COMMENT:THE SCANDAL OF THYROID CARE

Two recent stories in the newspapers have underscored the scandal of thyroid treatment today. This occurred not long after the decision by the UK’s General Medical Council (GMC) the regulatory body for practising doctors to suspend a Surrey based GP

Dr Barry Durrant Peatfield has had 40 years of experience in treating thousands of patients suffering from thyroid and adrenal insufficiencies, usually by prescribing natural thyroid hormones and frequently with low dose adrenal support such as hydrocortisone.

Hundreds of his patients sent letters of support to the GMC, but these were not even read. The decision to suspend him apparently had been taken before the final hearing they declared that he was a “danger to patients”.

Dr Durrant Peatfield’s crime was his use of a range of diagnostic methods rather than relying solely on blood tests, and his preference for prescribing the much more powerful (natural) thyroid hormone Tertroxin (T3) rather than Eltroxin, the usual UK version of the synthetic drug thyroxine sodium.

His real crime was his decision to avoid the current conventional thyroid treatment. The GMC considered this avoidance “dangerous” practice. However, new developments show that one of the drugs used in the US as standard thyroid treatment is itself so potentially dangerous that the American authorities now believe it may have to be taken off the market (see p 9).

The US Food and Drug Administration (FDA) is considering banning the drug Synthroid (levothyroxine), a popular thyroid drug produced by Abbott. This 40 year old drug, which has never been officially approved by the FDA for either hypothyroidism or other thyroid disorders, has had a “history of problems” and cannot be considered “safe and effective”, according to the Wall Street Journal (1 June 2001).

The main problem with this and other brands of levothyroxine is the wide variation in potency. This became apparent when the FDA began compiling data on adverse events associated with these drugs in the mid 1990s. Regulatory action, which may include removing the drug from the market, could start as early as the middle of this month.

It’s not surprising that medicine takes an overly simplistic approach to thyroid problems. Normal thyroid functioning is a highly complex matter.

Thyroid hormones are produced in the thyroid gland, and include mostly tetraiodothyronine (thyroxine or T4), some triiodothyronine (T3) and a little diiodothyronine (T2), plus calcitonin.

Most of the T4 undergoes deiodinisation (it loses an iodine molecule) and is converted by certain liver enzymes in peripheral tissues (liver, kidney and heart) to T3, which can be used by other organs and tissues.

The whole process is initiated in the brain by the hypothalamus (through the release of thyroid releasing hormone [TRH]) and controlled by the pituitary gland (through the release of thyroid stimulating hormone [TSH]).

There is a complex feedback mechanism between the thyroid and hypothalamus, so things can easily go wrong in the conversion process. When this happens, the result is a condition like hyper thyroidism (too many circulating thyroid hormones) or hypothyroidism (too few circulating thyroid hormones).

Often, a thyroid patient may be T3 starved while literally awash in T4. This is far more likely with the use of synthetic, rather than natural, T4 such as used by Dr Durrant Peatfield which contains all thyroid components and is said to be stable in its potency.

Medicine ignores the fact that the T3 to T4 conversion process is delicate and fraught. The treatment for patients with low thyroid is predicated on the erroneous assumption that everyone can convert T4 (even the synthetic variety, which standard thyroid drugs are) to T3. As a consequence, synthetic thyroxine has been promoted as the sole treatment for hypothyroidism.

However, at least two main problems can arise in the complex sequences of thyroid function. One is the conversion process itself, which is impaired if certain cofactors aren’t present. For example, it requires selenium as an integral component. Other liver enzymes involved in the conversion of T4 to T3 may be impaired by environmental toxins, such as fluoride or mercury.

The other problem is blocked receptors, resulting in reduced tissue uptake and accumulation of T3 in the blood.

In addition, a number of external factors can affect blood thyroxine levels without affecting clinical status, including viral infections, pregnancy or HRT (high oestrogen states), or drug interactions (such as with heparin). Reduced T4 levels can also occur as a result of severe illness such as chronic kidney failure, major surgery, caloric deprivation or even prescription drugs, such as phenytoin and androgens or even ironically T3 therapy.

Because low thyroid states have few noteworthy symptoms and don’t show up on blood tests, they often go undiagnosed. When they are identified, medicine offers a synthetic solution that may not work or, with some varieties, may even be dangerous.

Dr Durrant Peatfield had one of the most successful track records for treating patients in the UK. The fact that he has been struck off is all the more scandalous when you consider that one of the standard treatments to treat thyroid problems is considered so dangerous, it may be hauled off the market any day now. This is not good medical practice. This is a witchhunt by powerful vested interests whose rationale has little to do with the good of patients.

!ADoris Jones