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Desiccated thyroid extract

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It was known that not all of the iodine content of thyroid extract was in the form of effective T4 and T3 and that actual content of available preparations varied more than the permitted 15%. It was hoped that better dosing precision with levothyroxine (synthetic) alone would increase the proportion
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in human blood with approximate accuracy and confirmed that treatment with thyroxine alone could produce normal blood levels of both T4 and T3, but desiccated thyroid caused supraphysiologic levels of T3. In the majority of patients normalization of these levels eliminated all signs and symptoms of
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for a century as "the cleaned, dried, and powdered thyroid gland previously deprived of connective tissue and fat... obtained from domesticated animals that are used for food by man" (USP XVI). In the last few decades, pork alone is the usual source. Before modern assays, the potency was specified
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Replacement by thyroid extract in hypothyroidism was one of the most effective treatments of any disease available to physicians before the middle of the 20th century, and in severe cases afforded dramatic relief of the myriad symptoms. The decision to treat was usually based on the presence of
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The use of desiccated thyroid is usually accompanied with the practice of dosing according to symptoms instead of dosing to achieve "ideal" lab results (e.g. serum levels of TSH). While there is debate as to what the ideal serum levels are, dosing according to symptoms often results in higher
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Means JH, DeGroot LJ, Stanbury JB. The Thyroid and its Diseases. 3rd ed. New York:McGraw Hill, 1963. See chapter 9 for a lengthy discussion of the difficulties of assessing treatment in the era before effective tests, as well as the doctors' impressions of the superiority of the new synthetic
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By the 1960s, it was known that thyroxine was the essential hormone produced by the thyroid gland, and that most T3 was manufactured in other parts of the body by deiodination of thyroxine. It was demonstrated in hypothyroid animals and people that replacement of thyroxine alone corrected the
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and overtreatment. Blood levels of thyroid hormones and TSH were found to be the best predictors of objective benefits from thyroid replacement: those with the most severe measurable deficiency enjoyed the most dramatic and sustained benefits. It was also discovered that even mild
430:(synthetic T4), or by combinations of T4 and T3. Replacement occurred faster in the United Kingdom than in North America, but by the 1980s more patients were being prescribed synthetic T4 (levothyroxine) or synthetic T4/T3 combinations than desiccated thyroid extract. 462:
Furthermore, when T3 could be measured, it was discovered that thyroid extract and synthetic combinations of T4 and T3 produced significantly greater fluctuations of T3 throughout the day than occurred in healthy people or hypothyroid people treated with thyroxine
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recommend against the use of thyroid extract for the treatment of hypothyroidism. Concerns include the potential for adverse effects from superphysiological levels of T3 and the absence of long-term safety data from randomized clinical trials. They recommend
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the only accurate way to diagnose a thyroid disorder is via a blood test which measures hormone levels, and the only scientifically proven way of treating the condition is by topping up a patient's natural thyroxine levels with a synthetic form of the
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It was discovered that a healthy person varied the amount of T3 produced from T4 in response to changing needs and conditions and it seemed wiser not to bypass this control system by providing larger amounts of T3 than were naturally produced each
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Desiccated thyroid extract is prepared from pig thyroid glands. The glands are dried (desiccated), ground to powder, combined with binder chemicals, and pressed into pills. This was a new use for parts that were previously unwanted
392:(severe hypothyroidism) in 1920 His treatment was quickly adopted in North America and Europe. The first recorded American use dates to 1891 by a woman who was still taking it 52 years later at 84 years of age 437:
Although thyroid extract was useful and usually effective, some patients continued to complain of fatigue, weight gain, or other symptoms. Dosing until the 1960s was often a matter of prolonged adjustment
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Thyroid care changed in other ways as well. Accurate T4 and T3 measurements became widely used in the 1970s, and by the late 1980s, TSH measurement had become sensitive enough to detect mild degrees of
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Clyde PW, Harari AE, Getka EJ, Shakir KM (December 2003). "Combined levothyroxine plus liothyronine compared with levothyroxine alone in primary hypothyroidism: a randomized controlled trial".
