Good article on changes in meds ........

iVillage Member
Registered: 11-09-2001
Good article on changes in meds ........
1
Wed, 07-07-2004 - 10:30pm
This is a good article on why many hypothyroid patients are now undermedicated. It starts off talking about the adrenals bu then focuses on changes made in the mid-70's to the standard thyroid doses. It's very interesting:

Topic: Low Adrenal Function and Thyroid Problems

A Reader Writes:

I have seen many Doctors and am confused as to why I am not feeling better. I was diagnosed as having low adrenals for which I was prescribed Cortef and that gave me heartburn and general aches and pains. I then took a natural adrenal complex formula for one month without much notice of improvement. I also have been diagnosed with thyroid antibodies which came back positive >60 and then just recently came back negative??? I have all the signs of hypothyroidism (average daily temp 94.6, hair loss, low libido, depression, severe constipation, fatigue) and have been prescribed Armour thyroid starting with 30mgs x2 a day then will be increased to 120mg. I have so many symptoms that I won't go into depth about, but also have a hormonal imbalance, allergies, candida for which I take Diflucan and have been diagnosed with chronic fatigue which I am hoping is just hypothyroidism. I am trying to tackle one problem at a time, however due to multiple diagnoses here, I am confused. I have a question about treating hypothyroidism if one also has an adrenal problem...I understand that if one does not take care of the adrenal problem first, that taking medications for thyroid might not be advisable. Since my ob-gyn doesn't know much about adrenals, she prescribed Armour thyroid and has chosen to try this first. I am taking Armour thyroid now (just for one week 30mgs 2x per day, which will be increased to 120mgs)and I seem to be more depressed--I wondered if there could be any correlation between the medication and my moods? Could this possibly not be effective due to my adrenal problem and if so, why and what can I do?

David Derry Responds:

Dear Patient

From your description and temperature, clinically you are low thyroid and dead in the water. As the thyroid controls adrenal function it might be the reason your adrenals are not functioning normally. (1) Under normal circumstances, as the thyroid is corrected the adrenal function correspondingly rises at the same time. If you truly have low adrenal function and therefore the adrenals cannot respond correctly as the thyroid is given, then problems arise from this lack of adrenal hormones. Adrenal failure however, is quite uncommon.

From the experiences of patients I can guess you will have difficulty obtaining thyroid hormone in adequate doses to make you feel better. This is because the TSH test is quite sensitive. When the TSH was introduced in 1975 for diagnosis and treatment monitoring of thyroid diseases, it was a decision made by consensus of endocrinologists. No studies were done then or since to compare the TSH approach (Laboratory) to the clinical approach used for 83 years before that.

Unfortunately the TSH test approach to diagnosis and treatment lowered the dose used to treat patients considerably. The effective dose physicians used by clinical judgment and experience before 1975 was around 2-3 times higher than the dose used by TSH blood test monitoring. So everyone's dose of thyroid after 1975 was decreased by about two thirds of well established clinically effective doses. It is my personal view that the change in 1975 from clinical assessment of the patient to laboratory testing for thyroid diseases was a mistake. But perhaps this is because I was trained in the 1960s to do clinical assessment for thyroid diseases. However there is no doubt whatsoever that the higher doses are better for the patients and there are no side effects what so ever (short or long term) when these higher doses are used. (Toft) Patients get their lives back and carry on with the need for constant physician monitoring. Once a good effective dose of thyroid hormone is established which makes the patient feel good, cope well and get on with their life, medicine had accomplished what I call a cure. The patient has much reduced need for a physician.

Physicians before 1975 found the minimum clinically effective dose for hypothyroid patients was about 180 mg of desiccated thyroid or 180 micrograms of eltroxine (T4). (2) Physicians of the 1960s had great difficulty detecting any effects clinically or by laboratory tests, for patients on doses lower than 180 mg. Therefore your dose of 60 or 120 mg is not likely to work. At the same time that dose of thyroid will likely turn your thyroid off. This means you will only feel the benefits of the 60 mg of thyroid you are taking. But if your thyroid gland beforehand was putting out 100 mg of thyroid then you have just lowered your thyroid levels. This could account for feeling worse when you started on the medication. Likely a desiccated thyroid dose around 180-300 mg will solve your problems.

