion, severe rheumatoid arthritis and having overcome, hopefully, prostate cancer, articles like these get my full concentration. Congress better watch its step when mucking with our healthcare.
I especially appreciate the Tuesday edition of the NYTimes with its special section on Health and Science. With atrial filibrstion, severe rheumatoid arthritis and having overcome, hopefully, prostate cancer, articles like these get my full concentration. Congress better watch its step when mucking with our healthcare.
6
The simple TSH test is routinely used to check for hypothyroidism but a few percent of people with thyroid problems have pituitary or hypothalamic causes and may go undetected for years because medical zebras are generally outside the consideration of a primary care physician. Best to see an endocrinologist and/or rheumatologist for persistent symptoms and marginally elevated TSH levels.
4
People get tired, because they get old. Look at Rex Tillerson. He's 68, but looks ten years older. Why? Because he worked at a demanding job for forty years. Ponce de Leon tried to find the fountaIn of youth in Florida more than 300 years ago. He waits there still.
4
The title of this article is misleading and irresponsible.
18
I agree! I actually have hypothyroidism, get regular blood tests and have been taking slowly increasing dosages of Synthroid for decades! This headline implies that I've been wasting money on a uselss drug!
2
The standard normal rates for TSH are .03 - 3.0. Anybody consistantly testing outside that range needs further evaluation. Anybody who suddenly develops a TSH irregularity may or may not be hypothyroid - the more useful evaluation is to determine a range of problems that take place over a year or more, not a few weeks. All that said, hypo and hyperthyroid issues heavily favour women over men, and statistically tend to take some 7 years from first presentation to effective diagnosis. Hypothyroidism is indeed a medication balancing act and it's one that primary physicians or internists or naturopaths or gynecologists or nurse practitioners really should leave to endocrinologists.
12
Do you mean 0.3 - 3.0?
5
I have both hypothyroidism and hyperparathyroidism. The generic medication has been fine for me. but not everyone can tolerate it. I take mine in the morning on an empty stomach and don't eat for at least 1/2 hour. My TSH is very consistent the last three years. Keep in mind it can take years for the thyroid to completely stop production TSH and dosages will change. Also very important to get tested at the same time of day, every time.
I would advise anyone with serious thyroid or parathyroid problems to see a Fellowship trained Endocrine Surgeon. I believe here are only two hundred or so in the US.
I would advise anyone with serious thyroid or parathyroid problems to see a Fellowship trained Endocrine Surgeon. I believe here are only two hundred or so in the US.
1
Same here, but ended up with a total thyroidectomy. I tried levo (generic), went to Synthroid, then added T3 and am now finally doing better on Natural Desiccated Thyroid (WP). Calcium supplements are necessary and having gone gluten free has eased many symptoms.
3
Over simplification of a disease process which might start gradually as "subclincal" and progresses into full-blown hypothyroidism which impacts cardiovascular, metabolic and other systems as well. If folks here want to find parallel between their own condition and offer free advice to others with hypothyroidism that would be a GREAT ERROR. Each individual is different. As you might be on other medications which interact with the Thyroid supplements, synthetic or desiccated (dried and ground) thyroid hormone. Even when you take medication in the morning. Hint : need at least one half hour before you should eat or take any other meds after taking thyroid med first thing after waking up in the morning. Please avoid giving advice to others on what your personal experiences or your uncle Teddy's told you about his thyroid problems. You might be misguiding others and jeopardizing their wellbeing. Sincere concerns alone without firm medical Knowledge can cause lots of harm. FIRST DO NO HARM.
14
Synthroid dosing instructions say to take it first thing in the morning and don't eat for at least half an hour after. When I was on generic levo the dosing instructions were the same. They are standard dosing instructions for levo period. Despite how that individual set the sentence up, the information regarding medication timing is actually the recommended dosing instructions for everyone on levo. Ie if you don't know enough about something to comment accurately, please remain silent.
The article does not address the possibility that this particular drug is not always the best treatment for hypothyroidism. Many with hypothyroidism find better symptom relief with th addition of T3 — the active form of the thyroid hormone. And in the case of Hashimoto's disease, the most common cause of hypothyroidism, Synthroid alone, will rarely ameliorate all symptoms, as it does nothing to address the underlying autoimmune process.
17
I've been hypothyroid for almost 2 decades, and for several years I thought taking the medication wasn't really necessary, so I stopped for a while. what a big mistake! my symptoms weren't fatigue or aching joints (although I had those, they were due to lupus), they were dry, scaly patches of skin. once I returned to medication, those went away. I'm now taking a dessicated thyroid instead of levothyroxine, but both treatments work great. I realize hypothyroid may be over diagnosed and over prescribed, but for those of us who have definite clinical symptoms that are relieved by the medication, it's a Godsend.
17
why is there no discussion of Hashimoto's, the autoimmune disease that also is a cause of hypothyroidism? There is a blood test that can be done for antibodies that confirms it. Then there is no question about the need for synthroid (and your TSH is generally high anyway, which is when my doctor tested for Hashimoto's.)
24
Hashimoto's is the main culprit, but a certain percentage of people do not have the autoimmune aspect but still have hypothyroid.
2
I took this drug for almost a year and had an epiphany one day that I felt absolutely no different than I had before, so I stopped taking it. Not only did I not notice any difference by not taking it, I actually feel better. Go figure.
4
From the time I started taking Levothyroxine, the migraines that had plagued me my whole life dissipated. I was incapacitated 5-7 days a month by these painful onslaughts from the time I was 11 or 12 years old. Nothing eased them. Not diet change, not meditation...nothing. Now, for the last few years, I have been almost migraine free. Perhaps tiredness and lackluster are not cured by this medication, but I thank the day my doctor handed me my first prescription.
7
I've only been on it for a couple of months, but I've gone from 2-3 migraines a week to only one in two months. Because of that alone, this medicine has been life-changing.
I certainly agree with repeating the TSH before treating. And it's good to remember we too often put more weight on numbers than the patient.
However, the problem with relying on symptoms of hypothyroid is that, unless the problem is extreme, symptoms of hypothyroid are non-specific. E.g. there are many reasons for fatigue, weight gain, dry skin and constipation. Also, rates of obesity and depression are reportedly increasing in the US; this is, most likely, not due to thyroid problems.
So, whether or not to treat variations in TSH levels remains one of the gray areas of medicine.
BTW, how about an educational article on treating/not treating variations in Vitamin D levels? I see an uptick in patient requests for supplements and an increase in scripts for supplements.
However, the problem with relying on symptoms of hypothyroid is that, unless the problem is extreme, symptoms of hypothyroid are non-specific. E.g. there are many reasons for fatigue, weight gain, dry skin and constipation. Also, rates of obesity and depression are reportedly increasing in the US; this is, most likely, not due to thyroid problems.
So, whether or not to treat variations in TSH levels remains one of the gray areas of medicine.
BTW, how about an educational article on treating/not treating variations in Vitamin D levels? I see an uptick in patient requests for supplements and an increase in scripts for supplements.
12
There was a recent article saying that vitamin D is pretty much not useful for most people. The problem I saw with the article is that, for me, they weren't assessing the right thing. I started taking it because my MIL recommended it for getting thicker hair (yes, vanity), it didn't work for that, but what did happen is the pains in all my little joints (fingers, toes, ankles, wrists) went away. My doctor had already looked for arthritis and didn't find any. I have no idea why it works, but if I forget it for a week my ankles remind me to take it. Bodies are weird and complicated.
7
My wife had radioactive iodine thyroid reduction - followed by prescribed levothyroxine. She soon complained of depression - which she had never before experienced.
Because the February, 1999 New England Journal of Medicine article connecting levothyroxine with depression had recently garnered press attention, I became aware of it and bought Armour thyroid via the internet. Without my wife’s knowledge, I switched medications. She promptly returned to her usual sunny disposition.
Years later, she was bedridden, often very near death, in a New York area teaching hospital for almost four months. She was given levothyroxine. One day she stated that she “just wanted to go home and die.” She was depressed.
I informed her doctors of her thyroid history and referred them to the New England Journal article. Since their hospital formulary did not include T3, they had me bring our Armour thyroid from home. My wife promptly recovered her usual optimistic disposition, though her circumstances could scarcely have been more depressing.
She has made a full recovery and continues to take Armour thyroid, now prescribed by her internist.
Because the February, 1999 New England Journal of Medicine article connecting levothyroxine with depression had recently garnered press attention, I became aware of it and bought Armour thyroid via the internet. Without my wife’s knowledge, I switched medications. She promptly returned to her usual sunny disposition.
Years later, she was bedridden, often very near death, in a New York area teaching hospital for almost four months. She was given levothyroxine. One day she stated that she “just wanted to go home and die.” She was depressed.
I informed her doctors of her thyroid history and referred them to the New England Journal article. Since their hospital formulary did not include T3, they had me bring our Armour thyroid from home. My wife promptly recovered her usual optimistic disposition, though her circumstances could scarcely have been more depressing.
She has made a full recovery and continues to take Armour thyroid, now prescribed by her internist.
14
Okay, I can appreciate your good intentions, but I hope you realize that ordering medication online (who knows what you're getting) AND giving it to your wife without her knowledge was extremely unethical, dangerous, and illegal. There's a reason even Armour is a prescribed medication.
22
Charlierf this is really disturbing. Why on earth would you not discuss this article with your wife first, and then with her agreement, order the medication. To treat her like a non-person or family pet and give her medication she had no knowledge of or choice in is wrong on so many levels (and, I suspect, illegal). She's your wife! You don't own her. Also, when she was in hospital for four months on levothyroxine, why didn't one of you tell her doctor what medication she normally took right from the outset? This whole story is bizarre.
28
Norton, LW: Thanks for your concern for my wife’s welfare. If she had known about the switch, any benefit might have been attributable to the placebo effect. I had a reliable source for the branded thyroid and enough careful knowledge to know that there was little or no risk.
The hospital was very good, but I felt that making more waves than necessary would have been unwise. Maybe I should have immediately told them (it was on their written patient info), but you’d have to have been there to feel what would be best.
The hospital was very good, but I felt that making more waves than necessary would have been unwise. Maybe I should have immediately told them (it was on their written patient info), but you’d have to have been there to feel what would be best.
4
I take a very small dose, either 50 mcg. or 75. The only symptom that I was aware of was that I was cold but I didn't tell a doctor. Being cold didn't seem like a medical issue.
As soon as I stated levothyroxine, I was no longer cold. In fact, now I am frequently hot. Maybe if I stop the medication, I will no longer be hot or cold.
As soon as I stated levothyroxine, I was no longer cold. In fact, now I am frequently hot. Maybe if I stop the medication, I will no longer be hot or cold.
4
Please consult with your physician before discontinuing.
1
Levo doesn't work for many people, but desiccated thyroid does (like myself). Taking desiccated thyroid was life changing for me. But I had doctors that measures more than the outdated TSH test... you must also test Free T3 and T4, and take symptoms seriously. I do agree with an earlier commenter that you must correct the adrenals first before thyroid...
14
Speak for yourself. I am someone and Synthroid DOES work for me. Yes, it doesn't work for everyone but it does work for many.
4
Another plausible explanation for these findings is that the generic synthroid is of a much lower quality, so those taking generic prescriptions probably aren't ever getting the proper dose. This should be studied because it's been a big problem with synthroid for years.
20
This seems like a factless claim. I've taken both, starting with the brand name and now use the generic levothyroxine and perceive no difference in quality and experience no difference in results. I'd still like more energy and less weight, but I feel better with it than without.
3
treat the patient, not the labs
9
Doctors need more than 15 minutes to do the right thing for patients. Until the big brother and it's sister insurance giants get that, well, you'll keep getting lots of objective but useless blood tests with subsequent useless at best, dangerous at worst care that we have now. How do you get insurers to pay more for a full 30-45 minute visit to save lives and money in the end?
15
another W for the biggest group of crooks in America; its not Wall St, the military industrial complex, the prison indistrial complex, trial lawyers, used car salesmen (these guys wear better suits even if they act the same) or even the government. now you knbow why we dont have single payer like every other country in the industrialized world; the drug pirates will have none of it. how many gulible people now think they p too much or the twitch in their legs at night is a "disease" that needs a pill. answer; too many. and until the US sheeple get some science literacy, takes their hands out of their mouth, put the doink boxes and turn off the boob tube, you'll contiunue to be ripped off. the only thing their honest about with all these drugs is the 150 side effects they all seem to have many of which are worse than the malady at hand.
10
Maybe if the people don't take antacids on days they are using levothyroxine because they are afraid of synthetic side effects, they will experience decline a little later, Healthcare is expensive because of hospitals and specialists. Leave the primary care physicians alone when they hand out cheap placebos to cheer up oldies.
1
If your TSH is slightly high, take some kelp or other low doses of iodine for 2-3 months, maybe twice a week. The thyroid needs optimal amounts of that substance, but often people don't get enough (or may get too much). Then see where your thyroid is.
6
An iodine supplement is not necessary in most developed countries. Unless a person is diagnosed with a deficiency, iodine might can make hypothyroidism worse.
14
Or take the MDR of iodine in a pill made from kelp several times a week. Also,
review your diet in terms of foods that suppress iodine uptake, such as brussel sprouts. spinach, sweet potatoes, and many more. Don't not eat vegetables such as these, but maybe take some kelp an additional day of the week or reduce portions-- if your diet is heavy in these foods.
Before taking any iodine supplement, get a test for Hashimoto's. If you have this auto-immune disease, do not take iodine supplements until you get professional advice.
review your diet in terms of foods that suppress iodine uptake, such as brussel sprouts. spinach, sweet potatoes, and many more. Don't not eat vegetables such as these, but maybe take some kelp an additional day of the week or reduce portions-- if your diet is heavy in these foods.
