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Thyroid Hormone Therapy 101: Why You should Stick With Branded Synthroid.

Dr.Guttler’s comments on this article.
  1. Patients in my practice are always offered a generic substitute for Synthroid.
  2. My RX states only brand with a DSW1 . Local pharmacies all use different generic companies.
  3. My patient could be on 12 different brands of generic in a year.
  4. Maybe at Mayo they can control the type of generic to make sure there is no changing fro one to another.
  5. This paper is interesting but does not change my policy of brand only Synthroid for my patients.
  6. I am assured of uniform dosing by sticking to brand only.
Study finds similar cardiovascular outcomes for generic, brand-name drugs for hypothyroidism

Newswise — JACKSONVILLE, Fla. — A new study by Mayo Clinic researchers may have broad implications for treatment of patients with predominantly benign thyroid disease and newly treated hypothyroidism.

The study, to be published in Mayo Clinic Proceedings in July, looked at whether generic and brand-name levothyroxine therapy affected hospitalization for cardiovascular events for those patients who are more at risk of coronary heart disease and heart failure. Levothyroxine is the most prescribed medication in the U.S., with more than 23 million prescriptions written annually.

The retrospective analysis, using deidentified claims data from a large private U.S. health plan, found that cardiovascular event rates were similar for generic and brand-name levothyroxine therapy, with lower pharmacy costs for the generic drug. The findings, if confirmed with research into longer-term event rates, suggest that generic or brand-name levothyroxine may be used to treat hypothyroidism due to benign thyroid disorders. The average 30-day cost of the generic drug was about half the cost of brand-name medication for patients and insurers.

“More than 90% of thyroid prescriptions are for levothyroxine, and there has been disagreement as to whether generic levothyroxine and branded thyroxine preparations are equivalent,” says Robert Smallridge, M.D., a Mayo Clinic endocrinologist and the study’s principal investigator. “These findings suggest that generic and brand levothyroxine therapy are similar as related to cardiovascular events risk.”

Dr. Smallridge says the findings require confirmation with longer-term follow-up and study of subsets of patients, such as those with a history of thyroid cancer, who frequently receive higher doses of levothyroxine.

Hypothyroidism, or underactivity of the thyroid gland, affects the function of many organs in the body, elevating blood cholesterol levels and increasing the risk of heart attacks, heart failure and stroke. Levothyroxine is used to reduce elevated cholesterol and reverse symptoms of hypothyroidism. U.S. brand names for levothyroxine include Levothroid, Levoxyl, Synthroid, Tirosint and Unithroid.

The analysis was unusual in that it used information from an administrative claims database provided by OptumLabs Data Warehouse. OptumLabs was co-founded by Optum Inc. and Mayo Clinic in 2012. This data warehouse contains deidentified administrative claims data, as well as deidentified electronic health record data from a nationwide network of provider groups.

The study reviewed records for 87,902 patients followed for a mean period of one year, focusing on hospitalization for heart attacks, congestive heart failure, atrial fibrillation or strokes. The analysis found no difference in event rates for the four types of cardiovascular events.

Dr. Smallridge is the Alfred D. and Audrey M. Petersen Professor of Cancer Research and deputy director of the Mayo Clinic Cancer Center in Jacksonville. The study was funded by the Mayo Clinic Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, with an additional gift from Alfred D. and Audrey M. Petersen.

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Thyroid 101: Avoid Iodine Containing Thyroid Supplements,Iodine Drops ,Kelp and Armour Thyroid extract from Pigs.

The freaky little hormone-producing gland just under your Adam’s apple can malfunction in any number of ways. When it’s overactive it can cause weight and hair loss, and when underactive weight gain and sluggishness – but there are a whole slew of other potential symptoms.

Less common is the not necessarily serious goiter and the very scary thyroid cancer.

Hashimoto’s disease is a common cause of hypothyroidism, but they are not synonymous. In Hashimoto’s, dedicated lymphocytes attack and destroy the thyroid. It’s all very complicated!

A number of alt health types feel that conventional thyroxine treatments are inadequate and that standard blood tests aren’t sensitive enough to diagnose a low-functioning thyroid.

Many also recommend you up your iodine with foods like kelp, while endocrinologists are adamant this is actually dangerous. Make sure you get the right advice.

What the expert says

“Canada and the U.S. are iodine-sufficient areas. We get at 200 to 300 micrograms, and you only need 150 micrograms a day. Iodine in the form of supplements, including seaweed and kelp, is contraindicated for people with thyroid problems, especially those with Hashimoto’s or chronic thyroiditis. Avoid excess iodine outside the normal diet. If you eat fish, pizza, bread, eggs, broccoli, spinach, you will get enough. The tests are very accurate. Taking desiccated or Armour thyroid can get people in trouble because it changes from batch to batch and has a lot of T3 that can cause symptoms in the heart and bones.’

