Wall St Journal looks at Houston Doc who treats Rupp, other thyroid users

"I know for a fact that with regards to anemia and low ferritin that the coaches are seemingly way ahead of the scientific studies - maybe that's possible here as well."

Rojo-- there's not much contradiction between a recent med student grad telling you that low ferritin plus other normal blood values are "good", and most distance coaches thinking performance increases with higher ferritin levels. Ferritin is in part a reflection of iron storage, although other things (infection and inflammation) can cause higher values than are reflected by true iron stores, which are much more difficult to measure. I have many patients with raging infections whose ferritins are in the several hundred range, but who had bone marrow samples done as part of their work-up, which showed severe iron deficiency.

A big difference here is that there are values used to diagnose disease among a general population (i.e., not people pushing their bodies to the maximum), and there are values that might lead to maximal athletic performance.

As far as day-to-day function, most people are fine with a TSH in the normal range-- which used to be under 5, but then the endocrine society lowered it (and generated more patients for them to treat). That doesn't mean that performance in extreme athletes might not be improved by supplementing normal thyroid function-- but the key distinction is that it is not to treat any medical condition-- it's being done to improve performance.

To me, if an athlete doesn't meet standard criteria for hypothyroidism, but instead has to find a rogue endocrinologist who will agree with them and tell them that they have sub-clinical disease, that's crossing ethical lines, both as an athlete and as a physician. Many "wellness physicians" make the same argument with testosterone-- "sure, you don't meet official criteria for hypogonadism, but because you likely had a higher starting level of testosterone, really for you this is severely low, so it's the right thing to do to get you back to your normal level". Right. Disappointing, if true.

coach d wrote:

but it seems that we have a epidemic of hypothyroidism among professional US distance runners...

fixed.

And might it be partially responsible for the recent competetiveness of US runners on the world level?

A Duck wrote:

WADA and IAAF see the thyroid supplement as health care, and not sports performance enhancement.

Let them do their jobs and stow your paranoia and cynicism.

And the IAAF did their job and determined the blade runner's blades did not give him an advantage. But what if you had a 400 meter Olympic final with 4 blade runners? Would you still believe the IAAF did their job? That is what we seem to have in the US, where MANY of the fastest guys in history happen to be on this med.

Yes, in part.

nucular wrote:

And might it be partially responsible for the recent competetiveness of US runners on the world level?

more fixed.

...of US "endurance athletes" on the world level? Biking, swimming, triathlon, rowing, cross-country skiing, anything long duration.

There are some good comments being made on this thread.

We must now add Brown of Houston, to Galea of Toronto, and Muller-Wohlfahrt of Munich.

There are others, and they are to be found in many places.

This basic discussion plays itself out all the time in so-called "masters" athletics, where the grinding-down effect of heavy training is compounded by the normal ageing process.

Many athletes are in denial, have low self-esteem, and a weak moral compass, or view themselves as pragmatists.

Ultimately, I think we should stand up for those few who are doing the right thing, the right way--because given the choice, it is THEY who are deserving of our fullest attention, protection, and respect.

At some point, you have to call a spade a spade. These doctors exist in regulatory environments that permit latitude for "professional judgment"--fine, if their actions are colorable as being in the best interest of the patient, then don't sanction them professionally in those instances--but in others, investigate and sanction.

And that says nothing about the patient athletes, who should be judged by different criteria than are their chosen physicians, because the goals of the judgment are entirely different.

contemplate this wrote:

People with hypothyroidism who aren't elite athletes also get screwed by ignorant local GPs who think that as long as your TSH is 4.99, you're fine and you're just lazy/depressed/whatever else. They, too, benefit hugely from finding experts who know what they're doing in this field.

i don't think it is because the GPs are lazy. GPs don't see many endurance athletes and it appears that nobody takes into account that hypothyroid endurance athletes need to have some room in the TSH.

As posted earlier and in threads i have posted on for years here about the graph in the exercise phys book by brooks, fahey and white, there is an immediate increase in TSH and subsequent decrease in T3 following exerise but it returns to normal with recovery *for someone with a normal functioning thyroid*.

But someone with a low functioning thyroid is not going to bounce back as quickly and then they are off to do another 2 hour run.

For someone with a TSH of 4.99, supplementation improves life in general, not just running. If these elite athletes are truly hypothyroid, then their non-running health would eventually suffer without supplementation so it is justified that they take it.

The question is whether supplementation in someone with a TSH of 2.5 speed up recovery time?

What WADA needs to come up with the TSH that is considered to be clinical hypothyroidism.

Let's Contemplate wrote:

To summarize:

We have a doctor who is barely a doctor at all having gone to a degree mill called Rosalind Franklin University School of Medicine. This school was put on probation by the accrediting agencies and changed its name (formerly called Finch University of Health Sciences/The Chicago Medical School).

This endocrinologists has views that are way out of the main stream. Who has no evidence to back what he is saying. Who is viewed skeptically and/or derisively by all of his peers.

This same doctor is lauded by athletes because he is the only one who will give them the medication which they want a priori.

In return for his shady actions this quack doctor gets large consulting contracts with Nike, he gets to hob nob with famous athletes and he gets national exposure.

Just looking at the article w/the doc's pic holding up a Carl Lewis plaque--kind of says it all. Seems like he's more interested in 'collecting' his patients' athletes medals, hence cheesy smile and bragging how he takes care of them. Honestly, what makes me leery is the fact that most other endocrinologist are not backing up this doctor. I also have to agree why so many elites are being diagnosed w/hypothyroidism by this doctor. Just b/c the doctor treats famous people/athletes doesn't mean he's THE best doctor for this speciality.

I don't think there is nothing wrong w/discussing this topic. It brings up very interesting points...

