Page 37 - Summer2009

set the “normal range” for TSH, recanted and in treatment whatever combination of both thyroid hormones produces this
expressed openness to the idea that, at least in UHVXOW ,Q D PLQRUWL\ RI FDVHV WKLV ZLOO EH 7 DORQH 7KLV LV WUXH UHJDUGOHVV
VRPH SDWLHQWV WKH DGGLWLRQ RI 7 WR 7 WUHDWPHQW of whether the treatment results in a TSH level below its normal range.
PD\ ZHOO EH EHQH¿FLDO DQG PD\ EH WKH RQO\ ZD\ If such a result occurs, it simply means that the patient’s TSH feedback
to optimize thyroid function. He said: “It would loop is not functioning properly, or else it would not be suppressed below
appear that the treatment of hypothyroidism is QRUPDO ZKHQ WKH 7 DQG 7 WK\URLG KRUPRQH OHYHOV DUH QRW HOHYDWHG
27
about to come full circle.” Other researchers 8QOHVV WKH )7 OHYHO LQ D QHZ FDVH LV VLJQL¿FDQWO\ KLJKHU WKDQ WKH )7
followed. We see this in two articles published in OHYHO LW LV QRW RSWLPDOO\ KHOSIXO WR WUHDW ZLWK 7 RQO\ UHSODFHPHQW ,I WKH
WKH ¿UVW KDOI RI RQH E\ 6DUDYDQDQ DQG RWK- SDWLHQW KDV D KLJK 76+ OHYHO 76+ GULYHV 7 WR 7 FRQYHUVLRQ DQG VWLOO
ers published in the February issue of the Journal cannot directly produce enough T3 from his or her thyroid gland and from
of Clinical Endocrinology and Metabolism and WKH FRQYHUVLRQ RI 7 WR 7 SHULSKHUDOO\ WKHQ WKDW SDWLHQW ZLOO QRW FRQYHUW
involving 697 primary hypothyroid patients, 30 HQRXJK 7 IURP 7 RQO\ WUHDWPHQW DIWHU WKH 76+ OHYHO GURSV
and the other by Appelhof and others published The conventional approach to the treatment of hypothyroidism as-
in the May issue of the same journal and involv- VXPHV WKDW 7 RQO\ SUHSDUDWLRQV FRQYHUW SHULSKHUDOO\ WR 7 LQ IDLUO\
29
LQJ SULPDU\ K\SRWK\URLG SDWLHQWV The standard amounts and at fairly standard rates. If that does not occur, it is
Appelhof paper compared the outcomes for considered to be because of extrathyroidal illness “which is of no concern
WZR GLIIHUHQW UDWLRV RI 7 WR 7 DQG ,W to the physician charged with correcting thyroid dysfunction.” But, the
is notable that the patients receiving the higher FOLQLFDO H[SHULHQFH RI DOZD\V PHDVXULQJ IUHH 7 DQG IUHH 7 VHUXP OHYHOV
amounts of T3 reported the most satisfaction with shows that this assumed scenario is not true for the majority of patients.
their results, especially in weight loss. At least 80 percent of my patients have required some T3 in treatment
Unfortunately, both studies were still operat- DOZD\V SUHVFULEHG IRU WZR RU WKUHH WLPHV SHU GD\ LQ DGGLWLRQ WR 7 IRU
LQJ XQGHU WKH ÀDZHG DVVXPSWLRQ WKDW ZKDWHYHU WKHLU IUHH 7 DQG IUHH 7 VHUXP OHYHOV WR EH RSWLPL]HG
amount of T3 was added to any patient’s treat- &RQVLVWHQW PHDVXULQJ RI ERWK WKH )7 DQG )7 EORRG OHYHOV LQ DOO K\-
PHQW DQ HTXLYDOHQW DPRXQW RI 7 KDG WR EH VXE- SRWK\URLG SDWLHQWV ZKR DUH RQ 7 RQO\ WKHUDS\ ZLOO YHU\ UDSLGO\ GLVSHO WKH
WUDFWHG 8VLQJ P\ DSSURDFK WKH 7 GRVDJH ZRXOG myth of adequate conversion (as well as the myth of “purely extra-thyroidal
have been increased in many patients due to its causes” of low T3 levels). A certain minority of hypothyroid patients do
level still being suboptimal prior to the addition FRQYHUW HQRXJK 7 WR 7 DW D VXI¿FLHQW UDWH IRU 7 RQO\ WUHDWPHQW WR EH
of T3 being added. Because of the feedback loop effective in producing an adequate FT3 serum level. However, as stated
in which a high T3 level would suppress the TSH above, the majority (80 percent) of patients require some combination of T3
OHYHO ZKLFK ZRXOG WKHQ FDXVH WKH 7 OHYHO WR GURS DQG 7 WR RSWLPL]H )7 DQG )7 OHYHOV 2QFH WKHVH OHYHOV DUH RSWLPL]HG
because of less stiumlation by TSH, the addi- the patient’s health and performance improve.
tion of T3 would have actually lowered the total 2SWLPL]LQJ ERWK WKH )7 DQG )7 OHYHOV XVXDOO\ UHTXLUHV RQH RI
DPRXQW RI 7 LQ WKH EORRG VWUHDP WKXV UHTXLULQJ WKH IROORZLQJ D FRPELQHG 7 7 SUHSDUDWLRQ VHSDUDWH 7 DQG 7
DGGLWLRQDO DPRXQWV RI 7 2Q LQFUHDVHG LQWDNHV RI SUHSDUDWLRQV RU D FRPELQDWLRQ RI 7 DQG D 7 7 SUHSDUDWLRQ 'HVLF-
7 and the addition of T3, these patients would cated whole hog thyroid (such as Armour Thyroid or one of its generics,
have really experienced improved thyroid func- like Naturethroid) is a good, relatively inexpensive starting point for the
tion and physical and mental well-being, and not ¿[HG FRPELQDWLRQ 7 7 WUHDWPHQW 6LQFH LW FRQWDLQV WKH VKRUW DFWLQJ 7
just the minimal improvements noted in these hormone, it should always be prescribed to be taken after breakfast and
articles. supper (in the twice-daily regimen) to reduce the rapidity of onset and
prolong the duration of its action.
OPTIMAL TREATMENT The major shift in thinking for most physicians is to recognize that
Optimal treatment should not revolve on desiccated thyroid hormone should be taken not just once a day, but at
answering the question, “What is the best type of least twice daily after meals. An alternative would be dosages taken three
thyroid medication to use?” The best approach, times daily (every eight hours) without regard to meal times. If desiccated
one I have used very successfully since 1989 in WK\URLG DORQH GRHV QRW RSWLPL]H ERWK KRUPRQHV¶ IUHH OHYHOV DGGLWLRQDO 7
RYHU SDWLHQWV does not advocate any one (or, less often, T3) treatment can be added in order to achieve the goal. If
22
prescription medication for all cases but has the synthetic thyroid hormones are used exclusively, an estimated amount of
goal of optimizing the free serum levels of both 7 ZRXOG EH WDNHQ RQFH GDLO\ DORQJ ZLWK DQ HVWLPDWHG DPRXQW RI 7 WR
WKH 7 DQG 7 WK\URLG KRUPRQHV PHDVXUHG E\ be taken twice daily, after breakfast and supper (or as described above,
the dialysis methods). The physician should use every eight hours without regard to meal times). Thyrolar is a synthetic

SUMMER 2009 Wise Traditions 35