Monday, November 28, 2011

Avoid Desiccated Thyroid Hormone Replacement

Avoid Desiccated Thyroid Hormone Replacement

Desiccated thyroid hormone , Armour thyroid and Thyroid USP is listed as obsolete by the FDA but continues to be prescribed and used by some people . I recently saw a video promoting the use of desiccated thyroid which prompted me to write this note.

Our thyroid gland produces thyroid hormone in a response to TSH ( thyroid stimulating hormone ) from our pituitary gland. The primary form of thyroid hormone produced and released into our blood is T4 . This T4 is slowly converted to the active hormone T3 in our tissues,primarily the liver . The T3 Hormone in correct amounts helps keep all of the cells of our body running at peak efficiency.

A deficiency of T4 and T3 results in a slow down of all of the machinery in our body and an excess of T4 and T3 can have toxic effects especially for our heart causing arrhythmia , heart failure , angina or even cardiac arrest. The effect of excess T3 is a concern for anyone with heart disease.
( many of us have a little silent coronary heart disease ).

So, why is desiccated thyroid hormone not a recommended treatment for hypothyroidism ?

Desiccated Thyroid Hormone is of animal thyroid tissue origin. This means that it contains a mixture of T4 and T3. The T3 is almost 100% absorbed rapidly producing abnormally high levels of T3 in the blood stream and potentially a toxic effect on that persons heart.

Levothyroxine ( L-thyroxine , levothyroid , synthyroid and others) is T4 and is much safer to use. The T4 is absorbed and converted slowly to the active T3 , similar to the function of a normal thyroid gland. Be safe . If you need thyroid hormone replacement, use T4.
Dr. Calder

27 comments:

  1. Hey very interesting blog!
    Look into my page : Adrenal Fatigue Mild anxiety

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  2. This doctor or whatever he is...doesn't know what he's talking about. Most who suffer from hypothyroidism have found that T4 only treatment is horrible and that we DO NOT convert T4 to T3 readily. It has also been proven that taking NDT (Natural Desiccated Thyroid) helps prevent heart problems and heart attacks. Do the research Dr. Calder. I tried T4 only treatment and still felt like crap. Adding T3 into my regime only made things worse. It wasn't until I started taking NDT that I got optimized and all my hypo symptoms went away. Try looking up Janie Alexander Bowthorpe's STTM page on Facebook. 7000 of us strong and 90% of those on this board take NDT and have found it far superior to T4 only treatment. You are just like the 5 or 6 Endo's that I have fired who told me..."here take this one little pill (T4) and it will make you feel all better. To that I say BS! T4 does nothing but make most people sicker. Adding in T3 helps...but it is NDT that really makes the difference

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  3. Thanks for your comment. We are fortunate to have a variety of options available to help manage the various medical problems we all deal with in our lives. It is good that you found something that works for you. Dr. Calder

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  4. Hi, it seems to be very complex. I think a lot of people who are hypothyroid, most of whom have autoimmune disease, do not respond well to T4 alone. I appreciate you bringing up concern about risks, but going untreated or unsuccessfully treating with T4 is also risking heart problems. Not to mention many untreated or T4-supplemented patients whose lives have come to a standstill because of extreme fatigue, memory problems, and mood swings. So treating immune and adrenal imbalance and its possible causes with diet and safe herbs and supplements, and if necessary proceeding cautiously with whatever form of thyroid hormone works to improve life in general, seems imperative.

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  5. I have hashi and 2 months ago tried a combination of t4/t3 at 76mcg/18mcg split. I am 34, super fit and I recently took a ride in the back of an ambulance twice for cardiac arrythmia!!!! It was very, very scary. Today I skipped my dose and my resting heart rate immediately returned to normal at 60bpm versus the last two months of 80-90. We are all different but I think it's disrespectful and wrong to say the doc doesn't know of what he speaks. I also tried dedicated and my hr went the other way to 42bpm. So, guess who is going back to t4 only? Me. Thanks doc- this is important information.