Before taking any iodine supplement, get a test for Hashimoto's. If you have this auto-immune disease, do not take iodine supplements until you get professional advice.
2
Vegans need to be concerned with getting enough iodine as most food sources of iodine are not vegan friendly.
1
I see patients in my practice all the time who have most of the cardinal symptoms of hypothyroidism but have thyroid tests that are in the normal range or even indicative of hyperthyroidism. The only thing that is as common as this phenomenon is doctors telling these people that there's nothing wrong with their thyroid. This flies in the face of their own experience which is usually virtually 100% consistent with hypothyroidism. Read the book "Why do I Still Have Thyroid Symptoms When My Lab Tests are Normal", by Datis Kharrazian for starters, and you will start learning more about why this happens. As a hint, receptor hyposensitivity, hypothalamic-pituitary adrenal axis dysfunction and in some cases infections or heavy metal toxicity often conspire to produce this confusing situation. Modern medicine is about 20 years behind the curve when it comes to understanding what's going on in the human body, so don't expect these ideas to be accepted by your doctor until around 2030.
48
Bravo! Good to hear there are some real doctors like you out there who don't share the simple-minded solipsism of the establishment, which says, in effect, " If we don't know what is going on, and therefore our treatment of it fails, then the problem must not exist."
You would be interested in the material you can find on the website of the foundation which was left by Dr. Broda O. Barnes, a thyroid researcher, in order to address exactly this problem.
Also you would be interested in the excellent book about his life work, "Pets at Risk" by Dr. Al Plechner who spent fifty years, during which he worked on over 100,000 animals, defining a syndrome of combined adrenal and thyroid dysfunction which he demonstrated with over 90,000 test panels, to also be deregulating the immune system. He designed a treatment protocol for this syndrome which is explained in the book in detail. Human patients appear to have a very similar syndrome to that which exists in animals, and it appears to be a problem which is reaching epidemic proportions.
You would be interested in the material you can find on the website of the foundation which was left by Dr. Broda O. Barnes, a thyroid researcher, in order to address exactly this problem.
Also you would be interested in the excellent book about his life work, "Pets at Risk" by Dr. Al Plechner who spent fifty years, during which he worked on over 100,000 animals, defining a syndrome of combined adrenal and thyroid dysfunction which he demonstrated with over 90,000 test panels, to also be deregulating the immune system. He designed a treatment protocol for this syndrome which is explained in the book in detail. Human patients appear to have a very similar syndrome to that which exists in animals, and it appears to be a problem which is reaching epidemic proportions.
4
Are you a medical doctor? What kind of "patients" do you see?
7
Thank you! I have wondered that very thing...Every test I have comes up normal but I'm not. Going to check this out.
1
The issue that has been missed here is that the bulk of what is being discussed is sub-clinical hypothyroidism. This diagnosis is based on lab values and NOT overt symptoms. Thyroid hormone acts throughout the body and plays a role in many of the systems/functions. Correcting thyroid levels in a patient with sub-clinical hypothyroidism may not necessarily put a pep in their step, but that does not mean it worthless.
16
I was diagnosed with exactly this subclinical hypothyroidism. My doctor of osteopathy told me I didn't have to worry about it. He even said that slight hypothyroidism can promote a longer life. Glad to see his point of view validated.
7
The article does not discuss the use of Armour thyroid, that contains a mix of both T3 and T4. Synthroid/levothyroxine is pure T4. T3 is ten times more potent than T4. The body naturally converts T4 to T3. Taking Armour increases the risk of subclinical hyperthyroidism, which clearly can be dangerous. 10% of patients with newly diagnosed atrial fibrillation are found to have subclinical hyperthyroidism. It also accelerates calcium turnover in bones, increasing the risk for osteoporosis. Armour is not a "pep pill" and many doctors will prescribe it (or internet-driven patients will demand it) when their vague fatigue or excess weight is not improved by levothyroxine, a drug they probably didn't need to begin with.
11
NOPE. Not Orangefaced said Armour causes dangerous hyperthyroidism while Synthroid is pure T4. Pure, what? Purely SYNTHETIC, while Armour is natural and real, not a chemical copy.
Very likely the the heart palps are attributed to not treating the adrenals FIRST before starting the thyroid meds which is in the product package insert. Most patients and doctors do not read the package insert which clearly states that adrenals must be checked/treated first before starting thyroid treatment. Adrenals usually pick up the slack when the thyroid is slowing down. Starting thyroid meds cold can cause the heart issues.
It happened to me, then I read the insert, told my doctor, stopped the thyroid meds and worked on my adrenals, first with testing and then with low-dose, bio-identical hydrocortisone. Then, I restarted the thyroid meds and no palps. Success.
Please stop with the anti-Armour diversionary tactics. We know Synthroid is very expensive, patented and profitable, while Armour is not patented or expensive. Looks like those who don't like Armour eating into Synthroid's profits are unhappy about the competition.
Very likely the the heart palps are attributed to not treating the adrenals FIRST before starting the thyroid meds which is in the product package insert. Most patients and doctors do not read the package insert which clearly states that adrenals must be checked/treated first before starting thyroid treatment. Adrenals usually pick up the slack when the thyroid is slowing down. Starting thyroid meds cold can cause the heart issues.
It happened to me, then I read the insert, told my doctor, stopped the thyroid meds and worked on my adrenals, first with testing and then with low-dose, bio-identical hydrocortisone. Then, I restarted the thyroid meds and no palps. Success.
Please stop with the anti-Armour diversionary tactics. We know Synthroid is very expensive, patented and profitable, while Armour is not patented or expensive. Looks like those who don't like Armour eating into Synthroid's profits are unhappy about the competition.
12
In response to Lechrist. The term "pure" makes no reference to synthetic vs naturally derived. What it does refer to is a quality controlled pharmaceutical agent, unlike Armour which is derived from pig glands.
Second, you changed my term "atrial fibrillation" into "palpitations." This is disingenuous. Atrial fibrillation can be quite dangerous, and may cause embolic stroke, congestive heart failure and other serious consequences. Tying this into undiagnosed adrenal insufficiency is ridiculous.
Adrenal insufficiency is very rare, while hypothyroidism is very common. It is true, treating hypothyroidism before treating adrenal insufficiency may worsen the latter, but that would be true whether using levothyroxine or Armour.
Please note I used the word levothyroxine, not Synthroid. I get no financial benefit from recommending levothyroxine. I must add that generic levothyroxine can often be purchased for under $10 for a month supply, while Armour always costs over $50, and it is marketed by its own pharmaceutical company as is Synthroid.
I believe that people should make their decisions by evidence based medical science, not emotion driven internet conspiracy sites. The two most common symptoms people complain about when seeking thyroid testing are fatigue and the inability to lose weight. Unfortunately a million things can cause these two nonspecific symptoms. No thyroid medication, whether it's levothyroxine or Armour, should be prescribed as a pep pill or a diet aid.
Second, you changed my term "atrial fibrillation" into "palpitations." This is disingenuous. Atrial fibrillation can be quite dangerous, and may cause embolic stroke, congestive heart failure and other serious consequences. Tying this into undiagnosed adrenal insufficiency is ridiculous.
Adrenal insufficiency is very rare, while hypothyroidism is very common. It is true, treating hypothyroidism before treating adrenal insufficiency may worsen the latter, but that would be true whether using levothyroxine or Armour.
Please note I used the word levothyroxine, not Synthroid. I get no financial benefit from recommending levothyroxine. I must add that generic levothyroxine can often be purchased for under $10 for a month supply, while Armour always costs over $50, and it is marketed by its own pharmaceutical company as is Synthroid.
I believe that people should make their decisions by evidence based medical science, not emotion driven internet conspiracy sites. The two most common symptoms people complain about when seeking thyroid testing are fatigue and the inability to lose weight. Unfortunately a million things can cause these two nonspecific symptoms. No thyroid medication, whether it's levothyroxine or Armour, should be prescribed as a pep pill or a diet aid.
1
If you're at subclinical levels and notice no difference when you stop taking levothyroxine, you should get off of it. But let me tell you, when you really need it, and you stop taking it, you know the difference it makes. I've experimented myself. Three days, maybe four, is my limit; my body slows down like a car out of gas. Don't minimize the necessity that this medication is for some of us.
69
There is empirical data from more than 100 women that shows that Levothyrox at best is useless, at worst bad/dangerous.
Over 500 women from all around the world answered a survey on the Levothyrox - Thyroid connection from 2013 to 2015.
http://www.stop-levo.com/
Over 500 women from all around the world answered a survey on the Levothyrox - Thyroid connection from 2013 to 2015.
http://www.stop-levo.com/
1
treatment improves(slows) hair loss in women.
3
This is just another of the dangers of a doctor sending you for the euphemistic blood work. If he asks for a wide variety of tests it is likely that some will fall outside the normal range but are normal for you. This will become evident after another $1000 worth of tests.
Doctors and some patients don't think a visit is complete without a prescription or five. Most Americans over the age of 55 are on more than two prescription drugs. Instead of just accepting these sometimes dangerous prescriptions they should be asking if it is really necessary. Will it be beneficial or only enrich the drug companies. How many patients are harmed because of a drug interaction? Older patients sometimes are taking the same drug twice because it was prescribed with a different name by two different doctors. People should always strive to take fewer, not more drugs. The side effects and interactions can be horrendous. Obviously, prescribing levothyroxine on a single test shows total ignorance of the way the endocrine system works. It's easier to write a quick prescription than actually listen to what the patient is saying about symptoms.
Doctors and some patients don't think a visit is complete without a prescription or five. Most Americans over the age of 55 are on more than two prescription drugs. Instead of just accepting these sometimes dangerous prescriptions they should be asking if it is really necessary. Will it be beneficial or only enrich the drug companies. How many patients are harmed because of a drug interaction? Older patients sometimes are taking the same drug twice because it was prescribed with a different name by two different doctors. People should always strive to take fewer, not more drugs. The side effects and interactions can be horrendous. Obviously, prescribing levothyroxine on a single test shows total ignorance of the way the endocrine system works. It's easier to write a quick prescription than actually listen to what the patient is saying about symptoms.
5
Please do not start this assassination of Thyroid medicine. Just get your t3 and t4 with tsh tested. Everyone is different so the guidelines are kinda like 1--4. I know young people on this medicine, its possible to take a very low dose. I resent when things like this are put into print because it starts a whole thing where doctors will not give you the meds you need because they do not want to flaunt the category of over prescribing. i.e. It is hard to get Valium, Xanax or pain pills because of drug addicts, which the majority of us are not, yet when needed you practically have to beg a doctor and lots of times they just say no.
21
It's actually more complicated than portrayed either in the article or the posts. Thyroid hormones, both T3 and T4, are about 99% bound by a plasma protein: thyroid binding globulin (TBG). Both must separate from TBG in order to get into cells to do their jobs. Once separated they make up the "free faction" of thyroid hormones. Free T4 is converted into free T3, which is the main biologically active form and governs not only the cellular effects but also feeds back on the hypothalamus (in the brain) to regulate thyroid secretion via thyrotropin, which regulates pituitary secretion of TSH. Thus, the proper tests when TSH is borderline high should include repeat of the TSH and TBG, free T4 and free T3. As to the possible role of the adrenal hormone cortisol, it may be low in true hypothyroidism since the adrenal needs thyroid hormone to do it's job. While both might be low in pituitary failure, this is a rare condition and would show both low TSH and ACTH.
I am fairly sure Dr. Aron was trying to be humorous when he "suggested a couple of alternative diagnoses: “Postmodern humanity. The current state of politics." When patients are "tired" with or without a borderline TSH, the doctor should inquire in detail about other symptoms of depression and also about sleep disorders, particularly sleep apnea. Elderly patients often deny feeling sad or "blue" but acknowledge having the somatic symptoms of depression: poor appetite, insomnia, constipation, general weakness.
I am fairly sure Dr. Aron was trying to be humorous when he "suggested a couple of alternative diagnoses: “Postmodern humanity. The current state of politics." When patients are "tired" with or without a borderline TSH, the doctor should inquire in detail about other symptoms of depression and also about sleep disorders, particularly sleep apnea. Elderly patients often deny feeling sad or "blue" but acknowledge having the somatic symptoms of depression: poor appetite, insomnia, constipation, general weakness.
20
My mom started on a low dose of synthroid in the late 1950's--and took it every day until her death at age 90. Unfortunately, the high cholesterol and blood pressure she'd had for years prior to her vascular dementia diagnosis at 85 was never treated at all! Now I wonder if she ever needed the synthroid...
2
Oh, great, another scare about a medication many, many people need that will make it more difficult to receive proper treatment in the future. Perhaps Synthroid is so commonly prescribed because one third of women have this incredibly common autoimmune disease called Hashimoto's thyroiditis, often brought on by pregnancy (which the majority of women experience)!
Just like the kneejerk reaction to end HRT due to a miniscule increase in risk, to the detriment of quality of life for millions of post-menopausal women. Or a bronchial infection that progressed to pneumonia, requiring the radiation exposure from a chest X-ray to diagnose, before I could antibiotics, because of overreaction and undue reluctance to prescribe.
NYT, please stop it.
Just like the kneejerk reaction to end HRT due to a miniscule increase in risk, to the detriment of quality of life for millions of post-menopausal women. Or a bronchial infection that progressed to pneumonia, requiring the radiation exposure from a chest X-ray to diagnose, before I could antibiotics, because of overreaction and undue reluctance to prescribe.
NYT, please stop it.
25
NYT only reports important scientific studies. You make your own decisions. Let's not get into censorship.
