Dynamic Chiropractic - What your hypothyroid patients should know about Synthroid
Synthroid, a brand of thyroid hormone, is the third most prescribed drug in the United States. Over the past year, the product has been the subject of intense controversy. Although DCs do not prescribe Synthroid, the controversy is relevant to us. Synthroid is likely to limit the effectiveness of the musculoskeletal treatments you provide for your hypothyroid patients. The poor treatment outcome leaves patients suffering and DCs frustrated and perplexed.
Background
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I began treating hypothyroid patients with medical physicians in the mid-1980s. Then, as now, Synthroid was the only brand of thyroid hormone that mainstream physicians would prescribe. Their refusal to prescribe other brands was the successful outcome of a powerful marketing campaign by Synthroid’s manufacturers - formerly Knoll Pharmaceuticals (Knoll) and now Abbott Laboratories (Abbott). The marketing was reinforced by an almost unanimous endorsement of Synthroid by the endocrinology specialty. Mainstream medical physicians believed that Synthroid was the absolute pinnacle of the development of thyroid hormone products.
Some of my hypothyroid patients improved or recovered with the use of Synthroid. Many didn’t, however, and for a time I thought these patients’ persisting hypothyroid-like symptoms must be caused by nonthyroid disorders. I soon learned that hypothyroidism was the cause of their symptoms and that Synthroid failed to relieve them.3,4
In the early 1990s, I began referring hypothyroid patients to alternative MDs. Most of these physicians prescribed Armour Thyroid or Thyrolar, brands of thyroid hormone that contain both T4 (levothyroxine) and T3 (triiodothyronine). When an MD in my clinic began prescribing Cytomel, which contains only T3, results were usually even better. For most patients, treatment results with these products were distinctly superior to those with Synthroid, which contains only T4. A much higher percentage of patients using these products became normally responsive to chiropractic treatment and completely recovered from their musculoskeletal symptoms. These experiences drove me to a conclusion many alternative MDs share: The underlying cause of many patients’ chronic, treatment-resistant musculoskeletal symptoms (often diagnosed as “fibromyalgia”) is hypothyroidism ineffectively treated with Synthroid.4
Despite Synthroid’s relative ineffectiveness, when mainstream MDs in the United States diagnose hypothyroidism, they habitually write “Synthroid” on their prescription pads. Why? Because dogged endorsements of the drug by endocrinologists have fused the words hypothyroidism and Synthroid as inseparably as runny nose and Kleenex.
Why Endocrinologists Endorse Synthroid
Endocrinologists dictate other mainstream medical specialists’ beliefs about hypothyroidism and its treatment. One such belief is that the proper aim of thyroid hormone therapy is to bring the patient’s thyroid-stimulating hormone (TSH) blood level into the reference range (formerly called the “normal range”). To endocrinologists, when a patient’s TSH level is within this range, the patient is ipso facto well, even if he or she remains disabled by hypothyroid symptoms.4,6,7
Treating hypothyroid patients according to this criterion has left millions of them chronically ill, disabled, and prematurely dead.4 The reason is clear. During primary hypothyroidism, the pituitary gland increases its release of TSH, raising the blood level above the reference range. The pituitary is highly sensitive to T4, and small dosages of T4 decrease the pituitary release of TSH, lowering it into the reference range. Tissues other than the pituitary are comparatively insensitive to small dosages of T4. Much higher dosages are required to normalize the metabolism of these other tissues. However, T4 does not increase the metabolism of many patients’ tissues, no matter how high the dosage. Only a thyroid hormone preparation that contains T3 will accelerate these patients’ metabolism. Hence, when T4 therapy normalizes TSH blood levels of many patients, it leaves their metabolism subnormal. These patients remain symptomatic despite their normal TSH levels. This finding has led researchers, myself among them, to urge physicians to no longer titrate patients’ thyroid hormone dosages by TSH levels.4,6,7
In view of this, why do endocrinologists resolutely endorse Synthroid as the only brand of thyroid hormone any hypothyroid patient ever needs to use? The cause is a complex interplay of factors. Prominent among them are financial incentives to the endocrinology specialty from corporate marketers of Synthroid. The corporations have richly funded the specialty. He who pays the piper, of course, calls the tune. This reality makes the proposition plausible that lavish funding by these corporations has shaped endocrinologists’ beliefs about hypothyroidism - beliefs that are favorable, quid pro quo, to the financial interests of the corporations, yet shown false by substantial scientific evidence.1,4
