Written in The Guardian

[Guest guest]

http://www.guardian.co.uk/lifeandstyle/besttreatments/underactive-thyroid-treatments-liothyronine-plus-levothyroxine

How appalling is this. Is it any wonder that I cannot get anything published in the press - they run a mile when I come along. They are sitting in their nice cosy offices with no troubles in the world writing the slop given to them by the British Thyroid Association. Should anybody dare to say anything other than what is written here, they simply clam up. PLEASE will you write to them. I am sending them copies of everybody's letters to the Royal College of Physicians and asking them to let me have their comments. (you can see all these in the right hand column of our web site www.tpa-uk.org.uk .

Dr Thierry Hertoghe http://www.tpa-uk.org.uk/hertoghe_rcpresponses0409.pdf

Dr Lowe http://www.thyroidscience.com/Criticism/lowe.3.16.09/bta.rebuttal.htm

Pritchard http://www.tpa-uk.org.uk/committeeaction_rcp.pdf

Pritchard and Sheila http://www.tpa-uk.org.uk/rcp_statement_v_goals.pdf

Members of TPA-UK responses http://www.tpa-uk.org.uk/RCPletters0409.pdf

Response from TPA-UK http://www.tpa-uk.org.uk/tpa_rcp_rebuttal.pdf

Let’s inundate The Guardian in the same way we did the Royal College of Physicians. That way, they might see there really is a story that needs to be told.

luv - Sheila

Liothyronine plus levothyroxine

· BMJ Group, Tuesday 21 April 2009 00.00 BST

· Article history

Do they work?

Research shows that taking liothyronine together with levothyroxine doesn't help you more than just taking levothyroxine.

What are they?

Liothyronine is a man-made version of the hormone triiodothyronine (T3), which is made by the thyroid gland. Doctors sometimes use it in emergencies to treat severe symptoms of an underactive thyroid.[1] It starts to work more quickly than levothyroxine. It comes as tablets and injections.

Levothyroxine is a man-made version of the hormone thyroxine (T4). Thyroxine is the hormone that your body doesn't make enough of when you have an underactive thyroid. This is the treatment doctors usually use alone for an underactive thyroid.

How can they help?

Research shows that levothyroxine alone works just as well as levothyroxine plus liothyronine. Most people don't get any extra benefit from taking liothyrine as well.[2]

Why should they work?

Levothyroxine and liothyronine work by replacing your body's own thyroid hormones T4 and T3. Without enough of these hormones, you become sluggish and tired. This is because your body doesn't get the energy it needs. Your metabolism slows down. For example, your bowel muscles may slow down and you get constipated. Or your heart slows down or your cholesterol level rises, putting you at risk of heart problems.

Taking synthetic versions of these hormones gives back your body the T4 and T3 it needs to keep your metabolism at the correct level. Researchers hoped that using both these hormones together would help more than just one.

Can they be harmful?

We didn't find any research on the harmful effects of liothyronine alone. But in studies, taking the two drugs together caused about the same amount of side effects as just taking levothyroxine.[2]

In older people, taking too much levothyroxine has been linked with getting a fast and irregular heart beat (atrial fibrillation). About a fifth of people over 60 who have low levels of TSH get this problem. But it's not clear whether the problem is because of taking levothyroxine, or because of having an underactive thyroid.[3]

If you're a woman and have already been through the menopause, taking too much levothyroxine can cause thinning of the bones (osteoporosis). This can happen to women who've been taking high doses of levothyroxine for 10 years.[4]

If your bones get thinner, you have a higher risk of getting fractures. But there's no evidence that women who take levothyroxine are more likely to have a bone fracture than women who don't.[5]

If you have an underactive thyroid without having any symptoms, there's a small chance taking levothyroxine will make you feel more anxious.[6] There's also a small risk of heart problems, such as chest pain (angina) and a fast, irregular heart beat (atrial fibrillation). In one study of 18 people, two stopped taking levothyroxine because of heart problems.[7]

What's the evidence for levothyroxine plus liothyronine?

References

British National Formulary. Thyroid hormones. Available at http://www.bnf.org (accessed on 7 January 2008).

Grozinsky-Glasberg S, Fraser A, Nahshoni E, et al Thyroxine-triiodothyronine combination therapy versus thyroxine monotherapy for clinical hypothyroidism: meta-analysis of randomized controlled trials Journal of Clinical Endocrinology & Metabolism 2006/7; 91: 2592-2599

Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. New England Journal of Medicine. 1994; 331: 1249-1252.

Faber J, Galloe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. European Journal of Endocrinology. 1994;130: 350-356.

Leese GP, Jung RT, Guthrie C, et al. Morbidity in patients on L-thyroxine: a comparison of those with a normal TSH to those with a suppressed TSH. Clinical Endocrinology. 1992; 37: 500-503.

