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

I am a thyroid cancer survivor. I had a complete thyroidectomy ~ 10 years ago. From my experience, (ran a marathon last year, broke 2:00 for 800 in HS, under 56 for 10 miles) as a runner and a thyroid patient, there is a very narrow range of tsh where I feel good. Post thyroidectomy it is ~ 1.00 and pre thyroidectomy ~ 1.5 . I can tell if my tsh is approaching 2.00 or .25 . Unless someone really has a thyroid problem, I don't see how they could run well if they were 'supplementing'. Being hyperthyroid is just awful. I take synthroid only, which is synthetic t4. Perhaps people are fooling around with t3. If they are, they are fools.

the whole point of come on now's post was that hypothyroidism is not the normal result of training an excessive amount, and thus that salazar's runners and others are gaming the system.

older_fatter_slower wrote:

Being hyperthyroid is just awful. I take synthroid only, which is synthetic t4. Perhaps people are fooling around with t3. If they are, they are fools.

This is another interesting question. Too much thyroid and being hyperthyroid is not a competitive advantage. It makes you sicker that you would be with correct thyroid levels.

If taking thyroid supplements is self-limiting - you only get to normal, and not better than if your thyroid were healthy, is it really a PED?

Or is thyroid supplementing more like taking Tylenol or caffeine? Tylenol is definitely a PED (in the literal sense, but not according to WADA or USADA), but if you take too much you get liver failure so the benefit is self limiting. Or with caffeine - another legal PED - it can only improve performance by so much and then it either does no good or is counter-productive.

That really may be the thinking of WADA and USADA - that any benefit is questionable and self-limiting. Synthroid is also readily available - not quite like Tylenol or coffee, but close. So it's not necessarily giving anyone an unfair advantage if everyone can get their thyroid levels to normal.

It's a good question. IMO, these guys probably have some sub-clinical hypothyroidism, which takes them outside the "ideal" range (whatever that might be) for performance and recovery. Evidently, these levels aren't high enough that a normal endocrinologist would diagnose. So they have find a doctor with a particularly liberal view on when to prescribe thyroid hormones, and how much. Americans seem to have found that in this guy.

It's not that going hyperthyroid gives them an advantage -- they probably aren't using it to be hyperthyroid -- just that athletes are manipulating thyroid hormones to keep them within the ideal range. There are a lot of things that might take them outside of that range, one of which is under-eating.

You could do the exact same thing with testosterone, only it's banned. Hard training and overtraining lowers T, so go to your anti-aging doc and get diagnosed as "Low T". Master's athletes are doing this (and getting caught for it).

Actually, the IAAF hired a scientist to conduct some tests (which arguably is NOT their job), and determined that the blade runner's blades DID give him an advantage, and consequently barred Pistorious from competing against able-bodied athletes. The IAAF bent over backwards to fairly answer the eligibility question, and their answer was NO -- you can't run on kangaroo springs -- it's not fair.This finding was overruled on appeal to the CAS, who effectively found that the real reason for the advantage hadn't been proved with 100% certainty. Some of Oscar's own scientists agreed their was an advantage, but disagreed about the cause. The CAS (a panel of lawyers) was essentially forced to answer a scientific question, with neither the proper background, nor all of the data.Neither the IAAF nor the CAS determined that the blades gave no advantage.

US track fan wrote:

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.

Bob Kennedy has hypothyroidism.

That is why he is FAT now

somebody find me a damn picture

It wouldn't surprise me if a ton of runners had thyroid problems.

It also wouldn't surprise me if runner's were abusing thyroid medication for a benefit.

Both things are possibilities.

I think WADA needs to keep looking at thyroid medication and at least see if it is like asthma with stricter requirements for getting a prescription.

I wish the article had discussed more ways thyroid medication might enhance performance. And I wish it had discussed what negative side effects if any it can have if you don't need it and take it.

I don't want sport to become who has the best prescriptions.