Part and parcel of the thyroid system is your dietary iodine intake. If it is not adequate there are many iodine functions in the body for which you need to make sure you have enough in your diet. (3) The prime function of iodine is to make thyroid hormone in the thyroid gland. Therefore if you don't have enough iodine in your diet you will tend to become hypothyroid and or develop swelling of your thyroid (goiter). But there is evidence now that iodine has important other functions throughout the body including the getting rid of abnormal cells which are pre-cancerous. (3) Whether a low iodine intake is contributing to your problem is unclear but it is smart to make sure you do get iodine in some form. The commonest form is in table salt. If you do not eat salt then you will most surely have an inadequate iodine intake. This phenomenon is being seen often in adults and children now.

Although it appears that you have multiple problems, really, they could all be due to low thyroid. The problem of your adrenals may need to be addressed if you are unsuccessful with thyroid. If your physician watches you carefully then any problems can be avoided.

I hope this helps you sort out these problems.

David

References

1. Eartly,H. Leblond,C.P. Identification of the effects of thyroxine mediated by the hypophysis. N Engl J Med 249:249-271, 1953.

2. Williams,R.H. Bakke,J.L. The thyroid in Textbook of Endocrinology Eds Williams,R.H. 1962W.B. Saunders Company. Philadelphia. pages 252-3

3. Derry,D.M. Breast cancer and iodine. Trafford Publishing Company, Victoria, Canada. 2001

4. Thomson, C.D. Colls, A.J. Conaglen, J.V., M. Macormack, M. Stiles, and J. Mann Iodine status of New Zealand residents as assessed by urinary iodide excretion and thyroid hormones. British Journal of Nutrition 78, 901-912 1997.

5. Lee,R., Bradley,R., Dwyer, J., Lee,S.L. Two much versus too little: The implications of current iodine intake in the United States. Nutritional reviews. 57, 177-181. 1999. page 178

6. Hollowell,J.G., Staehling,N.W., Hannon,W.H. et al. Iodine nutrition in the United States. Trends and public health implications: Iodine excretion data from national health and nutrition examination surveys I and III (1971-1974 and 1988-1994). J Clin Endocrinol Metab 83:3401-3408, 21998.

7. Kamala Guttikonda, Cheryl A Travers, Peter R Lewis and Steven Boyages Iodine deficiency in urban primary school children: a cross-sectional analysis. MJA 2003; 179 (7): 346-348




iVillage Member
Registered: 11-09-2001
Wed, 07-07-2004 - 10:34pm
This paragraph is, I think, particularly telling and may account for why so many people have a hard time feeling well when they are first medicated:

"Physicians before 1975 found the minimum clinically effective dose for hypothyroid patients was about 180 mg of desiccated thyroid or 180 micrograms of eltroxine (T4). (2) Physicians of the 1960s had great difficulty detecting any effects clinically or by laboratory tests, for patients on doses lower than 180 mg. Therefore your dose of 60 or 120 mg is not likely to work. At the same time that dose of thyroid will likely turn your thyroid off. This means you will only feel the benefits of the 60 mg of thyroid you are taking. But if your thyroid gland beforehand was putting out 100 mg of thyroid then you have just lowered your thyroid levels. This could account for feeling worse when you started on the medication. Likely a desiccated thyroid dose around 180-300 mg will solve your problems."

What he's saying is that there is always the possibility that your own thyroid was producing MORE thyroid hormone than the replacememt hormone you're being given ..... it could account for that "lag" time in feeling good over the course of time, being tested every 6 weeks or so until you finally reach the right dose in medication, which needs to be more than what you produced on your own. Just a thought! Cathy :)