Talk:Desiccated thyroid extract

Aargh. Desperately needs sourcing and NPOV. The historical material is good, though, and can be moved to hypothyroidism where it belongs. JFW | T@lk 07:30, 23 June 2006 (UTC)

I have edited this for NPOV now. The original author is encouraged to link his statements to his sources, as I do not own these books and cannot verify which statement is made where. JFW | T@lk 10:17, 23 June 2006 (UTC)

NPOV

What is NPOV?? Also, I know that references can include websites, but am unsure how to put them in the article. After the sentence "Yet, the experience of patients reported on various interactive thyroid groups.........and many other positive results", the references would be http://www.altsupportthyroid.org/dt/dtexp2pr.php and http://www.stopthethyroidmadness.com/stories-of-others/.

Under treatment protocol, and after the sentence about suglingual would be this: http://www.positivehealth.com/permit/Articles/Colon%20Health/lea13.htm. As far as the statement about multi-dosing, that comes from reading patients comments on the Yahoo group Natural Thyroid Hormones Users. How is that cited?? It is http://health.groups.yahoo.com/group/NaturalThyroidHormones/

The same is true for the comment about generic thyroid being reported by patients as weaker than Armour and others--that comes from the comments of patients on the Natural Thyroid Hormones Users group mentioned above.

The comment from Forest Labs about T2, T1, and calcitonin not being removed come from talking to Daryl R. Wesche of the Forest Pharmaceutical Professional Affairs Department. How is that cited?

NPOV is the most important Wikipedia policy. It bears reading that article closely, as most discussions about appropriateness of content revolve around that policy and WP:NOR/WP:V.

If you have a quick look at the article you will see that I've embraced my references with <ref> and </ref> tags. Wikipedia:Footnotes contains more details.

On the whole I would avoid making generalising statements. "The experience of patients reported on various interactive thyroid groups" needs further support. Citing webpages is a bit troublesome, because one never knows whom the author of that webpage represents (himself, 100 of 10,000 people). That dilemma improves if the page is of an official organisation or there are clear indications that the views expressed are the aggregate of a representative group (e.g. a working party, a poll).

This is an interesting article. Are you sure natural desiccated thyroid hormones is a good title? Wouldn't thyroid extract be a more accessible title? JFW | T@lk 09:54, 25 June 2006 (UTC)

Actually, for most patients, no one would know what you were talking about if "thyroid extract" was used, even though it's a legitimate medical description. Now, the common term is "natural thyroid hormones", thus the title here being Natural Desiccated Thyroid Hormones.

As far as the "experience of patients reported on various interactive groups...." under the Controversies heading needing further support---citations to support that sentence can only come from citing these groups, I fear. Why? Because there is a huge movement going on with patients talking to each other about their experiences ON these internet groups: Yahoo Groups like the popular Natural Thyroid Hormones Users, the Hypothyroidism group sponsored by Cure Zone, the Thyroid group of Mary Shoman, and many other smaller but active groups. They are not reporting their experiences in books; they are reporting it in the huge amount of conversation going on in these groups, which can be viewed.

Also, they are reporting their experience (which is contrary to what doctors say about natural thyroid hormones) on the www.stopthethyroidmadness.com website, plus the thyroid.about.com thyroid website, and the www.altsupportthyroid.org website, and many other smaller sites.

Granted, it's a new phenomena, but it's real to our modern society with the abounding use of web groups and websites to communicate.

You state: "Citing webpages is a bit troublesome, because one never knows whom the author of that webpage represents (himself, 100 of 10,000 people). That dilemma improves if the page is of an official organisation or there are clear indications that the views expressed are the aggregate of a representative group." The websites definitely do appear to be the views of a representative group--thyroid patients on natural thyroid hormones--even if there are no clear-cut authorized 'officialdom'. The authors appear to have brought these views and 'stated experiences' together to form the 'website'. I think the Stop the Thyroid Madness is a good example of that. Plus, the websites themselves have their forums to continue the talk.

I will read the NPOV article, plus the one on footnotes. Thank you for steering me. I'm still unclear how to add them to what you've already done (and thank you for that), but will hopefully figure it out! I am new to this. Doodlebug1 (talk · contribs)

I understand your point about the naming issue. Is this the official generic name of all Armour-like products?

