By Dr Amtul Qudoos Farhat, MBBS, DCH (UK), FCPS (Pakistan) United Medicine Group, Canada

The concerns and quarries people have about Thyroid issues and prescription of desiccated thyroid extract has necessitated the need for this article. We have come across patients not only in our clinics but also in different chat rooms wondering where and how and when to start the desiccated thyroid extract. All these patients believe that desiccated thyroid extract is the miracle medicine; it is the real solution to their symptoms and it could be prescribed as soon as they know that they have the thyroid symptoms and of course that OHIP should pay for the costs.

We do agree with all what has been said. It is a good news that increasing number of people are becoming aware of the significance of natural approach to their health issues. After all ‘natural’ is the time old, time testified and the safest & simplest approach to any health issue. Actually, desiccated thyroid extract was the first ever replacement therapy given for a low function of thyroid gland. Obtained from bovine thyroids it was natural, safe, effective and available for decades till the pharmaceuticals invented T4. The doctors were overwhelmed by persuasion of pharmaceuticals and the idea of a single dose and a single monitoring tool! The question is: Is there really a single thyroid hormone and a single monitoring tool for thyroid issues?
Here, we try to resolve some of these misconceptions and issues one by one.

MISCONCEPTION ONE:
T4 IS THE ONLY HORMONE PRODUCED BY THYROID GLAND:
T4 is the medication routinely prescribed by your doctor to treat your thyroid deficiency. However T4 is not the only hormone produced by Thyroid gland. Depending upon how many Iodine molecules a hormone has, thyroid produces T4, T3, T2 and T1. T4 is inactive form and it can not bind to the thyroid receptors which are present on the surface of every cell in your body. T4 must convert to T3 by giving up one Iodine molecule before it can exert its actions. If your body does not have the ability to convert T4 to T3 then routine prescription medicine is useless for you.

TWO:
TSH IS THE ONLY MONITORING TOOL FOR THYROID FUNCTION
There is not only one monitoring tool for thyroid function. TSH is used as a routine monitoring tool to rule out thyroid deficiency or excess. However thyroid assessment needs not only TSH but also T4, T3 and even reverse-T3 to be monitored. Rarely you may require different type of scans and even a biopsy. Tests like reverse-T3 are not even available in Canada. Without doing appropriate tests for your situation, we may not be able to treat your thyroid problem successfully.

THREE:
T4 IS THE ONLY TREATMENT FOR THYROID;
T4 which is routinely prescribed to treat thyroid deficiency is not the only treatment for thyroid low function. If your body can not convert T4 to T3 then T4 is useless for you. In fact; at times your T4 level may be higher than normal and still you have all the symptoms of thyroid disease. Sometimes your doctor may give you increasingly higher doses of T4 with out making any difference to your symptoms. Such patients need further tests and work up before another treatment can be initiated.

FOUR:
T3 IS THE ALTERNATIVE TREATMENT
T3 may be the alternative type of treatment. However if the thyroid receptors are already occupied and blocked then T3 may also not work effectively.

FIVE:
T3 BINDS TO THE THYROID RECEPTORS.
This is true. However T3 and reverse-T3 both can bind to the thyroid receptors. In fact reverse-T3 may have preference over T3 when it comes to binding the receptor. Reverse-T3 is also an inactive form of thyroid hormone. So if you have high levels of Reverse-T3 then the situation is even more complicated. We need to find out why your Reverse T3 is high.

SIX:
T3 IS EFFECTIVE WHEN T3 LEVEL IS FOUND TO BE LOW:
This may be true. In some cases however, T3 level is found to be high and still there is no response. This is because the blood test done to measure-T3 does not discriminate between T3 and reverse-T3. You may not respond to T3 replacement if most of your T3 s actually reverse-T3. This makes the replacement therapy of thyroid more complicated.

SEVEN:
TYPICAL THYROID SYMPTOMS ARE ONLY DUE TO THYROID DEFICIENCY ALONE.
In complicated situations with high rT3, other glands need to be monitored. They affect thyroid function. We may need to treat other glands even before we set to treat thyroid deficiency.

EIGHT:
DESCANTED THYROID EXTRACT COULD BE PRESCRIBED WHEN EVER A PATIENT HAS TYPICAL THYROID DEFICIENCY SYMPTOMS;
If you have never been on any kind of thyroid replacement therapy or you are a good responder then desiccated thyroid extract may be initiated right away. However if you are one of the resistant or non responding patient or have other underlying causes for your symptoms then you will need to go through some kind of tests and evaluation before substituting your therapy.

NINE:
OHIP SHOULD COVER THE PRESCRIPTION FEES FOR DESCANTED THYROID EXTRACT
The doctors who practice integrated approach of treatment have done so because of their professional quest to treat the complicated problems to the complete satisfaction of their clients. These doctors believe that you need understanding of what is happening to you and how and why it is happening. That needs time, patience, interest, extra staff and extra tests. We do that to satisfy the clients who have been going to various physicians without being cured. We respect your assessment that all is not well when you don’t feel well. There is reason behind that feeling of being unwell. OHIP does not pay for these extra services. Some of the insurances help pay total or partial costs. However many of such patients have to share and pay upfront for these services.