Many more of my patients with normal TSH levels ask me to prescribe thyroxine or Armour Thyroid. I am hesitant to comply because of the Royal College of Physicians' statement about adverse effects from unnecessary thyroid hormone therapy. May I have your point of view on the potential for adverse effects from thyroxine treatment when patients do not actually need it?

Dr. Lowe: I'm familiar with the statement you refer to by the Royal College of Physicians. Specifically it is: ". . . some patients are inappropriately diagnosed as being hypothyroid (often outside the NHS) and are started on thyroxine or other thyroid hormones which will not only cause them possible harm . . ." (Italics and bold mine.)

Like too many other statements or implications by the Royal College of Physicians, when applied to the general population, this one is patently false.  

Unless you're a geriatric specialist whose patients are among the most fragile of human beings, even if they don’t need supplemental thyroid hormone, a trial of thyroid hormone therapy is harmless. If the hormone doesn’t help them, you can wean them off it and then have them stop it altogether. No harm done!

Proof of this is in the history of FDA-guided studies of the potency and stability of T4. To test T4 for potency and stability, researchers—using FDA test guidance!—have traditionally used volunteers who were "euthyroid," meaning, of course, that they subjects had normal thyroid function test results. Moreover, FDA test guidance has allowed researchers to use euthyroid volunteers to test higher-than-physiological (supraphysiologic) doses of T4.[1,p.109]

I ask the Royal College of Physicians: If T4 were likely to harm euthyroid volunteers, why would FDA-test guidance allow researchers to use them for the testing? And why would institutional review boards approve the studies as not potentially harmful to the volunteers?

The answer is simple, of course: A trial of thyroid hormone therapy—even for people with perfectly normal thyroid function—is harmless, even when they use supraphysiologic doses.

Only recently have researchers suggested that rather than testing euthyroid volunteers, they would best use thyroidectomized patients. But the researchers'  reason for this suggestion has nothing whatever to do with any harm ever done to euthyroid volunteers in the studies. The testing hasn't harmed the euthyroid volunteers, nor will a trial of thyroid hormone therapy harm practically any of your euthyroid patients except possibly the most severely fragile of them. But, then, a cup of coffee is just as likely to harm those fragile folks.

I just don't understand something: How does the Royal College of Physicians (as with this particular issue) and the British Thyroid Association make scientifically false statements and stand by them in the face of proof that they are false, yet receive no official reprimands from regulatory authorities in the UK? To me, their false statements are an affront to the noble tradition of science, and the organizations sticking by their false statements in the face of refuting evidence reduces the statements to examples of pseudoscience.

At any rate, I hope this reply is helpful to you in providing your patients with harmless trials of thyroid hormone therapy, whether they truly need it or not.

Reference

1. Royal College of Physicians. The diagnosis and management of primary hypothyroidism. 2008.

Subject: TSH is Not the Answer: Drs. Rowsemitt & Najarian
From: Writer prefers to stay anonymous
Date: Tue, July 26, 2011 9:41 am
To: editor@thyroidscience.com

Dear Dr. Lowe,

I'm glad that there are researchers and doctors that continue to work on Hypothyroidism. Over the years, I have continued to follow your website (I have your first book). You might be interested in my experience with TSH and the thyroid hormone.

I was diagnosed with Hashimoto's Disease in 1984, but did not take thyroid hormone until 1999 when I went from doctor to doctor for almost 2 years to find out what "disease" I might have. I had terrible symptoms of pain in my legs, numbness, not being able to think clearly, and generally not being able to walk without a cane. I was 51 and done with menopause, but doctors said that anti-depressants would help my "menopause symptoms," I threw them out because I wanted to get rid of the pain, not cover it up in "la la land."

After I was at least diagnosed with fibromyalgia, I found another doctor who prescribed Armour Thyroid, initially in tiny doses. (Synthroid did nothing for me. My TSH was 22.) This went on for months with the doctor increasing the dosage up to average. I still had symptoms that prevented me from working for 5 years. I lost a lucrative career and most of my life.

My symptoms would not subside (fibromyalgia, pain, could not get up from a sitting position, etc.). One day, I was sick of living with the pain and weakness. I decided to increase my dosage of Armour Thyroid to see if the excruciating pain in my legs would lessen. I honestly didn't care if I got a heart attack from it. I wrote a will before taking the dose. To my amazement and relief, I did not die, nor did my heart beat faster. The pain in my legs lessened. I continued increasing the dosage weekly until I felt o.k., not great, but able to function.

I was able to get a job in 2004 as a teacher, which keeps me very active during the day. I have been taking the dosage of 450 to 540 mg. of Armour Thyroid for 8 years. I am 62 years old, my blood pressure after medication is 120/76 and my heart rate continues to be normal. Even my Endocrinologist is surprised...he constantly tells me to take less medication, (He won't even prescribe the dose I'm taking . . . he writes "Take as Directed."

Finally, I have my life back. Thank you for your work.

Sincerely
An anonymous author

Subject: TSH is Not the Answer: Drs. Rowsemitt & Najarian
From: Best keep low profile because of you-know-who!
Date: Tue, July 26, 2011 10:08 am
To: editor@thyroidscience.com

Hello Dr. Lowe,