Kong WM, Sheikh MH, Lumb PJ, et al. A 6-month randomized trial of thyroxine treatment in women with mild subclinical hypothyroidism. American Journal of Medicine. 2002; 112: 348-354.

Jaeschke R, Guyatt G, Gerstein H, et al. Does treatment with L-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism? Journal of General Internal Medicine. 1996; 11: 744-749.

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[Guest guest]

EDITED TO REMOVE MESSAGES ALREADY READ. PLEASE CHECK YOU HAVE DONE THIS BEFORE

CLICKING SEND, AND JUST LEAVE A SMALL PORTION OF WHAT YOU ARE RESPONDING TO. LUV

- SHEILA

___________________________________________________

Hi Shelia,

That article written by the Guardian is going to do nothing to help those of us

who need more than just thyroxine,

I for one have been looking for links to help my own cause but i would help

anyone who is in the same boat as myself as it's an uphill struggle just trying

to get anyone to listen.

I've been reading some of the links you put up and was wondering if you had any

up to date links or studies done for T4 versus T3?

Thank you for all these links and the hard work you have put in.

Just hope the new Endo I should be seeing isn't a Guardian man.

Best wishes

Lolly

[Guest guest]

Hi Lolly

There have been no recent studies done for T3 versus T4 since

the ones quoted by the Guardian and BTA. However, they failed to mention all

the studies that have been done. Here are links

The medical literature contains

at least nineteen reports of studies in which researchers compared the

effectiveness and safety of different thyroid hormone Therapies.  Among

the therapies compared in the studies were T4 alone, desiccated thyroid, and

combined synthetic T3 /T4 . Instead of referencing these studies, however, the

Committee cited only two papers in which authors reviewed the most recent

studies that compared T monotherapy to synthetic T4 /T3 . One of those papers

is a review of the studies by Escobar- Morreale et al. and the other is a

report of a meta-analysis by Grozinsky-Glasberg et al.

For more links regarding T4

versus T3, check out my rebuttals to the BTA which I sent to their statement on

T4/T3 combination therapy a year last March, and to which they never responded.

Also, check out the rebuttal to their statement on Armour. You can find these

on our web site www.tpa-uk.or.guk - just

look in the right hand column of the Home Page, and scroll down. There are

hundreds of citations to show their statements are misleading, and in parts,

incorrect.

The 19 reports of studies into

the different thyroid hormone therapies are listed below.

1.

Bunevicius,

R., Kazanavicius, G., Zalinkevicius, R., et al.: Effects of thyroxine as

compared with thyroxineplus triiodothyronine in patients with hypothyroidism. N. Engl. J.

Med.,

340:424-429, 1999.

2.

Siegmund,

W., Spieker, K., Weike, A.I., et al.: Replacement therapy with levothyroxine

plus triiodothyronine(bioavailable molar ratio 14:1) is not superior to

thyroxine alone to improve well-being and cognitive performance in

hypothyroidism. Clin.

Endocrinol.

(Oxf), 60(6):750-757, 2004.

3.

Escobar-Morreale,

H.F., Botella-Carretero, J.I., Gómez-Bueno, M., et al.: Thyroid hormone

replacement therapy in primary hypothyroidism: a randomized trial comparing

L-thyroxine plus liothyronine with L-thyroxine alone. Ann. Intern.

Med.,

142(6): 412-424, 2005.

4.

Appelhof,

B.C., Fliers, E., Wekking, E.M., et al.: Combined therapy with levothyroxine

and liothyronine in two ratios, compared with levothyroxine Monotherapy in

primary hypothyroidism: a double-blind, randomized, controlled clinical trial. J. Clin. Endocrinol. Metab., 90(5):2666-2674,

2005.

5.

Bunevicius,

R., Jakubonien, N., Jurkevicius, R., et al.: Thyroxine vs thyroxine plus

triiodothyronine in treatment of hypothyroidism after thyroidectomy for

Graves’ disease. Endocrine, 18(2):129-133,

2002.

6.

Walsh,

J.P., Shiels, L., Mun Lim, E.E., et al.: Combined thyroxine/liothyronine

treatment does not improve well-being, quality of life, or cognitive function

compared to thyroxine alone: a randomized controlled trial in patients with

primary hypothyroidism. J. Clin. Endocrinol. Metab.,

88(10):4543-4550, 2003.

7.

Sawka,

A.M., Gerstein, H.C., Marriott, M.J., et al.: Does a combination regimen of

thyroxine (T4) and

3,5,3'-triiodothyronine improve depressive symptoms better than T4 alone in patients

with hypothyroidism? Results of a double-blind, randomized, controlled trial. J. Clin.

