Hypothyroidism: interesting.

[armchairclimber]

Flagged up by the Sports Science boys.
http://online.wsj.com/article/SB10001424127887323550604578412913149043072.html

I'm fascinated because it runs in my family and had already booked an appointment with the GP to have my son tested after a significant drop in his athletic performance.

I know it isn't a banned practice yet...but thought it belonged in here.

 

[armchairclimber]

And the SS guys' take on it.
http://www.sportsscientists.com/2013/04/the-thyroid-medication-debate-is-it.html

I'm not sure how I feel about it ...where there is an existing condition I think treatment should be permitted. It does introduce a massive grey area open to exploitation though....another one.

 

[martinvickers]

Flagged up by the Sports Science boys.
http://online.wsj.com/article/SB10001424127887323550604578412913149043072.html

I'm fascinated because it runs in my family and had already booked an appointment with the GP to have my son tested after a significant drop in his athletic performance.

I know it isn't a banned practice yet...but thought it belonged in here.

My wife suffers from it, has done for several years. It interferes in many things other than just athletic performance, not least pregnancy - my wife has to take 'extra' levothyroxine during each pregnancy, for example, on top of her normal doses.

I would only point out one thing, therefore, in response to the Article. The article expresses, or seems to suggest, a mild incredulity that 'some' doctors believe the 'thyroid' number should be kept as low as 2, as opposed to 4 or 5.

Well, I can categorically, from the horses mouth, confirm that this number is correct. It was 2.5 until a few years ago, and 2 is now the standard target number. If an athlete, or anyone else, has a number like 4 or 5, then they have a medical issue to consider.

That said, the named doctor seems to be VERY keen on his theory, and the authorities should investigate it immediately, just to be sure.

 

[hiero2]

Thyroid corrections: is normally correcting thyroid to "normal" levels, and it is easily tested, shouldn't be a problem. We do know from stuff Tyler has published that he used thyroid supplementation during training. I would suspect he was overcorrecting, not trying to return to normal readings. Thyroid stimulating hormone (TSH) and T4 (one of the thyroid types) are the standard tests, and they have well established ranges, within which they are considered "normal".

Excess thyroid can be extremely problematic (for the heart, circulatory system, and bones) - but that doesn't mean it could not be abused.

I would think this doc is finding REAL hypothyroid conditions, not made-up ones.

 

[armchairclimber]

Thyroid corrections: is normally correcting thyroid to "normal" levels, and it is easily tested, shouldn't be a problem. We do know from stuff Tyler has published that he used thyroid supplementation during training. I would suspect he was overcorrecting, not trying to return to normal readings. Thyroid stimulating hormone (TSH) and T4 (one of the thyroid types) are the standard tests, and they have well established ranges, within which they are considered "normal".

Excess thyroid can be extremely problematic (for the heart, circulatory system, and bones) - but that doesn't mean it could not be abused.

I would think this doc is finding REAL hypothyroid conditions, not made-up ones.

The point that they are making though is that "restoring to normal levels" where the deficit is caused by training is not correcting an existing condition, rather it is "enabling" greater training loads.
To be honest, I'm probably with you on this but I can see how this could become a tricky area.

 

[martinvickers]

The point that they are making though is that "restoring to normal levels" where the deficit is caused by training is not correcting an existing condition, rather it is "enabling" greater training loads.
To be honest, I'm probably with you on this but I can see how this could become a tricky area.

The same logic taken to an 'insane' conclusion would say don't drink extra water - you're SUPPOSED to sweat - or don't use blister plasters - you're supposed to Blister. We allow these, but we are unhappy with corticosteroids for saddle sores, rightly.

It's a difficult area, but I'm not convinced on the logic as it's currently presented. More investigation needed.

 

[armchairclimber]

I'll be interested to see what happens with my lad. I was baffled by what happened with him until my mother told me that hypothyroidism went back at least 3 generations.

