That’s part of the problem,
Most doc’s really take little interest in the detail of managing thyroid disease, one point in example is the testing for TRab’s, most believe it is only relevant in diagnosis, yet there are studies that show quite clearly that the pattern of behaviour of TRab’s during the course of treatment is a clear indicator of remission success or failure. You still read of frustrated patients dealing with doctors who think just TSH and sometimes FT4 testing is enough to determine thyroid health, when all the evidence suggests at a minimum 4 tests are required TSH, FT4, FT3 & TRab’s.
Early B&R did use very high doses, but this is not required, I think there is very much a battle mentality in trying to “crush the enemy”, but many studies have shown that it is more a case of just managing thyroid levels, Low doses of ATD’s are adequate and it is moreso the duration of treatment that improves the likelihood of a successful outcome.
Some are using a modified version termed Add Back Therapy, where if thyroid levels are normalised, but TSH is still absent &/or antibodies are still high, rather than withdrawing ATD’s because thyroid hormones fall too much, low dose ATD is maintained with just enough thyroxine to bump up hormone levels.
But alas this actually takes a bit of dedication and monitoring and the system really just wants the patient in and out.
In the case of a B&R treatment in the abscence of thyroid, most doc’s would likely question why use ATD’s if there is no thyroid, but it appears they may be active not elswhere in the body, a low dose of ATD’s would likely be sufficient, but there has not been any studies done specifically to see if there is a benefit.
