Talk:Hypothyroidism/Archive 1

Subclinical Hypothyroidism

Ah - the section labeled "Subclinical hypothyroidism" is a bit confusing to me. Could someone detail what the meta-analysis found no benefit of?

76.190.30.87 (talk) 03:21, 19 December 2007 (UTC)Dave

Is Wilson's syndrome an important topic to discuss?

[1]

No. Why on earth are you posting this here and not on Wilson's disease? JFW | T@lk 03:52, 23 Jan 2005 (UTC)

Our querent has apparently happened on a web site that sells drugs for something they've termed "Wilson's Thyroid Syndrome" (which seems to be named after "E. Denis Wilson, MD", who owns the web page. Unfortunately, as you and I know, that's not the accepted name for anything, and is likely to be confused with both "Wilson's disease" (to which there is not even a purported relation) and with hypothyroidism...from reading the website, it isn't even what would normally be called "sick euthyroid syndrome" or "subclinical hypothyroidism" - it's a disease "discovered" by Dr. Wilson, who says that "most doctors" don't "know about" it "yet", and who says it must be treated according to his "naturopathic" doctrines...and with his medicines only. [2] So I'd agree that the answer is, no, it's not a syndrome that is established in the medical literature, and we therefore needn't be discussing it. - Nunh-huh 04:09, 23 Jan 2005 (UTC)

Fluoride poisoning?

The first experiments in 1854 determined that Fluoride caused goiter in dogs. Human experiment began shortly afterwards. In the 1930’s Fluoride was used successfully to treat Hyperthyroidism. It would reverse Hyperthyroidism in 30 days. — Preceding unsigned comment added by 24.155.204.31 (talk) 03:15, 7 October 2013 (UTC)

The analogy of fluoride poisoning with hypothyroidism is weak. The external link goes to an advocacy group: Parents of Fluoride Poisoned Children. The 'scientific evidence' provided by the website is very poor. Here is one example: PFPC claims a link between fluoride poisoning and multiple sclerosis. PFPC refers to the paper 'Neurotoxicity of sodium fluoride in rats' by PJ Mullenix in 'Neurotoxicology & Teratology' Journal. Mullenix's paper is valid and rigorous. However Mullenix makes no comparison to any specific human disease. MS was not mentioned at all.

This link was added by anonymous user 24.202.242.119 After reviewing the user's edits, it is apparent that he/she has a preoccupation with fluoride. Axl 17:47, 24 Jan 2005 (UTC)

Myxoedema

I can't find the definition or the peculiar signs which define the mixoedema in this article. The redirection is obviously wrong, but during those days of cleaning, I'm not going to write something which will be "mercilesssly deleted".

NEW COMMENT

• Someone undo the redirection from "Myxoedema" please*

Or at least teach me how to do it.

Myxoedema refers to the skin and tissue disorder usually due to hypothyroidism. It is NOT one and the same as Hypothyroidism. I can do up a page on it if someone would just unlink it or teach me how to do it thanks.

--Mkmk

Hi Mkmk!

To answer your question: you can edit the Myxoedema page by typing "Myxoedema" into the search box (which currently redirects you here). Then look for the text under the title "Hypothyroidism" and under the phrase "from wikipedia, the free encyclopedia" -- which says "(redirected from Myxoedema)". Click on the word 'myxoedema' (it's a link to the actual myxoedema page, it should not redirect you back to this page). You can then edit that page like you would any other page, and get rid of the #REDIRECT tag you'll find when you edit it for the first time. By the way, you can sign your name and the date and time with four tildes. J Lorraine 13:10, 9 February 2006 (UTC)

thanks! --Mkmk

Quote from American Thyroid Association Hypothyroidism Booklet "myxedema: severe hypothyroidism; the brain, heart, lungs, kidneys, and other organs slow to the point that they cannot keep up critical functions like maintaining temperature, heart rate, blood pressure, and breathing myxedema coma: often-fatal unconsciousness resulting from severe hypothyroidism "

Is Myxedema Severe Hypothyroidism or just a result?

Primary and secondary

Does anyone think it's worth mentioning primary and secondary hypothyroidism? Primary being due to gland dysfunction and secondary due to decreased drive from TSH? Evilhypnotist 20:29, 21 February 2006 (UTC)

Primary hypothyroidism results from the thyroid gland itself not making sufficient thyroid hormone when it is stimulated by thyroid-stimulating hormone (TSH), from the pituitary.

Secondary hypothyroidism results from insufficient TSH from the pituitary.

Tertiary is further back the stimulation highway and involves too little stimulation of the pituitary by the hypothalamus.

Both secondary and tertiary forms of hypothyroidism are termed "central" hypothyroidism. In either of these cases, "it's all in your head"--literally! regards, good2Bherewithyou

Sources

Maybe I'm missing them, but I'm not seeing many(or any) sources cited on this article; at least the sources I do see contain very little in terms of all of the total content on the article. Smeggysmeg 01:33, 9 March 2006 (UTC)

"Stop the Thyroid madness" does not have the appearance of a WP:RS WP:EL compliant source. I removed it. Midgley 11:46, 23 June 2006 (UTC)

Subclinical hypothyroidism

Subclinical hypothyroidism gives a modest increase in cardiovascular risk[3]. JFW | T@lk 17:40, 9 July 2006 (UTC)

Actually

The most common cause of hypothyroidism is Atrophic (autoimmune) hypothyroidism and not Hashimoto's thyroiditis. While both are associated with thyorid microsomal antibodies, they are not the same.

The article should probably mention iodine deficiency and dyshormonogenesis as a cause too.

Wow that's interesting. I've heard of the possible difference between atrophic and goitrous autoimmune hypothyroidism, but I didn't know the atrophic version is more common. Do you know where I could find a reference? I appear to suffer from the atrophic version. --GrimRC 86.4.58.252 17:00, 24 October 2006 (UTC)

I am new at this but here goes... (Endocrinology: An Integrated Approach was the text I used...)

The most common causes of hypothyroidism is autoimmunity. T-cell mediated actions destroy thyroid gland and disrupt certain, or all, function. Hashimoto's disease is one characterized means of autoimmune thyroid disruption.

Secondary hypothyroidism often results from damage to the hypothalamic-pituitary axis, which interfers with thyroid hormone production or action.

Thyroid hormone is normally released by follicles within the thyroid gland. The formation of hormone is dependant upon the addition of four iodine molecules. The follicles sequester about ninety days worth of iodine for this purpose, but long-term iodine deficiency, beyond follicle stores, is life-threatening.

The World Health Organization (WHO) recognized that ~30% of the world's population was at risk for such iodine deficiency. Efforts to include iodized salt into populations at risk have had great success.

Fluoride and Herbal remedies

I removed the unsourced claim that consuming fluoride causes hypothyroidism. I can't find any claims to this effect other than from anti-fluoride conspiracy theorists. A website devoted to denouncing fluoride is a biased source. If fluoride really causes hypothyroidism, how come this isn't mentioned in the 25 page booklet published by the American Thyroid Association? They don't use the word fluoride once.

Also, while iodine deficiency is apparently a leading cause of hypothyroidism in developing countries, in developed countries where iodized salt is readily available this isn't a problem. In fact, the American Thyroid Association notes that taking excess iodine can actually make the codition worse.

I also edited the "Possible Cures" section, which I renamed "Treatment". Previously it appeared to be spam for a particular herbal remedy. The American Thyroid Association (which represents professional thyroid researchers and physicians) states that herbal remedies are ineffective. -- Tim314 16:35, 3 January 2007 (UTC)

REPLY, Change it to say that there is controversy about this claim or that this is only claimed by anti-flouride groups. Do that at least, don't remove it completely. Would you like me to delete the other stuff saying that it is from a biased source which is the government? Anyway I'm putting it back in. IF YOU WANT TO CHANGE IT, CHANGE IT SO SAY THAT THE AMERICAN THYROID ASSOCIATION DOESN'T BACK THE CLAIM! DO NOT REMOVE THE VIEW POINT COMPLETELY. AntiLiberal2 04:05, 5 January 2007 (UTC)

If there is a source for the claims about fluoride and hypothyroidism, please give it. Rosemary Amey 23:55, 9 January 2007 (UTC)

It doesn't do any good. The person above deleted it because they said that all studies that support it are from biased sources. If source that has a study about this they say that it's biased and ignore it, because they say that it's an "antifluoride" or a "conspiracy site" and refuse to accept it. Anyway I'm going to say that certian sources like antifluoride groups claim that fluoride is the main cause of this. You can't argue with that. AntiLiberal2 04:49, 12 January 2007 (UTC)

I don't think the claims about fluoride causing hypothyroidism are notable enough to be included in this article. See WP:N. If we start including every fringe theory, then we would have to add urine therapy, homeopathy, accupuncture, etc etc to this page, which I think would be ridiculous. Also, please see WP:RS for what constitutes a reliable source. Rosemary Amey 05:22, 12 January 2007 (UTC)

The problem is that it's true, really it should be the main point in the article, but I'm being nice. French doctors did prescribe Sodium Fluoride to treat over active thyroid. People today are exposed to fluoride levels higher than the doctors prescribed. It's so simple, how can you not get this? AntiLiberal2 00:34, 13 January 2007 (UTC)

If it's true, I would certainly want to know about it, as I suffer from hypothyroidism myself, but you still have not given a reference! Rosemary Amey 00:36, 13 January 2007 (UTC)

What about all the other stuff that doesn't have a source? Somebody just put it there as if it's common knowledge? Anyway, there are quite a few people with string anti-fluoride beliefs and it is worth mentioning on wikipedia! AntiLiberal2 01:03, 13 January 2007 (UTC)

The fact that there are other unsourced statements in the article means the article needs improvement. It isn't license for adding unproven allegations. Is there a scientific paper (not an advocacy group) that even mentions fluoride in connection with hypothyroidism?0nullbinary0 (talk) 06:44, 28 February 2008 (UTC)

Request for comment: fluoride and hypothyroidism

This is a dispute about whether claims that fluoride causes hypothyroidism should be included in the hypothyroidism article. 02:14, 13 January 2007 (UTC)

Statements by editors previously involved in dispute

• Although some anti-fluoride activists claim that fluoride causes hypothyroidism, this is a fringe theory which is not notable enough to merit inclusion on this page. No one has given a reliable source for the anti-fluoride claims. Rosemary Amey 02:14, 13 January 2007 (UTC)

• So basically only sources that are from the government or the established medical system are qualified for wikipedia? I see that you searched PubMed. Had you searched google for the same thing you would have found maybe even hundreds of papers and possible many studies that support the claim that I presented. AntiLiberal2 04:07, 13 January 2007 (UTC)

