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

Most of us view doping as a categorical thing: yes or no. Cheating or not cheating. Why anyone would try draw out the distinction between doping and "über doping" is beyond me. Probably reacting to a troll. Oh well.

for those in the know wrote: Also, remember when WADA was saying that steroids don't improve strength? That wasn't so long ago.

As long as there are "gray" zones people will make the best use of them. Once a cap, or elimination, is placed on TUEs another loophole will be found.

WADA is in for a very longer term game of cat and mouse. Unfortunately, for TUEs WADA is currently playing the part of the mouse.

A troll brought up the issue. It's about what is obvious, and what is not obvious.

Like anything, TUEs can be abused even if legitimate.

I was quite surprised that Oscar Pistorius evidently had steroids at his home when he shot his GF. He was actively competing, yet possibly taking something illegal and not caught at it. Maybe he knew how to time his use, if that's possible.

The problem with determining whether these athletes are looking for a PED is that a normal TSH level is debatable for everyone. Some say it is 5.5 and between 3.0 and 5.5 is sub clinical. A lower limit has been tossed out because low thyroid tends cause hyperlipidemia. Some docs will treat at 3.0 because of this.

Even if it is found that increasing thyroid improves performance, it will never have as large an effect as something like EPO because it is a pretty fine line between just enough an too much. with too much thyroid hormore, you can't walk down the street without sucking wind and it would take time to get it down to normal.

As a doctor, do you think TSH over 2 would be sub-optimal for runners? Say someone came in at 2.5, would that have a significant negative effect from an athletic standpoint?

I guess what I'm getting at here, is: are the negative effects of hypothyroidism on a linear scale, or is it a step discontinuity?

We're cheating, but just a little.

US track fan wrote:

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.

Idiotic, apples and oranges.

And hyperbole.

Many of the fastest guys in history are not on this drug.

Many of the fastest guys in history (a HUGE number) are from East Africa. Hundreds and hundreds.

When all is said and done you will find that a very small number of runners have early onset of thyroid problems due to extreme exercise, and a subset of them get relief from medical treatment. Others do not.

Copy and paste that last paragraph into your brain, cos that's the facts, jack.

Perhaps this is what Dr. Brown means by stating that he is willing to sleuth further and further to see what is going on with an athletes health.

TLW wrote:

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.

Anyone who doesn't want to face the medical fact that taking this medication if you don't need it can and most likely will deliver detrimental effects to your health, is a paranoid idiot looking for Ped cheats under every stone.

I said in the US, you hump. And it is a large number of them. People arn't lying to you. You are basically asking for proof for things your brain probably already know are true. Its called the lawyer defense. OJ used it to stay out of jail.

Let's Contemplate wrote:

Since the proportion of elite USA distance runners diagnosed with hypothyroidism is WAY higher than the population at large there are several possibilities:

(1) The genetic benefits associated with elite endurance are also associated with genetic risk factors for hypothyroidism

(2) Exercise at the top level/ over training induces hypothyroidism in those on the border

(3) Thyroid medication has a direct benefit on performance or recovery as long as levels don't go too high

(4) Thyroid medication can somehow mask the use of PEDs

(5) PEDs alter thyroid levels which need to be corrected

(6) Thyroid medications are a placebo that current athletes buy into

Now, go back and take each one of your "contemplations" and dry and figure out the holes in each one.

They are gaping.

I'll give you two.

1. If thyroid meds worked as a ped or a ped masker, WADA would ban them ASAP.

2. How many times do you have to be told that thyroid meds don't always work well for those needing them, and that they are health damaging to take if you don't need them?

a/ wrote:

Anyone who doesn't want to face the medical fact that taking this medication if you don't need it can and most likely will deliver detrimental effects to your health, is a paranoid idiot looking for Ped cheats under every stone.

This is why no one takes steroids.

older_fatter_slower wrote:

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.

Exactly. This is how it was for a close, dear family member of mine.

And this is why Rojo's reckless speculations piss me off so much and are so egregiously dangerous.

This is what we know today: A few runners are predisposed to early thyroid problems, so treatment is a medical treatment to address a health problem and not a quest for a ped advantage.

If treating non existent thyroid problems were some secret huge advantage, or masked HGH, or other PEDS, since Dr. Brown has been treating known athletes since 1996, hoards more would be on it, the secret would have spread like wildfire around the world and according to you Tin Hat LRC crew, all of Nike/Salazar's athletes EVER would have been on it.

It has been known since 1996 that Carl Lewis was treated successfully. Rupp's story has been out for what, 6-7 years?

Since the very first thyroid thread on this site, knowledgeable people, and many thyroid patients have explained to the board how hard it is to feel good as a thyroid patient, to feel normal again, or to get the medication/thyroid levels right.

This isn't "pop a pill" and get an east advantage people.

Anyone fooling around taking thyroid meds who did not need them would be really risking their health -- and the most likely outcome is a health decline.

F*xking with that and risking needing to take a medication that could make you feel like crp for the rest of your life???

Not worth it.

Hall, Yoder Begley, and Rupp need the medication to have normal health.

Keep working it Ducky.