 

[hiero2]

As I pointed out Tyler Hamilton listed thyroid supplementation on his training diary, wherever he published it - his book, wherever. I remember seeing it, as I am hypothyroid, and have been taking thyroid for quite a few years.

I can tell you first hand, that if all the doc is doing is running the TSH down to the lowest "normal" level, he's not doing anything to get fashed about. Taking the TSH LOWER would be a concern - in that condition you can experience heart palpitations, high blood pressure, overheating, bone density loss (not quite so obvious as heart palpitations!).

If he's just saying the "trigger" point is a little lower than the ordinary medical consensus, I certainly wouldn't get fashed about that, either. I tend to agree with whoever said in the article that most endocrinologists, ftm, most gp's, don't have a clue. Actually, I'm not QUITE that dismissive of medical knowledge, but my experience has taught me that the medicos are rather more fallable than they would like us to believe. Hypothyroid can be difficult. The biggest symptom is just being tired. Dog. Tired. But if you overcook and are taking too much, you can tell pretty quick, with fairly small amounts.

I agree with the OP that he should have his son tested. I was given a type of medical treatment, the byproduct of which was killing my thyroid - but before I started the docs tested and said I was low. Could have been that way for decades, and could have been why I often suffered from fatigue, and just didn't know. The tests are done from a simple blood draw - you get the results back in a couple of days. No problem.

Just to restate, taking someone in the "normal" range - but slightly on the high side - and reducing their TSH, within "normal" ranges - imo should not be a concern. I would say it ain't doping. It IS trying to be normal when some part of your body is malfunctioning.

 

[hiero2]

The point that they are making though is that "restoring to normal levels" where the deficit is caused by training is not correcting an existing condition, rather it is "enabling" greater training loads.
To be honest, I'm probably with you on this but I can see how this could become a tricky area.

Sorry - I don't think I was clear about one thing - the connection to greater training loads. I find this treatment far less suspicious than testosterone replacement therapy. Frankly, thyroid doesn't enhance performance, as near as I can tell, and I take it. It DOES allow me to wake up in the morning, and not laze about all day, a la Wiggo and his gin. With thyroid, it isn't depleted by exercise - but this endo doc is saying the production might be suppressed. Which means it is an existing condition for the athlete. He's not saying that the athleticism is depleting the thyroid, he is saying that it is causing an abnormal condition - suppression of thyroid production - a condition that we correct for in the general public. And, he is (presumably) correcting within accepted ranges.

I would put this in the basket with digestive upset - too much exercise upsets the digestion, so you take a digestive aid. Or like iron - a lot of exercise depletes iron levels - so we correct for that. No harm, no foul.

Speaking of which - if you wanted to, you COULD correct thyroid levels with diet - but the amounts of thymus gland you would have to eat make that somewhat impractical. In addition to that, eating thymus would not give you a predictable dose. The amounts vary too much from one to the next.

Where thyroid abuse comes in to play would be in weight control, where it could have some useful application, albeit illegal.

 

[hiero2]

Ok - sorry - I didn't quite "get" exactly what you were saying. I read the follow thru articles on the Science Guys and LetsRun.

This quote from the Science of Sport guys expresses what you are saying, and when I read it, it hit me:

Now, ideally, we will develop a way to clearly identify whether a person has developed hypothyroidism because of a genuine medical condition, or whether it is training related. As I've said in the article, when it's training related, I cannot see how the use of synthetic hormones can be justified.

Frankly, I don't agree. But, I do believe that he, and you, have a point. My thinking is this is not "enhancement" - it is trying to keep the body normal. The Science Guy quoted above believes that if you suffer hypothyroidism as a result of the stresses of endurance athletics, then you should just play with the cards you got. I don't agree. If that thinking held as the case, Oscar P shouldn't be running in the Olympics.

I can certainly see prohibiting its use above the normal levels - as I said, it can be dangerous then. I thought it was prohibited, actually.