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found that treatment with thyroxine alone worked as well or better than thyroid extract for the majority of patients, although even thyroxine did not reverse all the symptoms of a minority.
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A combination of various ratios of T4 and T3 might not provide benefits over T4 alone. Some controlled trials have shown inconsistent benefits of various ratios of T4 and T3.
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Desiccated Thyroid became a commercial treatment option in 1934 with Westhroid,. In the early 1960s, desiccated thyroid hormones (thyroid extract) began to be replaced by
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Pileggi VJ, Golub OJ, Lee ND (July 1965). "Determination of Thyroxine and Triiodothyronine in Commercial Preparations of Desiccated Thyroid and Thyroid Extract".
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Penny R, Frasier SD (January 1980). "Elevated serum concentrations of triiodothyronine in hypothyroid patients. Values for patients receiving USP thyroid".
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Saberi M, Utiger RD (November 1974). "Serum thyroid hormone and thyrotropin concentrations during thyroxine and triiodothyronine therapy".
1403:"A new radioimmunoassay for plasma L-triiodothyronine: measurements in thyroid disease and in patients maintained on hormonal replacement" 716: 982: 644: 617: 315:) of thyroid extract contains approximately 38 mcg and 9 mcg of measurable levothyroxine (T4) and liothyronine (T3), respectively. 446:
revealed continued large ranges of hormone content and potency in all of the available thyroid extracts on the American market.
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dosages. Most endocrinologists are opposed to these higher dosages as there may be risks of hyperthyroidism and osteoporosis.
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is generally safe. Regular blood tests are recommended to verify the appropriateness of the dose. They contain a mixture of
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Desiccated thyroid has been used since the late 1800s. It is usually made from pigs, sheep, or cows. It is available as a
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with thyroid extract in 1891, and published a description of long-term successful treatment (28 years) of a patient with
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Side effects may occur from excessive doses. This may include weight loss, fever, headache, anxiety, trouble sleeping,
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measurable manifestations (laboratory test results) of hypothyroidism. By the 1970s doctors could measure T4, T3, and
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of thyroid function. Many less severe cases of hypothyroidism went untreated. Dosage was regulated by improvement of
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Desiccated thyroid has roughly a 4:1 ratio of thyroxine (T4) to triiodothyronine (T3). In humans, the ratio is 11:1.
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Desiccated thyroid contains all the hormones produced exclusively by the thyroid gland, including calcitonin.
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Rees-Jones RW, Rolla AR, Larsen PR (February 1980). "Hormonal content of thyroid replacement preparations".
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Desiccated thyroid therapy can be combined with synthetic thyroxine (T4) to balance out the T4/T3 correctly.
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Catz B, Ginsburg E, Salenger S (January 1962). "Clinically inactive thyroid U.S.P. A preliminary report".
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as defined by a suppressed TSH level, whether due to disease or overtreatment, was associated with poorer
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Several reasons have been identified as to why prescriptions changed from desiccated thyroid treatment.
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content ("not less than 0.17% and not more than 0.23%"), rather than hormonal content or activity.
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Desiccated thyroid preparations have a greater variability from batch to batch than synthetic ones.
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Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. (December 2012).
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Burgess AM. Myxedema-- controlled by thyroid extract for fifty-two years: report of a case.
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of patients effectively treated. In 1980, a widely publicized investigation published in
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Murray GR. The life history of the first case of myxoedema treated by thyroid extract.
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signs and symptoms of hypothyroidism because there were no accurate, readily available
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Capiferri R, Evered D (March 1979). "Investigation and treatment of hypothyroidism".
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Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, Segal RL (2002).
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as the preferred treatment. Some practitioners refuse to use desiccated thyroid.
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Natural thyroid, natural thyroid hormones, pork thyroid, thyroid USP, thyroid BP
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Repas, Thomas. Desiccated thyroid in the management of hypothyroidism: Part I.
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The earliest oral treatment for hypothyroidism consisted of thyroid extract.
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in the 20th century, supplied the best-known brand of thyroid extract.
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US Pharmacopeia Natural Formulary USP 37 N32 2014 Volume 3 May 1, 2014
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Macgregor AG (February 1961). "Why does anybody use thyroid B.P.?".