Hall, Yoder Begley, and Rupp are all hereby anointed super saints. Mother Teresa was not as pure as these three.

GP's are indeed lazy. OR if you want to use another term, they are "programmed."

With managed care, and consultants teach doctors how to spend the least amount of time in the exam room with the patients...

My own GP (a rebel) told me that a consultant tried to teach him to:

1. Only ask patients yes or no questions.

2. Do not make eye contact with your patients.

3. Cut the patient off if they try and explain too much.

Get in and out of the exam room in 7 minutes.

That was 25 years ago. The health care system is broken in many ways.

Fortunately my doctor was a rebel and told them to F off.

He worked insane emergency room hours to make the bucks to work the rest of the week in a small family practice and really treat the whole person, and to act like a kind and concerned human being with his patients.

There are a lot of books out there today that teach you the inside ways the doctors are taught to just run the standard tests, keep costs down for insurance companies, and how to protect yourself from abuse and neglect in the hospital, and how essentially you have to be the CEO of your own care and treatment and use the internet to educate yourself on meds and treatments, and of course diagnosis.

A Duck wrote:

Hall, Yoder Begley, and Rupp need the medication to have normal health.

Well the US top ten lists seems to suggest that the normal via medication runners have a big advantage over the normal via natural genetics runners.

This is a great thread, for sure. However, I think almost everyone is missing the point and nobody has asked the real question: How are they using the drug?

In other words, people with real thyroid conditions take Synthroid every day at the same time. That's how it's prescribed and that's what the research shows is most effective at keeping consistent TSH levels.

So to me the real proof is in how they take the drug. Is Rupp taking Synthroid every single day for the rest of his life? Or is he taking it during certain phases of his training? For example, Synthroid does boost metabolism and reduce weight. So if I was going to cheat with Synthroid, I would start taking it a few weeks prior to the big race, and watch my weight drop 3-5 pounds. Pretty significant, especially when that weight loss occurs without having to do other things harmful to your physical fitness, like reduce calorie intake or increase calorie burn.

This is certainly in the gray area, but I think if you're using a prescription medication in ways that are not consistent with how it is prescribed (in other words, taking it during certain phases of training, rather than daily), than that's cheating. You are abusing a prescription medication to gain a competitive advantage.

Now, is it possible that Salazar's athletes have real thyroid deficiencies? Yes. But is it also possible that they've found a doctor willing to prescribe thyroid meds with a TSH in the 2.0 range so that they have access to the medication and can then use it as they wish? First part seems likely, second part hard to know.

Unfortunately, we'll never find the answers to these questions because of privacy laws. However, my guess is that if these athletes are abusing thyroid meds, they're likely abusing other substances and we can just hope that they eventually get caught for something.

"do you think TSH over 2 would be sub-optimal for runners? Say someone came in at 2.5, would that have a significant negative effect from an athletic standpoint?"

Hard to know. Medicine is more interested in where to draw the line between disease and no disease, and also the implications of that decision. As the WSJ piece points out, a decision to treat more aggressively would double the number of hypothyroid pts in the US (adding over 15 million pts). Even though the drug is cheap, toss in the office visits and labs and you're talking serious money, in a system that already spends too much.

My wife was put on synthroid when her TSH approached 10, and then with pregnancy the levels fluctuated a bit, so she bounced around. She says she felt better running when it was in the 2 range, and more tired when it was in the 5 range. But, there was also less sleep with kids, job stuff, not training as much, etc. not to mention the potential placebo effect of thinking you're taking something that will boost your energy. To truly answer that question you'd want to randomize elite athletes to dosing levels targeting different TSH levels, have them train identically, and have they and their coaches be blinded to what their TSH was (including things like sham dose increases in the less-aggressive group). Not an easy study to do, and not sure who would fund it. Any unblinded study is of dubious value, since just the process of being monitored, receiving extra attention, and all the other things that make placebos have an effect come into play.

Finally, say you found that aggressive dosing improved performance by 2%. A big deal to an elite runner. But do you change the definition of hypothyroid based on that, and treat an extra 15 million Americans? Or just treat the ones who want to run a bit faster? What if the guy who just wants to break 20 min in a 5k hears about it, do you treat him? What else do we "optimize"? Testosterone? Growth hormone? Cortisol?

Let's Contemplate wrote:

The biggest red flag that something is going on is this:

When a physician near his California home found no evidence of thyroid dysfunction, Smyth flew to Houston to see Brown, who conducted some blood tests and diagnosed him with the condition.

In other words, the athletes are looking for doctors to give the thyroid medication. They are shopping around for meds instead of looking for actual medical help.

This is such a stupid contention.

Top athletes fly all over the country all the time to get second opinions -- and to go to top experts.

Follow the NFL much?

Why does a Seattle Seahawk see an expert in Florida?

Cancer patients are known to get treatment thousands of miles away from their local hospitals -- if they can afford it -- because they are seeking out the top expert and treatment.

Geezus, there are so many great posts by thyroid patients on these threads -- and then you freaking idiots who just want to see through accusing and paranoid and cynical eyes, and use stupid arguments like this.