As I am not an endocrinologist I have no way of knowing how "popular" the use of natural desiccated thyroid hormones is. But I very frequently encounter patients who are hypothyroid, and most are doing just fine on 50-75 μg/24h of levothyroxine. In fact, I wasn't aware of a large support base for natural thyroid supplements until I'd read your contributions. This makes me wonder about the currency of the view that levothyroxine is inadequate and that TSH is not a useful blood test.

I'll have a stab at converting your references to footnotes. JFW | T@lk 18:59, 25 June 2006 (UTC)

reply: Thank you for all you assistance (and I'm bolding this to get it to stand out). Yes, patients are calling all Armour-like products Natural Thyroid Hormones. Not sure where it started, unless it was with Mary Shoman, a thyroid advocate, or Janie, the owner of the Natural Thyroid Hormone site on Yahoo and another thyroid patient advocate on the Stop the Thyroid Madness site. Yes, the use of Natural Thyroid Hormones is becoming quite popular, apparently, because patients are stating that they never got resolution of symptoms on levothyroxine, and have gotten it on Armour. When they informed their doctors of their continued symptoms while on levothyroxine, they have consistently been put on anti-depressants, statins, and numerous other medications which only masked the inferior treatment of levothyroxine. On dessicated thyroid, they are stating that have gotten resolution of those symptoms, plus others. In fact, when you say that most of your patients are doing fine on levothyroxine, you might want to see what patients are saying on these sites. They are also stating that going by the TSH has kept them sick, and that even includes on the Armour-like products. When they say they are rid of all their former hypo symptoms, they have a suppressed TSH, yet no hyper symptoms whatsoever.

Removal of T2/T1/calcitonin

Referring to a company spokesperson without a verifiable source makes it impossible for any other reader to verify this statement. If Forest Labs says Armour contains T2/T1/calcitonin doesn't that imply that it does indeed contain these hormones? JFW | T@lk 19:13, 25 June 2006 (UTC)

reply: JFW, I'm unclear what you mean about the company spokesman. I included the Armour Contact page so anyone can call and verify from Daryl what he stated. So, it's not "impossible" to verify it! The reason I included that info is because of what you removed---that there is an ongoing rumor that desiccated thyroid like Armour ONLY contains T4 and T3 (i.e. that the T2, T1 and calcitonin are removed. Doodlebug1 (talk · contribs)

Doodlebug1, this is an encyclopedia. Encyclopedias refer to other sources, but they never instruct their readers to go ahead and phone/email someone for confirmation. Please provide a reliable source. JFW | T@lk 22:01, 25 June 2006 (UTC)

Need help on the following

In the paragraph titled Controversies and in the first sentence "It has been said by medical professionals that natural desiccated thyroid like Armour is inconsistent from dose-to-dose, dangerous, unstable, hard to dose, unreliable, and outdated.", these are again reports made by patients about their doctors on these patient-to-patient talk groups. These are very common reports by patients about how their doctors described desiccated thyroid. Perhaps I can state "Patients report their doctors as saying that natural desiccated thyroid like Armour is...." and then cite the group. In fact, I would say that most everything stated under the Controversies heading comes from the discussions between patients on most of the groups on the net, including the Yahoo groups, the About.com forums, and many others.

By the way, you added that the Yahoo Natural Thyroid Hormones group is related to the Stop the Thyroid Madness group. It is not. The STTM group has it's own forum, which is not the Yahoo group. It's the same subject, but they are two totally different groups, just as the other thyroid groups on the net are.

Also, I am trying to add the same #6 as a reference to information under Controversies, but all I get is a #7 which ends up repeating #6 in the References below. I think I remember there is a way to avoid that??

I think the Controversies is a good reality to the Encylopedic discussion about Natural Desiccated Thyroid Hormones, and am doing it from a "Neutral Point Of View", but am forced to cite the groups where patients talk about this over and over, since there appears to be no book to verify what they are talking about.

The references are to different URLs, so they should not be merged. If you want to make multiple references to one footnote, please consult Wikipedia:Footnotes, which explains it clearer than I ever could. JFW | T@lk 22:17, 25 June 2006 (UTC)

Reasons for changes and some removed material

I am moving some of the references here as they do not belong in this article. Note that the trials cited did not use desiccated thyroid but synthetic preparations, and are tests of the T4 vs T4+T3 controversy, and used different ratios of T4 and T3. These studies were not tests of thyroxine versus desiccated thyroid, and used T4:T3 ratios higher than those of desiccated thyroid preparations (about 5:1 and about 12:1 by quick look). I will try to find an example of a study of thyroxine versus desiccated thyroid.