4
Oh, great, another reader posting garbage factoids.
mdieri, maybe YOU should "please stop it."
"one third of women have this" - not quite.
How about, "in adults, the incidence is estimated to be 3.5 per 1000 per year in women and 0.8 per 1000 per year in men. Incidence may be as high as 6% in the Appalachian region." source: http://emedicine.medscape.com/article/120937-overview#a5
mdieri, maybe YOU should "please stop it."
"one third of women have this" - not quite.
How about, "in adults, the incidence is estimated to be 3.5 per 1000 per year in women and 0.8 per 1000 per year in men. Incidence may be as high as 6% in the Appalachian region." source: http://emedicine.medscape.com/article/120937-overview#a5
2
You are comparing apples and oranges. Please reread the article, or better yet, the actual study. Your anger is misdirected.
1
While ineffective medication regimens can reflect careless care - elevated TSH as well as high thyroid antibody levels are worth monitoring & treating.
Too often middle-aged & older women are dismissed for a variety of complaints. Coronary heart disease in women was not adequately diagnosed until quite recently, as symptoms that appear for men were used as the standard.
Sometimes a low dose of thyroxine can modify HDL/LDL ratios & metabolic rates.
The ideal is individualized treatment, with care, monitoring and adjustments. This requires an attentive MD in a long term relationship with a patient !
Too often middle-aged & older women are dismissed for a variety of complaints. Coronary heart disease in women was not adequately diagnosed until quite recently, as symptoms that appear for men were used as the standard.
Sometimes a low dose of thyroxine can modify HDL/LDL ratios & metabolic rates.
The ideal is individualized treatment, with care, monitoring and adjustments. This requires an attentive MD in a long term relationship with a patient !
34
The TSH test is not reliable for evaluating thyroid deficiencies. There are nineteen signs and symptoms for hypothyroidism that physicians should consider instead of the TSH test. See the "Hormone Handbook, Vol. 2" by Thierry Hertoghe, M.D. Physicians should be treating the patient and his or her symptoms instead of blindly treating a blood test. Second, 85% of hypothyroid patients do better on natural thyroid instead of synthetic thyroid meds. However, 15% of patients do better on the synthetics. Subclinical hypothyroidism has been undertreated as supported by articles in JAMA going back to 1957. In that prestigious journal, scientists determined that 40% of mid-western women have untreated subclinical hypothyroidism. Another undertreated thyroid problem is goiter. Still another hormone problem is the current epidemic of untreated type 2 diabetes.
Evaluating hypothyroidism with a TSH test is at least thirty years outdated, and its time for the medical community to wake up to this fact.
Evaluating hypothyroidism with a TSH test is at least thirty years outdated, and its time for the medical community to wake up to this fact.
56
I was diagnosed with hashimotos after a visit to an allergist who tests everyone for thyroid function. I suffered for years with unexplained hives that erupted on feet, lips, scrotum, and eyes that I thought were allergies. Low dose levothyroxin has stopped the symptoms.
17
How deconditoned had the participants become prior to the study? When you're tired, you don't exercise. It would take a long time to bounce back even with a healthy lifestyle. It's not obvious that a year is enough time as it takes several months for the medication to start working and longer still to put a healthy routine into practice.
6
Hmmmm....
"Why are so many taking levothyroxine, then? The prevalence of overt hypothyroidism hasn’t changed much, but the number of annual prescriptions keeps climbing."
I'll sum it with one phrase. We live in a Capitalistic country. It is in the best interests of those promulgating the medicine to maximize its consumption in every possible way. Don't get me wrong; I get it. I'm not exactly a spring chicken these days. So I sympathize with those who feel they are benefiting. But the body ages. Its functioning changes from when you were young. So why is it aging bodies are oft-times held to metrics of someone decades younger? So much so that....well....ever looked in the medicine cabinet of a +70 year old American? It isn't always a pretty sight. What is normal for a young (er) person may not, probably is not, normal for an older one.
Yet for the most part there's no allowance for the medical philosophy of normative changes thru time. Isn't it odd that we seem unable to see this? But then again...go back to where I started off. We live in a Capitalistic society; and you must consume and feed the machine. So it goes.
John~
American Net'Zen
"Why are so many taking levothyroxine, then? The prevalence of overt hypothyroidism hasn’t changed much, but the number of annual prescriptions keeps climbing."
I'll sum it with one phrase. We live in a Capitalistic country. It is in the best interests of those promulgating the medicine to maximize its consumption in every possible way. Don't get me wrong; I get it. I'm not exactly a spring chicken these days. So I sympathize with those who feel they are benefiting. But the body ages. Its functioning changes from when you were young. So why is it aging bodies are oft-times held to metrics of someone decades younger? So much so that....well....ever looked in the medicine cabinet of a +70 year old American? It isn't always a pretty sight. What is normal for a young (er) person may not, probably is not, normal for an older one.
Yet for the most part there's no allowance for the medical philosophy of normative changes thru time. Isn't it odd that we seem unable to see this? But then again...go back to where I started off. We live in a Capitalistic society; and you must consume and feed the machine. So it goes.
John~
American Net'Zen
5
If you need this medication, it is a miracle drug. When at 38, I suddenly gained weight, had absurdly dry skin and hair, and was falling asleep while watching my children or talking to friends, I thought I was depressed. I tried a therapist, but fell asleep in his office. A physician friend took me to an endochronologist who gave me levothryroxine. Within six weeks I had lost most of the weight, regained my regular skin and hair and was ready to apply for part time jobs! I am so grateful to the friend, doctor and the pharmacists who came up with this pill.
38
A common cause of high levels of TSH is the tendency of many people to resist adding table salt to their food.
Processed and canned foods -- as well as restaurant meals -- are generally made with non-iodized salt ... because it is cheaper. People generally buy iodized table salt ... because it is healthier.
Withholding the table salt from food contributes to an iodine deficiency, which in turn elevates TSH, and leads doctors to treat the apparent thyroid problem with lifelong drugs that cannot be stopped, once started.
Processed and canned foods -- as well as restaurant meals -- are generally made with non-iodized salt ... because it is cheaper. People generally buy iodized table salt ... because it is healthier.
Withholding the table salt from food contributes to an iodine deficiency, which in turn elevates TSH, and leads doctors to treat the apparent thyroid problem with lifelong drugs that cannot be stopped, once started.
10
This is a little off topic but may explain another reason that the effects of levothyroxine can vary.
My mother had acute hypothyroidism which was being appropriately treated with levothyroxine. She took her pill every morning with breakfast without fail. But frequent blood test results would show either that the medication was working well or that it was not working at all. Yo-yoing symptoms indicated that also.
Finally the CCRC Independent Living nurse and I read about levothyroxine in her "Nurse's Guide to Drugs" book. The clue we found was more explicit than the remark about calcium near the end of this article. There was a warning that dairy products eaten when or soon after the pill was taken would undermine its effectiveness. Aha! I knew that sometimes Mother had eggs for breakfast; sometimes she had cereal with milk. Hypothesis: egg days good tests, cereal days bad tests. Mother then decided the best time for the levothyroxine pill would be at 4:30 am when she briefly awoke to take her Lasix, so she could eat dairy whenever. When we clued in the prescribing doctor, who was one of the community's top diagnosticians, she was really annoyed at herself for not thinking of that possibility. And of course henceforth no more hypothyroid symptoms.
My mother had acute hypothyroidism which was being appropriately treated with levothyroxine. She took her pill every morning with breakfast without fail. But frequent blood test results would show either that the medication was working well or that it was not working at all. Yo-yoing symptoms indicated that also.
Finally the CCRC Independent Living nurse and I read about levothyroxine in her "Nurse's Guide to Drugs" book. The clue we found was more explicit than the remark about calcium near the end of this article. There was a warning that dairy products eaten when or soon after the pill was taken would undermine its effectiveness. Aha! I knew that sometimes Mother had eggs for breakfast; sometimes she had cereal with milk. Hypothesis: egg days good tests, cereal days bad tests. Mother then decided the best time for the levothyroxine pill would be at 4:30 am when she briefly awoke to take her Lasix, so she could eat dairy whenever. When we clued in the prescribing doctor, who was one of the community's top diagnosticians, she was really annoyed at herself for not thinking of that possibility. And of course henceforth no more hypothyroid symptoms.
34
I was told (rather, I read it, my doc told me nothing) to take the rx on an empty stomach about 30-45 minutes before eating. That may be how it's affecting your mom, too, now that she takes it very early.
7
Thanks for posting this - very interesting and good for people to know - my wife did not have yoyo test results but was informed recently by Kaiser Pharmacy not to take the levothyroxine within 4 hours of taking calcium which she takes for Osteoporosis. She has been taking the medication with calcium for years and was never informed. She started separating the two pills and her level increased slightly but not significantly. Obviously it affects others differently.
4
Actually, even that time may not be enough, especially with older people. The general recommendation is not to eat for one hour after taking the pill
4
"Postmodern humanity. The current state of politics." Doc, you got my diagnosis completely right! I feel better already! Thanks.
21
Just to add my two cents for the record, I've been taking small doses of levothyroxine for only slightly elevated TSH levels for over ten years. I noticed an immediate and striking improvement in long-standing symptoms, including marked intolerance of cold and mid-afternoon exhaustion. I even grew back the outer third of my eyebrows, the loss of which is supposed to be a late symptom of hypothyroidism. The severity of the symptoms doesn't always correlate with the test results.
49
I've been on 125 mcg of levothyroxine for 8 years. My symptoms prior to taking it were extreme daytime sleepiness (I fell asleep at my desk in front of a classroom of second graders!) in spite of sleeping a lot at night; thick calloused skin on the heels of my feet; and teeth chattering sensitivity to cold even in the heat of summer. I could sit in a hot car in summer with windows rolled up and no a/c for 30 minutes without breaking a sweat. After taking the medication for 8 weeks my daytime sleepiness went away, the thick dry skin on my heels disappeared, and my sensitivity to cold lessened to where I could tolerate air conditioning. HYPERthyroidism runs in my immediate family but I definitely have an underactive thyroid. Some people may be prescribed thyroid meds who do not need it but it was life changing for me.
41
7.5 to 9.5 after a 4 April 1979 near fatal poisoning by a disgruntled chemical engineering graduate student at NBC School, FT Lewis WA. One year of erupting, oozing sores from head to foot and many other symptoms. TSH 10 was the magic number.
A year ago my primary care doctor prescribed a trial of levothyroxine in the morning. To my surprise family agrees I drive much better, clarity and concise thinking are greatly improved.
I have had so many pharmaceutical treatments of many levels of success, good, mediocre, and even a one year extreme allergic reaction, and other bad reactions, that it is always relieving when a med works. This is not a placebo effect for its success was unexpected by me and by my doctor. For me, this has worked for a year. Hope it continues.
A year ago my primary care doctor prescribed a trial of levothyroxine in the morning. To my surprise family agrees I drive much better, clarity and concise thinking are greatly improved.
I have had so many pharmaceutical treatments of many levels of success, good, mediocre, and even a one year extreme allergic reaction, and other bad reactions, that it is always relieving when a med works. This is not a placebo effect for its success was unexpected by me and by my doctor. For me, this has worked for a year. Hope it continues.
16
The title of this article makes it sound as though doctors are pushing these drugs on patients unnecessarily. However the reality is, as a physician, I had numerous patients coming in demanding these medications even if they did not meet criteria for them.
There are large rabbit holes of information on the Internet leading pseudo- knowledgeable patients to demand levothyroxine (and antibiotics, and opioids and benzodiazepines, etc. ) even if they have subclinical hypothyroidism.
I love the NYT but I am just tired of the constant denigration of physicians. How about reporting on the demands of unreasonable patients? How about telling the story about the skewed notion of tying patient satisfaction to physician pay and discussing that research showing that more satisfied patients are also likely to get unnecessary and harmful care? I think it's time to show both sides of the coin.
There are large rabbit holes of information on the Internet leading pseudo- knowledgeable patients to demand levothyroxine (and antibiotics, and opioids and benzodiazepines, etc. ) even if they have subclinical hypothyroidism.
I love the NYT but I am just tired of the constant denigration of physicians. How about reporting on the demands of unreasonable patients? How about telling the story about the skewed notion of tying patient satisfaction to physician pay and discussing that research showing that more satisfied patients are also likely to get unnecessary and harmful care? I think it's time to show both sides of the coin.
198
Unless your patients write their own prescriptions, you're writing those prescriptions that you deem unnecessary.
9
You have my sympathy, Doctor. That unrelenting and mindless propaganda spewing from TV "talk to your doctor" quickly morphs into "tell your doctor" and ultimately "demand from your doctor" because of the rampant ignorance and malleability of so many patients populating "post modern humanity."
I have been taking the medication for 20 years. I was not tired, and I was slender. But the test results were clear. My wonderful PCP whom I now fly 3000 miles to see annually since retiring to the right coast monitors my blood-work routinely between visits. Results are now in the appropriate range. I am 68 y/o, healthy, slim and mentally vibrant enough to serve as adjunct faculty in a graduate program. I would not entertain the prospect f changing my medication routine which does include a statin and a beta-blocker. So, yes, it's 3 for me daily, but every study does not send me rushing to the keyboard to second-guess my doctor.
I have been taking the medication for 20 years. I was not tired, and I was slender. But the test results were clear. My wonderful PCP whom I now fly 3000 miles to see annually since retiring to the right coast monitors my blood-work routinely between visits. Results are now in the appropriate range. I am 68 y/o, healthy, slim and mentally vibrant enough to serve as adjunct faculty in a graduate program. I would not entertain the prospect f changing my medication routine which does include a statin and a beta-blocker. So, yes, it's 3 for me daily, but every study does not send me rushing to the keyboard to second-guess my doctor.