 

[131313]

Frankly, I don't agree. But, I do believe that he, and you, have a point. My thinking is this is not "enhancement" - it is trying to keep the body normal. The Science Guy quoted above believes that if you suffer hypothyroidism as a result of the stresses of endurance athletics, then you should just play with the cards you got. I don't agree. If that thinking held as the case, Oscar P shouldn't be running in the Olympics.

I can certainly see prohibiting its use above the normal levels - as I said, it can be dangerous then. I thought it was prohibited, actually.

This is pretty much the justification Fuentes (and countless others) have used for blood doping. The hct and rbc levels of a non-doped athlete at the end of a grand tour or a hard 6 week block of trainer are often not "normal", and are often considered "low" compared the regular population. This seems like a difficult justification to make, IMO. I'm with the SoS guys on this one.

 

[More Strides than Rides]

Ok - sorry - I didn't quite "get" exactly what you were saying. I read the follow thru articles on the Science Guys and LetsRun.

This quote from the Science of Sport guys expresses what you are saying, and when I read it, it hit me:



Frankly, I don't agree. But, I do believe that he, and you, have a point. My thinking is this is not "enhancement" - it is trying to keep the body normal. The Science Guy quoted above believes that if you suffer hypothyroidism as a result of the stresses of endurance athletics, then you should just play with the cards you got. I don't agree. If that thinking held as the case, Oscar P shouldn't be running in the Olympics.

I can certainly see prohibiting its use above the normal levels - as I said, it can be dangerous then. I thought it was prohibited, actually.

You're going to run into more flak than you expect with the Oscar P comparison... The general consensus of opponents of his participation is that the science evaluating the physical advantage/disadvantage of his blades was done poorly.

I have the same opinion of this thyroid issue: the analysis of its performance enhancement does not seem concrete. I'm skeptical that enough research has been done, although I'll say right now that I haven't exhausted myself looking for it. The fact that there is grey area concerns me.

I'm skeptical of the articles statistic that 17% (5 of the 30 athletes) of Salazar's group are treated for thyroid problems, compared to 5% of the general population when using the higher threshold of 5, and 10% when using the Doctor's (and posters here) more encompassing opinion of 2.

To me, something about that doesn't sit right. On one hand, the natural selection of the elitest athletes would predictably ween out those with limiting disorders. Further, The higher proportion of thyroid problems in elite athletes lends more weight to the idea that the medication is treating a training affect, rather than a naturally occurring condition.

 

[hiero2]

This is pretty much the justification Fuentes (and countless others) have used for blood doping. The hct and rbc levels of a non-doped athlete at the end of a grand tour or a hard 6 week block of trainer are often not "normal", and are often considered "low" compared the regular population. This seems like a difficult justification to make, IMO. I'm with the SoS guys on this one.

I understand they have some surface similarity. But I don't think they are similar, and here is why.

Those hct and rbc levels are a direct result of the levels of effort, and they happen to pretty much everybody who does this, in slightly varying amounts. The hypothyroid doesn't happen to everybody. It happens to a few people, and I will guess (and bet on) two things:
1. Once the thyroid levels are low, they will never revert to readings that are more "normal"
2. It would be likely to be noticed in the person at some point in their life regardless of the exercise.

It is a condition we wouldn't hesitate to "fix" in the general population. If these athletes were a couple of points higher with their TSH - every GP and endo doc would prescribe for it. The only difference is where Brown is setting his "trigger" to get the levels back within "normal" range.


And last, I would be a lot more concerned over a performance enhancement some guy gets because he got a testosterone replacement therapy scrip. Even legit. T gets you a real performance enhancement. Thyroid? I wish. Taking thyroid doesn't give me a performance enhancement - it only means I don't drop into the realm of non-performing. I think it has a lot more similarity to diabetes and insulin than EPO and blood counts.

