Given your practice focus and experience, can you discuss the disease burden of hypothyroidism, the spectrum of the disease, treatment options, and how DTE formulations differ in terms of T4 and T3 composition?
Hashimoto's thyroid disease is the number one autoimmune disease in the United States right now. It is rising. It's about 5 times what its rates were in the early 2000s, and it affects females much more than men. The ratio of men to women is about 10:1 women to men. It is unknown why that occurs, but we do know that females in general. more autoimmune disease. Research is continuing to be done on the factors that drive that autoimmune disease, but we do know that genetics plays a part. The part that genetics plays is probably about 30% of why people develop this, and then 70% of the reason why people develop autoimmune thyroid disease is likely due to their environment and environmental exposures, things that are in our food supply. Um, in water, in air, that activate an immune response and contribute to autoimmunity. Autoimmune thyroid disease is the number one cause of hypothyroidism in the US, um, but people can develop thyroid issues for other reasons. They can be born congenitally with no thyroid. They can have thyroid surgery to remove goiters or nodules or cancers. Excuse me. Um, and when they have hypothyroidism, Um, the, the conventional treatment is to put them on T4. Um, that is in all of the guidelines, the American Thyroid Association and the European Thyroid Association guidelines recommend that, um, monotherapy with levothyroxine or LT4 therapy be what is the standard of care. Back 130 years ago, the standard of care actually was animal extracted thyroid gland, so porcine gland from a pig or bovine gland from a cow, um, and the thyroid glands from these animals had both T4 and T3 in them. They also had other derivatives like T2 and T1, um, but they had both inactive thyroid hormone T4 and active thyroid hormone T3. Because they weren't actually regulated or they hadn't gone through FDA approval, um, some people became hyperthyroid on those um derivatives because they weren't tightly regulated and too much T3 or too much thyroid hormone in general can cause things like atrial fibrillation or hyperthyroid symptoms. So when T4 was discovered, um, levothyroxine in the lab. In the 1950s, it was marketed and became Synthroid. It became levothyroxine generic. There are multiple other formulations that are LT4 only. There's Terracin, there's Terracin solution, there's Unothroid, there's Levoxyl, multiple different brands. They all have T4 only, the inactive form of thyroid hormone. But they all constitute different formulations because they have different excipients or different fillers, and that affects how somebody actually absorbs the medication, how quickly they absorb it, how much they absorb in the small intestine, and the way that they absorb it affects how their body metabolizes it. And so the thought was, um, when T4 came onto the scene, that the body would take that T4 and convert it to T3 in the muscle tissue and in the periphery, um, in liver, and kidneys. And there are these enzymes called Diodenase enzymes. There's Diodenase 1, which is primarily in the liver. That's an activating enzyme that takes T4 and makes T3, or active thyroid hormone. And then there's diodenase 2, which is the major activating enzyme, and that's primarily in muscle, but it's in other organs as well. And so, um, if somebody is in good metabolic health, they have good muscle mass, they're not, they don't have liver disease, they don't have kidney disease, they should theoretically be able to take that T4 medicine and make T3 active thyroid hormone. Unfortunately, because of our food supply and all of the chemicals in our environment and the fact that as a population we're dealing with morbid obesity and excess fat mass and sarcopenia and muscle loss, we're not able to, um, a lot of patients are not able to take that T4 monotherapy and make T3 like they're supposed to be making. And, um, those are the patients that may benefit from combination T4-T3 therapy. That can include the addition of Cytomel or leothyronine, which is actually the T3 product to the T4 or the, the Synthroid product, or it could also constitute DTE products, desiccated. thyroid extract products. So those are those porcine or bovine derivatives from 130 years ago, now in tablet form, now FDA regulated and on their way hopefully for FDA approval in the future. And those medications have both T4 and T3 in them. They're derived from animal products as opposed to human bioidentical products. And again, they have different fillers that affect how they are absorbed by the patient and how they're metabolized by the body. Um, so that is, in a nutshell, um, what the options are and the disease burden that we have here in the US.