• • But do any of these googled sites constitute WP:Reliable sources ? David Ruben ^Talk 10:13, 13 January 2007 (UTC)

Comments

• I'ld be a bit kinder and state trivial un-notable theory, as the provided link to campaigning site does in itself cite real research. The problem is one of over interpretation of the research results and linking ideas not then supported by external 3rd party research. One of the links itself cited numerous studies showing no effect of fluoride on thyroid function where iodine levels are normal, but possibly some effect in Himalyas when iodine deficiency was occuring. This though does not support hypothyroidism occuring in the UK where all salt has been supplemented for many years with iodine, thus laergely preventing iodine-deficiency, yet we still see cases of hypothyroidism

  A search of PubMed for "hypothyroide fluroride" keywords gives 22 hits, of which just 4 seem direct research suspecting such a link, and the last of these was printed 21 years ago - hardly a topic of current interest:

  • Bachinskiĭ P, Gutsalenko O, Naryzhniuk N, Sidora V, Shliakhta A (1985). "[Action of the body fluorine of healthy persons and thyroidopathy patients on the function of hypophyseal-thyroid the system]". Probl Endokrinol (Mosk). 31 (6): 25–9. PMID 4088985.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • Börner W, Eichner R, Henschler D, Moll E, Ruppert G (1980). "[Pharmacokinetics of fluorides in thyroid dysfunctions. The plasma fluoride concentration after oral administration of 40 mg of NaF in delayed and nondelayed form depending on the thyroid function]". Fortschr Med. 98 (28): 1083–6. PMID 7419155.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • Hillman D, Bolenbaugh D, Convey E (1979). "Hypothyroidism and anemia related to fluoride in dairy cattle". J Dairy Sci. 62 (3): 416–23. PMID 447892.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  • Strubelt O, Bargfeld D (1973). "[Toxicology of drinking water fluoridation]". Dtsch Med Wochenschr. 98 (15): 778–83. PMID 4266645.

  I did see in the search though one paper that for endemic "Chronic fluoride toxicity in the form of osteo-dental fluorosis was observed in cattle, buffaloes, sheep and goats from 21 villages of Banswara, Dungarpur and Udaipur districts of Southern Rajasthan where the mean fluoride concentration in drinking water varied from 1.5 to 4.0 ppm" found "None of the fluorotic hibited any apparent evidence of hypothyroidism, stunted growth or low milk production" - Choubisa S (1999). "Some observations on endemic fluorosis in domestic animals in Southern Rajasthan (India)". Vet Res Commun. 23 (7): 457–65. PMID 10598076.

  I think if fluoride and thyroid must be mentioned, then perhaps as part of arguements in Water fluoridation controversy, but this is really a trivial viewpoint (thus not requiring mention under WP:NPOV) as far as human clinical hypothyroidism is concerned (no biomedical research paper in last 21 years).

  Remember as Wikipedia:Fringe theories content guidence states: "The discussion of a non-mainstream theory, positively or negatively, by other non-mainstream groups or individuals is not a criterion for notability, even if the latter group or individual is itself notable enough for a Wikipedia article. If a non-mainstream theory is so unnotable that mainstream sources have not bothered to comment on it, disparage it, or discuss it, it is not notable enough for Wikipedia.". Surely teh absence of any PubMed abstracted paper in last 21 years counts as "not bothered to comment on it, disparage it, or discuss it" ? David Ruben ^Talk 03:26, 13 January 2007 (UTC)

• You're saying that a study that is 22 years old is no longer any good??? Fluoride is still fluoride, and people are still people. Has there been a change in human beings or chemical properties in the last 22 years? AntiLiberal2 22:56, 13 January 2007 (UTC)

• No, the study was the study, but the 2 dacades of no further research indicates not "a topic of current interest" and thus not seeming to be a concept thought worthy of ongoing research. David Ruben ^Talk 04:20, 14 January 2007 (UTC)

• That is not how science works. Whether something is a "topic of current interest" is irrelevant to its merit. It may be that the study in question has been debunked, and that is why there is no current interest in the topic, but if this result has been reached, surely somebody must have published it, right?0nullbinary0 (talk) 06:51, 28 February 2008 (UTC)

• No - a trivial minority fringe theory will tend to just be ignored (why should anyone waste their time having to debunk every claim made). To go back to wikipedia guidelines, as stated above, "If a non-mainstream theory is so unnotable that mainstream sources have not bothered to comment on it, disparage it, or discuss it, it is not notable enough for Wikipedia.". Remember this is a talk page for discussing the edit of the article, not to discuss the topic itself. Now if the theory had entered mainstream acceptance and so need nolonger any new research papers on the topic as per Randroide's point immediately below, then there would still be current sources to cite from, namely standard textbooks on endocrinology. So unless it can be shown that this idea is prevalent in current standard textbooks on the subject, or mainstream reviews (eg MedlinePlus, eMedicine etc) then it is not a mainstream view, but a minority one. Next the failure to find it even reasonably well mentioned-in-passing if only to merely disparage it, strikes me as a reasonable criteria for considering this a trivial minority viewpoint, and thus under WP:NPOV inappropriate to mention at all in the encyclopaedia.David Ruben ^Talk 12:05, 28 February 2008 (UTC)

• A 20yo study could be as good (or better, or worse) than a current year study. If there is no new evidence showing that those studies were flawed, the age of those studies is totally irrelevant. Just an example: Pasteur#Germ_theory. That experiment was made in the 19th century, but it is still cited.Randroide 09:36, 28 January 2007 (UTC)

• comment -The studies should be mentioned, but it should be clear how old they are and they should not be given undue importance. futurebird 19:10, 31 January 2007 (UTC)

Hypothyriodism and Iraq War Vets.......

Durring My first trip To Iraq during the invasion with the us army myself and other soldiers found our selves in a predicament, we were working out every day after missions as well as dieting but were becoming grossly over wieght. after reading this i have one question. can this have to groups of men that were exposed to depleted uranium? or maby some other chem or substance? I am asking this because this condition usualy effects women. but out of about 120 men almost 25 of us now have it. and it has ruined my life and the va will do nothing for me. please contact me via email.....cherplace@aol.com —Preceding unsigned comment added by 67.131.224.6 (talk • contribs) 03:37, 12 November 2007

A quick search on PubMed gives no hit for "uranium hypothyroid", whilst "hypothyroidism gulf" came up with just one (?relevant) link of PMID 12888300. Seems therefore lack of information, and certainly insufficent for commenting generally within the article, but I hope it is of interest. David Ruben ^Talk 10:31, 12 November 2007 (UTC)

Treatment section is biased

Regarding the T3/T4 meta-analysis, please do not provide unreferenced facts and your own personal commentary. You mention the poor design of the studies in the analysis--this is clearly an opinion, not an unbiased fact. Please edit. It's acceptable that you mention that patients were all assigned the same dose, but saying that the studies were poorly designed is an opinion.

I haven't read the studies, but just offhand: if you're comparing T3 and T3 + T4, regardless whether or not the doses were tailored to the patient, I believe you can reasonably gauge whether or not T3 has an additive therapeutic effect. These were controlled trials, no?

Your tidbit about most clinicians finding that patients need higher doses of T3 needs to be referenced, otherwise, delete.

What drug company are you with? —Preceding unsigned comment added by 67.81.40.233 (talk) 03:41, 3 December 2007 (UTC)

Treatment using T3/T4 or T3-only medicines

I added a comment regarding treatment using T3/T4 or T3-only as opposed to the mainstream view of treating using T4-only medicine. This is relevant because a "mainstream source" - i.e. the American Thyroid Association, has addressed this issue in their guidelines, and said that there is not "enough" evidence to change the current treatment, although there's certainly a new interest in this type of treatment (the ATA said so). That is their opinion, and I believe the encyclopedia acticle deserves a review of other opinions. (different eyes gave different opinions to current "evidence", we cannot ignore the different opinions on the evidence and give just the opinion of ATA). Mathityahu (talk) 21:21, 23 April 2008 (UTC)

Organization problem when new content was added

I am very sorry, but I keep trying to add a section to the Treatment Controversy. I think that this section is important in balancing the Treatment Controversy portion of the article, but for some reason, everything goes out of alignment when I try to add my content. Adding the information somehow messes up the portion of the article on Subclinical Hypothyroidism. I do not understand this because I included two equal signs around the phrase Subclinical Hypothyroidism. When I try to correct the organization problem, strange things happen. I might try editing it half a dozen times, and it remains a mess! Sometimes, the references disappear. Other times, the text about Subclinical Hypothyroidism appears below the references. I have tried adding the information on two different occasions, and the same thing happens every time: the content from Treatment Controversy somehow becomes merged (in an unreadable way) with the content from Subclinical Hypothyroidism, without any separation between the two portions of the article. Right now, I have the article the way I think it should be, except for the fact that the references have disappeared! Could anyone possibly help me to reorganize this and include some of this information? Here is what I wished to write on the Treatment Controversy portion:

Levothyroxine is the standard treatment for hypothyroidism, but both the American Association of Clinical Endocrinologists (AACE) and the American Thyroid Association (ATA) have said that some patients may fare better on a combination of T₄ and T₃. T₃ can clear up symptoms in patients who still show symptoms on T4 treatment. Some patients report that they feel so much better when they switch treatments. T₃ treatment may be necessary for patients who have trouble converting T₄ to T₃. The journal Thyroid Science states, “[T]oday's conventional thyroid hormone therapy, T4-replacement, has been documented to be ineffective and harmful to many patients.” Some studies have shown that a combination of T₄ and T₃ is more effective.

More often than not, however, L-T₄ is the more appropriate treatment option. T₃ is ten times more active than T₄, but almost all hypothyroid people can convert T₄ to T₃; their thyroid glands simply are not producing enough T₄ and T₃. The ATA has explained that T₃ treatment can cause T₃ levels to fluctuate in the bloodstream, from very high to low, producing symptoms of hyperthyroidism. T₄ has a much longer half-life than T₃. T₃ levels are more stable during L-T₄ treatment. One source of controversy is the fact that the ATA has received funding from Knoll, producer of Synthyroid. However, Arnold Stern, M.D., Ph.D, in an endocrinology course from New York University, also says that T₄ has a longer half-life: seven days versus twenty-four hours for T₃, and T₄ is used both for replacement therapy and TSH suppression while T₃ is used chiefly for TSH suppression.

