User talk:Mathityahu

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Welcome!

Hello, Mathityahu, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are some pages that you might find helpful:

I hope you enjoy editing here and being a Wikipedian! Please sign your messages on discussion pages using four tildes (~~~~); this will automatically insert your username and the date. If you need help, check out Wikipedia:Questions, ask me on my talk page, or ask your question on this page and then place {{helpme}} before the question. Again, welcome! JFW | T@lk 23:18, 3 April 2008 (UTC)

[edit] Hypothyroidism debate

You requested an article on the debate of how hypothyroidism should be treated. I think this needs to be incorporated into hypothyroidism, if at all. There are some pretty good large clinical research studies that show good benefit from levothyroxine treatment. Looking at the evidence a while ago I was pretty sure that those advocating alternative approaches tend to be alternative practitioners, but I might be wrong. Let me know what you think. JFW | T@lk 23:18, 3 April 2008 (UTC)

Hello, and thank you for your response!

The article I wish to write is about TREATMENT and DIAGNOSIS - the debate is about both. There are many peer-reviewed medical texts showing benefit for combined T3/T4 treatment, and also showing that diagnosis using TSH is wrong (rT3/T3 is right). It hasn't been embraced as a common practice because it hasn't been proven on very large groups with varying parameters as required for new treatments/drugs. It also won't be, because the drug companies won't benefit from it and universities do not conduct wide-scale research of that kind. So as it is, only knowledgeable practitioners treat using the right approach they learned using medical texts, and see that it indeed works. Most patients are treated an inappropriate treatment, and after feeling bad for decades come and tell their story on one of the many forums for this. For many, the switch to T3 or Armour is a life-changing experience. I think this is an important debate to bring to the public attention, so they know how they are treated and why, and the other options. See, for example:

TSH is a poor measure to tissue levels of thyroid hormone -

http://www.hormoneandlongevitycenter.com/nss-folder/pictures/BeenToldYourThyroidisNormal.pdf rT3/T3 is the best marker for tissue levels of thyroid hormone -

http://www.hormoneandlongevitycenter.com/nss-folder/pictures/ReverseT3_BestMarkerforTissueThyroidLevels_7_7.pdf Standard thyroid tests lack accuracy to determine dosing - http://www.hormoneandlongevitycenter.com/nss-folder/pictures/StandardThyroidFunctionTests-ProperThyroidDose.pdf Tissue levels of T3 with T4-only (levothyroxine) treatment are insufficient: http://www.hormoneandlongevitycenter.com/nss-folder/pictures/TissueLevelsofT3withT4.pdf The article is quite a long one so I don't think it fits inside hypothyroidism. You can also see a comprehensive reference list for this issue by clicking on "REFERENCES" under "RESOURCES" at the site stopthethyroidmadness.com Thank you. Mathityahu (talk) 08:43, 4 April 2008 (UTC)

The problem is that the "TSH/T4/T3 paradigm" is internally consistent (e.g. refer to the recent JAMA paper PMID 18285588 that showed normal T3 levels in people on levothyroxine alone), and that the numerous non-mainstream practitioners that take issue with this have not conducted trials of similar quality. It is scientifically possible to quantify "I still don't feel right doc" (e.g. using SF36) and measure interventions such as adding in lyo or starting Armour. Until that time, we can certainly quote a source that says "some people disagree with the standard model and suggest ..." but we cannot say that this has been proven scientifically beyond the experience of the practitioners and their patients. JFW | T@lk 13:56, 4 April 2008 (UTC)
Thanks for your comments. I disagree. However I can't do more than cite a journal article showing that TSH is an incorrect measure to diagnosis and rT3/T3 a better measure - one issue of controversy. And I can't do more than cite a journal article showing that combined T4/T3 therapy gives more T3 to TISSUES in comparison with T4-only therapy. And I cannot do more than cite an article stating rT3 is a potent blocker of T3 receptors, thus T4-only therapy creates lots of rT3 and blocks many receptors, which means less T3 reaches the cells, no matter what the serum levels are. In addition to that, it has been scientifically proven that as you said "I still don't feel well doc", in this journal article from 1999 in the New England Journal of Medicine: http://content.nejm.org/cgi/content/abstract/340/6/424
If that is not enough to convince you then I'd have to give up, if you can call someone else to review it I'll be grateful. Mathityahu (talk) 09:43, 5 April 2008 (UTC)

It has little to do with "agreeing" or "convincing". When it comes to presenting the facts, I'm afraid that the Wikipedia article will continue to state that hypothyroidism is treated with levothyroxine, and that studies have repeatedly shown that there is no added benefit from T3. doi:10.1210/jc.2006-0448 is a meta-analysis, and so is doi:10.1176/appi.psy.48.5.379. Meta-analyses have a habit of being more reliable than individual studies. Please do provide a source for the T3/rT3 measure being more specific than TSH. JFW | T@lk 22:21, 5 April 2008 (UTC)

Obviously I am not the final arbiter on including information on the debate. I would suggest that you find a highly reliable source that describes the views of the "thyroid skeptics", and contribute to hypothyroidism. But I think you will have to make it very clear that there are no studies with hard outcome data; the NEJM study has been contradicted manifold. JFW | T@lk 22:26, 5 April 2008 (UTC)
A source for rT3/T3 being more specific than TSH: (this is a summary of the article referenced): http://www.hormoneandlongevitycenter.com/nss-folder/pictures/ReverseT3_BestMarkerforTissueThyroidLevels_7_7.pdf Regarding the meta-analyses you are correct. Perhaps I can add a short paragraph to hypothyroidism outlining the debate and referencing ALL the articles we've talked about here? So the interested reader would know where to look for and judge objectively.