Controversial aspects of thyroid disease
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7214.894 (Published 02 October 1999) Cite this as: BMJ 1999;319:894
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Soy milk preparations interfere with thyroid hormone absorption in
infants. If adults are on soy preparations it may also interfere. The
reference is in a NEJM article in the mid 1950's. Although many things
apply to children as well as adults it might be a good idea to point out
when thingd apply to adults only. e.g. atrial fibrillation in subclinical
hyperthyroidism. An excellent review article
Competing interests: No competing interests
In their admirably comprehensive review of difficult thyroid disease
Hanna et al(1) discuss amiodarone induced
hyperthyroidism. However, they omit to mention lithium which has been
found to be a useful and safe treatment for severe cases(2) and may
obviate the need for high risk surgery.
Christopher Walton FRCP, Consultant Physician, Dept of Endocrinology
& Diabetes, Hull Royal Infirmary, Hull HU3 2RW
Ewan Masson MD FRCP, Senior Lecturer in Medicine, University of Hull,
Hon Consultant Physician, Dept of Endocrinology
& Diabetes, Hull Royal Infirmary, Hull HU3 2RW
(1) Hanna FWF, Lazarus JH, Scanlon MF. Controversial aspects of
thyroid disease. BMJ, 1999; 319: 894-9
(2) Dickstein G; Shechner C; Adawi F; Kaplan J; Baron E; Ish Shalom
S. Lithium treatment in amiodarone-induced
thyrotoxicosis. Am J Med, 1997; 102: 454-8
Competing interests: No competing interests
combination treatment of T4 and T3
We had a patient in our practice who was diagnosed with a TSH of over
100 and subsequently started on thyroxin treatment ending up with a daily
dose of 175 ug OD. Her TSH did not go below 12. The local endocrinology
department thought she was poorly compliant and the patient being offended
by this allegation sought a tertiarry referral. She was then told that a
combination of T3 and T4 would be beneficial, that it had been tried in
the USA but that he was unable to prescribe it as it was not licensed in
the UK.
As she was still symptomatic I gave her a two month trial of this
combination and low and behold she felt a lot better and this was
confirmed by a TSH of 1.0.
I discussed this with our local biochemistry consultant and he
advised me to take this to this site.
Do other professionals have this experience?
Do we know whether there are people who just do not convert T4 well into
T3?
Competing interests:
None declared
Competing interests: No competing interests