I would recommend we move the T4 vs T4+T3 controversy to the hypothyroidism article.

The article should do justice to both perspectives and I will make a couple more changes to the latter part but don't have time to finish right now. I plan to leave the current pointers and references to the pro-armour websites and books, but will find some balancing studies showing no difference, and will try to add some material on the T4 vs T4+T3 controversy to the hypothyroidism article where it better belongs.

Here is the removed paragraph to preserve the references for use elsewhere.

than regained popularity due to experiential reports of success, as compared to their former thyroxine-only treatment, by thyroid patients on numerous interactive websites, in spite of the lack of "medical" evidence that adding T3 to the treatment is beneficial.

The references are in the copied block but do not show up above until you switch to edit mode.

alteripse 15:40, 29 June 2006 (UTC)

I left a brief allusion to the T4+T3 issue and replaced the references. alteripse 16:51, 2 July 2006 (UTC)

reason for page move and title change

"Desiccated thyroid extract" is the briefest accurate title. The preparation is not "desiccated thyroid hormones" but desiccated thyroid gland. Natural is simply a marketing adjective like "organic" or "new and improved" and is not the name it has been known by for most of the last century or in most current publications. We can leave a redirect for readers looking for the other terms and can include them in the first paragraph.

The other additions are to balance a one-sided article: a reader would have had almost no clue as to the reasons nearly all thyroid doctors prefer thyroxine for most patients. I am not done yet and have no intention of deleting either the pro-thyroid extract POV and arguments, nor the websites and books cited, but I am providing a broader perspective for the reader who is interested in more background, both sides of the controversy, and a more accurate delineation of strength of evidence. alteripse 22:02, 1 July 2006 (UTC)

npov the other way?

I believe this to be factually inaccurate...

"Attempts to objectively demonstrate the superiority of desiccated thyroid pills over synthetic thyroxine by controlled clinical trials have generally shown no advantage, and many physicians remain unconvinced that the superiority is anything other than a placebo effect or an overtreatment effect."

I know of no clinically controlled trials comparing natural thyroid products to levothyroxine. Suggest it is removed and replaced with a statement that "no clinical trials were ever done" to demonstrate the adequacy of levothyroxine as a replacement when it was introduced, unless a reference can be provided. These days an introduced drug would have to go head to head with the best current treatment - this was never done (and has never been done to my knowledge).

There have been trials of levothyroxine against combined T4/T3 medications. And these show a consistent patient preference for the combined medications (even when the mean TSH in the combined group rose slightly (Weston study) - suggesting it isn't just an increase in dose that causes this preference), suggesting patients (in double blind trials) strongly prefer combined medications, even if doctors don't understand why (no other medically significant results were found - although that suggests the doctors were measuring the wrong things to me). However I think it would be foolish to assume these results can readily be applied to natural thyroid extracts, as natural thyroid have a much higher ratio of T3 to T4 and other components (for better or worse).

Similarly the article overstates the case for thyroxine as effective treatment, and fails to reference papers that demonstrate experimentally that levothyroxine replacement doesn't result in normal levels of thyroid hormones in all tissues. There are also studies showing obesity levels in people on levothyroxine treatment with normal TSH being higher than the population average, which contradicts the claim that levothyroxine treated patients have normal levels of symptoms of hypothyroidism. Indeed such a claim is I think indefensible -- if taking one dose of levothyroxine a day was a complete treatment, why would the body have such elaborate feedback mechanisms to adjust and control these levels so precisely, evolution doesn't tend to favour unnecessary over engineering. As such it is likely inevitable that those treated for hypothyroidism will exhibit more symptoms of both over and under activity of the thyroid, until a full replacement of the thyroid (and any faults in the control mechanism) is possible.

My understanding is that dessicated thyroid products are now assayed in the same manner as synthetic thyroid medications. Whether the USP requires this I haven't ascertained. The assay by Iodine content was merely because when it was introduced, this was the only test that was possible. Levothyroxine Sodium was also assayed by Iodine content, and possibly in the early days that gave it an advantage in consistency of potency. There is evidence now that the dessicated products are as good or better in consistency than the synthetics (note that the synthetics had to undergo a NDA (new drug application) in the US -- i.e. lost their grandfather right to be consider "general safe and effective" - due to issues surrounding their potency, and most were reformulated at this point). --ANON

Thanks for taking the trouble to respond. To facilitate constructive discussion, the custom here is to add a comment like this either in a new section or at the bottom of the page so it can be more easily recognized as new, and to sign it so it becomes possible to recognize the parts of a discussion. I moved your comment and added ANON, but strongly request you take 30 seconds and make an account, which will be free and more anonymous than your Shrewsbury IP number. You sign with 4 tildes and it will add your username and a date stamp.

