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Dear STTM Blog readers, I am so fortunate to talk to many wonderful individuals because of Stop the Thyroid Madness. And recently, I had a conversion with the very insightful Dr. Hugh Melnick of New York City.
Dr. Melnick brought my attention to a very disturbing article titled “For borderline underactive thyroid, drug therapy isn’t always necessary” that came from the Harvard Health Letters in October 2013, You can see it here: http://www.health.harvard.edu/blog/for-borderline-underactive-thyroid-drug-therapy-isnt-always-necessary-201310096740.
This conversation between Dr. Melnick and I may be of great interest to STTM readers, besides alarming once you see what is being stated in this article and suggested as treatment guidelines. It’s simply Thyroid Treatment Dark Ages!
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JANIE: Hello Dr. Melnick. I’m so glad to chat with you! Can you tell our readers a little about yourself?
DR. MELNICK: I am a reproductive endocrinologist who has been in medical practice since 1976. As the medical director of Advanced Fertility Services In Vitro Fertilization Center in New York City, I have always been impressed by the large number of infertile women that I have seen over the years, who are symptomatically hypothyroid, and who conceive after treatment with thyroid medication.
Although I did my medical training at a point in time when the TSH test and Synthroid were just being introduced into clinical practice, I was trained by one of the most widely respected endocrinologists of that era, Herbert Kupperman, MD, Ph.D. to diagnose and treat patients with potential thyroid issues according to their symptoms, rather than solely by their blood test results. His vast clinical experience, and subsequently mine, as well, is that treatment with Natural Desiccated Thyroid (NDT) gives far superior symptomatic improvement for the vast majority of patients. Furthermore, the dosage of thyroid medication should always be based upon a patient’s clinical symptoms and not the TSH level.
JANIE: That greatly impresses me when I learn of doctors like yourself who understand the efficacy of Natural Desiccated Thyroid as well as the problems with using the TSH lab test. You recently brought my attention to what was written just a few months ago by Heidi Godman, the Executive Editor of Harvard Health Letter (see introduction above). Can you expound on what Ms Godman meant by “borderline underactive thyroid”?
DR. MELNICK: Actually, Ms. Godman is mistakenly defining hypothyroidism by TSH levels, rather than by a patient’s clinical symptoms. It is obvious that there are many symptomatic and genuinely hypothyroid individuals, who have normal TSH levels, and who experience relief when given a proper dose of the appropriate thyroid medication. The TSH level only diagnoses a type of hypothyroidism that is due to failure of the thyroid gland itself, or a failure of the pituitary gland.
In my experience, the most common form of hypothyroidism is called subclinical because the TSH levels are in the “normal range.” It is a genetic condition, usually passed through the mother and manifests itself later in adulthood. In subclinical hypothyroidism, the individual’s cells need more active thyroid hormone–T3–than their bodies are able to produce in order to function properly. Therefore, supplementation with a thyroid medication containing T3, in the proper dose, will relieve the troubling symptoms and allow the cells to function optimally.
Again, basing the dosage of thyroid medication on TSH levels is incorrect. When treating hypothyroidism, we are not treating a condition like diabetes, in which the insulin dose is based upon the patients’ blood sugar levels. Although they are both endocrine disorders, they are vastly different conditions and cannot be treated in the same fashion, although many endocrinologists still insist on doing so!
JANIE: In the article, Godman quotes that prescriptions for levothyroxine have increased from 50 million in 2006 to about 70 million in 2010, and a similar increase has occurred in England and Wales. She then calls this increase in treatment “pretty risky business”, citing irregular heart rhythms, insomnia, and loss of bone density”. What is she implying there?
DR. MELNICK: I think that the observed increase in the use of the thyroid medication Synthroid is due to the fact that hypothyroidism is a very common condition, affecting at least 35% of the female and 10% male population. Considering the population estimates for 2013 is 317 million people in the U.S.A. and the population of the United Kingdom is estimated to be 70 million, 28% of the population in the U.S. and 23% of the population in England, (assuming one prescription per year per individual patient) are being treated for hypothyroidism. This is actually a bit less than the estimated incidence of hypothyroidism in this country. I also believe that more cases of hypothyroidism are being found because people, in general, are more informed about the symptoms of hypothyroidism and seek treatment.
In my opinion, Ms. Godman erroneously categorizes treatment of hypothyroidism a “pretty risky risky business”. The risks of not treating hypothyroidism is, in fact, more potentially injurious to a patient’s health!
For example, the increased risk of heart disease in untreated hypothyroid individuals is a solid example of why hypothyroidism needs to be treated. The examples that she cites, namely, irregular heart rhythms and insomnia, are found in many people with hypothyroidism before treatment and are cured by adequate thyroid treatment. The symptoms that she mentioned are not exclusively associated with hyperthyroidism. The loss of bone density claim comes from studies of hyperthyroid individuals, who because of their hyperthyroidism and excessively high metabolic rate, may develop osteoporosis.