On the other side of the coin, there are tons of 100% outlawed ways athletes can cheat and not get caught so taking a drug that isn't banned with a legal prescription isn't big on my priority list.

If people are abusing the prescriptions then they are probably doing something else prohibited as well. Taking prescriptions as not prescribed is a doping violation. I think many athletes are using the prescriptions legitimately. Then, WADA needs to decide if the drug needs to be banned or if you should require a TUE for it.

The WSJ piece made me more formally publish the quotes from Jos Hermens and the head of Dutch anti-doping on thyroid meds, Mo Farah and Galen Rupp from the Olympics. (I had them up in a thread withouth much fanfare before). The implication from the Dutch camp was the drug is dangerous if abused, which the WSJ said nothign about. Article up on homepage with Hermens quotes:

http://www.letsrun.com/news/2013/04/hypothyroidism-the-wall-street-journal-jos-hermens-mo-farah-galen-rupp-and-the-olympics/

Wow, more great contributions. This may be the best thread of all-time on this board.

Some things:

1) I agree with the "researcher" who said that sometimes the establishment doesn't know squat. To that, I would add "especially the medical establishment", which is driven by insurers and which is risk-averse, even when they DO know something.

2) The difference between iron and T3/T4 is that iron is a nutrient, whereas T3/T4 are hormones; iron is not "produced" in the body, its intake is required by everyone to maintain life and health--so intaking some iron is universal, no matter from where it comes, and the amount varies according to individual requirements, but intaking T3/T4 is NOT universal.

What is the essential difference? You would have to believe (and I do believe) that with nutrients, if there is a deficiency, the body will send signals to the organism to seek intake to correct the deficiency--basically, hunger, and cravings. The body will then, on its own (assuming normal health), regulate the intake to the level that is required. It is an automatic process.

What is the biological response to hypothyroidism, in terms of adaptive responses? I know there are all sorts of symptoms of hypothyroidism, depending on its stage and its cause(s), but one would think that there are biological responses to correct the imbalance, as it is the integrated hormonal control system that is affected. Go out and eat something with T3 or T4 in it? Can it be absorbed if taken in? If so, does it reach receptors intact?

Since you used iron as the example, I will tell you something--for one week a month, my wife goes NUTS for red meat and spinach. It might have been conditioned over 40+ years, it might be automatic, or it might be a combination of both--but she needs it, and will kill to get it.

Sure there are nutrients in there other than iron, but let's assume that iron is the critical micronutrient.

Is there any similar mechanism experienced by those with hypothyroidism, at any level of hypothyroidism, and does it relate to the natural intake of T3/T4? In my admittedly uneducated opinion, if the "hypothyroidism" was genuine "clinical" hypothyroidism, there would be some deficit to normal function that the body would try to rectify on its own, through some mechanism or other--for instance, eating more or differently, sleeping more, training less, drinking more, whatever.

Again, if the CAUSE of the hypothyroidism is the performance of training itself, and if that hypothyroidism diminishes training performance, then pharmacologic correction of the hypothyroidism will by definition enhance that performance. The difference between T3/T4 and iron is that, AFAIK, nobody NEEDS to take concentrated iron supplementation, enough is available from natural sources if prepared correctly and eaten with foods containing transport-enabling compounds and not with those containing compounds that inhibit uptake, to compensate for any reasonable deficiency.

However, if the cause of that iron deficiency is training itself, then an argument could be made that the situation is exactly analogous to the situation where hypothyroidism results from training--except that with iron deficiency, even if you couldn't correct completely using natural sources, you could correct somewhat, meaning that you would naturally find the level of training that your body and habits can support, and any increased level of training would be enabled by an increased intake and uptake of iron; but with hypothyroidism, you couldn't correct naturally in any way that would result in an increased level of training--you would have to decrease your training level in order to regain homeostasis.

So, as far as hypothyroidism goes, pharmacologic intervention results in training advantage that is not achievable in any measure by natural means, which is totally different from the situation of an iron deficiency.

Unless, again, you can get T3/T4 from natural sources.