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The American Association of Clinical Endocrinologists and the
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million prescriptions. Usage has decreased since the 1960s.
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Surks MI, Schadlow AR, Oppenheimer JH (December 1972).
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The Journal of Clinical Endocrinology and Metabolism
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The Journal of Clinical Endocrinology and Metabolism
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The Journal of Clinical Endocrinology and Metabolism
977:. The United States Pharmacopeial Convention. 2014. 800: 798: 2173: 2123: 2062: 2045: 1987: 1970: 1936: 1866: 1805: 1791: 1774: 1669: 1634: 1601: 1538: 1529: 1491: 204: 199: 174: 169: 153: 139: 109: 91: 83: 73: 68: 56: 44: 39: 504:This product is sometimes referred to as thyroid 2125: 1793: 1242:Braverman LE, Ingbar SH, Sterling K (May 1970). 512:. Brands differing only in binders and fillers. 1989: 559:. American Society of Health-System Pharmacists 213: 1000:Remington The Science and Practice of Pharmacy 318:Arguments against desiccated thyroid include: 1749: 1464: 1361: 1359: 359:Desiccated thyroid has been described in the 8: 128: 32: 609:Endocrinology - E-Book: Adult and Pediatric 547: 545: 2064: 2059: 1984: 1802: 1788: 1756: 1742: 1734: 1535: 1471: 1457: 1449: 612:. Elsevier Health Sciences. p. 1608. 601: 599: 543: 541: 539: 537: 535: 533: 531: 529: 527: 525: 343:Arguments for desiccated thyroid include: 1428: 1418: 1269: 1259: 1183: 1051:thyroxine that had just become available. 579:"Thyroid desiccated Use During Pregnancy" 79:Armour Thyroid, NP Thyroid, Nature-Throid 1330:American Journal of Diseases of Children 2236: 1368:Clinics in Endocrinology and Metabolism 521: 31: 27:Thyroid gland prepared for medical use 1407:The Journal of Clinical Investigation 1248:The Journal of Clinical Investigation 1166:Mangieri CN, Lund MH (January 1970). 553:"Thyroid Monograph for Professionals" 237:that has been dried and powdered for 101: 7: 1342:10.1001/archpedi.1980.02130130008003 671:from the original on 15 January 2024 636:Principles of Endocrine Pharmacology 1098:The New England Journal of Medicine 487:in women, and with higher rates of 18:Natural desiccated thyroid hormones 1954:Tetraiodothyroacetic acid (Tetrac) 773:"Thyroid disorders 'misdiagnosed'" 25: 2272:Thyroid hormone receptor agonists 691:"Thyroid - Drug Usage Statistics" 260:. Other side effects may include 2239: 2151:Ipodate sodium (sodium iopodate) 2130:Tooltip Iodothyronine deiodinase 1798:Tooltip Thyroid hormone receptor 1221:10.1001/jama.1980.03300320041023 1994:Tooltip Sodium-iodide symporter 2262:Drugs not assigned an ATC code 1: 2218:Receptor/signaling modulators 1380:10.1016/S0300-595X(79)80008-0 1075:10.1016/s0140-6736(61)91498-2 633:Thomas JA, Keenan EJ (2012). 606:Jameson JL, Groot LJ (2010). 