Endocrinol. Metab.,

88(10):4551-4555, 2003.

8.

Clyde,

P.W., Harari, A.E., Getka, E.J., and Shakir, K.M.M.: Combined levothyroxine

plus liothyronine compared with levothyroxine alone in primary hypothyroidism:

a randomized controlled trial. J.A.M.A., 290:2952-2958,

2003.

9.

Cassio,

A., Cacciari, E., Cicgnani, A., et al.: Treatment of congenital hypothyroidism:

thyroxine alone or thyroxine plus triiodothyronine? Pediatrics, 111(5):

1055-1060, 2003.

10.

Lavietes,

P.H. and Epstein, F.H.: Thyroid therapy of myxedema: A comparison of various

agents with anote on the composition of thyroid secretion in man. Ann. Intern.

Med.,

60:79-87, 1964.

11.

Gorowski,

T., Pucilowska, J., and Wernic, K.: Comparative effects of desiccated thyroid

gland and sodium salt of L-thyroxine in the treatment of hypothyroidism. Pol. Tyg.

Lek.,

44(32-33):768-770, 1989.

12.

Krenning,

E.P., Docter, R., Visser, T.J., et al.: Replacement therapy with L-thyroxine:

serum thyroid hormone and thyrotropin levels in hypothyroid patients changing

from desiccated thyroid to pure thyroxine substitution therapy. Neth. J. Med., 28(1):1-5, 1981

13.

Felt,

V. and Nedvidkova, J.: Comparison of treatment with L-thyroxine and a dried

thyroid gland preparation in patients with hypothyroidism. Vnitr. Lek., 28

(11):1067-1073, 1982.

14.

,

T., Lavis, V.R., Meininger, J.C., et al.: Substitution of liothyronine at a 1:5

ratio for a portion of levothyroxine: effect on fatigue, symptoms of

depression, and working memory versus treatment withlevothyroxine alone. Endocr.

Pract.,

11:223–233, 2005.

15.

Singh,

S.P., Feldman, E.B., and , A.C.: Desiccated thyroid and levothyroxine in

hypothyroidism: comparison in replacement therapy. N.Y. State

J.

Med., 72(9):1045-1048,

1972.

16.

Sawin,

C.T., Hershman, J.M., Fernandez-, R., et al.: A comparison of thyroxine

and desiccated thyroid in patients with primary hypothyroidism. Metabolism, 27(10):1518-1525,

1978.

17.

,

R.N., , S.A., and Massey, J.C.: Controlled clinical trial of combined

triiodothyronine and thyroxine in the treatment of hypothyroidism. Brit. Med. J., 4:145-148, 1970.

18.

McGavack,

T.H. and Reckendorf, H.K.: Therapeutic activity of desiccated thyroid

substance, sodium Lthyroxine and D, L-triiodothyronine: a comparative study. Am. J. Med., 20:774-777, 1956.

19.

,

S., Kapur, M., and Adie, R.: Combined thyroxine and triiodothyronine for

thyroid replacement therapy. Brit. Med. J., 2:270-271, 1970.

I for one have been looking for links to help my own cause but i would help

anyone who is in the same boat as myself as it's an uphill struggle just trying

to get anyone to listen.

I've been reading some of the links you put up and was wondering if you had any

up to date links or studies done for T4 versus T3?

[Guest guest]

EDITED AGAIN TO REMOVE MOST OF THE PREVIOUS MESSAGE. IT IS VERY FRUSTRATING FOR

THOSE WHO OPTED TO RECEIVE A DAILY DIGEST OR WHO READ DIRECT FROM THE WEB SITE

TO SCROLL THROUGH LOADS OF MESSAGES THAT THEY HAVE ALREADY READ. PLEASE TRY TO

REMEMBER TO DELETE THEM BEFORE CLICKING 'SEND'. LUV - SHEILA

==================================================================

Hi Sheila,

I'm going to looks through each and everyone of them and take some with

me on my appointment when it finally gets here.

I stopped subscribing to the BTA over a year ago. I don't feel they are

out to help us at all and I won't waste my money on something that won't

benefit me.

I couldn't get into this link at first www.tpa-uk.or.guk mazmaged to

figure it out in the end, it was an error with the end bit and have now

got it up.. tpa-uk.org.uk

Thank you so much for taking the time to put all those links up and for

pointing me in the right direction too.

Best Wishes

Lolly

> There have been no recent studies done for T3 versus T4 since the ones

> quoted by the Guardian and BTA. However, they failed to mention all

the

> studies that have been done. Here are links

>

> The medical literature contains at least nineteen reports of studies

in

> which researchers compared the effectiveness and safety of different

thyroid

> hormone Therapies.