The "more often than not" statement has to be referenced. Besides, I don't think the moderators in wikipedia would agree to cite a certain MD's opinion. However I think you can cite his article if it shows more favourable results to T4 therapy compared to T3+T4 therapy in a clinical research article published in a peer-reviewed journal.Mathityahu (talk) 08:48, 6 June 2008 (UTC)

Besides, a statement such as "some patients report that they feel so much better when they switch treatments" is clearly an opinion and IMO does not belong to wikipedia. Mathityahu (talk) 08:55, 6 June 2008 (UTC)

Thank you, Mathityahu, for repairing this page for me. This page had no references last night. However, there are still two minor problems with the article that I need someone to help me with. First, the same content for Subclinical Hypothyroidism appears twice in the article, in two different places. Yesterday, when I was attempting to correct the organization problems, I tried moving the section on Subclinical Hypothyroidism, placing it between the sections on Diagnostic Testing and Treatment. Second, the Table of Content shows that Subclinical Hypothyroidism (5.2) is part of the Treatment section (5); it should be a separate section (6). I really do not have a preference about whether the section comes after Diagnostic Testing or Treatment. I also wonder: if someone else were to add content to Treatment Controversy, would the article end up a mess again? I wish that I knew how to format this article to correct these problems, but all that I know is that you use two equal signs for the name of a new section and three equal signs for a subsection. Can someone please help me? —Preceding unsigned comment added by 69.34.87.191 (talk) 00:42, 7 June 2008 (UTC)

I removed one of them subclinical hypothyroidism paragraphs. IMO, subclinical hypothyroidism should be a part of treatment as it is now. If some else adds content to treatment controversy and makes it well-referenced and well-edited, there won't be a mess again. I am not much of an expert on editing either, I guess you can read the help, and also create a user for yourself. Mathityahu (talk) 09:45, 7 June 2008 (UTC)

Thank you so much, Mathityahu! —Preceding unsigned comment added by 69.34.86.215 (talk) 22:52, 7 June 2008 (UTC)

Removal of Thyroid Science

WP:NPOV describes how equal weight should not be given to minority view points. Thyroid Science, as far as I can tell, is a website with a very specific agenda ("Today's conventional thyroid hormone therapy, T4-replacement, has been documented to be ineffective and harmful to many patients. Resistance to abandoning T4-replacement, or limiting its use to particular appropriate cases, is strong."[4]) which is hardly compatable with scientific open mindedness of their byline "A journal dedicated to truth in thyroid science and clinical practice". Furthermore again as far as I cen tell it allows self-publishing ("Thyroid Science is an open-access electronic journal"[5]).

To describe Thyroid Science as a "medical journal" seems misleading and imply that articles are as rigorously peer-reviewed and credentials of authors checked, something this website goes out of its way to reject "In that we are dedicated to such truth, we consider Thyroid Science a stark contrast to most major medical journals today—especially endocrinology journals. In my judgment, most such journals have been co-opted by corporations and are used as cloaked advertising media. We conceived Thyroid Science as an alternative to those publications, offering it as a medium of expression for those who do not want their views censored"[6] - but seems material accepted not for being of a rigorous researcher and study design, but for "such truth" as fits their preset ideas (that conventional T4 replacement is wrong as set out in the previously mentioned author guideline link). Hence long quote of this journal is of WP:UNDUE nature compared to the conventional mainstream majority view. The controversy section provides references to 2 papers from peer-reviewed journals which suitably verify this minority viewpoint.

Finally the AACE view seemed to be dismissed by stating that "recent publications have also challenged the status quo", yet used sources older than that given for the AACE ! I removed the "recent" description (I could have used "older" but so nearly contempory as to be splitting hairs) but placed views into order that they have been expressed. David Ruben ^Talk 00:22, 8 June 2008 (UTC)

Hello. By similar criteria, I believe the misguided opinion of the NAACE should be removed as well, as they are funded by Abbott Laboratories, makers of Synthroid (T4), and although presented as a "non-profit" organization, is guided by commercial interests. Mathityahu (talk) 05:22, 8 June 2008 (UTC)

Please reference above statement. While you are at it, does Forest Pharmaceuticals (maker of Armour Thyroid, a competitor of Synthroid) also "fund" NAACE. —Preceding unsigned comment added by 24.170.49.91 (talk) 03:16, 14 June 2008 (UTC)

Hello. Abbott Laboratories funds many of of the activities of AACE in meetings in conferences and in many of their presentations AACE thanks Abbott. They also give an "unrestricted educational grant" to AACE to send free copies of their "educational thyroid brochures" as can be seen on the order page: http://www.aace.com/pub/bookstore/edumaterials.php . For a reference, I cannot cite a medical journal as this is not a scientific "conclusion" of any article, but it is well known and I don't think it should be referenced in that way. This issue has received much attention throughout the internet, here is an example of a letter sent to AACE's president and his reply regarding this issue http://thyroid.about.com/library/hotze/bllawletter.htm . Forest Pharmaceuticals of course do not fund the AACE. Mathityahu (talk) 09:49, 14 June 2008 (UTC)

Wikipedia is not a soapbox[7] and to dismiss views of the majority (endocrologists) just because of a perceived conflict of interest due to Pharma support and thus some conspiracy is not helpful Mathityahu. One might likewise look at Coronary artery disease (CAD) and the advocacy and guidelines recomending use of statins to reduce colesterol levels. Yes there are cholesterol-CAD deniers (see Lipid hypothesis#The cholesterol controversy of atherogenesis), who in part claim all guidelines purely the drug companies pushing of their products, but the majority view is not this and the CAD article does not add caveats of Pharma funding.

That all said, there are some intersting issues to do with T3 administration, such as why it seems to cause such swings in circulating thyroid hormone levels across the day. Likewise what is the best TSH range to seek is interesting - as an example an article finding low tissue T3 levels when treatment with T4 is given to reach TSH targets... concluding that slightly higher T4 levels perhaps should be given to give low-normal TSH values and higher tissue T3 levels - Alevizaki M, Mantzou E, Cimponeriu AT, Alevizaki CC, Koutras DA (2005). "TSH may not be a good marker for adequate thyroid hormone replacement therapy". Wien. Klin. Wochenschr. 117 (18): 636–40. doi:10.1007/s00508-005-0421-0. PMID 16416346. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link). David Ruben ^Talk 01:41, 15 June 2008 (UTC)

Psychological associations

I want to amend something, any thoughts?

Although there are some psychological associations, namely depression and bi-polar disorder, these two are erroneous.

1. borderline personality disorder[citation needed]
2. a psychotic disorder (typically, paranoid schizophrenia)

Borderline is a serious personality dysfunction and schizophrenia is an organic disorder and not related to schizophrenic personality disorder. Neither of these are related to thyroid disease. Also the term 'a psychotic disorder' is vague and can mean anything from a grand delusional thought process to an extreme organic disorder. These are mental illnesses, not thyroid illnesses and are not caused by or a cause of thyroid dysfunction. Thyroid dysfunction may agitate mental & mood problems but it is not to be confused with being a catalyst. Starlightning (talk) 05:22, 2 July 2008 (UTC)

Myxoedema madness is well known. But rare. Phrasing of the sort "can be confused with" rather than "diagnosed as" is also probably more helpful and informative. Midgley (talk) 09:36, 11 November 2009 (UTC)

External Links

I wish to delete the link to icarecafe. The organisation is a market research-type company which spams both Usenet and private member forums. The linked 'forum' had, when I looked, zero posts. The link exists only for promoting icarecafe. Any comments? Polyamide (talk) 08:56, 18 December 2008 (UTC)

Bad article

There is some good material here, but it is a mess. Needs a complete rewrite. Midgley (talk) 08:38, 11 November 2009 (UTC)

Alternative

I've cut this from the main article:

An excellent overview is a neutrality concerning the administration of synthetic T4 (by itself) that appears to miss a crucial issue, namely the flawed assumption that the natural conversion of T4 to the active T3 invariably takes place in the body. That this is not the case has been amply demonstrated in peer-reviewed literature; factors including pesticides (now ubiquitous in the diets of people in developed societies), stress, allergies, and selenium deficiencies (or in cases of excessive selenium in water supplies, selenium toxicity) -- all may block the endogenous T4 to T3 conversion. The statement that prompted the above paragraph is in your page as: The traditional treatment for hypothyroidism is thyroid hormone replacement, which involves taking a prescription drug (T4, T3, or a combination product containing both T4 and T3). Armour is a naturally derived thyroid replacement containing both T4 and T3, and it is available by prescription. I don't think I am being picky by focusing on the "(T4, T3, or a combination product) since the beginning of the phrase clearly implies that T4 by itself can be used, without bringing up the problematic aspects of such an assumption. T4 alone may indeed convert nicely in some people, but there are a plethora of studies that suggest, either directly or indirectly, that this conversion is not something that can be assumed, in fact an aggregate of the various investigations would suggest that up to 40% of people do not have the capacity to make this conversion upon taking Synthroid, or it is even (possibly most often) missing in the case of endogenous T4 production. I could take the time to gather all the studies I have referred to, but at this time they are tacit knowledge to me from my own researches stretching back some years. I would have to take a trip to my local university to revisit them. Your site says you have a research staff, well this is something they can focus on. To be fair, I do happen to have on hand one study that indirectly contradicts what I have said (in a narrow way):

"Psychological Well-Being Correlates with Free Thyroxine But Not Free 3,5,3΄-Triiodothyronine Levels in Patients on Thyroid Hormone Replacement" Journal of Clinical Endocrinology & Metabolism 91(9). I think the above study, focusing on patient psychological well-being, is in response to the NEJM study "EFFECTS OF THYROXINE AS COMPARED WITH THYROXINE PLUS TRIIODOTHYRONINE IN PATIENTS WITH HYPOTHYROIDISM" (New England Journal of Medicine, Volume 340 Number 6 [1999] - curiously, this pivotal NEJM study is not referenced in the J Clin Endoc Metab study. This area is very 'political' and there is evidence from the area of Science and Technology Studies and from the Sociology of Scientific Knowledge, that the former study may qualify for a contrived one motivated and possibly financed, directly, indirectly, assisted in covert ways, by major pharmaceutical manufacturers.http://www.raysahelian.com/thyroid.html From the Journal of Pharm. Pharmacol., vol. 9, 1998. By: Drs. Panda & Kar, School of Life Sciences, D.A. University, Indor, India. These findings reveal that the Ashwagandha root extract stimulates thyroid activity and 'that Ashwagandha extract] also enhances the anti-peroxidation* of 'liver] tissue." Emphasis added.

• Peroxidation can destroy tissue. Therefore, Ashwagandaha is somewhat protective to the liver.