Some of your detailed points are substantive and evaluatable. Some can and perhaps should be included but need sourcing. Here are four of your specific assertions and replies:

• No clinical trial compared thyroxine and extract head to head. Not true, see the Surks reference, and I will find some more. Your comment is only supportable if you are specifying the type of rigorously constrolled and monitored tests that the FDA would require now. The fact that you cannot readily find a well-controlled study from the 1950s demonstrating that penicillin treated syphilis more effectively than mercury is pretty weak support for continuing to prefer mercury. One can certainly find descriptions by endocrinologists caring for large numbers of patients and seeing no disadvantage. It is fairly strong evidence that virtually none of the doctors with the most experience with thyroid patients stopped switching patients or published concerns about the switch-- you would have to concoct a mass conspiracy theory to explain this as one can readily find all sorts of dissenting opinion articles in medical journals of the last 60 years against many other conventionally preferred treatments. Before you reject this argument, you have to recognize that nearly all of the evidence of thyroid extract proponents is no better and most is even weaker (smaller numbers with larger possible sources of personal bias). Why do you think none of the proponents of thyroid extract have conducted the type of controlled study that would satisfy you?

• The T4 vs T4+T3 issue is an interesting one and is certainly a live controversy as mentioned in the article. I just heard an excellent detailed review of the ten published controlled studies (incl the 2 cited here) by Wilmar Wiersinga at the 2006 Endocrine Society meeting in Boston. The audience was packed and interested. The evidence of superiority of the mixture is weak and inconsistent. Every study that attempted to blind the recipients as to the preparation they were receiving and to track objectively the key symptoms for more than a few months revealed inconsistent short term differences and long term differences diminishing to undetectable. I will try to find a more recent overview. And as you admit, trials of T4+T3 mixtures are not trials of thyroid extract for a number of reasons and I think a more detailed discussion of this controversy belongs in the hypothyroidism article.

• Your assertion that newer preparations of thyroid extract are better standardized and controlled for hormone content might be true, but needs sourcing. It was demonstrated in 1980 that the first 2 decades of criticism of unevenness and unreliability did not result in improved thyroid extract products. If there is evidence of improvement since then, I agree it should be added. I think your specific claim that current thyroid extracts are "as good or better than synthetics in consistency" is doubtful but please offer evidence if you have it.

• The issue of normalcy of hormone levels in blood and tissue during treatment may be a valid issue and worth mentioning. What the article says is true: T4 alone produces normal T4, T3, and TSH blood levels in most patients. Can you cite the studies you had in mind that show demonstrable differences at the tissue level? I won't even ask you for a study showing that tissue levels are closer to normal in patients on thyroid extract.

• And a citation please for the one showing higher obesity rates in properly treated thyroxine patients? And how about a study showing lower obesity rates in patients on thyroid extract with similar blood hormone levels? In other words, there is a difference between showing that a treatment is less than perfect for some patients and showing that treatment A is better than treatment B in reversing those same imperfections. Most of us suspect that no matter how much money the thyroid extract companies make from patients looking for further improvement, they will never fund a relatively inexpensive head-to-head blinded trial against standard treatment (similar to the best of the T4 vs T4+T3 trials).

Thanks for the constructive criticism. I will change one of the sentences and await your evidence for the other points. I am trying to make this article accurately descriptive of the controversy. alteripse 16:04, 2 July 2006 (UTC)

reversion of misleading and inaccurate material

All of the alterations of the last 24 hours either removed accurate statements or introduced inaccurate statements or reduced the precision of the statement. Please no more anonymous drive-by editing. Please produce documentation for any more alterations. alteripse 21:36, 3 July 2006 (UTC)

As above. Specifically, no matter how Good our anonymous contributors think dried pork thyroid is, and how Evil endocrinologists are, it is accurate to say that there are numerous studies and references documenting that the majority of people with hypothyroidism treated with thyroxine have relief of signs and symptoms. No one has claimed that all patients get relief from all symptoms. alteripse 12:34, 20 July 2006 (UTC)

Concerning this entire page--looks good, but.....