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  6. also the chinese have been using desiccated for 2100 years yes that's 900BC so I am going to buy it off the net instead of t4/t3 which is all we get in the uk as it's CHEAP! crap life for thirty years, don't forget desiccated adrenal which so farr is saving my life.

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  7. Thanks for your comment.
    I would use caution in buying any medication from the internet, especially desiccated thyroid. You have no idea of where or under what conditions the internet medications are produced.( see my post above)
    Treating the lab test TSH , free T4 is easier than treating the symptoms of hypothyroidism . The symptoms of tiredness and fatique may have other causes. Many people with hypothyroidism have Hashimotos Thyroiditis ( a chronic autoimmune inflammation of the thyroid gland) causing the symptoms .
    T3,has 3 iodine molecules,and is the active form of Thyroid hormone . It is produced in our body by by an enzyme that removes one iodine molecule from T4 . T4 has 4 iodine molecules and is the less active precursor to T3. A small percentage of people with Hypothyroidism may also have genetically cause malfunction of the enzyme system responsible for removing an iodine molecule from T4 resulting in a deficiency of
    T3. This person will benefit from taking a thyroid replacement containing both T4 and T3.

    I recommend seeing an endocrinologist for an opinion and using FDA approved thyroid from your local pharmacy and avoiding desiccated thyroid.
    Dr. Calder

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  8. Dr. Calder, If I could find a doctor to prescribe me T4, I would. However, although I have every single hypothyroid symptom and have family members who have hypothyroidism, I keep getting told by one doctor after another that my test results are normal. I know my body. I know it isn't aging. I know that my symptoms came out of nowhere and I know that no, it isn't normal for a person to be covered in candida from head to to. And I don't just mean a little thrush. I had candida coming out from my cuticles, draining from my gums, a rash over my entire body, thrush so bad I couldn't eat for a week. I tested negative for diabetes too. I keep getting told to see a shrink. It's US doctors that are crazy! I know my body.

    And so I order dessicated thyroid and adrenal from, you guessed it, the internet. Because I shouldn't be paying people to tell me I don't know what I'm talking about.

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    Replies
    1. This is a frustrating situation for you to have normal TSH , T4and T3 levels and ongoing symptoms that suggest hypothyroidism. I suggest that you see an endocrinologist .Other conditions , such as Hashimoto's thyroiditis and vitamin D deficiency, can have almost the same symptoms . Deiodinase enzymes 2 is primarily responsible for converting T4 to T3 the active component of thyroid hormone. It is possible to have a problem with this enzyme system resulting in situations such as yours. An endocrinologist may be able to help you .
      The candida problem is a separate issue and also needs to be evaluated to rule out any problems with your immune system.Have you been tested for diabetes ?
      David Calder, MD

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    2. I have attached a copy of a comment from a friend and previous partner, Byron Musa , MD

      Excellent review of desiccated Thyroid, Dave. Another concern is the diet of the animals from which the Thyroids were obtained. If they consumed a low iodine diet, their thyroids would have had higher T3/T4 ratios. Thyroid USP is calibrated based on iodine content and not T3 orT4 concentration.
      Keep up the good work.
      Byron

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    3. Dear Dr., your theory depends upon the unfailing conversion of T4 to T3. There is no guarantee of that. In fact, I have seen my wife suffer for years on T4, still trapped in her energy-less body until a "mistake" each by two endocrinologists gave her life back to her. The first endocrinologist prescribed 5mcg/day of Cytomel. The second thought that should be three times a day. In two weeks she was virtually resurrected.

      Years and more doctors later, she is now on 3 grains of NDT per day. The notion, your notion, that NDT is obsolete is only a figment of pharmaceutical marketing. Check this out:

      http://tpauk.com/news/8639-medical-negligence-within-endocrinology-are-you-a-victim--

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  9. The theory that desiccated thyroid is dangerous for your heart due to "T3 toxicity" was spread by Abbott Laboratories to promote their T4-only product Synthroid. On the contrary, Broda Barnes proved that heart disease could almost be eliminated with desiccated thyroid. The "theory" of T4-only effectiveness was proven faulty by a study showing the unique pituitary T4-->T3 conversion compared to the rest of the body. Misleading information on this topic is still sent to pharmacies, doctors, and universities even today.