JANIE: The next part of this article is alarming. It refers to a particular “clinical practice guidelines” authored by Endocrinologist Dr. Jeffrey Garber, an associate professor of medicine at Harvard Medical School. These guidelines come from a task force representing the American Thyroid Association and the American Association of Clinical Endocrinologists. The first guideline is as follows, and goes completely against what informed thyroid patients know to be wise. Can you comment?
1) The best way to check for hypothyroidism is to look at the level of thyroid stimulating hormone (TSH) in the blood, and when the TSH level is above 10 mIU/L, there’s uniform agreement that treatment with levothyroxine is appropriate.
DR. MELNICK: Firstly, clinical practice guidelines are merely suggestions that have been developed to help physicians with limited experience diagnose and treat medical issues. Clinical guidelines are like a cook book, which describes a recipe that makes a simple meal, but not necessarily a complex and elaborate feast. That said, it is quite obvious that the way in which I diagnose and treat hypothyroidism is quite different than that which is suggested by the above referenced societies.
Although I do perform a complete battery of blood tests, including antithyroid antibodies, iron, vitamin B12 and vitamin D levels, I believe that a clinical approach – listening to a patient’s symptoms and treating a patient accordingly – is, in some ways, more important in diagnosing and properly treating patients suffering with the symptoms of hypothyroidism. If a physician only looks at a patient’s blood tests, without listening to the patient’s symptoms and asking them appropriate questions, many people who legitimately need thyroid medication will be denied proper treatment. That is precisely the reason that so many people come to me suffering with all the classical symptoms of hypothyroidism and tell me that their doctors have tested their thyroid and found them to be “within normal limits”.
It is not surprising when these very same patients experience symptomatic improvement when treated with adequate doses of NDT. I rarely treat patients initially with Synthroid. The primary reason is that Synthroid, being a synthetic T4 (a weak thyroid hormone- not chemically identical to human T4), must be converted into T3, the potent form of the hormone that enters every cell in the body and makes the cells of the body function normally. Unfortunately, many individuals are unable to successfully convert T4 into T3, so the patients’ symptoms remain, yet the TSH level is normal.
Natural desiccated thyroid (NDT) is made from the thyroid glands of pigs, which produce thyroid hormones chemically similar to that found in humans and does contain T3. Porcine (pig) thyroid gland also contains other thyroid hormones and proteins, which, in my experience are much more effective in relieving the symptoms of hypothyroidism than synthetic T4. Who can argue that a natural treatment, if availble, is to be preferred over a synthetic one.
JANIE: I loved the analogy above to a cook book, Dr. Melnick! Garber’s second most-emphasized guideline is the following, and I would love for you to comment on this as well, as informed thyroid patients would find this very disturbing, as well:
2) If the TSH level is between 4mIU/L and 10mIU/L, treatment may still be warranted in various situations:
- if the levels of actual thyroid hormones in the blood–known as thyroxine (T4) and triiodothyronine (T3)–are abnormal
- if the bloodstream contains anti-thyroid antibodies that attack the thyroid. These antibodies would indicate a hypothyroid condition called Hashimoto’s disease, in which the immune system mistakenly attacks the thyroid.
- if there is evidence of heart disease or risk for it.
Garber is next quoted as saying “Use thyroid hormone for a brief period of time.” and “If you feel better, you can continue with treatment. If not, then stop.” That recommendation is quite alarming as well, as it fails to understand that it may not be about stopping thyroid medication, but moving over to a far better treatment with natural desiccated thyroid, which informed thyroid patients know should have been the first treatment of choice anyway. Can you comment?
DR. MELNICK: In my clinical experience, 99% of patients with TSH levels over 4.0 are quite symptomatic, if questioned about their symptoms properly. Therefore, treatment is absolutely mandatory, both to relieve “quality of life symptoms” as well as to prevent heart disease, lower blood pressure, normalize blood sugar and cholesterol levels, if they are found to be elevated.
Dr. Garber’s recommendations about using thyroid medicine for a short period of time and continuing it if improvement is noted omits two essential factors. The first is that since he treats his patients only with Synthroid, a significant percentage will show no improvement because their symptoms are not relieved because they cannot convert T4 into T3. The second factor is that by following TSH levels in the blood, a patient may not actually be taking a high enough dose of thyroid medication, yet will show low TSH levels in the blood. The level of thyroid hormones circulating in the blood-whether they are bound or free- only indicate absorption of the medication and give no indication as to the amount of T3 entering the cells. When an individual gets enough T3 into their cells, their symptoms will improve.
The only way to measure the correct dose of thyroid medication, in addition to noting improvement in symptoms, is by measuring the Basal Body Temperature and by the measurement of nerve conduction velocity (Thyroflex Test). This is a noninvasive test which gives a good indication of dosage adequacy. The slower the patient’s nerve conduction velocity, the higher the dose of thyroid medication that is required.
One main point that must be noted is that thyroid medicine may take up to twelve weeks in order to experience some degree of symptomatic relief. The other is that the patients’ dosage should be increased gradually and in divided daily doses until symptomatic relief is experienced. The dose should be reduced if the patient experiences rapid or irregular heartbeat, shakiness or anxiety. These symptoms will resolve in several hours and are not harmful.
