Can you summarize the current role of DTE in managing persons with hypothyroidism, and the approach to identifying the 10%-20% of persons on LT4 monotherapy who, because of symptomatic shortfalls, may be appropriate for combination therapy?
So we've looked at hypothyroidism as a disease that is very common and is in your clinic within you and your employers perhaps and employees perhaps, and also your patients and you're dealing with it. Certainly on a weekly basis, we've talked about the burden of the disease. We've talked about how it affects so many important systems in the body when you have either an access, but in this case the positive, your deficit in thyroid hormone, particularly the metabolically active thyroid hormone of triad of thyroid unity three. We've talked about it being a major cardiovascular disorder. Very important. We talked about it having can competency with metabolic syndrome, which is now known as cardio dis metabolism. It's right up there. We talked about how it's important to look at that. In fact, when we're assessing patients, we need to look not only at some of the issues the patients have, certainly with heart failure, just arrhythmias, bradycardia lights. We've talked about that. We talked about the terrible impairment on mood and neuro cognition that utterly affects quality of life even more than some of the heart failure, some of these other big events or increased risk for my so it's that what's going on between the ears. It's a really dangerous place for many of us to go and for the patients with hypothyroidism untreated, it truly is. So that's a problem. And with from a genesis and those of you who do a lot of well women work, you understand the problem with poorly managed hypothyroidism when it comes to successful pregnancy and when it comes to fertility issues in generations. So there's a lot of uncertainty out of, possibly in the like. So there's there's a lot of reasons why this carries a burden, not just what quality of life that affects patients with a lot of common in morbidity, zor complications related to hypothyroidism that's driving them to providers driving health care costs and also causing missed work days. So that is pretty clear. It is common and it's in your wheelhouse in primary care. Mostly take care of these patients. We know that a lot of the guidelines say when we identify these patients that we want, you identify the guidelines state is retreating them with monotherapy lt for. But we also know that 50 someone say 10-15 and I will say it depends on the population, much higher than that. I mean 1920, I mean, who knows? It's it's not really quite there. There's a number of patients that monotherapy though, good therapy and it's done a great job for a number of patients. There is a number of patients. It just doesn't do it. Despite reaching laboratory goals for au thyroid state, we can get patients to appear you thyroid on the labs, but they're not they're still symptomatic. And so we talked about how we identify these patients and these patients who you might see normal labs or you thyroid labs. But yet they are still symptomatic. Look at their blood pressure, look at their heart rate, look how they're feeling subjectively. And that's very important. Make sure you diagnose you, write that down in your records, because that's going to be what you'll be using to see with the patients to tease out how much better they're doing. We know there's a patient for a variety of reasons. It could be genetic polymorphisms. We know medications, we know that is disease progresses over time. Um again, other auto uh auto diseases that can impair this. We know that for some reason we're not getting sufficient Activation production and or penetrates tissue, penetrates of T. three, the metabolically active thyroid hormone. So, we know that we identify as we mentioned, it's going to be those those symptoms, a whole bunch of the symptoms they have, What's driving them to you. These patients will come to you. It's a diagnosis that when you rule it out, you almost feel bad. Sorry, it doesn't appear to have that. Maybe you have hypothyroidism, but it's one of those that we really need to look at and make sure we diagnose in a efficiently and we should actually keep that back of mind is a differential diagnosis. So once we do that, we do know that because not all patients are seem to have low thyroid T three with the labs, but they have subjective symptoms. We know that mono therapy does not work. And we need to be looking at other options. We must look at other options. And there is now a conversation about those options That there's patients we need to look at Combo therapy. Yes, there's synthetic short varieties, short term T3 varieties that we can have. But it's also time to look at desiccated thyroid extract is another another avenue to help alleviate symptoms. There will be more studies going on about this because there's been such enticing data that we are seeing that when we do have the biomarkers, lab biomarkers and the other things that we could tangibly touch and see when those look normal, the patient still don't feel normal. So, uh, that is that is where this may be an option that we should, we should look at this and critically look at this. We also mentioned that no matter what you use or choose to use in your thyroid replacement hormone therapies. And we hope you're giving you options, identify those patients who need the combo drugs and how to give them. We need to again remember primarily Number one, when we treat patients with thyroid disease. It is it's a highly subjective that's their symptoms, not just the metabolic symptoms that we see, the EKGs, bowel movements and the like. But there is a subjective symptoms that we can't measure. And so we want to alleviate their symptoms. And then we also want to prevent. That's why we have to intervene early, identify him quick prevent and mitigate complications of hypothyroidism. And if anybody's seen what it looks like down the road with hipaa thyroid and I have in mixed oedema and the pathologies that goes with it, that we could have maybe stopped along the way because we paused to see that there might be another option out there, that maybe there's more we can give these patients. And I think, and I hope that I've been able to share with you what those options can be. And I encourage you to look and give a look at another avenue for adding combination therapy D. T. T. Four and T. Three in the form of yeah Uh desiccated thyroid hormone. I've been using it off and on for many many years. I go right along with the 88 guidelines I to do that and and being a path a physiologist as well I'm very interested in how things work but I want you to know that as an option and it can be used very safely and surprisingly easily in your clinics. Just make sure the patients understand what you're trying to do. That. It takes time for there is thyroid hormone penetrating the body. These hormones effect every cell in the body. So it takes a while to get there to be patient, but that you care, you understand and you want to help them, and that will go a long way for not only getting good laboratory biomarkers, but you're also going to get a patient who feels better, better quality of life and a patient to you may just be able to not only better, but longer.