Alternative

I've cut this from the main article:

An excellent overview is a neutrality concerning the administration of synthetic T4 (by itself) that appears to miss a crucial issue, namely the flawed assumption that the natural conversion of T4 to the active T3 invariably takes place in the body. That this is not the case has been amply demonstrated in peer-reviewed literature; factors including pesticides (now ubiquitous in the diets of people in developed societies), stress, allergies, and selenium deficiencies (or in cases of excessive selenium in water supplies, selenium toxicity) -- all may block the endogenous T4 to T3 conversion. The statement that prompted the above paragraph is in your page as: The traditional treatment for hypothyroidism is thyroid hormone replacement, which involves taking a prescription drug (T4, T3, or a combination product containing both T4 and T3). Armour is a naturally derived thyroid replacement containing both T4 and T3, and it is available by prescription. I don't think I am being picky by focusing on the "(T4, T3, or a combination product) since the beginning of the phrase clearly implies that T4 by itself can be used, without bringing up the problematic aspects of such an assumption. T4 alone may indeed convert nicely in some people, but there are a plethora of studies that suggest, either directly or indirectly, that this conversion is not something that can be assumed, in fact an aggregate of the various investigations would suggest that up to 40% of people do not have the capacity to make this conversion upon taking Synthroid, or it is even (possibly most often) missing in the case of endogenous T4 production. I could take the time to gather all the studies I have referred to, but at this time they are tacit knowledge to me from my own researches stretching back some years. I would have to take a trip to my local university to revisit them. Your site says you have a research staff, well this is something they can focus on. To be fair, I do happen to have on hand one study that indirectly contradicts what I have said (in a narrow way):

"Psychological Well-Being Correlates with Free Thyroxine But Not Free 3,5,3΄-Triiodothyronine Levels in Patients on Thyroid Hormone Replacement" Journal of Clinical Endocrinology & Metabolism 91(9). I think the above study, focusing on patient psychological well-being, is in response to the NEJM study "EFFECTS OF THYROXINE AS COMPARED WITH THYROXINE PLUS TRIIODOTHYRONINE IN PATIENTS WITH HYPOTHYROIDISM" (New England Journal of Medicine, Volume 340 Number 6 [1999] - curiously, this pivotal NEJM study is not referenced in the J Clin Endoc Metab study. This area is very 'political' and there is evidence from the area of Science and Technology Studies and from the Sociology of Scientific Knowledge, that the former study may qualify for a contrived one motivated and possibly financed, directly, indirectly, assisted in covert ways, by major pharmaceutical manufacturers.http://www.raysahelian.com/thyroid.html From the Journal of Pharm. Pharmacol., vol. 9, 1998. By: Drs. Panda & Kar, School of Life Sciences, D.A. University, Indor, India. These findings reveal that the Ashwagandha root extract stimulates thyroid activity and 'that Ashwagandha extract] also enhances the anti-peroxidation* of 'liver] tissue." Emphasis added.

• Peroxidation can destroy tissue. Therefore, Ashwagandaha is somewhat protective to the liver.

Omission From Table in Causes Section

I was surprised to see that iodine deficiency is not listed as a cause for primary hypothyroidism in the table summarizing the "Causes" section. Is it not the main cause for primary hypothyroidism? Privman (talk) 09:09, 6 March 2011 (UTC)

Color sensitivity--got a source for this?

I've never seen any other reference to this as a symptom of hypothyroidism. Is is a typo? —Preceding unsigned comment added by 68.183.87.10 (talk) 17:22, 26 March 2011 (UTC)

Some sources for diagnosis

Fatourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clin Proc. 2009;84(1):65-71. PMID 19121255

Vaidya B, Pearce SH. Management of hypothyroidism in adults. BMJ. 2008;337. PMID 18662921

Allahabadia A, Razvi S, Abraham P, Franklyn J. Diagnosis and treatment of primary hypothyroidism. BMJ. 2009 Mar 26;338. PMID 19325179

pgr94 (talk) 11:36, 30 April 2011 (UTC)

British guideline

I hadn't realised that the British guideline for the management of hypothyroidism is hidden in the guideline of blood tests. This is it (2006). JFW | T@lk 11:26, 30 November 2011 (UTC)

Psychiatric Signs and Symptoms

Shouldn't these get a bit more attention? Seems they are perhaps the most troubling symptoms, and they are not uncommon:

The hypothyroid patient may, among the earliest and most prominent signs or symptoms, report psychiatric symptoms. At times, the psychiatric presentation may be so striking that patients are first diagnosed with a primary psychiatric disturbance rather than hypothyroidism. The association between thyroid deficiency and psychiatric presentation is not infrequent and is commonly overlooked as an etiology for behavioral, affective, and cognitive changes. Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC419396/

google gives 8.7 million hits for hypothyroid hallucinations. That doesn't prove anything, but it does suggest a correlation, and the article doesn't mention hallucinations even once. Case studies are easily found, some described as "hallucinations of soliloquy". Ssscienccce (talk) 13:51, 22 April 2012 (UTC)

Also, I don't know the source for the list of symptoms considered "uncommon", but at least three of them are listed as "Common features of hypothyroidism in source 7 (ATA booklet):

New or worsening problems with memory, slower thinking

Feeling irritable

need for more sleep

The New York Times source (9) lists difficulty concentrating as early symptom, and impaired mental activity, including problems with concentration and memory, particularly in the elderly, as later symptoms.

Reader's digest (not the best source I admit) listed hypothyroidism as one of the ten most misdiagnosed diseases. Ssscienccce (talk) 15:09, 22 April 2012 (UTC)

Iodine

How come that "Iodine deficiency is the most common cause of hypothyroidism worldwide.", but it is not even mentioned under Treatment? If "iodine deficiency is the most common cause", then clearly iodine is needed to eliminate the deficiency that created the problem in the first place. --92.224.48.17 (talk) 21:41, 14 September 2012 (UTC)

"Stuff"

Not sure if/where you want to use this. I will be adding more here if I happen to come across it. Lesion (talk) 11:08, 14 June 2013 (UTC)

• Hypothyroidism is a possible cause of [[dysgeusia]] (taste disturbance) which may be the basis of a complaint of [[halitosis|pseudohalitosis]] (where the individual perceives bad breath but there is no detectable odor to others).<ref name="Falcão 2012">{{cite journal|last=Falcão|first=Denise Pinheiro|coauthors=Vieira, Celi Novaes; Batista de Amorim, Rivadávio Fernandes|title=Breaking paradigms: a new definition for halitosis in the context of pseudo-halitosis and halitophobia|journal=Journal of Breath Research|date=1 March 2012|volume=6|issue=1|pages=017105|doi=10.1088/1752-7155/6/1/017105}}</ref>

• No current wikilink to myxedema, even though that page immediately states that the term is often used as a synonym of severe hypothyroidism. We do wikilink to myxedema madness though.

• Enlarged lips (suggest add to enlarged tongue in symptom list)

Thanks, I saw the part about dysgeusia and was thinking about how to incorporate that into the article today. I did not notice the part about the myxedema though, so good catch on that one for sure and I'll look into the enlarged lips part too. Thanks for the help Lesion, keep it coming! TylerDurden8823 (talk) 17:16, 14 June 2013 (UTC)

Pathophysiology section

Hello all! I have added a pathophysiology section for more detailed presentation of the underlying pathology of different causes of hypothyroidism, and also for an explanation of why there are different symptoms. LT90001 (talk) 02:23, 30 June 2013 (UTC)

an evolutionary rationale would be very nice to have - thyroid hormones precede the HPA substantialy and the thyroid hormone receptor has the unique property to be autoregulating without thyroid hormones, the thyroid hormones acting as an superimposed regulatory circuit added later throughout the evolution. Richiez (talk) 21:32, 30 June 2013 (UTC)

Suspicious reference -- links to an ad rather than a scientific article/book.

"In current practice, doctors often diagnose hypothyroidism based on TSH levels alone. This approach has been criticized by patient advocates[38] and some doctors."

The reference for this claim (38) is a site called "What we've learned" (http://www.stopthethyroidmadness.com/tsh-why-its-useless/) that advertises both a book and a medication, and which clearly has no place in this entry. Could someone please remove this? Thank you. Risssa (talk) 03:06, 14 October 2013 (UTC)

I took the link out. To some degree, most links will have some type of commercial promotion involved. e.g. Most scientific journals need to make revenue from people subscribing to the journal and buying the articles.

Mary Shomon sort of argues that TSH alone is not the best method for diagnosing hypothyroidism: http://thyroid.about.com/cs/hypothyroidism/a/normaltsh.htm Glennchan (talk) 14:29, 16 October 2013 (UTC)

About.com is not even a reliable source, much less compliant with WP:MEDRS. SandyGeorgia (Talk) 16:46, 15 November 2013 (UTC)

Evolutionary Consideration

I am looking to add a section regarding the evolutionary history and implications of Hypothyroidism as part of an assignment for a college class, but I am having a hard time finding much in the way of sources, especially secondary.

–I have this article so far, but I am concerned about the reliability of this online journal: http://www.thyroidscience.com/hypotheses/rowsemitt.najarian.H.6.11/rowsemitt.najarian.6.11.pdf

–I also have this article reviewing the previous article, but it is from the same site, so I am a little suspicious: http://www.thyroidscience.com/

I don't want to put anything unreliable on the page. Does anyone have any suggestions or opinions? — Preceding unsigned comment added by Lek39 (talk • contribs) 04:24, 24 October 2013 (UTC)

Most definitely not compliant with our medical sourcing guidelines or in accordance with due weight. SandyGeorgia (Talk) 16:45, 15 November 2013 (UTC)

User:Lek39 who added this is in user:Sanetti's Darwinian medicine class. It is often difficult to go to an article with an agenda and then look for sources to back that agenda. The research literature is not comprehensive and does not cover everything one may imagine; it is often easier to browse the literature - for example just on evolutionary history or just on hypothyroidism and not on both - and when something strikes your interest, then read on that and contribute that to Wikipedia. It can be very useful for you to come to a Wikipedia talk page and share that you have looked for a certain kind of source, and that what you were seeking seems to not exist. That is a valid and useful outcome to research. Blue Rasberry (talk) 14:34, 20 November 2013 (UTC)

I have added a section regarding Evolutionary Considerations, but with a PubMed source that, instead of looking at the evolutionary implications of hypothyroidism, considers the proximate cause of the disease and its evolutionary cause. I had much better success while searching for this outcome, instead of specificly the disease itself. Lek39 (talk) 08:56, 9 December 2013 (UTC)Lek39

I don't believe a 10-year-old hypothesis belongs in the article; if the hypothesis had traction, it would have been included in other secondary reviews by now. I do wish the Sanetti class students would stop adding WP:UNDUE sections to our articles. WP:MEDMOS#Sections shows how we organize medical articles; we don't separate one hypothesis to its own "Evolutionary [c]onsiderations" section. For now, I've copyedited and moved this information to the correct section, but unless someone can find mention of this in a more recent secondary review, I believe the content is UNDUE and should be removed.[8] SandyGeorgia (Talk) 14:20, 9 December 2013 (UTC)

Primary sources, MEDRS

I'm done for now removing primary sources, but this article is still in bad need of an update and better citation to sources complaint with our medical sourcing guidelines; to that end, I have listed numerous full-text reviews in the "Further reading" section. There are plenty of secondary reviews available (more than I listed), and there is no reason to cite a common condition like this to advocacy organizations or websites like Mayo.

