Åbent Brev til dr. Mark Vanderpump

[Anisa]

Hvem er dr. Vanderpump?

Ikke alene regnes dr. Vanderpump blandt de ledende medforfattere bag de britiske retningslinjer for behandling af lavt stofskifte, men via sine aktiviteter i British Thyroid Association og samarbejde med Anthony Weetman, har han også med-indflydelse på de europæiske retningslinjer.

Idet de europæiske retningslinjer er den selveste årsag til at så mange danske patienter enten nægtes diagnose og behandling, eller forbydes behandling med andet end det syntetiske efterligning af et hormon, som kun nogenlunde virker mens man er ung... er kendskabet til dr. Vanderpump relevant også for os med lavt stofskifte i Danmark.

Dr Mark Vanderpump is Consultant Physician and Honorary Senior Lecturer in Diabetes and Endocrinology at the Royal Free London NHS Foundation Trust in London. Prior to this he was a Consultant Endocrinologist at the North Middlesex Hospital NHS Trust. His training in general medicine and endocrinology was completed at posts in the West Midlands, North East England and North Staffordshire.

His main area of expertise is thyroid disease but his clinical practice includes all aspects of diabetes and endocrinology. He has published on various aspects of thyroid disease and is the current President of the British Thyroid Association.

Oven i alle disse medicinskfaglige aktiviteter, dr. Vanderpump finder også tid til at hjælpe private patienter på flere private hospitaler, herunder på klinikken beliggende på den verdensberømte, fashionable læge-gade i London - Harley Street. Dr. Vanderpump byder sine private patienter velkommen på sin hjemmeside med det retoriske spørgsmål: "Need to get your life back?", dog samtidigt er han en af medicinske autoriteter som støtter afskaffelsen af kombinationsbehandling i UK.

Personligt har jeg umådelig svært ved at forstå, hvordan dr. Vanderpump kan love sine patienter to get their life back når han er en af de fornemmeste støtter af behandling af lavt stofskifte udelukkende med syntetisk T4... når enhver ved at denne behandling ikke holder hvad den lover på livstid. Hvem ved...? Måske er dr. Vanderpump mere large i valget af behandling når patienten kommer fra Buckingham Palace, Downing Street, Kensington & Chelsea, Westminster eller fra The House of Lords?

Heller ikke hos os kan man forestille sig overlægerne Bonnema, Hegedüs, Nygaard, Faber, Kølendorf m.fl. stå fast og insistere på at behandle Dronning Margrethe, Lars løkke, Lars Larsen, Kirk Kristiansen, eller medlemmer af familien Mærsk med Eltroxin, hvis Hendes Majestæt og de andre udtrykte ønske om hellere at blive behandlet med Thyreoid fra Glostrup, vel?

Det er nemlig den britiske dr. Vanderpump, der blev citeret i artiklen publiceret i The Pharmaceutical Journal i juli 2013, og det er i denne anledning at jeg skrev et brev til ham. Et brev, jeg senere forfremmede til et Åbent Brev, som siden sidste år blev læst til d.d. 4.764 gange på vores anden hjemmeside Forum for Stoffskiftesykdommer i Norge, tillige med at jeg også har sendt samme brev til flere danske "toneangivende" overlæger, og nu vil jeg dele brevet med stofskiftepatienter, besøgende på denne hjemmeside.

Bag mit skriv ligger mere end et årti af fuldtids studier af forskningsartikler indenfor medicin, biokemi og farmakologi, publiceret i respekterede tidsskrifter på begge sider af Atlanten, siden begyndelsen af 1900-tallet og frem til i dag. Mit budskab er altså ikke baseret på fri fantasi eller hjemmestrikkede amatør-teorier. Jeg har blot overskuet, hvad der allerede står skrevet sort på hvidt af læger og forskere i tiden inden og efter at behandlingen af lavt stofskifte sidst i 1960-erne blev kuppet af producenter af syntetiske hormon-analoger, og deres tro følgesvende - Den Moderne Lægestand.

Både indledningen og selve brevet er efter bedste evne skrevet på engelsk, men jeg vil gøre mit bedste for så snart som muligt at oversætte brevet til dansk, så også de ramte af kronisk brain fog kan få nytte af budskabet.

Enjoy!