    Desiccated thyroid has been around for over 100 years and has ALWAYS been FDA approved. Levothyroxine just received FDA approval about 10 years ago after a long history of significant stability and potency problems. Liothyronine (synthetic T3) is also FDA approved, by the way.

    Desiccated thyroid has a higher T3/T4 ratio than humans, but this is often useful since people commonly develop T4-->T3 conversion problems. Levothyroxine contains NO T3, which is very much unlike humans.

    T3 is the active thyroid hormone which is absorbed from your bloodstream fairly quickly, but remains in your system for about 6 weeks. Some people do feel like their heart is racing during initial treatment, but the only studies I've seen on this suggest the feeling is due to improved heart function.

    I've read dozens of studies suggesting T4 treatment is as effective as desiccated thyroid, all of which only consider the effects on the bloodstream. A few of the studies added that patients "preferred" desiccated thyroid, but this was not considered scientifically relevant.

    Doctors make this same mistake during treatment by assuming the goal is "normal" blood test results, even for indirect causes. Supplementation is not a cure that makes people normal, so an effective dosage may not be in the normal range. Dosing is extremely easy when based on symptoms.

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  10. A sad commentary on the dysfunction of our modern medical system. MD's unwilling to listen to their patients because the popular trend is synthetic medicine. We trusted you but you are losing that trust. Drugs are not the answer to good health. There is no consideration given to diet or the body's ability to heal itself if the right nutrients are available Worse yet, blogs by "EXPERTS" such as Dr Calder seek to silence the small voice of those trying to share their experience with others frustrated by their doctor's inability to properly diagnose or treat their health problems. They just give them a pill for their symptoms, and then another pill for the side effects of the first. I know of a number of women, (My wife, daughter, my wife's best friend etc. etc.) that used synthroid for twenty to thirty years, fought weight problems, depression, fibromyalgia, and a host of other common female problems. They have all recently switched to porcine thyroid along with nutritional support for their endocrine system and have experienced an immediate improvement in their symptoms.
    MD's, with the support of the FDA would like to silence them. WHY? If t4 only treatment is truly lacking in it's ability to treat thyroid disorders why aren't the MD's raising the questions rather than their patients? Why in fact are they refusing to even hear their patients?

    They

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  11. If it were not an appropriate treatment for hypothyroidism, the FDA would PROHIBIT its use. As a prescribed medication, it falls subject to the same regulations as every other FDA approved medication. Moreover, how much MONEY has the maker of Synthroid shelled out to BUY such a ringing endorsement???

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    Replies
    1. FDA list desiccated thyroid as obsolete; use levothyroxine instead.
      Dr. Calder

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    2. In addition to feeling like recycled dog food, I would be dead had I not added some porcine thyroid to a reduced dose of my T4 med. I do not know if it was apnea or asthma, but I was awakening gasping for breath. That stopped when we added the Armour Thyroid, as did my joint pain. For the last twelve years, I have been on various combinations of porcine thyroid and synthetic levothyroxine and doing well. May you be thyroidectomized and given 50 mcg of $ynthroid!

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  12. Recently diagnosed hypo. Used Levo briefly. Some relief of symptoms. Wanted to try NDT. Dr. obliged me and after just two doses, consider it superior. Mood, headache, energy, stamina, joint pain and fibro much improved. My frustration with Drs is, after having migraines for 20+ years and given every preventable drug known to man, which none helped but gave horrendous side effects, I became my own advocate. I constantly complained of neck pain. Was told by several neuros they did not care about neck, just head. Long story short, I requested an xray of neck by primary. Two discs collapsed, neck out of alignment. How many imitrex injections did I take? What long term consequences will there be because of this? Maybe not all HA caused from neck but how many were? Why not have suggested blood work to check for hypo? Had this done on my own too. How many HAs caused from hypo? Not listening to patient. They know best. Was also told by couple neuros if I don't follow their plan then they didn't want to treat me. Also wasted time going to chiro and PT cause this is what Dr suggested. Want did Drs do before blood testing? Treated symptoms and listened to patients. Signs of what I call real doctoring.