2
Dear Fiddlesticks:
I used to work with a lot of people who were forever going to Drs who prescribed antibiotics for their every cold, etc, etc. It seemed from the outside that it took two to tango, or in those cases, to dance around the facts. This was before all of the ratings business. When I was quite a bit younger, and looking for an internist, there were always some Drs. who were popular with those who wanted "diet pills" or other medically unjustified junk drugs. My own main Drs. do not prescribe anything without a reason, and remain "popular" and more to the point, respected. They are also willing to explain their reasoning. In the end, you are the professional and responsible for your work.
I used to work with a lot of people who were forever going to Drs who prescribed antibiotics for their every cold, etc, etc. It seemed from the outside that it took two to tango, or in those cases, to dance around the facts. This was before all of the ratings business. When I was quite a bit younger, and looking for an internist, there were always some Drs. who were popular with those who wanted "diet pills" or other medically unjustified junk drugs. My own main Drs. do not prescribe anything without a reason, and remain "popular" and more to the point, respected. They are also willing to explain their reasoning. In the end, you are the professional and responsible for your work.
5
some months ago I was "diagnosed" as having a thyroid problem and given a rx for levo... A few months earlier a similar blood test said things were fine. While i waited for a second opinion, I tood the drug and wound up with headaches, bowel problems, probably higher BP which I don't need and it turned out on second opinion, I didn't need it.
Great for the drug companies, the dr visits--everybody making easy money.
My suggestion, get a second opinion.
Great for the drug companies, the dr visits--everybody making easy money.
My suggestion, get a second opinion.
2
The link "unless doses get too high" takes you an article about hyperthyroidism,not hypothyroidism
8
Yes, too high a dose of levothyroxine can produce hyperthyroidism, which is associated with heart arrhythmias and osteoporosis.
9
I don't know when a headline has called to me more. I have been on generic levothyroxine for many, many years. And I still drag all the time. But I also have the most boring job and life -- and ennui nails it.
I was put on the levo partly due to tests, but perhaps more to family history? My mother surely had Riedel's thyroiditis, which wasn't diagnosed before her surgery. Her throat never healed and it killed her within two or three months. (Officially, aspiration of "discharge" aka pus.)
Four of my five siblings are also on thyro med, being diagnosed with Hashimoto's (and multiple other autoimmune disorders). But none of us have had numbers as high as this article says ought to be the threshold.
I dunno what to think anymore.
I was put on the levo partly due to tests, but perhaps more to family history? My mother surely had Riedel's thyroiditis, which wasn't diagnosed before her surgery. Her throat never healed and it killed her within two or three months. (Officially, aspiration of "discharge" aka pus.)
Four of my five siblings are also on thyro med, being diagnosed with Hashimoto's (and multiple other autoimmune disorders). But none of us have had numbers as high as this article says ought to be the threshold.
I dunno what to think anymore.
18
Hashimoto's thyroiditis involves far more than a sluggish thyroid gland! I have it and had antibodies over 1,000 and TSH of 10 when I was diagnosed. Through diet changes and a combination of T4 (Levothyroxine) and T3 (you need BOTH) My antibodies are in the 200-300 range and TSH (least important indicator) is below 1. Reverse T3, Direct T3, T4 (full thyroid panel) is what is important. Doctors who prescribe simply based on TSH are not being through and this article misses the point by not mentioning this.
25
Studies like the one in this story (which still desperately needs a new headline) honestly slay me.
Here's a huge point to understand, if you read the wordy insert with your thyroid meds you will learn: IF YOU HAVE ADRENAL PROBLEMS, THE MEDS DON'T WORK; THE ADRENALS MUST BE TREATED FIRST, THEN THE THYROID. Most doctors don't read the insert either, so don't feel bad if you still feel wired and tired and missed that one.
Did the researchers check the elderly patients' adrenals first?
I learned this one first hand when I was given natural desiccated thyroid meds (Naturethroid) to take before my adrenals were treated (by a highly-respected doc no less). My thyroid sped up, my seriously fatigued adrenals which had been taking up the slack couldn't handle it, my heart sped up scarily and I fell off a ladder (into the grass thankfully). That's when I read the insert and embarked on the journey of taking my health into my own hands. Don't do blindly what any doctor says; trust but verify. You'll soon find out they are just people with opinions not necessarily based upon facts.
Education is a good thing. If you think you have thyroid and adrenal issues, start by reading the work of thyroid patient advocate Mary Shomon. The website stopthethyroidmadness dot com is incredibly helpful in figuring out which tests to get and how to read the levels. Always get copies of your blood tests and learn to read them.
Lastly, find a good doctor who treats you with respect.
Here's a huge point to understand, if you read the wordy insert with your thyroid meds you will learn: IF YOU HAVE ADRENAL PROBLEMS, THE MEDS DON'T WORK; THE ADRENALS MUST BE TREATED FIRST, THEN THE THYROID. Most doctors don't read the insert either, so don't feel bad if you still feel wired and tired and missed that one.
Did the researchers check the elderly patients' adrenals first?
I learned this one first hand when I was given natural desiccated thyroid meds (Naturethroid) to take before my adrenals were treated (by a highly-respected doc no less). My thyroid sped up, my seriously fatigued adrenals which had been taking up the slack couldn't handle it, my heart sped up scarily and I fell off a ladder (into the grass thankfully). That's when I read the insert and embarked on the journey of taking my health into my own hands. Don't do blindly what any doctor says; trust but verify. You'll soon find out they are just people with opinions not necessarily based upon facts.
Education is a good thing. If you think you have thyroid and adrenal issues, start by reading the work of thyroid patient advocate Mary Shomon. The website stopthethyroidmadness dot com is incredibly helpful in figuring out which tests to get and how to read the levels. Always get copies of your blood tests and learn to read them.
Lastly, find a good doctor who treats you with respect.
59
How did you resolve your adrenal issues? Your post could have been written by me!
4
good luck with that !
1
Dr. Majid Ali in NYC is expert in treating these problems. Read Dr. Al Plechner, "Pets at Risk" to learn more about them, as they have been defined in animals as well as people. Dr. Plechner spent 50 years and worked on over 100,000 animals in the course of defining these problems and how they can result in many diseases. He designed an effective treatment protocol in animals. Dr. Thiery Hertoghe is also expert in treating these problems but he is in Brussels. There are doctors in the USA who have trained under Dr. Hertoghe. Dr. Hertoghe is the 4th generation in a family of famous thyroid researchers.
1
As other posters have noted, hypothyroidism is marked by low thyroid hormone levels (T3 and T4). TSH is a hormone released by the pituitary gland, and is supposed to stimulate the thyroid to produce more T3 and t4. Normally, when one is hypothyroid, the T3 and T4 levels are low and TSH levels are high because the pituitary gland is trying (and failing) to get the thyroid to produce more T3 and T4.
High TSH and normal T3/T4 levels, though, sounds like something different - as if the thyroid gland is becoming less responsive to TSH, and so the pituitary has to crank out more just to get the 'signal' through. Treating this with a thyroid supplement strikes me as a very bad idea, because it can cause hyperthyroidism. I'm surprised more cases of chemically induced hyperthyroidism haven't been reported among people being treated for subclinical hypothyroidism.
High TSH and normal T3/T4 levels, though, sounds like something different - as if the thyroid gland is becoming less responsive to TSH, and so the pituitary has to crank out more just to get the 'signal' through. Treating this with a thyroid supplement strikes me as a very bad idea, because it can cause hyperthyroidism. I'm surprised more cases of chemically induced hyperthyroidism haven't been reported among people being treated for subclinical hypothyroidism.
10
Could be me in a few years. I only wish there was a physician within a few hundred miles who really understood this better. Meanwhile I take my desiccated thyroid because without it I have absolutely no energy, sleep poorly, am extremely constipated, and gain tonnes of weight whist changing the family's diet salad only. At least they can have the salad dressing.
2
There is not more hyperthyroid reaction because thyroid hormone can be present but not be active. Usually the inactivated hormone situation would include symptoms of low thyroid function including low body temperature.
2
It is very good to see a serious investigation on the subject of Thyroid Function and Treatment.
I had become "aware" of this elusive gland, way back in 1990. I was diagnosed with; "Hashimoto Thyroiditis". I was informed by my Endocrinologist that I had shown "positive" for this disorder. Additionally, I was informed that it was rare for a male and was predominately diagnosed in women.
Essentially, this is an autoimmune disease where your own body's defenses sees your thyroid gland as "the enemy" and attacks it.
Aside from diminishing the normal output of thyroid hormones, there is a general increase in systemic inflammation.
The treatment of choice if hormone replacement therapy - there a synthetic hormone is introduced to supplement what your thyroid "under duress" is currently producing.
There is an "Adjustment Period" where frequent blood tests will zero in on your correct dosage.
In response to this article and the "abusive" use of thyroid supplements - well - now the story gets very complicated.
There is no single endocrine test which "should" be looked at for determining treatment, ESPECIALLY in senior patients, where several "systems" are under-preforming. The delicate balance of the entire endocrine system, as well as "all other systems" requires a comprehensive overview of the "Entire Person" !
I had become "aware" of this elusive gland, way back in 1990. I was diagnosed with; "Hashimoto Thyroiditis". I was informed by my Endocrinologist that I had shown "positive" for this disorder. Additionally, I was informed that it was rare for a male and was predominately diagnosed in women.
Essentially, this is an autoimmune disease where your own body's defenses sees your thyroid gland as "the enemy" and attacks it.
Aside from diminishing the normal output of thyroid hormones, there is a general increase in systemic inflammation.
The treatment of choice if hormone replacement therapy - there a synthetic hormone is introduced to supplement what your thyroid "under duress" is currently producing.
There is an "Adjustment Period" where frequent blood tests will zero in on your correct dosage.
In response to this article and the "abusive" use of thyroid supplements - well - now the story gets very complicated.
There is no single endocrine test which "should" be looked at for determining treatment, ESPECIALLY in senior patients, where several "systems" are under-preforming. The delicate balance of the entire endocrine system, as well as "all other systems" requires a comprehensive overview of the "Entire Person" !
14
1) How many people are going to stop their medication after reading this article?
2) So so so ironic that Jane Brody's piece and this are running concurrently.
3) The debate about whether or not to treat subclinical hypothyroidism is an old debate. It is sometimes thought of as a feminist issue because although women are more affected than men, most research has been done on men.
The jury isn't in yet, the research is inconclusive: the most informed and honest answer is we're still not sure.
But it is less expensive to not treat subclinical hypothyroidism- to wait until it becomes overt, despite the consequences.
Paula Spann is no fool- she knows all of this, and therefore knows her article would trigger lots of response. Excellent clickbait, and strong alliance with the medical industrial complex.
2) So so so ironic that Jane Brody's piece and this are running concurrently.
3) The debate about whether or not to treat subclinical hypothyroidism is an old debate. It is sometimes thought of as a feminist issue because although women are more affected than men, most research has been done on men.
The jury isn't in yet, the research is inconclusive: the most informed and honest answer is we're still not sure.
But it is less expensive to not treat subclinical hypothyroidism- to wait until it becomes overt, despite the consequences.
Paula Spann is no fool- she knows all of this, and therefore knows her article would trigger lots of response. Excellent clickbait, and strong alliance with the medical industrial complex.
16
Just curious. How is an article that is telling millions of people, simply, to stop taking their pills in alliance with the medical industrial complex?
7
I don't disagree with the general theory that monetary incentives in our health care "system" can be perverse, but I doubt that would incentivize under or over treatment with levothyroxine. Levothyroxine is available as a generic from several different manufacturers and is really, really cheap. The blood tests to monitor results are the major expense and presumably would be done anyway to determine whether the condition had progressed from subclinical to disease.
6
Dear cz,
It seems pretty clear that T.U.C is referring to gender bias in at least part of his/her post. Considering the ongoing inequality of women's medical needs vs men's it isn't surprising to read an endorsement for ending a treatment that primarily impacts women, even if written by a woman.
Does anyone still question that the medical establishment has treated women and women's diseases unequally? Really? Even after all the statistics on undiagnosed and untreated heart disease in women? Not to mention the "cramps are all in your head" videos we watched in grade school back in the day.
Not everything in the industry is about money. there is still some good old fashioned sexism to go around, don't you think?
It seems pretty clear that T.U.C is referring to gender bias in at least part of his/her post. Considering the ongoing inequality of women's medical needs vs men's it isn't surprising to read an endorsement for ending a treatment that primarily impacts women, even if written by a woman.
Does anyone still question that the medical establishment has treated women and women's diseases unequally? Really? Even after all the statistics on undiagnosed and untreated heart disease in women? Not to mention the "cramps are all in your head" videos we watched in grade school back in the day.
Not everything in the industry is about money. there is still some good old fashioned sexism to go around, don't you think?
9
Frankly, I held my breath when I saw this headline because NYT gets so much wrong about health. It is like NYT is living in an alternate traditional healthcare universe which just regurgitates press releases.
Does the author know that the TSH test only measures whether the pituitary and thyroid gland are communicating which is a separate illness from hypothyroidism? To determine hypothyroidism, one must measure ACTUAL THYROID HORMONE LEVELS, not the TSH. That means T3 (energy hormone) and T4 (storage hormone). T4 converts into T3. You must also measure for thyroid anti-bodies; there are two. This determines if your thyroid was attacked and you have an auto-immune disease called Hashimoto's. Also measure Reverse T3, which is a sort of limbo area where T3 energy hormone goes when one doesn't convert T4 very well into T3. Reverse T3 problems are very common in those with hypothyroidism. One should also measure first thing in the morning cortisol levels to see how the adrenals are doing because they pick up the slack when the thyroid goes south.
