Talk:Desiccated thyroid extract
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- 1 Encyclopedic Tone?
- 2 Clinical trial
- 3 Wilson's Dessicated Thyroid?
- 4 RCT patient preference
- 5 Current status of thyroid extract use
- 6 Article biased, needs fixing
- 7 Desiccated Thyroid Powder is not the same as Desiccated Thyroid Extract.
- 8 Improve readability and information on Desiccated thyroid extract wikipedia page
- 9 Edits July 2014 for balance
- 10 material supported by dead reference removed.
While I think this article is well done, I wonder about the use of a question format in the last section of the article. Is there a way to write this section so that instead of questions, these uncertainties could be presented in a more encyclopedic format? I may attempt to edit this in the future, if there are not good reasons to leave this question format. --Coppercable (talk) 20:13, 7 July 2010 (UTC)
I've archived the old talk page. This article is missing one of the few trials on DTE, which I found on the hypothyroidism article. I have verified that dessicated thyroid extract was used in this trial: *Baisier, W.V.; Hertoghe, J.; Eeckhaut, W. (September 2001). "Thyroid Insufficiency. Is Thyroxine the Only Valuable Drug?". Journal of Nutritional and Environmental Medicine 11 (3): 159–66. doi:10.1080/13590840120083376. — Abstract
This was not a controlled trial. It simply found that some patients who didn't respond to T4 responded to T4 + T3. Impossible to know whether synthetic T4 + T3 would have had the same result. II | (t - c) 03:41, 7 March 2009 (UTC)
Wilson's Dessicated Thyroid?
Whilst the Armour company is the best known now, the medical literature is replete with references to glandular preparations (including, but not just, desiccated thyroid) supplied by "The Wilson Laboratories" of Chicago Il (Part of Wilson and Company - another huge meat packer). I understand Wilson Laboratories were subsequently bought by Inolex. Various staff also published papers whilst working for "The Wilson Laboratories", mostly on the correct preparation of glandular products.
RCT patient preference
No mention is made that in a number of trials of combined T4 and T3 versus T4, patients express a preference for the combined treatment, even when blinded.
Related to the controversy in desiccated thyroid, as it may be patient preference for combined T4 and T3, has the same basis as the preference for desiccated thyroid. Although none of the studies tie it to any clear change in reported symptoms or measures of psychological well being or mental acuity. It is presumably possible combined therapy improves something that isn't being tested for in the trials.
Some case and anecdotal strong preference for desiccate thyroid are almost certainly due to patients with problems in converting T4 into T3, who receive little benefit (or occasionally adverse effects) from thyroxine only treatment.
- Grozinsky-Glasberg et al 2006 found only one trial where combination was better than T4 alone ... I'm not seeing the preference either. II | (t - c) 21:48, 19 March 2009 (UTC)
- Joffe 2007 Not all studies included patient preference, and Grozinsky-Glasberg doesn't list it in the comparison. Found a better review (from this perspective) in Joffe which notes: " in the four studies where patient preference for treatment was assessed, three10,15,16 report patient preference for combination treatment, and only one reports no preference for treatment type.12". —Preceding unsigned comment added by 184.108.40.206 (talk) 20:09, 11 April 2009 (UTC)
Current status of thyroid extract use
Re: Current Status of Thyroid Extract Use
“When their blood levels of thyroid hormones and TSH are most normal, the majority have no more signs or symptoms of hypothyroidism than similar members of the population.”
The key word in this sentence is “majority “ – Although the majority of hypothyroid individuals do fine on just synthetic T4 alone – there is a significant minority of individuals that perform best when taking a combination of T4 and T3, within this group there are also individuals that do best when they take desiccated thyroid or a combination of synthetic T4/dessicated thyroid (1, 2).
More recent studies have identified biological factors that may account for these differences. For example, up to 16% of the population have a genetic variation that decreases the effectiveness of deiodinase D2 enzyme in the conversion of T4 to T3 in target organs. Individuals that perform better using a T4/T3 combination are more likely to have this genetic variation (3).
1. The New England Journal of Medicine. “Effects of Thyroxine as Compared with Thyroxine plus Triiodothyronine in Patients with Hypothyroidism”, Vol. 340, No. 6, 1999.
2. European Journal of Endocrinology. “Effect of combination therapy with thyroxine (T4) and 3,5,30-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study”, 161 895–902, 2009.
3. Journal of Clinical Endocrinology and Metabolism. “For Some, L-Thyroxine Replacement Might Not Be Enough: A Genetic Rationale.” May, 2009. — Preceding unsigned comment added by Bjnorth (talk • contribs) 03:41, 20 October 2011 (UTC)
- In my opinion, there should be some wiki page or section that deals with the controversy/debate on T3, slow-release T3, T3+T4, and T4 (and maybe desiccated thyroid). Glennchan (talk) 16:49, 5 October 2013 (UTC)
Article biased, needs fixing
Thyrotropin (talk) 04:00, 23 October 2011 (UTC)Many thyroid treatment research articles define "success" when a perceived level of hormone from a secondary effect is satisfied i.e. the TSH test. The "normal" range for this test is under periodic revision. The current generation of the TSH-test is now at Gen 5, and the upper level for acceptable TSH level, which is trending down, is set to 2.0 in one medical textbook published by Springer but is typically higher, like 4.5. http://www.springer.com/medicine/book/978-3-642-13261-2
The TSH level in the body is set by a feedback mechanism involving many factors, which to my knowledge, are not tested, the mechanism is assumed to be working. The desired effect from L-Thyroxine further depends on deiodination where three different enzymes are involved. How often is the effectiveness of the deiodination measured? The T4 --> T3 deiodination effect of L-Thyroxine (T4) depends on an intracellular process, many cells processes T4 and the resulting T3, may not be offered for circulation but used locally.