Same thing goes for other hormones that are produced in the body. Can you ingest testosterone or HGH, and will it be absorbed into the blood unchanged? I really have no idea.

Would eating mountain oysters temporarily increase your circulating testosterone? Again, I really have no idea.

Anybody know?

Hopefully I won't be craving those oysters any time soon.

"Thyroid medicine is not a performance enhancer. It's only useful to repair the thyroid to the state it's suppose to be in." - Ryan Hall 10:39 a.m. PDT on 10 April.

so who were the 15 Gold Medalist?

ryanhallstwitter wrote:

"Thyroid medicine is not a performance enhancer. It's only useful to repair the thyroid to the state it's suppose to be in." - Ryan Hall 10:39 a.m. PDT on 10 April.

Ryan Hall also believes a lot of bizarre stuff like glory clouds (google it).

He is literally delusional on certain things and is probably (like many top athletes) downplaying the impact of certain things, including thyroid medication on performance.

For being an "informed discussion" on an important topic, it seems to me, that a lot of prerequisite information is missing.After reading the whole thread, a few basic questions are not yet answered:- Is thyroid medication performance enhancing? Why is anyone calling it a PED if the PE part hasn't really been established?- If the medication is not banned, and doesn't require a TUE, why is anyone talking about abusing TUE's?- Curiously, it is not a secret. The IAAF and WADA have both looked at the question of thyroid medication, and declined to ban it. Why? Is it a conspiracy, or can it be that it really is a non-issue?- It's also interesting to see Belgian/Dutch quotes, especially coming from Jos Hermans. Does he know more than he is telling, or is this just more conspiracy theory?There are some leads, which need to be followed up (this is the IAAF's, WADA's, USATF's, USADA's, etc. job), but before we can talk about cheating, someone has to make a case that cheating is happening.

teamdoc wrote:

...

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.

rekrunner you are missing a major point.

People that dope or abuse drugs for performance ARE AHEAD OF TESTING AND GENERAL MEDICAL UNDERSTANDING.

An example: 'The Clear' wasn't banned because it was designed by BALCO - Testing DID NOT KNOW IT EXISTED so it WASN'T BANNED.

Please people, think. The same thing is going on with thyroid medicines and performance.

RuKiddingMe!! wrote:

so who were the 15 Gold Medalist?

I was just about to post on that. I think he actually said his athletes have won 15 gold medals. Carl Lewis accounts for 9 of them (although only the last of those was after hooking up with Doc Brown in 1996).

Who could account for the other 6?

Not sure I totally believe the 15 gold medals claim. The guy seems pretty weaselly to me. None of the other athletes that were named have accounted for any. I do like the quote where he says he swooped into Atlanta and met with USATF officials to save the day:

""I told them 'You can't help me, but I can help you.' " He explained why Lewis's newly-diagnosed thyroid disorder made saline an inappropriate remedy for cramps. "So one of the [team doctors] looked around at the others and he said, 'You're right. How would you like to be our consultant?' "

What a tool! He just sounds like one of these guys that tries to make himself out to be this super-unconventional thinker who always figures things out when "mainstream" thinkers cannot.

Check out his not-so-impressive customer reviews:

examples:

"Avoid this dcotor,rude,arrogant and wants everything done his way,looking to enrich himself"

"Avoid this Doctor! Very rigid and mean. Its his way or the highway, will refuse to treat patients if they don't do things such as have the medical assistant measure their height, etc. Will not accept testing recommendations from other Doctors. Find someone else."

or even more interesting maybe:

"This Diet actually works!!! I am a 23 year old women, who has been on this diet for 8 months and I have already lost 85 lbs thanks to Dr.B!! The diet is simple, just follow what is on the paper that he gives you and you are set! I think you have to be ready in all aspects of your life! It's now or never baby!! I think Dr. B is a very funny but at the same time a serious man! And his staff are Angels, honestly each and everyone! Hey the office isent the best looking but it's an office, and it does the job! I have met such amazing people in the waiting room! This is what it comes down to.. Is cheating really worth it??? It just sets you back from ur goals. If I can do this anyone can do this!! Just think positve! Thanks Dr. B 85 lbs and counting.... "

TLW wrote:

People that dope or abuse drugs for performance ARE AHEAD OF TESTING AND GENERAL MEDICAL UNDERSTANDING.