Synthroid is synthetic T4 which depends upon the body being a good converter to T3 (see Reverse T3 above). The TSH scam was invented in the '70s to market it. Before, Synthroid, since the 1880s, doctors used Armour thyroid (pig thyroid) and dosed until symptoms went away with no testing. Has anyone noticed the obesity gains since the '70s? Synthroid is one reason. It doesn't work for so many; doctors are brainwashed.
Does the author know that the TSH test only measures whether the pituitary and thyroid gland are communicating which is a separate illness from hypothyroidism? To determine hypothyroidism, one must measure ACTUAL THYROID HORMONE LEVELS, not the TSH. That means T3 (energy hormone) and T4 (storage hormone). T4 converts into T3. You must also measure for thyroid anti-bodies; there are two. This determines if your thyroid was attacked and you have an auto-immune disease called Hashimoto's. Also measure Reverse T3, which is a sort of limbo area where T3 energy hormone goes when one doesn't convert T4 very well into T3. Reverse T3 problems are very common in those with hypothyroidism. One should also measure first thing in the morning cortisol levels to see how the adrenals are doing because they pick up the slack when the thyroid goes south.
Synthroid is synthetic T4 which depends upon the body being a good converter to T3 (see Reverse T3 above). The TSH scam was invented in the '70s to market it. Before, Synthroid, since the 1880s, doctors used Armour thyroid (pig thyroid) and dosed until symptoms went away with no testing. Has anyone noticed the obesity gains since the '70s? Synthroid is one reason. It doesn't work for so many; doctors are brainwashed.
53
One reason doctors went to levothyroxine because Armour contains T3 + T4, and the T3 can overstimulate the heart. Most folks can convert levothyroxine (T4) to the active T3. Some apparently don't. Calling TSH measurement a scam is pointless, ludicrous. It's a useful test, if not the be-all and end-all.
As for your explanation of the obesity epidemic, I think that's utterly wrong. Our per capita sugar consumption is probably the chief factor.
It's amazing how much bad info appears in readers' comments on medical articles.
As for your explanation of the obesity epidemic, I think that's utterly wrong. Our per capita sugar consumption is probably the chief factor.
It's amazing how much bad info appears in readers' comments on medical articles.
2
Dear Cogito~ You said doctors went to Synthroid because Armour contains T3 and over-stimulates the heart. Please search for and read my post about lack of adrenal treatment FIRST (you must make sure the adrenals are performing OK before treating the thyroid) since adrenals usually pick up the slack for low thyroid and will cause heart palps. THIS IS CONTAINED IN THE MED INSERT which most doctors don't read. You cannot ignore the adrenals when treating the thyroid.
The fact is that doctors almost exclusively use patented Synthroid because that is what they are taught in med school and not-patented though USP-regulated Armour is downgraded and lied about. As the article implies, Synthroid is the most prescribed drug and therefore wildly financially successful. Keep in mind that Armour had a perfect record of effectiveness for 90 years before Synthroid and the TSH test came on the scene.
I disagree from a decade of talking to other thyroid patients that as you say "most folks can convert T4 storage hormone to T3 energy hormone." While some can, many, many cannot which is why Synthroid fails in a large percentage. There are studies comparing the two and patients prefer Armour in general.
Not measuring actual T4 and T3 and free and circulating thyroid hormone levels in favor of the simple-minded TSH test defies common sense.
Finally, I said that Synthroid "is one reason" for the obesity epidemic and that means there are other reasons as well. Please read carefully.
The fact is that doctors almost exclusively use patented Synthroid because that is what they are taught in med school and not-patented though USP-regulated Armour is downgraded and lied about. As the article implies, Synthroid is the most prescribed drug and therefore wildly financially successful. Keep in mind that Armour had a perfect record of effectiveness for 90 years before Synthroid and the TSH test came on the scene.
I disagree from a decade of talking to other thyroid patients that as you say "most folks can convert T4 storage hormone to T3 energy hormone." While some can, many, many cannot which is why Synthroid fails in a large percentage. There are studies comparing the two and patients prefer Armour in general.
Not measuring actual T4 and T3 and free and circulating thyroid hormone levels in favor of the simple-minded TSH test defies common sense.
Finally, I said that Synthroid "is one reason" for the obesity epidemic and that means there are other reasons as well. Please read carefully.
4
About 25 years ago, I went to my GP cause I was running a slight fever, and had a bad cold. He noted my pulse was up, and a blood test revealed by TSH was elevated. He put me on a thyroid drug, and recommended that I have my thyroid gland zapped! I wasn't presenting other typical overactive thyroid symptoms, but wasn't feeling that well! I was close to having my thyroid zapped with iodine, when I went to a more experienced GP for a second opinion! He took me off the thyroid drug, and his more complete tests, revealed there was nothing wrong with my thyroid! I felt much better, and was back to myself! Buyer beware!!!
17
I don’t believe this. I got this thyroid med 7 years ago when I was borderline obese and for the first time in my life I was able to lose weight. I was never tired, groggy, or unenergetic, and I got plenty of exercise—I was just fat. Now I’m not because of this wonderful drug! It’s all about being fat, and nothing else. These other symptoms are just baloney.
I believe in better living through chemistry, and I’ve experienced it. I’m amazed at all the ridiculous articles about doctors over-prescribing—I had a huge hassle getting these pills. Doctors are puritans and fat-shamers, and stingy about giving people drugs.
I believe in better living through chemistry, and I’ve experienced it. I’m amazed at all the ridiculous articles about doctors over-prescribing—I had a huge hassle getting these pills. Doctors are puritans and fat-shamers, and stingy about giving people drugs.
11
the thyroid does have an effect on your metabolism so you would likely lose weight once your T was working. BTW, doctors DO overprescribe and I am living proof. It is money all the way around. I go to the dr, they presc Levo, the pharmacy makes or the producer makes out and the insurance co makes out--eventually.
2
This is the exact type of demanding Pseudoknowledgeable patient I was talking about above. Most demand Armour Thyroid or levothyroxine without any clinical indication. Not realizing that they are often unnecessary and even possibly harmful. When you try to explain that ethically there is no clinical indication and that a prescription for this unnecessary medication could be harmful, they get very upset.
4
Just out of curiosity, have you ever told a fat patient his/her symptoms would be easily corrected by weight lists without doing any testing or physical examination of their body? It's a rhetorical question, of course, but when I went from my "normal" 125 lbs to 174 lbs in 2 years experiencing debilitating energy loss (my husband used to drive me around with the window down for some fresh air because I couldn't even walk around the house), I was given that advice repeatedly, in one form or another, by at least 10 doctors doctors as I went out of my mind trying to figure out what was wrong. I had been on the thin side for 45 years of my life, fully believing that fat people were all the same; they were compulsive eaters or ate chocolate and junk food all the time (i.e. "it was their own fault") and then it happened to me, without chocolate, bread, or compulsive eating. So please stop complaining about how you and your fellow doctors are treated. Many patients who come down with inexplicable symptoms are often derided, condescended to and brushed off by physcians, especially people who might also exhibit subclinical symptoms of hyperthyroidsism, and most especially if they are fat.
17
I have Hashimotos and have improved enormously on Armour Thyroid.
I am shocked that this article is advising an all or nothing approach to patients Shouldn't we think less “If it helps you feel better, great. If it doesn’t, we stop.” and more "...if it doesn't we try something different"?
I was diagnosed subclinical in my 20s and no doctor would treat me with medication for years citing Ms. Span's let's wait and see theory. I was still a skinny girl after all and had all my hair. They didn't seem to care about my mood or fatigue. I was finally put on Synthroid but my symptoms persisted and my numbers eventually climbed beyond subclinical. I learned about the T3 T4 differences and became interested in Armour Thyroid. The first three specialist literally laughed at me, and wouldn't test for anything other than TSH. I felt like Big Pharma was hovering overhead like in Orwell's 1984.
I finally found a great endocrinologist who tested for everything, and spent 40 minutes asking questions about symptoms. He sent me off for an ultrasound which confirmed a goiter others had denied and my Hashimotos diagnosis. He switched me to Armour Thyroid and within a few months the goiter was gone and I'd lost over 30 of the 40 lbs I'd gained.
I hope the doctors and author involved in this article will seriously reconsider their damage this advice may do if they do not clarify that there are alternatives to the one Big Pharma drug, levothyroxine.
I am shocked that this article is advising an all or nothing approach to patients Shouldn't we think less “If it helps you feel better, great. If it doesn’t, we stop.” and more "...if it doesn't we try something different"?
I was diagnosed subclinical in my 20s and no doctor would treat me with medication for years citing Ms. Span's let's wait and see theory. I was still a skinny girl after all and had all my hair. They didn't seem to care about my mood or fatigue. I was finally put on Synthroid but my symptoms persisted and my numbers eventually climbed beyond subclinical. I learned about the T3 T4 differences and became interested in Armour Thyroid. The first three specialist literally laughed at me, and wouldn't test for anything other than TSH. I felt like Big Pharma was hovering overhead like in Orwell's 1984.
I finally found a great endocrinologist who tested for everything, and spent 40 minutes asking questions about symptoms. He sent me off for an ultrasound which confirmed a goiter others had denied and my Hashimotos diagnosis. He switched me to Armour Thyroid and within a few months the goiter was gone and I'd lost over 30 of the 40 lbs I'd gained.
I hope the doctors and author involved in this article will seriously reconsider their damage this advice may do if they do not clarify that there are alternatives to the one Big Pharma drug, levothyroxine.
81
I'm very glad to hear that you're feeling better, Cici. Note, though, that I am writing about people in their 60s and older with mildly elevated TSH and otherwise normal hormone levels. Hashimoto's more commonly occurs in younger people.
14
To be clear, I am 50 now. Yes, I've probably had Hashimoto's all along but since doctors use the same tests and treatment on young people as you describe in your article for those over 65 we often don't get a proper diagnosis until we are indeed old(er). Especially if our numbers are on the border. My TSH was only 6 when they found my goiter. I had seen two doctors earlier that week who refused to do any tests other than TSH because they viewed me through the cookie-cutter thyroid lens as the more common older population. This was about 5 years ago.
I'd be interested to hear if you think people over 65 should still be tested for Hashimoto's? If so, which tests? I can't seem to find any references to T3, T4 or sonograms in your article. If I hadn't been proactive and assertive I'd soon be in your 65 range and still misdiagnosed.
I'd be interested to hear if you think people over 65 should still be tested for Hashimoto's? If so, which tests? I can't seem to find any references to T3, T4 or sonograms in your article. If I hadn't been proactive and assertive I'd soon be in your 65 range and still misdiagnosed.
13
This article is about SUBCLINICAL hypothyroidism - ie. an minimally abnormal lab result - not to be confused with the condition of true clinical hypothyroidism. For myself - and I hope most doctors - it has been understood for a long time that few if any people benefit from treatment for the former condition, but people do benefit from treatment for the latter (even if they don't "feel" better). But patients feel tired and sluggish and put on weight and lose hair and get dry skin (it's called getting older!) and want an answer and a quick fix, which the drug companies and some doctors are only too willing to supply - be it with levothyroxine, testosterone, and no end of other medications (including zillions of herbs, supplements, "bioidenticals", vitamins, you name it) - and a number of people say they feel better - probably a placebo effect for most, perhaps a real effect for a few
33
Someone earlier suggested to treat the symptoms, don't treat the numbers.
It's incredibly frustrating and belittling to suggest symptoms exist only inside our pretty heads. We are not talking about mysterious stomach pains, we are talking about dry skin, etc., i.e. physical symptoms. If this were all due to aging, why then do they disappear with a thyroid drug, whether natural or synthetic? Now we've really entered the fantasy world of male doctors where female brains are so powerful they can dry out their own skin and make their hair sparse, and then do the reverse, just by imagining...
It's incredibly frustrating and belittling to suggest symptoms exist only inside our pretty heads. We are not talking about mysterious stomach pains, we are talking about dry skin, etc., i.e. physical symptoms. If this were all due to aging, why then do they disappear with a thyroid drug, whether natural or synthetic? Now we've really entered the fantasy world of male doctors where female brains are so powerful they can dry out their own skin and make their hair sparse, and then do the reverse, just by imagining...
9
And all the excellent results I have seen from the use of both hormones and supplements and herbs in animals who do not know what is going into their food or drinking water? All the improvements on their lab tests? All of those things are just my imagination? As are the dropped jaws and looks of shock on the faces of the veterinarians who collaborate, but are not really believers until they see the ultrasounds of the blocked tumor with regression, or the previously dying cats who have overcome feline leukemia by manipulating the function of their own immune systems, with these same "worthless" therapies. Yes it takes a lot of knowledge to successfully use herbs, vitamins, and hormones, but yes the biochemistry underlying their use is real, and it is possible to achieve results that conventional medicine does not achieve.
4
Let's hear it for placebos! Especially if they do no harm. While it's a jungle out there in the supplement world, in my MD's office it's not. While my allopath knows little about alternative meds, he acknowledges and allows its place. He cooperates with my naturopath, providing test result and other information. My own thyroid levels were within his parameters, but she prescribed a thyroid supplement. If the resulting lessening of fatigue has been a placebo effect, well as I said, 'Let's hear it for placebos!'
L&B&L
L&B&L
1
Thyroid disease and the heart:
http://circ.ahajournals.org/content/116/15/1725
http://circ.ahajournals.org/content/116/15/1725
4
Lithium affects thyroid functioning. Those of us who take lithium can be prescribed levothyroxine to offset the affects of lithium. In short, we have healthy thyroids which we mess with and then we undo the distorting effects with a 2nd medication. If the 2nd medication doesn't work, we need a 3rd medication, all to remedy our healthy thyroids.