The range for "normal" TSH typically is 0.4 - 4.5, which furthermore can be argued on a numerical basis as having a 1:11 ratio. Using "the majority" as an argument for an acceptable level of quality is pretty lame. Synthetic L-Thyroxine is shipped with a list of side-effects which is remarkable, when you consider that "only" a missing hormone is being replaced. The thyroid gland normally produces other hormones, of which the most significant may be the T3, and in typical therapy only T4 is offered. Some persons cannot convert T4 correctly, and T3 have been used alone in some cases. (Synthetic T3 in a more recent product). The natural form of thyroid hormone is available in desiccated form and has a very long history, and people that use it seldom return to synthetics.
Can it be that the marketing efforts are promoting the mono-therapy as very few pharmaceutical companies have production of both T3 and T4? If the thyroid gland normally produces both hormones (and more) then why is this not normally the replacement procedure? Recent published research has shown that T3 in the cerebrospinal fluid does not increase with L-thyroxine therapy. http://informahealthcare.com/doi/abs/10.3109/00365513.2010.541931
It seems like quite a few medical practitioners have painted themselves into a corner with many years of care suggested by commercial interests. The large raft of side-effects from this monotherapy are either conveniently ignored, or relegated to a different disease, preferably something of a neuropsychotic nature.
This article need not repeat the industry dogma, but take a more neutral approach. If one of the writers of this article, who appears to be a MD, have treated patients according "common practice", which may not be uncommon in the UK and his reference given the RCP policy, and perhaps not taken less than perfect treatment-results too seriously, then the article may well reflect this bias. The fact that there are all to many patient-advocate organizations on the web regarding this subject, alone, points to less than perfect "standard" practice option.
There are too much guesswork and assumptions involved in typical thyroid care and this article does not provide unbiased information that really could help.
- While I personally think that the endocrinology community have many positions not supported by science (e.g. double-blind controlled studies) and am dismayed at the harm inflicted on patients, should Wikipedia be the venue for pushing those beliefs onto others? I think that the article should fairly reflect both sides of the controversy.
- Secondly, most of the treatment issues probably do not belong here. This should simply be an article about desiccated thyroid. It makes more sense to put controversies over diagnosis and treatment on the pages where that belongs, e.g. on the page on hypothyroidism. Glennchan (talk) 17:10, 5 October 2013 (UTC)
- I think it is the relevant page to put both points of view, though I think more needs to go on the hypothyroidism page too. The use of thyroid extract is different in a couple of ways; the t4 plus t3, as well as dosing high enough to resolve symptoms. These two things go together, and before the extract went out of favour, it was the standard way to treat. This makes the current medical use, history, and actual use in society highly relevant to this article in particular. Preceole (talk) 15:02, 7 July 2014 (UTC)
Desiccated Thyroid Powder is not the same as Desiccated Thyroid Extract.
The title of this article is "Desiccated Thyroid Extract", but it sounds more like "Desiccated Thyroid Powder". An extract is made by using a solvent (typically alcohol) to dissolve soluble compounds for further filtration/purification/concentration. This is completely different than what this article states.
As such, an extract contains concentrations of the desired compounds that are hundreds of times higher than the raw material. Think vanilla extract, which removes and concentrates the essential flavors and leaves everything else behind. This article is very inaccurate with respect to the discussions about the ingredients of desiccated thyroid extract and how it is made. Cresard (talk) 09:05, 21 December 2011 (UTC)
Improve readability and information on Desiccated thyroid extract wikipedia page
I would like to make improvements to this page. From using the product and surface level research, I would like to work on the following: 1) restructuring the page 2)adding additional information, 3)adding/finding citations to support new and existing information and 4) rewriting content for readability and clarification. Since I am new to making these types of edits, I would appreciate any assistance with any of the above. Would anyone be willing to collaborate with the research? Thank you!
Edits July 2014 for balance
I changed the introduction for readability. I added comments and references to the medical uses section, and edited for readability. I added comments and a reference to the society and culture section, and edited for readability. I gather there is some disagreement about the article, I hope my additions add balance to the article without negating either POV. My source is the Oxford Textbook of Endocrinology and Diabetes. I did not find a T4 vs T3 controversy section to add to anywhere, but I don't think it's the only issue. I would like to have a look at the history section soon. Preceole (talk) 14:25, 7 July 2014 (UTC)
material supported by dead reference removed.
- Desiccated thyroid preparations have a greater variability from batch to batch than synthetic ones.
Refers to a page that does not support the assertion made. Since the link was too vague I searched the site for a reference supporting this assertion, non was present either supporting the assertion, or with the stated date. There was however an article supporting the use of thyroid extract. http://www.healio.com/endocrinology/thyroid/news/online/%7B0cb20cd0-616e-4a68-a799-760a97f92282%7D/desiccated-thyroid-extract-a-safe-alternative-to-levothyroxine-in-hypothyroidism
- Cite error: The named reference
endocrinetoday.comwas invoked but never defined (see the help page).