Page 38 - Summer2009

7 7 FRPER SUHSDUDWLRQ ZLWK 7 DQG 7 LQ cal Health. NewYork, Ballantine Books/ Random House, June 1999.
the same ratios as that of desiccated pig thyroid 3. Ridgway, E.C., Canaris, G., et al.: Thyroid disease often undiagnosed. Reuters Wire Service, New
York, Oct. 1997. [Later published in a medical journal.]
extract; it should also be taken two to three times /RZH - & *DUULVRQ 5 / 5HLFKPDQ $ - HW DO (IIHFWLYHQHVV DQG VDIHW\ RI 7 WULLRGRWK\URQLQH
per day because of the short half-life of the T3 WKHUDS\ IRU HXWK\URLG ¿EURP\DOJLD $ GRXEOH EOLQG SODFHER FRQWUROOHG UHVSRQVH GULYHQ FURVVRYHU
study. Clin. Bull. Myofascial. Ther.
component. 6KDPHV 5 / DQG 6KDPHV . + Thyroid Power. New York, Harper Resource, 2001.
6. Wilson, D.: A Doctor’s Manual for Wilson’s Syndrome. 6XPPHU¿HOG )/ 32 %R[ 7KH
2QFH RSWLPDO 7 DQG 7 KRUPRQH UHSODFH- Wilson’s Syndrome Foundation, 1992.
ment has been achieved, the ultra-sensitive TSH 7. Braverman, L.E. and Utiger R.D., eds.: Werner and Ingbar’s ‘The Thyroid’: A Fundamental and
Clinical Text, 8th ed.. Philadelphia, Lippincott Williams & Wilkins, 2000.
remains useful as a gauge of optimal thyroid 8. DeGroot, L.J.: Dangerous dogmas in medicine: The nonthyroidal illness syndrome. J. Clin.
function only if it is still in the low end of its Endocrinol. Metab.,
normal range, or it may go below the low end of 'RPPLVVH - 9 7 LV DW OHDVW DV LPSRUWDQW DV 7 LQ DOO FDVHV RI K\SRWK\URLGLVP J. Clin. Psychi.,

the range (down to 0.01 mU/L). If this occurs, *HOHQEHUJ $ - 7 7 VXFFHVV Biological Therapies in Psychi. Nsltr.,
11. Joffe, R., Blank, D.W., Post, R.M., and Uhde, W.: Decreased triiodothyronines (T3) in depression:
thyroid function will have been optimized by the A preliminary report. Biological Psychi.
yardstick of both the TSH level and the dialysis -RIIH 5 7 DQG 6LQJHU : $ FRPSDULVRQ RI WULLRGRWK\URQLQH 7 DQG WK\UR[LQH 7 LQ WKH
potentiation of tricyclic antidepressants. Psychiatric Res.
WHVWHG )7 DQG )7 OHYHOV 13. Uzzan, B., Campos, J., Cucherat, M., et al.: Effects on bone mass of long-term treatment with
As one who has both a personal and a thyroid hormones: A meta-analysis. J. Clin. Endocrinol. Metab.
'XOODDUW 5 3 YDQ'RRUPDDO - - +RRJHQEHUJ . DQG 6OXLWHU : - 7 UDSLGO\ ORZHUV SODVPD
perfectionist interest in optimal thyroid func- lipoprotein-A, apo-B and LDL-cholesterol in hypothyroid subjects. Neth. J. Med. $SU