Additional explanation of how to apply MEDRS can be found at Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches.

Please also review WP:MEDMOS for the organization of sections in medical articles, and WP:UNDUE in terms of what content should be included. SandyGeorgia (Talk) 16:44, 15 November 2013 (UTC)

Feedback from SG

I'm starting to flag the reviews:

• PMID 22524444 is not listed in PubMed as a Review, and the PubMed page shows erratum; is the source being used correctly? SandyGeorgia (Talk) 17:03, 13 December 2013 (UTC)
• PMID 22903940 is a position paper; is it being used correctly? SandyGeorgia (Talk) 17:25, 13 December 2013 (UTC)

The sourcing is superb; all of the symptoms are not cited. Subject to some minor adjustments here and there, prose looks sound. Since I am not a regular at GAN (in fact, I don't even know their criteria), I'm going to post to WT:MED asking for more input here, since this article is in great shape as far as I can tell. SandyGeorgia (Talk) 18:40, 13 December 2013 (UTC)

Re the position paper, is using a position paper not okay? It seems like a secondary source when I look at it again. The other one looks like a systematic review to me and seems to review the physiology surrounding the relationship of hyperprolactinemia and hypothyroidism. Seems appropriate to me, but let me know if I violated Wikipedia policy somehow or you come across a more suitable review article reference verifying this point. Can you clarify what you mean that not all of the symptoms are cited? Do we need to have a reference number after each and every single symptom listed? That's going to look awfully messy...Also, isn't reference 30 a case report & literature review, not just a case report? TylerDurden8823 (talk) 06:45, 14 December 2013 (UTC)

The position paper is supporting one statement-- probably OK. Yes, all of the symptoms should be cited. SandyGeorgia (Talk) 14:51, 23 December 2013 (UTC)

See my comments below. I think the list of symptoms should be drawn from a small number of high-quality sources such as medical textbooks. As far as I'm concerned, it is possible to cite one source for a cluster of related symptoms. JFW | T@lk 20:41, 23 December 2013 (UTC)

Advice from JFW

Tyler, this article is looking pretty good. I have expanded the introduction a bit, to ensure that all sections in the article are represented. Without wanting to overburden you, I would like to make the following suggestions:

• There is some duplication between "Classification" and "Causes". I have recently stopped putting the "classificaiton" section at the top in almost all my articles because I find I often need to introduce lots of technical concepts in the wrong place. In this case, I would consider merging the two sections but keeping the framework of primary/secondary/tertiary as you have done in "classification".
• In "signs and symptoms", the use of bullet point lists can be a bit overwhelming. Do the sources say which symptoms are rare and which are common? I would place a lot of emphasis on the common symptoms, and relegate the rarer symptoms to a subsection. Do the references say how common certain symptoms are in people with confirmed hypothyroidism, and is this worth mentioning?
• In "pathophysiology", I think it might be worthwhile discussing how deficiency of a small molecule can have such a huge physiological impact. That means a few lines about the ubiquitous expression of the thyroid hormone receptor and how hypothyroidism impacts on particular tissues (e.g. the heart). Perhaps this is the place to discuss the fact that people with hypothyroidism may have accelerated atherosclerosis.
• In "diagnosis", the basal body temperature is not a laboratory test but carried out at the bedside. Does the source explain why a 24h urinary T3 might be particularly helpful? It sounds onerous.
• In "treatment" I really like how you have covered recent controversies. No specific changes suggested.
• Do we need sections about "Prognosis", "History", "Society and culture"? This is not crucial, but often adds to the comprehensiveness of the article.

You might find this document useful. It is the slightly embarrasing UK guideline for thyroid testing and treatment. I can't find any evidence that a more robust guideline is being produced by NICE. [.nice[.]org[.]uk/hypothyroidism This] is the NICE "clinical knowledge summaries" page for hypothyroidism, but I don't think we need it. JFW | T@lk 15:58, 23 December 2013 (UTC)

No worries, you're not overburdening me and much of what needs to be revised/was revised (thank you all, the article looks much better) is older material from previous editors before I got to the article. I agree with you that the classification/causes sections do overlap quite a bit and might benefit from merging the two sections. Many of the sources do not explicitly state which symptoms and signs of hypothyroidism are rare and which ones are common, but Axl and I recently looked over Harrison's and found a short list of common hypothyroidism signs/symptoms in descending order of frequency. The pathophysiology suggestion seems reasonable to me. The basal body temperature bit was not placed by me and I actually never came across a review paper stating its use in diagnosis, so I would actually be okay with removing it completely from the article. I also cannot take credit for the controversies bit, that was already in the article before I got to it. Lastly, for the prognosis, history, and society and culture sections...maybe. I'm not sure if I'll be able to find high-quality sources discussing the history of hypothyroidism, but I'll look around and see if I come across anything that seems appropriate. TylerDurden8823 (talk) 09:03, 25 December 2013 (UTC)

OK. With a bit of luck I might be able to offer some further assistance over the next few days. Harrisson's is a very good source for information about signs and symptoms and I have often found myself relying on it for those sections, as review articles are rather quiet about this aspect. Another great source is the JAMA "Rational Clinical Examination" series (link), but there is no article about hypothyroidism although there is one on goitre (doi:10.1001/jama.1995.03520340069039). JFW | T@lk 09:30, 25 December 2013 (UTC)

doi:10.1210/er.2009-0007 is a somewhat technical review of thyroid hormone action that could be used to discuss why thyroid hormone deficiency has such widespread physiological implications. JFW | T@lk 09:34, 25 December 2013 (UTC)

doi:10.1016/j.mcna.2012.01.015 discusses emergency treatment of severe hypothyroidism. Unfortunately this resource, while probably the best quality one, is difficult to access. JFW | T@lk 13:51, 25 December 2013 (UTC)

Timeline is a historical resource. Unfortunately it is not well referenced and non-peer reviewed. I will keep on looking. JFW | T@lk 17:08, 25 December 2013 (UTC)

doi:10.1136/bmj.a801 is the last BMJ review, with a very general scope.

doi:10.1016/S0140-6736(11)60276-6 is a recent Lancet review about subclinical hypothyroidism. Actual hypothyroidism hasn't been reviewed since 2004 it appears. JFW | T@lk 23:43, 25 December 2013 (UTC)

Macroglossia

A while ago I expanded macroglossia a bit. Unless I am imagining things (which may well be), this article used to link to macroglossia but now it does not. If you wish to link it back, here is a source: [9] (first hit... didn't look any further). I think it may only apply to congenital hypothyroidism and therefore be unsuitable for this main page, not sure.Lesion (talk) 00:39, 26 December 2013 (UTC)

I was also going to ask about use of the term "cretinism" in anywhere but the history section, but sadly authors seem to be still using such a term: [10]. One would think that cretinism would be a bit un-PC nowadays. Lesion (talk) 00:43, 26 December 2013 (UTC)

I do think that we need a few lines about congenital hypothyroidism, because it is a form of hypothyroidism and the concept comes up again later in the article. I am not sure if macroglossia is just part of the myxoedema complex and that Harrisson's does not list it separately for that reason.

As for cretinism, I think it is a historical term because most people with congenital hypothyroidism have no characteristic physical features and yet are at a similar risk of developmental delay. JFW | T@lk 08:54, 26 December 2013 (UTC)

Copyediting

I'm slowly expanding and copyediting the article. The 2012 AACE/ATA guideline (doi:10.1089/thy.2012.0205) contains quite a lot of useful stuff, and I have started incorporating some of its major points into the article. The below list of sections is mainly for my benefit, but feel free to comment.

1.  Done Symptoms and signs - this is essentially done, unless we want to spend a lot of time incorporating the signs and symptoms of associated diseases
2.  Done Causes - this is still a bit chaotic, and I wonder if we should adopt the framework from the "Classification" section
3.  Done Pathophysiology - currently the section mainly discusses normal thyroid hormone physiology but does not provide a lot of pathology; we should probably have one further paragraph discussing how various common conditions affect thyroid function (although some of that is covered in "Causes" also). The pregnancy subsection probably needs to be broken up because it is not about pathophysiology
4.  Done Diagnosis
5.  Done Screening - I have simply mentioned neonatal screening and recommendations for adult screening from AACE/ATA
6.  Done Management - this is mainly done, with the exception of some sources for "liothyronine" that I can probably find. Do we need a separate section about treatment in children?
7.  Done Epidemiology - pulled together some stuff from a number of sources
8.  Done Other animals - written

The sources are sparse on "Prognosis" so I cannot say with certainty whether such a section is going to possible. As I suggested above, we should ideally have a section about "History" (no idea where to find a good source). JFW | T@lk 18:49, 25 December 2013 (UTC)

Sources I will need to request: doi:10.1210/jc.2012-1616 (currently cited, can be used for discussions about central hypothyroidism) and doi:10.1016/j.mcna.2012.01.015 for the emergency treatment of severe disease. JFW | T@lk 09:07, 26 December 2013 (UTC)

Thyroxine in ART and SCH

I removed the following:

“ In pregnant women with subclinical hypothyroidism, supplementation with levothyroxine results in a significantly higher delivery rate. ”

This was based on doi:10.1093/humupd/dms052. Now this is a reasonably good MEDRS-compatible secondary source, but it is at odds with what is currently recommended by the ATA guidelines. We were also generalising the findings: these studies are particularly from cohorts of assisted reproduction (which we were not saying). The results were not clearly split between anti-TPO-positive and negative groups, making it difficult to fit them with current recommendations. Please let me know if you disagree. JFW | T@lk 14:01, 26 December 2013 (UTC)

Jfdwolff See my COI comment below. It is a secondary source, it is a current controversy, and some endocrinologists (eg mine) disagree with the ATA guidelines on management of hypothyroid. SandyGeorgia (Talk) 16:00, 31 December 2013 (UTC)

Moved from the article

I am moving the ===Classification== section here for reference. It is mainly built to "Gaitonde2012".