I am the one who originally started the Natural Desiccated Thyroid article here, but have had to be out of town so much that I haven't been back. It's greatly increased it's information--good job, though I see some of the information is suspect in accuracy and needs sourcing itself, as was asked of me. By the way, what "drive-by editing" is going on? Also, in reference to the above comment about "evil" endocrinologists"...laughing...I don't see that these patients are calling them evil but "uninformed and rigid", which looks valid when you take the time to open-mindedly read their arguments against Endocrinologists.

Additionally, you stated that "there are numerous studies and references documenting that the majority of people with hypothyroidism treated with thyroxine have relief of signs and symptoms": THAT is exactly what I see needs citing. Because these patients are strongly claiming that if you interview the majority if not all of thyroid patients on thyroxine meds, they do not get total relief or are even close, and are instead "bandaided" (their words) with anti-depressants, statins and "other" meds which only cover up the obvious "signs and symptoms" of undertreatment.

Thanks for commenting & appreciating the humor. If you look at the page history, you will see at least 3 recent instances of anonymous editing primarily pushing some of the points you make but not explaining or discussing on the talk page despite my requests-- this is what I was referring to as "drive-by editing". As to the proportion of hypothyroid patients who have satisfactory resolution of signs and symptoms being the majority, I provided at least one reference at the point the assertion is first made, and can provide many more. It is certainly my experience as an endocrinologist that the vast majority of patients with hypothyroidism are adequately replaced with thyroxine and do not complain of unrelieved symptoms. I ask them that when I see them. I have certainly known a few who continued to have symptoms. I hope I made it abundantly clear in the article that there are plenty of such people but they are certainly not the majority. You will have to offer a bit more evidence than I have hitherto seen that the "majority" of hypothyroid patients are inadequately treated with thyroxine. I am sure you understand that an internet site that solicits those who still feel that they have unrelieved symptoms is unlikely to have lots of postings from those who feel they are adequately treated with thyroxine. No matter how many people log onto it and agree, you cannot claim it is the majority until someone has actually performed an unbiased survey of a representative population. So until then I will continue to remove claims that the majority of hypothyroid people on thyroxine complain of unrelieved symptoms as it contradicts what is amply and repeatedly published as well as my own daily experience. alteripse 22:32, 23 July 2006 (UTC) PS please sign your post.

Sorry about not signing my post--I am new to Wikipedia and thought it would show up automatically since I am signed in. As far as your reference supporting that the majority of patients report satisfactory resolution, I think you're going to need to cite references to the opposite as well to be balanced in this article, which I am not seeing. Because once again, if you really check out these patient websites (and there are many), they are reporting that most patients on thyroxine absolutely do not acquire satisfactory resolution. They are reporting that "satisfactory resolution" is only in the eyes of the doctor who sees an in-range TSH, and from that, make the "dubious" conclusion that the patient is now adequately treated.

The paragraph I am concerned about is this one:

Current status of thyroid extract use

At present, a large majority of people (at least in the English-speaking world) of all ages with hypothyroidism are being replaced with synthetic levothyroxine. 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.

A significant minority of adult patients feel that current methods of replacement with thyroxine, guided by normalization of TSH, do not completely eradicate all of the symptoms they attribute to their hypothyroidism. Many of them report that thyroid extract gives them better symptom relief, often at doses that produce abnormal levels of TSH.

I think you need to cite or more fully explain "when their TSH is normal"...."the majority have no more signs or symptoms of hypothyroidism than similar members of the population." Because this is exactly opposite what patients are saying on these numerous websites and groups. And since I have been observing them for the past 6 years, the amount of patient websites are growing in leaps and bounds, and their message is being done extremely professionally.

In the next paragraph, you state "A significant minority of adult patients..."--where does this statement come from? How do you know it's a "significant minority"? Because once again, if you listen to thousands of patients who are represented on these growing sites, including the Stop the Thyroid Madness site, Mary Shoman's About website, and many others, it doesn't appear to be a "significant minority". I am concerned that medical professionals aren't aware of or listening to what is going on out there with patients. That is why the Stop the Thyroid Madness site, as well as numerous Yahoo groups, appear to exist.

