A recent article in the February issue of Endocrine Practice, which is directed at hormone specialists, discussed the use of adding thyroid hormones to very sick people in hospital ICU situations.
The term “Sick Euthyroid Syndrome” is given for people who have abnormal blood tests for thyroid hormones (T3 and T4) during a variety of acute and chronic illnesses.?? For some reason, there is controversy in the medical community over whether to give prescription thyroid hormones (meaning non-bio-identical) to these patients.
This latest study was a review of a number of other studies that tried to examine the outcomes of double blind studies in very sick people.?? The author’s conclusion was that doctors should not worry about the thyroid gland or concern themselves with terribly abnormal lab values on T3 and T4 because the outcomes did not change whether patients received them or not.
The author says that it is debatable if alterations in thyroid function produce negative effects or simply reflects the multisystem failure that occurs in critically ill patients.?? He says what it is not debatable is that thyroid hormone replacement (non-bio-identical) has no benefit.
Wow.?? Just hope he doesn’t become your doctor if you get very sick.
I get in major debates frequently with my mainstream colleagues on adding thyroid hormones to people who exhibit symptoms of hypothyroidism but show “normal” thyroid lab values.?? But when someone has off-the-wall thyroid blood tests and doctors refuse to treat that – yikes!
Let me offer some reasons why adding thyroid hormones in acutely sick patients in an ICU setting seem to offer no benefit:
Thyroid is sloooooow.?? The half life of T4 (Thyroxine) is about a week.?? The body takes at least a week or two to respond to each dosage change.?? In an office setting, it typically takes 4 – 6 months to get the ideal dose of thyroid hormone right.?? Acute ICU patients are dead by then.?? Most likely, acute ICU patient with a preceding chronic problem (like heart disease) are already hypothyroid for longstanding period unrecognized by the medical profession.?? Too little, too late.
The wrong thyroid hormone is prescribed.?? Prescription T4 is usually levothyroxine, which is a backwards “dimer” of thyroxine.?? it is not natural.?? This is why drug companies can get a patent on it because it is not found in nature.?? Who knows what your body thinks of it?
T4 to T3 conversion is practically non-existent in sick people. The active form of thyroid hormone is T3. Doctors almost always prescribe a T4 variant. Many people have trouble converting T4 to T3 anyway.?? This is more pronounced in acute illness and all bets are off.
What does all of this have to do with migraine headaches? Practically every one with migraines I have ever met exhibits some symptoms of hypothyroidism (although their blood tests are almost always “normal”).
By the way, a good thyroid resource website to look at is www.1-Thyroid.com?? I helped to write it.
Andrew Jones, M.D.
Medical Director, Women’s Health Institute of Texas