Sorry that Lance was exposed -- that must have been hard for you.

This is an informed discussion on an important topic. There is plenty of evidence to justify a conversation about likely misuse of thyroid meds in competitive running -- with the aims of eliminating the unfair advantage involved.

Cheating stinks -- it violates the public and competitive trust that forms the foundation of fair competition and "fandom" as most people know it. Even worse are the cheaters themselves, particularly the pathological ones who rationalize themselves as hard workers and pretend that they've earned their just rewards. What they have earned is a lifetime ban and a loss of reputation.

Armstrong was using low levels of banned substances, only giving a slight advantage, to stay under the the radar screen, which he was able to do. Plus, Armstrong maybe used some things that were not banned. He likely didn't take advantage of TUEs because the way of taking advantage of them was not developed well.

With TUEs there is less worry about testing levels because a "doctor" has given a "special" prescription.

Why is it then that all of the doctors state that if you don't need it the body will not benefit from it??? Big differene between that and EPO, Testosterone, and other agents that in any use is beneficial to the athlete.

Again you can call USADA and they will tell you. If you do not have a thyroid problem you will feel negative affects from taking this medicine. Therefore they can not ban it.

Why is it that if the body needs thyroid medicine it is a bad thing to take it.

But, if you need IRON its okay to take it. Wouldn't the better solution be to back off on training and eat a better diet? Until you levels are higher and you are healthy.

Enduring Endurance wrote:

Armstrong was using low levels of banned substances, only giving a slight advantage, to stay under the the radar screen, which he was able to do. Plus, Armstrong maybe used some things that were not banned. He likely didn't take advantage of TUEs because the way of taking advantage of them was not developed well.

With TUEs there is less worry about testing levels because a "doctor" has given a "special" prescription.

Your head is in the sand partner. Armstrong was "to the gills". He was on the maximum possible while being able to go undetected, which means when there was no test for something he was on a lot of junk!

As for TUEs, you still have to be below a certain threshold, just look at those who have TUEs for their supposed asthma and still get a suspension because they were above the legal TUE limit. Alessandro Petachi, for instance.

Let's Contemplate wrote:

To summarize:

We have a doctor who is barely a doctor at all having gone to a degree mill called Rosalind Franklin University School of Medicine. This school was put on probation by the accrediting agencies and changed its name (formerly called Finch University of Health Sciences/The Chicago Medical School).

This endocrinologists has views that are way out of the main stream. Who has no evidence to back what he is saying. Who is viewed skeptically and/or derisively by all of his peers.

This same doctor is lauded by athletes because he is the only one who will give them the medication which they want a priori.

In return for his shady actions this quack doctor gets large consulting contracts with Nike, he gets to hob nob with famous athletes and he gets national exposure.

Well said.

"Ryan Hall ‏@ryanhall3 1h

Thyroid medicine is not a performance enhancer. It's only useful to repair the thyroid to the state it's suppose to be in."

This argument that overtraining causes hypothyroid, hypothyroid would go away if you trained less, and therefore treating hypothyroid is "doping" brings up the same issue as on the Fam threads - We know that running can cause low ferritin and/or anemia. Not running might make the condition go away. So is everyone taking iron supplements a "doper"?

Tylenol and Advil let people train harder and train through things like plantar fasciitis. Your average doctor would just tell you to stop running so much until the pain goes away. Are runners who use Tylenol and Advil to keep running high miles "overtraining" now considered "dopers."

WADA and USADA would say that neither iron supplements or pain relievers are banned doping - they are treating a medical condition even if the medical condition could be corrected if you stopped training hard and became a hobby jogger.

There may be something here but, as someone who is hypothyroid, I would give a few key points to consider. The first two are facts, the third my personal opinion.

1. As Hall just said, thyroid is about balance. Being Hyperthyroid is at least just as bad as being hypothyroid. So giving thryoid to a non-hypo athlete would probably do more harm than good.

2. This is a condition that is really not understood even by top endocrinologists. Unless caused by auto-immune or thyroid cancer, they really do not know how some becomes hypo.

3. Here's my personal opinion - There is something to endurance training (especially high intensity) and thyroid function. I have found one study on this (lactate production and thyroid) but not enough. In addition to track runners, there are a lot of cyclists and ultra-runners with hypo-thyroid. Again, no one has been able to explain, and I do not think anyone is really looking into this.

It is super frustrating to have this condition as an athlete because there is not much guidance and when you ask why this might be happening, doctors say "no one knows." I have tested multiple times and it seems like when I am training the hardest in both intensity and volume, my TSH is the highest but no doctor has been willing to test this by doing multiple tests matched against the phase of my training cycle.

This is the new form of doping.

For example, if there was a real medical issue here Smyth wouldn't have had to FLY ACROSS THE COUNTRY to see a doctor that subscribes PEDs to athletes.

Anyone making excuses is naive or doesn't want to believe.

Enduring Endurance wrote: Your head is in the sand partner. Armstrong was "to the gills". He was on the maximum possible while being able to go undetected...

Wrong, fool. "to the gills" is what Landis did, instant-test-fail. Armstrong didn't fail those types of tests. The lower the level of PED used, the lower the benefit.

As a researcher myself I can tell you that some of the time the establishment doesn't know squat -- and as someone pointed out earlier it's very possible that the coaches and athletes are far ahead of sanctioned research and acceptable medical standards/practice. Thyroid meds may provide an advantage -- that is what this discussion is for.

I like your recent post, it shows a willingness to have a discussion (e.g. the difference between IRON supplements and thyroid meds).

Chris Derrick is awesome. I'm excited about him -- he has big balls. Rupp may be a good marathoner, indeed. It would be nice to see him give it a shot sooner rather than later. Those things are also discussed elsewhere.