Classification section

Hypothyroidism may be classified by association with the indicated organ dysfunction. Type Origin Primary Thyroid gland Primary hypothyroidism occurs when the thyroid gland is absent or there is an abnormality intrinsic to the thyroid gland (most often due to anautoimmune thyroiditis such as Hashimoto's thyroiditis or subacute thyroiditis). Other causes of primary hypothyroidism include: TSH receptor genetic mutations, cystinosis, iodine deficiency, amyloidosis, sarcoidosis, hemochromatosis, Riedel's thyroiditis, scleroderma, thyroidectomy, radiation of the neck (including the thyroid), or drug-induced hypothyroidism. Secondary Pituitary gland Occurs if pituitary malfunction leads to insufficient production of thyroid-stimulating hormone (TSH), which normally induces the thyroid gland to produce enough thyroxine and triiodothyronine. Although not every case of secondary hypothyroidism has a clear cause, it is usually caused by damage to the pituitary gland, as by a tumor, radiation, or surgery. Tertiary Hypothalamus Results when the hypothalamus fails to produce sufficient thyrotropin-releasing hormone (TRH). TRH prompts the pituitary gland to produce thyroid-stimulating hormone (TSH); it may also be termed hypothalamic-pituitary-axis hypothyroidism.

As explained above, I will merge the main points into the "causes" section. JFW | T@lk 16:15, 31 December 2013 (UTC)

History

The source currently marked "Chakera" has a lovely historical section that I have used to build the basics of a history section. I am inclined to add citations to Murray's first report of subcutaneous thyroid extract (PMID 20753415) and Fox's report on oral thyroid extract (PMID 20753901) because they were pivotal reports and supported by a secondary source, and both are digitally available on PMC. I know that they of themselves are not secondary sources, but I would not want to withhold this opportunity to link history with present day. JFW | T@lk 17:30, 31 December 2013 (UTC)

Epidemiology

The high-quality secondary sources all refer back to a number of prevalence and incidence studies, but all of these have been performed in developed countries where iodine deficiency is not common. Even the WHO report on USI doesn't have a section that clearly mentions the prevalence of iodine deficiency-related hypothyroidism. I think the article is incomplete without it. Does anyone know what source might be useful here? Jmh649 have you any ideas? JFW | T@lk 12:12, 1 January 2014 (UTC)

doi:10.3945/an.113.004192 seems relevant, but I have no access. JFW | T@lk 12:14, 1 January 2014 (UTC)

The "history" section could also do with more discussion about the link between hypothyroidism and iodine. JFW | T@lk 12:15, 1 January 2014 (UTC)

This book says 1) the most common cause in places were iodine is common is chronic autoimmune 2) were it is not the most common cause is iodine deficiency (which 1 billion people may have ). How many of these have hypothyroidism is not know [11].Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:43, 1 January 2014 (UTC)

This ref says most who have low iodine have normal thyroid [12] Doc James (talk · contribs · email) (if I write on your page reply on mine) 12:52, 1 January 2014 (UTC)

Jmh649 I can't seem to access the relevant page in Cooper & Braverman's book. Could you please verify that the edit I have made is correct? JFW | T@lk 13:42, 1 January 2014 (UTC)

Which edits? Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:44, 1 January 2014 (UTC)

Jmh649 This one: diff. JFW | T@lk 13:52, 1 January 2014 (UTC)

Adjusted and fixed the page number. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:59, 1 January 2014 (UTC)

Many thanks. JFW | T@lk 14:29, 1 January 2014 (UTC)

Symptoms and signs

I understand it was discussed at the peer review, but ... I'm not thrilled with the table format. First, although we may know the difference, there is no distinction made to our layreaders between a "symptom" and a "sign" (and I'm not sure there needs to be-- it's not clear that we should separate them). Second, as mentioned by someone at the PR, our article doesn't discuss the most common vs lesser common. I just don't find the table format helpful. SandyGeorgia (Talk) 16:22, 31 December 2013 (UTC)

The symptoms currently cited from Harrisson's are the most commonly reported. Gaitonde2012 makes a note of the symptoms most commonly encountered (to the exclusion of several others) so perhaps those should be listed with emphasis.

I am minded to change the table to prose again. JFW | T@lk 17:27, 31 December 2013 (UTC)

To Sandy: I have added wikilinks for "symptom" and "medical sign" to the article. Before I inserted the table, the section was a list derived from several sources. I explained why that approach is unhelpful. Harrison's Principles of Internal Medicine is an authoritative source, and relatively accessible. The table in Harrison's Principles lists the features in decreasing frequency, although the exact percentages are not given. Axl ¤ [Talk] 19:26, 31 December 2013 (UTC)

I won't change the table approach. It sounds like the studies haven't been done. A lot of these parameters are subjective, so it would be a methodological nightmare. JFW | T@lk 01:09, 1 January 2014 (UTC)

Much better now that Signs and Symptoms are linked. This article is quite readable, and shaping up nicely (appreciative that you all took it on :) SandyGeorgia (Talk) 15:08, 1 January 2014 (UTC)

Does Cochrane displace ASRM and RCOG?

Another intesting discussion. Currently professional bodies such as the American Society for Reproductive Medicine and the Royal College of Obstetricians and Gynaecologists do not recommend checking for thyroid autoimmunity in women with recurrent pregnancy loss. A recent Cochrane review of four small-ish studies (doi:10.1002/14651858.CD007752.pub3) suggests that risk of prematurity may be reduced, and there was a trend towards reducing the risk of miscarriage. At the moment I am not going to include the Cochrane review because it acknowledges that the data is limited. JFW | T@lk 16:38, 26 December 2013 (UTC)

Jfdwolff I wish you would include it, with sufficient qualifiers, since it is Cochrane and it is a current controversy. (COI alert, I don't add it myself: multiple miscarriages, hypothyroid, my endocrinologist is one of those who believes my miscarriages could have been avoided with better management of my hypothyroid.) SandyGeorgia (Talk) 15:57, 31 December 2013 (UTC)

SandyGeorgia I might have misread the results, because the Cochrane recommendation is actually aligned with the AACE/ATA document with regards to treatment. I have now added it to the article. The review acknowledges that this is based on limited data, so I have used lots of modifiers to communicate the uncertainty.

With a bit of luck this article is soon going to be ready for GAC. I hope it does justice to your experiences and am keen on having your feedback about its comprehensiveness and readability. JFW | T@lk 16:11, 31 December 2013 (UTC)

Ah, ha, thanks; well that's a horse of a different color :) (My endocrinologist, who has been the first to adequately manage my hypothyroid, is solidly in the other camp on that controversy, and in my case, she seems to have been right, so it's personally disheartening to hear that's what the review says, but it is what is!) And thanks for all your work for helping move this towards GA status: my COI makes it difficult to help too much! SandyGeorgia (Talk) 16:20, 31 December 2013 (UTC)

Jfdwolff, I've just read through, and the article does cover my endocrinologist's approach and statements completely-- well done. SandyGeorgia (Talk) 15:11, 1 January 2014 (UTC)

SandyGeorgia Thanks. I need to add a little bit more stuff about "signs and symptoms" in children, and I am tweaking the "causes" section; then I want to talk about the discovery of the role of iodine in "history". Then it should be ready for GAC. JFW | T@lk 15:23, 1 January 2014 (UTC)

Paediatrics

I think discussions about hypothyroidism in childhood (not neonatal) will be incomplete without doi:10.1542/pir.30-7-251. Unfortunately I can't get access. JFW | T@lk 16:33, 1 January 2014 (UTC)

GA Review

This review is transcluded from Talk:Hypothyroidism/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Jmh649 (talk · contribs) 18:12, 9 January 2014 (UTC)

Okay will review.

General comments

•  Done Should combine the last "see also" into the text and get rid of that section.
  • The only way to include that would be with a lengthy context discussion. I've removed it completely for now. JFW | T@lk 20:33, 9 January 2014 (UTC)
• Would be nice to have a picture of the conditions. There is a great one here[13]. Wonder if they would release it? Doc James (talk · contribs ·email) (if I write on your page reply on mine) 21:27, 7 January 2014 (UTC)

I might have found some.[14] They have higher quality images that they are willing to release to use and I will ask. Doc James (talk ·contribs · email) (if I write on your page reply on mine) 21:43, 7 January 2014 (UTC)

There are also these [15] Doc James (talk ·contribs · email) (if I write on your page reply on mine) 22:01, 7 January 2014 (UTC)

Thanks for adding the image of congenital hypothyroidism. Unfortunately the CNX.org images are of doubtful quality. JFW | T@lk 13:39, 9 January 2014 (UTC)

I have requested high quality images from them. They have donated a lot in the past. These are from them [16] One just needs to ask. Doc James (talk · contribs ·email) (if I write on your page reply on mine) 14:01, 9 January 2014 (UTC)

Great. Looking forward to the product! JFW | T@lk 19:32, 9 January 2014 (UTC)

Unfortunately they are uninterested in releasing more images. I am not sure why the change in heart. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:50, 23 January 2014 (UTC)

Diagnosis

• We have ""Subclinical hypothyroidism" is said to exist when serum TSH levels are high but serum free thyroxine is within normal limits." and "In subclinical hypothyroidism, TSH is elevated but below the limit representing overt hypothyroidism." Should this be combined into a single statement? Doc James (talk · contribs ·email) (if I write on your page reply on mine) 14:40, 9 January 2014 (UTC)
  • Agree. Second (imprecise) sentence dumped. JFW | T@lk 20:15, 9 January 2014 (UTC)

• Overt hypothyroidism has a specific meaning. It is not just symptomatic hypothyroidism. This ref gives " overt hypothyroidism (defined as TSH >20 mIU/L or free T4 below the normal range)"[17] But we of course need a better one. Doc James (talk · contribs ·email) (if I write on your page reply on mine) 17:49, 9 January 2014 (UTC)
  • The article cited on Medscape is 10 years old. Since then (see e.g. Garber), "overt hypothyroidism" has been defined as raised TSH and low T4. Subclinical hypothyroidism has been defined as mild (TSH<10) and severe (TSH>10). In pregnancy, TSH>10 is "overt" even if the T4 is normal, at least according to the consensus guidelines currently cited. JFW | T@lk 20:15, 9 January 2014 (UTC)

Continue

I will continue next week. Sorry for the delay. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:03, 17 January 2014 (UTC)

Sounds good. I was wondering where we had landed on the GA nomination. Looking forward to seeing this as GA. TylerDurden8823 (talk) 06:16, 18 January 2014 (UTC)

We're back on track. Thanks Tyler for taking care of some of James' points. JFW | T@lk 14:14, 26 January 2014 (UTC)