Hashimoto’s or autoimmune thyroiditis is a much more complex clinical condition, in that symptoms in many individuals may vary, from hypo to hyper from time to time. Treatment with thyroid hormone is usually needed, but some patients, in the early stages of thyroid autoimmunity, may be fairly asymptomatic. As the condition progresses, symptoms will eventually be experienced. The levels of antithyroid antibodies do not correlate with the severity of a person’s symptoms. Antithyroid antibodies never disappear and will always be detectable in the blood. There may also be gluten sensitivity in some instances, so dietary factors may be important. When an infertility patient is found to have antithyroid antibodies, whether they are symptomatic or not, I always treat them with NDT since it does help them to conceive and seems to reduce the incidence of miscarriages.
JANIE: Heidi Godman then states the following about individualized treatment for hypothyroidism, which informed thyroid patients know by years of experience is a recipe for disaster: “That requires measuring TSH four to eight weeks after starting treatment or changing a dose, another TSH test after six months, then every 12 months.”
DR. MELNICK: I respectfully disagree with both Ms. Godman’s formula as stated above, as well as with Dr. Garber’s method for diagnosing and treating hypothyroidism. Although the Harvard Medical School is a very prestigious institution, and that the information that they published cited the work of a physician of professorial rank, it is quite contrary to my own clinical experience and that of the many untreated or inadequately treated individuals who suffer with the many debilitating and disturbing symptoms arising from thyroid hormone deficiency.
I say this in jest, but if a patient follows the treatment protocol advocated by Ms. Godwon, they are more like to die of old age before their symptoms of hypothyroidism begin to show signs of clinical improvement .
JANIE: Your last sentence was excellent, Dr. Melnick. Your sage observations and wisdom jive with over a decade of successful patient experiences and wisdom! And we must push AGAINST the guidelines suggested by Dr. Jeffrey Garber. Informed thyroid patients know how disastrous they can be!
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40 Responses to “Dr. Melnick discusses alarming article from Harvard about the use of the TSH and thyroid treatment!”
oreo
Janie- FYI. It’s poobah not PooPah
Love Love Love all the info you have gathered for everyone. Thank You!
Janie Bowthorpe
Hey oreo. Glad you like all the info I have gathered. And FYI: I have enjoyed the fun company of several friends over the years, and we all call it PooPah. So PooPah works for us, even if doesn’t for you.
Christianne
Hi!
I recently joined this group. I live in NYC and have a hypothyroid and Reverse T3 issue. I don’t see Dr. Melnick talking about that in his interview.. I have an appointment with him for next week, but now I’m doubting if I should go with him or not. I know I need T4 and T3 medications and also direction for supplements.. but since he doesn’t even talk about Reverse T3 now I’m not sure if I should go to him for help. Do any of you guys know if he could treat me, or maybe I should look for someone else..?
Mellie
I think you are probably right. I think I just feel that way because my symptoms were ignored since the age of 15 and now my dad has stage 4 terminal cancer when it could have been caught earlier but his numerous dr.s completely ignored his symptoms telling him he had everything under the sun and never screening him for cancer. So i think in my grief and anger it is easy for it to feel personal. On a more proactive note, does anybody know a good canadian pharmacy with free shipping over 50 or 100 dollars? There are TONS of them out there and I don’t know which pharmacy to choose, so I would love some personal feedback from people having got good quality meds through one. Any reccomendations would be greatly appreciated!
Mellie
This article from Harvard Health Newsletter, scare me. I think this might be my rampant untreated health symptoms talking a bit (just started NDT yesterday) but I feel paranoid like there is a HUGE conspiracy to make and keep us sick by preventing us (those who have symptoms but who have been undiagnosed) from recieving appropriate treatment. It is sad to me that when I talk to Dr.s they really could care less what my or any or our lives are like and insist on a diagnostic/treatment protocole that is damaging and ultimatly deadly. I am so sick with hypothyroid, low progesterone,low cortisol and low B12 that I am about to ruin my first year of my master’s degree because I cannot function. Not only does this protocole ruin lives, but it does not even follow the mounting research, especially that coming out of Japan ( where Hoshi’s was discovered!) How can they call themselves professionals if they ignore the science when the research right there in front of them. I don’t now, i realize I am ranting, but it just makes me so mad. I have suffered for years and it seams like doctors everywhere ( except a small minority) want to keep us sick and ensure that as a population we do not have access to appropriate medical treatment. Does anybody else feel like it’s a conspiracy or is this just all my symptoms talking?
PS. Thanks Dr. Melnick for your openminded treatment of us hypothyroid patients!
Janie Bowthorpe
Hi Mellie. I truly doubt there is a conspiracy going on. Instead, it seems to be more about greed by human beings who own and run pharmaceuticals as well as too much arrogance and narrow-mindedness acquired by those who got through medical school.