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  13. I guess each situation is unique. There are lots of countries where US medicines cannot be sold, mostly due to the attitude of 'it is business or return for investment quick". There are more side effects than the benefits for most medicines, look at the ads on TV. Saying synthetic T4 is the gold standard without even bothering to find out whether T4 to T3 conversion & beyond is happening with the patient. Never shell out time to identifying the root cause because that takes Dr. time which means less patients per hour. So for Dr. T4 is the solution, here you go, who cares if T3 conversion/absorption has happened or not, just don't believe in T3 conversion/absorption problem , next patient! FYI.. You don't need FDA to tell you water is good for you and FDA has approved it. These are things the entire planet knows. There is for sure benefit in measured amount of synthetic T4 only if your body can work with it. Doctors need to first find that out for the patient, which is the point of going to school and getting a degree else anybody on the street can repeat T4 is the best why do I need a doctor!

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  14. Dr..... where does the insulin your diabetic patients use come from? For many years, drug companies derived the hormone using pancreases that came primarily from stockyards, taken from slaughtered cows and pigs, which didn't need the organs anymore. Animal insulin has saved millions of lives..... so if we can use insulin from cows and pigs and they perform well.....why not thyroid?

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    1. Thanks for you comment. Animal insulin has been generally replaced by human analogue insulins. This was a welcome change. The human insulin is more reliable , faster onset of action and many of the skin problems associated with animal insulin disappeared with the use of human insulin.
      Animal based thyroid hormones has less predictable concentrations of T4 and the active form of thyroid hormone T3.
      T3 is rapidly absorbed and can increase cardiovascular risk.
      FDA -desiccated thyroid " Obsolete : use levothyroxine instead"
      Caution - desiccated thyroid " combination of T4 and T3 content varies between 2:1 to 5:1

      Synthetic T4 has reliable concentration of T4 that is slowly converted to T3, by our body removing one iodine molecule . This is a safer more reliable form of thyroid hormone replacement.

      There is a very small percent of people who are unable to convert T4 into T3 and will benefit from taking a combination of T4 and T3 . This is available as thyrolar or Liotrix. It is available is various concentrations allowing the doctor to adjust the dose slowly to the amount needed.
      Have fun Dr Calder

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  15. An low level of thyroid hormone really affects whole body. It can make you feel tired and weak. So I really believe - a hot ginger tea, use coconut oil it is considered better for overall thyroid health.

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  16. Great post! Thanks for sharing this helpful post. Will check some of them up. Thanks for sharing this blog..
    ----
    Tahsin
    Testosterone Therapy

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  17. Rather than encouraging patients to avoid Natural Dessicated Thyroid, I think you should turn around and face the medicinal manufacturers and ask them to make a medicine as effective as Natural Dessicated Thyroid.

    FACT: Despite NO changes in patients' TSH, T4 or T3, those who were given either Natural Dessicated Thyroid or T4/T3 therapy rather than just T4 FELT better. Look it up! Research has been done. By scientists, who were just as unconvinced as yourself! Not just hippies and Big Pharma Sceptics.

    The sad thing is that how the patient FEELS appears to be the least important factor when doctors like yourself decide upon their treatment. It breaks my heart that there are doctors out there who insist that how the patient feels cannot be right (or even worse, try to convince the patient it's "all in their head" or "cannot be related to the thyroid") unless it can be detected in a blood test. It's detrimental to the patient, but also to the doctor and in fact to the entire concept of medical science.