Lead

• We mention "subclinical hypothyroidism" in the lead but do not define it.
  •  Done if you want to tweak what I added, that's fine, but there's an associated definition with it in the lead now courtesy of the Fatourechi paper from Mayo Clinic Proceedings. TylerDurden8823 (talk) 22:32, 25 January 2014 (UTC)

Signs and symptoms

• This may be better under diagnosis "There are a number of symptom rating scales; they provide a degree of objectivity but have limited use for diagnosis."
  •  Done TylerDurden8823 (talk) 22:36, 25 January 2014 (UTC)
• Should define goiter first time we use the term.
  •  Done TylerDurden8823 (talk) 00:22, 26 January 2014 (UTC)

Causes

• And data on how often certain medications cause the problem?
  • The sources are silent on exactly how many cases of hypothyroidism are thought to be medication-induced; the problem becomes even bigger if you accept that immunomodulatory drugs cause hypothyroidism by inducing Hashimoto's (e.g. interferon). There are not many proper case series of hypothyroidism. A lot of associations are based on case reports (e.g. the tyrosine kinase inhibitors). JFW | T@lk 14:14, 26 January 2014 (UTC)

Pathophysiology

• Good

Diagnosis

• Wondering we "Subclinical hypothyroidism" is in quotes and we use "said to exist"?
  •  Done. Removed the unnecessary quotation marks and the phrase "said to exist". TylerDurden8823 (talk) 00:28, 26 January 2014 (UTC)
• We call the section "subclinical" yet the first line discusses overt primary hypothyroidism. Wondering if we should change the name of that section? Maybe to "types" and add in the table and the central hypothyroidism definitioon?
  • Sounds reasonable to me. TylerDurden8823 (talk) 00:29, 26 January 2014 (UTC)
  • The section needs to define "overt hypothyroidism" before explaining the counterintuitive concept of subclinical hypothyroidism. I see no massive problem here. JFW | T@lk 14:14, 26 January 2014 (UTC)

Prevention

• "This public health measure has effectively eliminated childhood hypothyroidism." Has it eliminated all of it or just much of it?
  • Considering there are other reasons why children develop hypothyroidism, I have rephrased this. JFW | T@lk 14:14, 26 January 2014 (UTC)

Screening

• Good

Management

• What is the "by the free T₄ index"
  • It is a slightly outmoded part of specialist thyroid function testing. I have added a link to a section in the thyroid function testing article. JFW | T@lk 14:14, 26 January 2014 (UTC)
• What does "the results are sensitive to the stage of the pregnancy" mean?
  • Rephrased. JFW | T@lk 14:14, 26 January 2014 (UTC)

Epidemiology

• This is strange "1:20,0000 to 1:80,0000"
  •  Done. Fixed, it was just a typographical error. The referenced paper said 1:20,000 to 1:80,000. TylerDurden8823 (talk) 22:38, 25 January 2014 (UTC)
  • Silly mistake on my part. Heavens know how that happened. JFW | T@lk 14:14, 26 January 2014 (UTC)
• Would move this to screening "If T4 determination is included in the screening done at birth, this will identify cases of congenital hypothyroidism of central origin in 1:16,000 to 1:160,000 children. Considering that these children usually have other pituitary hormone deficiencies, early identification of these cases may prevent complications."
  •  Done.TylerDurden8823 (talk) 22:41, 25 January 2014 (UTC)

History

• Good

Other animals

• Good

Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:49, 24 January 2014 (UTC)

Further reading and external links

Maybe combine as not many?

• I separated them because I wanted to avoid the impression that these are sources of similar reliability and quality. JFW | T@lk 14:14, 26 January 2014 (UTC)

Review

Looks good. Passed. Many thanks to Jfd and all who worked on this article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:26, 27 January 2014 (UTC)

Causes

Axl I might need some help here. At the moment, the "list of causes" is pulled together from a number of mostly secondary sources. I agree that this is not satisfactory. I have no access to Harrison's 18th edition, but perhaps we could get the list of causes from there? Alternatively we could use one of the current reviews. Garber only has a list of medications that interfere with thyroid physiology in general (but it is very long and highly inclusive).

For central hypothyroidism I thought we should use Persani's review. JFW | T@lk 08:08, 31 December 2013 (UTC)

Harrison's Principles does have a list of causes. I could prepare a draft table on the Peer Review page. Perhaps we should have small subsections on the major causes: Hashimoto's thyroiditis and iodine deficiency? If these are large enough, we even be able to justify a subsection on central hypothyroidism, drawn mainly from Persani. Axl ¤ [Talk] 12:21, 3 January 2014 (UTC)

I am happy with the lists of causes as they are. The "primary" list is from Garber, which is a national guideline and highly authoritative (and likely to contain the same information as a textbook). The "secondary" list is from a paper devoted exclusively to the rare clinical entity of central hypothyroidism. The "congenital" list is similarly from a high-quality secondary source.

I agree that iodine deficiency and Hashimoto's are sufficiently large topics to merit their own paragraph or section. There is already a fair bit about Hashimoto's (including a few words on T cells and antithyroid autoantibodies). The iodine bit could be fleshed out more if I can find a decent source (surprisingly hard). JFW | T@lk 13:22, 3 January 2014 (UTC)

Now I am confused. A few days ago: "At the moment, the "list of causes" is pulled together from a number of mostly secondary sources. I agree that this is not satisfactory." Today: "I am happy with the lists of causes as they are." Axl ¤ [Talk] 22:41, 3 January 2014 (UTC)

No need to be confused. A few days ago, the causes (which were in paragraph text and not a real "list") were individually sourced. This means that there was a lack of a unifying secondary source for each group of causes. The list that I have now created (in table format) should solve that problem. JFW | T@lk 22:05, 4 January 2014 (UTC)

Okay, I see. Axl ¤ [Talk] 23:30, 5 January 2014 (UTC)

Epidemiology in Europe

doi:10.1210/jc.2013-2409 - meta-analysis. JFW | T@lk 20:41, 6 March 2014 (UTC)

Thyroid hormone defects

Consensus paper - probably relevant here or in related articles. But I can't access it. http://press.endocrine.org/doi/full/10.1210/jc.2013-3393 JFW | T@lk 20:38, 6 March 2014 (UTC)

Unfortunately, I am unable to access this paper or the one in the section below since they're both from the same journal. They do look like they would be good additions to the article. TylerDurden8823 (talk) 06:32, 10 March 2014 (UTC)

SEO (search engine optimization) with the words "Low thyroid" =)

You should incldue the words "Low thyroid" at the top, so that you can optimize for search, so if people who don't know anything about medicine search for "low thyroid", they'll find this article! 129.180.1.214 (talk) 08:57, 4 June 2014 (UTC)

DOne Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:55, 4 June 2014 (UTC)

Google is quite clever. It gets the right articles (on Wikipedia) with minimal SEO. Still, if a term is in widespread use we should include it. JFW | T@lk 21:34, 8 June 2014 (UTC)

I've heard it enough in real life that I think it merits brief mention in the article. I'm fine with it being there though I don't care much about search engine optimization. TylerDurden8823 (talk) 23:09, 8 June 2014 (UTC)

USPSTF

Yes, they've reviewed their recommendations but the conclusions are much the same - doi:10.7326/M14-1456. We probably ought to update the reference though. JFW | T@lk 22:09, 28 October 2014 (UTC)

Treatment with liothyronine

I would like to add a reference to the European Thyroid Association guidelines on combination treatment (levothyroxine + liothyronine). I think it's particularly interesting, as this is probably the most important document on the topic by one the main medical thyroid associations: at least is the only one that I know that talks exclusively about this. I understand that the ETA is a reliable source, and this includes this particular guidelines. The ETA is a professional body with more than 900 members (I take it from its website, http://www.eurothyroid.com/). One of the authors of the guidelines is Dr. Vanderpump, who is the president of the British Thyroid Association, which is referred in this same section.

My original addition was: Nevertheless, the European Thyroid Association suggests a combination of levothyroxine and liothyronine as an experimental approach for LT4-treated patients with persistent complaints despite a normal serum TSH.

My text heavily based on one of the guidelines recommendations: It is suggested that L-T4 + L-T3 combination therapy might be considered as an experimental approach in compliant L-T4-treated hypothyroid patients who have persistent complaints despite serum TSH values within the reference range, provided they have previously given support to deal with the chronic nature of their disease and associated autoimmune diseases have been ruled out.

Actually, exactly this text is also quoted in the recent American Thyroid Association guidelines for the treatment of hypothyroidism (page 96):

However, the ETA has suggested that “L-T4 and L-T3 combination therapy might be considered as an experimental approach in compliant L-T4–treated hypothyroid patients who have persistent complaints despite serum TSH values in the reference range, provided they have previously been given support to deal with the chronic nature of their disease and associated auto-immune diseases have been ruled out.” This document outlines methods for calculating L-T4 and L-T3 doses for physicians who are considering using a trial of combination therapy in their patients.

My text also follows the "Identifying reliable sources (medicine)" Wikipedia guidelines. It is stated there that Ideal sources for such content includes [...] medical guidelines or position statements from nationally or internationally recognised expert bodies. As it's the case of the European Thyroid Association.

So yes, I strongly believe that my addition would be convenient. If no one is against it, tomorrow I will include again my original addition. Badxellos (talk) 15:59, 26 November 2014 (UTC)

Badxellos You are misrepresenting the guidelines. When they say "experimental approach", they mean exactly that. The ETA guideline even says "L-T4 + L-T3 combination therapy should be considered solely as an experimental treatment modality. The present guidelines are offered to enhance its safety and to counter its indiscriminate use." That is a restrictive statement. I would strongly want to avoid giving the impression that this is somehow the standard of care. SandyGeorgia removed it for that reason. JFW | T@lk 01:33, 27 November 2014 (UTC)

Thanks for your answer, Jfdwolff. I agree that this is not the standard of care. In the text this is pretty clear, that's why I included the experimental approach thing. As the ETA clearly states, it's an experimental approach for use on a minority of the patients. In any case, it's not a dangerous, out-of-the guidelines modality of treatment as the current text suggests. On the contrary, it's an experimental but guideline-regulated approach. The text needs to clearly state this.

You seem to suggest that ETA guidelines are exclusively restrictive. This is not the case. There is at least one European country where they are being followed as a positive, not only restrictive, guidelines. In Denmark, combination treatment has been prescribed in the last years for hypothyroid patients who have persistent complaints, as the guidelines state. It's prescribed not by private quacks, but by endocrinologists working in the public health care system. This is, I believe, a direct consequence of the ETA guidelines, as Birte Nygaard, one of the authors is also the president of the Danish Thyroid Association. You can find more information about this topic in an article written by Nygaard here (http://www.thyreoidea.dk/artikler/medicin/kombinationsbehandling-og-naturligt-thyroideahormon.html) where she states that A small group of patients with hypothyroidism can potentially benefit from the combination of T4 and T3 - which appeared European treatment guidelines in June this year (sorry for the translation). I don't believe that she is "misrepresenting" her own guidelines.