DP
My daughter is a patient of Dr. Melnicks and lives in NYC. She encouraged me to see him so I traveled 3 hours to his office. But he also offers Skype visits and will treat you remotely if you cannot travel to NYC. We do follow up by Skype or phone consults….but I will return in a month for more labs. he has a website that explains how you can remotely be treated by him over Skype. I’ve just started treatment with Armor
and feeling ok so far…..Wish me luck.
maria
hi did you end up trying dr melnick? did you like him?
Amy
Dear Martine,
Did you actually go visit Dr. Hugh Melnick?
How did it go? I have not been able to find anyone in Brooklyn, NY.
I just found the following docs in Manhattan who accept GHI. Hugh Melnick; Clifton Jackness; Anjali Grover.
Thanks a million
Martine
Janine!
Thank you for posting this interview!
I just discovered Dr Melnick exists (and I nearly passed out!) through your amazing site through Good Docs and through this interview. I’ve been looking for a doc like him for YEARS! ANd he takes my insurance! (it seems too good to be true and I’ve had my hopes dashed before so many, many times)
Please, please tell me:
Do you endorse him?? Does he get it…I mean REALLY get it? I live in NYC and I want him to approach testing/treating my Thyroid/Adrenals etc. according to YOUR guidelines. Is he the one?? He’s an Endo, which scares me. I’m in dire shape, truly. I need help. Please answer and thank you so much for all you’ve been doing/teaching/sharing over so many years through STTM!
Martine
Janine!
Thank you for posting this interview!
I just discovered Dr Melnick exists (and I nearly passed out!) through your amazing site through Good Docs and through this interview. I’ve been looking for a doc like him for YEARS! ANd he takes my insurance! (it seems too good to be true and I’ve had my hopes dashed before so many, many times)
Please, please tell me:
Do you endorse him?? Does he get it…I mean REALLY get it? I live in NYC and I want him to approach testing/treating my Thyroid/Adrenals etc. according to YOUR guidelines. Is he the one?? He’s an Endo, which scares me. I’m in dire shape, truly. I need help. Please answer and thank you so much for all you’ve been doing/teaching/sharing over so many years through STTM!
Janie Bowthorpe
Martine, not even the best docs get everything….so be prepared that there will be some areas you’ll have to teach even Melnick about.
And you are welcome about STTM. 🙂 Labor of love.
Veronica Darling
I was a patient of Dr Melnick’s and while he prescribes NDTs I don’t think he understands the connection between adrenals and thyroid. When the additional thyroid med started causing me palpitations his answer was to start beta blockers. I asked about saliva cortisol testing and the connection b/w iron issues, adrenals etc all potentially making it challenging to get the thyroid med into one’s system but was met with you need beta blockers so we can increase the NDT meds. Disappointing because I thought he was the one who would be able to help me.
Missy
Hi Veronica, I had the same exact experience with Dr Melnick. Did you ever find an endocrinologist in NYC that was able to help you? Thanks.
maria
hi ! Did you end up trying melnick? any luck? did you like him?
Nell
It’s so refreshing to read these responses from Dr. Melnick. I am seeking a health provider who gets it–that my symptoms mean more than matching a statistic whose application only works for a portion of the population I don’t happen to fit into. My current health provider forced me to accept a much lower dosage of Armour Thyroid (and of course, giving me the lecture on why synthroid is better). After this reduction, I fell back into the terrible state I was before I was properly diagnosed. Not only am I fatigued, puffy, depressed, and foggy, About a week after the lower dose, during which I had severe tinnitus, I lost about a third of the hearing in my left ear. Naturally I’m depressed! Will I lose even more?? I am worried about driving because I’m not alert. I lose my car in the parking lot. I’m a newlywed, and now have lost my sex drive. My eyes look like Homer Simpson, and there’s a bag under my chin. All this due to the reduction of my former dosage. My carpal tunnel is back with a vengeance, so I don’t sleep. When I sleep for 9 hours, it feels like 5. I’ve been ordered to have all kinds of unnecessary tests that aren’t covered by my insurance, because I have a high deductible. So, I’ve been put on this merry-go-round, and am about at my wit’s end.
All this because I moved away to a new state, and the new health provider won’t look outside the box or listen to me. I hope I can find a good health care provider who is sensitive to my symptoms, and has done his or her homework about the TSH level controversy. I do not have heart disease or bone density issues after 10 years. I was healthy, no weight issues, no smoking, no diabetes, no cancer, no nothing to worry about. I didn’t get sick. I ran my own business. Now I’m a zombie, and worried I’ll become a shut in if this continues. My Mom is way more active, and she’s 84!
Ren Gron
Please address the issue of excess mucin, and its subsequent water retention. NO ONE talks about this! A lot of people think their being fat is their fault and suffer psychologically for this. It’s the forgotten symptom that was the FIRST symptom Dr. Ord wrote about in 1878. It’s name, myxedema, was the FIRST name given to the disease hypothyroidism. Doctors are totally ignorant of its effects–high bp, irritated joints… Your view would be appreciated.
