More than 100 years ago, doctors recognized that some patients with a slow pulse, low body temperature, swollen hands and feet and mental and physical sluggishness were suffering from too little thyroid hormone. The treatment back then was a diet of fried sheep thyroid glands with currant jelly on the side.
Eventually, pharmacists learned to dry animal thyroid so it could be taken in a pill. For the past 50 years, however, physicians have relied mostly on synthetic preparations such as Synthroid.
Considering how long this condition has been recognized and treated, it still generates surprising controversy. A recent report in the British Medical Journal (Feb. 8, 2003) suggests that the standard test (TSH) doesn’t always give doctors an accurate way to judge how much thyroid hormone a patient needs. TSH levels are very helpful in making an early diagnosis of thyroid problems, but if hypothyroidism is severe, the clinical symptoms don’t correlate very well with the TSH measurement.
Most experienced endocrinologists acknowledge that the patient’s clinical picture is an important piece of the puzzle. But some physicians, looking for a more objective guideline for treatment, have seized on the TSH. Both doctors and patients can become frustrated in this process.
One reader relates: “I’m a very young and lively 58 years old. Thirty years ago I had thyroid surgery for benign nodules. I have taken thyroid hormone ever since then, first Armour and then Synthroid.
“Until my mid-40s I weighed 130 pounds. I’m 5′ 5 1/2” tall and I was one sexy babe, happily dating and making $90,000 as an advertising executive.
“Then a doctor decided I was taking too much Synthroid and dropped the dose. Within a month I gained almost 17 pounds, even though I ate a healthy diet and walked a fast 3 miles a day. The doctor actually said, ‘At your age, why do you care if you gain some weight?’
My metabolism is still screwed up and I’m still overweight. My current doctor has adjusted my dose of Synthroid from .125 to .112 and back again. (He does not do a T3 or T4, just TSH.)
“I have exceptionally dry skin and bowel movements the size of a large baked potato. They are hard and painful. I say that’s hypothyroidism. He says I might have a ‘lazy colon,’ but I get lots of vegetables, fruit and fiber as well as a lot of water and plenty of physical activity. At a dosage above .125 I don’t ever have this bowel issue.
“I have a bone density test every two years and I’m fine. The doctor says too much thyroid will erode my bone mass. But at this point my bones are in good shape. Why shouldn’t I take enough Synthroid to make me feel good?”
Some experts now believe that thyroid treatment is more complicated than previously thought. Using only TSH for guidance may not be enough, and Synthroid (levothyroxine) alone may not work for every patient.
We have summarized the latest thinking in our Guide to Thyroid Hormones. Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (60 cents), self-addressed envelope: Graedons’ People’s Pharmacy, No. T-4, P. O. Box 52027, Durham, NC 27717-2027.
