Thyroid Hormone Use: Trends in the United States from 1960 Through 1988

Kaufman, Steven C.; Gross, Thomas P.; Kennedy, Dianne L.

doi:10.1089/thy.1991.1.285

Cited by 41 publications

(31 citation statements)

References 30 publications

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“…21 Finally, approximately 1 in 8 participants used thyroid hormone, which is consistent with U.S. population-based studies. 1,22 These results suggest that the design of our study and its results are not spurious.…”

Section: Discussionmentioning

confidence: 60%

“…1 From 1960 through 1988, per capita mentions of thyroid hormone preparations in a government survey rose 4-fold for men and 10-fold for women ages $59 years. In 1988, thyroid preparations accounted for 1% of all drug prescriptions filled in retail pharmacies.…”

Section: Introductionmentioning

confidence: 99%

“…In 1988, thyroid preparations accounted for 1% of all drug prescriptions filled in retail pharmacies. 1 In 1999, nearly 19 million new prescriptions for thyroid hormone were written, and nearly 60 million were written in total. 2 In view of these numbers, the use of thyroid hormone may be considered a public health issue, especially among older women.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Thyroid Hormone Use and the Risk of Hip Fracture in Women ≥65 Years: A Case-Control Study

Eeden

Barzilay

Ettinger

et al. 2003

Journal of Women's Health

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thyroid Hormone Use and the Risk of Hip Fracture in Women ≥65 Years: A Case-Control Study

Eeden

Barzilay

Ettinger

et al. 2003

Journal of Women's Health

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“…This preference was reinforced by the unique ability of desiccated thyroid to reproduce a normal serum PBI (33). The predominance of natural thyroid products was illustrated by prescribing patterns in the United States: In 1965, approximately 4 of every 5 prescriptions for thyroid hormone were for natural thyroid preparations (38). Concerns about inconsistencies in the potency of these tablets arose (26) after the discovery that some contained anywhere from double to no detectable metabolic activity (39).…”

Section: Rise and Fall Of Natural Thyroid Productsmentioning

confidence: 99%

The History and Future of Treatment of Hypothyroidism

McAninch¹,

Bianco²

2016

Ann Intern Med

102

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Thyroid hormone replacement has been used for more than a century to treat hypothyroidism. Natural thyroid preparations (thyroid extract, desiccated thyroid, or thyroglobulin), which contain both thyroxine (T4) and triiodothyronine (T3), were the first pharmacologic treatments available and dominated the market for the better part of the 20th century. Dosages were adjusted to resolve symptoms and to normalize the basal metabolic rate and/or serum protein-bound iodine level, but thyrotoxic adverse effects were not uncommon. Two major developments in the 1970s led to a transition in clinical practice: 1) The development of the serum thyroid-stimulating hormone (TSH) radioimmunoassay led to the discovery that many patients were overtreated, resulting in a dramatic reduction in thyroid hormone replacement dosage, and 2) the identification of peripheral deiodinase-mediated T4-to-T3 conversion provided a physiologic means to justify l-thyroxine monotherapy, obviating concerns about inconsistencies with desiccated thyroid. Thereafter, l-thyroxine mono-therapy at doses to normalize the serum TSH became the standard of care. Since then, a subgroup of thyroid hormone–treated patients with residual symptoms of hypothyroidism despite normalization of the serum TSH has been identified. This has brought into question the inability of l-thyroxine monotherapy to universally normalize serum T3 levels. New research suggests mechanisms for the inadequacies of l-thyroxine monotherapy and highlights the possible role for personalized medicine based on deiodinase polymorphisms. Understanding the historical events that affected clinical practice trends provides invaluable insight into formulation of an approach to help all patients achieve clinical and biochemical euthyroidism.

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“…In 1988, 26% used natural agents (desiccated thyroid 22%, thyroglobulin 4%) and 74% used synthetic agents (L-T 4 68%, liothyronine 2%, liotrix [T 4 + T 3 ] 4%). Thyroid hormones were used by 1.8% of the US resident population [8]. …”

Section: Historical Notesmentioning

confidence: 99%

Thyroid Hormone Replacement Therapy

Wiersinga¹

2001

Horm Res Paediatr

112

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Thyroid hormone replacement has been used for more than 100 years in the treatment of hypothyroidism, and there is no doubt about its overall efficacy. Desiccated thyroid contains both thyroxine (T₄) and triiodothyronine (T₃); serum T₃ frequently rises to supranormal values in the absorption phase, associated with palpitations. Liothyronine (T₃) has the same drawback and requires twice-daily administration in view of its short half-life. Synthetic levothyroxine (L-T₄) has many advantages: in view of its long half-life, once-daily administration suffices, the occasional missing of a tablet causes no harm, and the extrathyroidal conversion of T₄ into T₃ (normally providing 80% of the daily T₃ production rate) remains fully operative, which may have some protective value during illness. Consequently, L-T₄ is nowadays preferred, and its long-term use is not associated with excess mortality. The mean T₄ dose required to normalize serum thyroid stimulating hormone (TSH) is 1.6 µg/kg per day, giving rise to serum free T₄ (fT₄) concentrations that are slightly elevated or in the upper half of the normal reference range. The higher fT₄ values are probably due to the need to generate from T₄ the 20% of the daily T₃ production rate that otherwise is derived from the thyroid gland itself. The daily maintenance dose of T₄ varies widely between 75 and 250 µg. Assessment of the appropriate T₄ dose is by assay of TSH and fT₄, preferably in a blood sample taken before ingestion of the subsequent T₄ tablet. Dose adjustments can be necessary in pregnancy and when medications are used that are known to interfere with the absorption or metabolism of T₄. A new equilibrium is reached after approximately 6 weeks, implying that laboratory tests should not be done earlier. With a stable maintenance dose, an annual check-up usually suffices. Accumulated experience with L-T₄ replacement has identified some areas of concern. First, the bioequivalence sometimes differs among generics and brand names. Second, many patients on T₄ replacement have a subnormal TSH. TSH values of ≤0.1 mU/l carry a risk of development of atrial fibrillation and are associated with bone loss although not with a higher fracture rate. It is thus advisable not to allow TSH to fall below – arbitrarily – 0.2 mU/l. Third, recent animal experiments indicate that only the combination of T₄ and T₃ replacement, and not T₄ alone, ensures euthyroidism in all tissues of thyroidectomized rats. It is indeed the experience of many physicians that there exists a small subset of hypothyroid patients who, despite biochemical euthyroidism, continue to complain of tiredness, lack of energy, discrete cognitive disorders and mood disturbances. As organs vary in the extent to which their T₃ content is derive...

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Thyroid Hormone Use: Trends in the United States from 1960 Through 1988

Cited by 41 publications

References 30 publications

Thyroid Hormone Use and the Risk of Hip Fracture in Women ≥65 Years: A Case-Control Study

Thyroid Hormone Use and the Risk of Hip Fracture in Women ≥65 Years: A Case-Control Study

The History and Future of Treatment of Hypothyroidism

Thyroid Hormone Replacement Therapy

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