Challenges: Research

Updated 2018-07-09

To support urgent changes in testing and therapy, we call for more research on hypothyroidism, important improvements to research methodologies, and ask researchers to investigate questions that are central to patients’ present concerns and future quality of life.

Very little research is now going into hypothyroidism in comparison to research on thyroid cancer. We do not diminish the importance of studying thyroid cancer, but wish to ensure that thyroid cancer patients also have the best possible therapy after a thyroidectomy. The prevalence of hypothyroidism is far more common than thyroid cancer and it affects a much longer portion of our lifespan. As previously stated, chronic hypothyroidism affects approximately 4.6% of the population. However, thyroid cancer affected approximately 0.000407 percent of the Canadian population in 2017, based on the highest levels in Ontario.[43]

Because autoimmune thyroid disease is one of the most common types of autoimmune disease, [44] its study promises to yield an integrative understanding of autoimmune disease in general. It has already been shown that thyroid hormone therapy can be a tool in treating patients with normal thyroid glands who experience temporary thyroid hormone imbalance due to their illness or its drug therapy.

In terms of research methodology, we see two major things that need to change. First of all, too few studies have included measurements of the Free T3 hormone and signs and symptom within the context of thyroid therapy, and too many have made questionable generalizations based on TSH measurements alone. Secondly, hypothyroid patients on hormone therapy have often been excluded from studies of medical conditions that are directly affected by thyroid hormone imbalance, most importantly, the so-called “non-thyroidal illness” phenomenon of hormone deactivation, which can occur not only in acute illness but during thyroid hormone therapy.

Keeping these two fundamental issues in mind, we suggest the following research questions to researchers and research funders:

Hypothyroidism and thyroid hormone therapy in Canada

  • What is the prevalence of both treated and untreated hypothyroidism and anti-thyroid antibodies across Canada, and by region, ethnicity, sex and age? What is the prevalence of hypothyroidism among Canadian Aboriginal populations, and urban vs. rural populations? Is hypothyroidism more prevalent among people who drink fluoridated water or in areas that have more exposure to certain environmental toxins?
  • What are the social and economic costs and risks of untreated or insufficiently treated hypothyroidism in Canada?
  • Do patients in all provinces and hospitals have equal access to the full range of thyroid tests and hormone therapies, or are some patients denied access based on regional policies and guidelines, problems with drug availability, and drug price inflation?
  • In terms of Canadians’ access to hormone therapies that include T3 (desiccated thyroid and liothyronine), what are the factors that currently limit manufacturing, competition, and cause interruptions in supply and price increases? What can Canada do to ensure stable and equitable access to these effective therapy alternatives?
  • To what degree does Canadian hypothyroid patients’ restricted access to tests and therapies influence patients to change doctors, seek naturopathic medicine services, engage in international or online hormone purchases and self-medication, and/or order blood testing kits outside of the Canadian health care system? What health risks and socioeconomic factors are associated with these attempts to seek more thorough testing and more effective therapy?

Hypothyroidism in connection with other diseases

  • To what degree are other health disorders and autoimmune diseases associated with, and affected by, T3 and T4 hormone levels and thyroid antibody levels?
  • How do various non-thyroid health disorders, drugs, toxins, nutrients and natural substances alter the HPT axis and thyroid hormone metabolism, as well as the incidence and progression of thyroid disease?
  • How might various thyroid hormone therapies assist patients who temporarily experience thyroid hormone deficiency or imbalance?

Short and Long-term effects of all thyroid hormone therapies

  • How do the various thyroid hormone drug therapies (levothyroxine, desiccated thyroid extract, and liothyronine) affect thyroid patients’ physical and mental health, physical activity levels, employment, and lifespan?
  • To what degree can both T4- and T3-based hormone therapies achieve resolution of hypothyroid symptoms and signs when they are permitted to achieve optimal thyroid hormone balance based on multiple physiological indicators, not just TSH?
  • How do orally delivered thyroid hormones of all types interact with individual patients’ gut microbiome, and their other hormones, such as sex hormones and adrenal hormones?
  • What are the long-term effects of relative levels of T3 and T4 hormone, even within “normal” range, in thyroid patients on all forms of hormone therapy?
  • In combination therapy, do synthetic and animal-derived (desiccated thyroid) therapies affect the hypothyroid patient differently when T3 and T4 hormone are ingested in equal ratios across both therapies?
  • What are the long term health effects of chronic non-thyroidal illness (also known as low T3 syndrome) and low T3/T4 ratios in patients on thyroid hormone therapy, both in the context of acute illness in the hospital, and in “healthy” patients in the community?

Thyroid autoimmunity, genetics, and environment

  • What are the roles of all known anti-thyroid antibodies in thyroid disease diagnosis, testing, and treatment (TSH receptor stimulating, TSH receptor blocking, thyroid peroxidase, thyroglobulin, and anti-T3 and T4 [45])?
  • By what mechanisms do anti-thyroid antibodies cause thyroid inflammation or atrophy, thyroid follicular cell destruction, the growth of thyroid nodules, and the development of various thyroid cancers?
  • What drugs and substances can be used to reduce antibody levels?
  • How do genetic factors alter thyroid hormone conversion, transport, thyroid receptor sensitivity, and the various genomic and non-genomic effects that thyroid hormones initiate?



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