5
Interesting point. A recent article on thinning hair had a comment about Biotin affecting thyroid levels. There is a lot to consider when we take medicine and supplements.
2
What a biased and dangerous article. For years and years doctors only tested my TSH levels. They kept telling me my fatigue, anxiety, depression, cold sensitivity, sky-high ANA levels (at one point twice the normal) complete lack of energy, joint pain, etc. were all "in my head". Years of intense psychiatric treatment left me in worse shape (and unnecessary drugs such as lithium), contributing to my increasing UNDIAGNOSED/MISDIAGNOSED thyroid problems. And all this despite my well-documented extensive family history (mother with severe thyroid problems all her life). Doctors just blew me off.
End result: Total thyroidectomy because the thyroid had wrapped itself around my esophagus, cutting off my air supply big-time. Nodules had reached into my chest. Oh, and by the way, post-surgical biopsy showed previously undiagnosed (despite numerous biopsies and scans) carcinoma. Perhaps if I had been treated years earlier with the proper medications (as some later endocrinologists suggested), I might have been able to save my thyroid.
What gets me is that if this were an article about the "ineffectiveness" of psychotropics, people would be brandishing their pitch forks. But hey, throw out a (poorly edited) article about the "ineffectiveness" of thyroid medication, no problem.
End result: Total thyroidectomy because the thyroid had wrapped itself around my esophagus, cutting off my air supply big-time. Nodules had reached into my chest. Oh, and by the way, post-surgical biopsy showed previously undiagnosed (despite numerous biopsies and scans) carcinoma. Perhaps if I had been treated years earlier with the proper medications (as some later endocrinologists suggested), I might have been able to save my thyroid.
What gets me is that if this were an article about the "ineffectiveness" of psychotropics, people would be brandishing their pitch forks. But hey, throw out a (poorly edited) article about the "ineffectiveness" of thyroid medication, no problem.
45
I have to say my medical knowledge is not extensive, but these articles - and comments - are educating me. Knowing that I have benign nodules on my thyroid, I am interested in this subject and want to be prepared for a discussion with my doctor.
I've been able to find doctors who do not automatically reach for the Rx pad, but it's good to be aware of such practices.
I've been able to find doctors who do not automatically reach for the Rx pad, but it's good to be aware of such practices.
2
A slight error in the article:
"levothyroxine (brand name Synthroid) "
Synthroid is not the only brand name for levothyroxine.
Others are Tirosint, Levoxyl, Levothroid, Unithroid, and Novothyrox.
"levothyroxine (brand name Synthroid) "
Synthroid is not the only brand name for levothyroxine.
Others are Tirosint, Levoxyl, Levothroid, Unithroid, and Novothyrox.
18
If you are taking a drug designed to boost a necessary hormone, you should have a blood test to see (1)if you do have that lack, and (2)is the drug doing its job. If you have not had these tests and do not have continuing monitoring, you should not be takaing the drug. If you do have a documented need then you should take it. Same as anything else. If you are tired,have alittle coffee - or a short walk.
7
Broda O. Barnes, M.D. a thyroid researcher, left a foundation to teach medical professionals about sub-clinical thyroid disease, which can exist even when blood tests for T-3 and T-4 are normal. Often there is low body temperature. A later discovery originally made by veterinarian, Dr. Al Plechner is that often the defect also involves insufficient adrenal function, which causes and over-stimulation of the adrenals by the pituitary gland. When the adrenals are unable to produce adequate cortisol, or produce inactive cortisol, or the body is unable to hydroxylate the cortisol to make it able to enter the system, the pituitary continues to stimulate the adrenals, which causes them to produce excess estrogens which can be found only by testing for total estrogens which is rarely done. In this situation, thyroid hormone, even if present in normal quantity, becomes inactivated. It has been theorized that it binds due to the excess estrogens.This condition has been successfully treated with hydrocortisone at physiologic doses, given at least twice a day, together with thyroid hormone. When the total estrogen levels lower to normal on the total estrogen test, the pituitary is satisfied with the amount of functional cortisone in the system, thus the dose of hydrocortisone is correct. Patients should be tested for food intolerances and allergies and placed on a hypoallergenic diet. Proper gut flora are important as an inflamed gut will not absorb hydrocortisone at low doses well.
13
Broad Barnes also advocated testing basal body temperature, as a way of monitoring adequacy of thyroid replacement therapy. We use this form of monitoring to good effect.
5
Thank you for posting this.
(Oh, and this paper will never hire you to write for them. You actually know your stuff.)
(Oh, and this paper will never hire you to write for them. You actually know your stuff.)
4
I was diagnosed with Hashimoto's decades ago and took actual Synthroid daily for a few years without side effects then the Levothyroxine (no insurance for Synthroid any longer) for the past 20 years but suffered with dozens of awful side effects. Finally, I just refused to take it any longer causing my MD to become hotly annoyed with me but changed me to Levoxxyl. I felt like a normal person within a few weeks. BIG PHARMA RULES! Today it appears that the business of most medicine is too silently maintain the general population in a constant state of poor health with pills. Obeying the rule that you can't make any money off healthy or dead people. THAT's RIGHT, BELIEVE IT!
Did you know that BIG PHARMA now makes a pill to treat folks for scruples?
Did you know that BIG PHARMA now makes a pill to treat folks for scruples?
11
Agree the drug matters. For me, Levoxyl was working great, and then was suddenly -- and unnecessarily -- taken off the market for a year or two. Had to switch to Synthroid. (Doc told me to just take the generic .. but I knew enough to insist on a brand.)
Synthroid just doesn't do it for me; I've tried to ask for Levoxyl, and been told it's not available or carried in only one dosage by my (major chain) pharmacy.
I just feel lousy, and am tired of chasing this ...
Good luck to us all.
Synthroid just doesn't do it for me; I've tried to ask for Levoxyl, and been told it's not available or carried in only one dosage by my (major chain) pharmacy.
I just feel lousy, and am tired of chasing this ...
Good luck to us all.
6
An additional downside, along with taking and paying for a possibly unnecessary prescription, is that overmedication for hypothyroidism can affect the body's ability to absorb calcium. For women who are being unnecessarily medicated for osteoporosis, their prescriptions could be working at cross purposes. I have osteoporosis and my doctor recently reduced my levothyroxine dosage (which I've been taking for 37 years) after blood tests showed my levels were a little high.
4
There are two issues here, while It is appropriate to adjust thyroid hormone dosages in response to blood tests, it is a different case when the condition of hypothyroidism does not improve despite thyroid medication. In that case you do not have to worry that the body has become hyperthyroid due to the medication. Even subclinical hypothyroidism can have a serious impact on health, the problem is that it can involve more factors, including adrenal insufficiency, which are not being addressed. As you will see in these comments, some people need Armour thyroid which contains the active thyroid hormone, T 3. It is not that the problem is not real, it is that it is not being fully defined or effectively treated in conventional medicine as this article shows. Hormones have complex interactions with other hormones and with other factors in the biochemistry. It is not correct to simply refuse to treat problems in the elderly, because the elderly are old. Animals and people can heal at any age when given the proper treatments.
4
"mild hypothyroidism" Better find out if you are "mild" or not, because untreated hypothyroidism can lead to cancer.
Be careful; seek other opinions and blood tests when in doubt.
Be careful; seek other opinions and blood tests when in doubt.
11
You will be interested in the book, "Pets at Risk" by Dr. Al Plechner, who in a 50 year career of treating over 100,000 animals never saw an animal with cancer without what his clients called the Plechner Syndrome. All the animals with cancer had inadequate adrenal function and 90 percent of the dogs had low thyroid function associated with the low adrenal function. Seee my previous explanation of the biochemistry. Dr. Plechner documented with over 90,000 test panels that the hormonal imbalances lowered the immunity by deregulating the immune system. These hormonal imbalances appear to cause the body to lose proper immune surveillance.
8
It may well be that synthroid does not help with subclinical hyporthyroidism. But for those of us with established Hashimotos (diagnosed during menopause in my case) it is a life-saver. What I have found is that the right dose does vary over time and seems now to be decreasing as I get older (69).
However, I am surprised that a doctor would prescribe such a powerful drug without more tests (T3/T4, TPO and thyroid ultrasound) to confirm the disease. To prescibe this powerful drug with an "it might help attitude" strikes me as questionable. And yes, it does interact with other drugs and foods (calcium and soy products) so one has to be careful to take it on an empty stomach.
However, I am surprised that a doctor would prescribe such a powerful drug without more tests (T3/T4, TPO and thyroid ultrasound) to confirm the disease. To prescibe this powerful drug with an "it might help attitude" strikes me as questionable. And yes, it does interact with other drugs and foods (calcium and soy products) so one has to be careful to take it on an empty stomach.
10
I don't know if the author is aware of Hashimoto's throiditis, an auto-immune disease that has no cure. It took me a long time to get diagnosed starting about age 49. I went from tons of responsibilities and lots of energy to barely getting out of bed. Once diagnosed, it was had to find treatment. I take Levo and it helps a little. For those with Hashimoto's, we must get checked for antibodies that could lead to cancer. Please don't discourage people from seeking treatment. They could have Hashimoto's or another auto-immune problem that is treatable. Until good immunology research leads to another drug, that is all we have. Is it over-prescribed? Possibly. Do we need better treatments? Yes. Write about that please.
24
As an RN and a three-decades long sufferer of hypothyroidism, this study's results do not surprise me at all.
Not because these patients don't need thyroid medications, but because too many primary care physicians/mid-levels don't have good training in assessment of overall thyroid function, relying far too heavily on TSH levels alone to determine need, and levothyroxine alone to treat hypothyroidism which is NOT be the best way to effect their patients active thyroid hormone levels.
Most top specialists in endocrinology now know not to simply rely on the "TSH" as a measure of how well the thyroid is functioning, and routinely run lab values assessing total T4, T3, free T4 and T3 levels in addition to the TSH.
Synthetic thyroid hormone in the form of levothyroxine, also known as "T4" is normally converted in the body to the active hormone called "T3" which is responsible for increasing metabolism and energy at the cellular level. Ideally, people with elevated TSH levels can take T4 which increases their active hormone and tells the brain to stop signalling for more, thus lowering the TSH. And generally, they feel better.
For yet undetermined reasons, some patients on T4 alone, even with low TSH levels, still have low T3 at the cellular level, possibly due to resistance or enzyme differences in the liver.
Reducing the levothyroxine dose slightly and adding active T3 hormone (liothyronine) to avoid this "T3 resistance" can help these folks feel better.
Not because these patients don't need thyroid medications, but because too many primary care physicians/mid-levels don't have good training in assessment of overall thyroid function, relying far too heavily on TSH levels alone to determine need, and levothyroxine alone to treat hypothyroidism which is NOT be the best way to effect their patients active thyroid hormone levels.
Most top specialists in endocrinology now know not to simply rely on the "TSH" as a measure of how well the thyroid is functioning, and routinely run lab values assessing total T4, T3, free T4 and T3 levels in addition to the TSH.
Synthetic thyroid hormone in the form of levothyroxine, also known as "T4" is normally converted in the body to the active hormone called "T3" which is responsible for increasing metabolism and energy at the cellular level. Ideally, people with elevated TSH levels can take T4 which increases their active hormone and tells the brain to stop signalling for more, thus lowering the TSH. And generally, they feel better.
For yet undetermined reasons, some patients on T4 alone, even with low TSH levels, still have low T3 at the cellular level, possibly due to resistance or enzyme differences in the liver.
Reducing the levothyroxine dose slightly and adding active T3 hormone (liothyronine) to avoid this "T3 resistance" can help these folks feel better.
112
Excellent comment and concluding suggestion.
9
Thanks for this explanation! Now I know my doctor has me on both...(she explained, just hard to grasp.)
2
My daughter missed an entire year of grade school from extreme fatigue which was all but cured when we switched her Armour Thyrroid, the thyroid made from desiccated pig thyroid. She improved so dramatically that the teachers and principal at her school would come up and grab my arm, asking the "What's happened?" questions at her improvement.
She was seeing the top pain doctors and top endocrinologists in a major metropolitan area--and get this, they don't listen or really care that this is one child saved from chronic fatigue and the loss of a year of her childhood--or that this could help some subset of kids who don't respond to other thyroid medications.
She was seeing the top pain doctors and top endocrinologists in a major metropolitan area--and get this, they don't listen or really care that this is one child saved from chronic fatigue and the loss of a year of her childhood--or that this could help some subset of kids who don't respond to other thyroid medications.
58
CK, was she taking the generic levothyroxine previously? Just want to make sure I understand - you are saying that she was switched to Armour's Synthroid?
2
There's no such thing as "Armour's synthroid." Two completely different medications. Armour is the T4/T3 natural-derived (still an Rx) and synthroid is the name brand levothyroxine.
7
The name is "Armour Thyroid" It is a natural, porcine-derived thyroid hormone replacement containing both T4and T3.
It's what I take and has worked wonders compared to Synthroid (which didn't help me at all). I have Hashimoto's.
It's much cheaper than Synthroid so doctors don't get incentives to push it.
It's what I take and has worked wonders compared to Synthroid (which didn't help me at all). I have Hashimoto's.
It's much cheaper than Synthroid so doctors don't get incentives to push it.
