Experts advise against hormone treatment in adults with mild thyroid problems
Thyroid hormones should not be routinely offered to adults with a mildly underactive thyroid gland (known as subclinical hypothyroidism) say a panel of international experts in The BMJ today.
Their strong recommendation against hormone treatment is based on new evidence that it does not improve quality of life or symptoms including low mood and fatigue.
Their advice is part of The BMJ’s ‘Rapid Recommendations’ initiative – to produce rapid and trustworthy guidance based on new evidence to help doctors make better decisions with their patients.
Subclinical hypothyroidism (SCH) occurs when the thyroid stimulating hormone (TSH) levels in the bloodstream are slightly raised, while the level of thyroid hormone remains normal.
It affects up to about 5% of the adult population, but 10-15% of the elderly. While some people have no symptoms at all, others can show mild signs of fatigue, low mood and weight gain, which may or may not be related to the condition.
Subclinical hypothyroidism can only be detected by a blood test. In the UK, about 25% of adults have thyroid function tests every year and guidelines tend to recommend hormones for those with TSH levels above 10 mIU/L (a normal TSH level is 0.4 to 4.0 mIU/L).
Research shows that hormone treatment for SCH has doubled from 1996 to 2006.
So an international panel of clinicians and patients with SCH used a recent detailed analysis of the latest evidence (a systematic review of 21 trials and about 2,200 participants comparing the effects of thyroid hormone treatment with no treatment or placebo in adults with SCH) to develop recommendations for clinical practice.
Using the GRADE approach (a system used to assess the quality of evidence), the panel makes a strong recommendation against thyroid hormones for almost all adults with SCH, because there were no benefits from treatment on fatigue, low mood, weight gain or any other outcomes that were tested.
What’s more, they say taking a pill and attending lifelong check-ups is burdensome, and they cannot rule out the possibility of harms.
And while they did not take costs and resources into account beyond direct costs to patients, they say thyroid hormones cannot be cost effective.
The recommendation does not apply to women who are trying to become pregnant or patients with particularly high TSH levels (above 20 mIU/L). It may also not apply to patients with severe symptoms or some aged under 30.
Future research could explore whether there is an unidentified group of patients who might benefit from treatment, say the authors.
In the meantime, if implemented, this recommendation “may substantially alter prescribing trends” they conclude.
Notes to Editors
Rapid Recommendations: Thyroid hormone treatment for subclinical hypothyroidism: a clinical practice guideline
Journal: The BMJ
Link to Academy of Medical Sciences press release labelling system: https://press.psprings.co.uk/AMSlabels.pdf
Externally peer-reviewed? Yes
Type of evidence: Recommendations based on systematic review and meta-analysis of randomised trials
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What’s Your Experience With CBD Oil?
Over the last few years there has been a lot of buzz about cannabidiol, also known as CBD. CBD can be derived from hemp or cannabis, which are both members of the same plant species, Cannabis sativa. While both hemp-derived CBD oil and cannabis-derived CBD oil offer certain health benefits, not everyone will respond the same to each of these. Although cannabis-derived CBD oil seems to be a much richer source of phytochemicals and cannabinoids, including a compound called tetrahydrocannabinol (THC), this doesn’t mean that hemp-derived CBD oil can’t benefit people with different types of health conditions…including thyroid and autoimmune disorders.
As for how CBD oil can help with thyroid and autoimmune thyroid conditions, cannabinoids are potent anti-inflammatory agents that can decrease proinflammatory cytokines , while increasing T-regulatory cells (Tregs) (1) . As I have discussed in past articles and blog posts, proinflammatory cytokines promote inflammation, while Tregs suppress autoimmunity. One of the main proinflammatory cytokines associated with autoimmunity is interleukin-17 (IL-17), which is produced by Th17 cells. And there is evidence that CBD oil can reduce levels of IL-17 (2) (3) .