Janie Bowthorpe
Ren, patients are definitely aware of the water retention and talk about it a lot in groups. The edema goes away with the right treatment, which is natural desiccated thyroid in the presence of good iron and cortisol, or at the very least, adding T3 to T4. Groups are here under #2: https://stopthethyroidmadness.com/talk-to-others
Lynette
I was on Synthroid for 27 years before finally talking a doc into putting me on Armour in 2008. I was fine on it with slight adjustments here and there. In March 2013, I went to an integrative doctor/neuro chiropractor/nutritionist who began to manage my thyroid along with leaky gut, food sensitivities, brain based therapies, addressing spinal issues, etc. He was disturbed that my T3 was way too high when the T4 was within range and began reducing my Armour dosage. As he did, my TSH got higher and higher, and the T4 got too low. By Thanksgiving I was dragging while taking 45-60mg Armour. Doc insisted I try Tirosint (synthetic) to see if he could get my T3 down. Oh, it went down alright…dropped like a rock. After 2 weeks, I felt terrible and refused to take it any longer so I am assuming my body cannot convert T4 to T3 or at least it did not kick in during that period of time. My doctor then prescribed a compounded T4/T3 with less T3 and more T4. Unbeknownst to either of us, the pharmacist used plant based T4/T3, not Armour (I now know they cannot change the ratio of T4/T3 in the bulk Armour). I took that for 30 days and my latest labs looked like I had received NO hormone at all for the whole month…too low on T4/T3 and TSH over 60. I also did the saliva hormone tests a few weeks ago and my cortisol is low. I am now on DHEA for that. Did I read on this site that adrenal dysfunction can cause T3 to pool in the blood and cause high lab readings? I need some documentation of that to prove it to my doctor. I never felt hyper with the high T3 but my doc thinks I was and said it could be dangerous although my TSH was still between 7-10 and I felt good. I am wondering how I can get the T3 down and stay on Armour. I am also very eager for my Armour to kick back in as I am totally dragging at this point!
Janie Bowthorpe
Hi Lynette. This probably explains why your T3 got so high with Armour: https://stopthethyroidmadness.com/ndt-doesnt-work-for-me DHEA is not how you treat low cortisol either.
Lynette
Thank you SO much for your reply and directing me to the article about cortisol and iron issues affecting T3. Am I understanding you to say that correcting my low cortisol is probably the remedy to high T3 on Armour? What can I do to bring my cortisol up as it was low on my recent saliva test except for the morning reading which was within normal range 6.01, noon 1.87, evening .52, night .87. This is all a drop from 10 months ago. My DHEA is also low-63.81 and a drop from 10 months ago as well. My iron levels have been lab normal (maybe not optimal!) Do you go by the total iron, (108), the binding capacity (366) or the saturation (30)? I was diagnosed with leaky gut and my doc seems to think I have low HCL but when I take a supplement, I get heartburn. My doctor has had me on Adrenaven by Premier Research Labs and Adrenastim cream by Apex Energetics. Will any of that help my adrenals or does he have me on a wild goose chase since he sells these supplements? Thank you!
Janie Bowthorpe
Hi Lynette. Yes, the article explains why you are getting high FT3. 🙂 Here’s where you can either schedule a coaching call or talk to others in groups: https://stopthethyroidmadness.com/talk-to-others
cynthia
I say this because my mood swings are insaine, I’m always tired and my 3rd Endo Dr. in 1 year is saying all levels are fine 🙁 But it’s NOT fine even a little fine. I’m always tired and always Bipolar which wasn’t my life before this awful surgery. I was seeing the “Best Endo in DC” he was 76 and very old school and only believes in Synthriod same as my current Dr. Im feeling hopeless and don’t know what to do. Life is out of control and I’m stressed, moody, depressed and this just can’t be it RIGHT????
Janie Bowthorpe
Cynthia, now you know why informed thyroid patients RUN as fast as they can from Endocrinologists!! They use the lousiest test ever invented to diagnosed hypothyroidism–the TSH–and proclaim you “normal” in spite of clear hypothyroid symptoms. https://stopthethyroidmadness.com/tsh-why-its-useless
They also use the worst medication ever invented for hypothyroidism: Synthroid. https://stopthethyroidmadness.com/t4-only-why-its-useless
You need a MUCH better doctor to prescribe Natural Desiccated Thyroid ASAP, and you’ll need to learn how to use it and teach the next doctor, just in case. Here’s how to find a better doctor: https://stopthethyroidmadness.com/how-to-find-a-good-doc And here’s how to use NDT: https://stopthethyroidmadness.com/natural-thyroid-101
I know that’s a lot of reading in your horrible condition, but you need to. Also get a loved one or friend to read it all and you two talk about it!! Hang in there. THIS is why Stop the Thyroid Madness exists.
cynthia
Hi i’m wondering if anyone else feels completely crazy with no thyriod?