tion rather than “normal” function, my view 'HPHUV / 0 6SHQFHU & $ DQG &RRSHU ' 6 HGV Laboratory Medicine Practice Guidelines:
is that the only satisfactory optimization is the Laboratory Support for the Diagnosis and Monitoring of Thyroid Disease. Washington, DC,
National Academy of Clinical Biochemistry (www.nacb.org), Sept. 18, 2002.
one just described. It remains to be decided, in 16. Stancer, H.C. and Persad, E.: Treatment of intractable rapid-cycling manic-depressive disorder
certain rare cases in which the TSH needs to with levothyroxine. Arch. Gen. Psychi., 39:311-312, 1982.
be suppressed below 0.01 mU/L for the dialysis :K\EURZ 3 & 7KH WKHUDSHXWLF XVH RI WULLRGRWK\URQLQH 7 DQG KLJK GRVH WK\UR[LQH 7 LQ
psychiatric disorder. Acta Medica Austriaca,
)7 DQG )7 OHYHOV WR EH RSWLPL]HG ZKHWKHU WR &RRNH 5 * -RIIH 5 7 DQG /HYLWW $ - 7 DXJPHQWDWLRQ RI DQWLGHSUHVVDQW WUHDWPHQW LQ 7
replaced thyroid patients. J. Clin. Psychi. -DQ
DFFHSW VXERSWLPDO IUHH 7 DQG IUHH 7 OHYHOV RU 19. Logothetis, J.: Psychotic behavior as the initial indicator of adult myxedema. J. Nerv. Ment. Dis.,
a sub-0.01 mU/L TSH level. My own preference
would be for the latter, except in frail or cardiac- 7HLWHOEDXP - %LUG % *UHHQ¿HOG 5 HW DO (IIHFWLYH WUHDWPHQW RI FKURQLF IDWLJXH V\QGURPH
&)6 DQG ¿EURP\DOJLD )06 $ UDQGRPL]HG GRXEOH EOLQG SODFHER FRQWUROOHG LQWHQW WR WUHDW
arrhythmic patients. study. J. Chron. Fatigue Syn., 8:2, 2001.
A small number of large or overweight thy- 21. Escobar-Morreale, H.F., del Rey, F.E., Obregon, M.J., and de Escobar, G.M.: Only the combined
treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroid-
roid hormone-resistant patients, usually women, ectomized rat. Endocrinology,
may need up to 6-9 grains of Armour Thyroid 22. Dommisse, J.V.: Unpublished clinical data, 1989-2008.
23. Refetoff, S.: Thyroid hormone resistance syndromes. In Werner and Ingbar’s ‘The Thyroid’: A
per day (or the equivalent of thyroxine, count- Fundamental and Clinical Text, 6th ed. Edited by L.E. Braverman and R.D. Utiger, Philadelphia,
- % /LSSLQFRWW SS
LQJ PJ RI 7 DV HTXLYDOHQW WR JUDLQ RU D /H0DU + - :HVW 6 * *DUUHWW & 5 HW DO &RYHUW K\SRWK\URLGLVP SUHVHQWLQJ DV D FDUGLRYDVFXODU
combination of the two. These patients seem to event. Am. J. Med 1RY
5HQVKDZ ' & 7KHUDSHXWLF URXQGV $ FDVH RI SULPDU\ LPSRWHQFH GXH WR JUDGH K\SRWK\URLGLVP
represent some form of thyroid hormone resis- and a marginal free testosterone level in a 29-year-old man. Clin. Therapeutics, 7(3):309,390,
tance syndrome, as described by Refetoff. 23
Patients who already take Armour Thyroid 26. Wortsman, J., Rosner, W., and Dufau, M.L.: Abnormal testicular function in men with primary
hypothyroidism. Am. J. Med., 82(Feb):207-212, 1987.
(or one of its generic equivalents) in once per 7RIW $ ' 7 7 FRPELQDWLRQ WKHUDS\ (QGRFULQH $EVWUDFWV $SULO 6
day dosages should be advised to split their 28. Dommisse, J.V.: Pseudotumor cerebri in two patients with lithium-induced hypothyroidism. J.
Clin. Psychi.,
doses immediately, according to the twice- to 29. Appelhof, B.C., Fliers, E., Wekking, E.M., Schene, A.H., Huyser, J., et al.: Combined therapy
with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in
thrice-daily regimen described in several sec- primary hypothyroidism: A double-blind, randomized, controlled clinical trial. J. Clin. Endocrinol.
Metab.
tions above. Then, the Free-T3 levels obtained in 30. Saravanan, P., Simmons, D.J., Greenwood, R., Peters, T.J., and Dayan, C.M.: Partial substitu-
blood monitoring of the treatment would be much WLRQ RI WK\UR[LQH 7 ZLWK WUL LRGRWK\URQLQH LQ SDWLHQWV RQ 7 UHSODFHPHQW WKHUDS\ 5HVXOWV RI D
more meaningful in terms of the all-important large community-based randomized controlled trial. J. Clin. Endocrinol. Metab.

T3 fraction of the thyroid function. 31. Kaplan, M.M., Sarne, D.H., and Schneider, A.B.: In search of the impossible dream?: Thyroid
hormone replacement therapy that treats all symptoms in all hypothyroid patients (Editorial). J.
Clin. Endocrinol. Metab
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36 Wise Traditions SUMMER 2009