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by Mary Shomon

February, 1999 -- The February 11, 1999 issue of the New England Journal of Medicine reports on the results of research that found that "treatment with thyroxine plus triiodothyronine improved the quality of life for most [hypothyroid] patients."

The article is titled:

"Effects of Thyroxine as Compared with Thyroxine plus Triiodothyronine in Patients with Hypothyroidism"

by Robertas Bunevicius, Gintautas Kazanavicius, Rimas Zalinkevicius, Arthur J. Prange, Jr.. Research was conducted by the Institute of Endocrinology, Kaunas Medical University, Kaunas, Lithuania along with the Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill.

How the study was conducted

Essentially, they took a group of 33 people who were hypothyroid, either due to autoimmune thyroid disease, or removal of their thyroids due to thyroid cancer. All the patients were studied for two five-week periods. During one five-week period, the patient received his or her regular dose of levothyroxine alone. (Levothyroxine is the generic name for the brand names such as Euthyrox, Levoxyl, Levothroid and Synthroid.) During the other five-week period, the patient received levothyroxine PLUS triiodothyronine (T3.) (Note: In the U.S., the brand name for T3 is "Cytomel." ) In the T4 plus T3 phase, 50 µg of the patient's typical levothyroxine dose was replaced by 12.5 µg of triiodothyronine (T3). A variety of blood, cognitive, mood and physical tests were conducted at various stages of the testing.

Results

From the standpoint of physiological effects, the differences between pulse, blood pressure, reflexes and a variety of other functions for T4 alone, versus T4 plus T3, were very small. Blood pressure and cholesterol in fact dropped slightly on the T4 plus T3.

Where the results were dramatic were in mental functioning. Patients performed better on a variety of standard neuropsychological tasks on the T4 plus T3. Patients' psychological state also showed improvement on T4 plus T3.

At the end of the study, patients were asked whether they preferred the first or second treatments. 20 patients said they preferred the T4 plus T3 treatment, 11 had no preference either way, and only 2 preferred T4 only. The 20 patients who preferred T4 plus T3 reported that they had more energy, improved concentration, and just felt better overall.

The researchers determined that "treatment with thyroxine plus triiodothyronine improved the quality of life for most patients."

The researchers also recommended that the ideal thyroid hormone replacement program for someone without a thyroid gland, or whose thyroid gland is nearly non-functioning, would be "10 µg of triiodothyronine daily in sustained-release form. . . along with enough thyroxine to ensure euthyroidism."

Implications for Your Treatment

This study has major implications for people who don't feel well on their current thyroid hormone replacement.

If you are on standard levothyroxine only therapy, it's possible that, like the majority of study subjects, you too could feel better with the addition of a time-release T3 product in the recommended dosage ratio.

If you are on Armour Thyroid or Thyrolar, the current percentages of T3 in those drugs may be somewhat too high, compared to the recommended ratios described in this study. Optimal results may be obtained by modifying the treatment regimen to conform more specifically to the recommended ratio described in this article.

If you are on thyroid hormone replacement and don't feel well, I recommend that you notify your doctor right away about this research study, and get a copy of this article for yourself as well.

If you are going to share any information with your doctor, at the same time, you might also want to share a copy of a British Medical Journal article that suggests that values above TSH of 2 may not be "normal," but in fact represent abnormal levels indicative of a thyroid already in the process of failing.

Getting a Copy of the New England Journal Article

You can obtain a copy of this article online, for $10. Click here for access to their online access system.

You can also order a copy by phone, to be mailed or faxed to you. It's the New England Journal of Medicine, ask for "Effects of Thyroxine as Compared with Thyroxine plus Triiodothyronine in Patients with Hypothyroidism," Volume 340:424-429, February 11, 1999, Number 6.

Call their Customer Service Department and order by phone at 1-800-THE-NEJM

The Bigger Picture for Thyroid Patients

This is actually quite groundbreaking research, confirming in the research environment what many patients, myself included, and some doctors, have been claiming for a number of years: levothyroxine-only thyroid hormone replacement does not leave a substantial percentage of hypothyroid patients feeling well, and these patients feel and function better when T3 is added to their thyroid hormone replacement.

Interestingly, this offers an explanation for why patients have felt well all along on alternative thyroid drugs like the natural Armour Thyroid, Westhroid and Naturethroid, which contain T4 and T3 naturally, and the synthetic T4/T3 drug Thyrolar, which is the drug that I take. In some cases, patients also added Cytomel (synthetic T3) or time- release T3 to standard levothyroxine therapy and also have better results.

For years, patients have been told that all they need is levothyroxine treatment to get them into "normal TSH range," and thyroid treatment is considered complete. Time and time again, people who still suffered with symptoms -- including fatigue, depression, cognitive problems, and more -- were told that once their thyroid range was normal, these problems were no longer related to the thyroid, and instead were now depression, stress, PMS, or simply "in your head." Patients who had done well for years on Armour, then switched to Synthroid, for example, and complained of not feeling well were told they were "getting old."

Consider this pronouncement in The Bridge, the quarterly newsletter from the Thyroid Foundation of America, the organization that is supposed to be on the cutting edge of patient issues and advocacy:

"TSH tests are very precise, and if your TSH is normal, then thyroid dysfunction is not the cause of these symptoms."
Douglas Ross, Medical Advisor to the Thyroid Foundation of America

It's absolutely unconscionable that patients have been ignored, denigrated, overlooked, and undertreated for as long as they have been by the conventional medical establishment, thyroid organizations and medical groups.

Meanwhile, doctors who prescribed natural thyroid drugs like Armour -- or even its synthetic counterpart Thyrolar -- were written off as quacks, or irresponsible, or in some cases, even brought up on charges by the levothyroxine-only zealots in their local medical boards.

Let's hope that this information causes the patient and medical organizations, as well as the doctor, to start listening more to patients -- and not to the pharmaceutical companies. Clearly, it's been the marketing position of companies like Knoll Pharmaceutical, manufactuer of Synthroid, that levothyroxine alone is all anyone needs. Following right behind and parroting every word have been the hordes of endocrinologists who gladly benefit from Knoll and its competitors' handouts of grant money, project funding, conference fees, and freebies galore, and are reluctant to rock the levothyroxine money boat.

Leading the parade were fellows like Richard Guttler who calls himself a "thyroidologist" and charges patients a hefty $150 or more "required in advance" for his "Second Opinion" service on the Internet. Prior to the NEJM publication, he kept angrily dismissing patients who complained of unresolved symptoms and a desire to try these alternative drugs that are now found to work better. A reader of mine wrote to him to let him know that the absence of Synthroid after only three to four days relieved her of a persistent choking cough that she had been enduring for the past twenty (or more) years. She told him that she'd changed to Armour. He wrote back to her: "get a life! synthroid is not the cause of your problems." He also graced me with his unique brand of "bedside manner" (lack of proper capitalization and punctuation is his):

"i'm glad all the "fringes" are filling up your e mail, not mine. it makes my life easier dealing with only the mainstream thyroid patients who would never think of taking armour or combo thyrolar or cytomel.what are you going to do when they finally take thyrolar off the market? next it will be natural designer organic bathtub thyroid personally brewed at your web site...dr.g"