You stated above "It is certainly my experience as an endocrinologist that the vast majority of patients with hypothyroidism are adequately replaced with thyroxine and do not complain of unrelieved symptoms." Once again, if you really peruse these sites, you will note that patients are screaming that Endocrinologists are the worst to not listen to their continuing hypo symptoms on thyroxine, or you fail to see them because of your reliance on the TSH, which these patients are calling "the holy grail of diagnosis". As you read the words of these patients, they are also stating that they have complained, but the doctor only "bandaided" their symptoms..implying that these symptoms had nothing to do with their treatment, when patients are discovering that they did.

I personally am not claiming it is the "majority". I have no idea. But I am stating here that these websites are making it clear that there is a large and growing body or patients who are not getting relief from hypothyroid symptoms on thyroxine, and it's impressive what they are trying to say. Remember: you stated above: "I will continue to remove claims that the majority of hypothyroid people on thyroxine complain of unrelieved symptoms as it contradicts what is amply and repeatedly published as well as my own daily experience. Experience does count for something, but this paragraph fails to give enough credit to the "experiences" of these patients who are doing a bangup job of trying to spread the word of THEIR experience..that thyroxine hasn't worked well. Because by my observation, they don't look like they are "soliciting". It looks like they are trying to explain to patients why they continue to have symptoms of hypothyroid on thyroxine. And I note that on the Stop the Thyroid Madness site, it also is speaking to doctors, asking them to at least be more open minded that perhaps the TSH is not telling the whole story. Just my opinions and observation. I am doodlebug1.

Sign by typing 4 tildes. The paragraphs you quote are the summary paragraphs. They are not referenced in the summary because they only repeat assertions made in more detail earlier in the article where they were fully referenced. Essentially they are a valid summary of the whole subject. I have no doubt you have seen many well-done websites describing many people who prefer desiccated thyroid, but that is far from evidence that they are the majority and in simple fact they are a relatively small minority. If you are intelligent, you have to realize there is no reason for endocrinologists to lie about this. Thyroid drugs are low-profit drugs, there are no thyroxine companies showering endocrinologists with enough attention or bribes to make it worth ignoring a clear superiority if there were such; there is no orchestrated conspiracy to suppress a superior treatment. Cui bono? Throughout the 1960s, 1970s, and 1980s, the doctors treating the most thyroid patients gradually changed from use of desiccated thyroid to thyroxine and did not see that there were more complaints of inadequate relief. You cannot find any documentation of worsening treatment results because there was none. Surely some would have written, "hey this doesnt work as well," as medical journals are full of opinion letters and disagreements over optimal treatment. Demonstrating this would have been a way to make an academic reputation. There were always people whose symptoms of fatigue, depression, or adiposity were not completely relieved and there is no evidence there are more of them now than in the 1950s when everyone used desiccated thyroid. No endocrinologist claims that thyroxine relieves all the complaints of every adult with hypothyroidism. If some of them feel better with desiccated thyroid, mixtures of T4 and T3, or doses that suppress their TSH, the facts deserve to be acknowledged and the article clearly does so. The presence of websites that profess the opinion that they represent a majority opinion are simply evidence that people can hold mistaken opinions, not evidence that the opinion is correct. Most of them have seen endocrinologists and, believe me, they are a small subset of our patients. alteripse 04:58, 24 July 2006 (UTC)

More....

If the paragraphs I refer to above "repeat assertations made in more detail earlier in the article", they are only repeating assertations made by doctors and not these patients. That is why I am saying this paragraph is not balanced, and thus not valid. Granted, I see good information that represents the other side, but in these summaries, it doesn't represent the whole. It's a biased summary. To say that it's a "small minority" is certainly biased. I am not saying it's a majority, but you are clearly using a biased opinion.

As far as your personal comments above, I don't see these patients saying that Endocrinologists are lying or are being conspirators. There is no chutzpah going on here. Read the sites. They are clearly saying that Endocrinologists are not fully informed, that they consistently make labwork more important than symptoms, and they also fail to be open minded about the subject. That is not being represented by the word "lying" or "conspiratory".

I would say they believe you that doctors "did not see that there were more complaints of inadequate relief." Because patients are making it clear that doctors saw these complaints as unrelated to their thyroid treatment, when in fact, they were. They report that when they switched to desiccated thyroid (and practically NONE of them refer to it as extract), those symptoms which their doctors "did not see" and attributed to other problems...went away.

No documentation of worsening treatment results?? The "documentation" is clearly coming out via these numerous patient websites that tell the story of how thyroxine treatment was never working, as was dosing by the TSH range. Why didn't they tell the doctors? They state they did, but the doctors routinely claimed that it wasn't their thyroid since their TSH was normal and they were "optimally treated."

