Better Diagnosis and Management of Symptomatic Hypothyroidism

The time is long overdue for the Medical Profession to amend current diagnosis and management protocols for symptomatic sufferers of hypothyroidism.
We have first hand experience of treatment failures with thyroxine (T4) alone, and the inadequacy in diagnosis and dosing according to TSH laboratory reference ranges. Adherence to this protocol can result in symptom continuance despite T4 therapy.

Our experience and clinical presentation of failures in T4-only therapy to relieve symptoms has been repeatedly dismissed or ignored by doctors, who attribute our continuing symptoms to "somatoform disorder".

T4-only therapy works for some but not those suffering a failure of peripheral utilisation at the cellular level. They need a different diagnosis and thyroid hormone therapy i.e. a combination of synthetic T4 and tri-iodothyronine (T3), or natural desiccated thyroid extract (NDT). NDT was the only available treatment prior to introduction of synthetic T4.

Many patients using NDT report symptom resolution not seen with T4-alone. This may be because NDT contains the hormones a normal thyroid produces: T4, T3, T2, T1, calcitonin.

We recommend stringent safety guidelines where a combination of synthetic T4/T3 or NDT is prescribed as detailed below:

1. Screen patients with thyroid deficiency for low adrenal reserve (adrenal fatigue) - a condition possibly more common than expected. Patients with weak adrenals may have difficulty tolerating and utilising prescribed doses of synthetic thyroid hormone and may experience "hyperthyroid" symptoms, even at low doses.

Other patients with adrenal fatigue may experience the opposite, remaining hypothyroid at high doses. Here, thyroid hormone may build up in serum, leading doctor and patient to believe the dose is too high and the treatment doesn't work. The solution to both problems is to treat adrenal fatigue before commencing thyroid therapy, or simultaneously.

2. Use the following laboratory tests to guide assessment and treatment of hypothyroid symptom sufferers: TSH, free T4, free T3 plus TPO and Tg Antibodies.

3. Start combination therapy at safe low doses of synthetic T4/T3 and, for NDT, to familiarise themselves with combined therapy and prescribe safe dosages, e.g. 15mgs of NDT for patients with adrenal fatigue, or 30 to 60mgs otherwise, and adjust doses according to clinical needs.

4. To give credence to patients’ subjective reports of symptoms rather than make laboratory results the sole treatment guide. We advocate medical practitioners have freedom of choice to prescribe T4, combined synthetic T4/T3, T3 and/or NDT, without incurring the wrath of the mainstream establishment.

We implore the Scottish Government to urge doctors to address misconceptions that NDT is inconsistent, dangerous and unreliable, recognising that NDT products - Armour Thyroid®, Westhroid®, Nature-Throid®, Erfa Thyroid® - meet stringent guidelines laid down by the United States Pharmacopoeia (USP), and Food and Drug Administration (FDA).

We exhort the Scottish Government to urge medical practitioners to make a full assessment of clinical presentations of patients already on NDT therapy.

In conclusion, we strongly recommend that selection of treatment with synthetic or natural preparations is a matter for patient and doctor working together, having freedom of choice in this matter.