EDIT: Det åbne brev der kan læses herunder bliver redigeret og opdateret i den nærmeste fremtid, idet undervejs gennem sidste redigering kom jeg i tanker om andre relevante og skelsættende aspekter af denne sag, jeg tidligere har stødt på i det medicinske litteratur, men som jeg først nu har forstået som værende yderst relevante for budskabet.

[Anisa]

Både indledningen og selve brevet er skrevet på engelsk, men jeg vil gøre mit bedste for så snart som muligt at oversætte brevet til dansk, så også de ramte af kronisk brain fog kan få nytte af budskabet.

Levothyroxine: from sheep thyroid injections to synthetic formulations

The Pharmaceutical Journal, 18 JUL 2013

Jenny Bryan takes a look at the colourful and interesting history of levothryoxine sodium, and the ongoing debate over combination treatment versus monotherapy.

By Jenny Bryan

Although synthetic forms of levothyroxine have been available since the 1950s,1 there is continued public demand for porcine thyroxine as a more “natural” product than the synthetic version.

“Synthetic levothyroxine is exactly the same as human thyroxine and has the obvious advantage that you don’t need to go to an abattoir to get it. But no randomised controlled trials were done to compare the effectiveness of the two products before patients were switched to synthetic treatment, and some patients feel that their symptoms are better controlled with pig thyroid hormone preparations,” says Dr Vanderpump.

Read more: http://www.pharmaceutical-journal.co...123454.article

Author of this article, Jenny Bryan has interviewed the doctor Mark Vanderpump and his claims I have commented in the following e-mail to which by the way (of course?) I has not received a reply.

Subject: "Article: "Levothyroxine: from sheep thyroid injections to synthetic formulations"
Date: Fri, 22 May 2015 15:51:43 +0200
From: Me
To: Email.co.uk

Dear dr. Mark Vanderpump

I read with great interest the article "Levothyroxine: from sheep thyroid injections to synthetic formulations" by Jenny Bryan. http://www.pharmaceutical-journal.co...123454.article

Based on this article, I would like to make you aware that there is no longer such a thing as "exactly the same as human thyroxine" in relation to synthetic T4 products. Since nature-identical hormone molecules are not patentable, the industry has developed a long range of so-called "thyroxine analogues" consisting many kinds of structure changed molecules which are no longer built exactly as human thyroxine.

I have studied this issue for several years. After having examined several synthetic levothyroxine patents I found the first 29 patented molecular "versions" of "artificial levothyroxine", it was no longer necessary to continue because my point was already confirmed for 29th time: there is in fact no such a thing as "synthetic levothyroxine is exactly the same as human thyroxine".

Regardless that in almost all inventions of those artificial T4-molecules, the number of atoms of the basic elements remains the same as in human T4-molecule, those atoms are arranged differently, or rotated different from the "real" human thyroxine. Only the first commercial forms of synthetic thyroxine was "nature identical", which has been the reason for the reasonable good effect, far better than from the following patented T4 analogues.

When a specific molecular structure of a hormone is required before the body can successfully utilize it, it can not be surprising that treatment with the "changed" thyroxine is insufficient and causes side effects.

But even if al those marketed synthetic thyroxine-products consisted exact molecular copies of the human thyroid hormone, exists the critical biochemical difference between those synthetics T4-analogues and preparations of animal thyroid gland.

There is no such a thing as a "free thyroxine" in human or animal thyroid gland, while the synthetic thyroxine analogues are only in the free form. Therefore, one can not compare these two biochemical forms of medications - Dessicated Thyroid USP and synthetic T4-analogues, because their pharmacokinetics and pharmacodynamics are quite different from each other.

In a normal healthy human body the blood contains less than 1% free thyroxine of the body's total (at the time) content of thyroxine. More than 99% of thyroxine in the blood is bound to carrier proteins which are thyroxine-binding globulin, transhyretin and albumin. In this state the thyroxine can not be converted into free T3, as well as a protein-bound triiodothyronine/T3 is biochemically inert (not active). This means that in the blood, in the normal human body the thyroxine frees from protein binding only in the limited amounts (successively) so the blood levels of free thyroxine are constantly maintained less than 1%.

Therefor, in relation to pharmacokinetics and pharmacodynamics, the drugs made from animal thyroid gland - in the body's metabolism of thyroid hormones works exactly the same way as if these hormones were released from the thyroid gland it self.