384:first described treatment of 1110:10.1056/nejm196201182660308 361:United States Pharmacopoeia 301:Royal College of Physicians 245:., but less preferred than 2288: 2069:Tooltip Thyroid peroxidase 1913:Sobetirome (GC-1, GRX-431) 1521:Thyroid gland preparations 227:Desiccated thyroid extract 34:Desiccated thyroid extract 2209: 1694: 859:10.4158/1934-2403-8.6.457 1765:Thyroid hormone receptor 1531:Antithyroid preparations 909:10.1001/jama.290.22.2952 407:, the dominant American 1636:Sodium-iodide symporter 953:"Endocrine Today Blog" 931:"Endocrine Today Blog" 806:"Endocrine Today Blog" 378:George Redmayne Murray 241:. It is used to treat 2016:potassium perchlorate 2007:Cyanogenic glycosides 1650:Potassium perchlorate 1307:10.1210/jcem-39-5-923 1185:10.1210/jcem-30-1-102 1145:10.1210/jcem-25-7-949 736:10.1089/thy.2012.0205 661:"The Top 300 of 2021" 491:in elderly patients. 2026:sodium pertechnetate 1878:Eprotirome (KB-2115) 1871:(selective agonists) 1660:Sodium pertechnetate 955:. Endocrinetoday.com 933:. Endocrinetoday.com 808:. Endocrinetoday.com 335:The preference for " 495:Society and culture 489:atrial fibrillation 36: 1848:Tiratricol (TRIAC) 1721:Never to phase III 1540:Thyroid peroxidase 876:on 8 December 2015 847:Endocrine Practice 753:on 14 January 2016 405:Armour and Company 311:Each 64.8 mg (one 285:generic medication 262:allergic reactions 2227: 2226: 2169: 2168: 2056: 2041: 2040: 1981: 1966: 1965: 1962: 1961: 1785: 1731: 1730: 1690: 1689: 1420:10.1172/jci107137 1413:(12): 3104–3113. 1261:10.1172/jci106304 1069:(7172): 329–332. 1039:Ann. Intern. 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55: 52: 49: 47: 43: 38: 30: 19: 2214: 2213: 2137: 2110:2-Thiouracil 2076: 2032:Thiocyanates 2012:Perchlorates 2003: 1857: 1833:Liothyronine 1578:-containing 1553:Thiouracils 1543:inhibitors ( 1520: 1506:Liothyronine 1410: 1406: 1396: 1374:(1): 39–48. 1371: 1367: 1336:(1): 16–18. 1333: 1329: 1323: 1298: 1294: 1288: 1251: 1247: 1237: 1212: 1208: 1202: 1175: 1171: 1161: 1136: 1132: 1126: 1101: 1097: 1091: 1066: 1062: 1056: 1046: 1033: 1023: 1018: 999: 993: 974: 969: 957:. 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Retrieved 556: 503: 485:bone density 472: 432: 425: 413: 394: 375: 358: 342: 317: 310: 298: 295:Medical uses 282: 251: 230: 226: 225: 176:Legal status 170:Legal status 111:License data 29: 2156:Propranolol 2138:Inhibitors: 2095:Methimazole 2085:Carbimazole 2077:Inhibitors: 2004:Inhibitors: 1972:Transporter 1937:Antagonists 1707:from market 1646:Perchlorate 1591:Methimazole 1586:Carbimazole 1104:: 136–137. 239:medical use 200:Identifiers 84:Other names 75:Trade names 2256:Categories 2186:Iodine-131 2053:inhibitors 1908:Resmetirom 1768:modulators 1604:conversion 1516:Tiratricol 1009:0781763789 880:3 February 757:8 November 700:14 January 675:14 January 516:References 508:, thyroid 409:meatpacker 254:arrythmias 206:CAS Number 2215:See also: 2090:Genistein 1893:KB-130015 1843:Thyroxine 1717:Phase III 1705:Withdrawn 1639:inhibitor 1580:imidazole 1545:thioamide 1482:therapy ( 583:Drugs.com 557:Drugs.com 355:Chemistry 276:(T4) and 274:thyroxine 266:pregnancy 264:. Use in 215:8001-24-9 141:Routes of 103:Monograph 97:Drugs.com 46:Thyroxine 2246:Medicine 2201:Tyrosine 2191:Selenium 2115:Thiourea 1978:blockers 1903:MB-07811 1898:MB-07344 1806:Agonists 1776:Receptor 1153:14319377 1118:13877407 1083:13764789 1025:Br Med J 917:14665656 867:15260011 790:hormone. 