Saturday, February 21, 2009
The national health service NHS, of the United Kingdom, has banned the use of Armour thyroid, compounded combination thyroid preparations, Cytomel, and other products with anything but LT4 in them for treatment of hypothyroidism for all patients treated by the NHS. This is a good step by the NHS to get rid of these second tier drugs that cause more harm than good. The recent story by Ms. Shomon on about.thyroid.com was off base as usual, and aimed again at the fringe patients who feel they are not "doing well" on T4 alone, even though all the proven tests of T4, and TSH are completely normal. They are not hypothyroid, but are truly not feeling well, but for other reasons, not thyroid. As an expert in thyroid disease for 35 years, I am glad that we are finally seeing the beginning of the end of these drugs. To all the thyroid patients in the NHS, and the USA, do not pay any attention to doomsayers like Ms. Shomon, as she is not a physician, and as a hired gun for a large corporation, has an interest in appealing to the patients who are unhappy with the results of their thyroid therapy, even though it is properly treated with thyroid hormone of the T4 type. However, there are problems with the other part of the NHS guidelines. Although a TSH less than 10 is rarely associated with symptoms, as they correctly state,therefore, therapy for pure hypothyroidism is rarely needed when a TSH is less than 10. However, the problem is more complicated than that. TSH values between 2.5-10 are abnormal,and are associated with other problems than symptomatic hypothyroidism. As the TSH rises there is a increased risk of cancer of the thyroid, nodules, and goiter formation. If the NHS mandates ultrasounds for all patients with elevations of TSH above 2.5 and there is no goiter, or nodules, then follow up without thyroid therapy is reasonable. Also if the patient does not have heart disease or lipid abnormalities, then the use of TSH > 10 is a reasonable choice for symptomatic hypothyroidism for therapy. Remember, by the time the TSH rises it may be already the cause of significant nodule formation,and increased risk of thyroid cancer.