That's why in patients treated with Dessicated Thyroid Extract, the blood values of free T4 has to be low because of the long half-life of free T4, and because of the short half-life of free T3, the values of free T3 has to be in the top of the reference range in patients who are correctly dosed in the treatment with preparations of animal thyroid gland. As long as the depot of free thyroid hormones in the blood is sufficient, the pituitary holding back on TSH, which remains low and this continues as long as this sufficiency sustains.

As in healthy human bodies, blessed with a healthy metabolism, thyroid hormones are working exact in this way, exactly same effect is achiewed in hypothyroid patients treated with DTE. This explains why so many patients prosper so much better with this treatment.

Please note: It is an expression of biochemical and pharmaceutical ignorance when individual doctors choose to "supplement" the DTE-treatment with an amount of synthetic T4 analog in order to raise blood levels of free T4, and after the effect of DTE-treatment for that reason fails, they say that it is DTE which does not work. It works alright, just do not mix together these two types of medications.

In relation to pharmacokinetics and pharmacodynamics of synthetic thyroxine analogues in the human body, works these drugs so the body becomes flooded with free thyroxine to a degree, that in a normal human body this would be called "hyperthyroxinemia", whereas for some inexplicable reasons - in a hypothyroid bodies this condition is considered - by the doctors - as "normal".

It's NOT normal!

Too much free thyroxine in the blood at a time, is not normal and the body's genetic control will always try continuously to break down the excess of free thyroxine. This explains why so many patients treated with synthetic thyroxine analogues, nevertheless remains sick.

I wrote once in the past as an comment to another relevant article:

Now we just hope that at some point we can succeed in explaining to our doctors that the missing link in understanding that the carrier-protein binding is the difference between DTE (Dessicated Thyroid Extract) and synthetic T4 analogues.

Because more than 99% of thyroid hormones in the DTE are carrier-protein-bound, it means that the pharmacodynamics of DTE occurss with Slow Release Effect, which eliminating all the talk about the difference between Ratio of T4 / T3 in DTE made from thyroid gland of pigs and in human thyroid gland, and making it pointless.

All reflections on the Ratio of T4 / T3 in thyroid glands of pigs could only makes sense in the context of issues associated with transplant surgery between two different species, but in orally ingested drugs it does not matter.

Our doctors need to learn more about the biochemistry of the human body, and they really do need to learn about the difference between the pharmacokinetics and pharmacodynamics of these two types of drugs - Dessicated Thyroid USP and synthetic T4-analogues - because right now they consider those two medications as synonymous (which they are not) and consequently doctors are committing so many serious mistakes, that their patients basically remains sick.

It is almost impossible, touch briefly every detail, including corresponding metabolic aspects of artificial free triiodothyronine (synthetic T3) versus protein-bound triiodothyronine (T3) in preparations of animal thyroid gland, which in principle is exactly the same as the difference between metabolic aspects of "real" and "artificial" thyroxine, as well as briefly respond to claims that most patients are comfortable with synthetic T4 alone therapy, but I try anyway...

The problem is that most hypothyroid patients are mature women, and a large number of symptoms associated with inadequate treatment of hormone deficiency, are overlapping the most characteristic early and following later signs and symptoms of menopause. This means that as long as doctors choose to interpret the results of inadequate treatment of hypothyroidism, as simple state of menopause (or simple signs of age in men) - will no positive development happen. Doctors will remain dogmatic instead of knowing, while patients will remain sick.

Please, be aware that while the preparations of animal thyroid gland over the last 120 years has proved their effectiveness and efficiency in the treatment of hypothyroidism, no matter how many new patents are filed in still new artificial synthetic thyroxine "designs" over the last 65 years, they have still not proven their value for the hypothyroid patients. Only for the doctors.

Basically continues this controversy only because those oldtimers, animal derived drugs works very satisfactory, while those new artificial synthetic hormone analogs works only temporarily and incompletely, because of their deviant molecular structures.

I remember someone once said: "Hypothyroid patients will continue to suffer as a result of the synthetic treatment, as long as doctors prefer the synthetic treatment more than they love their patients."

Please, always be aware of the difference between knowledge and dogma, because they are so dangerous easy not to notice the difference between. All rational human beings know how easily that can happen if one becomes too self-confident.

Best regards
(me)
Denmark