    Arguing against a medication that works for millions of patients (who were not FEELING well on T4 alone) is utterly arrogant! Instead, ask the medicinal companies to make a synthetic medicine with T4, T3, T2, T1 and Calcitonin. I know they like to make money, so surely, they can be convinced to make a medicine, which mimics the human thyroid and replaces the entire group of thyroid hormones rather than just the one. You know, like natural dessicated thyroid does. That's progress in favour of patients! And I can tell you'd also be much happier if you had a medicine with Big Pharma approval and earning potential that you could prescribe!

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  18. Lots of really well informed comments on this misinformed article.

    The one that hits the nail on the head for me is this: "I've read dozens of studies suggesting T4 treatment is as effective as desiccated thyroid, all of which only consider the effects on the bloodstream. A few of the studies added that patients "preferred" desiccated thyroid, but this was not considered scientifically relevant."

    How patients "feel" is not clinically relevant. Not to Dr. Calder and his comrades and not to the pharmaceutical companies - . It breaks my heart and I don't understand (try as I may) why how patients feel is not important. I believe that people, who chose to go into medicine have some philanthropic desire to do good and heal and make better. Where does it go wrong? When does that change? Why does this change?

    All Dr. Calder's responses sound so disrespectful and parrot like. It breaks my heart that patients are under the care of him and others like him.

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  19. I was diagnosed Hypothyroid at the age of 7 with an enlarged thyroid. Hashimoto's. Put on Thyrolar T3/T4 combo. It's not available anymore. Miserable on Synthroid and generics, but better than nothing. Convinced endo too add Cytomel T3. Felt a bit better. Ordered NDT online and it was miraculous. Doc changed my synthetic to match more closely the NDT ratio. Miserable in 2 days. Told doc I would take it for 6 weeks for blood work. On NDT my TSH is suppressed but I feel great with no hyper symptoms. Blood work can back with TSH in low normal range. Why won't anyone check T3? It seems if you are going to prescribe it, you would check the levels before and during. Not standard practice. Went back to NDT after getting a doctor friend from out of state to prescibe it after he consulted with his doctor wife and they both agree there is no reason not to let me have it if I do better on it and there is no obvious risk or bad side effects. I just have to keep monitoring it. Unfortunately, I can't find a local doctor willing to do it. So it's be unable to function and work, or take matters into my own hands and take NDT and be able to function and work. I was told I had hypertension, Lupus, Undifferentiated connective tissue disease, despite trying to explain my Hashimoto's. I can get as many painkillers as I want, which I don't want, but not a prescription for an FDA approved drug for a condition I have that eliminates the majority of symptoms and other medications and allows me to live a happy and productive life. I guess modern medicine has decided narcotics are safer than a naturally occuring hormone is. Go figure. I will keep being honest with my doctors, and continuing to do what's best for me. I am glad Synthroid works for many people though, just not me.

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  20. Hello,

    I am a 32 year old male and after 2 years with Synthroid (0.137 mg), I asked my doctor to change for dessicated thyroid (Thyroid ERFA) because I was still tired and I had mood problems (normal tsh , t4 , t3). I have started with with Thyroid 60 mg (2 weeks) and increase to 90 mg (recommanded by pharmacist and MD).

    The first few days that I have used Thyroid, I have started having erectile dysfunction (weak erection, difficulty to maintain erection). I never had problems like this in my life, (with or without Synthroid). I have not changed anything else in my life, except Thyroid ERFA.

    I feel better on dessicated thyroid (happiest, more energy) but erectile dysfunction is a major problem. I have talked to my MD and I am back on Synthroid. I have used Thyroid ERFA for 4 weeks and I had erectile dysfunction all the time.

    Does someone has already had erectile dysfunction with Thyroid (ERFA) or another desiccated thyroid?

    Thank you
    Adam

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  21. I doubt that your thyroid replacement has any thing to do with erectile dysfunction unless you are taking to or not enough thyroid hormone replacement.. A TSH level is an easy way to resolve that problem .Talk to your doctor about other possible causes , such as testosterone deficiency. Dr. Calder

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Your comments and questions are appreciated. David Calder,MD