7
I was diagnosed with Hashimoto's Thyroiditis. At first my endocrinologist watched my numbers. When they went too low I was prescribed Synthroid, starting with a low dose and now on .88 (still considered a low dose). I get my blood tested 3 -4 times a year and my numbers have been consistent. I remember when I was still finding the right dose, that I would feel exhausted (the first sign for me) indicating I needed a different dose. It's been a few years now and most days I feel fine, but at age 60 and still working full time, I'm tired by the end of the day. A good night's sleep does it for me.
5
Your summary line on the main NYT webpage is misleading - this article is about subclinical hypothyroidism, not hypothyroidism. This is a very important distinction that I would suggest should be stated more transparently.
78
Wow, the headline and blurb on the front page are quite misleading, to the point of being dangerous to people who have well-documented hypothyroidism and may be tempted to ditch their medications. The article itself makes clear that the study in question focused on a very narrow subset of people taking this medication -- older adults recently exhibiting borderline symptoms of hypothyroidism. It does not seem to suggest anything about the efficacy of the medication for actual hypothyroidism, but rather that it is being over prescribed for people who do _not_ have hypothyroidism. I expect more precision from the Times!
40
To say nothing about the lack of studies involving YOUNGER people exhibiting the same symptoms. You know, that age group that works, has children at home, etc but can't keep their head's up after noon and go to bed at 8 because they are exhausted and who used to be active an very productive.
4
Also an important subject, Ms. Smith. But this column is called the New Old Age and its focus is aging and caregiving.
3
The Times should take care to ensure that titles and summaries of health articles are accurate. The article’s title - Could Be the Thyroid; Could Be Ennui. Either Way, the Drug Isn’t Helping” - and the Times home page summary – “Levothyroxine has no significant effect for most who take it, according to a recent study” - are misleading and potentially hazardous.
The article reports that older adults with "subclinical hypothyroidism" (mildly elevated TSH but normal thyroid hormone) derive no symptomatic benefit from levothyroxine. This conclusion, which was suspected from prior studies, is not surprising as symptoms associated with this condition are vague and non-specific - hence the term "subclinical" as opposed to "clinical" hypothyroidism.
This condition is distinguished from the more severe thyroid disorder termed "overt" or "clinical hypothyroidism" with more markedly elevated TSH, decreased thyroid hormone, and clear symptoms of thyroid deficiency. As the article rightly states, such individuals have a medical need for levothyroxine.
However, the article's title and summary ignore this key distinction, and causal readers may conclude that levothyroxine is generally ineffective. One can envision patients with clinical hypothyroidism petitioning their doctors to stop the medication - or deciding to do so themselves. Responsible journalism in health care should consider the consequences of article titles and avoid provocative statements designed to attract page clicks.
The article reports that older adults with "subclinical hypothyroidism" (mildly elevated TSH but normal thyroid hormone) derive no symptomatic benefit from levothyroxine. This conclusion, which was suspected from prior studies, is not surprising as symptoms associated with this condition are vague and non-specific - hence the term "subclinical" as opposed to "clinical" hypothyroidism.
This condition is distinguished from the more severe thyroid disorder termed "overt" or "clinical hypothyroidism" with more markedly elevated TSH, decreased thyroid hormone, and clear symptoms of thyroid deficiency. As the article rightly states, such individuals have a medical need for levothyroxine.
However, the article's title and summary ignore this key distinction, and causal readers may conclude that levothyroxine is generally ineffective. One can envision patients with clinical hypothyroidism petitioning their doctors to stop the medication - or deciding to do so themselves. Responsible journalism in health care should consider the consequences of article titles and avoid provocative statements designed to attract page clicks.
118
El Jefe, thanks to you and to several other readers who pointed out that the summaries and headlines might be misleading, we have changed the wording to more accurately reflect the findings discussed in the column.
25
Shame on you, NYT, for posting a potentially dangerous link on your main page inferring that Levothyroxine is an ineffective drug. I shudder to think of all the folks who may react to that headline alone by stopping their medication. One must read well into the article before you confirm that Levothyroxine is critical to those who suffer from true hypothyroidism. Of course, people who don't need it shouldn't be taking it, and that is what your link could have better communicated rather than using shock value to get people to "click on it".
16
Not that I understand it all, but getting a prescription for levothyroxin based on high TSH is a often (usually?) a preventative measure more than anything else, which isn't made clear here. Many people are given a sort of a crude mechanical explanation, like if their TSH works too hard stimulating the thyroid, it'll eventually need help, so we might as well make its job easier now. The sentence "High blood levels of TSH indicate that the thyroid gland is less active than it should be" is, I think, slightly misleading. Does it not indicate that the thyroid *may be* producing lower levels of hormones--but that further tests need to confirm this? Often (usually?), they don't, and the justification for prescribing TSH is to prevent things from breaking down in the future, rather than to ameliorate any symptoms that may or may not exist currently. High TSH doesn't cause fatigue, etc. It just indicates there's a higher than normal effort by the TSH to boost the (harder to measure?) actual thyroid hormones. How many people are told in their 20s, 30s or 40s, with no symptoms or only ennui or common unhappiness, that they'll probably have to take levothyroxine the rest of their lives, simply because some people's TSH just has to do more to keep the thyroid doing its thing.
1
I was given the wrong radioactive iodine,it should have been the tracer and i got the high dose to kill thyroid cancer. I wasn't diagnosed as hypothyroid for 3 years. I was sleeping 14 hours a day, gained weight on little food, had no energy, was chronically depressed, voice dropped 2 octaves, guts stalled out, eyesight dimmed, hair started falling out and so on Suicidal, i walked into the emergency ward and after a blood test i was told it was amazing that i walked in. Small variations in dosage have a large effect for me and the generic pills are widely variable.
At low doses the effects are subtle and the cited study has serious shortcomings.
At low doses the effects are subtle and the cited study has serious shortcomings.
16
I realized that my TSH levels went up when I switched from regular salt to kosher salt - which tastes better. Kosher salt is not iodized. So, I bought iodized regular salt and use it sometimes. My TSH levels went down. They still go up occasionally to high normal - but since I have no symptoms I have refused medication. I wonder how many people are using non-iodized salt. There is a reason that salt is iodized.
13
Try sea vegetables too! Plenty of iodine.
3
Right or wrong, I've given up on testing for TSH. Have been on 100 mcg for years now. Occasionally I'll run out and within 2-3 days begin to feel poorly. In my head or physiological? That's the big question for me.
2
I've been prescribed this medication not because of symptoms but because of consistently low levels via testing. I have never felt a "difference" taking the pill but assumed it was necessary to continue to produce hormones. Perhaps not. I will ask my doctor (but may or may not get a satisfactory answer).
4
Just to make sure your readers don't get the wrong idea: I suffered from hyperthyroidism (Graves disease) in my early 20's. While I was initially treated medically, I ultimately needed to have my thyroid essentially burned out by a radioactive iodine preparation, Iodine 131. The therapy left me with very little to no functioning thyroid tissue. Since that time, around 40 years ago, I have taken levothyroxine (or synthroid) daily; a dose designed to be effective replacement for normal thyroid function. Without it, I would presumably die unpleasantly in a fairly short time. I am well aware that small doses of levothyroxine are overprescribed for people who are just a little bit hypothyroid, overweight, listless (depressed?). I know some of them. But for me, it is like insulin for a diabetic, and it is no joke.
159
There's no such thing as a "little bit" hypothyroid. Just like being pregnant, either you are or aren't. Btw, hypothyroid does cause depression and weight gain--those are true symptoms, so it's really unfair to label people like that without getting to the bottom of the cause--often times it IS the thyroid.
I also need thyroid hormones the rest of my life or I will die since I have zero thyroid tissue left post surgery--and I agree---it's no laughing matter.
I also need thyroid hormones the rest of my life or I will die since I have zero thyroid tissue left post surgery--and I agree---it's no laughing matter.
8
I too have a thyroid history like Rick. The thyroid ablation was achieved by a radioactive iodine preparation in my 30's. For about 40 years, I have been dependent on L-thyroxine (synthroid). It took a great deal of testing along the way to find a dosage level that met my needs but since then, like Rick said, it is like insulin for diabetes. This drug is effective for me in brand form but not in generic form. I take it daily.
5
EXACTLY - but EXACTLY - my story (even the 40 years part)! An interesting aside: While I had Graves disease, all four of my sons (now in their mid-30s to mid-40s) developed Hashimoto's thyroiditis at some point in their 20s and now take levothyroxine. Our endocrinologist explained that when it runs in the family, it runs in the family; some of the family members will be hyperthyroid and others will be hypothyroid. So it's definitely something to keep in the back of your mind if a relative begins to show any or all of the symptoms that can point to hyper or hypo. Jes' sayin' . . .
6
My understanding is that statins can interfere both with cellular absorption of thyroxin as well as confound blood tests so that TSH reads low. Many older patients are on statins. Hashimoto's in particular is associated with hypercholestorolemia.
Who cares what the blood levels are if it's not absorbed? My doctor and I have decided to go with monitoring morning temperature readings, blood pressur/pulse rate and weight loss/gain as metabolic markers, rather than the blood tests.
Who cares what the blood levels are if it's not absorbed? My doctor and I have decided to go with monitoring morning temperature readings, blood pressur/pulse rate and weight loss/gain as metabolic markers, rather than the blood tests.
10
Statins also can be dangerous by mocking the production of Co Q10 which is necessary for life, and which if not at adequate levels can contribute to heart failure. All people taking statin drugs should look up the research on this. Many cardiologists are now advising their patients to take Co Q10 with the statin drugs.
3
Sorry, that should be blocking, not mocking.
1
I've been on .88 mcg for 12 years.
I was told that it wouldn't cure my thyroid issues, but it could them from getting worse.
So far, so good.
But that's just me.
I was told that it wouldn't cure my thyroid issues, but it could them from getting worse.
So far, so good.
But that's just me.
3
I was diagnosed with Hashimoto's Syndrome many years ago. I've been taking levothyroxine so long now that I don't remember the symptoms or even whether there were any. So is Hashimoto's Syndrome considered a "True or 'overt' hypothyroidism"?
6
The answer: It depends. Hashimoto's is a cause hypothyroidism. Via an autoimmune mechanism the thyroid gland is damaged. If the reduction of thryoid hormone is sufficient to cause overt signs and symptoms of hypothyroidism, then it is overt. One might have zero signs or symptoms of hypothyroidism for years, despite Hashimoto's and then eventually develop overt symptoms (or never develop them). If one has Hashimoto's but not overt hypothyroidism, treatment with thyroid hormone is not necessarily mandated, though many would recommend treatment anyway to prevent goiter formation or worsening.
4
My 14.5 year old Australian Terrier (72 yrs old according to the AKC) was prescribed levothyroxine (thyro-Vet) at 13 and while I may not have noticed any outward improvements, his thyroid numbers leveled out in a month and have remained steady since. Plus I get a 6-mo supply for him for $12. Oh, the life of a dog...
4
For the dog, you would definitely find Dr. Al Plechner's book, "Pets at Risk" of value. The dog is likely to have an adrenal defect which generates the thyroid problem. This can be tested for, and if so, should be treated.
3
I've read that if you need to take Synthroid, stick to the brand-name formulation, if possible. Dosages can vary more in generic formulations.
28
Untrue. The FDA and Abbott Laboratories battled for years over the poor control of quality and dosage of Synthroid. Just google "Synthroid recall." Abbot is now AbbVie and had two recalls of Synthroid in six months in 2012-13. Quoting from the page at the following link: "An FDA enforcement report dated Jan. 9 said the product labeled as having "150 mcg tablets actually contained 75 mcg tablets." No adverse events have been recorded ..." Very interesting, that last bit, which seems to support the thrust of this NYT article!
http://www.fiercepharma.com/supply-chain/new-manufacturing-issues-lead-a...
http://www.fiercepharma.com/supply-chain/new-manufacturing-issues-lead-a...
2
This used to be true. I understand that for some reason generic levothyroxine did not need to meet the same standard as most other drugs in terms of how much the effective dosage could vary (up to 25%?). But according to my pharmacist, that is no longer the case.
1
Sorry Tim in Michigan, but your "facts" are faulty regarding "no adverse effects." For some people, especially if you've had a total thyroidectomy, a difference between 75 and 150 is huge. That could mean your body could shut down---the thyroid controls everything in your body--weight, temperature, moods, as well as vital organs such as the heart, liver, etc.. If you don't have a thyroid anymore, that means your body has to work extra hard to produce enough to keep you functioning, i.e, alive. If you go months without the proper dosage, you will suffer tremendously and your body will start shutting down.
You appear to be satisfied that your conclusions "support" this NYT article, but I can assure you that when it is literally a matter between life and death as a thyroid patient dependent on a certain dose, you would not be happy with faulty dosages.
You appear to be satisfied that your conclusions "support" this NYT article, but I can assure you that when it is literally a matter between life and death as a thyroid patient dependent on a certain dose, you would not be happy with faulty dosages.
2
It might have to do with not prescribing the right dose and not ordering the right tests. Just looking at t.s.h doesn't give the whole picture. I'm not a medical practitioner nor a researcher, but you guessed it, my thyroid is low. I encourage the reporter to research further into the details of diagnosing hypothyroidism and determining an effective dose for the individual. It's my understanding that's where the disconnect is. Thanks for the article.
15
Been taking Levo/Synthroid for nearly 25 years since a partial thyroidectomy. Seen half a dozen different endocrinologists and had hundreds of TSH/T3/T4 tests, and still my levels fluctuate. I've come to realize endocrinology might be one of the least certain fields of medicine around. If it's not my thyroid, maybe it's my pituitary or the hypothalamus the doctors say when I ask what is going on with my annual (erratic) blood test results. Still, I feel fine...unless I tell them I'm a bit tired from time to time, or a little less hungry, or I've lost two pounds or I sweat a bit more...then I'm not taking the right amount of Levo/Synthroid. It's a cycle and it always ends with "take this dosage and let's see what happens." One (excellent), about to retire, endocrinologist told me the most healthy thing to consider is walking out and never seeing another endocrinologist again and simply live life! Science it ain't! Gotta go take my .175 now...