Yes, many facts of desiccated thyroid have been presented on this page. In much of it, there is a good overview of desiccated thyroid. But in other places, and especially in the summary I am referring to...it stinks with bias. And honestly, for you to state that these websites are simply evidence that "people can hold mistaken opinions" is just more fuel for their fire that doctors aren't listening. Ecce signum. The proof is in the pudding.

Doodlebug1 06:28, 24 July 2006 (UTC) 04:58, 24 July 2006 (UTC)

You are misreading or misunderstanding or misrepresenting my reply. It is not my "opinion" that a minority of patients with hypothyroidism treated with thyroxine have incomplete resolution of symptoms; it is what we see every day and has been reported over and over, and is referenced amply in the article. You missed my point about the changeover: in the years when endocrinologists were changing from thyroid extract to thyroxine no one saw an increase in unrelieved symptoms in the majority of patients. Why not? Nothing in all those websites you cite is convincing evidence that the majority of people with hypothyroidism are inadequately treated with thyroxine, just that some people with hypothyroidism continued to have symptoms, which even the summary of the article clearly states. The summary is exactly and concisely correct and sums up the article. And the article clearly does not say, and I do not believe, that for those people the benefits are imaginary. Don't put words in my mouth. alteripse 11:49, 24 July 2006 (UTC)

I can certainly respect your comment that doctors feel it's 'what they see every day and has been reported over and over'. But the summary represents what you feel doctors 'see and report', and is not representing what these growing body of patients 'see and report'. i.e. the summary is biased and is written in the slant of a medical professional. So perhaps Wikipedia is not an unbiased information center at all, and that needs to be made clear to the unsuspecting public out there.

Something fairly formidible has been going on to propell these patients to form so many interactive thyroid groups, and they aren't just chewing the cud in these groups, nor are the groups little isolated entities. Additionally, for other patients to create the websites as professional as the about.com and Stop the Thyroid Madness site, plus other smaller ones, means we aren't seeing a little piffling phenomena going on that represents the latest fashion of the day. These patients are clearly spelling out what has gone on in remarkable detail, and that precision is making it quite clear that doctors are certainly not getting it if they "see and report" that "a minority have an incomplete resolution of symptoms" on thyroxine.

You stated that no one saw an increase in unrelieved symptoms when patients were switched to thyroxine. No one?? Then who are these numerous older patients who come on these sites and say that when they were switched from desiccated thyroid to thyroxine, they got worse and give numerous examples of how they got worse?? The patients saw the increase! Is the only true opinion that of the doctors and not these patients? Who is Dr. David Derry who stated that he definitely saw the increase in symptoms, and especially when the TSH was introduced? And who are all these patients who, though they were never on desiccated thyroid at the beginning, state they noticed a huge difference in the resolution of symptoms when they switched to desiccated thyroid? Does the average doctor just cop out and say it's a placebo effect of thousands of patients?

Additionally, perhaps doctors didn't see the increase in symptoms because it was decided that instead, a series of "new" and mysterious conditions were popping up, aka "Chronic Fatigue Syndrome". If you haven't already, check out the time frame between patients going on thyoxine, and the sudden appearance of CFS. Additionally, chronic low grade depression became rampant when patients were moved onto thyroxine. Low free T3, which is common on thyroxine, has a strong connection with chronic depression. Also, note the rise in high cholesterol in patients on thyroxine. That is not a simple coincidence of a MacDonalds society.

And frankly, even I can identify with the frustration of these patients when you state that nothing on these websites is 'convincing evidence'. Since when is the repeated experience of patients not evidence! Evidence is not just found in written reports! There are thousands of patients right now reporting the exact same experience--that switching to desiccated thyroid has rid them of the irritating if not debilitating symptoms they had while on thyroxine, and that their doctors have never been listening. Experience is evidence!! These websites are not manned by a plethera of looney tunes reporting their senseless illusions.

Overall, the page is well done and presents a wide variety of information. But in some spots and most expecially in this summary, it's "exactly and consisely correct" only in the eyes of someone who wrote it and his medical colleagues, and definitely does not represent the opinion of a large and growing body of patients who are consisely reporting what they have experienced, and appear to know what they are talking about when they state that doctors aren't listening, and never have.

Doodlebug1 16:32, 24 July 2006 (UTC)