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T3 + T4 |
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| Name: liothyronine (T3), levothyroxine (T4)Content: 30 + 120 mcg/tab. (100 tab.)Manufacturer: GENESIS (Singapur) | ||
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| ( Genesis ) |
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24.90 €
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(liothyronine - T3, levothyroxine - T4) 30 + 120 mcg/tab.(100 tab.)As written in our prior article, before having a chance to review the full study, the progress of medical science is very slow, not dependent on any one particular research project. It was my preliminary impression that it would be premature to conclude that T3 added to T4 is not useful. Now that I have read the Sawa. et. al study, I am even more of that opinion.From what I can observe, these were not well-designed studies. Doctors familiar with using T-3 in combination with T-4 in appropriate situations would NOT have used these particular amounts of T-3 and T-4. Frequently, a person with 125 mcg of T4 might get 5 mcg of T-3 added to it, with good results. In the Sawa study, people had their T4 reduced by 50% (resulting in a comparatively low dosage of T4), and then were given 12.5 mcg twice a day of T3 (a comparatively very high dose).Simply put, this is the wrong dosage for almost everyone. This would be like reading a sex manual written by a eunuch! It's almost as if they didn't know how to use T3 successfully, or perhaps didn't even care to learn. A more mercenary mind might even wonder which drug company was funding the study, which is always a fair question and should be considered in all pharmaceutical research.Successful practicing physicians that we are in contact with many in our practitioner Thyroid Power seminars would never approach it this way. Why the researchers came up with this experimental design I cannot fathom, except to wonder about their desire for objective data.If they wanted to really test the idea of benefits from the addition of T3, they could have consulted with Nathan Becker, Professor of Endocrinology at UCSF Medical Center what dosage he's been using that has made him so successful at this over the past 20 years.They could have asked Ridha Arem, a Professor of Endocrinology at Baylor and editor of a thyroid journal. Or, they could have simply read his book, The Thyroid Solution, wherein he describes a more modest reduction of T4 before adding a smaller amount of T3 than these researchers chose.They may have instead chosen with Dr. Glenn Rothfeld, a professor of Medicine at Tufts University, whose thyroid book Thyroid Balance suggests an addition to T4 of perhaps 5 mg. T3, not 12.5 twice a day.Or, they could have asked me, though I'm "just" a Family Doctor; I've been providing a Becker-Arem-Rothfeld type protocol as a practicing physician for over 25 years, and have also written a book on this topic, Thyroid Power.In addition to the problem of dose, there were other difficulties with this experiment. In a manner not fully described, an independent doctor adjusted the doses of the T-3 added participants to "keep the TSH within normal range", which they describe as 0.5 - 5.5. Anyone who is up on recent advances in thyroid care is aware that the AACE and the Association of Clinical Chemists who come up with these normal ranges have, for years now, been advising a more narrowed TSH range, saying this was too broad and therefore incorrect. In recent years, they have suggested lower and more narrow ranges.The research studies in question are using the older ranges. An editorial from the same journal lists, in addition to these problems, several other difficulties with the experimental design. What the editors commented on was "more needs to be done to understand why some patients do not feel completely well on what, according to current standards, is adequate thyroid hormone replacement". In other words, even the editors of one of the most prestigious journals, are saying that we indeed still have a problem that is not fully understood, and that more research needs to be done. They enumerate how the future research should be improved.So where does this leave us? The editors needed to be kind and diplomatic to the authors of this research, but I do not feel this same compulsion; I feel the need instead to be kind to my patients, and to help them to feel better. I think this research design utilized inadequate and inappropriate methods of partially replacing T4 with T3.How would these previously-mentioned professors of endocrinology, and I, do it differently?First of all, a person who is on 125 mcg of T4 and has TSH of 1.75 might already be under-medicated with too low a dose of T4 to handle all their symptoms.Second, this may be an inadequate dosage, in fact, for anyone who weighs more than 125 pounds, as many thyroid patients do (using the 1 mcg per pound of body weight formula).Third, once you do decide to add T3, don't reduce the T4 by 50%, as was done in the research study. Instead, maybe cut it down by 12.5 or 25 mcg, and add 5 mcg T3 initially.Then, depending upon the patient's response, you could add additional amounts of T3, with or without further reducing the T4. Once again, you would closely monitor the patients' symptoms and test results. It's impossible to tell in this study, since they haven't revealed this, how the dosages were adjusted, using what criteria, and when. All we were told was that adjustments were made to keep the TSH in the (incorrect) normal range.I have had frequent success with the combined T3 / T4 therapy, using it in a way that is perhaps difficult to duplicate in a standardized research protocol. It may be difficult to study this appropriate under lab conditions. Perhaps this means that careful individualized patient-centered health care is hard to compress and standardize for research purposes.In summary, it is my impression that this study proves nothing, except that giving way too much T3, and way too little T4, is just as bad for some patients as is T4 alone, This is especially true when the old outdated TSH ranges are used. It is also true when the T4 (Synthroid) dose is insufficient in the first place.Therefore I urge anyone who is not doing well on their T4 alone to try different dosages and perhaps different brands of T4. Then, for further support if symptomatic, try a small amount of T3 added (without dropping your T4 levels by half!) Not everyone, either in studies or my clinical practice, does better with the addition of T3 to their T4 - but many do. And you may be one of them. You deserve a chance to find out. |
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