RICHARD GUTTLER, clinical professor of medicine, U. of Southern California

“Nodules can be caused by radiation. A lot of people who were treated with radiation for acne and ear problems in the early 60s are coming back now with thyroid nodules, and a significant proportion are cancerous. Also, the explosion at Chernobyl has resulted in a lot of cancer cases, particularly in kids. Surgery can be used to treat overactive thyroid. Take out the thyroid and the problem is gone. Genetics can play a role in thyroid cancer, as can ethnicity. Hawaiians have the highest incidence and Filipinos the second-highest. The incidence of thyroid cancer has doubled in the last decade. It’s the fastest-growing cancer in the world.”

JEREMY FREEMAN, professor of otolaryngology, head and neck surgery, University of Toronto

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1990 Today Show Thyroid Week After The President Bush and Wife Developed Graves’ Disease.
                      TV medical doctor Art Ulene for NBC interviews Dr.Guttler.
 Transcript of the show.
 https://archives.nbclearn.com/portal/site/k-12/browse/?cuecard=32058TranscriptHyperactive Thyroid GlandART ULENE, M.D.

Apr. 1990. NBC Learn. Web. 19 August 2017APAUlene, A. (Reporter). 1990, April 16. Hyperactive Thyroid Gland. [Television series episode]. NBC TodayShow. Retrieved from  Thyroid Gland

ART ULENE, M.D. reporting:The thyroid gland is a small gland located in your neck right, right here, right in front of your windpipe.The gland produces a hormone that helps to regulate the body’s metabolism and the rate at which you burn up calories. If the thyroid gland is underactive, the metabolism slows down. If it’s overactive—or hyperactive, as we say in medicine–many body functions will seem to speed up.LOUISE WAN: hot, and I can’t sleep. I’m really hyper. I don’t know why. Just jump around, and even though I sit at the seat, maybe a couple of minutes I ha–I need to switch.ULENE: Five years ago, Louise Wan began to develop the classic symptoms of a hyperactive thyroid gland: nervousness, shakiness, excessive warmth, weight loss, and heart palpitations. Louise went to Dr.Richard Guttler, an endocrinologist, who found that her thyroid gland was slightly enlarged. He examined her for signs of hyperthyroidism, and ordered a blood test to check her thyroid hormone levels. They were high.Dr. Guttler also did a radioactive scan to measure how quickly her thyroid was processing iodine, which is an essential ingredient in thyroid hormone. The test uses minute amounts of radioactive iodine, note enough to damage any tissues in the body. The iodine is concentrated by the body in the thyroid gland. If the gland is hyperactive, it will take in greater amounts than normal of the iodine and will appear dark like this scan. Dr. Guttler diagnosed Louise’s problem as Grave’s disease, a condition in which the immune system manufactures abnormal antibodies which cause a speedup in the activity of the thyroid gland.RICHARD GUTTLER, MD (Endocrinologist): She had every classic symptom of Grave’s disease. She was shaking, she was nervous, she was losing weight.ULENE: Louise was then treated with radioactive iodine. She was given a much larger dose, large enough to literally destroy the overactive gland. Today she takes thyroid hormone pills in just the right amount to make up for what her gland can no longer produce.

 GUTTLER: How about till, tell me when.LANGFORD: Now.GUTTLER: Now.ULENE: Some patients with Grave’s disease, like Mary Ann Langford, also have problems with their eyes. This protrusion caused by swelling in the muscles behind the eyes.LANGFORD: It felt like someone holding my eyes open, and blowing, and going outside in bright sunlight. My eyes would water so badly that I couldn’t see.ULENE: Recently, Mary Ann underwent surgery to extend the length of one of her eyelids. Now she can close that eye, and is much more comfortable. The hyperthyroidism also caused changes in her skin,which required treatment with cortisone cream. Her problems continue today, even though her thyroid gland was removed twenty-five years ago.GUTTLER: She’s a classic example of how you have Grave’s disease for your whole life. You don’t just have Grave’s disease when your thyroid’s overactive. You can have trouble with your eyes and your skin your whole life, and that’s exactly what happened to her.ULENE: Lily O’Neary is at the opposite end of the spectrum.
LILY O’NEARY: My thyroid is hypro–it doesn’t work. So, I tired, I’m gaining weight, I had a headache.ULENE: Lily had the classic symptoms of an underactive or hypoactive thyroid. She was always tired, gaining weight, her face and hands were puffy, her reflexes were slow, and her hair and skin were dry. Dr.Guttler noticed that her thyroid gland was enlarged, a condition called goiter. A blood test confirmed that she had an underactive or hypothyroid condition, and she’s begun taking synthetic thyroid hormone to normalize her body’s metabolism.GUTTLER: Luckily, we have available the exact human thyroid, synthetically made in a factory, which is exactly what your thyroid makes, so we can just get you your thyroid function back in a pill. And the use of thyroid medication is what turned her around.ULENE: When your thyroid gland is overactive or underactive symptoms will appear, although they may occur so gradually it takes a long time to notice them.
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  •  Hashimoto/Graves’ Diseases Together: A patient in her own words.
  • K.B.