An example: 'The Clear' wasn't banned because it was designed by BALCO - Testing DID NOT KNOW IT EXISTED so it WASN'T BANNED.

Please people, think. The same thing is going on with thyroid medicines and performance.

So, does NOP know something the rest of us don't?

I am sick to death of this cheating. Rupp and Radcliffe and Salazar make me want to puke. They know, and anybody who is not delusional knows, that what they are doing is cheating.

So training makes them tired. Big news. Here's some more news: that is what this sport is all about. The cure is rest. They are not fooling anybody with TUEs.

At this point, yes, ban EVERYTHING. No supplements of any kind. The NOPers have proven time and again, since AW, that they will always choose the cheating option. They can't be trusted with anything. They will doctor shop until they find a quack to prescribe.

Salazar is a bitter, unfulfilled has-been. He was always amoral and suspect. Rupp is on the road to a short, battered life. Radcliffe will limp for ten thousand miles if there is any justice.

I question whether an iron deficiency can always be addressed by "natural means" - certainly many doctors prescribe iron supplements for runners when eating liver, etc. doesn't seem to help.

And if your thyroid supplementation is with natural thyroid obtained from pigs (apparently it's just powdered pig thyroid glands), how is that different from eating liver to get extra iron?

With regard to Tylenol, ibuprofen, etc. there's no question that they can't be obtained by "natural means." If pain relievers are the only thing that let you train through PF or maintain high mileage, how is that different from synthetic thyroid?

Having had Graves Disease, which causes hyperthyroidism, I can guarantee you it is to no one's advantage to have too much hormone. It causes some real problems - fatigue, shortness of breath, joint pain, elevated heart rate, hair loss, sore muscles - and that's a short list. These athletes levels have to be in the normal range.

With that said, I have some real questions about all these athletes actually having underactive thyroids. I've been going to an endocrinologist for 17 years, and have never heard that over exertion/intense exercise could cause thyroid disfunction. Hypothyroidism is typically caused by either an autoimmune disease (Hashimoto's), a congenital problem with the actual gland, medications, pregnancy, and even treatment for hyperthyroidism (which is why I have to have my levels checked yearly for the rest of my life).

After reading that article, although not discussed, it is pretty clear that not one of these athletes suffers from one of the known causes of hypothyroidism I listed above. Does anyone think Bob Kennedy needed treatment for an underactive thyroid after he retired?

We should make a distinction here, that dopers being ahead of testing is different from being ahead of medical understanding.

The difference being, drug testing exists purely to catch dopers. On the other hand, medical research is generally not driven by trying to catch the tiny fraction of the world cheating at sports. Most researchers submit their grants to governmental agencies like the NIH, the VA, and others. Or they go to foundations like the American Heart Association, Bill and Melinda Gates Foundation, etc. They also go to industry (or industry seeks them out), but there the motives are different. The first step in getting a research project funded is to show that it is important-- the disease is killing x thousands of people a year, causing y number of hospitalizations, or costing z amount of dollars.

Lets face it-- there is limited appeal to the NIH, or other funders, to look into whether treating elite athletes with this proposed entity of "sub-clinical hypothyroidism" results in performance improvements. So we can wait all we want for definitive proof from the medical community-- it likely won't come. Improving athletic performance via medication is not high on their list of priorities. The one entity that might be interested in funding this type of research is the military-- for them a small performance benefit might be meaningful, and they don't have the same qualms about a level playing field. But short of them, the answers likely will come from trial and error of athletes, coaches, and physicians willing to skate up to the edge of (or over) the rules.

So when people say "there's no proven benefit to athletes from doing this", it's because no one is looking in a rigorous manner.