Endokrinologer halverte behandlingsdoser i 1973

[Anisa]

Jeg har lest på www.drlowe.com at amerikanske endokrinologer halverte behandlingsdosene med tyroksin i 1973.

Før dette var behandlingsdoser 200-400 mikrogram pr dag. Dette førte til at TSH ikke var målbar, så da måtte dosene senkes slik at de fikk brukt TSH-testen. Ingen vits i å ha en flott ny test hvis den ikke er målbar i en stor gruppe pasienter! :( Og så ble det bestemt at behandlingsdosen skulle være 100-200 mikrogram daglig....
Han spekulerer i om den plutselige oppblomstringen i diffuse sammensatte sykdommer (Fibomyalgi, Kronisk Tretthetsyndrom) er kommet som en direkte følge av TSH-testen, for høye referanseområder og halvering av tyroksindoser.

Citat: The genesis of the misguided concerns you expressed was a number of studies published in the early 1970s. Researchers tested patients taking 200-400 mcg of T4--common therapeutic dosages at the time, but dosages that suppressed the TSH level. They found "abnormal" values for a number of biochemical measures, and changes such as increased heart rate during sleep. There was no evidence that these findings were harmful to the patients, but the researchers speculated that the findings would eventually lead to significant health problems. They advised clinicians not to permit patients to take more than 100 to 200 mcg--the amount that keeps the TSH within the normal range. Clinicians complied, and as a result, we read statements by clinicians such as yourself, advising patients to get their TSH levels checked. (You wrote, "To find out whether your thyroid function is normal, ask your doctor to do a blood test to check your TSH level.")

The well-intended but scientifically unjustified conclusion that the only safe and effective T4 dosage is one that keeps the TSH within the normal range started in 1973.

Since then, complaints by patients that these dosages leave them symptomatic have become legend. It is a sad commentary on modern medical practice that clinicians now strive for a mid-range TSH and ignore the fact that it leaves many patients suffering--all because of a speculation made almost 25 years ago that has failed to be supported by subsequent scientific studies. I want to emphasize for you: studies have not confirmed the conjecture that dosages of 200-400 mcg cause patients any harm. Quite to the contrary, some studies have shown that these dosages are the only ones that benefit many patients. Still, though, most patients are denied the opportunity to determine whether such dosages are beneficial for them. The reason is that this speculation has now become entrenched in the unquestioning minds of many clinicians.

As a result, hypothyroid patients the world over, including hypothyroid fibromyalgia patients, live a life of hell because of what I call the tyranny of the TSH.

Kilde: Dr. Lowe's Response to Robert Loblay, M.D. June 10, 1997 http://www.drlowe.com/jcl/comentry/drloblay.htm (ikke længere online efter dr. Lowe's død, men kan fortsat læses på Web.archive.org: http://web.archive.org/web/201204061...y/drloblay.htm)

EDIT/Mod:

Jeg har lest på www.drlowe.com at amerikanske endokrinologer halverte behandlingsdosene med tyroksin i 1973.

Dessverre er Dr Lowes nettinfo ikke lenger tilgjengelig

"The number of patients with chronic, widespread pain (a classic symptom of hypothyroidism) increased in the mid-1970s to a point that rheumatologists began totake notice. This occurred shortly after endocrinologists, in 1973 and 1974, recommended cutting hypothyroid patients’ thyroid hormone dosages in half. This reduced patients’ dosages from the equivalent of 200-to-400 mcg of T4 to 100-to-200 mcg. [74][75] The purpose was to raise the patients’ TSH levels. (The new TSH test had recently come into widespread use.)" (...)

"As standard practice at this time, physicians had come to adjust patients’ thyroid hormone dosages to keep their TSH levels within the reference range.[77] As Dr. David Derry wrote in the British Medical Journal, "In 1973 thyroidologists officially endorsed the newly designed TSH test for thyroid function . . . ."[78]

• [74] Evered, D., Young, E.T., Ormston, B.J., et al.: Treatment of hypothyroidism: a reappraisal of thyroxine therapy. Br Med J. Jul 21, 1973; 3(5872): 131–134.
• [75] Stock, J.M., Surks, M.I., and Oppenheimer, J.H.: Replacement dosage of L-thyroxine in hypothyoidism - A Re-Evaluation N. Engl. J. Med., 1974 Mar 7;290(10):529–533.
• [77] Vanderpump, M.P., Ahlquist, J.A., Franklyn, J.A., et al.: Consensus statement for good practice and audit measures in the management of hypothyroidism and hyperthyroidism. The Research Unit of the Royal College of Physicians of London, the Endocrinology and Diabetes Committee of the Royal College of Physicians of London, and the Society for Endocrinology. BMJ. Aug 31, 1996; 313(7056): 539–544.
• [78] Derry, D.M.: Consequences of the TSH. BMJ 2000;320:1332

Source/Kilde: Critique of replacement studies by Dr. J. C. Lowe