JAMA Publishes New Research Saying T3 Offers No Benefit

T4 and T3 Controversy Continues

Different Causes of Hypothyroidism

Studies have included patients who became hypothyroid by different means. The NEJM study in 1999 looked at patients with surgical or post ablative hypothyroidism. The JCEM studies included mixed groups, and the JAMA study were Hashimoto’s patients. How different patients become hypothyroid may significantly impact the type of treatment that is most effective, the optimum TSH at which relief of symptoms is achieved, and the type of thyroid hormone to which they are most responsive. These factors have not been studied in any of the research.

What Should You Do?

At this point, you should continue taking whatever thyroid hormone replacement treatment offers you the best possible relief of symptoms, safely. And this can only be determined by you and your practitioner, evaluating your symptoms and test results. None of these studies has practical significance for thyroid patients who are on a particular treatment and have found that it is working optimally, without significant side effects.

Roby Mitchell, MD, a holistic practitioner and radio host known as "Dr. Fitt," had this to say about the JCEM T4/T3 studies:

…we only have to look back at all the prospective, randomized, double blinded, placebo-controlled trials 'proving' that hormone replacement with Premarin and Provera would reduce heart disease, Alzheimer's and didn't cause breast cancer. No clinician who routinely uses T3 therapy would buy either of these studies read or unread as they just don't match up with clinical experience…”

Drs. Richard and Karilee Shames, authors of Thyroid Power, had some good advice after the October JCEM studies came out, and it bears repeating here.

IT DOESN'T MATTER IF 100, OR 1000, STUDIES SHOW THAT MOST PEOPLE DO BETTER WITH THYROXINE ALONE. THERE ARE ALWAYS SOME PEOPLE IN ANY OF THOSE STUDIES THAT DID BETTER ON THYROXINE WITH T3 ADDED. There are some people who do better on T3 alone. There are some who do better on Armour thyroid alone. There are some who do better with a mix of Armour and thyroxine. NONE OF THE STUDIES OF THESE QUESTIONS WILL EVER BE 100% IN ANY ONE DIRECTION. People are just too different. Nothing is black and white.

What this means to us is that there are some people who may do better on the combo. You may be one of them, or you may not be. It is more likely that you are one of them if you are currently not doing all that well on thyroxine (T4) alone.

Keep an open mind and you'll be one step ahead of many of the doctors and the researchers.

Overall, it’s safe to say the controversy will continue until either a commercially available long acting or “slow-release” form of T3 becomes available and studies are done with appropriate dosing schedules of the right forms of T3 to determine the proper role of combined T4 plus T3 in the therapy of hypothyroidism.

Note: For additional information on the T4/T3 issue, read: “Combined T4/T3 Therapy: Placebo or Tomato? An Assessment” by Kenneth Woliner, MD and see various practitioner thoughts about the T4/T3 controversy.

Dr. William Cline contributed to this article.