Standard Treatment for Underactive Thyroid Gland Still Best

A expert panel reviewing treatments for hypothyroidism has concluded that the drug levothyroxine (L-T4) should remain the standard of care.

The updated guidelines from the American Thyroid Association were published recently in the journal Thyroid.

The thyroid gland produces hormones that control the way every cell in the body uses energy. For example, thyroid hormones control how fast you burn calories and how fast your heart beats. If the thyroid gland produces too little thyroid hormone to control these activities the condition is called hypothyroidism.

A task force convened by the thyroid association reviewed available medical literature and found no evidence that other types of thyroid hormone replacements are better than L-T4, which has long been the standard of care for patients with hypothyroidism. Brand names for L-T4 include Synthroid and Levoxyl.

However, while L-T4 is effective in most patients, some do not regain ideal health when taking L-T4 alone, the authors noted.

The guidelines “provide useful, up-to-date information on why to treat, including subclinical disease, who to treat, and how to treat hypothyroidism,” Dr. Hossein Gharib, president of the thyroid association, said in a journal news release.

“Information is evidence-based and recommendations are graded. I think they will be used extensively by all clinical endocrinologists, especially by our members,” added Gharib, a professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minn.



Dr. Peter Kopp, an associate professor of medicine at Northwestern University Feinberg School of Medicine, called the guidelines “very comprehensive.” They provide a “superb overview on the current evidence about treatment modalities for patients with hypothyroidism,” he added in the news release.

MY TAKE:
“Evidence-based” medicine is much more than a review of available literature. Good research only accounts for a third of the decision making process in health care. Clinical experience and patient preference are the remaining two-thirds of the equation. While I suspect these last two factors prompted the task force, there was no mention of such input in their decision making process.

It is estimated that at least a third of all cases of hypothyroidism in the US are actually suffering from Hashimoto’s Thyroiditis. This is an autoimmune disease that begins with the immune system attacking and destroying the thyroid but can process to attack any tissue in the body.

Clinically, I am finding the incidence of Hashimoto’s Thyroiditis is closer to 50% of all hypothyroid cases. Unfortunately, conventional medicine does not address the autoimmune aspect of the disease. The standard of care remains hormone replacement therapy with L-T4.

Dr. G.E. Abraham and Dr. David Brownstein have published extensive research on the use of iodine for hypothyroidism. Their studies in Japan show a strong correlation between adequate iodine intake and the prevention of reproductive cancers of the breast, prostate, and uterus. Their research was not included in the review of literature.

THE BOTTOM LINE:
Hypothyroidism is often undiagnosed, untreated Hashimoto’s Thyroiditis. There are many alternative therapies to hormone replacement therapy. If you have been diagnosed as hypothyroid, request a TPO (thyroid peroxidase), thyroid auto-antibodies, and reverse T3 lab test in addition to the normal thyroid panel. You may just uncover the real cause of your underactive thyroid.

Source: National Institutes of Health (NIH) -Friday, October 3, 2014