Tyroksiinihoidosta lausuttua

Viime aikoina on näkynyt muutama kommentti tyroksiinimonoterapiasta.

Tri Malcolm Kendrickin blogissa:

 

I should mention here that I have been told that the RCP has been asked on numerous occasions to cite references to research/studies showing “overwhelming evidence supports the use of thyroxine (T4 alone)”, but to date, they have provided none. A Freedom of Information (FOI) request that the RCP provide such evidence – again met with no response. A request was made via the ‘Ask for Evidence’ website, run in association with ‘Sense About Science’ asking for evidence on the safety and efficacy of L-T4 as a treatment for hypothyroidism. This request was directed to the RCP who eventually responded stating “The RCP’s guidance is based on the opinion of an expert panel which was temporarily formed for this purpose. The evidence they used to form their individual opinions has not been collated and therefore the RCP cannot provide any evidence list”

(Brittilääkärien kokoama näyttö jäi tallentamatta, ja sen vuoksi Kuninkaallinen lääkärikollegio ei voi antaa listaa näytöstä, joka kiistattomasti osoittaa tyroksiinimonoterapian ylivoimaisuuden!)

British Medical Journalissa:

Johtopäätökset ovat erittäin mielenkiintoisia.

Treatment approach

All patients with primary hypothyroidism should be treated. The goal of treatment is reduction of symptoms and prevention of long-term complications. [1] [5] [12] Treatment is given upon establishing the diagnosis and is lifelong. Treatment is with levothyroxine. [B Evidence] There is no evidence that ’natural’ or pig thyroid extract provides clinically reliable therapy. [19]’

We found no direct information from RCTs about whether levothyroxine is better than no active treatment. There is consensus that treatment reduces symptoms.
Treating clinical (overt) hypothyroidism with thyroid hormone (levothyroxine) can lead to hyperthyroidism, reduction of bone mass in post-menopausal women, and increased risk of atrial fibrillation if the person is over-treated.Benefits and harms
Levothyroxine (L-thyroxine) versus placebo:We found no systematic review or RCTs comparing levothyroxine versus placebo in people with clinical hypothyroidism, although there is consensus that treatment improves symptoms. We found one systematic review that reported on adverse effects.(Emme löytäneet mitään suoraa tietoa satunnaistetuista kaksoissokkotutkimuksista, jotka osoittaisivat että levotyroksiini on parempi kuin hoitamatta jättäminen)

(Emme löytäneet mitään systemaattisia katsauksia tai satunnaistettuja kaksoissokkotutkimuksia, jotka vertaisivat levotyroksiinia plaseboon kliinisesti vajaatoimintaisille potilaille)

 

 

SECTION II. THERAPIES OTHER THAN
LEVOTHYROXINE ALONE
Thyroid Extracts
12. In adults requiring thyroid hormone
replacement treatment for primary hypothyroidism,
is treatment with thyroid extracts superior
to treatment with levothyroxine alone?
& RECOMMENDATION
We recommend that levothyroxine be considered as routine
care for patients with primary hypothyroidism, in
preference to use of thyroid extracts. Although there is
preliminary evidence from a short-duration study that
some patients may prefer treatment using thyroid extracts,
high-quality controlled long-term outcome data are lacking
to document superiority of this treatment compared to
levothyroxine therapy. Furthermore, there are potential
safety concerns related to the use of thyroid extracts, such
as the presence of supraphysiologic serum triiodothyronine
levels and a paucity of long-term safety outcome data.
Strong recommendation. Moderate quality evidence

Konsensus siis korvaa näissä hoitokäytäntöarvioissa laadukkaat kaksoissokkotutkimukset, jotka puuttuvat kokonaan tyroksiinimonoterapian kohdalta! Kun endokrinologit niin kovasti haluavat uskoa tyroksiinimonoterapiaan.

 

Puuttuva tutkimus on alkanut Yhdysvaltain armeijan puitteissa. Lyhyen, vuonna 2013 julkaistun pilottitutkimuksen perusteella on nyt tekeillä laajempi tutkimus, jossa verrataan tyroksiinimonoterapiaa, eläinperäisiä kilpirauhasvalmisteita ja synteettistä yhdistelmävalmistetta, jossa T4:ää eli tyroksiinia on 4 osaa ja T3:a eli liotyroniinia eli trijodityroniinia on 1 osa.