I am not sure about the situation in other European countries: I don't think there is any data on that. Nevertheless, I believe that combination treatment also has traction in Germany and Norway. Here it is stated that in a German district, 8.9% of the patients were on combination treatment: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821462/#B10.

I want to avoid giving the impression that thousands of Europeans in countries like Denmark or Germany are receiving a dangerous, out-of-the-guidelines quackery as treatment. This may be the opinion of some people, but it is clearly not the position of the last guidelines issued on this topic by one of the major thyroid associations. Badxellos (talk) 12:40, 27 November 2014 (UTC)

Badxellos What we need is a secondary source that confirms that clinicians in some countries use combination therapy despite the negative meta-analyses. I don't read Danish, and the source you included is a primary rather than a secondary source.

I am fully aware of the intense debate on the subject in patient groups and professional associations. On Wikipedia we can only reproduce what other secondary sources say about this. Please do let me know if you can present a source that confirms the above, and hopefully we can achieve consensus on this issue. JFW | T@lk 21:41, 27 November 2014 (UTC)

Postscript: Perros' editorial is yet another piece of proof that by adding T3 to T4, clinicians are being pragmatic rather than evidence-based. I am quite surprised that you seem to be presenting this as proof of efficacy. JFW | T@lk 21:45, 27 November 2014 (UTC)

Badxellos, I'm sorry for my delay in getting back here, but JFW has explained thoroughly. Regards, SandyGeorgia (Talk) 03:38, 28 November 2014 (UTC)

Hi, JFW and SandyGeorgia. It will be pretty hard to find a secondary source in English talking above the use of T3 in Denmark. Anyway, I can offer you a couple of documents (in Danish) that prove the use of Lio in DK: http://www.irf.dk/dk/publikationer/rationel_farmakoterapi/maanedsblad/2013/behandling_af_hyper-_og_hypotyreose.htm (Kombinationsbehandling med -liothyronin section) from the Institut for Rationel Farmakoterapi, an advisory body of the Danish Medicine Agency. If you want something from an actual hospital, I can offer this: https://www.scribd.com/doc/248736533/Behandling-Af-Lavt-Stofskifte-Med-Liothyronin (I have uploaded it myself, but it's pretty obvious that is official (fuck, I hope there are no legal problems about uploading this xD)). Both documents are in Danish, but they are easy to understand, at least the basics. Google Translate helps too: I don't read Danish either, I just live here.

But I guess that the problem here may be the guidelines of Wikipedia about language of the referenced documents. If this is the case, I think we could compromise on a reference to the ETA 2012 Guidelines. Something like: In 2012, the European Thyroid Association issued a guidelines for the safe use of combination therapy as an experimental treatment modality for patients with persistent complaints despite normal serum TSH values. What do you think? — Preceding unsigned comment added by 2.111.94.248 (talk • contribs) 00:36, 1 December 2014‎

I presume that was you, Badxellos. I think any attempt to include the 2012 ETA guidelines (doi:10.1159/000339444) will need some very careful thought. We cannot create the tacit acknowledgement that adding T3 is somehow in keeping with current professional understanding of hypothyroidism. I might have a go. JFW | T@lk 00:44, 1 December 2014 (UTC)

To cheer you up, there is definitely a perception that we haven't heard the last from combination therapy yet (doi:10.1038/nrendo.2013.258) and that levothyroxine might not induce euthyroidism in all tissues. I'm not sure how this recent source could be presented in the article. JFW | T@lk 01:00, 1 December 2014 (UTC)

Water fluoridation

Can this condition be caused by water fluoridation, as claimed here. Are there any better sources? Martinevans123 (talk) 15:46, 26 February 2015 (UTC)

It's an interesting paper but this issue hasn't received much study. We usually don't like to rely on media/news sources for medical information. Here's the actual study in question: http://www.ncbi.nlm.nih.gov/pubmed/25714098 TylerDurden8823 (talk) 15:54, 26 February 2015 (UTC)

I was thinking of the actual study, not the media coverage. But you're suggesting that a peer-reviewed replication at least would be required? Martinevans123 (talk) 16:04, 26 February 2015 (UTC)

This is a primary study (according to WP:MEDRS secondary sources are very strongly preferred and primary sources are only used in exceptional circumstances). If you look at the actual paper, you'll see that this is a cross-sectional study design, which does not permit us to infer causation. This issue really needs to be studied further before it merits inclusion on this page IMO. TylerDurden8823 (talk) 16:43, 26 February 2015 (UTC)

Yes. I wonder if there are any longitudinal studies in progress. What minimum duration would be considered fair and reasonable? We don't want to stop people drinking water, do we. Martinevans123 (talk) 21:35, 26 February 2015 (UTC)

I couldn't find any other sources, primary or secondary, that describe this association. Axl ¤ [Talk] 22:19, 26 February 2015 (UTC)

Nor I, alas. Martinevans123 (talk) 22:29, 26 February 2015 (UTC)

USPSTF

... have updated their recommendations. They are effectively unchanged but the reference will need updating doi:10.7326/M15-0483 JFW | T@lk 10:15, 26 March 2015 (UTC)

Subclinical hypothyroidism

Risk of cognitive impairment is increased in those below 75 and with higher TSH levels. Would need to read the study in detail to decide how to present this. There is no real intervention mentioned. doi:10.1210/jc.2015-2046 JFW | T@lk 17:10, 1 September 2015 (UTC)

Preterm birth

doi:10.1210/jc.2015-3074 - OH is associated with small risk of preterm birth, while SH is not. JFW | T@lk 08:58, 21 September 2015 (UTC)

ETA guideline

doi:10.1159/000362597 - subclinical hypothyroidism in pregnancy. Not yet included. JFW | T@lk 17:37, 29 October 2015 (UTC)

Historical review

doi:10.7326/M15-1799 JFW | T@lk 18:57, 5 January 2016 (UTC)

Link not working... Axl ¤ [Talk] 21:27, 5 January 2016 (UTC)

Axl They'll turn the DOI on eventually. Here's the URL[18]. JFW | T@lk 00:08, 6 January 2016 (UTC)

lol, thanks. Axl ¤ [Talk] 10:55, 6 January 2016 (UTC)

It's working now. JFW | T@lk 10:42, 16 May 2016 (UTC)

Moved here

"In a retrospective analysis of a sample of 62 mother with hypothyroidism and children compared to a control of 124 participants it was found that untreated mothers (48 participants) had children that scored 7 points lower than the control and 19% had IQ's lower than 85 points, Treated mothers (14 participants) children had IQ's similar to the control, the controls average IQ score of 107 and 5% occurrence of IQ scores below 85 points."

"Syncope caused by complete AV block due to severe hypothyroidism leading to extreme bradycardia has been recorded as successfully being treated with levothyroxine, AV conduction was restored not requiring internal implantation of a pacemaker.

"

Need better sources for this type of content. Doc James (talk · contribs · email) 18:02, 16 April 2017 (UTC)

Historical Methods of Diagnosis?

Is there any information out there on how hypothyroidism was diagnosed and treated before the modern tests existed? I've heard from one source that up to the early 1980s it was often diagnosed by symptoms, and then slowly increasing doses of levothyroxine were used until symptoms of induced hyperthyroidism showed up at which point the dose was decreased by 10% and that was used. 207.172.210.101 (talk) 04:54, 16 May 2017 (UTC)

That is distinctly possible but I haven't found a good historical source that compares previous to current practice. The radioimmunoassays of the thyroid hormones and TSH have substantially improved diagnosis. JFW | T@lk 13:45, 16 May 2017 (UTC)

I found this source. However it does not mention the treatment regime that you [IP editor] describe. Axl ¤ [Talk] 14:55, 16 May 2017 (UTC)

Hepatic Invovlement needs Including.

The article at present does not address issues with peripheral converstion of Thyroxine to Triiodothyronine. This occuring primarily at the liver. Under conversion of T4 to T3 is addressed in at least one of The Oxford textbook of diabetes endocrinology or The Williams . While much rarer these are also a cause of hypothyroidism.

More recent research has implicated both Cortisol and Inflammation in this issue, I will attempt to find references when time permits. Leopardtail (talk) 18:28, 23 May 2017 (UTC)

Lancet

Seminar doi:10.1016/S0140-6736(17)30703-1 JFW | T@lk 11:33, 24 September 2017 (UTC)

BTA has also made this: persistent symptoms despite normal TSH doi:10.1111/cen.12824 JFW | T@lk 11:39, 24 September 2017 (UTC)

Prose versus point form

"A person is more likely to develop hypothyroidism if they:

• have had a thyroid problem before, such as a goiter
• have had surgery to correct a thyroid problem
• have received radiation treatment to the thyroid, neck, or chest
• have a family history of thyroid disease
• were pregnant in the past 6 months
• have Turner syndrome , a genetic disorder that affects females
• have other health problems, including
  • Sjögren’s syndrome, a disease that causes dry eyes and mouth
  • pernicious anemia, a condition caused by a vitamin B12 deficiency
  • type 1 diabetes
  • rheumatoid arthritis, an autoimmune disease that affects the joints
  • lupus, a chronic inflammatory condition"

A couple of issues.

1) We should generally write in prose 2) Much of this was already covered.

So moving this here. Doc James (talk · contribs · email) 20:19, 10 December 2017 (UTC)

T3 again

JCEM review doi:10.1210/clinem/dgaa430 JFW | T@lk 21:22, 18 August 2020 (UTC)

NICE NG145

I had completely missed the release of this guideline: NG145 https://www.nice.org.uk/guidance/ng145

Definitely needs to be incorporated and probably to replace the outdated UK guidance. JFW | T@lk 14:24, 24 September 2020 (UTC)

"Mental patients"

Tikisim added the following to the lead section:

There are growing connections between hypothyroidism and mental health. Thyroid health influences cerebral homeostasis and ultimately, the function of the brain; resulting in much overlap of patients with both thyroid abnormalities and mental illness.

The main sources are over five years old and some are not WP:MEDRS compatible. This association has been recognised since the 1950s (e.g. by Richard Asher as "myxoedema madness") but a recent high-quality source would be needed. I would also recommend that it is discussed in the body of the article rather than in the lead section. JFW | T@lk 19:30, 2 February 2021 (UTC)

References