Deirdre Ryan
if you want to use this go ahead, just reading BMJ email today makes me – one again – think of all the money that is wasted because of non-diagnosis, incorrectly treated thyroid/adrenals, but mainly another example of waste – in so many areas not only the almighty $$ – how many are really Thyroid Patients who do not show up on TSH tests but have high cholesterols etc, and so statins are thrown at them also other meds and Anti-depressants?? this medical world needs treatment for lack of concentration, muddled thinking, confusion – maybe they’re all Hypothyroid? Regards, Deirdre
Jane, EXCERPT from BMJ todayMeanwhile the controversy over the wider use of statins rumbles on. After controversial new US guidance last year that extended the use of statins to people at low risk of cardiovascular disease (doi:10.1136/bmj.f6858), the UK National Institute of Health and Care Excellence (NICE) has just published its own draft recommendations (doi:10.1136/bmj.g1518). These would halve the risk threshold for starting statins in people at low risk of cardiovascular disease–from a 20% risk over 10 years to a 10% risk, as assessed by the QRISK2 tool. This is against a background of falling mortality but rising morbidity from heart disease and widening related health inequalities. The guidance cites the falling cost of generic statins and new evidence of benefits. If you have any views on these draft recommendations, you have until 26 March to make them known to NICE.
Des Spence makes his views abundantly clear (doi:10.1136/bmj.g1899). The evidence supporting the new guidance comes from “a reworked meta-analysis of old disparate cholesterol studies,” he says. “Shouldn’t we have definitive research before we ‘statinise’ a whole population?”
John Abramson and colleagues echo this cry. Replying to criticism of their recent BMJ article (doi:10.1136/bmj.f6123), they call for a publicly funded randomised controlled trial to compare statins, lifestyle intervention, and both for the prevention of cardiovascular disease in people at low risk.
Abramson’s critics are Mark Huffman and colleagues. Their Cochrane review prompted NICE’s change of heart and was largely based on the Cholesterol Treatment Trialists’ meta-analysis, to which Spence refers. We hope soon to hear from the authors of the meta-analysis, but in the meantime you can read the correspondence between the Cochrane authors and Abramson and colleagues (doi:10.1136/bmj.g1520; doi:10.1136/bmj.g1523).
Cite this as: BMJ 2014;348:g1954
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Follow BMJ Editor Fiona Godlee on Twitter @fgodlee and the BMJ @bmj_latest
Deirdre Ryan
. Janie,
Not proof-read by me so hope it all makes sense. One keeps spending so much time on these thyroid/adrenals — as you more than know. And we are all very thankful for your involvement in it.
Which comes first – the Adrenals or the Thyroid – re dysfunction of the endocrine system? I found photos of myself with big black eyes aged 6 years, & remember being taken to a Bio-chemist aged 10 years with black eyes & THIS knowledge enabled me to diagnose myself & 2 sons with Hypoadrenia. Having already gone through 15 years of non-diagnosis, then finally diagnosed as I fitted the Ref Range in Australia for Hypothyroidism – “just a little over” Dr stated re the ref range, but I was twice my weight, hair, thought processing/articulation, extreme fatigue (of course that was previously diagnosed as Chronic Fatigue but no question as to WHY is she fatigued?? facial features etc., etc., and given a Medical Certificate to NOT work for some years before diagnosis, plus a letter from a Consultant(Autism) he said I had an Auto Immune disorder and possible infection. Did end up in Japanese hospital emergency with infection 7 years later – answering “how do you feel” and I said “my brain & body is so much lighter than 20 years ago” said off the top of my head. But that is one of those Thyroid trauma “I remember moments” so do excuse my (Thyroid-like) ramblings. So possibly infection there for 20 years (cat scratch fever?? Does not always show up in blood tests nor in antibodies. Blood tests are fallible??
Back to the Adrenals, I remain convinced that the Adrenals malfunctioning can cause the Thyroid like Symptoms’ and these are ignored by doctors because in their training there is no such thing as Hypoadrenia/Adrenal Insufficiency!! Therefore the Medical world automatically does its Gold Standard TSH blood test and one is “within range” despite all the other multitude – over years of Signs & Symptoms that one has been paying the Dr to hopefully put the medical jigsaw together as DOCTORS USED TO DO but NO, they do not even know the questions to ask of the patient and routinely order tests for …. & prescribe e.g. Prozac for depression, creams for feet problems etc.,, etc.,
In Dr William McK Jefferies book — Safe Uses of Cortisol, he tells us that women who when given Hydrocortisone for other complaints would then fall pregnant, though prior to Cortisone treatment had been unable to do so.
The Endocrinologists really need to face the fact that they are in the 21st century and people and their lives have changed therefore their BODY’s chemical system reacts differently to the demands/new stressors place upon it. That’s a very simplistic sentence, but the essence & intent is in it.
Frankly, I cannot believe how stupid the medical world is to ignore these 2 essential little glands of “Emotion & Stress” yet they have in-vitro fertilization, heart replacements, kidney replacements etc., etc., and yet the Endocrine system is the petrol & oil for the body & brain — and yes, I am aware of Big Pharma involvement but really this is way beyond the proverbial joke Doctors! If you ALL have the courage to stand up at your Medical conferences/Associations’ in public (vale Dr RGB Skinner-UK) and DEMAND that solutions are found. USE YOUR BRAINS and show by your actions that you uphold what you used to stand for: Firstly, DO NO HARM!!