 

[Steve H.]

http://www.endocrineweb.com/conditions/hypothyroidism/risk-factors-hypothyroidism

"If you're concerned about your risk of developing hypothyroidism, there are two main factors to consider—age and sex. Your chances of being hypothyroid increase with age, and they are greater if you're a woman. Hypothyroidism occurs primarily in women older than 50"

Once a person start treatment, they will continue with that treatment for their entire life. The thyroid will quit functioning properly. Oh, and you have to get blood work done every so often to ensure the levels are maintained.

 

[hiero2]

You're going to run into more flak than you expect with the Oscar P comparison... . . .


To me, something about that doesn't sit right. On one hand, the natural selection of the elitest athletes would predictably ween out those with limiting disorders. Further, The higher proportion of thyroid problems in elite athletes lends more weight to the idea that the medication is treating a training affect, rather than a naturally occurring condition.

If it turns out that what Brown is seeing IS a training effect, then it will revert when such training ceases. IF this is the case, I'm with you, using it is a problem. I don't think this is the case.

As for Oscar, yeah -- -- but hey, he is, by nature, unqualified to enter the Olympics, and is only enabled to do so by medical, or technological, intervention! Voila!

 

[Cloxxki]

Athletes should perhaps be given a 50% kind of rule suspension when they feel they suffer from something this serious. Get off the training, for at least 6 months, and don't secretly try and get your workout fix, it's not good for you. Why take the treatment when you could just take away the cause of the condition? Imagine they'd devise a treatment that correct for the health effect of smoking. Keep on smoking, we have the treatment!

I get similar feelings here as with diabetes. Sure they need insulin to pperform, but how much is fair? Seems that they can handle a heck of a lot. And sometimes, more seems to be better actually. If you test me at just the right time, my physician may well decide that I suffer from some exersize enduced diabetes, and some insulin will make it healthier for me. Etc, etc.

17% of Salazar's group, and the most elite part of it, NOT NORMAL.
What else do they suffer from?

 

[Dear Wiggo]

17% of Salazar's group, and the most elite part of it, NOT NORMAL.
What else do they suffer from?

Agree on taking a break.

Would be interesting to open book the TUE list.

 

[Cloxxki]

Can these measurements be influenced?
I'd take product X before seeing the doctor. He's freak out over my values, and give me treatment Z to compensate. Repeat. And, my profession of being a runner is my excuse.

 

[armchairclimber]

It's murky isn't it. The restorative concept especially. After all, taking extra vitamins and minerals on board when training heavily is restorative. Vitamin D is a hormone...many people have low Vit D levels these days which would impact upon performance in many ways: calcium absorption, blood vessel elasticity, impaired immune function etc etc. Taking vitamin D supplements or Codliver oil would seem a good idea when restorative.
The problem comes when you have to decide what is normal. Is it acceptable to give HGH to someone who is deficient...as a restorative? Messi?
Salazar's hypothyroidic athletes?
It seems to me that scientists often don't agree what "normal" parameters are.

 

[Ripper]

Hmmm, a very interesting set of reads. And one I think that will especially spark debate for folks who experience 'legitimate' medical hypothyroidism. I say this because I find that when something medical is abused, there is always a bit of debate between the potential to abuse, and those who actually need the treatment.

I think Ross nailed it though. The blunt reality is if training "creates" a chronic condition that stops you from training, and a medical treatment you take on an ongoing basis allows you to return to your training volumes, then there are major issues.

In the medical world, when there is this much debate about something being done (Brown is one of how many docs doing this? .... I think he is the only one), then there is an issue.

Keep in mind Brown is adding symptom report into the diagnosis, as in ...

- "I am too tired to train 30 hours a week any more"

- My thyroid levels are 'normal' by most standards, but one doctor is willing to say that, "for a young athlete", they are not normal.

As a result, said athlete gets thyroid treatment and can resume higher training volumes, in which case there is a definite performance effect.

