The History and Future of Treatment of Hypothyroidism

[Nelson Vergel]

The History and Future of Treatment of Hypothyroidism Posted: 11 Jan 2016 10:46 AM PST Thyroid hormone replacement has been used for more than a century to treat hypothyroidism. Natural thyroid preparations (thyroid extract, desiccated thyroid, or thyroglobulin), which contain both thyroxine (T4) and triiodothyronine (T3), were the first pharmacologic treatments available and dominated the market for the better part of the 20th century. Dosages were adjusted to resolve symptoms and to normalize the basal metabolic rate and/or serum protein-bound iodine level, but thyrotoxic adverse effects were not uncommon. Two major developments in the 1970s led to a transition in clinical practice: 1) The development of the serum thyroid-stimulating hormone (TSH) radioimmunoassay led to the discovery that many patients were overtreated, resulting in a dramatic reduction in thyroid hormone replacement dosage, and 2) the identification of peripheral deiodinase-mediated T4-to-T3 conversion provided a physiologic means to justify l-thyroxine monotherapy, obviating concerns about inconsistencies with desiccated thyroid. Thereafter, l-thyroxine monotherapy at doses to normalize the serum TSH became the standard of care. Since then, a subgroup of thyroid hormone–treated patients with residual symptoms of hypothyroidism despite normalization of the serum TSH has been identified. This has brought into question the inability of l-thyroxine monotherapy to universally normalize serum T3 levels. New research suggests mechanisms for the inadequacies of l-thyroxine monotherapy and highlights the possible role for personalized medicine based on deiodinase polymorphisms. Understanding the historical events that affected clinical practice trends provides invaluable insight into formulation of an approach to help all patients achieve clinical and biochemical euthyroidism. McAninch EA, Bianco AC. The History and Future of Treatment of Hypothyroidism. Ann Intern Med. 2016;164:50-56. http://annals.org/article.aspx?articleid=2480052

 

[Sean Mosher]

I haven't heard about thyroid problems as much in men.
Is it something that needs to be regularly tested along with our bloodwork for TRT??
What would the symptoms in men be to alert you to a potential problem?

 

[Vince]

Signs and symptoms that could be due to hypothyroidism include:
Chronic fatigue
Cold intolerance
Weight gain
Headache
Trouble concentrating
Aches and pains
Constipation
Dry skin

 

[Nelson Vergel]

Look at what I just put together from one my lectures on thyroid health.

Graphics: Diagnosis of Thyroid Dysfunction and Its Treatment