Of course just as is the case with other natural anti-inflammatory agents, CBD oil doesn’t do anything to address the underlying cause of the condition. So while CBD oil might be able to help to reduce symptoms by decreasing inflammation, you still want to find and detect the triggers and correct underlying imbalances. In other words, if you have Graves’ disease or Hashimoto’s, taking CBD oil alone probably isn’t the solution, as you need to remove your autoimmune triggers, correct other underlying imbalances, heal the gut, etc. That being said, it’s important to add that at times removing the triggers won’t break the inflammatory cycle, and CBD oil might be helpful in this case as well.
Have You Tried CBD Oil?
The purpose of this blog post isn’t to get into detail about the benefits of CBD oil, but instead is to learn about the experiences those with thyroid and autoimmune thyroid conditions have had when taking this. If you have taken CBD oil to improve your thyroid health (or for any other purpose) please share your experience in the comments section below. Did you take hemp-derived or cannabis-derived CBD oil? If you took it for your Hashimoto’s or Graves’ disease condition I’d be especially interested to see if it benefited you, how long it took before you noticed positive changes, and anything else you’d be willing to share to help others who might be interested in using CBD oil.
Christine Pellerin says
I used CBD oil topically for joint pain in my hands and orally to help me sleep. It works. But then I was diagnosed with slightly elevated eye pressure, and searched for scientific studies and found one that showed CBD increases eye pressure, so I stopped using it. Interestingly, one of the main uses for medical marijuana is for glaucoma, but it’s the THC that reduces eye pressure.
Thanks for posting your comment Christine. That’s interesting about CBD possibly increasing eye pressure. I’ll have to do more research on this, but you might be referring to the following study which shows that THC lowers intraocular pressure, while CBD seems to prevent THC from lowering intraocular pressure:
I used cbd hemp-based oil on a leg for pain. I apparently used too much, as my heart began racing, and it took nearly 12 hours for it to return to normal. I have only had this happen two other times
once when using too much magnesium, and once when applying helichrysum oil. I guess I am just extra sensitive.
I’m sorry that the hemp-based CBD oil caused the heart racing, as I guess this serves as a warning not to overdo it with CBD oil, which of course applies to many other natural agents as well. Thanks for sharing Laura.
I used CBD oil topically for my swollen thyroid and also orally. I helped me a lot. I have Graves.
Thanks for sharing your experience with CBD oil Toi! I’m glad it helped with your swollen thyroid.
Dolores Guertin says
Hi Dr Eric, I have been taking CBD oil (<.1 mg THC) for colitis for one yr. I believe it plays a significant role in my healing, better than prednisone, and without side effects. I never thought that I would take anything with THC in it for fear of getting high. Well for 7 months, I have added .35 mg (that's like 3 drops of CBD, THC) blend at night before bed, and it has been the one thing that has freed me from insomnia of 40 yrs. I also dont wake up groggy and have managed getting into all stages of sleep. I have not experienced any high, not even close. I've been working on sleep hygiene and light management as well for many years, that part had not changed, the thing that did change was adding those few drops of THC. Getting to my thyroid, numbers were up and down, but with more regular sleep, thyroid is more stable. Also just read an article on Green Flower how CO can help with liver disease. Mind you the study was done on mice but their liver dysfunction improved quite significantly. I too have liver dysfunction and it creates problems for me. I exercise health and lifestyle practices daily , but have had numerous past injuries/insults. I am hoping that while I'm taking the CO, it will help my liver heal and maybe even improve the function of other glands and organs. Many folks with thyroid issues do have liver dysfunction issues as well, so this is encouraging news. If they are looking here at the liver specifically, maybe they need to do some studies on CO and thyroid specifically, that would be great, after-all the endocannabinoid system is everywhere in our body, densely in our gut, brain and then organs. Have a smooth day:)
Dolores, thank you so much for sharing your experience with CBD oil! A lot of people are afraid of taking THC, but very small amounts usually don’t cause any psychoactive side effects. I also realize some people aren’t concerned about the psychoactive effects, as depending on where they live they might not be able to legally get CBD with THC. Either way it’s encouraging that a small amount of THC greatly helped with the insomnia. And thank you for also letting me know about the study that showed it might help with liver disease.
I just start to try : have a nodule with hyperthyroid but don’t know the dosage exactly.
In the shop they told me only one drop .I will tell you if it’s efficient!