41
I'm guessing you already know this but just in case:
As I just wrote in a separate comment, my mother had that problem with Synthroid because she was taking it with her breakfast that sometimes included dairy (milk on her cereal) and sometimes did not. Eating dairy at or near the same time as taking one's Synthroid makes the drug almost completely ineffective.
As I just wrote in a separate comment, my mother had that problem with Synthroid because she was taking it with her breakfast that sometimes included dairy (milk on her cereal) and sometimes did not. Eating dairy at or near the same time as taking one's Synthroid makes the drug almost completely ineffective.
2
ANY food taken at the same time as the Synthroid (and any other thyroid medication, even Amour, etc.) will render the medication completely ineffective (no almost about it). Even coffee, tea, lemon juice, etc. will make it not work.
As for calcium (supplements and dairy), four hours minimum it's four hour minimum after the medication for it to work.
Why don't more doctors tell the patient about this?I had to learn it from other patients. And yet many doctors still resent the "informed" patient.
As for calcium (supplements and dairy), four hours minimum it's four hour minimum after the medication for it to work.
Why don't more doctors tell the patient about this?I had to learn it from other patients. And yet many doctors still resent the "informed" patient.
5
"A slightly elevated T.S.H. may represent a normal consequence of aging. Or a temporary problem. It only rarely leads to serious hypothyroidism."
This should read: 'It only rarely indicates serious hypothyroidism.'
Elevated TSH is never a cause of hypothyroidism.
This should read: 'It only rarely indicates serious hypothyroidism.'
Elevated TSH is never a cause of hypothyroidism.
14
If levothyroxine (aka synthroid) isn't working for hypothyroidism, the next step isn't to stop levothyroxine and suffer in silence. The next step is to try liothyronine (aka cytomel).
Liothyronine supplies T3, which is what the body actually uses. Levothyroxine supplies T4 - the body has to convert it to T3 before it can be used.
The human body actually makes both T4 and T3. If the body can't get enough T3, it won't be healthy, it will be in a hypothyroid state no matter what the TSH value is. TSH just doesn't give a full picture of thryroid health. T3 and T4 need to be measured as well. Its not an age thing - levothyroxine doesn't work for many young people either. For these people, liothyronine is the next logical step.
Liothyronine supplies T3, which is what the body actually uses. Levothyroxine supplies T4 - the body has to convert it to T3 before it can be used.
The human body actually makes both T4 and T3. If the body can't get enough T3, it won't be healthy, it will be in a hypothyroid state no matter what the TSH value is. TSH just doesn't give a full picture of thryroid health. T3 and T4 need to be measured as well. Its not an age thing - levothyroxine doesn't work for many young people either. For these people, liothyronine is the next logical step.
57
Yes, and check adrenal function and total estrogens. An adrenal problem may be part of a multiple hormone imbalance, in which the thyroid hormone becomes inactivated, and total estrogens rise due to pituitary hyper stimulation, as I have previously explained more fully in these comments..
6
There are so many possible causes of fatigue that the first treatment suggestion may have more to do with the doctor's recent reading material than any clinical manifastation. Is there a standard differential diagnosis algorithm for fatigue?
3
Fatigue can be caused by subtle biochemical failures which impact the production of energy through oxygen metabolism. The most brilliant biochemist out there for comprehending this and treating it is Majid Ali, M.D.
3
Subclinical hypothyroidism is not actually a medical condition. It was literally invented by the marketing department of a company that formerly held the rights to manufacture and sell a particular brand name levothyroxine product. In addition, high TSH is not a medical condition. Only confirmed low levels of thyroxine (T4) require treatment, by taking synthetic T4.
6
You should read the work of Broda O. Barnes M.D., who was a well known thyroid researcher at a university and left a foundation to teach medical professionals about the existence of this condition, which he discovered and defined.
5
If you have been taking Synthroid or its generic for 6 years should I stop?
Discuss with your prescribing physician, or seek out a second opinion.
6
You should talk to your doctor before you stop taking any medication.
8
Reread the article. It does say that for people with full blown hypothyroidism medication, usually levothyroxine, is essential. It questions treating subclinical (aka borderline, aka not really too high test results) hypothyroidism with the drug. Discuss with your doctor which of these conditions you have.
Wonder if desiccated thyroid hormone products fare any better.
6
Desiccated Thyroid improved my stamina by 80% when I started taking it 12 years ago. Prior to that I was extremely tired, gaining weight (50lbs) eating salad and drinking water, having difficulty walking 1/2 block. While I still have stamina problems, without desiccated thyroid the level starts to deteriorate within a week. There were a few times when it hasn't been available due to the unavailability of the thymus sources (porcine or bovine). My understanding is that it is a better drug than Synthroid because it includes more T3 and T4. Within 4 months, I could walk for 20 minutes, lost 50 lbs without changing my diet (maybe actually eating a carb or two), and slept better. Every year I have my TSH tested but I always insist on testing my T3and T4 levels too; always within range, even though the TSH is low. I don't think I could function without it.
16
Yes
2
You don't mean "thymus" sources, you mean thyroid sources, two different organs. Yes, desiccated thyroid (Armour, ERFA, Westhroid are some) is superior to synthetic T4, because you receive all of the Ts--actual thyroid hormone replacement. While Synthroid works for some, for a vast majority it does not work. Congrats on getting your T3 and T4, especially FREE and circulating T3 tested. TSH normally goes very, very low on those who take natural desiccated thyroid replacement which is not a problem, even though it freaks out poorly trained doctors. Many are brainwashed into thinking only measuring TSH and prescribing Synthroid are the solution. I met several myself. They are more interested in lab numbers than resolution of symptoms.
8
I take 112 mg of levotiroxine and the study is right: it makes no difference. I keep taking it though since my doc told me so.
Just read the study, and would point out a couple of things. First, it did not account for people with TPO antibodies, who are likely present and may have responded differently than those without them.
Second, while study found no improvement at 12 months in the treated vs. placebo group, but it did find an improvement at the extended follow-up visit:
"There was a small-magnitude between-group difference in the Tiredness score, with a lower value in the levothyroxine group than in the placebo group (difference, −3.49; P=0.05) at the extended follow-up review (Table 2). "
It might just take longer than 12 months for persistent improvement in symptoms to take place, and that improvement may be relatively minor in the population of people with low-level symptoms anyway. Does that warrant treatment? Imagine you are the patient, and you are told "you don't feel bad enough yet; we will treat you later." Nothing wrong with trying it and stopping if it doesn't help. This drug is cheap and not harmful.
Second, while study found no improvement at 12 months in the treated vs. placebo group, but it did find an improvement at the extended follow-up visit:
"There was a small-magnitude between-group difference in the Tiredness score, with a lower value in the levothyroxine group than in the placebo group (difference, −3.49; P=0.05) at the extended follow-up review (Table 2). "
It might just take longer than 12 months for persistent improvement in symptoms to take place, and that improvement may be relatively minor in the population of people with low-level symptoms anyway. Does that warrant treatment? Imagine you are the patient, and you are told "you don't feel bad enough yet; we will treat you later." Nothing wrong with trying it and stopping if it doesn't help. This drug is cheap and not harmful.
17
Kay, notice that in the discussion section of the article, the authors say that the "small-magnitude between-group difference in tiredness" after extended follow-up "is likely to be a chance finding."
That said, the try-it-and-see-if-it-helps approach you suggest, and Dr. Aron often uses, can make sense if people actually do re-evaluate after a few months and don't make levothyroxine a lifetime drug that doesn't help them feel better.
I'd suggest, though, that adding another drug -- one that's not easy to time and requires multiple tests to find the proper dose -- is not such a simple thing if, like many elders, you are already taking half a dozen prescriptions. That's a harm, of a type.
That said, the try-it-and-see-if-it-helps approach you suggest, and Dr. Aron often uses, can make sense if people actually do re-evaluate after a few months and don't make levothyroxine a lifetime drug that doesn't help them feel better.
I'd suggest, though, that adding another drug -- one that's not easy to time and requires multiple tests to find the proper dose -- is not such a simple thing if, like many elders, you are already taking half a dozen prescriptions. That's a harm, of a type.
4
I was diagnosed with Hashimoto's at age 25, and to this day have elevated antithyroid antibodies.
This explains to me why, after years of taking only levothyroxine I finally started to feel better when my endocrinologist added Cytomel (T3) to my medication regimen--if my body is still attacking my already "dead" thyroid, it must also be disabling the thyroid hormone I take, which means I need to supplement it in order to achieve the proper cellular levels.
This explains to me why, after years of taking only levothyroxine I finally started to feel better when my endocrinologist added Cytomel (T3) to my medication regimen--if my body is still attacking my already "dead" thyroid, it must also be disabling the thyroid hormone I take, which means I need to supplement it in order to achieve the proper cellular levels.
9
If this is your argument then please change the title to "Could Be the Thyroid; Could Be Ennui. Either Way, the Drug Isn’t Helping THE ELDERLY".
This is not just an old persons disease. You are putting women who are pregnant or want to become pregnant at risk of not seeking treatment. Subclinical is not okay in pregnancy.
This is not just an old persons disease. You are putting women who are pregnant or want to become pregnant at risk of not seeking treatment. Subclinical is not okay in pregnancy.
12
There are other potential benefits in taking levothyroxine for mild hypothyroidism (i.e. when the TSH is higher than normal but only slightly so). Specifically, with levothyroxine supplements, people with mild hypothyroidism will have their cholesterol levels improve as will indices of their cardiac function. In other words, even if people don't feel better when taking such levothyroxine supplements, their health may nonetheless be improving overall.
20
These days, we seem to feel the need to treat anything and everything that falls even slightly outside of "normal" ranges. Some changes are likely simply the result of aging. The more you test and screen and scan, the more likely you are to find something. No wonder some people are left taking medications in the double digit quantities every day. Also no wonder that our medical costs are so high relative to other countries.
11
Very interesting to read this in conjunction with yesterday's column by Jane Brody, which scolds people for not taking prescribed meds.
12
Have been on it 13 years, have been wondering if it really makes any difference. Perhaps time to reduce use and find out.
5
Don't make any change without consulting your doctor first. The doctor may have a good reason for prescribing it. Some people have a barely functional thyroid because of surgery, irradiation to alleviate an earlier thyroid condition. In cases like this, stopping can be deadly.
4
Nothing is said here about Hashimoto's thyroiditis, which is why I take thyroid meds, so I am confused. Is Hashimoto's diagnosed in these older people, or just low thyroid hormones?
34
If you have Hashimoto's, you need thyroid meds. This article is about subclinical hypothyroidism, where TSH is high but T4 levels are either normal or not tested at all. Like you, I have Hashimoto's - My TSH levels were high for 6 years before my T4 level started to fall and I needed to take levothyroxine.
16
Hashimoto's is an autoimmune disease, which you correctly point out, is not addressed in this article. I have Graves, the autoimmune mirror image of Hashimoto's. In the case of Graves and Hashimoto's I think a doctor would consider subclinical TSH levels in a different light than a case where there are no autoimmune antibodies. It's a different ball game because you could be subclinical, but you would need ongoing monitoring to evaluate whether you're moving into overt disease.
12
I had autoimmune thyroid disease - not sure which now, Hashi's or Graves, as I had thyroid cancer years ago and they only discovered it after surgery. I was on $ynthroid for years before and after, and was a poor converter of T4 to T3. Cytomel (synthetic T3) didn't help - I was always at the lowest range of normal for Free T3. Finally I switched to Naturethroid, and my T3 finally got to a place that helped me feel normal again, but my T$ now was very low, so my doctor added Levothyroxine back to my regimen and I take a split dose of Naturethroid (NDT) and a small dose of Levo. Levels are improving. Everyone is different and it's a tricky thing to nail. A good endo will look at the whole picture - adrenals, your iron levels, entire CBC. I did my own research and challenged my doctors. You have to educate yourself and push back for the blood tests that really tell you something, like Free T4 and Free T3. TSH doesn't give you the entire picture.
14
I'm one of the people with Addison's Disease who also develop hypothyroidism. Levoxyl did nothing for me, I had to search for an M.D. who would give me Armour Thyroid, which provides the necessary T3 to overcome the debilitating fatigue from a hypothyroid state. T3 is the active hormone, four times as potent as T4. Levoxyl only has T4. Also, most doctors don't order an accurate enough T.S.H. to really see what's going on with your thyroid on a granular level. By the way, Armour Thyroid, and similar medications are what was given to hypothyroid patients before Big Pharma invaded Medical Schools with Levoxyl.
86
Normally, the body converts T4 to the active form of the hormone, T3. By providing T3 in the supplement, you are bypassing the body's normal control over the conversion of T4 to T3. When looked at this way, it doesn't seem to make sense to supplement with both T4 and T3 (let alone when you consider research results showing that there's no difference in people's response to supplements containing only T4 with those containing both T4 and T3).
5
I agree with Nicole. I have Hashimoto. T4 (Synthroid) does nothing for me. It's the T3 (Cytomel) that works. The body is supposed to convert T4 into T3, but it doesn't work, at least for me.
14
Dear Karl, a huge percentage of thyroid patients don't convert T4 into T3 very well. There's an issue called REVERSE T3, a sort of limbo for T3 which doesn't get used by the body and builds up. I'd be interested in that research that shows one doesn't need T3, would the makers of Synthroid (synthetic T4) have financed it to push up sales?
7