Treating T3 Deficiency: Thyroid Optimization
High Dose Replacement with thyroid hormone DOES NOT cause harm as demonstrated in interventional studies. The harm of Graves’ disease should not be extrapolated to optimal replacement.
Understanding the controversies of thyroid hormone levels and thyroid hormone replacement-that which AACE and your peers do not understand or realize.
The last webinar was entitled, “The most important webinar on thyroid.” The reason for this was to contrast and explain how and why the endocrine societies and the ATA frighten us into not using thyroid hormone. I introduced the concepts that the endocrinologists use when treating hypothyroid patients as well as their reluctance to prescribe thyroid hormone to SC hypothyroid patients. Despite the plethora of data and studies proving that patients DON’T improve on T4-alone therapy, the ATA and AACE reject all the studies demonstrating that patients DO benefit when T3 is added to T4, but also when DTE is used preferentially in place of T4-alone or T4 and low dose T3. When used correctly, most recent literature overwhelming proves that patients prefer DTE over any other thyroid preparation.
In the next series of webinars, we are going to take it one step further, that not only is T3 beneficial, but high dose T3 is more preferred. OMG, yes, HDT3. That will certainly provoke ire in some endos, but you can’t reject the scientific literature. However, their cognitive dissonance proves them right, but that’s not scientific! So, the last several webinars addressed those fears as we reviewed opinions that thyroid hormone should not be used to treat SCH, should never be used to treat seniors over 65, and should never be used in high dose due to the extreme harm professed by some, claiming that exogenous replacement causes thyrotoxicosis and severe CVD. Unfortunately, these authors can’t see the forest for the trees as studies with very high dose replacement caused none of the harm as they suggest and as that shown in patients with Graves’ disease.
The next series of webinars will involve a very in-depth look into all the literature demonstrating no harm in HDR of thyroid hormone. There is a tremendous amount of literature in which very high dose T3 proved no sudden cardiac death, a-fib, osteoporotic fractures, or strokes as did the studies that evaluated patients with Graves’ hyperthyroidism. Last webinar I presented the data proving that Graves’ disease is harmful, but that harm should not be extrapolated to exogenous thyroid replacement. Hopefully, you will be able to ascertain the lack of harm of thyroid hormone administration in HDR. However, that does not mean that our peers will understand the lack of harm of HDR. Nevertheless, HDL has been of such tremendous benefit to so many patients, yet one has to stay under the radar when prescribing HDL. I tried to set the stage as to why our peers believe that thyroid hormone replacement is harmful. We must understand these concepts in order to carefully and cautiously prescribe thyroid hormone to our patients as our peers will misinterpret optimal replacement to thyrotoxicosis. Failing to follow this caution frequently leads to confrontation with our peers. We must understand that this conflict results from what we and they are taught and misled to believe. Our reaction would be the same as our peers if we did not have access to, and a thorough understanding, all the thyroid literature. I have painstakingly sifted through the literature to provide an in-depth synopsis of all the studies demonstrating the lack of harm of HDR as well as the benefit, safety, and efficacy of HDR. Dr. T Kelly provides an excellent review of HDR found in the psychiatric literature.
Most patients do not improve on T4-alone. Most patients will improve upon adding T3 or DTE. However, there is still a subset of patients that don’t improve until they are treated with HDR with just T3. I term this thyroid resistance. Dr. Kadambi refers to it as thyroid hypofunction. The literature refers to it as HDR. The endocrine societies refer to it as crazy. Nevertheless, the scientific literature proves that HDL is required in some patients and the literature supports the safety of doing so. Oddly, it is the psychiatric literature where we find most of the data. In one of the first thyroid webinars, I presented a letter from one of our esteemed WLM psychiatrists where he suggested that hypothyroid patients should be treated only by psychiatrists and not endocrinologists because endocrinologists do not know how to make patients feel better, only psychiatrists do. I know only a few endocrinologists that would laugh at that because most can’t relate to the meaning of Dr. Joe’s humor. Yet, all of us that have successfully treated so many of our patients with thyroid hormone optimization can certainly relate, which is why we find it humorous, yet our peers would not.