    “Dr. Guttler FIXED ME!. I went to 4 other doctors before I got to Dr. Guttler. NONE of them understood thyroid well enough to figure out my problem.  I found Dr. Guttler in 2008.  My daughter has acute Hashimoto’s Thyroiditis.  I have Hashimoto’s and Graves Disease (Hashi-toxicosis).  I went to a physician in Pasadena who told me that I needed to visit my OBGYN.  I had eyelid retraction, bulging eyeballs and double vision.for some reason, my internist did not find my eyelid retraction disturbing or concerning.  FOUR Ophthalmologists told me I had glaucoma.  I had Thyroid Eye Disease!!!!! Please understand that one can go blind using glaucoma drops when one does not have glaucoma but has thyroid eye disease.  I found out that thyroid is not taught in medical school.  To truly understand the thyroid, a doctor has to study and specialize in thyroid, not just endocrine.
    Dr. Guttler takes your blood himself in his office.  I LOVE IT.  He also does the ultrasound right in his office. I had developed nodules on my thyroid, my hair was falling out, I had bleeding fibroids, wasn’t sleeping well, thin nails and I was freezing all the time in addition to my pronounced eyelid retraction. NO ONE TOLD ME!  Luckily those nodules were benign.  I had gotten a physical from my internist every year.  The “normal” thyroid panel often does not reflect a problem. The correct blood tests can’t be ordered if the doctor doesn’t know how to order the proper blood tests.  Dr. Guttler is the ONLY Thyroid Endocrinologist that I have met that knows what he is doing. After three months on Synthroid my eyes went back in my head and my hair grew back at the temples. I immediately began sleeping more soundly.  I also lost the ten pounds that wouldn’t come off. It was amazing. ”

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Is Mono Lisa Lisa Gherardini Severely Hypothyroid?

Mono Lisa is not hypothyroid by expert second opinion.

The patient below is severely  hypothyroid before and after treatment.

DR.Guttler’s Comments:

  1. Discoloration of Gherardini’s skin, the thickness of her neck, and her enigmatic smile to hypothesize about her health during the Renaissance time period.
  2. The cardiologist cites her yellow skin, the enlarged appearance of her thyroid gland, and lack of eyebrows as symptoms to support his theory. He also writes that her mysterious smile may represent a hint of resulting psychomotor retardation and muscle weakness.
  3. “Second opinion” The documentation of thyroid disease is well known in art history, and this painting doesn’t match the countless other depictions of goiters, or enlargements of the thyroid gland.
  4. If Gherardini had a goiter from iodine deficiency, it would have been severe and more clearly demarcated in the painting like the other historical representations; a talented painter like da Vinci would have had no problem expressing it.
  5. Many of da Vinci’s paintings depict women without eyebrows, so it’s not conclusive to attribute that feature to underactive thyroid.
  6. Typically, having long-term hypothyroidism would have severely affected fertility, but Gherardini is known to have given birth to five children, including one only months before sitting for the painting.
  7. The discoloration of the skin could simply be attributed to the age of the artwork, as well as the varnish applied by the artist. Furthermore, the painting was stolen and then hidden away for almost three years, and someone also once vandalized it with acid in an act of sabotage.
  8. As for the mysterious smile and the proposal that it’s caused by muscle weakness.
  9. There are plenty of people who have an asymmetric smile, but this does not necessarily mean that they are hypothyroid.
  10. Mona Lisa second opinion is most likely correct she was normal and not hypothyroid.
Pediatric endocrinologist gives iconic ‘Mona Lisa’ a second medical opinion

by Amy Laukka, University of Texas Health Science Center at Houston

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Quackery 101: EB Virus Causes 95% of Thyroid Diseases: Snake Oil Salesman Like Gwyneth Paltrow and Anthony William are Still Doing Well in 2019. Dr.Guttler’s comments:

Stay away from Gop, Paltrow, and The Medical Medium Anthony Williams.

