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Consensus # 1 International Thyroid Patient Organisation (ITPO)


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We, as thyroid patients who circle the world, feel the time is long overdue for the medical profession to amend the current protocol regarding the treatment of hypothyroidism.

We have first hand experience of the failure of treatment with thyroxine (T4) only, as well as the inadequacy in diagnosing and dosing according to the TSH laboratory reference range. Adherence to this protocol has allowed our cholesterol to rise, chronic depression to hinder our lives, our aches and pains to continue, our hair to thin, our sense of feeling cold to continue, our thinking processes to be foggy, our abilities to work and live adequately to be compromised, our immune systems to be weak and caused many other symptoms due to under-treatment which have been affecting our health and well-being.

Yet, our experience and clinical presentation of the failure of thyroxine to relieve our symptoms has been repeatedly dismissed and ignored by too many doctors, who often attribute these hypothyroid symptoms to “somatoform” disorders.

Although thyroxine only treatment works for many people, it is not ideal for everyone – a combined treatment of thyroxine and tri-iodothyronine (T4/T3) should also be considered as should natural desiccated thyroid extract (the best known is Armour® Thyroid, USP), which was the only treatment prior to the introduction of synthetic thyroid hormone replacements. Many patients using thyroid extract are reporting a resolution of all the above-mentioned problems encountered whilst on thyroxine treatment alone, which may be due to the fact that thyroid extract contains all the hormones a normal thyroid produces – T4, T3, T2, T1 and Calcitonin.

We recommend the following safety guidelines where the combined treatment of T4/T3 or thyroid extract are used, and in the following order:

  1. to screen patients with thyroid deficiency for low adrenal reserve, a condition that may be more common than generally expected. Patients with weak adrenals may have difficulty tolerating the dose of thyroid hormone they need, and may experience apparent "hyperthyroid" symptoms, even at low insufficient doses. In other patients with low adrenal reserve the problem may be the opposite: the patient may remain hypothyroid even at higher doses of thyroid hormones. Thyroid hormones can not be normally used by the cells and may instead build up too high in serum, leading the physician and patient to believe that a particular dose is too high and that the treatment doesn't work. The solution to both problems is treatment of the low cortisol condition, prior to the thyroid treatment, or simultaneously.

  2. to use the following laboratory tests as a guide in the assessment and treatment of hypothyroidism: TSH, free T4, free T3, TPOAb and TgAb.

  3. to start the combined treatment at a safe low dose of T4/T3 synthetic combination, or, if thyroid extract is prescribed, physicians should familiarize themselves with the equivalence of this medication compared with thyroxine and begin treatment on an appropriate safe dose, e.g. 1/4 grain of Armour® Thyroid USP for patients with low adrenal reserve, or 1/2 to 1 grain otherwise, and to have their dose adjusted according to their clinical needs every few weeks.

  4. to listen and give more credence to patients’ subjective reports of symptom continuance or resolution, rather than make laboratory results the sole guide in dosing.
Moreover, we advocate that medical practitioners should have freedom of choice in prescribing T4 alone, combined T4/T3 or thyroid extract, without incurring the wrath of the mainstream establishment as happens at present in some countries.

We strongly recommend that physicians address the misconceptions that thyroid extract is inconsistent, dangerous, unreliable and/or outdated, and recognize that thyroid extract products such as Armour® Thyroid; Westhroid® and Nature-Throid® meet the stringent guidelines laid down by the United States Pharmacopoeia (USP), and the Food and Drug Administration (FDA). We also feel that physicians should make a full assessment of the clinical presentation of patients already on this medication.

In conclusion, we further strongly recommend that the selection of treatment, whether it is synthetic or natural, should be a matter between the patient and the doctor, both having freedom of choice in this respect.

compiled by :

Sheila Turner ( UK ) tpa-uk
Susanne König ( France )
Sabine Seichter ( Germany )
Janie ( USA ) stopthethyroidmadness
Lyn Mynott ( UK ) thyroiduk

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