Refer the Harvard Dr to historical and present day literature that Dr Thierry Hertoghe of Brussels/Belgium has as a 4th generation family of Endocrinologists AND a fellow sufferer of Hypothyroidism & Hypoadrenia and a world leader in the field of anti-aging (which is what the faltering chemical system does to a humans body — ages it).
This is one big problem that researchers’ IGNORE so much that has already been learnt in the past in the Medical world. And they especially ignore the people who are actually suffering from their INEPTITUDE and IGNORANCE and who can tell them so much. Does it NOT penetrate their brains that people throughout the World have suffered the same ghastly experiences in this area of medical ineptitude/ignorance and that the Internet has only proved that there is something terribly wrong with their medicine/treatments re thyroid & Adrenals? We can’t all have SOMATAFORM disorders when prior to this we all had full and vibrant lives and many of us rarely ill.
I’ve wondered a number of times if there has EVER been a FRAMINGHAM type of study done with regard to patients who’ve only been treated with Synthetic T4 – since it was introduced, and the illnesses that they have compared to patients treated with Porcine Extract ONLY?? (& Cortisone) – I think it may prove MORE THAN very interesting!
SO SO SAD that people who theorise such as the Harvard lady waste precious time, human lives and actually destroy whole families and friendships/relationships’ built up over a lifetime and their forbears – simply because they have little idea of what they are talking about in the broadest terms and rely on various papers to inform them, and as we know research is seriously flawed and that there are vested interests presenting their views too. This is why someone like Dr Thierry Hertoghe is invaluable as he is independent of such influences. But no paid-in-jobs people are so scared, like the Doctors of losing their pay packets and prestige, and researchers of their funding. Look at the latest Nobel prize winner who refuses to have his research published in mainstream publications. What a statement!
Sally
The adrenals and thyroid gland are linked.
Salivary adrenal tests and 24 urine thyroid tests will confirm symptomatic patient history.
We know that both high or low Cortisol and DHEA levels will affect the ability of thyroid hormone to access the body’s cells.
Further low thyroid hormone will affect the function of the adrenal glands. The patient will complain of associated symptoms.
For this reason informed Drs will provide both adrenal AND thyroid support .
Antonia
BTW, thanks for this excellent interview! Wonderful!
Antonia
Do you think Dr. Melnick might be a good doc to consider for a hypothyroid 16yo. girl with newly-diagnosed PCOS? We’re in NJ and could actually get to him. I wonder if his PCOS approach is in any way as holistic as his hypothyroidism approach. We don’t want to use the synthetic combination birth control pills. She’s not insulin-resistant, so Metformin doesn’t seem called-for, either, for her.
Keith Stumpf
I was severely Iodine deficient, thanks to the standard American diet. I started supplementing with Iodine, Selenium, and L-Tyrosine. My TSH has temporarily spiked incredibly high (38), but should return to normal in a few months. I shrank a goiter, and nodule, and now have absolutely no thyroid symptoms. I have never had this much energy in my life, and lost 56 pounds.
I agree, TSH should not be the only indicator thyroid patients look at. I’m not a doctor, but in my humble opinion, TSH is only a flag, or indicator that there could be a problem. T4 and especially T3 are the critical indicators to look at. The research on Iodine supplementation by Dr. Brownstein and Dr. Flechas is awesome, and provided me an alternative (healing) to the thyroid meds which only masked the symptoms of my growing goiter and nodule. Thyroid meds just control symptoms, they don’t heal the thyroid. The supplements I’m taking helped me wean off all meds, including thyroid meds. For me, these 3 supplements were life changing!! Just some additional food for thought.
Janie Bowthorpe
Keith, it’s actually Free T3 and Free T4 one needs to look at, not just T3 and T4, as well as symptoms. And it’s great that you had such good results with iodine!! 🙂 But a lot of folks haven’t been able to get the same great results, so you are lucky and we’re glad for you. 🙂
Barb
YaY! for YOU!!! Yes, it IS possible, and telling your story provides others with hope. Thank you for commenting. For those of us who are thyroidless, replacing the T3 NOT converted from T4 is imperative, and a T4-only med prescribed based solely on lab results (plural) is, in reality, disabling, bankrupting and deadly. I was sitting in a wheelchair, dying from congestive heart failure that cardiologists could not explain when I (not doctors) figured out that I can’t convert T4 into the T3 that every individual cell NEEDS. Within ten days of ingesting replacement doses of T3, my wheelchair was returned, because my CHF had “magically” disappeared. My a-fib and bone loss were directly caused by too much T4; today I know them as symptoms of too little T3 at the cellular level (even though I have NO thyroid, I have “thyroid” antibodies) for which there is NO blood test. In my experience, doctors who don’t know how their own healthy thyroid works are unable to help me now be my own thyroid from the outside in, and I will die after being bankrupted by all the other specialists who also don’t know how their healthy thyroid works, if I follow their “advice”.