For all of those on the forum who take thyroid medication, please note I have family members who are treated for hypothyroidism. I 'get' the need for treatment. However, I also believe that the search for an edge, or to fix a "problem" that might simply be the wrong genetics to be an elite athlete, will always push the boundries of abuse.

 

[Ripper]

It's murky isn't it. The restorative concept especially. After all, taking extra vitamins and minerals on board when training heavily is restorative. Vitamin D is a hormone...many people have low Vit D levels these days which would impact upon performance in many ways: calcium absorption, blood vessel elasticity, impaired immune function etc etc. Taking vitamin D supplements or Codliver oil would seem a good idea when restorative.
The problem comes when you have to decide what is normal. Is it acceptable to give HGH to someone who is deficient...as a restorative? Messi?
Salazar's hypothyroidic athletes?
It seems to me that scientists often don't agree what "normal" parameters are.

Actually, there is more agreement than is sometimes perceived when you have outlier physicians (e.g. Brown) given equal footing to the rest of the community.

Also, keep in mind that Vit D is something you can get over the counter, or eat in your food, or (the best treatment) ... get via sunshine. In other words, it does not require a major medical intervention.

BTW - if you need steroids or other treatment due to, let's say a particular acute issue, then you should also be taking time away from the sport. So if you're an elite athlete and you're training volume results in you getting low thyroid, then perhaps you should modify your training load?

 

[Catwhoorg]

Its certainly an issue, and like asthma meds should be looked at closely (or Low T diagnosis for masters racers...)


I wouldn't draw too much into the 17% of Salazars group versus 5/10% of as it is such a small group. Its two people more than would be predicted, easily could just be random.


But responding to and sustaining a training load is clearly one of the genetic things that differentiates an elite from a near elite.

Not happy about it ? Well my frame, sub elite CV system etc etc are not fixable, thats the joys of the genetic lottery.

 

[zigmeister]

So we are taking one "endocrinologists" idea that hypothyroidism is possibly caused by endurance training, with no proof?

So, that must mean since one guy has an unproven theory and puts it out there, then somebody takes thyroid medication, they must be dopers?

Stupid.

I didn't read one single medical fact, details regarding how/what this "doctor" is looking at regarding blood labs to make that determination whatsoever.

Thyroid meds aren't anabolics, nor do/would they increase RBC.

There really is only one true doping product worth even doing in cycling, and that is EPO.

I'll keep repeating this over and over, guys can take asthma inhalers which have studies showing an increase in performance, in cyclist specifically...yet, nobody even bothers talking about it, WADA/USADA allow it to be used without even so much as a TUE.

But, now we are all worried about thyroid meds?

 

[armchairclimber]

So we are taking one "endocrinologists" idea that hypothyroidism is possibly caused by endurance training, with no proof?

So, that must mean since one guy has an unproven theory and puts it out there, then somebody takes thyroid medication, they must be dopers?

Stupid.

I didn't read one single medical fact, details regarding how/what this "doctor" is looking at regarding blood labs to make that determination whatsoever.

Thyroid meds aren't anabolics, nor do/would they increase RBC.

There really is only one true doping product worth even doing in cycling, and that is EPO.

I'll keep repeating this over and over, guys can take asthma inhalers which have studies showing an increase in performance, in cyclist specifically...yet, nobody even bothers talking about it, WADA/USADA allow it to be used without even so much as a TUE.

But, now we are all worried about thyroid meds?

Blimey.
Take all the EPO in the world but if your thyroid is fecked, you will be too.

 

[More Strides than Rides]

http://ajpregu.physiology.org/content/287/3/R600.full

I may need some help to make sense of it, but it seems that Thyroid hormones increase the body's response to hypoxia by influencing the gene which produces EPO.

Obviously, it could be read to explain why hypothyroid sufferers can't do endurance sports well. It could also explain the motivation for an otherwise healthy athlete (one who has already risen to the top...) to seek out a diagnosis.

EDIT: And Hypothyroidism can be an indicator of HGH use