783:30 March 777:BBC News 744:22954017 695:ClinCalc 669:Archived 665:ClinCalc 421:symptoms 390:myxedema 386:myxedema 364:only by 155:ATC code 148:By mouth 125:DailyMed 2267:Thyroid 2024:(e.g., 2014:(e.g., 1923:VK-2809 1918:VK-0214 1888:KB-2611 1838:Liotrix 1782:ligands 1626:Ipodate 1511:Liotrix 1480:Thyroid 1439:4539287 1350:7350782 1315:4422006 1280:4986007 1229:7351788 1194:5409525 959:24 July 937:24 July 812:24 July 724:Thyroid 588:9 April 563:8 April 438:trials. 380:of the 372:History 337:natural 127::  2232:Portal 2181:Iodine 2174:Others 2047:Enzyme 1997:  1883:KB-141 1700:WHO-EM 1602:Block 1576:Sulfur 1437:  1430:332992 1427:  1388:371874 1386:  1348:  1313:  1278:  1271:535757 1268:  1227:  1192:  1151:  1116:  1081:  1063:Lancet 1006:  981:  915:  865:  742:  643:  616:  463:alone. 403:, and 366:iodine 289:  280:(T3). 256:, and 233:), is 191:℞-only 189: 123:  1944:1-850 1823:DITPA 1818:DIMIT 1670:Other 874:(PDF) 843:(PDF) 751:(PDF) 720:(PDF) 500:Names 401:offal 313:grain 1928:ZYT1 1435:PMID 1384:PMID 1346:PMID 1311:PMID 1276:PMID 1225:PMID 1209:JAMA 1190:PMID 1149:PMID 1114:PMID 1079:PMID 1004:ISBN 979:ISBN 961:2014 939:2014 913:PMID 897:JAMA 882:2015 863:PMID 814:2014 785:2009 759:2014 740:PMID 702:2024 677:2024 641:ISBN 614:ISBN 590:2019 565:2019 459:day. 444:JAMA 268:and 162:None 93:AHFS 2126:DIO 2065:TPO 1990:NIS 1949:NH3 1794:THR 1611:to 1484:H03 1425:PMC 1415:doi 1376:doi 1338:doi 1334:134 1303:doi 1266:PMC 1256:doi 1217:doi 1213:243 1180:doi 1141:doi 1106:doi 1102:266 1071:doi 905:doi 901:290 855:doi 732:doi 506:USP 452:TSH 231:DTE 2258:: 1713:: 1613:T3 1609:T4 1606:of 1433:. 1423:. 1411:51 1409:. 1405:. 1382:. 1370:. 1358:^ 1344:. 1332:. 1309:. 1299:39 1297:. 1274:. 1264:. 1252:49 1250:. 1246:. 1223:. 1211:. 1188:. 1176:30 1174:. 1170:. 1147:. 1137:25 1135:. 1112:. 1100:. 1077:. 1065:. 911:. 899:. 861:. 849:. 845:. 797:^ 787:. 775:. 738:. 728:22 726:. 722:. 693:. 667:. 663:. 598:^ 581:. 555:. 524:^ 510:BP 423:. 185:US 120:US 2234:: 2055:) 2051:( 2028:) 2018:) 1980:) 1976:( 1784:) 1780:( 1757:e 1750:t 1743:v 1662:) 1658:( 1652:) 1648:( 1547:) 1486:) 1472:e 1465:t 1458:v 1441:. 1417:: 1390:. 1378:: 1372:8 1352:. 1340:: 1317:. 1305:: 1282:. 1258:: 1231:. 1219:: 1196:. 1182:: 1155:. 1143:: 1120:. 1108:: 1085:. 1073:: 1067:1 1012:. 987:. 963:. 941:. 919:. 907:: 884:. 857:: 851:8 816:. 761:. 734:: 704:. 679:. 649:. 622:. 592:. 567:. 229:( 187:: 95:/ 20:)

Index

Natural desiccated thyroid hormones
Thyroxine
Thyroid hormone
Triiodothyronine
Thyroid hormone
Trade names
AHFS
Drugs.com
Monograph
License data
DailyMed
Thyroid porcine
Routes of
administration

By mouth
ATC code
Legal status
℞-only
CAS Number
8001-24-9
thyroid gland
medical use
hypothyroidism
levothyroxine
arrythmias
heart failure
allergic reactions
pregnancy
breastfeeding
thyroxine
triiodothyronine

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