PR Lundy
Barb, you may be interested in this study from 2011. “Levothyroxine Monotherapy Cannot Guarantee Euthyroidism in All Athyreotic Patients” PR http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148220/pdf/pone.0022552.pdf
linda
Hello Keith,
Thank you for sharing this great info and your experience. Would you mind sharing what supplement brands you use for the iodine, L-tyrosine and selenium? I would appreciate it.
Lissa Gay
I think perhaps some of the answer John is looking for, in his question about why doctors approve in general, in the suppression of the TSH in cases of thyroid cancer, is the rationale that suppressing the TSH in cases such as this, will tend to diminish the function of the gland itself in toto, and hopefully , they reason, thus reduce the activity of the cancer growth in the gland (cancerous activity) as well, until other treatment options have been carried out. ON ANOTHER NOTE, I did not know that THERE EXIST studies that show that there is no significant issue with BONE LOSS AND/OR ATRIAL FIBRILLATION WITH THE SUPPRESSION OF THE TSH. I WANT VERY MUCH TO HAVE COPIES OF THESE STUDIES! I TAKE NDT AND SO FAR I HAVE NOT FOUND A DOCTOR WHO DOES BELIEVE THIS! I HAD AN ABSCESSED TOOTH AND MY HEART RATE SHOT UP. THE DOCTOR JUMPED TO THE CONCLUSION IT MUST BE MY THYROID DOSE, SO I LOWERED IT EVEN THOUGH I FELT TERRIBLY TIRED ON ONLY ONE GRAIN, WHEN I HAD BEEN TAKING FOUR GRAINS UP TIL THEN. MY ELEVATED HEART RATE TURNED OUT TO BE FROM OTHER THINGS, INCLUDING THE INFECTION IN MY JAW. THE DOCTOR SCARED ME OUT OF MY WITS, TELLING ME THAT MY NDT DOSE (AT THE TIME OF MY ELEVATED HEART RATE AND THE ABCESS) WOULD CAUSE A-FIB AND HEART FAILURE AS WELL AS BONE LOSS, FRACTURES AND PREMATURE DEATH!. I WOULD LOVE TO HAVE SOME ACCESS TO THE STUDIES YOU REFERENCE, TO TAKE WITH ME TO MY NEXT APPOINTMENT. I ALSO HAVE LOW RENIN AND HIGH ALDOSTERONE AND VERY LOW POTASSIUM, SO I AM CHALLENGED ON THIS FRONT AS WELL, AND NEED TO FIND SOME DOCTOR WHO COULD HELP SORT THIS OUT WITHOUT BAILING ON ME BECAUSE OF MY USE OF “THE DEVIL’S OWN” NDT. SO MANY DOCTORS THINK TAKING NDT IS RISKING DEATH! WHAT ON EARTH DID THEY GET TAUGHT, TO THINK SO NARROWLY!!??
John V. Billings MS Advanced Psychiatric Nurse
I have treated treatment resistant depression with T3 when the T3 levels were below 3.0 ug/ml. I always did an assessment of their symptoms and monitored changes in their symptoms every visit. Treating major depression with T3 supplementation had a dramatic effect and frequently the use of antidepressants were decreased or discontinued.
My question has to do with the issue of TSH suppression. This was one of the biggest complaints I had from other health care professionals. If it is ok to suppress the TSH in patients with thyroid cancer, and the studies show that there isn’t a significant issue with bone loss or atrial fibrillation, why is it so taboo to suppress the TSH in treating other thyroid conditions?
Barb
Because then doctors would have to treat actual patients quite frequently, instead of a (singular) lab result once a year, and their lack of education about how a healthy thyroid actually works would be, um, glaringly obvious. For me, being thyroidless, a suppressed TSH means my PITUITARY is working EXACTLY as it’s supposed to work (I never did have a PITUITARY problem). 🙂
PR Lundy
John, treating with T3 almost always leaves the TSH suppressed and FT3 at the top of range or above. Paul Robinson gives a very good explanation in his book “Recovering With T3” of the type of lab results patients have on T3. This has also long been a problem with shrinks. In the study done by Kelly T. et al 2009 they finally used suppressive doses and achieved results similar to your own. Myths die hard in medical science. You have to keep in mind that at any point in time science rarely has a full understanding of the situation and therefore many assumptions are based on incomplete information. As has been mentioned elsewhere on Janie’s site, it is actually common for many of us to suppress our TSH before we feel ‘normal’. Keep treating and paying attention to the patient. PR
Carol Nelson (Venizia)
What a wonderful article and yet frustrating one. Dr. Melnick is a doctor we need desperately. Hopefully, he and those who understand this devastating disease and its inferior treatment can make those doctors, who are stuck in the dark ages for treatment and diagnoses, be wiling to open up their minds and think beyond their inaccurate medical books. This is such a long and uphill battle for all those who want to feel well and find a doctor who understands. Thank you Janie!!! THANK YOU Dr. Melnick!!!!!!