  1. By leveraging celebrity endorsements and the overlapping wellness, anti-vaccine, conspiracy theorist circles on social media, “the one and only Medical Medium” has crafted a lucrative business peddling books, supplements and unproven elixirs. Central to his rise is Goop, Gwyneth Paltrow’s wellness company, which is notorious for hawking expensive clothes and questionable health treatments.
  2. Gullible celebrities have fuelled the rise of America’s online quack, the ‘Medical Medium’,
  3. The claim would be laughable, but for the fact that Coviello, who now goes by the name Anthony William, has built an unlikely — and, critics argue, dangerous — empire.
  4. William is perhaps best known as the progenitor of celery juice. He claims that in liquefied form, the vegetable is a “miracle tonic” that cures everything from restless leg syndrome to psoriasis.
  5. Naomi Campbell is a devotee, as is tennis star Novak Djokovic. Robert de Niro called him a “trusted source for our family”.
  6. Critics claim, however, that he is little more than a canny snake oil salesman.
  7. William’s core customers, the community upon which he has built his brand, are the chronically ill — desperate people looking for answers.
  8. He presents them with easy, cure-all remedies to ailments that conventional medicine has failed to solve. Alzheimer’s, he argues, can be reversed by a diet heavy on wild berries “only from Maine” and Atlantic red seaweed.
  9. A lot of what he is promoting is dangerous.
  10. He claims that the Epstein-Barr Virus, the cause of mononucleosis, is behind “95% of thyroid disease cases”. He prescribes a mix of vegetables, herbs and supplements to treat the disease. “What if some mom reads that and says, ‘Oh, well I had mono when I was young, so maybe that’s why my kid has thyroid disease’, and then stops giving medication?” Gunter said.
  11. Critics claim Anthony William has built a dangerous empire
  12. A personal endorsement from Paltrow appears prominently on his website, in which she says much of what he teaches “feels inherently right and true”.
  13. Goop has been heavily criticised for marketing “wellness” products that have no basis in science.
  14. Regulators hit it with a $145,000 fine last year for “unsubstantiated” claims that its jade eggs could, if inserted into the vagina, aid bladder control and regulate hormones.
  15. Celery juice could be William’s biggest coup yet. Scan his social media feed and you will find devotees ranging from Sylvester Stallone to supermodel Miranda Kerr, toting big glasses of electric-green juice and name-checking him.
  16. William claims that drinking 16oz of celery juice, every day, on an empty stomach, gives people access to what he says are undiscovered “cluster salts” that can starve pathogens responsible for a range of maladies.
  17. DR.G.
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Thyroid disease 101: Dark Patches, Rings or Pigmentation: A Sign of Thyroid Disease?
  1. Acanthosis nigriacans could be a sign of thyroid problems.
  2. Technical term for dark patches of skin is acanthosis nigricans.
  3. Neck rings may suggest a hormone imbalance.
  4. Underactive thyroid is one cause for dark  skin patches.
  5. Dark pigmentation on your neck, merit a visit your local GP.
  6. Although it’s usually harmless, it’s best to get any skin changes checked out.
  7. In some cases, it can be a sign of something more serious, such as hypothyroidism,diabetes or cancer.
  8. Dr.G.
   
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  1. Sometimes aggression is revealed due to medical conditions.
  2. Pain is a reasons dogs may show aggression.
  3. Thyroid disease in dogs can change your well-mannered dog to an aggressive dog.
  4. Consult with your veterinarian to see if there’s a thyroid issue.
  5. It may be that simple to manage the dogs aggressive symptoms by treating the thyroid condition.
  6. Dr.G.
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Dr.Guttler’s comments:
  1. The Risk of developing 7 autoimmune diseases is largely inherited.
  2. Twin study from Sweden found the link between all 7 that were inherited.
  3. Autoimmune diseases tend to run in families.
  4. The likelihood of both twins in a pair having the same disease.
  5. Or the likelihood of both twins in a pair having different autoimmune diseases.
  6. The diseases are Addison’s disease, a type of adrenal insufficiency; celiac disease, or gluten intolerance; and type 1 diabetes, are strongly influenced by genes.
  7. Environmental factors contribute to disease for Hashimoto’s hypothyroidism, a form of underactive thyroid; the skin disease vitiligo; Graves’ disease, an overactive thyroid; and atrophic gastritis, a chronic inflammation of the stomach.
  8.  Addison’s disease and vitiligo often overlap with other disorders, whereas celiac disease more rarely associates with the other diseases.
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Cannabis and Your Thyroid Gland 101: Use at your own unknown risk for damaging effects on your hormones including thyroid gland hormones TSH and T4.

Dr.Guttler’s comments:

  1. Cannabis suppresses pituitary hormones.
  2. Which could cause changes in thyroid function.
  3. The effect of  cannabis on the thyroid has yet to be determined.
  4. Cannabis may be helpful for Graves’ disease and Hashimoto’s disease.
  5. TSH can be lower on cannabis.
  6. The thyroid is a very sensitive yet powerful gland that controls hormones that regulates mood, digestion, metabolism, and brain function.
  7. Cannabis suppresses pituitary hormones, which could cause changes in thyroid function, the consequences of which have yet to be determined.
  8. Smoke at your own risk.
  9. DR.G.

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