Om Armour eller thyroxin og lav TSH

Her er kanskje noe bra om Armour eller thyroxin og lav TSH:
http://bmj.bmjjournals.com/cgi/elett...7384/295#35891

"High dosage thyroid replacement should be considered in 'refractory' hypothyroidism

Dear Sir,

There has been correspondence in the British Medical Journal (8th February 2003) discussing tangentially risk assessment in patients receiving high dosage thyroid replacement. As my practice is mainly concerned with problems of thyroid function, I seek advice from colleagues on the advisability of long term high dosage thyroid replacement in patients with refractory hypothyroidism.

Hypothyroid patients who do not respond to thyroid treatment comprise two groups namely patients who show no improvement but become clinically thyrotoxic and patients who show no improvement nor adverse effect. The latter creates a frustrating and difficult situation for both patient and doctor which is often compounded by FT4 or FT3 levels above the upper limit of the 95% reference interval and TSH levels approaching zero.

During the last decade I have treated at least fifty patients who had irresolvable or refractory hypothyroidism with sodium thyroxine at dosages over 350µg per day or natural Armour Thyroid extract at over 4 Grains per day or a combination of the two medications at equivalent dosage. These patients have been returned to optimal or near optimal health with no evidence of adverse effect.

The critical question concerns possible long term adverse effects. A priori, it is unlikely that restoration of a patient to health where she is up and about and living a full life will be detrimental or associated with long term pathological sequelae. Perceived complications are unproven. Cardiac irregularity is a well recognised feature of hypothyroidism and usually disappears on thyroid replacement and (in my experience) asymptomatic thyroxine induced irregularity is rare but is easily detected by physical examination and is reversible within 1-2 days. Evidence of osteoporosis is insecure and may have arisen from the purported association of osteoporosis with chronic hyperthyroidism where there may also be accompanying hyperparathyroidism with bone demineralisation but this is speculation. The author has never encountered significant adverse effects in patients restored to euthyroidism by high dosage thyroid replacement.

There is a second more philosophic consideration; many patients unequivocally state that they would rather run the gauntlet of putative and unproven pathological sequelae than continue a wretched hypothyroid existence. This raises an ethical question on the degree of self determination or self selection of medical care which is desirable, acceptable or indeed is a patient¹s right in a society based on consensual rather than dictatorial principles.

However it remains an unpalatable fact that many patients are receiving inadequate and ineffective thyroid replacement from unfounded fears that return of a patient to euthyroidism will be accompanied by crumbling bones or undiagnosable cardiac pathology. It is suggested that the efficacy and safety of higher dosage thyroid replacement be subjected to the scrutiny of formal clinical trial.

Yours sincerely,
Gordon R B Skinner MD, DSc, FRCOG, FRCPath

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